Residual vein thrombosis for assessing duration of anticoagulation after unprovoked deep vein thrombosis of the lower limbs: The extended DACUS study

The safest duration of anticoagulation after idiopathic deep vein thrombosis (DVT) is unknown. We conducted a prospective study to assess the optimal duration of vitamin K antagonist (VKA) therapy considering the risk of recurrence of thrombosis according to residual vein thrombosis (RVT). Patients...

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Bibliographic Details
Published in:American journal of hematology 2011-11, Vol.86 (11), p.914-917
Main Authors: Siragusa, Sergio, Malato, Alessandra, Saccullo, Giorgia, Iorio, Alfonso, Di Ianni, Mauro, Caracciolo, Clementina, Coco, Lucio Lo, Raso, Simona, Santoro, Marco, Guarneri, Francesco Paolo, Tuttolomondo, Antonino, Pinto, Antonio, Pepe, Iliana, Casuccio, Alessandra, Abbadessa, Vincenzo, Licata, Giuseppe, Battista Rini, Giovan, Mariani, Guglielmo, Di Fede, Gaetana
Format: Article
Language:English
Subjects:
Acenocoumarol - administration & dosage
Acenocoumarol - adverse effects
Acenocoumarol - therapeutic use
Adult
Aged
Anticoagulants - administration & dosage
Anticoagulants - adverse effects
Anticoagulants - therapeutic use
Biological and medical sciences
Blood and lymphatic vessels
Cardiology. Vascular system
Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous
Drug Administration Schedule
Female
Hematologic and hematopoietic diseases
Hematology
Hemorrhage
Humans
Lower Extremity - diagnostic imaging
Lower Extremity - pathology
Male
Medical sciences
Middle Aged
Prospective Studies
Recurrence
Risk Factors
Ultrasonography
Venous Thromboembolism - diagnostic imaging
Venous Thromboembolism - drug therapy
Venous Thromboembolism - pathology
Venous Thromboembolism - prevention & control
Venous Thrombosis - diagnostic imaging
Venous Thrombosis - drug therapy
Venous Thrombosis - pathology
Vitamin K - antagonists & inhibitors
Vitamin K - metabolism
Warfarin - administration & dosage
Warfarin - adverse effects
Warfarin - therapeutic use
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Summary:The safest duration of anticoagulation after idiopathic deep vein thrombosis (DVT) is unknown. We conducted a prospective study to assess the optimal duration of vitamin K antagonist (VKA) therapy considering the risk of recurrence of thrombosis according to residual vein thrombosis (RVT). Patients with a first unprovoked DVT were evaluated for the presence of RVT after 3 months of VKA administration; those without RVT suspended VKA, while those with RVT continued oral anticoagulation for up to 2 years. Recurrent thrombosis and/or bleeding events were recorded during treatment (RVT group) and 1 year after VKA withdrawal (both groups). Among 409 patients evaluated for unprovoked DVT, 33.2% (136 of 409 patients) did not have RVT and VKA was stopped. The remaining 273 (66.8%) patients with RVT received anticoagulants for an additional 21 months; during this period of treatment, recurrent venous thromboembolism and major bleeding occurred in 4.7% and 1.1% of patients, respectively. After VKA suspension, the rates of recurrent thrombotic events were 1.4% and 10.4% in the no‐RVT and RVT groups, respectively (relative risk = 7.4; 95% confidence interval = 4.9–9.9). These results indicate that in patients without RVT, a short period of treatment with a VKA is sufficient; in those with persistent RVT, treatment extended to 2 years substantially reduces, but does not eliminate, the risk of recurrent thrombosis. Am. J. Hematol. 2011. © 2011 Wiley‐Liss, Inc.
ISSN:0361-8609
1096-8652
DOI:10.1002/ajh.22156