Article ID Journal Published Year Pages File Type
3027652 Thrombosis Research 2013 7 Pages PDF
Abstract

IntroductionStudies suggest a decreasing risk of recurrent venous thromboembolism (rVTE) in relation to time since the index event. We sought to conduct a meta-analysis examining the time course of rVTE over the first 3-months of anticoagulation.Materials and MethodsA literature search of MEDLINE, EMBASE and CENTRAL (through 4/2013) was conducted to identify randomized trials of acute pharmacologic treatment and prevention of rVTE, enrolling ≥ 200 subjects/treatment arm, requiring anticoagulation for ≥ 3-months and reporting time-to-objectively-confirmed rVTE. Trials assessing extended-duration treatment, randomizing only cancer patients or not in English were excluded. Treatment arms were divided into monthly and weekly time periods for comparison (months 1-3 and weeks 1-12 after the index event). Treatment arm rVTE rates (per person-year) were pooled using a random-effects approach.ResultsFifteen trials (31 treatment arms; n = 27,237) were included. Higher rVTE rates were observed during the first month after the index event (0.19, 95%CI = 0.16–0.23) compared to the second (0.05, 95%CI 0.04–0.06; p < 0.001 vs. first month) and third months (0.02, 95%CI = 0.02–0.03; p < 0.001 vs. first month). While the highest rate of rVTE was in week 1 (0.29, 95%CI = 0.21-0.37; p < 0.01 vs. week 2), rates remained high through the fourth week (between 0.15 and 0.10 events/person-year) before decreasing and stabilizing at week 5 (≤ 0.05 events/person-year; p < 0.01 vs. week 4).ConclusionsOur findings demonstrate a significant interaction between rVTE rates and time after the index event. High rVTE rates during the 3-4 weeks following the index event emphasize the importance of frequent surveillance during this time and the early optimization of pharmacologic therapy.

Related Topics
Health Sciences Medicine and Dentistry Cardiology and Cardiovascular Medicine
Authors
, , , , ,