Duration of anticoagulant therapy for deep vein thrombosis and pulmonary embolism.
It takes about 3 months to complete "active treatment" of venous thromboembolism (VTE), with further treatment serving to prevent new episodes of thrombosis ("pure secondary prevention"). Consequently, VTE should generally be treated for either 3 months or indefinitely (exceptions will be described in the text). The decision to stop anticoagulants at 3 months or to treat indefinitely is dominated by the long-term risk of recurrence, and secondarily influenced by the risk of bleeding and by patient preference. VTE provoked by a reversible risk factor, or a first unprovoked isolated distal (calf) deep vein thrombosis (DVT), has a low risk of recurrence and is usually treated for 3 months. VTE associated with active cancer, or a second unprovoked VTE, has a high risk of recurrence and is usually treated indefinitely. The decision to stop anticoagulants at 3 months or to treat indefinitely is more finely balanced after a first unprovoked proximal DVT or pulmonary embolism (PE). Indefinite anticoagulation is often chosen if there is a low risk of bleeding, whereas anticoagulation is usually stopped at 3 months if there is a high risk of bleeding. The decision to continue anticoagulation indefinitely after a first unprovoked proximal DVT or PE is strengthened if the patient is male, the index event was PE rather than DVT, and/or d-dimer testing is positive 1 month after stopping anticoagulant therapy.
Department of Medicine, Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, ON, Canada; and.
Clive
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Kearon
Elie A
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D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications; D017410:Practice Guidelines as Topic; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000517:prevention & control; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention; D013997:Time Factors; D054556:Venous Thromboembolism / Q000150:complications / Q000188:drug therapy / Q000517:prevention & control; D020246:Venous Thrombosis / Q000150:complications / Q000188:drug therapy* / Q000517:prevention & control
D000925:Anticoagulants