Prolonged Secondary Prevention After Venous Thromboembolism

Abstract

Recent studies: Shortly after discontinuation of the oral anticoagulation (OAC) there is a 2- to 3 fold increase in VTE recurrences. The risk for recurrence is particularly high in VTE events that occurred without provoking risk factor, with minor provoking factors and in cases with persistent risk factors such as active cancer.Guidance document for the categorization of risk factors for VTE: A recent guidance document defined underlying risk factors for the occurrence of VTE and categorized them into three groups. Direct oral anticoagulants (DOACs): For long-term secondary prevention, a reduced dosing regimen of DOACs was found to be effective with a low bleeding risk. Aspirin should no longer be used for secondary prevention of VTE because the efficacy to prevent recurrent events is lower, while there was no difference in the risk of major bleeding.A Traffic light system helps to select the appropriate duration of anticoagulation. Patients are risk stratified into three groups according to their presumed risk of recurrence. For the majority of the patients this leads to a clear decision to stop or continue OAC (green or red traffic light, respectively). In case of prolonged anticoagulation, the use of a reduced dose DOAC regimen may be considered in view of risk-benefit-balancing.