The most important decision in the long-term treatment of VTE is how long to anticoagulate. VTE provoked by a reversible risk

 

Abstract

The most important decision in the long-term treatment of VTE is how long to anticoagulate. VTE provoked by a reversible risk factor, or a first unprovoked isolated distal DVT, generally should be treated for 3 months. VTE provoked by a persistent or progressive risk factor (eg, cancer), or a second unprovoked proximal DVT or PE, is generally treated indefinitely. First proximal DVT or PE may be treated for 3 to 6 months, or indefinitely. Male sex, presentation as PE (particularly if concomitant proximal DVT), a positive D-dimer test after stopping anticoagulation, an antiphospholipid antibody, low risk of bleeding and patient preference favor indefinite anticoagulation. The type of indefinite anticoagulation is of secondary importance. Low dose oral Xa inhibitors are convenient and thought to have a lower risk of bleeding; they are less suitable if there is a higher risk of recurrence. For cancer-associated VTE, we prefer full-dose oral Xa inhibitors over low molecular weight heparin, with gastrointestinal lesions being a relative contraindication. Graduated compression stockings are not routinely indicated after DVT but are encouraged if there is persistent leg swelling or if a trial of stockings improves symptoms. Medications have a limited role in the treatment of post-thrombotic syndrome. After PE, patients should have clinical surveillance for chronic thromboembolic pulmonary hypertension (CTEPH), with ventilation-perfusion scanning and echocardiography being the initial diagnostic tests if CTEPH is a concern. Patients with CTEPH, and other symptomatic patients with extensive residual perfusion defects, should be evaluated for endarterectomy, balloon pulmonary angioplasty or vasodilator therapies.

PMID: 31917402 [PubMed - as supplied by publisher]

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pubmed: caandvteortroorpul

ACUTE TREATMENT OF VENOUS THROMBOEMBOLISM.

ACUTE TREATMENT OF VENOUS THROMBOEMBOLISM.

Blood. 2019 Jan 09;:

Authors: Becattini C, Agnelli G