The Risk for Fatal Pulmonary Embolism after Discontinuing Anticoagulant Therapy for Venous Thromboembolism

Douketis, James D.; Gu, Chu Shu; Schulman, Sam; Ghirarduzzi, Angelo; Pengo, Vittorio; Prandoni, Paolo

doi:10.7326/0003-4819-147-11-200712040-00007

Cited by 199 publications

(122 citation statements)

References 26 publications

Supporting

Mentioning

113

Contrasting

Unclassified

Order By: Relevance

“…These facts might well account for the difference between the study by Heit et al and the present study. Douketis et al [11] evaluated the survival rate in two cohorts of patients (one Italian and one Canadian, in total 2052 patients), data of these cohorts were combined. Similar to our results, patients with spontaneous thrombosis had a worse survival, whereas there was not much difference in survival with regard to the site of the venous thromboembolic event.…”

Section: Discussionmentioning

confidence: 99%

“…[2,9]. Factors influencing the survival rate in thrombosis patients are as follows: time since onset of thrombosis [10], age [11], idiopathic thrombosis [10,11] and, most importantly, cancer [10,12]. Studies comparing survival rates of patients with a history of thrombosis to the survival of the general population are scarce and show considerable variability [10,12,13].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Long-term survival of patients with a history of venous thromboembolism

et al. 2011

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Long-term survival of patients with a history of venous thromboembolism

et al. 2011

View full text Add to dashboard Cite

“…The annual risk of recurrent VTE after a first idiopathic VTE is about 10% during the first 2 years, and then about 3%, which gives a cumulative recurrence rate of 20% at 3 years and 40% at 5 years. 18 Recently, a case-fatality rate for VTE after treatment discontinuation of 8% (idiopathic DVT) to 12% (idiopathic PE) could be established by Douketis et al 22 in a pooled analysis of the DURAC I study 9 and an Italian study 18 in more than 2000 patients who were followed for several years. On the other hand, annual risks of major bleeding have been reported in 2% to 12% in controlled studies, 24 or even 29% 25 in the RIETE Registry with a case-fatality rate of 10% 26 to 33%.…”

Section: Balancing the Risk Of Vte Recurrence And The Risk Of Bleedingmentioning

confidence: 99%

“…In addition, the first 2 years following the treatment discontinuation seem to represent a higher-risk period than the subsequent years. 22 …”

Section: Evaluating the Risk Of Thromboembolic Recurrencementioning

confidence: 99%

Duration of Anticoagulation Therapy for Venous Thromboembolism

Bounameaux¹,

Perrier²

2008

Hematology

View full text Add to dashboard Cite

Treatment of acute deep vein thrombosis and pulmonary embolism-often denominated together as venous thromboembolism (VTE)-consists of parenteral administration of heparin (usually low-molecularweight heparin or alternatively unfractionated heparin or fondaparinux) overlapped and followed by oral vitamin K antagonists that are administered for a certain period (usually 3 to 12 months). Recommended or suggested durations differ according to guidelines. Practically, the clinical decision in an individual patient depends upon the estimated risks of VTE recurrence and treatment-induced bleeding. The risk of VTE recurrence is higher in idiopathic events (about 10% per year during the first two years and 3% per year thereafter) (odds ratio of 2.4, compared to secondary events); in male subjects (at least before the age of 60, with an odds ratio of 2-4); in patients with persistently elevated D-dimer level (odds ratio of 2.3, compared with normal level); and during the first two years after discontinuation of treatment. The annual risk of major bleeding on anticoagulant treatment vary largely in observational studies with figures of 2% to 29%, depending on the patient characteristics. The case-fatality rate is 8% (DVT), 12% (PE) for recurrent VTE, and about 10% for major bleed. These figures do not support long-term anticoagulant therapy, except in those patients exhibiting a very high risk of recurrence and/or a very low risk of bleeding.New therapeutic aspects might impact on the duration of anticoagulant therapy after a venous thromboembolic event. They include the possibility of pursuing anticoagulant treatment at a reduced INR after an initial period with an INR 2-3, and the advent of new, more specific and orally active anticoagulants. These features might modify the risk-benefit balance of extending anticoagulant therapy beyond the usual, limited duration.

show abstract

“…older age, malignancy, trauma, major surgery, immobilization, female hormone therapy, pregnancy) as compared to provoked ones [6]. Case-fatality rate of VTE recurrence was reported as 5-12% [8]. Patients affected by VTE recurrence are predisposed to chronic pulmonary hypertension and recurrent PE that is reported to be fatal in 4-9% cases [8][9][10].…”

Section: Introductionmentioning

confidence: 99%