Risk factors associated with recurrent venous thromboembolism after a first cerebral venous thrombosis event: A cohort study. Issue 178 (June 2019)

• Record Type: Journal Article
• Authors: Pires, Giselli S.; Ribeiro, Daniel D.; Oliveira, João A.Q.; Freitas, Luís C.; Vaez, Rodrigo; Annichino-Bizzacchi, Joyce M.; Morelli, Vânia M.; Rezende, Suely M.
• Is Part Of: Thrombosis research. Issue 178(2019)
• Page Start: 85
• Page End: 90
• Publication Date: 2019-06
• Subjects: Cerebral venous thrombosis -- Recurrence -- Risk factor -- Venous thromboembolism -- Epidemiology; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2019.04.008
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Background: Cerebral venous thrombosis (CVT), although rare, is potentially fatal. Few studies have investigated risk factors associated with recurrent venous thromboembolism (VTE) after a first CVT event of which most are from Caucasian populations. The aim of this study was to evaluate risk factors associated with recurrent VTE after a first CVT event in a South American-population. Patients/methods: In this cohort, multicenter study, patients aged >18 years and objectively-diagnosed with CVT were included, with follow-up starting after discontinuing anticoagulant therapy. The primary outcome was symptomatic VTE recurrence at any venous site. Results: We included 203 patients with a median age of 30.8 (interquartile range [IQR], 24.7–40.9) years and a follow-up of 3.0 (IQR, 1.2–5.6) years. Most patients (86.2%) were women, and among those of reproductive age (n = 162), 65.4% developed CVT during oral contraceptive use, and 9.2% during pregnancy/puerperium. Thirteen patients (6.9%) developed VTE recurrence after a first CVT, yielding an overall rate of 1.6/100 patient-years (95% confidence interval [CI], 0.8–2.8). Recurrence rate was higher in males (4.6/100 patient-years; 95% CI, 1.2–11.7) than in females (1.2/100 patient-years; 95% CI, 0.6–2.4), and in patients with factor V Leiden mutation (9.2/100 patient-years; 95% CI, 1.1–33.1) than in those without it (1.2/100 patient-years; 95% CI, 0.5–2.4). Conclusions: VTE recurrence after a first CVT was low. In spite of the limitation of small sample size, male sex and factor V Leiden mutation were the only factors associated with a significant higher risk of recurrent VTE after a first CVT in a multivariate analysis. Highlights: Cerebral venous thrombosis (CVT) is a rare presentation of venous thromboembolism (VTE). VTE recurrence after CVT has rarely been studied in admixed populations. A total of 13/189 (6.9%) patients developed VTE recurrence after a first CVT. Recurrence rate was higher in males and in patients with factor V Leiden mutation.