The incidence of recurrent venous thromboembolism after treatment with vitamin K antagonists in relation to time since first event - A meta-analysis

Carlo J. J. van Dongen, Roel Vink, Barbara A. Hutten, Harry R. Büller, Martin H. Prins

Research output: Contribution to journalReview articleAcademicpeer-review

93 Citations (Scopus)

Abstract

Background: After a first episode of venous thromboembolism, patients are treated with vitamin K (phytonadione) antagonists. There are indications that the risk of recurrence after treatment with vitamin K antagonists decreases relative to the time since the first event. The aim of the present meta-analysis is to describe the risk of recurrent venous thromboembolism after treatment with vitamin K antagonist in relation to the time since the index event. Methods: Computerized searches in MEDLINE and EMBASE databases; reference checks of pertinent articles; personal communication with colleagues to find randomized clinical trials and cohort studies in which patients with venous thromboembolism were treated with vitamin K antagonists. Per treatment arm, 2 reviewers independently extracted data on the number of recurrent events and the duration of follow-up per time period of 3 months. Results: A total of 135 potentially eligible studies were identified. Of these, 18 studies could be included, comprising 25 treatment arms that could be analyzed. Treatment arms were divided into 3 groups based on treatment duration (short, medium, and long). For all 3 groups, the monthly incidence immediately after discontinuation of treatment was high and declined rapidly thereafter. The monthly incidence after 9 months seemed independent of the treatment duration. Conclusions: There is a diminishing risk of recurrent venous thromboembolism over time and a stabilization after 9 months independent of the duration of the initial treatment with vitamin K antagonists. These findings have important implications for decision making about the optimal duration of treatment with vitamin K antagonists
Original languageEnglish
Pages (from-to)1285-1293
JournalArchives of Internal Medicine
Volume163
Issue number11
DOIs
Publication statusPublished - 2003

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