The incidence of early recurrent venous thromboembolism: a systematic review and meta-analysis
Abstract
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.
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BibTeX
@article{eischer2026incidence,
title = {{The incidence of early recurrent venous thromboembolism: a systematic review and meta-analysis}},
author = {Lisbeth Eischer and Paul A Kyrle and Alexandra Kaider and Anton Schmidt and Brigitte Wildner and Anja Boc and Charlotte Bradbury and Anetta Undas and Francis Couturaud and Matteo Nicola Dario Di Minno and Geert-Jan Geersing and David Jimenez and Sameer Parpia and Gualtiero Palareti and Daniela Poli and Daniel P Potaczek and Paolo Prandoni and Sam Schulman and Astrid van Hylckama Vlieg and Michal Zabczyk and Sabine Eichinger},
journal = {Research and Practice in Thrombosis and Haemostasis},
year = {2026},
month = sep,
doi = {10.1016/j.rpth.2025.103317},
url = {https://univ-brest.hal.science/hal-05733784v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The incidence of early recurrent venous thromboembolism: a systematic review and meta-analysis
AU - Lisbeth Eischer
AU - Paul A Kyrle
AU - Alexandra Kaider
AU - Anton Schmidt
AU - Brigitte Wildner
AU - Anja Boc
AU - Charlotte Bradbury
AU - Anetta Undas
AU - Francis Couturaud
AU - Matteo Nicola Dario Di Minno
AU - Geert-Jan Geersing
AU - David Jimenez
AU - Sameer Parpia
AU - Gualtiero Palareti
AU - Daniela Poli
AU - Daniel P Potaczek
AU - Paolo Prandoni
AU - Sam Schulman
AU - Astrid van Hylckama Vlieg
AU - Michal Zabczyk
AU - Sabine Eichinger
PY - 2026
DA - 2026/09/01
JO - Research and Practice in Thrombosis and Haemostasis
DO - 10.1016/j.rpth.2025.103317
UR - https://univ-brest.hal.science/hal-05733784v1
AB - 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.
SN - 2475-0379
SN - 2475-0379
ER -