Currently available
anticoagulants are effective in reducing the recurrence rate of
venous thromboembolism (VTE). However,
anticoagulant treatment is associated with an increased risk for
bleeding complications. Thus, anticoagulation has to be discontinued when benefit of treatment no longer clearly outweigh its risks. The duration of
anticoagulant treatment is currently framed based on the estimated individual risk for recurrent VTE. The incidence of recurrent VTE can be estimated through a two-step decision algorithm. Firstly, the features of the patient (gender), of the initial event (proximal or distal
deep vein thrombosis or
pulmonary embolism), and the associated conditions (
cancer, surgery, etc) provide essential information on the risk for recurrence after
anticoagulant treatment discontinuation. Secondly, at time of
anticoagulant treatment discontinuation,
D: -dimer levels and residual
thrombosis have been indicated as predictors of recurrent VTE. Current evidence suggests that the risk of recurrence after stopping
therapy is largely determined by whether the acute episode of VTE has been effectively treated and by the patient's intrinsic risk of having a new episode of VTE. All patients with acute VTE should receive oral
anticoagulant treatment for three months. At the end of this treatment period, physicians should decide for withdrawal or indefinite anticoagulation. Based on intrinsic patient's risk for recurrent VTE and for
bleeding complications and on patient preference, selected patients could be allocated to indefinite treatment with VKA with scheduled periodic re-assessment of the benefit from extending anticoagulation. Alternative strategies for
secondary prevention of VTE to be used after conventional anticoagulation are currently under evaluation.
Cancer patients should receive
low molecular-weight heparin over
warfarin in the long-term treatment of VTE. These patients should be considered for extended anticoagulation at least until resolution of underlying disease. The risk for recurrent
venous thromboembolism can be estimated through a two-step algorithm. Firstly, the features of the patient (gender), of the initial event (proximal or distal
deep vein thrombosis or
pulmonary embolism), and the associated conditions (
cancer, surgery, etc) are essential to estimate the risk for recurrence after
anticoagulant treatment discontinuation. Secondly, a correlation has been shown between
D: -dimer levels and residual
thrombosis at time of
anticoagulant treatment discontinuation and the risk of recurrence. Currently available
anticoagulants are effective in reducing the incidence of recurrent
venous thromboembolism, but they are associated with an increased risk for
bleeding complications. All patients with acute
venous thromboembolism should receive oral
anticoagulant treatment for three months. At the end of this treatment period physicians should decide for definitive withdrawal or indefinite anticoagulation with scheduled periodic re-assessment of the benefit from extending anticoagulation.