Update on the Treatment of Venous Thromboembolism

During the past 7 years, results from phase III trials comparing nonvitamin antagonist K oral anticoagulants (NOACs) with vitamin K antagonists (VKAs) or with placebo, including 34,900 patients, have been published. Recent guidelines have been updated and now suggest treatment with NOACs rather than with VKA. Other updates in the guidelines concern the initial thrombolytic treatment for selected patients with deep vein thrombosis or pulmonary embolism as well as the possibility of withholding anticoagulation for minimal venous thromboembolism. The optimal duration of anticoagulation after an unprovoked event is still debatable, depending on values and preferences assigned to recurrent thromboembolism versus bleeding complications. The choice is essentially between a short duration of 3 or perhaps 6 months for extensive thromboembolism and indefinite duration. Several clinical prediction rules have been developed to aid in this choice but they all address only the risk of recurrent thrombosis without weighing in the risk of bleeding. This review provides an update on recent systematic reviews, meta-analyses, and guidelines on the treatment of venous thromboembolism.