Extended anticoagulant use for unprovoked VTE linked to ‘con
Patients who continued to use anticoagulant therapy beyond the initial 3 to 6 months of treatment for a first unprovoked venous thromboembolism were at “considerable” risk for major bleeding, researchers wrote. Although physicians often suggest indefinite anticoagulant therapy after a first unprovoked venous thromboembolism or weakly provoked Venous thromboembolism, the net clinical benefit of anticoagulant therapy is beyond 3 to 6 months “is uncertain,” they wrote.

Researchers reviewed 14 randomized clinical trials and 13 cohort studies that analyzed adverse events among 17,202 patients with a first unprovoked VTE who received oral anticoagulant therapy for at least 6 additional months after completing a minimum of 3 months of initial anticoagulant treatment. Among the entire cohort, 9,982 patients received a vitamin K antagonist (VKA) and 7,220 received a direct oral anticoagulant (DOAC).

The researchers reported that the incidence of major bleeding for each 100 person-years was 1.74 events with vitamin K antagonists and 1.12 events with direct oral anticoagulants. The 5-year cumulative incidence of major bleeding with vitamin K antagonists was 6.3%. In addition, among patients who received either therapy, the incidence of major bleeding was statistically significantly higher among patients who were older than 65 years or had a creatinine clearance of less than 50 mL/min, a history of bleeding, concomitant use of antiplatelet therapy, or a hemoglobin level less than 100 g/L.

The case-fatality rate of major bleeding appeared to be similar with vitamin K antagonists and direct oral anticoagulants. This finding ran contrary to a previous meta-analysis of phase 3 randomized trials comparing direct oral anticoagulants and vitamin K antagonists in patients with atrial fibrillation, according to the researchers.

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