Abstract
Background We aimed to validate and to refine current recurrent venous thromboembolism (VTE) risk classification.
Methods We performed a post-hoc analysis of a multicentre cohort, including 1,881 patients with a first symptomatic VTE prospectively followed after anticoagulation discontinuation. The primary objective was to validate the International Society of Thrombosis and Haemostasis (ISTH) risk classification in predicting recurrence risk. Secondary objective was to evaluate a refined ISTH classification based on recurrence risk estimate for each individual risk factors.
Results During a 4.8-year median follow-up after anticoagulation discontinuation, symptomatic recurrent VTE occurred in 230 patients (12.2%). Based on ISTH classification, patients with unprovoked VTE or VTE with minor or major persistent risk factor had a 2-fold increased recurrence risk as compared to those with VTE and major transient risk factor. Recurrence risk was not increased in patients with minor transient factor (Hazard Ratio[HR] 1.31;95%CI0.84–2.06). Individual risk factors analysis identified hormone-related VTE (pregnancy: HR 0.26; 95%CI0.08–0.82; estrogens: HR 0.25; 95%CI0.14–0.47) and amyotrophic lateral sclerosis (HR 5.84; 95%CI1.82–18.70). After reclassification of these factors as major transient for the former and major persistent for the latter, refined ISTH classification allowed to accurately discriminate between patients at low-risk (i.e., with major transient risk factor) and those at high-risk of recurrence (i.e., without major transient risk factors).
Conclusions Among patients who stopped anticoagulation after a first VTE, a refined ISTH classification based on recurrence risk intensity of individual factors allowed to discriminate between patients at low-recurrence risk, including hormonal exposure in women, and patients at high-recurrence risk.
Footnotes
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Conflict of interest disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Le Mao declares he has no conflict of interest related to this research. Dr. Orione declares he has no conflict of interest related to this research. Dr. Tromeur declares she has no conflict of interest related to this research. Dr. De Moreuil declares she has no conflict of interest related to this research. Dr Hoffmann declares he has no conflict of interest related to this research. Dr Fauché declares he has no conflict of interest related to this research. Dr. Robin declares he has no conflict of interest related to this research. Dr. Didier declares he has no conflict of interest related to this research. Ms Guegan declares she has no conflict of interest related to this research. Dr. Jimenez has served as an advisor or consultant for Bayer HealthCare Pharmaceuticals, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Leo Pharma, Pfizer, ROVI and Sanofi; served as a speaker or a member of a speakers’ bureau for Bayer HealthCare Pharmaceuticals, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Leo Pharma, ROVI and Sanofi; received grants for clinical research from Daiichi Sankyo, Sanofi and ROVI. Dr Le Moigne reports having received research grants from Leo Pharma. Dr Leroyer reports having received research grant support from Pfizer and fees for board memberships or symposia from Bayer and Astra Zeneca and having received travel support from Bayer, Daiichi Sankyo, Leo Pharma, Intermune and Actelion. Dr Lacut reports having received personal fees from Bayer-Health Care, Bristol-Myers Squibb and Boehringer Ingelheim. Dr. Couturaud reports having received research grant support from Pfizer and fees for board memberships or symposia from Bayer, Bristol-Myers Squibb/Pfizer and Astra Zeneca and having received travel support from Bayer, Bristol-Myers Squibb/Pfizer, Boehringer Ingelheim, Leo Pharma, and Actelion.
- Received July 10, 2021.
- Accepted January 30, 2022.
- Copyright ©The authors 2022. For reproduction rights and permissions contact permissions{at}ersnet.org
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