Index clinical manifestation of venous thromboembolism predicts early recurrence type and frequency: a meta‐analysis of randomized controlled trials

Summary 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 tria...

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Bibliographic Details
Published in:Journal of thrombosis and haemostasis 2015-06, Vol.13 (6), p.1043-1052
Main Authors: Mearns, E. S., Coleman, C. I., Patel, D., Saulsberry, W. J., Corman, A., Li, D., Hernandez, A. V., Kohn, C. G.
Format: Article
Language:English
Subjects:
Anticoagulants - therapeutic use
Bibliographic data bases
Clinical trials
deep vein thrombosis
Humans
Medical treatment
meta‐analysis
Predictive Value of Tests
pulmonary embolism
Pulmonary Embolism - diagnosis
Pulmonary Embolism - drug therapy
Pulmonary Embolism - mortality
Randomized Controlled Trials as Topic
Recurrence
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
venous thromboembolism
Venous Thromboembolism - diagnosis
Venous Thromboembolism - drug therapy
Venous Thromboembolism - mortality
venous thrombosis
Venous Thrombosis - diagnosis
Venous Thrombosis - drug therapy
Venous Thrombosis - mortality
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Summary:Summary 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 with 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 nine RCTs (N = 13 640; 413 rVTEs) evaluating persons with 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 with 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 with 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.
ISSN:1538-7933
1538-7836
1538-7836
DOI:10.1111/jth.12914