Long-term risk of recurrent venous thromboembolism after a first contraceptive-related event: Data from REVERSE cohort study

David Aziz; Leslie Skeith; Marc A. Rodger; Elham Sabri; Marc Righini; Michael J. Kovacs; Marc Carrier; Susan R. Kahn; Philip S. Wells; David R. Anderson; Isabelle Chagnon; Susan Solymoss; Mark A. Crowther; Richard H. White; Grégoire Le Gal

doi:10.1111/jth.15303

Long-term risk of recurrent venous thromboembolism after a first contraceptive-related event: Data from REVERSE cohort study

David Aziz, Leslie Skeith, Marc A. Rodger, Elham Sabri, Marc Righini, Michael J. Kovacs, Marc Carrier, Susan R. Kahn, Philip S. Wells, David R. Anderson, Isabelle Chagnon, Susan Solymoss, Mark A. Crowther, Richard H. White, Grégoire Le Gal

Medicine

Résultat de recherche: Article › examen par les pairs

10 Citations (Scopus)

Résumé

Introduction: The risk of recurrent venous thromboembolism (VTE) after combined oral contraceptive (COC) use is variably reported. We assessed the long-term risk of recurrent VTE in women on COC at the time of a first VTE, in comparison to women without COC use. Our secondary aim assessed the impact of COC use on the recurrent VTE risk in high-risk and low-risk hyperpigmentation, edema, or redness in either leg; D-dimer level ≥250 μg/L; obesity with body mass index ≥30; or older age, ≥65 years (HERDOO2) subgroups. Methods: The REVERSE cohort study derived the HERDOO2 clinical decision rule to predict recurrent VTE in patients who discontinued anticoagulation after 5–7 months for a first unprovoked VTE. Incidence rates of recurrent VTE among women with and without COC exposure were calculated as the number of recurrent VTE over the number of person-years of follow-up, and Cox proportional hazards model was used to compare risks between groups. Results: The risk of recurrent VTE among COC users was 1.1% (95% confidence interval [CI] 0.3–2.9) per patient-year as compared with 3.2% per patient-year (95% CI 2.4–4.3) among nonusers (hazard ratio 0.37; 95% CI 0.1–1.0). Women who were COC users and high risk by HERDOO2 score had a recurrence rate of 3.5% (95% CI 0.4–12.5) compared with 6.1% (95% CI 4.3–8.5) among women who were non-COC users and at high risk by HERDOO2 score (HR 0.6, 95% CI 0.1–2.5). Conclusions: Women who were COC users at the time of an otherwise unprovoked VTE event had a lower VTE recurrence rate during long-term follow-up, compared with nonusers. The use of HERDOO2 rule may help identify higher risk women with COC use.

Langue d'origine	English
Pages (de-à)	1526-1532
Nombre de pages	7
Journal	Journal of Thrombosis and Haemostasis
Volume	19
Numéro de publication	6
DOI	https://doi.org/10.1111/jth.15303
Statut de publication	Published - juin 2021

Note bibliographique

Funding Information:
Dr. Aziz: No conflicts of interest to report. Dr. Skeith: Received honoraria from Leo Pharma and research funding from CSL Behring. Dr. Rodger: No conflicts of interest to report. Dr. Sabri: No conflicts of interest to report. Dr. Righini: No conflicts of interest to report. Dr. Kovacs: No conflicts of interest to report. Dr. Carrier: Received research funding from BMS, Leo Pharma, and Pfizer; received honoraria from Bayer, Pfizer, BMS, Leo Pharma, Servier, and Sanofi. Dr. Kahn: No conflicts of interest to report. Dr. Wells: Received speaker honoraria from BMS and Bayer Healthcare and prior grant funding from BMS/Pfizer. Dr. Anderson: No conflicts of interest to report. Dr Chagnon:: No conflicts of interest to report. Dr. Crowther: Received honoraria from Pfizer, CSL Behring, and Diagnostica Stago; provided consultation services to/served on advisory boards for Servier Canada, Asahi Kasei, and Precision Biologics; was on the data safety monitoring board for Bayer; and has stock ownership in Alnylam; and holds the Leo Pharma Chair in Thromboembolism research, the funding for which is held in perpetuity at McMaster University (the interest is used to support M.A.C.'s research activities). Dr. White: No conflicts of interest to report. Dr. Le Gal: No conflicts of interest to report.

