title: Duration of anticoagulation after venous thromboembolism in real world clinical practice.
abstract: BACKGROUND
  Venous thromboembolism (VTE) carries a considerable risk of recurrence and anticoagulants should be administered for a minimum of three months. Since little is known about real life management of VTE, we aimed to describe current practice in the secondary prevention of VTE.
  
  
  METHODS
  Using the database of an international, prospective registry on patients treated for VTE, RIETE, information was collected on risk factors for VTE and bleeding, anticoagulant treatment, and clinical outcomes during follow up. Multivariate analysis using logistic regression was performed to identify predictors of treatment duration.
  
  
  RESULTS
  Of 6944 patients with a first episode of VTE 41.1% had unprovoked VTE, 31.8% had transient risk factors, 27.1% had cancer. After the exclusion of patients who died during the first year of observation, the rate of patients treated for >12 months was 55.1%, 41.9%, and 43.2%, respectively (p<0.001). Pulmonary embolism at presentation, recurrence while on treatment, chronic heart failure and age >65 years were independently associated with treatment for >12 months. Body weight <75 kg, anemia, cancer, and the presence of transient risk factors were associated with treatment for 12 months or less. Major bleeding occurred more frequently than recurrent VTE in patients with VTE secondary to transient risk factors and cancer; fatal bleeding was more frequent than fatal recurrent PE in all subgroups.
  
  
  CONCLUSIONS
  We observed heterogeneous duration of anticoagulant treatment for the secondary prevention of VTE. A substantial proportion of patients, in particular those with VTE secondary to transient risk factors, may be exposed to a possibly unnecessary risk of bleeding.
authors.affiliation: Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy. Electronic address: agewal@yahoo.com.
authors.forename: Walter
authors.initials: W
authors.lastname: Ageno
authors.affiliation: Department of Internal Medicine, Hospital Reina Sofía de Tudela, Navarra, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Samperiz
authors.affiliation: Department of Internal Medicine, Hospital Reina Sofía de Tudela, Navarra, Spain.
authors.forename: Ruth
authors.initials: R
authors.lastname: Caballero
authors.affiliation: Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Dentali
authors.affiliation: Department of Internal Medicine and Emergency Room, Ospedale Buonconsiglio Fatebenefratelli, Naples, Italy.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Di Micco
authors.affiliation: Department of Clinical Medicine, University of Padua, Padua, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Prandoni
authors.affiliation: Department of Medicine, University of Perugia, Perugia, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Becattini
authors.affiliation: Department of Pneumonology, Hospital de Cruces, Barakaldo, Vizcaya, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Uresandi
authors.affiliation: Department of Cardiovascular Sciences, Vascular Medicine and Haemostasis, University of Leuven, Belgium.
authors.forename: Peter
authors.initials: P
authors.lastname: Verhamme
authors.affiliation: Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Monreal
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000188:drug therapy* / Q000473:pathology
chemical_list: D000925:Anticoagulants