Florence, Italy – Should anticoagulation therapy be discontinued or continued in patients with uninduced deep vein thrombosis (DVT)? This question was at the heart of a debate between Francesco Dentari, Maryland. Federation of Hospital Physician Associations for Internal Medicine Professor of Internal Medicine at the University of Vallese in Italy and Dr. Manuel Monreal, Maryland, and director of the research committee on thromboembolic diseases at the University of Catrica, San Antonio de Murcia, University of Catrica, founder. Riete Registrythe largest global database of DVT patients.
At the 23rd European Conference on Internal Medicine, held from March 5-8, 2025, two experts argued and opposed the continued anticoagulation therapy for more than 3-6 months in these patients, offering scientific evidence and clinical insights. Both acknowledged that the boundaries between these two perspectives are often unknown, and that individualized treatment remains the best approach.
Evidence supports extended anticoagulation therapy: Dentary
Dentali opens discussion in an overview of anticoagulation therapy in DVT, recalls that since the early 1990s, research has consistently demonstrated the need for anticoagulation for at least three months. Early studies showed that 3 months of treatment significantly reduced the recurrence rate compared to a 4-week regimen, and did not significantly increase major bleeding.
Comparison of the 6-week and 6-month treatment periods further strengthened the need for long-term treatment, indicating that the recurrence rate was reduced by half in the 6-month treatment group (20.8% vs. 10.3%).
The chest guidelines currently recommend an anticoagulation of at least three months, emphasizing that after this period, patients need to be reevaluated to determine whether continuous therapy is necessary.
The decisions are whether and how to continue anticoagulation therapy for more than 3-6 months. The discussion highlights the need for careful patient assessments to balance the likelihood of bleeding complications with the risk of recurrence.
- After discontinuing anticoagulant therapy, the 10-year risk of recurrence in patients with unprovoked DVT or pulmonary embolism (PE) is approximately 50% compared to 20% of patients with transient risk factors. This suggests that unprovoked DVT may be considered a chronic disease.
- Meta-analysis shows that the risk of venous thromboembolism (VTE) recurrence is significantly higher than with long-term anticoagulation therapy (4-6 weeks) (>3 months).
- Although major bleeding is of concern, the incidence after long-term anticoagulation with direct-activated oral anticoagulants (DOAC) is relatively low (1.2 per 100 person-years).
- Actual data from Garfield-VTE Registry At 36 months, the risk of recurrence of VTE exceeds the risk of major bleeding and supports broadened anticoagulation therapy in high-risk patients.
- Risk stratification models may help identify patients at a low risk of recurrence who may safely discontinue anticoagulation therapy, despite the challenge remaining to define optimal treatment thresholds.
- Current chest guidelines recommend dilated DOAC treatment in DVT or DVT patients associated with persistent risk factors.
- Amplify-Ext Exam We have demonstrated that apixaban dosage (2.5 mg twice daily) effectively prevents recurrence, preventing recurrence without increasing the risk of major bleeding.
- Risk assessment tools such as VTE Predictive Risk ScoreIt helps to assess recurrence and bleeding risk for better decision making.
For continuation: Monreal
- When deciding whether to continue or stop anticoagulation therapy, it is essential to consider not only the risk of bleeding during treatment, but also the risk of post-dependent bleeding, which cannot be ignored.
- Analyses that include Riete registry data are VTE predictions The score provides a reasonable estimate, but may underestimate the risk of bleeding.
- Both the recurrence of VTE and the risk of bleeding should be considered when deciding on anticoagulation therapy for patients with VTE.
- Data from a Riete Registry-Based Research Of the more than 8,000 patients who discontinued anticoagulation after isolated DVT or PE, recurrent DVT and PE are more common, but bleeding episodes were often confirmed to be severe.
- The 30-day mortality rate was 0.4% for recurrent DVT, 4.6% for recurrent PE, and 24% for major bleeding.
Monreal declared no conflict of interest. Dentary has revealed that they received funding for the meeting from Bayer, Sanofi, Bristol-Myers Squibb/Pfizer, Bohringer Ingelheim, Daiichi Sankyo, Alpha Wasserman, Eli Lily and Sandos.
Training molecular biologist Christina Ferrario holds a Masters degree in Communication and Health from the University of Milan and a Masters degree in Cancer Genetics from Pavia University in Italy. After doing research in molecular oncology, she has been involved in scientific journalism and medical writing for over 20 years.
This story has been translated Univadis Italia As part of the process, we use several editing tools, including AI. Human Editors reviewed this content prior to its release.
