Long-term strategies in patients with unprovoked venous thromboembolism

Summary

Once anticoagulation is stopped, the risk of recurrent venous thromboembolism (VTE) over years approaches 40 % of all patients with a first episode of VTE. The risk is twice as high in patients with unprovoked VTE than in those with minor (either transient or persistent) risk factors of thrombosis. Although the latest international guidelines suggest indefinite anticoagulation for most patients with a first episode of unprovoked VTE, strategies that incorporate the assessment of residual vein thrombosis and D-dimer have the potential to identify a substantial proportion of subjects in whom anticoagulation can be safely discontinued. For those patients in whom anticoagulation cannot be discontinued, new opportunities are offered by the availability of low-dose anti-Xa compounds, which have been found to possess an extremely favorable benefit/risk profile.

Zusammenfassung

Nach Absetzen der Antikoagulation beträgt das Rezidivrisiko für venöse Thrombembolien (VTE) über Jahre etwa 40% aller Patienten mit einer ersten VTE-Episode. Das Risiko ist bei Patienten mit spontan aufgetretenen VTE doppelt so hoch wie bei Vorliegen von geringfügigen (passageren oder persistierenden) Risikofaktoren für eine Thrombose. Zwar empfehlen die aktuellen internationalen Richtlinien für die meisten Patienten mit einer erstmaligen, spontanen VTE-Episode eine unbegrenzte Antikoagulation, jedoch bieten Strategien wie u.a. die Beurteilung verbliebener Thrombosereste und die D-Dimer-Bestim-mung die Möglichkeit, einen maßgeblichen Anteil der Patienten zu identifizieren, bei denen die Antikoagulation ohne Risiko beendet werden kann. Für Patienten, bei denen die Antikoagulanzien nicht abgesetzt werden können, eröffnen sich neue Möglichkeiten durch die Verfügbarkeit von niedrig dosierten Faktor-Xa-Hemmern, für die ein extrem günstiges Nutzen-/Risikoprofil nachgewiesen wurde.

Keywords

Venous thromboembolism - deep venous thrombosis - pulmonary embolism - anticoagulation - residual thrombosis - D-dimer - direct oral anticoagulants

Schlüsselwörter

Venöser Thromboembolismus - tiefe Venenthrombose - Lungenembolie - Antikoagulation - residual thrombosis - D-dimer - direkte orale Antikoagulanzien

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