title: Optimal duration of anticoagulation in patients with venous thromboembolism.
abstract: The risk of recurrent venous thromboembolism (VTE) approaches 40 per cent of all patients after 10 yr of follow up. This risk is higher in patients with permanent risk factors of thrombosis such as active cancer, prolonged immobilization from medical diseases, and antiphospholipid syndrome; in carriers of several thrombophilic abnormalities, including deficiencies of natural anticoagulants; and in patients with unprovoked presentation. Patients with permanent risk factors of thrombosis should receive indefinite anticoagulation, consisting of subtherapeutic doses of low molecular weight heparin in cancer patients, and oral anticoagulants in all other conditions. Patients whose VTE is triggered by major surgery or trauma should be offered three months of anticoagulation. Patients with unprovoked VTE, including carriers of thrombophilia, and those whose thrombotic event is associated with minor risk factors (such as hormonal treatment, minor injuries, long travel) should receive at least three months of anticoagulation. The decision as to go on or discontinue anticoagulation after this period should be individually tailored and balanced against the haemorrhagic risk. Post-baseline variables, such as the D-dimer determination and the ultrasound assessment of residual thrombosis can help identify those patients in whom anticoagulation can be safely discontinued. As a few emerging anti-Xa and anti-IIa compounds seem to induce fewer haemorrhagic complications than conventional anticoagulation, while preserving at least the same effectiveness, these have the potential to open new scenarios for decisions regarding the duration of anticoagulation in patients with VTE.
authors.affiliation: Department of Cardiothoracic & Vascular Sciences, Clinica Medica II & Thromboembolism Unit, University of Padua, Italy. paoloprandoni@tin.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Prandoni
authors.forename: Chiara
authors.initials: C
authors.lastname: Piovella
authors.forename: Luca
authors.initials: L
authors.lastname: Spiezia
authors.forename: Fabio
authors.initials: F
authors.lastname: Dalla Valle
authors.forename: Raffaele
authors.initials: R
authors.lastname: Pesavento
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001777:Blood Coagulation; D015951:Factor Xa / Q000276:immunology / Q000627:therapeutic use; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008297:Male; D011655:Pulmonary Embolism / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D012008:Recurrence; D012307:Risk Factors; D012737:Sex Factors; D019851:Thrombophilia / Q000139:chemically induced; D054556:Venous Thromboembolism / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology*; D028761:Withholding Treatment
chemical_list: D000925:Anticoagulants; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D006493:Heparin; D015951:Factor Xa