Tuberc Respir Dis.  2019 Oct;82(4):341-347. 10.4046/trd.2019.0019.

Incidence and Risk Factors of Recurrent Venous Thromboembolism after Pulmonary Embolism

Affiliations
  • 1Respiratory Division, Department of Internal Medicine, Soonchunhyang University Gumi Hospital, Gumi, Korea.
  • 2Department of Medicine, Keimyung University Dongsan Hospital, Daegu, Korea. wichoi@dsmc.or.kr
  • 3Department of Biostatistic Consulting, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
  • 4Department of Occupational and Environmental Medicine, Sungso Hospital, Andong, Korea.

Abstract

BACKGROUND
Information about the epidemiology of venous thromboembolism (VTE) recurrence in Korea is lacking. The purpose of this study was to investigate VTE cumulative recurrence rates and identify risk factors for VTE recurrence among Korean adults.
METHODS
A retrospective cohort study was conducted on adult patients (≥18 years) admitted to a university teaching hospital for pulmonary embolism (PE) from 2005 to 2013. The main outcome of interest was a recurrence of VTE. We used Cox proportional hazard regression analyses to calculate the relative risk of VTE recurrence.
RESULTS
Five-year cumulative incidence of recurrent VTE events was 21.5% (95% confidence interval [CI], 17.7-25.4) in all cases of PE; 17% after provoked and 27% after unprovoked PE. Multivariate analysis showed that body mass index (BMI) of ≥25 (hazard ratio [HR], 2.02; 95% CI, 1.17-3.46; p=0.01) and longer anticoagulation therapy duration (HR, 0.90; 95% CI, 0.84-0.96; p<0.01) were independently associated with risk of VTE recurrence. Risk factors not found to be statistically significant at the <0.05 level included history of VTE (HR, 1.81; 95% CI, 0.84-3.88; p=0.12), unprovoked PE (HR, 1.70; 95% CI, 0.89-3.25; p=0.10), symptomatic deep vein thrombosis (HR, 1.62; 95% CI, 0.89-2.94; p=0.10), and female sex (HR, 1.42; 95% CI, 0.78-2.55; p=0.24). We found that age, history of cancer, and other co-morbidities did not significantly affect the risk of VTE recurrence.
CONCLUSION
Recurrence of VTE after PE is high. Patients with BMI ≥25 or reduced anticoagulation therapy duration have a higher risk of recurrent VTE.

Keyword

Pulmonary Embolism; Recurrence; Venous Thromboembolism

MeSH Terms

Adult
Body Mass Index
Cohort Studies
Epidemiology
Female
Hospitals, Teaching
Humans
Incidence*
Korea
Multivariate Analysis
Pulmonary Embolism*
Recurrence
Retrospective Studies
Risk Factors*
Venous Thromboembolism*
Venous Thrombosis

Figure

  • Figure 1 Cumulative incidence of recurrent venous thromboembolism. Unprovoked pulmonary embolism (solid line) vs. provoked pulmonary embolism (dotted line).


Cited by  1 articles

Predictors of Recurrent Venous Thromboembolism after Pulmonary Embolism in Korea
Yang-Ki Kim
Tuberc Respir Dis. 2019;82(4):357-358.    doi: 10.4046/trd.2019.0068.


