The risk of recurrent thromboembolic disorders in patients with unprovoked venous thromboembolism: new scenarios and opportunities

Eur J Intern Med. 2014 Jan;25(1):25-30. doi: 10.1016/j.ejim.2013.09.005. Epub 2013 Oct 9.


The risk of recurrent thromboembolic disorders in the 10-year period following an episode of unprovoked venous thromboembolism (VTE) ranges between 30 and 50%, the rate being higher in patients with primary deep venous thrombosis (DVT) than in those with primary pulmonary embolism (PE). The clinical presentation with primary PE increases by more than three times the risk of a new PE episode over that with isolated DVT. Baseline parameters that increase this risk are the proximal location of DVT, obesity, old age and male sex, whereas the role of thrombophilia is controversial. An increasing role is played by post-baseline parameters such as the ultrasound assessment of residual vein thrombosis and the determination of D-dimer. While the latest international guidelines suggest indefinite anticoagulation for most patients with the first episode of unprovoked VTE, new scenarios are being offered by the identification of risk stratification models and by strategies that have the potential to help identify patients in whom anticoagulation can be safely discontinued, such as those that incorporate the assessment of D-dimer and residual vein thrombosis. New opportunities are being offered by low-dose aspirin, which has recently been reported to decrease by more than 30% the risk of recurrent events without increasing the bleeding risk; and especially by a few emerging anti-Xa and anti-IIa oral compounds, which are likely to induce fewer haemorrhagic complications than vitamin K antagonists while preserving at least the same effectiveness, do not require laboratory monitoring, and can be used immediately after the thrombotic episode.

Keywords: Anticoagulation; Deep venous thrombosis; Pulmonary embolism; Thrombophilia; Venous thromboembolism.

Publication types

  • Review

MeSH terms

  • Age Factors
  • Anticoagulants / therapeutic use*
  • Aspirin / therapeutic use
  • Benzimidazoles / therapeutic use
  • Dabigatran
  • Disease Management
  • Female
  • Fibrin Fibrinogen Degradation Products / analysis
  • Fibrinolytic Agents / therapeutic use*
  • Fondaparinux
  • Humans
  • Male
  • Morpholines / therapeutic use
  • Obesity / complications
  • Polysaccharides / therapeutic use
  • Postthrombotic Syndrome
  • Pulmonary Embolism / complications
  • Pulmonary Embolism / diagnostic imaging
  • Pulmonary Embolism / prevention & control*
  • Risk Assessment / methods*
  • Risk Factors
  • Rivaroxaban
  • Secondary Prevention
  • Sex Factors
  • Thiophenes / therapeutic use
  • Thrombophilia / complications
  • Thrombophilia / drug therapy
  • Ultrasonography
  • Venous Thromboembolism / complications
  • Venous Thromboembolism / diagnostic imaging
  • Venous Thromboembolism / prevention & control*
  • Venous Thrombosis / complications
  • Venous Thrombosis / diagnostic imaging
  • Venous Thrombosis / prevention & control*
  • Warfarin / therapeutic use
  • beta-Alanine / analogs & derivatives
  • beta-Alanine / therapeutic use


  • Anticoagulants
  • Benzimidazoles
  • Fibrin Fibrinogen Degradation Products
  • Fibrinolytic Agents
  • Morpholines
  • Polysaccharides
  • Thiophenes
  • fibrin fragment D
  • beta-Alanine
  • Warfarin
  • Rivaroxaban
  • Dabigatran
  • Fondaparinux
  • Aspirin