FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 350:2558-2563 June 17, 2004 Number 25 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Elliott, C. G. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Whether a patient's sex is associated with the risk of recurrent venous thromboembolism is unknown.

Methods We studied 826 patients for an average of 36 months after a first episode of spontaneous venous thromboembolism and the withdrawal of oral anticoagulants. We excluded pregnant patients and patients with a deficiency of antithrombin, protein C, or protein S; the lupus anticoagulant; cancer; or a requirement for potentially long-term antithrombotic treatment. The end point was objective evidence of a recurrence of symptomatic venous thromboembolism.

Results Venous thromboembolism recurred in 74 of the 373 men, as compared with 28 of the 453 women (20 percent vs. 6 percent; relative risk of recurrence, 3.6; 95 percent confidence interval, 2.3 to 5.5; P<0.001). The risk remained unchanged after adjustment for age, the duration of anticoagulation, and the presence or absence of a first symptomatic pulmonary embolism, factor V Leiden, factor II G20210A, or an elevated level of factor VIII or IX. At five years, the likelihood of recurrence was 30.7 percent among men, as compared with 8.5 percent among women (P<0.001). The relative risk of recurrence was similar among women who had had their first thrombosis during oral-contraceptive use or hormone-replacement therapy and women in the same age group in whom the first event was idiopathic.

Conclusions The risk of recurrent venous thromboembolism is higher among men than women.

Source Information

From the Department of Internal Medicine I, Division of Hematology and Hemostasis (P.A.K., A.W., S.E.), Ludwig Boltzmann-Institut für Thromboseforschung (P.A.K.), and the Department of Internal Medicine II, Division of Angiology, Medical University of Vienna (E.M.); Wilhelminenspital (C.B.); and Hanusch Krankenhaus (M.H.) — all in Vienna.

Address reprint requests to Dr. Kyrle at the Department of Internal Medicine I, Division of Hematology and Hemostasis, Währinger Gürtel 18-20, A 1090 Vienna, Austria, or at paul.kyrle{at}meduniwien.ac.at.

Full Text of this Article

Related Letters:

Recurrent Venous Thromboembolism in Men and Women
Agnelli G., Becattini C., Prandoni P., Nieto J. A., Monreal M., the RIETE Investigators , Kahn S. R., Boari B., Salmi R., Manfredini R., Morita H., Nagai R., Ross D. J., Kyrle P. A., Eichinger S., Weltermann A.
Extract | Full Text | PDF  
N Engl J Med 2004; 351:2015-2018, Nov 4, 2004. Correspondence

This article has been cited by other articles:

