The incidence of early recurrent venous thromboembolism : a systematic review and meta-analysis

Eischer, Lisbeth (author), Eichinger, Sabine (author), Kyrle, Paul A. (author), Kaider, Alexandra (author), Schmidt, Anton (author), Wildner, Brigitte (author), Boc, Anja (author)

Background: Patients with venous thromboembolism (VTE) receive anticoagulation for at least 3 months. To evaluate recurrence risk thereafter, some strategies include D-dimer testing after discontinuing anticoagulation, which raises concern about early recurrence. Objectives: To assess the incidence of recurrent VTE within 30 days after stopping anticoagulation. Methods: We conducted a systematic review of EMBASE, CENTRAL, and MEDLINE to identify controlled trials and cohort studies of adult noncancer patients with deep vein thrombosis of the leg and/or pulmonary embolism treated with anticoagulants for ≥3 months. The primary outcome was symptomatic VTE within 30 days. The risk of bias was assessed using a modified version of the Newcastle-Ottawa Scale. Pooled recurrence rates were calculated using fixed random-effects meta-analyses. Results: Of 42 studies, 24 (57%) provided data, encompassing 11,407 patients. Early recurrence occurred in 115 patients (1.01%), with a pooled incidence of 1.04% (95% CI, 0.8%-1.4%). Men had a risk similar to that of women (risk ratio, 1.2; 95% CI, 0.6-2.3; P = .7). Unprovoked VTE was associated with a 2.6-fold increase in risk (95% CI, 1.4-4.6; P < .001) compared with provoked VTE. Patients with deep vein thrombosis at presentation had a similar risk of recurrence compared with those with an incident pulmonary embolism (risk ratio, 0.6; 95% CI: 0.3-1.2; P = .1). Findings regarding age were inconsistent. None of the recurrences was fatal. The overall risk of bias was low. Conclusion: The incidence of early VTE recurrence after stopping anticoagulation is low. Temporarily discontinuing therapy to assess recurrence risk, therefore, appears safe and may aid in guiding treatment duration.

• Language: English
• Keywords: anticoagulation, early recurrence, incidence, meta-analysis, venous thromboembolism
• Work type: Article
• Typology: 1.01 - Original Scientific Article
• Organization: MF - Faculty of Medicine
• Publication status: Published
• Publication version: Version of Record
• Year: 2026
• Number of pages: 9 str.
• Numbering: Vol. 9, iss. 1, art. 103317
• PID: 20.500.12556/RUL-181336
• UDC: 616.1
• ISSN on article: 2475-0379
• DOI: 10.1016/j.rpth.2025.103317
• COBISS.SI-ID: 273221123
• Publication date in RUL: 02.04.2026

Record is a part of a journal

• Title: Research and Practice in Thrombosis and Haemostasis
• Publisher: Elsevier
• ISSN: 2475-0379
• COBISS.SI-ID: 4091820

Licences

• License: CC BY 4.0, Creative Commons Attribution 4.0 International
• Link: http://creativecommons.org/licenses/by/4.0/
• Description: This is the standard Creative Commons license that gives others maximum freedom to do what they want with the work as long as they credit the author.

Secondary language

• Language: Slovenian
• Keywords: antikoagulacija, zgodnja ponovitev, incidenca, meta-analiza, venska trombembolija

Projects

• Funder: Austria, Medical University of Vienna