Long-Term Anticoagulant Therapy Increases Bleeding Risk in Patients with Unprovoked VTE
Patients who receive extended anticoagulant therapy after a first unprovoked or weakly provoked venous thromboembolism are at increased risk for major bleeding.
KEY FINDINGS: Patients who receive extended anticoagulant therapy after a first unprovoked or weakly provoked venous thromboembolism are at increased risk for major bleeding.
BACKGROUND: Anticoagulant therapy is recommended for three to six months after a first unprovoked venous thromboembolism (VTE). Extending treatment beyond this period requires balancing a patient's risk for a potentially fatal recurrent VTE with the risk of a potentially fatal major bleeding event associated with anticoagulation therapy. A systematic review and meta-analysis was undertaken to determine the risk of major bleeding in patients receiving extended anticoagulant therapy after a first unprovoked VTE and in clinically important subgroups.
DETAILS: Of the 27 studies included in the analysis, 14 were randomized controlled trials and 13 prospective cohort studies. A total of 17,202 patients who had a first unprovoked or weakly provoked VTE completed at least three months of anticoagulant therapy, including 9,982 patients who received a vitamin K antagonist and 7,220 who received a direct oral anticoagulant. The incidence of major bleeding per 100 person-years was 1.74 events among patients receiving vitamin K antagonists and 1.12 events among those taking direct oral anticoagulants. The five-year cumulative incidence of major bleeding among patients taking vitamin K antagonists was 6.3%. The incidence of major bleeding was significantly higher among patients who were older than 65, and who had a creatinine clearance less than 50 mL/min, a history of bleeding, concomitant use of antiplatelet therapy, and a hemoglobin level less than 100 g/L.
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Source: Rosenberg, K. (2022). Long-Term Anticoagulant Therapy Increases Bleeding Risk in Patients with Unprovoked VTE. AJN, American Journal of Nursing. 2022; 122(1): 59-59. Published: Januar, 2022. DOI: 6182521.
