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[Continued anticoagulation for unprovoked venous thromboembolism: guidance through the maze of recent studies]

F A Klok1, M V Huisman

  • 1Leids Universitair Medisch Centrum, afd. Trombose en Hemostase, Leiden.

Nederlands Tijdschrift Voor Geneeskunde
|August 24, 2017
PubMed

Insights

Guidelines recommend indefinite anticoagulation for unprovoked venous thromboembolism (VTE) unless high bleeding risk exists. Direct oral anticoagulants (DOACs) are preferred for long-term VTE treatment due to lower bleeding risks compared to Vitamin K antagonists.

Area of Science:

  • Cardiology
  • Hematology
  • Pharmacology

Background:

  • Current guidelines suggest indefinite anticoagulation for unprovoked venous thromboembolism (VTE) if bleeding risk is low.
  • Treatment cessation is advised after three months for patients with untreatable bleeding risk factors.

Purpose of the Study:

  • To evaluate the efficacy and safety of anticoagulation therapies for unprovoked VTE.
  • To compare direct oral anticoagulants (DOACs) with Vitamin K antagonists (VKAs) for long-term VTE management.

Main Methods:

  • Review of recent American, European, and Dutch guidelines on VTE treatment.
  • Analysis of data comparing DOACs and VKAs regarding recurrent VTE and major bleeding events.
  • Consideration of specific DOACs like apixaban and rivaroxaban for long-term use.

Main Results:

  • Both VKAs and DOACs reduce recurrent VTE but carry a risk of major bleeding.
  • DOACs demonstrate a lower major bleeding risk compared to VKAs.
  • Reduced-dose apixaban is available for long-term treatment; reduced-dose rivaroxaban showed superiority over aspirin.

Conclusions:

  • Indefinite anticoagulation is recommended for unprovoked VTE in patients without high bleeding risk.
  • DOACs are the preferred long-term treatment option for unprovoked VTE due to a more favorable bleeding profile.
  • Specific DOACs offer effective and safer long-term management strategies for VTE.

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