Comparison of 1 month with 3 months of anticoagulation for a first episode of venous thromboembolism associated with a transient risk factor

Kearon, Clive; Ginsberg, Jeffrey S.; Anderson, David R.; Kovacs, Michael J.; Wells, Phillip S.; Julian, Jim A.; MacKinnon, Betsy; Demers, Christine; Douketis, James D.; Turpie, Alexander G. G.; Nguyen, P.; Green, D.; Kassis, Jeannine; Kahn, Susan R.; Solymoss, Susan; Desjardins, Louis; Geerts, W.; Johnston, Marilyn; Weitz, Jeffrey I.; Hirsh, Jack; Gent, Michael

doi:10.1046/j.1538-7836.2004.00698.x

Cited by 131 publications

(115 citation statements)

References 27 publications

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“…at least 3 months duration in the case of a transient risk factor for VTE and at least 6 months in the case of persistent risk factors or absence of a clear risk factor [1,2]. These recommendations are based on landmark trials that compared shorter (4-6 weeks) to both standard (3-6 months) and extended (6-24 months) treatment durations [1,2,[68][69][70][71][72]. From these studies, it became clear that extended anticoagulation therapy with VKAs is very effective in preventing VTE recurrence, but also that the risk/benefit ratio of extended treatment after the first 3-6-month period is controversial because of the relatively frequent occurrence of major bleeding episodes (table 1).…”

Section: Treatment Durationmentioning

confidence: 99%

Predicting anticoagulant-related bleeding in patients with venous thromboembolism: a clinically oriented review

et al. 2014

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Diagnosis of venous thromboembolism (VTE) requires prompt treatment with anticoagulants in therapeutic doses. Since these drugs are associated with the occurrence of haemorrhage, identification of patients at increased risk of major bleeding is of utmost clinical importance for defining the optimal treatment regimen and duration of anticoagulation. Current suggested prediction scores for bleeding risk in VTE patients have been derived from observational studies of moderate quality, or from patients with various indications for therapeutic anticoagulation other than VTE. To date, none of the scores have been adequately validated in cohorts that underwent dedicated monitoring and independent adjudication of bleeding complications. In addition, while the scarce available evidence has focused on patients treated with heparins and/or vitamin K antagonists, risk stratification scores for bleeding complications in VTE patients treated with non-vitamin K dependent anticoagulants have not yet been developed. This clinically oriented review covers the incidence and risk factors of anticoagulation-related bleeding in VTE patients treated with different anticoagulant drugs as well as the available bleedingprediction scores. Further, we attempt to provide guidance for bleeding-prevention in clinical practice and speculate on developments in the near future that may fundamentally change our current thinking on VTE management. @ERSpublications Bleeding in VTE: no validated risk-prediction scores, no effective preventive measures: are NOACs the solution?

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Section: Treatment Durationmentioning

confidence: 99%

Predicting anticoagulant-related bleeding in patients with venous thromboembolism: a clinically oriented review

et al. 2014

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“…2,3,6,24 The power of these studies to detect a difference was limited, since recurrent VTE is a rare event. By pooling the results of many studies, this metaanalysis suggests that long-term anticoagulation reduces the risk of recurrent VTE.…”

Section: Commentmentioning

confidence: 99%

Duration of Anticoagulation Following Venous Thromboembolism

Ost¹,

Tepper²,

Mihara³

et al. 2005

JAMA

129

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“…Warfarin is given for a minimum of three months in persons with secondary venous thromboembolism (i.e. associated with a major transient risk factor) and for a minimum of six months for persons with an unprovoked or idiopathic episode [1][2][3]. Persons who suffer an unprovoked episode of venous thromboembolism are often found to have an underlying thrombophilia such as lupus anticoagulant or Protein C or S deficiency and may be candidates for indefinite oral anticoagulant therapy.…”

Section: Low Intensity Vs Standard Intensity Therapymentioning

confidence: 99%

The Standard is Still the Standard or Why an INR of 2–3 is Still the Optimal Intensity for Secondary Prevention of Venous Thromboembolism

Kovacs

2006

J Thromb Thrombolysis

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The optimal intensity of warfarin anticoagulation for secondary prevention of venous thromboembolism is debatable. Recent studies have shed light on the issue. The two pivotal studies, ELATE and PREVENT, are reviewed and discussed. Although the ELATE and PREVENT studies offer different conclusions, the results of the two studies are consistent with each other. Low intensity warfarin is more efficacious than placebo, although it is less efficacious than standard intensity and offers no safety advantage. For long term secondary prophylaxis of spontaneous venous thromboembolism, the optimal INR intensity of warfarin remains 2.0-3.0.

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Comparison of 1 month with 3 months of anticoagulation for a first episode of venous thromboembolism associated with a transient risk factor

Abstract: Duration of anticoagulant therapy for venous thromboembolism provoked by a transient risk factor should not be reduced from 3 months to 1 month as this is likely to increase recurrent venous thromboembolism without achieving a clinically important decrease in bleeding.

Cited by 131 publications

References 27 publications

Predicting anticoagulant-related bleeding in patients with venous thromboembolism: a clinically oriented review

Predicting anticoagulant-related bleeding in patients with venous thromboembolism: a clinically oriented review

Duration of Anticoagulation Following Venous Thromboembolism

The Standard is Still the Standard or Why an INR of 2–3 is Still the Optimal Intensity for Secondary Prevention of Venous Thromboembolism

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