Risk of recurrence after venous thromboembolism in men and women: patient level meta-analysis

作者：James D. Douketis, Alberto Tosetto, Maura Marcucci, Trevor P Baglin, Benilde Cosmi, Mary Cushman, Paul Alexander Kyrle, Daniela Poli, Robert Campbell Tait, Alfonso Iorio · 发表于：BMJ · 年份：2011 · DOI：10.1136/bmj.d813 · 被引用次数：279 · 研究领域：Venous Thromboembolism Diagnosis and Management、Blood Coagulation and Thrombosis Mechanisms、Cerebral Venous Sinus Thrombosis

OBJECTIVE: To determine the effect of sex on the risk of recurrent venous thromboembolism in all patients and in patients with venous thromboembolism that was unprovoked or provoked (by non-hormonal factors). Data source Comprehensive search of electronic databases (Medline, Embase, CINAHL, Cochrane Central Register of Controlled Trials) until July 2010, supplemented by review of conference abstracts and contact with content experts. STUDY SELECTION: Seven prospective studies investigating an association between D-dimer, measured after anticoagulation was stopped, and disease recurrence in patients with venous thromboembolism. DATA EXTRACTION: Patient level databases were obtained, transferred to a central database, checked, and completed with further information provided by authors. DATA SYNTHESIS: 2554 patients with a first venous thromboembolism had follow-up for a mean of 27.1 (SD 19.6) months. The one year incidence of recurrent venous thromboembolism was 5.3% (95% confidence interval 4.1% to 6.7%) in women and 9.5% (7.9% to 11.4%) in men, and the three year incidence of recurrence was 9.1% (7.3% to 11.3%) in women and 19.7% (16.5% to 23.4%) in men. Among patients with unprovoked venous thromboembolism, men had a higher risk of recurrence than did women (hazard ratio 2.2, 95% confidence interval 1.7 to 2.8). After adjustment for women with hormone associated initial venous thromboembolism, the risk of recurrence remained higher in men (hazard ratio 1.8, 1.4 to 2.5). In p...