Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2022 Jan;53(1):182-190.
doi: 10.1007/s11239-021-02520-5. Epub 2021 Jul 6.

Risk factors of thrombotic recurrence and major bleeding in patients with intermediate-risk for recurrence of venous thromboembolism

Yugo Yamashita #  1 , Hidewo Amano #  2 , Takeshi Morimoto  3 , Kazushige Kadota  2 , Reo Hata  2 , Kazuki Matsushita  2 , Kohei Osakada  2 , Arata Sano  2 , Toru Takase  4 , Seiichi Hiramori  5 , Kitae Kim  6 , Maki Oi  7 , Masaharu Akao  8 , Yohei Kobayashi  9 , Mamoru Toyofuku  10 , Moriaki Inoko  11 , Tomohisa Tada  12 , Po-Min Chen  13 , Koichiro Murata  14 , Yoshiaki Tsuyuki  15 , Yuji Nishimoto  16 , Tomoki Sasa  17 , Jiro Sakamoto  18 , Minako Kinoshita  19 , Kiyonori Togi  20 , Hiroshi Mabuchi  21 , Kensuke Takabayashi  22 , Takao Kato  1 , Koh Ono  1 , Takeshi Kimura  23 ; COMMAND VTE Registry Investigators
Affiliations
Multicenter Study

Risk factors of thrombotic recurrence and major bleeding in patients with intermediate-risk for recurrence of venous thromboembolism

Yugo Yamashita et al. J Thromb Thrombolysis. 2022 Jan.

Abstract

Prolonged anticoagulation therapy is recommended for patients with intermediate-risk for recurrence of venous thromboembolism (VTE). The current study aimed to identify risk factors of VTE recurrence and major bleeding in intermediate-risk patients. The COMMAND VTE Registry is a multicenter registry enrolled consecutive 3027 patients with acute symptomatic VTE among 29 centers in Japan. The current study population consisted of 1703 patients with intermediate-risk for recurrence. The primary outcome measure was recurrent VTE during the entire follow-up period, and the secondary outcome measures were recurrent VTE and major bleeding during anticoagulation therapy. In the multivariable Cox regression model for recurrent VTE incorporating the status of anticoagulation therapy as a time-updated covariate, off-anticoagulation therapy was strongly associated with an increased risk for recurrent VTE (HR 9.42, 95% CI 5.97-14.86). During anticoagulation therapy, the independent risk factor for recurrent VTE was thrombophilia (HR 3.58, 95% CI 1.56-7.50), while the independent risk factors for major bleeding were age ≥ 75 years (HR 2.04, 95% CI 1.36-3.07), men (HR 1.52, 95% CI 1.02-2.27), history of major bleeding (HR 3.48, 95% CI 1.82-6.14) and thrombocytopenia (HR 3.73, 95% CI 2.04-6.37). Among VTE patients with intermediate-risk for recurrence, discontinuation of anticoagulation therapy was a very strong independent risk factor of recurrence during the entire follow-up period. The independent risk factors of recurrent VTE and those of major bleeding during anticoagulation therapy were different: thrombophilia for recurrent VTE, and advanced age, men, history of major bleeding, and thrombocytopenia for major bleeding. CLINICAL TRIAL REGISTRATION: Unique identifier: UMIN000021132. COMMAND VTE Registry: http://www.umin.ac.jp/ctr/index.htm .

Keywords: Bleeding; Clinical equipoise; Intermediate risk; Recurrence; Venous thromboembolism.

PubMed Disclaimer

Similar articles

See all similar articles

References

    1. Kyrle PA, Rosendaal FR, Eichinger S (2010) Risk assessment for recurrent venous thrombosis. Lancet 376(9757):2032–2039. https://doi.org/10.1016/S0140-6736(10)60962-2 - DOI - PubMed
    1. Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ, Jenkins JS, Kline JA, Michaels AD, Thistlethwaite P, Vedantham S, White RJ, Zierler BK, American Heart Association Council on Cardiopulmonary CCP, Resuscitation, American Heart Association Council on Peripheral Vascular D, American Heart Association Council on Arteriosclerosis T, Vascular B (2011) Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation 123(16):1788–1830. https://doi.org/10.1161/CIR.0b013e318214914f - DOI - PubMed
    1. Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, Huisman M, King CS, Morris TA, Sood N, Stevens SM, Vintch JRE, Wells P, Woller SC, Moores L (2016) Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 149(2):315–352. https://doi.org/10.1016/j.chest.2015.11.026 - DOI - PubMed - PMC
    1. Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, Huisman MV, Humbert M, Jennings CS, Jimenez D, Kucher N, Lang IM, Lankeit M, Lorusso R, Mazzolai L, Meneveau N, Ni Ainle F, Prandoni P, Pruszczyk P, Righini M, Torbicki A, Van Belle E, Zamorano JL, Group ESCSD (2020) 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J 41(4):543–603. https://doi.org/10.1093/eurheartj/ehz405 - DOI - PubMed
    1. Devreese KMJ, Ortel TL, Pengo V, de Laat B, Subcommittee on Lupus Anticoagulant, Antiphospholipid A (2018) Laboratory criteria for antiphospholipid syndrome: communication from the SSC of the ISTH. J Thromb Haemost 16(4):809–813. https://doi.org/10.1111/jth.13976 - DOI - PubMed

Publication types

LinkOut - more resources