Recurrence of Venous Thromboembolism in Patients With Familial Thrombophilia

doi:10.1001/archinte.1997.00440400077009

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Vol. 157 No. 19, 27 OCTOBER 1997

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Recurrence of Venous Thromboembolism in Patients With Familial Thrombophilia

Angelique G. M. van den Belt, MD; Bernd-Jan Sanson, MD; Paolo Simioni, MD; Paolo Prandoni, MD; Harry R. Büller, MD; Antonio Girolami, MD; Martin H. Prins, MD

Arch Intern Med. 1997;157(19):2227-2232.

Abstract

Background
Treatment of patients with deep vein thrombosis and an antithrombinor protein C or S deficiency is based on case reports and personalexperience.

Objective
To systematically assess the risk for recurrence of venous thromboembolismafter a first episode in patients with these deficiencies, aliterature review and retrospective family cohort study wereperformed.

Methods
For the literature review, the annual incidence of a first recurrentvenous thromboembolism was assessed for each deficiency by dividingthe number of venous thromboembolic events by the number ofyears at risk. For the family cohort study, 1- and 5-year cumulativeincidences of first recurrence were calculated based on medicalhistories taken in relatives of consecutive patients in whomvenous thromboembolism and a deficiency were diagnosed.

Results
For the literature review, the annual incidence of a first recurrentvenous thromboembolism in patients with antithrombin or proteinS deficiency ranged from 13% to 17% and 14% to 16%, respectively.For the family cohort study, the 1- and 5-year cumulative incidencesof recurrent venous thromboembolism were 10% (95% confidenceinterval, 1%-19%) and 23% (95% confidence interval, 10%-36%),respectively. Warfarin sodium (Coumadin) prophylaxis was associatedwith 2 venous thromboembolic events in 141 years at risk (1.4%per year), in contrast with 19 events in 709 years at risk (2.7%per year) without prophylaxis (difference, -1.3%; 95% confidenceinterval, -3.5% to 1.0%).

Conclusions
The annual incidence of recurrent venous thromboembolism ishigh during the first years following a first episode, but seemsto decline thereafter. Therefore, our results challenge currentpractice of prescribing lifelong warfarin therapy after a firstor second episode of venous thromboembolism in patients withantithrombin or protein C or S deficiency.

Arch Intern Med. 1997;157:2227-2232

Author Affiliations

From the Department of Clinical Epidemiology and Biostatistics (Drs van den Belt and Prins) and Centre for Haemostasis, Thrombosis, Atherosclerosis, and Inflammation Research (Drs Sanson and Büller), Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands; and the Institute of Medical Semeiotics, Padova, Italy (Drs Simioni, Prandoni, and Girolami).

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