Fatal recurrent VTE after anticoagulant treatment for unprovoked VTE: a systematic review

Sake J. van der Wall, Liselotte M. van der Pol, Yvonne M. Ende-Verhaar, Suzanne C. Cannegieter, Sam Schulman, Paolo Prandoni, Marc Rodger, Menno V. Huisman, Frederikus A. Klok

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

Current guidelines recommend long-term anticoagulant therapy in patients with unprovoked venous thromboembolism (VTE). The risk of fatal recurrent VTE after treatment discontinuation (versus that of fatal bleeding during anticoagulation) is of particular relevance in the decision to continue or stop anticoagulation after the first 3 months. Our primary aim was to provide a point-estimate of the yearly rate of fatal recurrent VTE and VTE case-fatality rate in patients with unprovoked VTE after anticoagulation cessation. Data were extracted from both randomised controlled trials and observational studies published before May 1, 2017. The pooled fatality rates were calculated using a random-effects model. 18 studies with low-to-moderate bias were included in the primary analysis, totalling 6758 patients with a median (range) follow-up duration of 2.2 (1-5) years. After anticoagulation cessation, the weighted pooled rate of VTE recurrence was 6.3 (95% CI 5.4-7.3) per 100 patient-years and the weighted pooled rate of fatal recurrent VTE was 0.17 (95% CI 0.047-0.33) per 100 patient-years, for a case-fatality rate of 2.6% (95% CI 0.86-5.0). These numbers are a solid benchmark for comparison to the risks associated with long-term anticoagulation treatment for the decision on the optimal duration of treatment of patients with unprovoked VTE.
Original languageEnglish
JournalEuropean respiratory review : an official journal of the European Respiratory Society
Volume27
Issue number150
DOIs
Publication statusPublished - 2018

Cite this

van der Wall, Sake J. ; van der Pol, Liselotte M. ; Ende-Verhaar, Yvonne M. ; Cannegieter, Suzanne C. ; Schulman, Sam ; Prandoni, Paolo ; Rodger, Marc ; Huisman, Menno V. ; Klok, Frederikus A. / Fatal recurrent VTE after anticoagulant treatment for unprovoked VTE: a systematic review. In: European respiratory review : an official journal of the European Respiratory Society. 2018 ; Vol. 27, No. 150.
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title = "Fatal recurrent VTE after anticoagulant treatment for unprovoked VTE: a systematic review",
abstract = "Current guidelines recommend long-term anticoagulant therapy in patients with unprovoked venous thromboembolism (VTE). The risk of fatal recurrent VTE after treatment discontinuation (versus that of fatal bleeding during anticoagulation) is of particular relevance in the decision to continue or stop anticoagulation after the first 3 months. Our primary aim was to provide a point-estimate of the yearly rate of fatal recurrent VTE and VTE case-fatality rate in patients with unprovoked VTE after anticoagulation cessation. Data were extracted from both randomised controlled trials and observational studies published before May 1, 2017. The pooled fatality rates were calculated using a random-effects model. 18 studies with low-to-moderate bias were included in the primary analysis, totalling 6758 patients with a median (range) follow-up duration of 2.2 (1-5) years. After anticoagulation cessation, the weighted pooled rate of VTE recurrence was 6.3 (95{\%} CI 5.4-7.3) per 100 patient-years and the weighted pooled rate of fatal recurrent VTE was 0.17 (95{\%} CI 0.047-0.33) per 100 patient-years, for a case-fatality rate of 2.6{\%} (95{\%} CI 0.86-5.0). These numbers are a solid benchmark for comparison to the risks associated with long-term anticoagulation treatment for the decision on the optimal duration of treatment of patients with unprovoked VTE.",
author = "{van der Wall}, {Sake J.} and {van der Pol}, {Liselotte M.} and Ende-Verhaar, {Yvonne M.} and Cannegieter, {Suzanne C.} and Sam Schulman and Paolo Prandoni and Marc Rodger and Huisman, {Menno V.} and Klok, {Frederikus A.}",
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Fatal recurrent VTE after anticoagulant treatment for unprovoked VTE: a systematic review. / van der Wall, Sake J.; van der Pol, Liselotte M.; Ende-Verhaar, Yvonne M.; Cannegieter, Suzanne C.; Schulman, Sam; Prandoni, Paolo; Rodger, Marc; Huisman, Menno V.; Klok, Frederikus A.

