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The Incidence of Recurrent Venous Thromboembolism After Treatment With Vitamin K Antagonists in Relation to Time Since First Event
A Meta-analysis
Carlo J. J. van Dongen, MSc;
Roel Vink, MD;
Barbara A. Hutten, PhD;
Harry R. Büller, MD, PhD;
Martin H. Prins, MD, PhD
Arch Intern Med. 2003;163:1285-1293.
Background After a first episode of venous thromboembolism, patients are treated with vitamin K (phytonadione) antagonists. There are indications that the risk of recurrence after treatment with vitamin K antagonists decreases relative to the time since the first event. The aim of the present meta-analysis is to describe the risk of recurrent venous thromboembolism after treatment with vitamin K antagonist in relation to the time since the index event.
Methods Computerized searches in MEDLINE and EMBASE databases; reference checks of pertinent articles; personal communication with colleagues to find randomized clinical trials and cohort studies in which patients with venous thromboembolism were treated with vitamin K antagonists. Per treatment arm, 2 reviewers independently extracted data on the number of recurrent events and the duration of follow-up per time period of 3 months.
Results A total of 135 potentially eligible studies were identified. Of these, 18 studies could be included, comprising 25 treatment arms that could be analyzed. Treatment arms were divided into 3 groups based on treatment duration (short, medium, and long). For all 3 groups, the monthly incidence immediately after discontinuation of treatment was high and declined rapidly thereafter. The monthly incidence after 9 months seemed independent of the treatment duration.
Conclusions There is a diminishing risk of recurrent venous thromboembolism over time and a stabilization after 9 months independent of the duration of the initial treatment with vitamin K antagonists. These findings have important implications for decision making about the optimal duration of treatment with vitamin K antagonists.
From the Departments of Clinical Epidemiology and Biostatistics (Mr van Dongen and Dr Hutten) and Vascular Medicine (Drs Vink and Büller), Academic Medical Center, Amsterdam; and Department of Clinical Epidemiology, Academic Hospital, Maastricht (Dr Prins), the Netherlands. The authors have no relevant financial interest in this article.
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