• Lijfering, W. M., Veeger, N. J. G. M., Middeldorp, S., Hamulyak, K., Prins, M. H., Buller, H. R., van der Meer, J. (2009). A lower risk of recurrent venous thrombosis in women compared with men is explained by sex-specific risk factors at time of first venous thrombosis in thrombophilic families. Blood 114: 2031-2036 [Abstract] [Full Text]  
• Segal, J. B., Brotman, D. J., Necochea, A. J., Emadi, A., Samal, L., Wilson, L. M., Crim, M. T., Bass, E. B. (2009). Predictive Value of Factor V Leiden and Prothrombin G20210A in Adults With Venous Thromboembolism and in Family Members of Those With a Mutation: A Systematic Review. JAMA 301: 2472-2485 [Abstract] [Full Text]  
• Haspel, J., Bauer, K., Goehler, A., Roberts, D. H. (2009). Long-term Anticoagulant Therapy for Idiopathic Pulmonary Embolism in the Elderly: A Decision Analysis. Chest 135: 1243-1251 [Abstract] [Full Text]  
• (2009). Preventing recurrent venous thromboembolism. DTB 47: 38-40 [Abstract] [Full Text]  
• Zhu, T., Martinez, I., Emmerich, J. (2009). Venous Thromboembolism: Risk Factors for Recurrence. Arterioscler. Thromb. Vasc. Bio. 29: 298-310 [Abstract] [Full Text]  
• Bailey, A. L., Scantlebury, D. C., Smyth, S. S. (2009). Thrombosis and Antithrombotic Therapy in Women. Arterioscler. Thromb. Vasc. Bio. 29: 284-288 [Abstract] [Full Text]  
• Schellong, S. M., Bounameaux, H., Büller, H. R. (2009). CHAPTER 37 Venous Thromboembolism. ESC Textbook of Cardiovascular Medicine 2: med-9780199566990-chapter-med-9780199566990-chapter [Abstract] [Full Text]  
• Eichinger, S., Hron, G., Kollars, M., Kyrle, P. A. (2008). Prediction of Recurrent Venous Thromboembolism by Endogenous Thrombin Potential and D-Dimer. Clin. Chem. 54: 2042-2048 [Abstract] [Full Text]  
• Verhovsek, M., Douketis, J. D., Yi, Q., Shrivastava, S., Tait, R. C., Baglin, T., Poli, D., Lim, W. (2008). Systematic Review: D-Dimer to Predict Recurrent Disease after Stopping Anticoagulant Therapy for Unprovoked Venous Thromboembolism. ANN INTERN MED 149: 481-490 [Abstract] [Full Text]  
• Flinterman, L.E., van Hylckama Vlieg, A., Rosendaal, F.R., Doggen, C.J.M. (2008). Recurrent Thrombosis and Survival After a First Venous Thrombosis of the Upper Extremity. Circulation 118: 1366-1372 [Abstract] [Full Text]  
• Eichinger, S., Hron, G., Bialonczyk, C., Hirschl, M., Minar, E., Wagner, O., Heinze, G., Kyrle, P. A. (2008). Overweight, Obesity, and the Risk of Recurrent Venous Thromboembolism. Arch Intern Med 168: 1678-1683 [Abstract] [Full Text]  
• Rathbun, S. (2008). Venous thromboembolism in women. Vasc Med 13: 255-266 [Abstract]  
• Bounameaux, H., Perrier, A. (2008). Duration of Anticoagulation Therapy for Venous Thromboembolism. ASH Education Book 2008: 252-258 [Abstract] [Full Text]  
• Laczkovics, C., Grafenhofer, H., Kaider, A., Quehenberger, P., Simanek, R., Mannhalter, C., Lechner, K., Pabinger, I. (2007). Risk of recurrence after a first venous thromboembolic event in young women. haematol 92: 1201-1207 [Abstract] [Full Text]  
• Hron, G., Lombardi, R., Eichinger, S., Lecchi, A., Kyrle, P. A., Cattaneo, M. (2007). Low vitamin B6 levels and the risk of recurrent venous thromboembolism. haematol 92: 1250-1253 [Abstract] [Full Text]  
• Eichinger, S., Pecheniuk, N. M., Hron, G., Deguchi, H., Schemper, M., Kyrle, P. A., Griffin, J. H. (2007). High-Density Lipoprotein and the Risk of Recurrent Venous Thromboembolism. Circulation 115: 1609-1614 [Abstract] [Full Text]  