In: European respiratory review : an official journal of the European Respiratory Society, Vol. 27, No. 150, 2018.

Research output: Contribution to journalReview articleAcademicpeer-review

TY - JOUR

T1 - Fatal recurrent VTE after anticoagulant treatment for unprovoked VTE: a systematic review

AU - van der Wall, Sake J.

AU - van der Pol, Liselotte M.

AU - Ende-Verhaar, Yvonne M.

AU - Cannegieter, Suzanne C.

AU - Schulman, Sam

AU - Prandoni, Paolo

AU - Rodger, Marc

AU - Huisman, Menno V.

AU - Klok, Frederikus A.

PY - 2018

Y1 - 2018

N2 - Current guidelines recommend long-term anticoagulant therapy in patients with unprovoked venous thromboembolism (VTE). The risk of fatal recurrent VTE after treatment discontinuation (versus that of fatal bleeding during anticoagulation) is of particular relevance in the decision to continue or stop anticoagulation after the first 3 months. Our primary aim was to provide a point-estimate of the yearly rate of fatal recurrent VTE and VTE case-fatality rate in patients with unprovoked VTE after anticoagulation cessation. Data were extracted from both randomised controlled trials and observational studies published before May 1, 2017. The pooled fatality rates were calculated using a random-effects model. 18 studies with low-to-moderate bias were included in the primary analysis, totalling 6758 patients with a median (range) follow-up duration of 2.2 (1-5) years. After anticoagulation cessation, the weighted pooled rate of VTE recurrence was 6.3 (95% CI 5.4-7.3) per 100 patient-years and the weighted pooled rate of fatal recurrent VTE was 0.17 (95% CI 0.047-0.33) per 100 patient-years, for a case-fatality rate of 2.6% (95% CI 0.86-5.0). These numbers are a solid benchmark for comparison to the risks associated with long-term anticoagulation treatment for the decision on the optimal duration of treatment of patients with unprovoked VTE.

AB - Current guidelines recommend long-term anticoagulant therapy in patients with unprovoked venous thromboembolism (VTE). The risk of fatal recurrent VTE after treatment discontinuation (versus that of fatal bleeding during anticoagulation) is of particular relevance in the decision to continue or stop anticoagulation after the first 3 months. Our primary aim was to provide a point-estimate of the yearly rate of fatal recurrent VTE and VTE case-fatality rate in patients with unprovoked VTE after anticoagulation cessation. Data were extracted from both randomised controlled trials and observational studies published before May 1, 2017. The pooled fatality rates were calculated using a random-effects model. 18 studies with low-to-moderate bias were included in the primary analysis, totalling 6758 patients with a median (range) follow-up duration of 2.2 (1-5) years. After anticoagulation cessation, the weighted pooled rate of VTE recurrence was 6.3 (95% CI 5.4-7.3) per 100 patient-years and the weighted pooled rate of fatal recurrent VTE was 0.17 (95% CI 0.047-0.33) per 100 patient-years, for a case-fatality rate of 2.6% (95% CI 0.86-5.0). These numbers are a solid benchmark for comparison to the risks associated with long-term anticoagulation treatment for the decision on the optimal duration of treatment of patients with unprovoked VTE.

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U2 - 10.1183/16000617.0094-2018

DO - 10.1183/16000617.0094-2018

M3 - Review article

VL - 27

JO - European respiratory review : an official journal of the European Respiratory Society

JF - European respiratory review : an official journal of the European Respiratory Society

SN - 1600-0617

IS - 150

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