Abstract
Current guidelines recommend long-term anticoagulant therapy in patients with unprovoked venous thromboembolism (VTE). The risk of fatal recurrent VTE after treatment discontinuation (versus that of fatal bleeding during anticoagulation) is of particular relevance in the decision to continue or stop anticoagulation after the first 3 months. Our primary aim was to provide a point-estimate of the yearly rate of fatal recurrent VTE and VTE case-fatality rate in patients with unprovoked VTE after anticoagulation cessation. Data were extracted from both randomised controlled trials and observational studies published before May 1, 2017. The pooled fatality rates were calculated using a random-effects model. 18 studies with low-to-moderate bias were included in the primary analysis, totalling 6758 patients with a median (range) follow-up duration of 2.2 (1–5) years. After anticoagulation cessation, the weighted pooled rate of VTE recurrence was 6.3 (95% CI 5.4–7.3) per 100 patient-years and the weighted pooled rate of fatal recurrent VTE was 0.17 (95% CI 0.047–0.33) per 100 patient-years, for a case-fatality rate of 2.6% (95% CI 0.86–5.0). These numbers are a solid benchmark for comparison to the risks associated with long-term anticoagulation treatment for the decision on the optimal duration of treatment of patients with unprovoked VTE.
Abstract
The rate of fatal recurrent VTE after anticoagulation cessation for unprovoked VTE was 0.17 per 100 patient-years http://ow.ly/U1sM30mtbrp
Footnotes
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Provenance: Submitted article, peer reviewed.
Author contributions: S.J. van der Wall and F.A. Klok were responsible for the concept and design of the study, quality assessment and interpretation of the results and writing of the manuscript. L.M. van der Pol was responsible for data extraction, quality assessment and critical revision of the manuscript. Y.M. Ende-Verhaar was responsible for statistical analysis and critical revision of the manuscript. S. Schulman, P. Prandoni, M. Rodger, S.C. Cannegieter and M.V. Huisman were responsible for interpretation of the results, and critical revision of the manuscript.
Conflict of interest: S.J. van der Wall has nothing to disclose.
Conflict of interest: L.M. van der Pol has nothing to disclose.
Conflict of interest: Y.M. Ende-Verhaar has nothing to disclose.
Conflict of interest: S.C. Cannegieter has nothing to disclose.
Conflict of interest: S. Schulman has nothing to disclose.
Conflict of interest: P. Prandoni has nothing to disclose.
Conflict of interest: M. Rodger has nothing to disclose.
Conflict of interest: M.V. Huisman reports grants from ZonMW, and grants and personal fees from Pfizer-BMS, Boehringer-Ingelheim and Daiichi-Sankyo, outside the submitted work.
Conflict of interest: F.A. Klok reports grants from Bayer, Bristol-Myers Squibb, Boehringer-Ingelheim, Daiichi-Sankyo, MSD and Actelion, outside the submitted work.
- Received October 7, 2018.
- Accepted October 22, 2018.
- Copyright ©ERS 2018.
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