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Duration of Anticoagulant Therapy After Venous Thromboembolism

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Antithrombotic Drug Therapy in Cardiovascular Disease

Part of the book series: Contemporary Cardiology ((CONCARD))

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Abstract

Long-term treatment of venous thromboembolism (VTE) primarily focuses on the duration of anticoagulant therapy, usually with vitamin K antagonists (VKA). The duration of therapy should be individualized based on the risk of recurrent VTE if treatment is stopped and the risk of bleeding if treatment is continued. The risk of recurrence is low if thrombosis was provoked by a reversible risk factor such as surgery; 3 months of treatment is usually adequate for such patients. The risk of recurrence is high if thrombosis was associated active cancer; indefinite anticoagulant therapy, with low-molecular-weight heparin for at least the first 3 months, is often indicated for such patients. Risk of recurrence is interme­diate if thrombosis was an unprovoked proximal deep vein thrombosis or pulmonary embolism; indefinite anticoagulant therapy is often appropriate for such patients. Among patients with unprovoked proximal deep vein thrombosis or pulmonary embolism, more than one previous episode of VTE, presentation as pulmonary embolism, male sex, and a positive D-dilmer test 1 month after stopping anticoagulant therapy, particularly favor indefinite anticoagulant therapy. High risk of bleeding and patient preference favor treatment for only 3 months. New anticoagulants, that may improve the risk: benefit ratio of anticoagulant therapy and should reduce the burden of therapy, are expected to be available soon.

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  1. Department of Medicine, McMaster University, Hamilton, ON, Canada

    Clive Kearon MB, MRCPI, FRCPC, PhD

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  1. Clive Kearon MB, MRCPI, FRCPC, PhD
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  1. Western Reserve Heart Care, Corporate Dr. 1335, Hudson, 44236, U.S.A.

    Arman T. Askari

  2. Dept. Cardiovascular Medicine, Cleveland Clinic, Euclid Ave. 9500, Cleveland, 44195, U.S.A.

    A. Michael Lincoff

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Kearon, C. (2010). Duration of Anticoagulant Therapy After Venous Thromboembolism. In: Askari, A., Lincoff, A. (eds) Antithrombotic Drug Therapy in Cardiovascular Disease. Contemporary Cardiology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-235-3_19

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