Thursday, June 7, 2018

Anticoagulation in unprovoked proximal DVT

Q; 44 years old male is admitted to ICU with shortness of breath and diagnosed having a pulmonary embolism. Patient has a healthy lifestyle and no risk factors are identified. The patient responded well to intravenous heparin without any tendency to bleeding. Workup till discharge from ICU remained negative except proximal lower extremity deep venous thrombosis (DVT). Hematology service declared it as an "unprovoked DVT". The patient will require anticoagulation for?

A) 3 months
B) 6 months
C) 12 months
D) indefinite
E) Till discharge from hospital

Answer:   D

The estimated risk of recurrence following stopping of anticoagulation in patients with a first unprovoked episode of proximal DVT or PE is 10 percent at twelve months and 30 percent at five years. Full anticoagulation reduces the risk of recurrence by 90 percent. In a healthy patient who has no risk for an increased bleed, benefit of anticoagulation outweighs the risk of bleeding.



1. Baglin T, Bauer K, Douketis J, et al. Duration of anticoagulant therapy after a first episode of an unprovoked pulmonary embolus or deep vein thrombosis: guidance from the SSC of the ISTH. J Thromb Haemost 2012; 10:698. 

2. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest 2016; 149:315.

3. Patients with a first symptomatic unprovoked deep vein thrombosis are at higher risk of recurrent venous thromboembolism than patients with a first unprovoked pulmonary embolism. J Thromb Haemost 2010; 8:1926. 

4. Couturaud F, Sanchez O, Pernod G, et al. Six Months vs Extended Oral Anticoagulation After a First Episode of Pulmonary Embolism: The PADIS-PE Randomized Clinical Trial. JAMA 2015; 314:31. 

5. Kyrle PA, Kammer M, Eischer L, et al. The long-term recurrence risk of patients with unprovoked venous thromboembolism: an observational cohort study. J Thromb Haemost 2016; 14:2402. 

No comments:

Post a Comment