Duration of treatment with vitamin K antagonists in symptomatic venous thromboembolism

Middeldorp, Saskia; Prins, Martin H.; Hutten, Barbara A.

doi:10.1002/14651858.cd001367.pub3

Cited by 74 publications

(33 citation statements)

References 40 publications

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“…Conversely, in patients with TTR≥65% the risk of stroke/SE did not show a trend over time but the risk of major bleeding was highest in the third 4-month period. The latter finding confirms a previous publication reporting an increase of bleeding over time in patients with venous thromboembolism who are anticoagulated with VKA [19]. The authors compared major bleeding in patients with prolonged and short treatment and found major bleeding rates of 2.4% and 0.9%, respectively.…”

Section: Discussionsupporting

confidence: 88%

Quality of Vitamin K Antagonist Control and 1-Year Outcomes in Patients with Atrial Fibrillation: A Global Perspective from the GARFIELD-AF Registry

Cate²,

et al. 2016

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AimsVitamin K antagonists (VKAs) need to be individually dosed. International guidelines recommend a target range of international normalised ratio (INR) of 2.0–3.0 for stroke prevention in atrial fibrillation (AF). We analysed the time in this therapeutic range (TTR) of VKA-treated patients with newly diagnosed AF in the ongoing, global, observational registry GARFIELD-AF. Taking TTR as a measure of the quality of patient management, we analysed its relationship with 1-year outcomes, including stroke/systemic embolism (SE), major bleeding, and all-cause mortality.Methods and ResultsTTR was calculated for 9934 patients using 136,082 INR measurements during 1-year follow-up. The mean TTR was 55.0%; values were similar for different VKAs. 5851 (58.9%) patients had TTR<65%; 4083 (41.1%) TTR≥65%. The proportion of patients with TTR≥65% varied from 16.7% in Asia to 49.4% in Europe. There was a 2.6-fold increase in the risk of stroke/SE, 1.5-fold increase in the risk of major bleeding, and 2.4-fold increase in the risk of all-cause mortality with TTR<65% versus ≥65% after adjusting for potential confounders. The population attributable fraction, i.e. the proportion of events attributable to suboptimal anticoagulation among VKA users, was 47.7% for stroke/SE, 16.7% for major bleeding, and 45.4% for all-cause mortality. In patients with TTR<65%, the risk of first stroke/SE was highest in the first 4 months and decreased thereafter (test for trend, p = 0.021). In these patients, the risk of first major bleed declined during follow-up (p = 0.005), whereas in patients with TTR≥65%, the risk increased over time (p = 0.027).ConclusionA large proportion of patients with AF had poor VKA control and these patients had higher risks of stroke/SE, major bleeding, and all-cause mortality. Our data suggest that there is room for improvement of VKA control in routine clinical practice and that this could substantially reduce adverse outcomes.Trial RegistrationClinicalTrials.gov NCT01090362

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Section: Discussionsupporting

confidence: 88%

Quality of Vitamin K Antagonist Control and 1-Year Outcomes in Patients with Atrial Fibrillation: A Global Perspective from the GARFIELD-AF Registry

Cate²,

et al. 2016

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“…Among heart transplant patients, the incidence rate of VTE recurrence has been shown to be 30.5 (95% CI 13.2–60.2) episodes per 1000 patient‐years, mostly in patients in whom oral anticoagulation had been completed . While treatment with warfarin post‐VTE has been shown to strongly reduce the VTE recurrence rate, it is not associated with reduction in mortality and an elevated risk for major bleeding remains . There is evidence to show that continuation of low‐dose aspirin following completion of anticoagulant therapy reduces the rate of VTE recurrence without increased risk of major bleed .…”

Section: Discussionmentioning

confidence: 99%

Risk of deep vein thrombosis and pulmonary embolism after heart transplantation: clinical outcomes comparing upper extremity deep vein thrombosis and lower extremity deep vein thrombosis

Elboudwarej¹,

Patel²,

Liou³

et al. 2015

Clinical Transplantation

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“…Vitamin K antagonists (VKAs), delivered with a short period of parenteral anticoagulation [unfractionated heparin (UFH), low molecular weight heparin (LMWH), or fondaparinux] over the first 5-10 days, are recognized as the standard of treatment for VTE, being associated with a VTE recurrence risk of *3 % while patients are on treatment [2].…”

Section: Introductionmentioning

confidence: 99%

Non-vitamin K oral anticoagulants in patients with pulmonary embolism: a systematic review and meta-analysis of the literature

Dentali

Minno

Gianni³

et al. 2015

Intern Emerg Med

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Limited information exists on the safety and efficacy of non-vitamin K oral anticoagulants (NOACs) in patients with pulmonary embolism (PE). The aim of this study is to evaluate the difference in the safety and efficacy of the NOACs in comparison to the standard treatment in patients presenting with deep vein thrombosis (DVT) and with PE using data from randomized controlled trials. MEDLINE and EMBASE databases were searched. Differences in the efficacy (recurrent VTE or death-related VTE) and in the safety (major bleeding) outcome were expressed as risk ratio (RR) with 95% confidence intervals (95% CI). Heterogeneity among the studies was assessed. Six studies (27,023 patients) were included. NOACs appeared to have a similar efficacy and safety compared to VKAs in patients presenting with PE and with DVT with a non-significant heterogeneity between the groups (efficacy: RR 0.90, 95% CI 0.72, 1.13 in PE patients and 0.93, 95% CI 0.75, 1.16 in DVT patients; χ2 0.04, p = 0.84; safety: RR 0.49, 95% CI 0.26, 0.95 in PE patients and 0.74 95% CI 0.51, 1.06 in DVT; χ2 1.10, p = 0.29). Our results suggest that the efficacy and safety of the NOACs compared to VKAs is similar between patients with PE and DVT.

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Duration of treatment with vitamin K antagonists in symptomatic venous thromboembolism

Abstract: Analysis 2.1. Comparison 2 Long vs short, period a er cessation of study medication until end of follow-up, Outcome 1

Cited by 74 publications

References 40 publications

Quality of Vitamin K Antagonist Control and 1-Year Outcomes in Patients with Atrial Fibrillation: A Global Perspective from the GARFIELD-AF Registry

Quality of Vitamin K Antagonist Control and 1-Year Outcomes in Patients with Atrial Fibrillation: A Global Perspective from the GARFIELD-AF Registry

Risk of deep vein thrombosis and pulmonary embolism after heart transplantation: clinical outcomes comparing upper extremity deep vein thrombosis and lower extremity deep vein thrombosis

Non-vitamin K oral anticoagulants in patients with pulmonary embolism: a systematic review and meta-analysis of the literature

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