Extension of anticoagulation after venous thromboembolism

S. Schulman

doi:10.1055/s-0037-1617168

Hämostaseologie, Table of Contents

Hamostaseologie 2008; 28(03): 110-119
DOI: 10.1055/s-0037-1617168

Original Article

Schattauer GmbH

Extension of anticoagulation after venous thromboembolism

Risk factors influencing the decisionVerlängerung der antikoagulativen Behandlung nach venöser ThromboembolieEntscheidungsrelevante Risikofaktoren

Authors

S. Schulman

¹Department of Medicine, McMaster University, Hamilton, Ontario, Canada, and Coagulation Unit, Department of Hematology, Karolinska University Hospital, Stockholm, Sweden

Abstract

Summary

Whereas every clinician agrees on the need for anticoagulation initially after the diagnosis of venous thromboembolism (VTE), the opinions regarding optimal duration of secondary prophylaxis differ. The decision is complicated by the large number of identified risk factors associated with the risk of recurrence. In addition consideration has to be taken to the risk factors for bleeding and individual patient preferences. Data from long-term follow-up studies up to a decade indicate that some risk factors for recurrence decline and others seem to gain importance with time. In this review data has been extracted from the most illustrative trials to highlight controversies but also where there is consensus in order to give the clinician some support for the individual decisions on extension of anticoagulation after VTE.

Zusammenfassung

Während unter den Ärzten dahingehend Konsens herrscht, dass sofort eine Antikoagulanzientherapie einzuleiten ist, wenn eine venöser Thromboembolie (VTE) diagnostiziert wird, gehen die Meinungen bezüglich der optimalen Dauer der sekundären Thromboseprophylaxe auseinander. Die Entscheidung wird durch die große Anzahl nachgewiesener Risikofaktoren erschwert, die das Rezidivrisiko bedingen. Darüber hinaus sind die Risikofaktoren für das Auftreten von Blutungen und die Präferenzen der Patienten zu berücksichtigen. Daten aus Langzeitstudien, deren Follow-up bis zu zehn Jahren betrug, weisen darauf hin, dass bestimmte Rezidivrisikofaktoren mit der Zeit an Bedeutung verlieren, während andere im Laufe der Zeit größeres Gewicht erlangen. Dieser Überblick enthält Daten aus den aussagekräftigsten Studien. Es soll gezeigt werden, wo gegensätzliche Ansichten vorliegen und wo Konsens besteht. Der Arzt erhält damit eine Entscheidungshilfe bei der Festlegung der Dauer der Antikoagulanzientherapie nach VTE. Verlängerung der antikoagulativen Behandlung nach venöser Thromboembolie Entscheidungsrelevante Risikofaktoren

Keywords

Venous thromboembolism - risk factors - recurrence - bleeding

Schlüsselwörter

Venöse Thromboembolie - Risikofaktoren - Rückfall - Blutung

Full Text

References

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