Extended DOAC therapy reduced the incidence of recurrent VTE compared with placebo or aspirin (RR 0.25; 95% CI 0.07-0.98) without a clear excess risk of major bleeding.
Meta-Analysis (n=2,498)
Does extended DOAC therapy reduce recurrent VTE in adults with provoked VTE and persistent non-malignant risk factors?
Extended DOAC therapy significantly reduces the risk of recurrent VTE in patients with provoked VTE and persistent non-malignant risk factors, without a significant increase in major bleeding.
Relative Risk: 0.25 (95% CI 0.07–0.98)
Abstract Background Patients with venous thromboembolism (VTE) triggered by transient factors are typically treated with anticoagulants for 3–6 months. However, those with coexisting long-term non-malignant conditions may continue to carry a meaningful risk of recurrence beyond the initial treatment period. The benefit of extended anticoagulation in this subgroup remains uncertain. Objectives To evaluate the efficacy and safety of continued and reduced-dose direct oral anticoagulant (DOAC) therapy compared with no extended anticoagulation or aspirin in patients with provoked VTE and persistent non-malignant risk factors. Methods We performed a systematic review and meta-analysis of randomised controlled trials in accordance with PRISMA guidelines. MEDLINE, Embase and CENTRAL were searched from inception through 15 October 2025. Eligible trials enrolled adults with provoked VTE and persistent non-malignant risk factors who had completed initial anticoagulation and compared extended DOAC therapy with placebo, aspirin or discontinuation. Primary outcomes were recurrent VTE and major bleeding. Risk ratios (RRs) were pooled using random-effects models, with fixed-effects analyses as sensitivity. Results Three trials, including 2498 participants, were analysed. Continued DOAC therapy was associated with a lower incidence of recurrent VTE compared with placebo or aspirin (RR 0.25, 95% confidence interval CI 0.07–0.98; I 2 34%). Reduced-dose regimens demonstrated comparable effectiveness (RR 0.21, 95% CI 0.11–0.41). Major bleeding events were infrequent across all groups, and no clear excess risk was observed with extended therapy (RR 2.38, 95% CI 0.87–6.53; I 2 0%). Conclusion Among patients with provoked VTE and ongoing non-malignant risk factors, extended DOAC therapy appears to reduce recurrence without a definite increase in major bleeding. These findings support a more individualised approach to treatment duration in this intermediate-risk population.
Mantoo et al. (2026) conducted a meta-analysis in Provoked VTE with persistent non-malignant risk factors (n=2,498). Extended DOAC therapy vs. Placebo, aspirin, or discontinuation was evaluated on Recurrent VTE (RR 0.25, 95% CI 0.07-0.98). Extended DOAC therapy reduced the incidence of recurrent VTE compared with placebo or aspirin (RR 0.25; 95% CI 0.07-0.98) without a clear excess risk of major bleeding.