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Thromb Haemost
DOI: 10.1055/a-2535-7321
Stroke, Systemic, or Venous Thromboembolism

Relationship between Surgery and Trauma and Risk of Recurrence in Patients with an Associated First Venous Thrombotic Event: A Nested Case-Control Study

T. Gregorio
1   Internal Medicine Department, Unidade Local de Saúde de Gaia e Espinho-V. N. Gaia, Portugal
2   Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
,
K. J. Creeper
3   Haematology Department, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
4   Haematology Department, PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
,
L. Pagliani
5   Department of Cardiology, Veneto Institute of Oncology I.O.V.–IRCCS Padua, Italy
,
R. Providencia
6   Institute of Health Economics, University College of London, London, United Kingdom
,
A. Buzea
7   Clinical Hospital Colentina, Bucareste, Romania
,
C. Wallenhorst 
8   Institute for Epidemiology, Statistics and Informatics GmbH, Frankfurt, Germany
,
J. I. Weitz
9   Department of Medicine, McMaster University, Hamilton, Canada
10   Thrombosis and Atherosclerosis Research Institute, Hamilton, Canada
,
A. T. Cohen
11   Thrombosis and Haemostasis Department, Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom
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Abstract

Background

The duration of anticoagulation treatment for venous thromboembolism (VTE) depends on whether the event was provoked or unprovoked. Major surgery or trauma are well-established major provoking factors associated with a low risk of recurrence, but the magnitude of risk with VTE after minor surgery or trauma is uncertain.

Objective

To compare the rate of recurrence in patients with VTE provoked by minor surgery or trauma with that in patients with VTE provoked by major surgery or trauma.

Patients/Methods

Nested, case-control study of patients with a first VTE diagnosed within 90 days after major or minor surgery or trauma. Patients with unprovoked VTE or VTE provoked by cancer or nonsurgical risk factors were excluded. Crude and adjusted odds ratios with 95% confidence intervals (CI) were calculated and results were adjusted for potential confounders.

Results

A total of 319 patients with recurrent VTE (cases) were matched to 974 patients without recurrence (controls). The incidence of recurrence after VTE provoked by minor surgery (6.5%; 95% CI: 5.6–7.6) was more than double that after VTE provoked by major surgery (3.0%; 95% CI: 2.4–3.6), a difference that remained even after adjustment for known VTE risk factors. There were no differences in recurrence rates between VTE provoked by minor and major trauma.

Conclusion

The risk of recurrence is higher in patients with VTE provoked by minor surgery than major surgery. These findings support the concept that the risk of recurrence is higher with minimally provoked VTE than with VTE provoked by major transient risk factors.

Keywords

trauma - surgery - venous thromboembolism - recurrence

Authors' Contribution

A.T.C. initiated the study and all authors contributed to the conception and design of the study. C.W. and A.T.C. performed data acquisition and statistical analysis. T.G. and K.J.C. drafted the article, which was critically revised by J.I.W. and A.T.C. All authors contributed to the interpretation of results, reading and approving the final version of the manuscript.




Publikationsverlauf

Eingereicht: 22. Oktober 2024

Angenommen: 07. Februar 2025

Artikel online veröffentlicht:
05. März 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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