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

E S Mearns; C I Coleman; D Patel; W J Saulsberry; A Corman; D Li; A V Hernandez; C G Kohn

doi:10.1111/jth.12914

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

J Thromb Haemost. 2015 Jun;13(6):1043-52. doi: 10.1111/jth.12914. Epub 2015 May 11.

Authors

E S Mearns^{1

2}, C I Coleman^{1

2}, D Patel³, W J Saulsberry^{1

2}, A Corman², D Li², A V Hernandez^{4

5}, C G Kohn^{2

6}

Affiliations

¹ Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, CT, USA.
² University of Connecticut/Hartford Hospital Evidence-Based Practice Center, Hartford, CT, USA.
³ Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, PA, USA.
⁴ Health Outcomes and Clinical Epidemiology Section, Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
⁵ Postgraduate and Medical Schools, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru.
⁶ Department of Pharmacy Practice and Administration, University of Saint Joseph School of Pharmacy, Hartford, CT, USA.

PMID: 25819920
DOI: 10.1111/jth.12914

Abstract

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.

Keywords: deep vein thrombosis; meta-analysis; pulmonary embolism; venous thromboembolism; venous thrombosis.

Publication types

Meta-Analysis
Review

MeSH terms

Anticoagulants / therapeutic use
Humans
Predictive Value of Tests
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* / diagnosis
Venous Thromboembolism* / drug therapy
Venous Thromboembolism* / mortality
Venous Thrombosis* / diagnosis
Venous Thrombosis* / drug therapy
Venous Thrombosis* / mortality

Substances

Anticoagulants