• Prandoni, P., Noventa, F., Ghirarduzzi, A., Pengo, V., Bernardi, E., Pesavento, R., Iotti, M., Tormene, D., Simioni, P., Pagnan, A. (2007). The risk of recurrent venous thromboembolism after discontinuing anticoagulation in patients with acute proximal deep vein thrombosis or pulmonary embolism. A prospective cohort study in 1,626 patients. haematol 92: 199-205 [Abstract] [Full Text]  
• Zhan, H., Zheng, H. (2007). Fixed-Dose Unfractionated Heparin vs Low-Molecular-Weight Heparin for Venous Thromboembolism. JAMA 297: 261-262 [Full Text]  
• Merriman, L, Greaves, M (2006). Testing for thrombophilia: an evidence-based approach. Postgrad. Med. J. 82: 699-704 [Abstract] [Full Text]  
• Jilma, B., Kovar, F. M., Hron, G., Endler, G., Marsik, C. L., Eichinger, S., Kyrle, P. A. (2006). Homozygosity in the Single Nucleotide Polymorphism Ser128Arg in the E-Selectin Gene Associated With Recurrent Venous Thromboembolism.. Arch Intern Med 166: 1655-1659 [Abstract] [Full Text]  
• Hron, G., Kollars, M., Binder, B. R., Eichinger, S., Kyrle, P. A. (2006). Identification of patients at low risk for recurrent venous thromboembolism by measuring thrombin generation.. JAMA 296: 397-402 [Abstract] [Full Text]  
• Ho, W. K., Hankey, G. J., Quinlan, D. J., Eikelboom, J. W. (2006). Risk of recurrent venous thromboembolism in patients with common thrombophilia: a systematic review.. Arch Intern Med 166: 729-736 [Abstract] [Full Text]  
• Chew, H. K., Wun, T., Harvey, D., Zhou, H., White, R. H. (2006). Incidence of venous thromboembolism and its effect on survival among patients with common cancers.. Arch Intern Med 166: 458-464 [Abstract] [Full Text]  
• Vossen, C. Y., Walker, I. D., Svensson, P., Souto, J. C., Scharrer, I., Preston, F. E., Palareti, G., Pabinger, I., van der Meer, F. J.M., Makris, M., Fontcuberta, J., Conard, J., Rosendaal, F. R. (2005). Recurrence Rate After a First Venous Thrombosis in Patients With Familial Thrombophilia. Arterioscler. Thromb. Vasc. Bio. 25: 1992-1997 [Abstract] [Full Text]  
• Deguchi, H., Pecheniuk, N. M., Elias, D. J., Averell, P. M., Griffin, J. H. (2005). High-Density Lipoprotein Deficiency and Dyslipoproteinemia Associated With Venous Thrombosis in Men. Circulation 112: 893-899 [Abstract] [Full Text]  
• Christiansen, S. C., Cannegieter, S. C., Koster, T., Vandenbroucke, J. P., Rosendaal, F. R. (2005). Thrombophilia, Clinical Factors, and Recurrent Venous Thrombotic Events. JAMA 293: 2352-2361 [Abstract] [Full Text]  
• Cushman, M. (2005). Inherited Risk Factors for Venous Thrombosis. ASH Education Book 2005: 452-457 [Abstract] [Full Text]  
• Agnelli, G., Becattini, C., Prandoni, P., Nieto, J. A., Monreal, M., the RIETE Investigators, , Kahn, S. R., Boari, B., Salmi, R., Manfredini, R., Morita, H., Nagai, R., Ross, D. J., Kyrle, P. A., Eichinger, S., Weltermann, A. (2004). Recurrent Venous Thromboembolism in Men and Women. NEJM 351: 2015-2018 [Full Text]  
• White, R. H (2004). Men had greater risk of recurrent venous thromboembolism than women. Evid. Based Med. 9: 187-187 [Full Text]  
• (2004). 23 Apr 2004 to 23 Jul 2004. Evid. Based Nurs. 7: e4-e4 [Full Text]  
• (2004). Risk for VTE Recurrence: Does Patient Sex Matter?. Journal Watch Cardiology 2004: 3-3 [Full Text]  
• Bates, S. M., Ginsberg, J. S. (2004). Treatment of Deep-Vein Thrombosis. NEJM 351: 268-277 [Full Text]  
• (2004). Male Sex -- Risk Factor for Recurrent Venous Thromboembolism?. JWatch General 2004: 3-3 [Full Text]  
• Elliott, C. G., Rubin, L. J. (2004). Mars or Venus -- Is Sex a Risk Factor for Recurrent Venous Thromboembolism?. NEJM 350: 2614-2616 [Full Text]  
• Lopez, J. A., Kearon, C., Lee, A. Y.Y. (2004). Deep Venous Thrombosis. ASH Education Book 2004: 439-456 [Abstract] [Full Text]