Risk of recurrent venous thromboembolism after discontinuation of vitamin K antagonist treatment: a nested case–control study
Essentials Vitamin K antagonists (VKA) in venous thromboembolism (VTE) lower the risk of recurrences. 41 841 VKA‐treated VTE patients had 1242 recurrent VTEs on therapy or early after cessation. An increased risk of recurrence was found in the first 120 days after VKA cessation. Patient education fo...
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| Veröffentlicht in: | Journal of thrombosis and haemostasis 2016-07, Vol.14 (7), p.1374-1383 |
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| container_title | Journal of thrombosis and haemostasis |
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| creator | Martinez, C. Katholing, A. Folkerts, K. Cohen, A. T. |
| description | Essentials
Vitamin K antagonists (VKA) in venous thromboembolism (VTE) lower the risk of recurrences.
41 841 VKA‐treated VTE patients had 1242 recurrent VTEs on therapy or early after cessation.
An increased risk of recurrence was found in the first 120 days after VKA cessation.
Patient education for the early detection of recurrent VTE after VKA cessation is recommended.
Summary
Background
The standard treatment for venous thromboembolism (VTE) and the prevention of recurrent VTE (rVTE) consists of anticoagulant therapy. The optimal duration of anticoagulation depends on the presence of risk factors for rVTE.
Objectives
To estimate the risk of rVTE in association with time since discontinuation of vitamin K antagonist (VKA) treatment.
Methods
From the UK Clinical Practice Research Datalink with linked information on hospitalization and cause of death, a cohort of patients with a first VTE receiving initial VKA treatment between 2001 and 2013 was formed. With a nested case–control approach, patients with incident rVTE (cases) were matched to patients with VTE but without rVTE (controls). Adjusted rate ratios (RRs) of rVTE associated with time since VKA discontinuation relative to current VKA use were estimated from conditional logistic regression.
Results
The VTE cohort comprised 41 841 patients with 1242 rVTEs and 6205 matched controls. The RR of rVTE was increased within 60 days following VKA discontinuation (RR 2.23, 95% confidence interval [CI] 1.71–2.91) and within 61–120 days following VKA discontinuation (RR 1.49, 95% CI 1.08–2.05) relative to current VKA use. The increased RR corresponded to excess incidence rates of 6.72 (95% CI 3.90–10.06) rVTE cases per 100 person‐years within 60 days, and of 2.68 (95% CI 0.42–5.58) rVTE cases per 100 person‐years within 61–120 days after VKA discontinuation.
Conclusions
VKA discontinuation results in a transient increased risk of rVTE, which peaks within 60 days and lasts for up to 120 days after VKA discontinuation. Specific patient education for increased vigilance for signs and symptoms of recurrences is recommended in this period. |
| doi_str_mv | 10.1111/jth.13337 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1805761212</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1805761212</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5947-40e3a864967059827dc824ad5dec6bd8fff0d7cee74296356d7be6d61f7ab4573</originalsourceid><addsrcrecordid>eNp1kctKxTAQhoMo3he-gATc6OJo0rRJ6k7EuyCIrkvaTDXHNtEkVc5K38E39EnM8agLwYEwWXzzMcOP0AYluzTV3jje71LGmJhDy7RgciQk4_M__5KxJbQSwpgQWhYZWURLmSCipDxfRq_XJjxg12IPzeA92Iifwboh4HjvXV87SK8zoceqjeCxNqFxNho7qGicnU4-m6h6Y_EFVjaqO2dNiDh6ULFPun2ssIUQQeNGBfh4e5_Oe9fhEAc9WUMLreoCrH_3VXR7fHRzeDq6vDo5Ozy4HDVFmYtRToApyfOSC1KUMhO6kVmudKGh4bWWbdsSLRoAkWclZwXXogauOW2FqvNCsFW0PfM-evc0pH2qPl0CXacspGsrKkkhOM1oltCtP-jYDd6m7aZUXhIpCU_UzoxqvAvBQ1s9etMrP6koqaapVCmV6iuVxG5-G4e6B_1L_sSQgL0Z8GI6mPxvqs5vTmfKT_aGmdc</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1804908806</pqid></control><display><type>article</type><title>Risk of recurrent venous thromboembolism after discontinuation of vitamin K antagonist treatment: a nested case–control study</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><creator>Martinez, C. ; Katholing, A. ; Folkerts, K. ; Cohen, A. T.</creator><creatorcontrib>Martinez, C. ; Katholing, A. ; Folkerts, K. ; Cohen, A. T.</creatorcontrib><description>Essentials
Vitamin K antagonists (VKA) in venous thromboembolism (VTE) lower the risk of recurrences.