Funding Information:
The REVERSE study was funded by the Canadian Institutes of Health Research (grant no. MOP 64319) and bioMérieux (through an unrestricted research grant). M. A. R. is the McGill Harry Webster Thorp Professor of Medicine. S. R. K. is a Tier 1 Canada Research Chair holder. M. A. C. holds the Leo Pharma Chair in Thromboembolism research. G. L. G. holds an Early Researcher Award from the Province of Ontario; a mid‐career clinician scientist award from the Heart and Stroke Foundation of Ontario; and the Chair on Diagnosis of Venous Thromboembolism from the Department of Medicine at the University of Ottawa. M. C. holds the Chair in Cancer and Venous Thromboembolism from the Department of Medicine at the University of Ottawa. The authors acknowledge the CanVECTOR Network, which receives grant funding from the Canadian Institutes of Health Research (Funding Reference: CDT‐142654), for supporting this research.

Publisher Copyright:
© 2021 International Society on Thrombosis and Haemostasis

ASJC Scopus Subject Areas

Hematology

PubMed: MeSH publication types

Journal Article
Research Support, Non-U.S. Gov't

ODD de l’ONU

Cette action contribue à la réalisation des objectifs de développement durable suivants

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10.1111/jth.15303

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Aziz, D., Skeith, L., Rodger, M. A., Sabri, E., Righini, M., Kovacs, M. J., Carrier, M., Kahn, S. R., Wells, P. S., Anderson, D. R., Chagnon, I., Solymoss, S., Crowther, M. A., White, R. H., & Le Gal, G. (2021). Long-term risk of recurrent venous thromboembolism after a first contraceptive-related event: Data from REVERSE cohort study. Journal of Thrombosis and Haemostasis, 19(6), 1526-1532. https://doi.org/10.1111/jth.15303

Aziz, D, Skeith, L, Rodger, MA, Sabri, E, Righini, M, Kovacs, MJ, Carrier, M, Kahn, SR, Wells, PS, Anderson, DR, Chagnon, I, Solymoss, S, Crowther, MA, White, RH & Le Gal, G 2021, 'Long-term risk of recurrent venous thromboembolism after a first contraceptive-related event: Data from REVERSE cohort study', Journal of Thrombosis and Haemostasis, vol. 19, n° 6, pp. 1526-1532. https://doi.org/10.1111/jth.15303

@article{2c8087d2e46e4dec96a2d0a9fe68d5f3,

title = "Long-term risk of recurrent venous thromboembolism after a first contraceptive-related event: Data from REVERSE cohort study",

abstract = "Introduction: The risk of recurrent venous thromboembolism (VTE) after combined oral contraceptive (COC) use is variably reported. We assessed the long-term risk of recurrent VTE in women on COC at the time of a first VTE, in comparison to women without COC use. Our secondary aim assessed the impact of COC use on the recurrent VTE risk in high-risk and low-risk hyperpigmentation, edema, or redness in either leg; D-dimer level ≥250 μg/L; obesity with body mass index ≥30; or older age, ≥65 years (HERDOO2) subgroups. Methods: The REVERSE cohort study derived the HERDOO2 clinical decision rule to predict recurrent VTE in patients who discontinued anticoagulation after 5–7 months for a first unprovoked VTE. Incidence rates of recurrent VTE among women with and without COC exposure were calculated as the number of recurrent VTE over the number of person-years of follow-up, and Cox proportional hazards model was used to compare risks between groups. Results: The risk of recurrent VTE among COC users was 1.1% (95% confidence interval [CI] 0.3–2.9) per patient-year as compared with 3.2% per patient-year (95% CI 2.4–4.3) among nonusers (hazard ratio 0.37; 95% CI 0.1–1.0). Women who were COC users and high risk by HERDOO2 score had a recurrence rate of 3.5% (95% CI 0.4–12.5) compared with 6.1% (95% CI 4.3–8.5) among women who were non-COC users and at high risk by HERDOO2 score (HR 0.6, 95% CI 0.1–2.5). Conclusions: Women who were COC users at the time of an otherwise unprovoked VTE event had a lower VTE recurrence rate during long-term follow-up, compared with nonusers. The use of HERDOO2 rule may help identify higher risk women with COC use.",

author = "David Aziz and Leslie Skeith and Rodger, {Marc A.} and Elham Sabri and Marc Righini and Kovacs, {Michael J.} and Marc Carrier and Kahn, {Susan R.} and Wells, {Philip S.} and Anderson, {David R.} and Isabelle Chagnon and Susan Solymoss and Crowther, {Mark A.} and White, {Richard H.} and {Le Gal}, Gr{\'e}goire",

