Author(s): Siragusa S, Malato A, Saccullo G, Iorio A, Di Ianni M,
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Abstract The safest duration of anticoagulation after idiopathic deep vein thrombosis (DVT) is unknown. We conducted a prospective study to assess the optimal duration of vitamin K antagonist (VKA) therapy considering the risk of recurrence of thrombosis according to residual vein thrombosis (RVT). Patients with a first unprovoked DVT were evaluated for the presence of RVT after 3 months of VKA administration; those without RVT suspended VKA, while those with RVT continued oral anticoagulation for up to 2 years. Recurrent thrombosis and/or bleeding events were recorded during treatment (RVT group) and 1 year after VKA withdrawal (both groups). Among 409 patients evaluated for unprovoked DVT, 33.2\% (136 of 409 patients) did not have RVT and VKA was stopped. The remaining 273 (66.8\%) patients with RVT received anticoagulants for an additional 21 months; during this period of treatment, recurrent venous thromboembolism and major bleeding occurred in 4.7\% and 1.1\% of patients, respectively. After VKA suspension, the rates of recurrent thrombotic events were 1.4\% and 10.4\% in the no-RVT and RVT groups, respectively (relative risk = 7.4; 95\% confidence interval = 4.9-9.9). These results indicate that in patients without RVT, a short period of treatment with a VKA is sufficient; in those with persistent RVT, treatment extended to 2 years substantially reduces, but does not eliminate, the risk of recurrent thrombosis. TRIAL REGISTRATION: ClinicalTrials.gov NCT00623987. Copyright © 2011 Wiley-Liss, Inc.
This article was published in Am J Hematol
and referenced in Autism-Open Access