Reference

1. Heit JA. The epidemiology of venous thromboembolism in the community. Arterioscler Thromb Vasc Biol. 2008; 28:370–372. PMID: 18296591.
Article
2. Jang MJ, Bang SM, Oh D. Incidence of venous thromboembolism in Korea: from the Health Insurance Review and Assessment Service database. J Thromb Haemost. 2011; 9:85–91. PMID: 20942850.
Article
3. Cohen AT, Agnelli G, Anderson FA, Arcelus JI, Bergqvist D, Brecht JG, et al. Venous thromboembolism (VTE) in Europe: the number of VTE events and associated morbidity and mortality. Thromb Haemost. 2007; 98:756–764. PMID: 17938798.
4. Klok FA, Zondag W, van Kralingen KW, van Dijk AP, Tamsma JT, Heyning FH, et al. Patient outcomes after acute pulmonary embolism: a pooled survival analysis of different adverse events. Am J Respir Crit Care Med. 2010; 181:501–506. PMID: 19965808.
Article
5. Hong J, Lee JH, Yhim HY, Choi WI, Bang SM, Lee H, et al. Incidence of venous thromboembolism in Korea from 2009 to 2013. PLoS One. 2018; 13:e0191897. PMID: 29370290.
Article
6. Choi WI, Jo JY, Kwon YS, Kim JB, Lee MY. Incidence of pulmonary embolism among hospitalized patients. Thromb Res. 2012; 129:523–525. PMID: 22178580.
Article
7. Choi WI, Lee MY, Oh D, Rho BH, Hales CA. Estimated incidence of acute pulmonary embolism in a Korean hospital. Clin Appl Thromb Hemost. 2011; 17:297–301. PMID: 20530053.
Article
8. Ashrani AA, Heit JA. Incidence and cost burden of post-thrombotic syndrome. J Thromb Thrombolysis. 2009; 28:465–476. PMID: 19224134.
Article
9. Prandoni P, Kahn SR. Post-thrombotic syndrome: prevalence, prognostication and need for progress. Br J Haematol. 2009; 145:286–295. PMID: 19222476.
Article
10. Stain M, Schonauer V, Minar E, Bialonczyk C, Hirschl M, Weltermann A, et al. The post-thrombotic syndrome: risk factors and impact on the course of thrombotic disease. J Thromb Haemost. 2005; 3:2671–2676. PMID: 16359506.
Article
11. Kahn SR, Shrier I, Julian JA, Ducruet T, Arsenault L, Miron MJ, et al. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Ann Intern Med. 2008; 149:698–707. PMID: 19017588.
Article
12. Pengo V, Lensing AW, Prins MH, Marchiori A, Davidson BL, Tiozzo F, et al. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med. 2004; 350:2257–2264. PMID: 15163775.
Article
13. Guerin L, Couturaud F, Parent F, Revel MP, Gillaizeau F, Planquette B, et al. Prevalence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: prevalence of CTEPH after pulmonary embolism. Thromb Haemost. 2014; 112:598–605. PMID: 24898545.
14. Choi WI. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism: a retrospective analysis in a university teaching hospital. Clin Exp Thromb Hemost. 2015; 2:4–7.
Article
15. Klok FA, Dzikowska-Diduch O, Kostrubiec M, Vliegen HW, Pruszczyk P, Hasenfuss G, et al. Derivation of a clinical prediction score for chronic thromboembolic pulmonary hypertension after acute pulmonary embolism. J Thromb Haemost. 2016; 14:121–128. PMID: 26509468.
Article
16. Beckman MG, Hooper WC, Critchley SE, Ortel TL. Venous thromboembolism: a public health concern. Am J Prev Med. 2010; 38(4 Suppl):S495–S501. PMID: 20331949.
17. MacDougall DA, Feliu AL, Boccuzzi SJ, Lin J. Economic burden of deep-vein thrombosis, pulmonary embolism, and post-thrombotic syndrome. Am J Health Syst Pharm. 2006; 63(20 Suppl 6):S5–S15.
Article
18. LaMori JC, Shoheiber O, Mody SH, Bookhart BK. Inpatient resource use and cost burden of deep vein thrombosis and pulmonary embolism in the United States. Clin Ther. 2015; 37:62–70. PMID: 25524389.
Article
19. Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141(2 Suppl):e419S–e496S. PMID: 22315268.
20. Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, et al. Antithrombotic therapy for VTE disease: CHEST Guideline and Expert Panel Report. Chest. 2016; 149:315–352. PMID: 26867832.
