Pulmonary embolism

How Long Should VTE Patients Receive Anticoagulant Therapy?

Extended treatment with oral anticoagulation drugs significantly reduces the risk of recurrences in patients following their first pulmonary embolism, but the benefits cease as soon as treatment is stopped, according to a recent study.

In order to determine the optimal duration of anticoagulation therapy after first episode of unprovoked pulmonary embolism, researchers conducted a randomized, double-blind trial of 371 adults who had had a first pulmonary embolism and underwent initial anticoagulation therapy for 6 months.
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Participants were randomized to either receive an additional 18 months of warfarin treatment or placebo. Median follow-up was 24 months.

Overall, venous thromboembolism or major bleeding occurred in 6 of the 184 participants randomized to warfarin treatment and in 25 of the 187 controls during the 18 months of treatment.

Over the entirety of the 42-month study, recurrence occurred in 20.8% of the warfarin group and 24% of the controls.

“Among patients with a first episode of unprovoked pulmonary embolism who received 6 months of anticoagulant treatment, an additional 18 months of treatment with warfarin reduced the composite outcome of recurrent venous thrombosis and major bleeding compared with placebo,” the researchers concluded.

“However, benefit was not maintained after discontinuation of anticoagulation therapy.”

—Michael Potts

Reference:

1. Courturaud F, Sanchez O, Pernod G, et al. Six months vs extended oral anticoagulation after a first episode of pulmonary embolism: the padis-pe randomized clinical trial. JAMA. 2015;314(1):31-40.