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[Prolonged Secondary Prevention After Venous Thromboembolism]
1Klinik für Gefäßmedizin, Angiologie, Klinikum Darmstadt GmbH, Darmstadt.
Deutsche Medizinische Wochenschrift (1946)
|February 7, 2018
Summary
Discontinuing oral anticoagulation (OAC) significantly increases VTE recurrence risk. A traffic light system aids OAC duration decisions, favoring reduced-dose direct oral anticoagulants (DOACs) for long-term prevention.
Area of Science:
- Cardiology
- Hematology
- Pharmacology
Background:
- Discontinuation of oral anticoagulation (OAC) shortly after a venous thromboembolism (VTE) event leads to a 2- to 3-fold increase in recurrence.
- The risk of VTE recurrence is elevated in patients with unprovoked VTE, minor provoking factors, or persistent risk factors like active cancer.
Purpose of the Study:
- To review risk factors for VTE and discuss strategies for secondary prevention.
- To evaluate the efficacy and safety of direct oral anticoagulants (DOACs) and aspirin for long-term VTE prevention.
- To introduce a risk stratification system for guiding anticoagulation duration.
Main Methods:
- Review of recent studies and a guidance document on VTE risk factors.
- Analysis of data regarding the use of DOACs and aspirin for secondary VTE prevention.
- Description of a traffic light system for categorizing VTE recurrence risk.
Main Results:
- Reduced-dose DOACs are effective for long-term secondary VTE prevention with a low bleeding risk.
- Aspirin is less effective than OACs for preventing recurrent VTE and does not reduce major bleeding risk.
- A traffic light system stratifies patients into low, intermediate, or high recurrence risk groups, guiding OAC decisions.
Conclusions:
- A traffic light system provides clear guidance for OAC discontinuation or continuation.
- For prolonged anticoagulation, a reduced-dose DOAC regimen may be considered to balance efficacy and bleeding risk.
- Aspirin is not recommended for secondary VTE prevention due to lower efficacy and similar bleeding risk compared to OACs.
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