title: Major bleeding during secondary prevention of venous thromboembolism in patients who have completed anticoagulation: a systematic review and meta-analysis.
abstract: BACKGROUND
  The risk of major bleeding in patients who have completed anticoagulation therapy for unprovoked venous thromboembolism (VTE) is unknown.
  
  
  OBJECTIVE
  To report the major bleeding and fatal bleeding rates in patients randomized to placebo or observation (i.e. no anticoagulation therapy) for the secondary prevention of recurrent VTE.
  
  
  METHODS
  We performed a systematic review and meta-analysis of the literature to summarize the rates of major bleeding and fatal bleeding in patients randomized to placebo or observation during the secondary prevention of VTE. Unrestricted searches of MEDLINE (January 1, 1950 to August 31, 2013), Embase (January 1, 1980 to August 31, 2013), and the Cochrane Register of Controlled Trials using the OVID interface were conducted. Publications from potentially relevant journals were also searched by hand. We used a random-effects model to pool study results and I(2) testing to assess for heterogeneity.
  
  
  RESULTS
  The analysis included 11 studies and 3965 patients who were followed for a median of 24 months. The overall pooled major bleeding rate was 0.45 per 100 patient-years (95% CI 0.29-0.64, I(2) = 0%), and the overall pooled fatal bleeding rate was 0.14 per 100 patient-years (95% CI 0.057-0.26, I(2) = 0%).
  
  
  CONCLUSIONS
  Patients not receiving anticoagulant therapy for the secondary prevention of VTE experience major bleeding events, and this may have an impact on recommendations for extended treatment in this patient population.
authors.affiliation: Department of Medicine, The Ottawa Hospital Research Institute at the University of Ottawa, Ottawa, ON, Canada.
authors.forename: L A
authors.initials: LA
authors.lastname: Castellucci
authors.forename: G
authors.initials: G
authors.lastname: Le Gal
authors.forename: M A
authors.initials: MA
authors.lastname: Rodger
authors.forename: M
authors.initials: M
authors.lastname: Carrier
mesh_terms: D000925:Anticoagulants / Q000737:chemistry; D001777:Blood Coagulation / Q000187:drug effects; D006470:Hemorrhage / Q000150:complications* / Q000628:therapy; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D055502:Secondary Prevention; D054556:Venous Thromboembolism / Q000139:chemically induced* / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000139:chemically induced / Q000150:complications
chemical_list: D000925:Anticoagulants
keywords: anticoagulants; hemorrhage; review, systematic; venous thromboembolism; venous thrombosis