provoked VTE,吃coumadin吃三個月即可

porvoked VTE ->吃3個月即可

最近有一位病人，CVA長期臥床

約一年前hip fracture, 三個月後DVT(provoked VTE)

在長庚吃coumadin吃到現在 -> 應該不用吃了

Summary and Comment

Minimizing Recurrence of VTE

Initial presentation of venous thromboembolism and duration of previous anticoagulation were associated with risk for recurrence.

How does clinical presentation of venous thromboembolism (VTE) and duration of anticoagulation affect risk for recurrent VTE after anticoagulation is stopped? In this pooled analysis of data from seven randomized trials that involved 2925 participants, investigators addressed this question.

Twenty percent of the patients had isolated distal deep venous thrombosis (DVT), 52% had proximal DVT, and 29% had pulmonary embolism (PE). VTE was provoked by a temporary risk factor (e.g., immobilization) in 40%. During mean follow-up of 1.4 years, 312 episodes of recurrent VTE occurred. Risk for recurrent VTE in patients with isolated distal DVT was about half that of patients with proximal DVT or PE. Risk for recurrent VTE was significantly lower after provoked VTE than after unprovoked VTE (hazard ratio, 0.6). Risk for recurrent VTE was significantly higher when anticoagulation was stopped at 1 or 1.5 months than when it was stopped at ≥3 months (HR, 1.5), but risk was similar for 3 months and ≥6 months. This excess risk for recurrent VTE that was associated with short courses of anticoagulation was confined primarily to the first 6 months after anticoagulation was stopped.

Comment: These results suggest that 3 months of anticoagulation is sufficient to minimize risk for recurrent venous thromboembolism if anticoagulation is to be stopped eventually. However, risk for recurrent VTE is high in patients with unprovoked proximal deep venous thrombosis or pulmonary embolism whenever treatment is stopped. These patients should receive a minimum of 3 months of anticoagulation, and indefinite treatment should be offered to patients who have "a low risk [for] bleeding when this concurs with the patient's preference."

— Paul S. Mueller, MD, MPH, FACP

Published in Journal Watch General Medicine July 21, 2011

Citation(s):

Boutitie F et al. Influence of preceding length of anticoagulant treatment and initial presentation of venous thromboembolism on risk of recurrence after stopping treatment: Analysis of individual participants' data from seven trials. BMJ 2011 May 24; 342:d3036. (http://dx.doi.org/10.1136/bmj.d3036)

Original article (Subscription may be required)

Medline abstract (Free)

Middeldorp S. Duration of anticoagulation for venous thromboembolism: Treatment for more than three months is not necessary if lifelong treatment is not intended. BMJ 2011 May 24; 342:d2758. (http://dx.doi.org/10.1136/bmj.d2758)

Original article (Subscription may be required)

Medline abstract (Free)

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