41 841 VKA‐treated VTE patients had 1242 recurrent VTEs on therapy or early after cessation.
An increased risk of recurrence was found in the first 120 days after VKA cessation.
Patient education for the early detection of recurrent VTE after VKA cessation is recommended.
Summary
Background
The standard treatment for venous thromboembolism (VTE) and the prevention of recurrent VTE (rVTE) consists of anticoagulant therapy. The optimal duration of anticoagulation depends on the presence of risk factors for rVTE.
Objectives
To estimate the risk of rVTE in association with time since discontinuation of vitamin K antagonist (VKA) treatment.
Methods
From the UK Clinical Practice Research Datalink with linked information on hospitalization and cause of death, a cohort of patients with a first VTE receiving initial VKA treatment between 2001 and 2013 was formed. With a nested case–control approach, patients with incident rVTE (cases) were matched to patients with VTE but without rVTE (controls). Adjusted rate ratios (RRs) of rVTE associated with time since VKA discontinuation relative to current VKA use were estimated from conditional logistic regression.
Results
The VTE cohort comprised 41 841 patients with 1242 rVTEs and 6205 matched controls. The RR of rVTE was increased within 60 days following VKA discontinuation (RR 2.23, 95% confidence interval [CI] 1.71–2.91) and within 61–120 days following VKA discontinuation (RR 1.49, 95% CI 1.08–2.05) relative to current VKA use. The increased RR corresponded to excess incidence rates of 6.72 (95% CI 3.90–10.06) rVTE cases per 100 person‐years within 60 days, and of 2.68 (95% CI 0.42–5.58) rVTE cases per 100 person‐years within 61–120 days after VKA discontinuation.
Conclusions
VKA discontinuation results in a transient increased risk of rVTE, which peaks within 60 days and lasts for up to 120 days after VKA discontinuation. Specific patient education for increased vigilance for signs and symptoms of recurrences is recommended in this period.</description><identifier>ISSN: 1538-7933</identifier><identifier>ISSN: 1538-7836</identifier><identifier>EISSN: 1538-7836</identifier><identifier>DOI: 10.1111/jth.13337</identifier><identifier>PMID: 27079164</identifier><language>eng</language><publisher>England: Elsevier Limited</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; anticoagulants ; Anticoagulants - administration & dosage ; Blood Coagulation ; Body Mass Index ; Case-Control Studies ; Cohort Studies ; Female ; Fibrinolytic Agents - administration & dosage ; Health risk assessment ; Humans ; Incidence ; Male ; Middle Aged ; nested case–control studies ; Patient education ; Patient Education as Topic ; Recurrence ; Regression Analysis ; Risk Factors ; Thromboembolism ; United Kingdom ; venous thromboembolism ; Venous Thromboembolism - diagnosis ; Venous Thromboembolism - etiology ; Vitamin K - antagonists & inhibitors ; warfarin ; Young Adult</subject><ispartof>Journal of thrombosis and haemostasis, 2016-07, Vol.14 (7), p.1374-1383</ispartof><rights>2016 The Authors. published by Wiley Periodicals, Inc. on behalf of International Society on Thrombosis and Haemostasis.</rights><rights>2016 The Authors. Journal of Thrombosis and Haemostasis published by Wiley Periodicals, Inc. on behalf of International Society on Thrombosis and Haemostasis.</rights><rights>Copyright © 2016 International Society on Thrombosis and Haemostasis</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5947-40e3a864967059827dc824ad5dec6bd8fff0d7cee74296356d7be6d61f7ab4573</citedby><cites>FETCH-LOGICAL-c5947-40e3a864967059827dc824ad5dec6bd8fff0d7cee74296356d7be6d61f7ab4573</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,781,785,27929,27930</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27079164$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Martinez, C.</creatorcontrib><creatorcontrib>Katholing, A.</creatorcontrib><creatorcontrib>Folkerts, K.</creatorcontrib><creatorcontrib>Cohen, A. T.</creatorcontrib><title>Risk of recurrent venous thromboembolism after discontinuation of vitamin K antagonist treatment: a nested case–control study</title><title>Journal of thrombosis and haemostasis</title><addtitle>J Thromb Haemost</addtitle><description>Essentials
Vitamin K antagonists (VKA) in venous thromboembolism (VTE) lower the risk of recurrences.
41 841 VKA‐treated VTE patients had 1242 recurrent VTEs on therapy or early after cessation.
An increased risk of recurrence was found in the first 120 days after VKA cessation.
Patient education for the early detection of recurrent VTE after VKA cessation is recommended.
