Stopping oral anticoagulants in patients with residual vein thrombosis yielded a recurrent event rate of 27.2% compared to 19.3% with continuation (HR 1.58; 95% CI 0.85-2.93; P=0.145).
RCT (n=258)
randomized
Does continuing oral anticoagulants for 9 additional months reduce recurrent venous thromboembolism and/or major bleeding in patients with a first episode of deep vein thrombosis and residual vein thrombosis?
Absence of residual vein thrombosis on ultrasound after 3 months of anticoagulation for a first DVT identifies a low-risk group that can safely discontinue therapy.
Effect estimate: HR 1.58 (95% CI 0.85-2.93)
Absolute Event Rate: 27.2% vs 19.3%
p-value: p=.145
Residual vein thrombosis (RVT) indicates a prothrombotic state and is useful for evaluating the optimal duration of oral anticoagulant treatment (OAT). Patients with a first episode of deep vein thrombosis, treated with OAT for 3 months, were managed according to RVT findings. Those with RVT were randomized to either stop or continue anticoagulants for 9 additional months, whereas in those without RVT, OAT was stopped. Outcomes were recurrent venous thromboembolism and/or major bleeding. Residual thrombosis was detected in 180 (69.8%) of 258 patients; recurrent events occurred in 27.2% of those who discontinued (25/92; 15.2% person-years) and 19.3% of those who continued OAT (17/88; 10.1% person-years). The relative adjusted hazard ratio (HR) was 1.58 (95% confidence interval CI, 0.85-2.93; P = .145). Of the 78 (30.2%) patients without RVT, only 1 (1.3%; 0.63% person-years) had a recurrence. The adjusted HR of patients with RVT versus those without was 24.9 (95% CI, 3.4-183.6; P = .002). One major bleeding event (1.1%; 0.53% person-years) occurred in patients who stopped and 2 occurred (2.3%; 1.1% person-years) in those who continued OAT. Absence of RVT identifies a group of patients at very low risk for recurrent thrombosis who can safely stop OAT. This trial was registered at http://www.ClinicalTrials.gov as no. NCT00438230.
Siragusa et al. (Thu,) conducted a rct in deep vein thrombosis (n=258). stop anticoagulants vs. continue anticoagulants was evaluated on recurrent venous thromboembolism and/or major bleeding (HR 1.58, 95% CI 0.85-2.93, p=.145). Stopping oral anticoagulants in patients with residual vein thrombosis yielded a recurrent event rate of 27.2% compared to 19.3% with continuation (HR 1.58; 95% CI 0.85-2.93; P=0.145).