Management of patients with unprovoked venous thromboembolism: An evidence-based and practical approach

Maura Marcucci, Alfonso Iorio, James Douketis

Research output: Contribution to journalArticlepeer-review

Abstract

Opinion statement: The management of patients with unprovoked venous thromboembolism is a common and challenging clinical problem. Although the initial antithrombotic management is well-established, there is uncertainty about the optimal long-term anticoagulant management, specifically whether patients should receive a short (i.e., 3- to 6-month) duration of anticoagulant therapy or indefinite anticoagulation. Factors that may be considered to estimate patients' risk for recurrent thromboembolism include the mode of initial clinical presentation, as deep vein thrombosis or pulmonary embolism, patient sex, antecedent hormonal therapy use, thrombophilia, D-dimer levels, and residual vein occlusion in patients with deep vein thrombosis. Many of these factors have been integrated into clinical prediction guides which stratify patients with unprovoked venous thromboembolism according to their risk for disease recurrence and, thereby, can assist clinicians in decisions about the duration of anticoagulation. The objective of this review is to consider the evidence relating to the clinical significance of purported risk factors and provide a practical case-based approach to guide decisions on duration of anticoagulation for patients with unprovoked venous thromboembolism.

Original languageEnglish
Pages (from-to)224-239
Number of pages16
JournalCurrent Treatment Options in Cardiovascular Medicine
Volume15
Issue number2
DOIs
Publication statusPublished - Apr 2013

Keywords

  • Clinical prediction guide
  • D-Dimer
  • Extended anticoagulation
  • Inherited thrombophilia
  • Residual vein occlusion
  • Risk factors
  • Unprovoked
  • Venous thromboembolism

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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