Background Treatment for venous thromboembolism (VTE) has shifted from vitamin K antagonists (VKAs) to direct oral anticoagulants (DOACs), with increased use of indefinite therapy. However, data on bleeding and recurrence outcomes associated with these changes remain limited. Aims To evaluate the risk of major bleeding (MB), clinically relevant bleeding (CRNMB), and recurrence with changing treatment patterns. Methods Cancer-free VTE patients were identified in the Venous Thrombosis Registry in Østfold Hospital (TROLL registry), Norway, from January 2005 to May 2020, and categorized into Period 1 (2005-2012), Period 2 (2013-2016), and Period 3 (2017-2020). MB and CRNMB rates during anticoagulant treatment, and recurrence rates after anticoagulant discontinuation were assessed. Subhazard ratios (sHRs) were calculated using Fine-Gray analysis for time-period comparisons. Results Among 3,839 patients (48% female, median age 67 years; IQR, 54-78), VKA use decreased from 76% in Period 1 to 2% in Period 3, while DOAC use increased from 1% to 85%. The MB rate ranged from 5.6 (95% CI: 3.9-6.4) per 100 person-years in Period 2 to 3.1 (2.3-4.2) in Period 3. The CRNMB rate increased from 5.4 (95% CI: 4.3-6.9) per 100 person-years in Period 1 to 7.7 (6.3-9.5) in Period 3, sHR 1.87 (1.36-2.56). Conversely, the recurrence rate decreased from 5.1 (95% CI: 4.6-5.6) per 100 person-years after anticoagulant discontinuation in Period 1 to 3.9 (3.2-4.9) in Period 3, sHR 0.51 (0.41-0.65). Conclusion VTE recurrences after anticoagulant discontinuation declined, likely due to indefinite treatment in patients at high risk of recurrence, while CRNMB rates increased over time.
Sandblad et al. (Fri,) studied this question.