note = "Funding Information: Dr. Aziz: No conflicts of interest to report. Dr. Skeith: Received honoraria from Leo Pharma and research funding from CSL Behring. Dr. Rodger: No conflicts of interest to report. Dr. Sabri: No conflicts of interest to report. Dr. Righini: No conflicts of interest to report. Dr. Kovacs: No conflicts of interest to report. Dr. Carrier: Received research funding from BMS, Leo Pharma, and Pfizer; received honoraria from Bayer, Pfizer, BMS, Leo Pharma, Servier, and Sanofi. Dr. Kahn: No conflicts of interest to report. Dr. Wells: Received speaker honoraria from BMS and Bayer Healthcare and prior grant funding from BMS/Pfizer. Dr. Anderson: No conflicts of interest to report. Dr Chagnon:: No conflicts of interest to report. Dr. Crowther: Received honoraria from Pfizer, CSL Behring, and Diagnostica Stago; provided consultation services to/served on advisory boards for Servier Canada, Asahi Kasei, and Precision Biologics; was on the data safety monitoring board for Bayer; and has stock ownership in Alnylam; and holds the Leo Pharma Chair in Thromboembolism research, the funding for which is held in perpetuity at McMaster University (the interest is used to support M.A.C.'s research activities). Dr. White: No conflicts of interest to report. Dr. Le Gal: No conflicts of interest to report. Funding Information: The REVERSE study was funded by the Canadian Institutes of Health Research (grant no. MOP 64319) and bioM{\'e}rieux (through an unrestricted research grant). M. A. R. is the McGill Harry Webster Thorp Professor of Medicine. S. R. K. is a Tier 1 Canada Research Chair holder. M. A. C. holds the Leo Pharma Chair in Thromboembolism research. G. L. G. holds an Early Researcher Award from the Province of Ontario; a mid‐career clinician scientist award from the Heart and Stroke Foundation of Ontario; and the Chair on Diagnosis of Venous Thromboembolism from the Department of Medicine at the University of Ottawa. M. C. holds the Chair in Cancer and Venous Thromboembolism from the Department of Medicine at the University of Ottawa. The authors acknowledge the CanVECTOR Network, which receives grant funding from the Canadian Institutes of Health Research (Funding Reference: CDT‐142654), for supporting this research. Publisher Copyright: {\textcopyright} 2021 International Society on Thrombosis and Haemostasis",

year = "2021",

month = jun,

doi = "10.1111/jth.15303",

language = "English",

volume = "19",

pages = "1526--1532",

journal = "Journal of Thrombosis and Haemostasis",

issn = "1538-7933",

publisher = "Wiley-Blackwell",

number = "6",

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TY - JOUR

T1 - Long-term risk of recurrent venous thromboembolism after a first contraceptive-related event

T2 - Data from REVERSE cohort study

AU - Aziz, David

AU - Skeith, Leslie

AU - Rodger, Marc A.

AU - Sabri, Elham

AU - Righini, Marc

AU - Kovacs, Michael J.

AU - Carrier, Marc

AU - Kahn, Susan R.

AU - Wells, Philip S.

AU - Anderson, David R.

AU - Chagnon, Isabelle

AU - Solymoss, Susan

AU - Crowther, Mark A.

AU - White, Richard H.

AU - Le Gal, Grégoire

N1 - Funding Information: Dr. Aziz: No conflicts of interest to report. Dr. Skeith: Received honoraria from Leo Pharma and research funding from CSL Behring. Dr. Rodger: No conflicts of interest to report. Dr. Sabri: No conflicts of interest to report. Dr. Righini: No conflicts of interest to report. Dr. Kovacs: No conflicts of interest to report. Dr. Carrier: Received research funding from BMS, Leo Pharma, and Pfizer; received honoraria from Bayer, Pfizer, BMS, Leo Pharma, Servier, and Sanofi. Dr. Kahn: No conflicts of interest to report. Dr. Wells: Received speaker honoraria from BMS and Bayer Healthcare and prior grant funding from BMS/Pfizer. Dr. Anderson: No conflicts of interest to report. Dr Chagnon:: No conflicts of interest to report. Dr. Crowther: Received honoraria from Pfizer, CSL Behring, and Diagnostica Stago; provided consultation services to/served on advisory boards for Servier Canada, Asahi Kasei, and Precision Biologics; was on the data safety monitoring board for Bayer; and has stock ownership in Alnylam; and holds the Leo Pharma Chair in Thromboembolism research, the funding for which is held in perpetuity at McMaster University (the interest is used to support M.A.C.'s research activities). Dr. White: No conflicts of interest to report. Dr. Le Gal: No conflicts of interest to report. Funding Information: The REVERSE study was funded by the Canadian Institutes of Health Research (grant no. MOP 64319) and bioMérieux (through an unrestricted research grant). M. A. R. is the McGill Harry Webster Thorp Professor of Medicine. S. R. K. is a Tier 1 Canada Research Chair holder. M. A. C. holds the Leo Pharma Chair in Thromboembolism research. G. L. G. holds an Early Researcher Award from the Province of Ontario; a mid‐career clinician scientist award from the Heart and Stroke Foundation of Ontario; and the Chair on Diagnosis of Venous Thromboembolism from the Department of Medicine at the University of Ottawa. M. C. holds the Chair in Cancer and Venous Thromboembolism from the Department of Medicine at the University of Ottawa. The authors acknowledge the CanVECTOR Network, which receives grant funding from the Canadian Institutes of Health Research (Funding Reference: CDT‐142654), for supporting this research. Publisher Copyright: © 2021 International Society on Thrombosis and Haemostasis

