Identifying patients at increased risk for recurrent venous thromboembolism: Clinical, biochemical, and radiologic risk factors

Venous thromboembolism is a common vascular disease that presents clinically as deep vein thrombosis, pulmonary embolism, or both conditions. Once patients are diagnosed with this disease and anticoagulant therapy is initiated, the main objective is to prevent recurrent thromboembolism. Identifying patients who are at increased risk of recurrent venous thromboembolism is clinically relevant because recurrent disease is associated with considerable morbidity and mortality. In patients who present with deep vein thrombosis, recurrent ipsilateral thrombosis is associated with a six-fold increased risk of the post-thrombotic syndrome, which is associated with long-term leg swelling, pain, and venous ulceration. In patients who present with pulmonary embolism, recurrent embolization is associated with a 9%-26% mortality rate. The objective of this review is to provide a framework to stratify patients with venous thromboembolism according to the risk of recurrent disease. This information can assist clinicians in deciding about in-hospital or outpatient anticoagulant therapy, the frequency of clinical surveillance, and the duration of anticoagulation. © 2002 CVRR, Inc.