Marc A. Rodger, MD, MSc; Timothy Ramsay, PhD; Gregoire Le Gal, MD, PhD; Marc Carrier, MD, MSc
Potential Conflicts of Interest: None disclosed.
Rodger M., Ramsay T., Le Gal G., Carrier M.; Assessment of Recurrence Risk After Unprovoked Venous Thromboembolism. Ann Intern Med. 2011;154:644. doi: 10.7326/0003-4819-154-9-201105030-00015
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Published: Ann Intern Med. 2011;154(9):644.
TO THE EDITOR:
We congratulate Douketis and colleagues on an excellent collaborative project that yields useful insights into defining who is at high risk for recurrent venous thromboembolism (VTE) (1). Confounding among age, estrogen-associated VTE, and sex poses an important challenge in the analysis of the authors' data because of the weak association between VTE and estrogen exposure due to pregnancy, oral contraceptives, and hormone replacement therapy (2); the fact that estrogen exposure does not occur in men and rarely occurs in older women; and the apparent association between older age and recurrent VTE in women (3).
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