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Sex, age and venous thrombosis—Are men and women indeed from different planets?

  • Sabine Eichinger
    Correspondence
    Corresponding author at: Department of Medicine I, Div. of Hematology and Hemostaseology, Medical University of Vienna, Austria.
    Affiliations
    Department of Medicine I, Div. of Hematology and Hemostaseology, Medical University of Vienna, Austria

    Karl Landsteiner Institute of Thrombosis Research, Vienna, Austria
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  • Paul A. Kyrle
    Affiliations
    Department of Medicine I, Div. of Hematology and Hemostaseology, Medical University of Vienna, Austria

    Karl Landsteiner Institute of Thrombosis Research, Vienna, Austria
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Published:January 05, 2021DOI:https://doi.org/10.1016/j.ejim.2020.12.022
      “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 [
      • Elliott CG
      • Rubin LJ
      Mars or venus–is sex a risk factor for recurrent venous thromboembolism.
      ,
      • Kyrle PA
      • Minar E
      • Bialonczyk C
      • Hirschl M
      • Weltermann A
      • Eichinger S.
      The risk of recurrent venous thromboembolism in men and women.
      ]. 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 [
      • Martinez C
      • Cohen AT
      • Bamber L
      • Rietbrock S.
      Epidemiology of first and recurrent venous thromboembolism: a population-based cohort study in patients without active cancer.
      ]. Using the data set of the MEGA study, Roach et al. added a piece to the puzzle [
      • Roach RE
      • Lijfering WM
      • Rosendaal FR
      • Cannegieter SC
      • le Cessie S.
      Sex difference in risk of second but not of first venous thrombosis: paradox explained.
      ]. 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.
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      Linked Article

      • Long-term recurrence risk after a first venous thromboembolism in men and women under 50 years old: A French prospective cohort
        European Journal of Internal MedicineVol. 84
        • Preview
          Venous 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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