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Symptomatic Pulmonary Embolism and the Risk of Recurrent Venous Thromboembolism
Sabine Eichinger, MD;
Ansgar Weltermann, MD;
Erich Minar, MD;
Milena Stain, MD;
Verena Schönauer, MD;
Barbara Schneider, PhD;
Paul Alexander Kyrle, MD
Arch Intern Med. 2004;164:92-96.
Background In patients with a first symptomatic pulmonary embolism (PE), the risk of recurrence is unknown. We therefore investigated the risk of recurrence among patients with spontaneous symptomatic PE and among those with deep vein thrombosis (DVT) without symptoms of PE.
Methods After discontinuation of secondary thromboprophylaxis for a first venous thromboembolism (VTE), we prospectively observed 436 patients for an average of 30 months. Patients with secondary VTE, natural inhibitor deficiencies, lupus anticoagulant, cancer, long-term antithrombotic therapy, vena cava filters, or pregnancy were excluded. The study outcome was objectively documented recurrent symptomatic VTE.
Results Recurrent VTE was seen among 28 (17.3%) of 162 patients with symptomatic PE and among 26 (9.5%) of 274 patients with DVT without symptoms of PE. Compared with patients with DVT, the relative risk of recurrent VTE among patients with symptomatic PE was 2.2 (95% confidence interval, 1.3-3.7; P = .005). The relative risk was not affected by age, sex, presence of factor V Leiden or prothrombin G20210A, hyperhomocysteinemia, or high factor VIII levels. Compared with patients with DVT without symptoms of PE, patients with symptomatic PE had an adjusted relative risk of PE at recurrence of 4.0 (95% confidence interval, 1.3-12.3; P = .03).
Conclusion Patients with a first symptomatic PE not only have a higher risk of recurrent VTE than those with DVT without symptoms of PE, but are also at high risk of symptomatic PE at recurrence.
From the Division of Hematology and Hemostasis, Department of Internal Medicine I (Drs Eichinger, Weltermann, Stain, Schönauer, and Kyrle), Division of Angiology, Department of Internal Medicine II (Dr Minar), and Institute of Medical Statistics (Dr Schneider), University of Vienna, Vienna, Austria; and Ludwig-Boltzmann Institute for Thrombosis Research, Vienna (Dr Kyrle). The authors have no relevant financial interest in this article.
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