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Study and Editorial Address Three-Fold Greater Recurrence of DVT in Men
Jennifer Huizar, Pharm.D. Student, The University of Texas
September 2004
Review: Kyrle, PA, Minar, E, Bialonczyk, C, Hirschl, M, Weltermann, A, Eichinger, S. The Risk of Recurrent Venous Thromboembolism in Men and Women. N Engl J Med 2004; 350: 2558-2563.
Venous thromboembolism has a recurrence rate of 5 to 10 percent per year. In addition, patients with unprovoked venous thromboembolism are far more likely to recur after secondary anticoagulant treatment is stopped. Currently, it is uncertain what role gender plays in the risk associated with recurrent venous thromboembolism, and it has not been addressed in other studies.
This study assessed the association of patient gender with the risk of recurrence in 826 patients with a first episode of spontaneous venous thromboembolism. Patients were enrolled after the discontinuation of oral anticoagulants and followed for a mean of 36 months. Investigators excluded patients with major risk factors for recurrence. Venous thromboembolism recurred in 74 of the 373 men, as compared with 28 of the 453 women (20% vs. 6%). Their results found the risk of recurrence to be higher among men than women, suggesting gender may be a major determinant of recurrent thrombosis after an initial episode of spontaneous venous thromboembolism.
Review: Elliott, CG, Rubin, LJ. Mars or Venus - Is Sex a Risk Factor for Recurrent Venous Thromboembolism? N Engl J Med 2004; 350: 2614-2615.
This editorial suggested that the findings of Kyrle et al (that the risk of recurrent venous thromboembolism is higher among men than women) are not conclusive. Potential weaknesses were pointed out. For example, the men in this study were older than the women at the time of the index episode of VTE. This age issue may have increased the risk of recurrence in men in the study because the risk of VTE increases exponentially with increasing age. In addition, the investigators did not provide data with respect to the use of oral contraceptives or estrogens for hormone replacement after the index episode of VTE. The discontinuation of these medications may have lowered the risk of recurrent thromboembolism in some of the women. It is agreed upon by both the investigators and this editorial that additional confirmation of these findings is required before they can be translated into clinical practice. However, this finding does provide a new focus for future studies.
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