“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. added a piece to the puzzle [
[4]
]. They showed that when female reproduction-related risk factors were not taken into
account, the risk for a first venous thrombosis was twice as high in men than in women.
Despite brain-racking efforts a ready explanation for the paradox of the sex-related
difference in the risk of both a first and a recurrent VTE was not to be found.To read this article in full you will need to make a payment
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References
- Mars or venus–is sex a risk factor for recurrent venous thromboembolism.N Engl J Med. 2004 Jun 17; 350: 2614-2616
- The risk of recurrent venous thromboembolism in men and women.N Engl J Med. 2004 Jun 17; 350: 2558-2563https://doi.org/10.1056/NEJMoa032959
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- Sex difference in risk of second but not of first venous thrombosis: paradox explained.Circulation. 2014 Jan 7; 129: 51-56https://doi.org/10.1161/CIRCULATIONAHA.113.004768
De Moreuil C, Le Mao R, Le Moigne E, et al. Long-term recurrence risk after a first venous thromboembolism in men and women under 50 years old: a French prospective cohort. DOI:https://doi.org/10.1016/j.ejim.2020.10.014.
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- Thrombophilia, clinical factors, and recurrent venous thrombotic events.JAMA. 2005 May 18; 293: 2352-2361https://doi.org/10.1001/jama.293.19.2352
- Age at first venous thromboembolism and risk of recurrence: a prospective cohort study.Medicine (Baltimore). Nov 2009; 88: 366-370https://doi.org/10.1097/MD.0b013e3181c29e31
- Identifying unprovoked thromboembolism patients at low risk for recurrence who can discontinue anticoagulant therapy.CMAJ. 2008 Aug 26; 179: 417-426https://doi.org/10.1503/cmaj.080493
- Predicting disease recurrence in patients with previous unprovoked venous thromboembolism: a proposed prediction score (DASH).J Thromb Haemost. Jun 2012; 10: 1019-1025https://doi.org/10.1111/j.1538-7836.2012.04735.x
- Sex difference in the risk of recurrent venous thrombosis: a detailed analysis in four European cohorts.J Thromb Haemost. Oct 2015; 13: 1815-1822https://doi.org/10.1111/jth.13116
Article info
Publication history
Published online: January 05, 2021
Accepted:
December 28,
2020
Received:
December 20,
2020
Identification
Copyright
© 2021 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
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- Long-term recurrence risk after a first venous thromboembolism in men and women under 50 years old: A French prospective cohortEuropean Journal of Internal MedicineVol. 84
- PreviewVenous thromboembolism (VTE) is a frequent and potentially life-threatening disease. Beyond the initial three months of anticoagulation, it is essential to evaluate accurately the recurrence risk of VTE in order to stop or to prolong oral anticoagulation. In patients with VTE provoked by a major transient risk factor, the risk of recurrence is sufficiently low to warrant anticoagulation discontinuation [1–5]. In contrast, when VTE is unprovoked, the risk of recurrence is high and international guidelines recommend indefinite anticoagulation in patients with a low or an intermediate risk of bleeding [2–7].
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