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Long-term recurrence risk after a first venous thromboembolism in men and women under 50 years old: A French prospective cohort

Published:November 16, 2020DOI:https://doi.org/10.1016/j.ejim.2020.10.014
      • Data on long-term venous thromboembolism (VTE) recurrence risk according to gender in patients < 50 years are conflicting. Men are thought to have a greater risk of recurrent VTE than women, but risk factors at first venous thromboembolic event, and particularly hormonal exposure, have to be carefully considered because they may act as potential confounders.
      • In this cohort of 875 patients (315 men and 560 women), the risk of recurrent VTE was three-fold higher in men than in women in univariable analysis (annual incidence rates of recurrent VTE of 4.8% versus 1.8%-person-years, P<0.001).
      • However, in multivariable analysis, this difference was not found to be associated to gender itself, but to circumstances of the index thromboembolic event.
      • Women with a first episode of hormone-related VTE have a very low risk of recurrence (<2% per year), whatever the duration of hormonal exposure at the time of index event.

      Abstract

      Background

      Data on long-term venous thromboembolism (VTE) recurrence risk according to gender are conflicting.

      Objective

      To evaluate long-term VTE recurrence risk after a first VTE in men and women under 50 years old.

      Methods

      Since May 2000, 875 consecutive patients (315 men, 560 women) with a first symptomatic VTE under 50 years old were enrolled in a French prospective multicentre cohort study and were followed up as long as possible. The primary outcome was symptomatic recurrent VTE during follow-up.

      Results

      At baseline, men were older and had more comorbidities than women. First VTE was mainly unprovoked in men (80.6%) and hormone-related in women (84.3%). During a median follow-up of 7.0 years (inter-quartile range, 5.0–11.0), recurrent VTE occurred in 97 men (30.8%) and in 72 women (12.9%) (annual incidence rates of recurrent VTE of 4.8% versus 1.8%-person-years, P<0.001). However, there was no difference according to gender in subgroups of patients with a first unprovoked VTE (5.8% versus 3.8%-person-years, P = 0.09). In women, duration of hormonal treatment before first VTE did not influence recurrence risk. In multivariable analysis, unprovoked VTE and family history of VTE were independently associated with recurrence (hazard ratio of 2.50 (95% confidence interval, 1.61 to 3.85) and 1.52 (1.11 to 2.09) respectively).

      Limitations

      Number of women with unprovoked VTE was low.

      Conclusions

      In patients with a first VTE under 50 years old, a first unprovoked episode and a family history of VTE, but not gender, were associated with a high risk of long-term recurrence.

      Keywords

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      Linked Article

      • Sex, age and venous thrombosis—Are men and women indeed from different planets?
        European Journal of Internal MedicineVol. 84
        • Preview
          “Mars or Venus” titled Elliot and Rubin their editorial that accompanied the landmark study which described for the first time the strikingly higher risk of recurrent venous thromboembolism (VTE) in men compared with women [1,2]. This finding was unexpected, as - if at all - many people regarded women and not men at a higher risk of venous thrombosis. Indeed, large epidemiologic studies indicate slightly higher incidence rates of a first VTE in women, particularly in those at a younger age [3]. Using the data set of the MEGA study, Roach et al.
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