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Review
. 2018 Jun 6;2(3):529-534.
doi: 10.1002/rth2.12121. eCollection 2018 Jul.

Extended anticoagulation for unprovoked venous thromboembolism

Lana A Castellucci  1 , Kerstin de Wit  2 , David Garcia  3 , Thomas L Ortel  4 , Grégoire Le Gal  1
Affiliations
Review

Extended anticoagulation for unprovoked venous thromboembolism

Lana A Castellucci et al. Res Pract Thromb Haemost. .

Abstract

After completing anticoagulation therapy for acute venous thromboembolism (VTE), patients with unprovoked VTE are at increased risk of recurrent thrombotic events. Recent studies suggest a risk of nearly 10% in the first year after stopping anticoagulants and 30% at 8 years. Therefore, it is important to consider extended anticoagulation for secondary prevention in these high-risk patients. While several oral anticoagulants are available for this purpose, there is limited information available regarding the optimal agent to minimize bleeding risks and maximize efficacy at VTE prevention. This review article summarizes the evidence available for Vitamin-K antagonists (VKAs) and direct oral anticoagulants (DOACs) for extended treatment of VTE. We also introduce the COVET trial, the first head-to-head comparison of VKAs to DOACs, rivaroxaban and apixaban, for extended management of unprovoked VTE.

Keywords: anticoagulation; bleeding; recurrent; secondary prevention; venous thromboembolism; venous thrombosis.

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Figures

Figure 1
Figure 1
Antithrombotic dosing during phases of VTE treatment. ASA, acetylsalicylic acid; BID, bis in die, twice daily; INR, international normalized ratio; LMWH, low molecular weight heparin; VTE, venous thromboembolism.*LMWH is required for 5‐10 days prior to starting dabigatran or edoxaban; †30 mg daily if CrCl 30–50 mL/min or weight < 60 kg; **Dose reduction may be considered after 6 months of therapy; ***Less effective than alternative options available.
Figure 2
Figure 2
COVET trial study design. INR, international normalized ratio
See this image and copyright information in PMC

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