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 coexistent 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.[169]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 [170]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.[171]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.