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CC BY 4.0 · TH Open 2022; 06(04): e378-e386
DOI: 10.1055/a-1949-9404
Original Article

Risk of Recurrent Venous Thromboembolism in Selected Subgroups of Men: A Danish Nationwide Cohort Study

Ida Ehlers Albertsen 
1   Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
2   Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
,
Stavros V. Konstantinides 
3   Center for Thrombosis and Hemostasis, Johannes Gutenberg University, Mainz, Germany
4   Department of Cardiology, Democritus University of Thrace, Greece
,
Gregory Piazza
5   Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Samuel Z. Goldhaber
5   Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Torben Bjerregaard Larsen 
1   Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
2   Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
,
Mette Søgaard 
1   Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
2   Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
,
Peter Brønnum Nielsen 
1   Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
2   Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
› Author Affiliations Funding The Obel Family Foundation partly funded this research by an unrestricted grant. The sponsor had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; in the writing of the report; and in the decision to submit the paper for publication.
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Abstract

Background Although men are considered at high risk for recurrent venous thromboembolism (VTE), sex-specific data on prognostic factors are lacking. We estimated the cumulative recurrence risks associated with clinical characteristics and comorbidities known or suspected to be associated with the development of VTE recurrence: major surgery, trauma, history of cancer, rheumatic disorder, ischemic heart disease, congestive heart failure, chronic obstructive pulmonary disease, diabetes, chronic renal disease, varicose veins, alcohol-related diseases, and arterial hypertension.

Methods We linked nationwide Danish health registries to identify all incident VTE in- and outpatients in men from 2008 through 2018. Recurrent VTE risk 2 years after anticoagulant discontinuation was calculated using the Aalen-Johansen estimator, stratified by age above/below 50 years.

Results The study included 13,932 men with VTE, of whom 21% (n = 2,898) were aged <50 years. For men aged <50 years with at least one of the clinical characteristics, 2-year recurrence risk ranged from 6% (major surgery) to 16% (history of cancer). For men ≥50 years with at least one of the characteristics, recurrence risk ranged from 7% (major surgery) to 12% (ischemic heart disease, chronic obstructive pulmonary disease, and chronic renal disease). Men aged <50 and ≥50 years without the clinical characteristics all had a recurrence risk of 10%.

Discussion We demonstrated a 2-year recurrence risk of at least 6%, regardless of age category and disease status, in this nationwide cohort of men with VTE. The recurrence risk must be balanced against bleeding risk. However, the high recurrence risk across all subgroups might ultimately lead to greater emphasis on male sex in future guidelines focusing on optimized secondary VTE prevention.

Keywords

venous thromboembolism - recurrence - sex - men - anticoagulation - treatment

Authors' Contribution

I.E.A., S.V.K., T.B.L., M.S., P.B.N., G.P., and S.Z.G. contributed to the conception and design of the study. P.B.N. acquired and handled the data prior to statistical analysis. P.B.N. and I.E.A. performed the statistical analysis. I.E.A., P.B.N., M.S., and T.B.L. created the initial draft version of this manuscript. All authors participated in the writing and review of the article and accept full responsibility.


Supplementary Material



Publication History

Received: 03 January 2022

Accepted: 19 September 2022

Accepted Manuscript online:
23 September 2022

Article published online:
18 November 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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