Key result
Long-term anticoagulation reduces recurrent venous thromboembolism, but major bleeding limits indefinite therapy.
Why the study?
Indefinite anticoagulant treatment for venous thromboembolism is constrained by the risk of major bleeding and the inconvenience of monitoring, dose adjustment, and drug-food interactions.
Answers are grounded in this paper and cite their sources.
This review outlines the principles of long-term anticoagulation in venous thromboembolism, balancing recurrence risk in unprovoked and cancer-associated cases against bleeding risks and monitoring constraints.
Long term treatment of venous thromboembolism is essential to complete therapy of the index episode and to reduce recurrences. Vitamin K antagonists are the mainstay for the long term treatment of venous thromboembolism for the majority of the patients as they allow oral administration. Low-molecular weight heparins are recommended for the long term treatment of cancer patients. The duration of long term anticoagulation depends on the features of the index venous thromboembolism and on the presence of associated risk factors. Patients at high risk for recurrence - mainly those who suffered unprovoked venous thromboembolism and those with cancer - should be evaluated for extended anticoagulation. The risk for major bleeding complications and the inconvenience for monitoring, dose adjustment and drug-food interactions are the main constraints for indefinite anticoagulant treatment. New anticoagulants with more favourable efficacy- safety profile and reduced need for monitoring could improve the feasibility of extended anticoagulation.
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Becattini et al. (2014) conducted a review in Venous thromboembolism. Long-term anticoagulation (vitamin K antagonists, low-molecular-weight heparins, new anticoagulants) was evaluated on Venous thromboembolism recurrence and major bleeding complications. Long-term anticoagulation with vitamin K antagonists or low-molecular-weight heparins reduces venous thromboembolism recurrence, though major bleeding and monitoring limit indefinite use.
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