| The optimal duration of anticoagulation in patients with venous thromboembolism: how long is long enough? | |
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MedLine Citation:
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PMID: 22278115 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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The risk of recurrent venous thromboembolism (VTE) approaches 40% of all patients after 10 years of follow-up. This risk is higher in patients with permanent risk factors of thrombosis such as active cancer, prolonged immobilization from medical diseases, and antiphospholipid syndrome; in carriers of several thrombophilic abnormalities, including deficiencies of natural anticoagulants; and in patients with unprovoked presentation. Patients with permanent risk factors of thrombosis should receive indefinite anticoagulation, consisting of subtherapeutic doses of low-molecular-weight heparin in cancer patients, and oral anticoagulants in all other conditions. Patients whose VTE is triggered by major surgery or trauma should be offered three months of anticoagulation. Patients with unprovoked VTE, including carriers of thrombophilia, and those whose thrombotic event is associated with minor risk factors (such as hormonal treatment, minor injuries, long travel) should receive at least three months of anticoagulation. The decision as to go on or discontinue anticoagulation after this period should be individually tailored and balanced against the haemorrhagic risk. Post-baseline variables, such as the D-dimer determination and the ultrasound assessment of residual thrombosis can help identify those patients in whom anticoagulation can be safely discontinued. As a few emerging anti-Xa and anti-IIa compounds seem to induce fewer haemorrhagic complications than conventional anticoagulation, while preserving at least the same effectiveness, they have the potential to open new scenarios for decisions regarding the duration of anticoagulation in patients with VTE. |
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Authors:
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P Prandoni; C Piovella; L Spiezia; F Dalla Valle; R Pesavento |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Panminerva medica Volume: 54 ISSN: 1827-1898 ISO Abbreviation: Panminerva Med Publication Date: 2012 Mar |
Date Detail:
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Created Date: 2012-01-26 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0421110 Medline TA: Panminerva Med Country: Italy |
Other Details:
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Languages: eng Pagination: 39-44 Citation Subset: IM |
Affiliation:
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Department of Cardiothoracic and Vascular Sciences, Clinica Medica II and Thromboembolism UnitUniversity of Padua, Padua, Italy - paoloprandoni@tin.it. |
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