OBJECTIVES: Venous thromboembolism (VTE) increases the risk of developing several complications, including recurrent VTE. This study quantifies the long-term risk of complications associated with the development of an index recurrent VTE. METHODS: An analysis of healthcare insurance claims from the Ingenix IMPACTdatabase was conducted. Between January 2004 and September 2008, subjects aged ≥18 years on the date of first recurrent VTE diagnosis requiring hospitalization (index recurrent deep vein thrombosis [DVT], pulmonary embolism [PE], or both) with ≥ 12 months of baseline observation prior to the index recurrent VTE were matched 1:1 with control VTE patients without recurrence, based on exact matching factors and propensity scores. The risk of developing thrombocytopenia, superficial venous thrombosis, venous ulcer, pulmonary hypertension, stasis dermatitis, and venous insufficiency for up to 1 year after the index recurrent VTE event was compared between the recurrent VTE and the VTE control group. RESULTS: The recurrent VTE and VTE cohorts (8,001 subjects in each group) were well-matched with respect to age, gender, comorbidities, and VTE risk factors distributions. The absolute risks of developing thrombocytopenia, superficial venous thrombosis, venous ulcer, pulmonary hypertension, stasis dermatitis, and venous insufficiency were 7.1%, 4.4%, 1.5%, 5.3%, 1.4%, and 7.2% for the recurrent VTE group and 2.5%, 1.3%, 0.8%, 2.0%, 0.9%, and 3.8% for the VTE group, respectively. The corresponding risk ratios indicated that the risk of developing any complications was significantly higher for the recurrent VTE group compared to the VTE group (risk ratio [95% CI]: thrombocytopenia: 2.8 [2.4 - 3.3], superficial venous thrombosis: 3.3 [2.7 - 4.1], venous ulcer: 1.9 [1.4 - 2.6], pulmonary hypertension: 2.7 [2.2 - 3.2], stasis dermatitis: 1.5 [1.1 - 2.0], and venous insufficiency: 1.9 [1.6 - 2.2], all p-values<0.01). CONCLUSIONS: In this large matched-cohort study, recurrent VTE patients had significantly higher risk of complications compared to VTE control patients.