PDF herunterladen
Open Access
CC BY 4.0 · TH Open 2020; 04(04): e446-e456
DOI: 10.1055/s-0040-1721735
Review Article

Anticoagulation for Patients with Venous Thromboembolism: When is Extended Treatment Required?

Autoren

  • Jeffrey I. Weitz

    1   Thrombosis and Atherosclerosis Research Institute and McMaster University, Hamilton, Ontario, Canada

  • Paolo Prandoni

    2   Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padua, Italy

  • Peter Verhamme

    3   Vascular Medicine and Haemostasis, Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium

Funding This study was funded by Bayer AG.
Weitere Informationen
Auch verfügbar auf
  Lizenzen und Reprints

Abstract

The need for extended venous thromboembolism (VTE) treatment beyond 3 to 6 months is usually determined by balancing the risk of recurrence if treatment is stopped against the risk of bleeding from continuing treatment. The risk of recurrence, and in turn the decision to extend, can be determined through the nature of the index event. Patients with VTE provoked by surgery or trauma (major transient risk factors) are recommended to receive 3 months of anticoagulation therapy because their risk of recurrence is low, whereas patients with VTE provoked by a major persistent risk factor, such as cancer, or those considered to have “unprovoked” VTE, are recommended to receive an extended duration of therapy based on an established high risk of recurrence. Nonetheless, recent evidence and new guidance identify that this approach fails to consider patients with risk factors classed as minor transient (e.g., impaired mobility and pregnancy) or minor persistent (e.g., inflammatory bowel disease and congestive heart disease). Indeed, the risk of recurrence with respect to VTE provoked by minor persistent risk factors has been demonstrated to be not dissimilar to that of VTE without identifiable risk factors. This review provides an overview of the available data on the risk of recurrence according to the underlying cause of VTE, a critical evaluation of evidence from clinical studies on the available anticoagulants for extended VTE treatment, models of risk prediction for recurrent VTE and bleeding, and guidance on how to apply the evidence in practice.

Keywords

anticoagulants - recurrence - risk assessment - risk factors - venous thromboembolism


Publikationsverlauf

Eingereicht: 02. Juli 2020

Angenommen: 05. November 2020

Artikel online veröffentlicht:
23. Dezember 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany