Index Clinical Manifestation of Venous Thromboembolism Predicts Early Recurrence Type and Frequency: A Meta-Analysis of Randomized Controlled Trials.
J Thromb Haemost. 2015 Mar 28;
Authors: Mearns ES, Coleman CI, Patel D, Saulsberry WJ, Corman A, Li D, Hernandez AV, Kohn CG
BACKGROUND: Observational studies suggest index clinical manifestation of venous thromboembolism (VTE) predicts recurrence type. Data regarding the association between index manifestation and recurrence rates are conflicting.
OBJECTIVES: To perform a meta-analysis of randomized controlled trials (RCTs) to determine the type and frequency of recurrent VTE (rVTE) in persons after an index deep vein thrombosis (DVT) or pulmonary embolism (PE).
PATIENTS/METHODS: We searched bibliographic databases for RCTs of acute (early) treatment of rVTE in persons suffering an index DVT or PE (±DVT), enrolling ≥50 subjects anticoagulated ≥3-months and reporting types of rVTE. We pooled (random-effects) the proportion of rVTEs that were DVTs, PEs and fatal PEs, the proportion of recurrent PEs that were fatal and absolute rVTE rates.
RESULTS: In 9 RCTs (N=13,640; 413 rVTEs) evaluating persons suffering an index PE; 66% (95%CI, 60-72%) of rVTEs were PE and 27% (95%CI, 22-33%) were fatal PE. Among 25 RCTs (N=17,340; 692 rVTEs) evaluating persons suffering an index DVT, 36% (95%CI, 29-44%) experienced a recurrent PE and 10% (95%CI, 7-13%) a fatal PE. Recurrent PEs following an index PE had a higher fatality rate than after an index DVT (41%; 95%CI, 33-48% vs. 25%; 95%CI, 18-33%; p=0.007). The rVTE rate was higher following an index DVT compared to a PE (2.6%; 95%CI, 1.6-3.8% vs. 4.9%; 95%CI, 4.0-6.0; p=0.002) CONCLUSIONS: Our meta-analysis suggests most rVTEs will be the same type as the index event. While index DVTs are associated with a higher rVTE rate than index PEs; recurrent PEs are associated with high fatality. This article is protected by copyright. All rights reserved.
PMID: 25819920 [PubMed - as supplied by publisher]