Document Detail

Recurrence of venous thromboembolism in patients with familial thrombophilia.
MedLine Citation:
PMID:  9342999     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Treatment of patients with deep vein thrombosis and an antithrombin or protein C or S deficiency is based on case reports and personal experience. OBJECTIVE: To systematically assess the risk for recurrence of venous thromboembolism after a first episode in patients with these deficiencies, a literature review and retrospective family cohort study were performed. METHODS: For the literature review, the annual incidence of a first recurrent venous thromboembolism was assessed for each deficiency by dividing the number of venous thromboembolic events by the number of years at risk. For the family cohort study, 1- and 5-year cumulative incidences of first recurrence were calculated based on medical histories taken in relatives of consecutive patients in whom venous thromboembolism and a deficiency were diagnosed. RESULTS: For the literature review, the annual incidence of a first recurrent venous thromboembolism in patients with antithrombin or protein S deficiency ranged from 13% to 17% and 14% to 16%, respectively. For the family cohort study, the 1- and 5-year cumulative incidences of recurrent venous thromboembolism were 10% (95% confidence interval, 1%-19%) and 23% (95% confidence interval, 10%-36%), respectively. Warfarin sodium (Coumadin) prophylaxis was associated with 2 venous thromboembolic events in 141 years at risk (1.4% per year), in contrast with 19 events in 709 years at risk (2.7% per year) without prophylaxis (difference, -1.3%; 95% confidence interval, -3.5% to 1.0%). CONCLUSIONS: The annual incidence of recurrent venous thromboembolism is high during the first years following a first episode, but seems to decline thereafter. Therefore, our results challenge current practice of prescribing lifelong warfarin therapy after a first or second episode of venous thromboembolism in patients with antithrombin or protein C or S deficiency.
A G van den Belt; B J Sanson; P Simioni; P Prandoni; H R Büller; A Girolami; M H Prins
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Archives of internal medicine     Volume:  157     ISSN:  0003-9926     ISO Abbreviation:  Arch. Intern. Med.     Publication Date:  1997 Oct 
Date Detail:
Created Date:  1997-11-18     Completed Date:  1997-11-18     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  0372440     Medline TA:  Arch Intern Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  2227-32     Citation Subset:  AIM; IM    
Department of Clinical Epidemiology and Biostatistics, Academic Medical Centre, University of Amsterdam, The Netherlands.
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MeSH Terms
Anticoagulants / therapeutic use
Antithrombin III Deficiency
Cohort Studies
Protein C Deficiency
Protein S Deficiency
Thromboembolism / blood,  genetics*,  prevention & control
Thrombophilia / blood,  complications*,  drug therapy,  genetics
Reg. No./Substance:
Comment In:
Arch Intern Med. 1997 Oct 27;157(19):2174-7   [PMID:  9342993 ]

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