brand logo

Am Fam Physician. 2020;101(5):309

Clinical Question

After stopping anticoagulation for venous thromboembolism (VTE), what is the likelihood of a subsequent VTE over 10 years?

Bottom Line

Perhaps it is time to start thinking about VTE as a chronic disease. Approximately one in 10 patients that have a VTE will have a second VTE over the next 12 months and almost four in 10 will have a second VTE over 10 years. The risk of developing deep venous thrombosis is 6.2% over one year and 25.1% over 10 years. The risk for pulmonary embolism is 3.3% over one year and 11.2% over 10 years. (Level of Evidence = 1a–)


Researchers assembled 18 studies involving 7,515 patients by searching three databases for studies in any language that reported follow-up data on patients with a first, unprovoked VTE who were treated for at least three months and then followed up for at least nine months (range = two to 10 years). The authors included observational and intervention trials. All studies were evaluated as being high quality. Over the first year following discontinuation of treatment, 10.3% of patients had a second VTE, 6.2% developed deep venous thrombosis, and 3.3% developed pulmonary embolism. Over 10 years, the cumulative incidence of VTE was 36.1% (95% CI, 27.8 to 45.0), deep venous thrombosis was 25.1% (95% CI, 17.2 to 33.7), and pulmonary embolism was 11.2% (95% CI, 5.9 to 18.4). The confidence intervals for the 10-year figures are wide (and therefore the estimate is inexact) because only three studies of 1,975 patients followed patients for 10 years, with dropouts along the way. There was some significant heterogeneity among the studies for some of the outcomes that could not be explained by initial VTE site, sex, or use of aspirin following anticoagulant treatment.

Study design: Meta-analysis (other)

Funding source: Government

Setting: Various (meta-analysis)

Reference: Khan F, Rahman A, Carrier M, et al.; MARVELOUS Collaborators. Long term risk of symptomatic recurrent venous thromboembolism after discontinuation of anticoagulant treatment for first unprovoked venous thromboembolism event: systematic review and meta-analysis. BMJ. 2019;366:l4363.

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to

This series is coordinated by Natasha J. Pyzocha, DO, contributing editor.

A collection of POEMs published in AFP is available at

Continue Reading

More in AFP

More in Pubmed

Copyright © 2020 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.