Men and women may have different VTE risks

Douketis J. BMJ. 2011;342:d813.

Issue: April 25, 2011

In a cohort of patients with a first unprovoked venous thromboembolism, men were more than twice as likely as women to experience recurrence, according to study results.

Researchers from several sites in Europe and North America attempted to define the role of sex on the risk for recurrent VTE in all patients and in patients with VTE that was unprovoked or provoked (by non-hormonal factors).

There were 2,554 patients with a first VTE involved in the analysis.

At the 1-year mark, the incidence rate of recurrent VTE was 5.3% (95% CI, 4.1-6.7) among women and 9.5% (95% CI, 7.9-11.4) among men. At 3 years, the recurrence rate was 9.1% (95% CI, 7.3-11.3) in women and 19.7% (95% CI, 16.5-23.4) in men.

In the unprovoked cohort, men were more likely to experience recurrence than women (HR=2.2; 95% CI, 1.7-2.8). In an analysis adjusting for women with hormone-associated VTE, men remained more likely to have recurring disease than women (HR=1.8; 95% CI, 1.4-2.5).

After exposure to a major risk factor, men and women in the provoked cohort had similar recurrence rates (HR=1.2; 95% CI, 0.6-2.4). Women with hormone-associated disease but no other risk factors were less likely to experience recurrence than women with unprovoked disease and no previous hormone use (HR=0.5; 95% CI, 0.3-0.8).

Besides data from electronic databases — including Medline, Embase, Cinahl and Cochrane — conference abstracts were reviewed, and content experts provided further information. Research was conducted through July 2010. The initial results from patient-level databases were transferred to a central database for analysis.

Seven prospective studies that evaluated the link between D-dimer and disease recurrence in patients with VTE were included. Measurements of D-dimer were taken after anticoagulation was stopped.

The mean follow-up duration was 27.1 months, with a standard deviation of 19.6 months.

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