Hypercoagulable state

Prognosis depends on the underlying cause of the hypercoagulable state and the presence of a history of venous thromboembolism (VTE).

Asymptomatic hypercoagulable state

Outlook in these patients is determined by the type of thrombophilia and co-existent medical problems. Thromboprophylaxis during periods of high risk can reduce the chance of VTE and subsequent complications.

Symptomatic hypercoagulable state

Patients who develop VTE in the context of a surgical risk factor generally have a good prognosis, with low recurrence rate at end of treatment. Those who present with an unprovoked (idiopathic) VTE have a higher risk of recurrence.

Cancer increases the risk of death following VTE, and VTE is the leading cause of death in ambulatory patients with cancer.[162]Khorana AA, Francis CW, Culakova E, et al. Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy. J Thromb Haemost. 2007 Mar;5(3):632-4. http://www.ncbi.nlm.nih.gov/pubmed/17319909?tool=bestpractice.com [163]Prandoni P, Lensing AW, Cogo A, et al. The long-term clinical course of acute deep venous thrombosis. Ann Intern Med. 1996 Jul 1;125(1):1-7. http://www.ncbi.nlm.nih.gov/pubmed/8644983?tool=bestpractice.com Patients with occult malignancy at diagnosis of VTE also have poor outcomes, with increased rates of VTE recurrence, bleeding, and death within 3 months of therapy.[50]Trujillo-Santos J, Prandoni P, Rivron-Guillot K, et al. Clinical outcome in patients with venous thromboembolism and hidden cancer: findings from the RIETE Registry. J Thromb Haemost. 2008 Feb;6(2):251-5. http://www.ncbi.nlm.nih.gov/pubmed/18021305?tool=bestpractice.com

In patients with a first episode of unprovoked VTE who completed at least 3 months of anticoagulant treatment, the risk of recurrent VTE was 10% in the first year after treatment, 16% at 2 years, 25% at 5 years, and 36% at 10 years.[164]Khan F, Rahman A, Carrier M, et al. 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 Jul 24;366:l4363. https://www.bmj.com/content/366/bmj.l4363.long http://www.ncbi.nlm.nih.gov/pubmed/31340984?tool=bestpractice.com About 4% of recurrent VTE events resulted in death.