21. Lee CH, Lin LJ, Cheng CL, Kao Yang YH, Chen JY, Tsai LM. Incidence and cumulative recurrence rates of venous thromboembolism in the Taiwanese population. J Thromb Haemost. 2010; 8:1515–1523. PMID: 20345707.
Article
22. Nakamura M, Wang YQ, Wang C, Oh D, Yin WH, Kimura T, et al. Efficacy and safety of edoxaban for treatment of venous thromboembolism: a subanalysis of East Asian patients in the Hokusai-VTE trial. J Thromb Haemost. 2015; 13:1606–1614. PMID: 26179767.
23. Yamashita Y, Morimoto T, Toyota T, Shiomi H, Makiyama T, Ono K, et al. Asian patients versus non-Asian patients in the efficacy and safety of direct oral anticoagulants relative to vitamin K antagonist for venous thromboembolism: a systemic review and meta-analysis. Thromb Res. 2018; 166:37–42. PMID: 29655001.
Article
24. Eichinger S, Hron G, Bialonczyk C, Hirschl M, Minar E, Wagner O, et al. Overweight, obesity, and the risk of recurrent venous thromboembolism. Arch Intern Med. 2008; 168:1678–1683. PMID: 18695082.
Article
25. Jang MJ, Choi WI, Bang SM, Lee T, Kim YK, Ageno W, et al. Metabolic syndrome is associated with venous thromboembolism in the Korean population. Arterioscler Thromb Vasc Biol. 2009; 29:311–315. PMID: 19228603.
Article
26. Hansson PO, Sorbo J, Eriksson H. Recurrent venous thromboembolism after deep vein thrombosis: incidence and risk factors. Arch Intern Med. 2000; 160:769–774. PMID: 10737276.
27. Schulman S, Rhedin AS, Lindmarker P, Carlsson A, Larfars G, Nicol P, et al. A comparison of six weeks with six months of oral anticoagulant therapy after a first episode of venous thromboembolism: duration of Anticoagulation Trial Study Group. N Engl J Med. 1995; 332:1661–1665. PMID: 7760866.
28. Agnelli G, Prandoni P, Santamaria MG, Bagatella P, Iorio A, Bazzan M, et al. Three months versus one year of oral anticoagulant therapy for idiopathic deep venous thrombosis. Warfarin Optimal Duration Italian Trial Investigators. N Engl J Med. 2001; 345:165–169. PMID: 11463010.
29. Couturaud F, Sanchez O, Pernod G, Mismetti P, Jego P, Duhamel E, et al. Six months vs extended oral anticoagulation after a first episode of pulmonary embolism: the PADIS-PE Randomized Clinical Trial. JAMA. 2015; 314:31–40. PMID: 26151264.
30. Chee CE, Ashrani AA, Marks RS, Petterson TM, Bailey KR, Melton LJ 3rd, et al. Predictors of venous thromboembolism recurrence and bleeding among active cancer patients: a population-based cohort study. Blood. 2014; 123:3972–3978. PMID: 24782507.
Article
31. Hutten BA, Prins MH, Gent M, Ginsberg J, Tijssen JG, Buller HR. Incidence of recurrent thromboembolic and bleeding complications among patients with venous thromboembolism in relation to both malignancy and achieved international normalized ratio: a retrospective analysis. J Clin Oncol. 2000; 18:3078–3083. PMID: 10963635.
Article
32. Prandoni P, Lensing AW, Piccioli A, Bernardi E, Simioni P, Girolami B, et al. Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood. 2002; 100:3484–3488. PMID: 12393647.
Article
33. Olie V, Zhu T, Martinez I, Scarabin PY, Emmerich J. Sex-specific risk factors for recurrent venous thromboembolism. Thromb Res. 2012; 130:16–20. PMID: 22100316.
34. Garcia D, Akl EA, Carr R, Kearon C. Antiphospholipid antibodies and the risk of recurrence after a first episode of venous thromboembolism: a systematic review. Blood. 2013; 122:817–824. PMID: 23760616.
Article
35. Farmer-Boatwright MK, Roubey RA. Venous thrombosis in the antiphospholipid syndrome. Arterioscler Thromb Vasc Biol. 2009; 29:321–325. PMID: 19228605.
Article
36. Na YS, Jang S, Hong S, Oh YM, Lee SD, Lee JS. Clinical phenotype of a first unprovoked acute pulmonary embolism associated with antiphospholipid antibody syndrome. Tuberc Respir Dis. 2019; 82:53–61.
Article
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