PY - 2021/6

Y1 - 2021/6

N2 - Introduction: The risk of recurrent venous thromboembolism (VTE) after combined oral contraceptive (COC) use is variably reported. We assessed the long-term risk of recurrent VTE in women on COC at the time of a first VTE, in comparison to women without COC use. Our secondary aim assessed the impact of COC use on the recurrent VTE risk in high-risk and low-risk hyperpigmentation, edema, or redness in either leg; D-dimer level ≥250 μg/L; obesity with body mass index ≥30; or older age, ≥65 years (HERDOO2) subgroups. Methods: The REVERSE cohort study derived the HERDOO2 clinical decision rule to predict recurrent VTE in patients who discontinued anticoagulation after 5–7 months for a first unprovoked VTE. Incidence rates of recurrent VTE among women with and without COC exposure were calculated as the number of recurrent VTE over the number of person-years of follow-up, and Cox proportional hazards model was used to compare risks between groups. Results: The risk of recurrent VTE among COC users was 1.1% (95% confidence interval [CI] 0.3–2.9) per patient-year as compared with 3.2% per patient-year (95% CI 2.4–4.3) among nonusers (hazard ratio 0.37; 95% CI 0.1–1.0). Women who were COC users and high risk by HERDOO2 score had a recurrence rate of 3.5% (95% CI 0.4–12.5) compared with 6.1% (95% CI 4.3–8.5) among women who were non-COC users and at high risk by HERDOO2 score (HR 0.6, 95% CI 0.1–2.5). Conclusions: Women who were COC users at the time of an otherwise unprovoked VTE event had a lower VTE recurrence rate during long-term follow-up, compared with nonusers. The use of HERDOO2 rule may help identify higher risk women with COC use.

AB - Introduction: The risk of recurrent venous thromboembolism (VTE) after combined oral contraceptive (COC) use is variably reported. We assessed the long-term risk of recurrent VTE in women on COC at the time of a first VTE, in comparison to women without COC use. Our secondary aim assessed the impact of COC use on the recurrent VTE risk in high-risk and low-risk hyperpigmentation, edema, or redness in either leg; D-dimer level ≥250 μg/L; obesity with body mass index ≥30; or older age, ≥65 years (HERDOO2) subgroups. Methods: The REVERSE cohort study derived the HERDOO2 clinical decision rule to predict recurrent VTE in patients who discontinued anticoagulation after 5–7 months for a first unprovoked VTE. Incidence rates of recurrent VTE among women with and without COC exposure were calculated as the number of recurrent VTE over the number of person-years of follow-up, and Cox proportional hazards model was used to compare risks between groups. Results: The risk of recurrent VTE among COC users was 1.1% (95% confidence interval [CI] 0.3–2.9) per patient-year as compared with 3.2% per patient-year (95% CI 2.4–4.3) among nonusers (hazard ratio 0.37; 95% CI 0.1–1.0). Women who were COC users and high risk by HERDOO2 score had a recurrence rate of 3.5% (95% CI 0.4–12.5) compared with 6.1% (95% CI 4.3–8.5) among women who were non-COC users and at high risk by HERDOO2 score (HR 0.6, 95% CI 0.1–2.5). Conclusions: Women who were COC users at the time of an otherwise unprovoked VTE event had a lower VTE recurrence rate during long-term follow-up, compared with nonusers. The use of HERDOO2 rule may help identify higher risk women with COC use.

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Long-term risk of recurrent venous thromboembolism after a first contraceptive-related event: Data from REVERSE cohort study

Résumé

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ASJC Scopus Subject Areas

PubMed: MeSH publication types

ODD de l’ONU

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