Idiopathic venous thrombosis

Summary

Venous thrombosis is a chronic disease with a recurrence rate of approximately 30% within 5-8 years. The optimal duration of secondary thromboprophylaxis in these patients entails balancing the risk of recurrence against the risk of treatment-associated bleeding. There is agreement that patients with a first idiopathic venous thrombosis should receive vitamin K antagonists for at least 3-6 months. Convincing trials showing a clinical benefit in terms of morbidity or mortality with respect to expansion of anticoagulation beyond 6 months are lacking. Nevertheless, some subgroups of patients with venous thrombosis may benefit from indefinite anticoagulation. Thus, patients with antithrombin deficiency, combined or homozygous defects, more than one unprovoked episode of thrombosis, the lupus anticoagulant or high factor VIII plasma levels are good candidates for long-term prevention.

Zusammenfassung

Die venöse Thrombose ist eine chronische Erkrankung mit einer Rezidivrate von ca. 30% innerhalb von 5 bis 8 Jahren. Die Festlegung der optimalen Dauer der sekundären Thromboseprophylaxe bei diesen Patienten erfordert ein Abwägen des Rezidivrisikos gegen das Risiko einer behandlungsassoziierten Blutung. Es herrscht Übereinstimmung darüber, dass Patienten mit einer ersten idiopathischen venösen Thrombose über mindestens 3-6 Monate Vitamin- K-Antagonisten erhalten sollten. Klinische Studien, die den Nutzen einer Verlängerung der Antikoagulierung über 6 Monate hinaus hinsichtlich Morbidität oder Mortalität beweisen, sind ausständig. Nichtsdestoweniger könnte eine unbegrenzte Antikoagulierung einem Teil der Patienten mit venöser Thrombose zugute kommen. Deshalb sind Patienten mit Antithrombinmangel, kombinierten oder homozygoten Defekten, mehr als einer durchgemachten idiopathischen Thrombose, einem Lupushemmstoff oder hohen Faktor-VIII-Werten geeignete Kandidaten für eine Langzeitprävention.

Keywords

Venous thrombosis - recurrence - secondary thromboprophylaxis - vitamin K antagonists - risk factors

Schlüsselwörter

Venöse Thrombose - Rezidiv - sekundäre Thromboseprophylaxe - Vitamin-K-Antagonisten - Risikofaktoren

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