Summary
Background
The standard treatment for venous thromboembolism (VTE) and the prevention of recurrent VTE (rVTE) consists of anticoagulant therapy. The optimal duration of anticoagulation depends on the presence of risk factors for rVTE.
Objectives
To estimate the risk of rVTE in association with time since discontinuation of vitamin K antagonist (VKA) treatment.
Methods
From the UK Clinical Practice Research Datalink with linked information on hospitalization and cause of death, a cohort of patients with a first VTE receiving initial VKA treatment between 2001 and 2013 was formed. With a nested case–control approach, patients with incident rVTE (cases) were matched to patients with VTE but without rVTE (controls). Adjusted rate ratios (RRs) of rVTE associated with time since VKA discontinuation relative to current VKA use were estimated from conditional logistic regression.
Results
The VTE cohort comprised 41 841 patients with 1242 rVTEs and 6205 matched controls. The RR of rVTE was increased within 60 days following VKA discontinuation (RR 2.23, 95% confidence interval [CI] 1.71–2.91) and within 61–120 days following VKA discontinuation (RR 1.49, 95% CI 1.08–2.05) relative to current VKA use. The increased RR corresponded to excess incidence rates of 6.72 (95% CI 3.90–10.06) rVTE cases per 100 person‐years within 60 days, and of 2.68 (95% CI 0.42–5.58) rVTE cases per 100 person‐years within 61–120 days after VKA discontinuation.
Conclusions
VKA discontinuation results in a transient increased risk of rVTE, which peaks within 60 days and lasts for up to 120 days after VKA discontinuation. Specific patient education for increased vigilance for signs and symptoms of recurrences is recommended in this period.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>anticoagulants</subject><subject>Anticoagulants - administration & dosage</subject><subject>Blood Coagulation</subject><subject>Body Mass Index</subject><subject>Case-Control Studies</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Fibrinolytic Agents - administration & dosage</subject><subject>Health risk assessment</subject><subject>Humans</subject><subject>Incidence</subject><subject>Male</subject><subject>Middle Aged</subject><subject>nested case–control studies</subject><subject>Patient education</subject><subject>Patient Education as Topic</subject><subject>Recurrence</subject><subject>Regression Analysis</subject><subject>Risk Factors</subject><subject>Thromboembolism</subject><subject>United Kingdom</subject><subject>venous thromboembolism</subject><subject>Venous Thromboembolism - diagnosis</subject><subject>Venous Thromboembolism - etiology</subject><subject>Vitamin K - antagonists & inhibitors</subject><subject>warfarin</subject><subject>Young Adult</subject><issn>1538-7933</issn><issn>1538-7836</issn><issn>1538-7836</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><recordid>eNp1kctKxTAQhoMo3he-gATc6OJo0rRJ6k7EuyCIrkvaTDXHNtEkVc5K38E39EnM8agLwYEwWXzzMcOP0AYluzTV3jje71LGmJhDy7RgciQk4_M__5KxJbQSwpgQWhYZWURLmSCipDxfRq_XJjxg12IPzeA92Iifwboh4HjvXV87SK8zoceqjeCxNqFxNho7qGicnU4-m6h6Y_EFVjaqO2dNiDh6ULFPun2ssIUQQeNGBfh4e5_Oe9fhEAc9WUMLreoCrH_3VXR7fHRzeDq6vDo5Ozy4HDVFmYtRToApyfOSC1KUMhO6kVmudKGh4bWWbdsSLRoAkWclZwXXogauOW2FqvNCsFW0PfM-evc0pH2qPl0CXacspGsrKkkhOM1oltCtP-jYDd6m7aZUXhIpCU_UzoxqvAvBQ1s9etMrP6koqaapVCmV6iuVxG5-G4e6B_1L_sSQgL0Z8GI6mPxvqs5vTmfKT_aGmdc</recordid><startdate>201607</startdate><enddate>201607</enddate><creator>Martinez, C.</creator><creator>Katholing, A.</creator><creator>Folkerts, K.</creator><creator>Cohen, A. T.</creator><general>Elsevier Limited</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>201607</creationdate><title>Risk of recurrent venous thromboembolism after discontinuation of vitamin K antagonist treatment: a nested case–control study</title><author>Martinez, C. ; Katholing, A. ; Folkerts, K. ; Cohen, A. T.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5947-40e3a864967059827dc824ad5dec6bd8fff0d7cee74296356d7be6d61f7ab4573</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>anticoagulants</topic><topic>Anticoagulants - administration & dosage</topic><topic>Blood Coagulation</topic><topic>Body Mass Index</topic><topic>Case-Control Studies</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Fibrinolytic Agents - administration & dosage</topic><topic>Health risk assessment</topic><topic>Humans</topic><topic>Incidence</topic><topic>Male</topic><topic>Middle Aged</topic><topic>nested case–control studies</topic><topic>Patient education</topic><topic>Patient Education as Topic</topic><topic>Recurrence</topic><topic>Regression Analysis</topic><topic>Risk Factors</topic><topic>Thromboembolism</topic><topic>United Kingdom</topic><topic>venous thromboembolism</topic><topic>Venous Thromboembolism - diagnosis</topic><topic>Venous Thromboembolism - etiology</topic><topic>Vitamin K - antagonists & inhibitors</topic><topic>warfarin</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Martinez, C.