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. 2021 Jun;19(6):1526-1532.
doi: 10.1111/jth.15303. Epub 2021 Apr 21.

Long-term risk of recurrent venous thromboembolism after a first contraceptive-related event: Data from REVERSE cohort study

David Aziz  1 , Leslie Skeith  2   3 , Marc A Rodger  3   4 , Elham Sabri  3 , Marc Righini  5 , Michael J Kovacs  6 , Marc Carrier  1   3 , Susan R Kahn  4 , Philip S Wells  1   3 , David R Anderson  7 , Isabelle Chagnon  8 , Susan Solymoss  4 , Mark A Crowther  9 , Richard H White  10 , Grégoire Le Gal  1   3   11
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Free article

Long-term risk of recurrent venous thromboembolism after a first contraceptive-related event: Data from REVERSE cohort study

David Aziz et al. J Thromb Haemost. 2021 Jun.
Free article

Abstract

Introduction: The risk of recurrent venous thromboembolism (VTE) after combined oral contraceptive (COC) use is variably reported. We assessed the long-term risk of recurrent VTE in women on COC at the time of a first VTE, in comparison to women without COC use. Our secondary aim assessed the impact of COC use on the recurrent VTE risk in high-risk and low-risk hyperpigmentation, edema, or redness in either leg; D-dimer level ≥250 μg/L; obesity with body mass index ≥30; or older age, ≥65 years (HERDOO2) subgroups.

Methods: The REVERSE cohort study derived the HERDOO2 clinical decision rule to predict recurrent VTE in patients who discontinued anticoagulation after 5-7 months for a first unprovoked VTE. Incidence rates of recurrent VTE among women with and without COC exposure were calculated as the number of recurrent VTE over the number of person-years of follow-up, and Cox proportional hazards model was used to compare risks between groups.

Results: The risk of recurrent VTE among COC users was 1.1% (95% confidence interval [CI] 0.3-2.9) per patient-year as compared with 3.2% per patient-year (95% CI 2.4-4.3) among nonusers (hazard ratio 0.37; 95% CI 0.1-1.0). Women who were COC users and high risk by HERDOO2 score had a recurrence rate of 3.5% (95% CI 0.4-12.5) compared with 6.1% (95% CI 4.3-8.5) among women who were non-COC users and at high risk by HERDOO2 score (HR 0.6, 95% CI 0.1-2.5).

Conclusions: Women who were COC users at the time of an otherwise unprovoked VTE event had a lower VTE recurrence rate during long-term follow-up, compared with nonusers. The use of HERDOO2 rule may help identify higher risk women with COC use.

Keywords: oral contraception; recurrence; venous thrombosis.

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References

REFERENCES

    1. Rosendall FR. Venous thrombosis: a multicausal disease. Lancet. 1999;353:1167-1173.
    1. Kearon C, Ageno W, Cannegieter SC, Cosmi B, Geersing G-J, Kyrle PA. Categorization of patients as having provoked or unprovoked venous thromboembolism: guidance from the SSC of ISTH. J Thromb Haemost. 2016;14:1480-1483.
    1. Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 Sup):e419S-e494S.
    1. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease. Chest. 2016;149:315-352.
    1. Sandset PM. Mechanisms of hormonal therapy related thrombosis. Thromb Res. 2013;131(Suppl 1):S4-7.

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