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Family history, thrombophilia may predict VTE recurrence
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Family history of venous thromboembolism may predict recurrence among individuals who had an unprovoked first venous thromboembolism, according to study results.
Family history of VTE also may be a risk factor for recurrence in those with thrombophilia, results showed.
Several studies have shown that family history is a predictor of first VTE. Kristina Sundquist, MD, PhD, professor of family medicine at Lund University, and colleagues conducted a prospective follow-up study to determine its role in recurrent VTE.
Researchers analyzed data from 1,465 consecutive unselected patients with VTE from the Malmö Thrombophilia Study. Investigators followed study participants from warfarin discontinuation until diagnosis of recurrence or to the end of the study period.
“This is the first prospective study in which the role of family history of VTE as a predictor of VTE recurrence in any type of VTE and taking thrombophilia status into account has been investigated,” Sundquist and colleagues wrote.
The final analysis included 1,044 participants with prior VTE.
Mean follow-up was 3.9 years (maximum, 9.8 years). During this time, 127 (12.2%) study participants experienced VTE recurrence.
Multivariate Cox regression analysis showed family history appeared associated with a higher risk for VTE recurrence among all study participants with prior VTE (HR = 1.4, 95% CI, 0.99-2.1), as well as among a subgroup of 610 participants who experienced unprovoked first VTE (HR = 1.9, 95% CI, 1.2-2.9), compared with those who had no family history.
When researchers stratified outcomes in the first unprovoked VTE group by sex, results showed family history appeared strongly associated with a higher risk for VTE recurrence in women (HR = 3.1, 95% CI, 1.6-5.8) but not men (HR = 1.1; 95% CI, 0.6-2.2).
When researchers stratified data from those with first unprovoked VTE based on thrombophilia status, results showed those with family history of VTE and thrombophilia demonstrated a greater risk for recurrence (HR = 3.2; 95% CI, 1.8-5.9) than those with thrombophilia alone (HR = 1.8; 95% CI, 1.02-3.1), independent of deep vein thrombosis location and duration of warfarin treatment.
Researchers acknowledged their study may have been limited because participants’ self-reported family history was not confirmed by medical records, and because those who experienced a severe thromboembolic event may have been more likely to remember a family history of VTE.
“These results support that there are additional inherited factors which need to be identified for a better and potentially more comprehensive prediction of VTE recurrence, together with already identified inherited thrombophilias,” Sundquist and colleagues wrote. – by Kristie L. Kahl
Reference:
Sundquist K, et al. J Thromb Haemost. 2015;doi:10.1111/jth.13154.
Disclosure: The researchers report no relevant financial disclosures.