</creatorcontrib><creatorcontrib>Katholing, A.</creatorcontrib><creatorcontrib>Folkerts, K.</creatorcontrib><creatorcontrib>Cohen, A. T.</creatorcontrib><collection>Wiley Online Library (Open Access Collection)</collection><collection>Wiley Online Library (Open Access Collection)</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of thrombosis and haemostasis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Martinez, C.</au><au>Katholing, A.</au><au>Folkerts, K.</au><au>Cohen, A. T.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk of recurrent venous thromboembolism after discontinuation of vitamin K antagonist treatment: a nested case–control study</atitle><jtitle>Journal of thrombosis and haemostasis</jtitle><addtitle>J Thromb Haemost</addtitle><date>2016-07</date><risdate>2016</risdate><volume>14</volume><issue>7</issue><spage>1374</spage><epage>1383</epage><pages>1374-1383</pages><issn>1538-7933</issn><issn>1538-7836</issn><eissn>1538-7836</eissn><abstract>Essentials
Vitamin K antagonists (VKA) in venous thromboembolism (VTE) lower the risk of recurrences.
41 841 VKA‐treated VTE patients had 1242 recurrent VTEs on therapy or early after cessation.
An increased risk of recurrence was found in the first 120 days after VKA cessation.
Patient education for the early detection of recurrent VTE after VKA cessation is recommended.
Summary
Background
The standard treatment for venous thromboembolism (VTE) and the prevention of recurrent VTE (rVTE) consists of anticoagulant therapy. The optimal duration of anticoagulation depends on the presence of risk factors for rVTE.
Objectives
To estimate the risk of rVTE in association with time since discontinuation of vitamin K antagonist (VKA) treatment.
Methods
From the UK Clinical Practice Research Datalink with linked information on hospitalization and cause of death, a cohort of patients with a first VTE receiving initial VKA treatment between 2001 and 2013 was formed. With a nested case–control approach, patients with incident rVTE (cases) were matched to patients with VTE but without rVTE (controls). Adjusted rate ratios (RRs) of rVTE associated with time since VKA discontinuation relative to current VKA use were estimated from conditional logistic regression.
Results
The VTE cohort comprised 41 841 patients with 1242 rVTEs and 6205 matched controls. The RR of rVTE was increased within 60 days following VKA discontinuation (RR 2.23, 95% confidence interval [CI] 1.71–2.91) and within 61–120 days following VKA discontinuation (RR 1.49, 95% CI 1.08–2.05) relative to current VKA use. The increased RR corresponded to excess incidence rates of 6.72 (95% CI 3.90–10.06) rVTE cases per 100 person‐years within 60 days, and of 2.68 (95% CI 0.42–5.58) rVTE cases per 100 person‐years within 61–120 days after VKA discontinuation.
Conclusions
VKA discontinuation results in a transient increased risk of rVTE, which peaks within 60 days and lasts for up to 120 days after VKA discontinuation. Specific patient education for increased vigilance for signs and symptoms of recurrences is recommended in this period.</abstract><cop>England</cop><pub>Elsevier Limited</pub><pmid>27079164</pmid><doi>10.1111/jth.13337</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Adolescent Adult Aged Aged, 80 and over anticoagulants Anticoagulants - administration & dosage Blood Coagulation Body Mass Index Case-Control Studies Cohort Studies Female Fibrinolytic Agents - administration & dosage Health risk assessment Humans Incidence Male Middle Aged nested case–control studies Patient education Patient Education as Topic Recurrence Regression Analysis Risk Factors Thromboembolism United Kingdom venous thromboembolism Venous Thromboembolism - diagnosis Venous Thromboembolism - etiology Vitamin K - antagonists & inhibitors warfarin Young Adult |
| title | Risk of recurrent venous thromboembolism after discontinuation of vitamin K antagonist treatment: a nested case–control study |
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