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KMID : 1011220180040010001
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Clinical & Experimental Thrombosis and Hemostasis
2018 Volume.4 No. 1 p.1 ~ p.6
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The Optimal Duration and Selection of Anti-coagulants after First Episode of Unprovoked Venous Thromboembolism
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Choi Won-Il
Kim Yang-Ki
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Abstract
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The first attack of venous thromboembolism (VTE) patients without transient risk factors recur in a significant number of patients after discontinuation of therapy. Remaining vein occlusion and D-dimer elevation after VTE treatment suggest an increase in the risk of VTE recurrence. Direct oral anti-coagulant (DOAC) has been shown to replace vitamin K antagonists in VTE therapy, and the safety of DOACs has been proven in many studies, and the efficacy is not inferior to that of vitamin K antagonists. For secondary prevention of VTE, the dose of rivaroxaban can be lowered to 10 mg/day to maintain the preventive effect and reduce the frequency of bleeding. Anticoagulation therapy does not reduce the risk of recurrence of VTE and can only delay the recurrence. Therefore, if the risk of bleeding is not high, anticoagulation therapy should be indefinitely extended to prevent recurrence of VTE. Predictive rules can help identify patients with a low risk of recurrence after the first episode of unprovoked VTE, and it may be safe to stop after three months of anticoagulant therapy based on its criteria. In conclusion, it is necessary to consider extending the treatment period indefinitely for secondary prevention of the first unprovoked VTE. However, the risks of bleeding and recurrence should be considered to determine the duration of the extended treatment. Finally, the role of DOAC in long-term and short-term treatment has increased.
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KEYWORD
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Venous thromboembolism, Unprovoked, Recurrence, Bleeding
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