title: Residual vein thrombosis for assessing duration of anticoagulation after unprovoked deep vein thrombosis of the lower limbs: the extended DACUS study.
abstract: The safest duration of anticoagulation after idiopathic deep vein thrombosis (DVT) is unknown. We conducted a prospective study to assess the optimal duration of vitamin K antagonist (VKA) therapy considering the risk of recurrence of thrombosis according to residual vein thrombosis (RVT). Patients with a first unprovoked DVT were evaluated for the presence of RVT after 3 months of VKA administration; those without RVT suspended VKA, while those with RVT continued oral anticoagulation for up to 2 years. Recurrent thrombosis and/or bleeding events were recorded during treatment (RVT group) and 1 year after VKA withdrawal (both groups). Among 409 patients evaluated for unprovoked DVT, 33.2% (136 of 409 patients) did not have RVT and VKA was stopped. The remaining 273 (66.8%) patients with RVT received anticoagulants for an additional 21 months; during this period of treatment, recurrent venous thromboembolism and major bleeding occurred in 4.7% and 1.1% of patients, respectively. After VKA suspension, the rates of recurrent thrombotic events were 1.4% and 10.4% in the no-RVT and RVT groups, respectively (relative risk = 7.4; 95% confidence interval = 4.9-9.9). These results indicate that in patients without RVT, a short period of treatment with a VKA is sufficient; in those with persistent RVT, treatment extended to 2 years substantially reduces, but does not eliminate, the risk of recurrent thrombosis.
authors.affiliation: Cattedra ed Unità di Ematologia con trapianto, Dipartimento di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy. sergio.siragusa@unipa.it
authors.forename: Sergio
authors.initials: S
authors.lastname: Siragusa
authors.forename: Alessandra
authors.initials: A
authors.lastname: Malato
authors.forename: Giorgia
authors.initials: G
authors.lastname: Saccullo
authors.forename: Alfonso
authors.initials: A
authors.lastname: Iorio
authors.forename: Mauro
authors.initials: M
authors.lastname: Di Ianni
authors.forename: Clementina
authors.initials: C
authors.lastname: Caracciolo
authors.forename: Lucio Lo
authors.initials: LL
authors.lastname: Coco
authors.forename: Simona
authors.initials: S
authors.lastname: Raso
authors.forename: Marco
authors.initials: M
authors.lastname: Santoro
authors.forename: Francesco Paolo
authors.initials: FP
authors.lastname: Guarneri
authors.forename: Antonino
authors.initials: A
authors.lastname: Tuttolomondo
authors.forename: Antonio
authors.initials: A
authors.lastname: Pinto
authors.forename: Iliana
authors.initials: I
authors.lastname: Pepe
authors.forename: Alessandra
authors.initials: A
authors.lastname: Casuccio
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Abbadessa
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Licata
authors.forename: Giovan
authors.initials: G
authors.lastname: Battista Rini
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Mariani
authors.forename: Gaetana
authors.initials: G
authors.lastname: Di Fede
mesh_terms: D000074:Acenocoumarol / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005260:Female; D006470:Hemorrhage; D006801:Humans; D035002:Lower Extremity / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D014463:Ultrasonography; D054556:Venous Thromboembolism / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology / Q000517:prevention & control; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D014812:Vitamin K / Q000037:antagonists & inhibitors / Q000378:metabolism; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014812:Vitamin K; D014859:Warfarin; D000074:Acenocoumarol