Predicting the risk of recurrent venous thromboembolism

P. A. Kyrle; L. Eischer

doi:10.5482/HAMO-13-03-0018

Hämostaseologie, Table of Contents

Hamostaseologie 2013; 33(03): 201-209
DOI: 10.5482/HAMO-13-03-0018

Review

Schattauer GmbH

Predicting the risk of recurrent venous thromboembolism

The Austrian Study on Recurrent Venous Thromboembolism (AUREC)Vorhersage des Rezidivrisikos der venösen ThromboembolieDie Austrian Study on Recurrent Venous Thromboembolism (AUREC)

Authors

P. A. Kyrle

¹Medical University of Vienna; Karl Landsteiner Institute for Thrombosis Research, Vienna, Austria
L. Eischer

¹Medical University of Vienna; Karl Landsteiner Institute for Thrombosis Research, Vienna, Austria

Abstract

Summary

Venous thromboembolism (VTE) is a disease, which often recurs. The recurrence risk is highest in patients with unprovoked proximal deep-vein thrombosis (VT) or pulmonary embolism. Men have a higher risk than women. The risk is low in patients with VTE related to a temporary risk factor such as surgery or estrogen use. Other risk factors include overweight, post-thrombotic syndrome, history of VTE, residual VT or a vena cava filter.

Both factor V Leiden and the prothrombin mutation confer a negligible increase in recurrence risk. High clotting factor levels, deficiency of a natural coagulation inhibitor, or hyperhomocysteinaemia are also associated with an increased risk. Reasons why routine laboratory thrombophilia screening however is no longer warranted are addressed in this article. Prediction rules combining clinical characteristics and coagulation assays have recently been developed. One such model, the Vienna Prediction Model, allows predicting recurrent VTE on the basis of VTE location, sex and D-dimer. This article describes strategies to distinguish between patients with high risk of recurrent VTE from those with a lower risk, who might not benefit from long-term antithrombotic therapy.

Zusammenfassung

Die venöse Thromboembolie (VTE) rezidiviert häufig. Das Rezidivrisiko ist nach spontaner proximaler Venenthrombose (VT) oder Lungenembolie am höchsten. Männer haben ein höheres Risiko als Frauen. Das Risiko ist gering, wenn die VTE mit einem zeitlich begrenzten Risikofaktor (z.B. Operation, Östrogene) assoziiert war. Weitere Risikofaktoren sind Übergewicht, post-thrombotisches Syndrom, frühere VTE, residuale VT oder ein Vena cava-Filter. Sowohl der Faktor V Leiden wie auch die Prothrombin-Mutation erhöhen das Rezidivrisiko nur unbedeutend. Hohe Gerinnungsfaktorenspiegel, Mangel an einem natürlichen Gerinnungsinhibitor oder die Hyperhomozysteinämie sind ebenfalls mit einem erhöhten Risiko vergesellschaftet. Gründe, warum das Routine-Thrombophiliescreening obsolet ist, werden im Manuskript besprochen. Vorhersagemodelle, die klinische Faktoren mit Gerinnungstests kombinieren, sind seit kurzem verfügbar. Das Vienna Prediction Model errechnet die Rezidivwahrscheinlichkeit auf Basis von Lokalisation der VTE, Geschlecht und D-Dimer. Dieser Artikel bespricht Strategien um Patienten mit hohem Rezidivrisiko von Niedrigrisiko-Patienten, die von eine lange dauernden Antikoagulation nicht profitieren, zu unterscheiden.

Keywords

Venous thromboembolism - recurrence - prediction

Schlüsselwörter

Venöse Thromboembolie - Rezidiv - Vorhersage

Full Text

References

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