Key result
Longer duration of Vitamin K antagonist therapy significantly reduced the rate of recurrent venous thromboembolism compared with shorter duration therapy (OR 0.75).
Why the study?
The optimal duration of oral anticoagulant therapy for patients with VTE remains highly uncertain in clinical practice.
Does longer duration of Vitamin K Antagonist therapy reduce recurrent VTE in patients with venous thromboembolism?
Meta-Analysis (n=3,109)
Does longer duration of Vitamin K Antagonist therapy reduce recurrent VTE in patients with venous thromboembolism?
Odds Ratio: 0.75 (95% CI 0.57–0.99)
Extended VKA therapy beyond 6 months significantly reduces recurrent VTE without a continuous significant increase in major bleeding risk after the initial 6-month peak.
May support extended VKA in VTE; leaves open need for RCTs before practice change.
BACKGROUND: The optimal duration of oral anticoagulant therapy for patients with venous thromboembolism (VTE) remains highly uncertain in clinical practice. It is essential to accurately assess the effect of anticoagulant therapy in reducing recurrent VTE against the risk of inducing major bleeding. METHODS: Randomized controlled trials were identified by searching PubMed, Web of Science, Embase, and the Cochrane library, reporting rates of recurrent VTE and major bleeding in patients taking Vitamin K Antagonists (VKA) with VTE and comparing different durations. RESULTS: Eleven RCTs with 3109 participants utilizing varied durations were included in the meta-analysis. Longer VKA therapy was associated with significantly lower rates of VTE recurrence compared with shorter duration of VKA therapy (OR 0.75, 95%CI 0.57-0.99), with significant difference noted in major bleeding risk (OR 2.31, 95%CI 1.17-4.56). During anticoagulation duration, patients treated by 6-month VKA had higher risk of major bleeding compared with 3-month VKA regimen (OR 33.45, 95%CI 2.00-559.67). CONCLUSIONS: Regimen longer than 6 months did not show statistical elevation of major bleeding risk. VKA treatment strongly reduces the risk of recurrent VTE during anticoagulation therapy. The absolute risk of recurrent VTE declines over time while the risk for major bleeding after 6 months' treatment did not demonstrate a continuous significant increase with extended duration of VKA therapy.
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Wang et al. (2020) conducted a meta-analysis in Venous thromboembolism (VTE) (n=3,109). Longer duration Vitamin K antagonists (VKA) therapy vs. Shorter duration VKA therapy was evaluated on Incidence of recurrent VTE (OR 0.75, 95% CI 0.57-0.99). Longer duration of Vitamin K antagonist therapy significantly reduced the rate of recurrent venous thromboembolism compared with shorter duration therapy (OR 0.75).
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