Recommendation ID
CG144/2
Question
Long-term versus 3-month oral anticoagulation treatment in subgroups of patients at increased risk of VTE recurrence:- What is the clinical and cost effectiveness of long-term oral anticoagulation treatment in specific subgroups of patients with a first unprovoked VTE?
Any explanatory notes
(if applicable)
Why this is important:- There is evidence that some risk factors, such as male sex, raised D-dimer or the presence of post-thrombotic syndrome, are associated with a greater risk of VTE recurrence than others. Although it is thought that subgroups with these risk factors are at increased risk of VTE recurrence, high-quality evidence on the benefits of extending anticoagulation treatment in these subgroups is lacking. An RCT comparing long-term oral anticoagulation with 3 months of oral anticoagulation treatment in patients with a first unprovoked VTE is needed to determine the relative benefits and risks of long-term oral anticoagulation treatment in these subgroups. The
trial should include initial presentation because, compared with a DVT, a pulmonary embolism (PE) is a stronger predictor of a future PE, and therefore initial presentation is likely to be a factor in the decision to offer long-term oral anticoagulation. The trial should include the following outcomes: all-cause mortality, VTE recurrence of venous thromboembolism (VTE), major bleeding and quality of life. Follow-up should be for 5 years. The results would inform the recommendation in this guideline on continuing oral anticoagulation treatment beyond 3 months.

Source guidance details

Comes from guidance
Venous thromboembolic diseases: diagnosis, management and thrombophilia testing
Number
CG144
Date issued
June 2012

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 10/07/2012