Predictors of recurrence of venous thromboembolic disease after discontinuing of anticoagulation: a prospective cohort study

MARIA LOURDES POSADAS MARTINEZ; FELIPE TORRES GOMEZ; DANIELA MEZZAROBBA; NATALIA SCHUTZ; JESICA RUBERTO; FERNANDA DOVASIO; MARTA ELBA MARTINUZZO; FERNANDO JAVIER VÁZQUEZ; FERNAN BERNALDO DE QUIRÓS; DIEGO GIUNTA

Medwave

Medwave

Año: 2021

0717-6384

Medwave. 2021 Dec 28;21(11):e8504. doi: 10.5867/medwave.2021.11.002068.Predictors of recurrence of venous thromboembolic disease after discontinuing of anticoagulation: a prospective cohort study[Article in Spanish, English]María Lourdes Posadas-Martínez 1, Felipe Torres Gómez 2, Daniela Mezzarobba 3, Natalia Schutz 4, Jesica Ruberto 5, Fernanda Dovasio 6, Marta Elba Martinuzzo 7, Fernando Javier Vázquez 8, Fernan Bernaldo de Quirós 9, Diego Giunta 10Affiliations expandPMID: 34964447 DOI: 10.5867/medwave.2021.11.002068Abstract in English, SpanishObjective: We aim to evaluate factors associated with the recurrence of thromboembolic episodes among patients with a first episode of venous thromboembolic disease during anticoagulation treatment and at least one year after treatment suspension.Methods: A prospective cohort of patients with a first episode of deep vein thrombosis confirmed by Doppler ultrasound and initiated anticoagulation treatment. Participants were registered in the Institutional Registry of Thromboembolic Disease between June 2015 and March 2019. Patients with cancer, with permanent inferior vena cava filter implant, and those who refused to participate or did not provide informed consent were excluded. All patients were evaluated within treatment at 30 days and at least one year after the suspension of anticoagulation with a D-dimer study and an ultrasound. All patients were evaluated for recurrence, bleeding (major and minor), and death.Results: A total of 304 patients were recruited during the study period. Seventy-three percent were female, and the median age was 80 years. The rate of recurrence rate during anticoagulation treatment was 5% (N = 16/303; 95% confidence interval: 3 to 8), and 5% during post-suspension follow-up (N = 11/202; 95%CI: 3 to 9). The overall bleeding rate was 13% (N = 39; 95%CI: 9 to 17), and 5% for major bleeding. Patients who recurred had higher basal D-dimer mean, higher neutrophils and monocytes, and a higher prevalence of age-adjusted D-dimer ratio greater than 0.5 before discontinuation. In addition, they more frequently had complete leg involvement by ultrasound and received a shorter treatment.Conclusions: Although some baseline and pre-suspension parameters had a higher recurrence incidence, statistical significance was not reached, probably due to small statistical power and a short-term follow-up.Keywords: Bleeding; Pulmonary embolism; Deep vein thrombosis.