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Long-Term Management of Venous Thromboembolism: Strategies for Reducing the Risk of Recurrence

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Handbook for Venous Thromboembolism

Abstract

Long-term care of patients with venous thromboembolism (VTE) includes determining the optimal duration of anticoagulation after VTE. Selection of the optimal duration and drug regimen requires an individualized assessment of the patient’s long-term risk of recurrence as well as bleeding. Warfarin and non-vitamin K oral anticoagulants (NOACs) have been validated for extended duration anticoagulation to prevent recurrent unprovoked VTE. Aspirin also plays a role in the prevention of recurrence in patients with unprovoked VTE.

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References

  1. Goldhaber SZ, Piazza G. Optimal duration of anticoagulation after venous thromboembolism. Circulation. 2011;123:664–7.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141:e419S–94.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. Piazza G. Venous thromboembolism and cancer. Circulation. 2013;128:2614–8.

    Article  PubMed  Google Scholar 

  4. Palareti G, Cosmi B, Legnani C, et al. D-dimer testing to determine the duration of anticoagulation therapy. N Engl J Med. 2006;355:1780–9.

    Article  CAS  PubMed  Google Scholar 

  5. Kearon C, Spencer FA, O'Keeffe D, et al. D-dimer testing to select patients with a first unprovoked venous thromboembolism who can stop anticoagulant therapy: a cohort study. Ann Intern Med. 2015;162:27–34.

    Article  PubMed  Google Scholar 

  6. Ridker PM, Goldhaber SZ, Danielson E, et al. Long-term, low-intensity warfarin therapy for the prevention of recurrent venous thromboembolism. N Engl J Med. 2003;348:1425–34.

    Article  CAS  PubMed  Google Scholar 

  7. Kearon C, Ginsberg JS, Kovacs MJ, et al. Comparison of low-intensity warfarin therapy with conventional-intensity warfarin therapy for long-term prevention of recurrent venous thromboembolism. N Engl J Med. 2003;349:631–9.

    Article  CAS  PubMed  Google Scholar 

  8. Agnelli G, Buller HR, Cohen A, et al. Apixaban for extended treatment of venous thromboembolism. N Engl J Med. 2013;368:699–708.

    Article  CAS  PubMed  Google Scholar 

  9. Bauersachs R, Berkowitz SD, Brenner B, et al. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med. 2010;363:2499–510.

    Article  CAS  PubMed  Google Scholar 

  10. Schulman S, Kearon C, Kakkar AK, et al. Extended use of dabigatran, warfarin, or placebo in venous thromboembolism. N Engl J Med. 2013;368:709–18.

    Article  CAS  PubMed  Google Scholar 

  11. Becattini C, Agnelli G, Schenone A, et al. Aspirin for preventing the recurrence of venous thromboembolism. N Engl J Med. 2012;366:1959–67.

    Article  CAS  PubMed  Google Scholar 

  12. Brighton TA, Eikelboom JW, Mann K, et al. Low-dose aspirin for preventing recurrent venous thromboembolism. N Engl J Med. 2012;367:1979–87.

    Article  CAS  PubMed  Google Scholar 

  13. Simes J, Becattini C, Agnelli G, et al. Aspirin for the prevention of recurrent venous thromboembolism: the INSPIRE collaboration. Circulation. 2014;130:1062–71.

    Article  CAS  PubMed  Google Scholar 

  14. Ageno W, Becattini C, Brighton T, Selby R, Kamphuisen PW. Cardiovascular risk factors and venous thromboembolism: a meta-analysis. Circulation. 2008;117:93–102.

    Article  PubMed  Google Scholar 

  15. Parkin L, Sweetland S, Balkwill A, Green J, Reeves G, Beral V. Body mass index, surgery, and risk of venous thromboembolism in middle-aged women: a cohort study. Circulation. 2012;125:1897–904.

    Article  PubMed  Google Scholar 

  16. Rosengren A, Freden M, Hansson PO, Wilhelmsen L, Wedel H, Eriksson H. Psychosocial factors and venous thromboembolism: a long-term follow-up study of Swedish men. J Thromb Haemost. 2008;6:558–64.

    Article  CAS  PubMed  Google Scholar 

  17. Piazza G, Goldhaber SZ. Venous thromboembolism and atherothrombosis. Circulation. 2010;121:2146–50.

    Article  PubMed  Google Scholar 

  18. Prandoni P, Bilora F, Marchiori A, et al. An association between atherosclerosis and venous thrombosis. N Engl J Med. 2003;348:1435–41.

    Article  PubMed  Google Scholar 

  19. Spencer FA, Ginsberg JS, Chong A, Alter DA. The relationship between unprovoked venous thromboembolism, age, and acute myocardial infarction. J Thromb Haemost. 2008;6:1507–13.

    CAS  PubMed  Google Scholar 

  20. Sorensen HT, Horvath-Puho E, Pedersen L, Baron JA, Prandoni P. Venous thromboembolism and subsequent hospitalisation due to acute arterial cardiovascular events: a 20-year cohort study. Lancet. 2007;370:1773–9.

    Article  PubMed  Google Scholar 

  21. Steffen LM, Folsom AR, Cushman M, Jacobs Jr DR, Rosamond WD. Greater fish, fruit, and vegetable intakes are related to lower incidence of venous thromboembolism: the Longitudinal Investigation of Thromboembolism Etiology. Circulation. 2007;115:188–95.

    Article  CAS  PubMed  Google Scholar 

  22. Goldhaber SZ, Morrison RB. Cardiology patient pages. Pulmonary embolism and deep vein thrombosis. Circulation. 2002;106:1436–8.

    Article  PubMed  Google Scholar 

  23. Douketis JD, Gu C, Piccioli A, Ghirarduzzi A, Pengo V, Prandoni P. The long-term risk of cancer in patients with a first episode of venous thromboembolism. J Thromb Haemost. 2009;7:546–51.

    Article  CAS  PubMed  Google Scholar 

  24. Sorensen HT, Johnsen SP. Venous thromboembolism and subsequent short-term risk of an occult cancer. J Thromb Haemost. 2008;6:249–50.

    Article  CAS  PubMed  Google Scholar 

  25. Trujillo-Santos J, Prandoni P, Rivron-Guillot K, et al. Clinical outcome in patients with venous thromboembolism and hidden cancer: findings from the RIETE Registry. J Thromb Haemost. 2008;6:251–5.

    Article  CAS  PubMed  Google Scholar 

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Piazza, G., Hohlfelder, B., Goldhaber, S.Z. (2015). Long-Term Management of Venous Thromboembolism: Strategies for Reducing the Risk of Recurrence. In: Handbook for Venous Thromboembolism. Springer, Cham. https://doi.org/10.1007/978-3-319-20843-5_10

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  • DOI: https://doi.org/10.1007/978-3-319-20843-5_10

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-20842-8

  • Online ISBN: 978-3-319-20843-5

  • eBook Packages: MedicineMedicine (R0)

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