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. 2019 May 3;2(5):e193690.
doi: 10.1001/jamanetworkopen.2019.3690.

Risk and Risk Factors Associated With Recurrent Venous Thromboembolism Following Surgery in Patients With History of Venous Thromboembolism

Banne Nemeth  1   2 , Willem M Lijfering  1 , Rob G H H Nelissen  2 , Inger B Schipper  3 , Frits R Rosendaal  1 , Saskia le Cessie  1   4 , Suzanne C Cannegieter  1   5
Affiliations

Risk and Risk Factors Associated With Recurrent Venous Thromboembolism Following Surgery in Patients With History of Venous Thromboembolism

Banne Nemeth et al. JAMA Netw Open. .

Erratum in

  • Typographical Error in Results.
    [No authors listed] [No authors listed] JAMA Netw Open. 2019 Jun 5;2(6):e196420. doi: 10.1001/jamanetworkopen.2019.6420. JAMA Netw Open. 2019. PMID: 31173109 Free PMC article. No abstract available.

Abstract

Importance: The size of the risk of recurrent venous thromboembolism (VTE) after surgery in patients with a history of VTE is not well known.

Objectives: To estimate the risk of and to identify the factors associated with recurrent VTE in patients undergoing surgery who have a history of VTE.

Design, setting, and participants: This population-based, follow-up cohort study includes patients with VTE who participated in the Multiple Environment and Genetic Assessment (MEGA) study. Original data were collected from March 1999 to April 2010. Data analysis began in June 1999 and ended in April 2010.

Exposures: Surgery following a first VTE.

Main outcomes and measurements: Kaplan-Meier analyses were used to estimate cumulative incidences of recurrent VTE. Cox regression with a time-dependent covariate (surgery) was used to calculate the hazard ratio (HR) for developing recurrent VTE after surgery compared with no surgery.

Results: Overall, 3741 patients (mean [SD] age, 48.4 [12.8] years; 2020 [54.0%] women) with a history of VTE were included in the analysis, amounting to 18 899 person-years, with a median (interquartile range) follow-up of 5.7 (3.0-7.2) years. Of the 3741 patients, 580 (15.5%) underwent surgery and 601 (16.1%) developed a recurrent thrombotic event. The 1-month cumulative incidence of recurrent VTE for all surgery types was 2.1% (95% CI, 1.2%-3.6%), which increased to 3.3% (95% CI, 2.1%-5.1%) at 3 months and 4.6% (95% CI, 3.1%-6.6%) at 6 months. At 6 months, risk of recurrent VTE ranged from 2.3% to 9.3%, depending on surgery type. In addition to surgery type, factor V Leiden mutation (HR, 3.4; 95% CI, 1.6-7.4) and male sex (HR, 2.7; 95% CI, 1.3-5.8) were associated with increased risk of recurrent VTE.

Conclusions and relevance: Surgery was associated with an increased risk of recurrent VTE in patients with a history of VTE; risk remained high for up to 6 months after the procedure. This study suggests that high-risk individuals may be identified based on surgery type, sex, and the presence of factor V Leiden mutation. These findings stress the need for revision of the current thromboprophylactic approach to prevent recurrence in these patients.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Nelissen reported grants from the Netherlands Organization for Health Research and Development (ZonMW) during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Visualization of Time-Dependent Analysis
Exposure time denotes the time window of surgery exposure during which each individual was at risk of venous thromboembolism (VTE; 1 month, 3 months, 6 months, or 1 year). Three hypothetical patient pathways are presented. Patient 1 represents an individual who underwent surgery halfway through follow-up (FU) with no thrombotic event during exposure time. Patient 2 represents an individual who developed a thrombotic event within the surgery exposure time, and patient 3 represents an individual who had no surgery during FU but developed VTE.
Figure 2.
Figure 2.. Absolute Risk of Recurrent Venous Thromboembolism After Surgery in Patients With a History of Venous Thromboembolism
See this image and copyright information in PMC

References

    1. Gould MK, Garcia DA, Wren SM, et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2)(suppl):-. - PMC - PubMed
    1. Falck-Ytter Y, Francis CW, Johanson NA, et al. Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2)(suppl):e278S-e325S. - PMC - PubMed
    1. Allen D, Sale G. Lower limb joint replacement in patients with a history of venous thromboembolism. Bone Joint J. 2014;96-B(11):1515-1519. doi: 10.1302/0301-620X.96B11.33492 - DOI - PubMed
    1. Bahl V, Hu HM, Henke PK, Wakefield TW, Campbell DA Jr, Caprini JA. A validation study of a retrospective venous thromboembolism risk scoring method. Ann Surg. 2010;251(2):344-350. doi: 10.1097/SLA.0b013e3181b7fca6 - DOI - PubMed
    1. Nelson DW, Simianu VV, Bastawrous AL, et al. ; Colorectal Writing Group for Surgical Care and Outcomes Assessment Program–Comparative Effectiveness Research Translation Network (SCOAP-CERTAIN) Collaborative . Thromboembolic complications and prophylaxis patterns in colorectal surgery. JAMA Surg. 2015;150(8):712-720. doi: 10.1001/jamasurg.2015.1057 - DOI - PMC - PubMed

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