Benefits of Indefinite Anticoagulant Unclear After First VTE

In HealthDay News
by Healthday

Indefinite anticoagulation prevented recurrent VTE events, but induced major bleeding events

By Elana Gotkine HealthDay Reporter

THURSDAY, June 29, 2023 (HealthDay News) — For patients with a first unprovoked venous thromboembolism (VTE), indefinite anticoagulation prevents some recurrent VTE events but induces additional major bleeding events, according to a study published online June 27 in the Annals of Internal Medicine.

Faizan Khan, Ph.D., from the University of Calgary in Canada, and colleagues estimated the benefit-harm tradeoffs of indefinite anticoagulation in patients with a first unprovoked VTE who completed three to six months of initial anticoagulant treatment.

The researchers found that in a hypothetical cohort of 1,000 patients aged 55 years, indefinite anticoagulation prevented 368 recurrent VTE events, including 14 fatal pulmonary emboli in the base-case analysis, but induced 114 major bleeding events, including 30 intracranial hemorrhages and 11 deaths from bleeding. The cost of indefinite anticoagulation was $16,014 (in Canadian dollars) more per person, and did not increase quality-adjusted life years. In the sensitivity analysis, during extended anticoagulation, the model results were most sensitive to the case-fatality rate of major bleeding and the annual risk for major bleeding.

“Continuing versus discontinuing anticoagulation indefinitely in all (that is, unselected) patients with a first unprovoked VTE has little chance of improving life expectancy but might provide a mortality benefit in certain subgroups,” the authors write.

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