Minimizing recurrent venous thromboembolism

Anticoagulation is the cornerstone of management for acute venous thromboembolism (VTE). After a provoked VTE event, standard anticoagulation is usually short term. The optimal management of a first unprovoked VTE event (ie, not triggered by factors such as surgery, trauma, or hyperestrogenic states) is, however, uncertain.1 Such patients have a higher risk of recurrence than those with transient risk factors. The intent of long term treatment is to reduce the risk of recurrence,23 although the benefit of prolonged anticoagulation is counterbalanced by an excess risk of bleeding. Current uncertainty about the balance of risks and benefits is reflected in recommendations from the professional societies.456789 We are in dire need of more evidence to inform these patients’ treatment decisions.

In their paper, Khan and colleagues (doi:10.1136/bmj.l4363) present the results of their systematic review and meta-analysis on the long term risk of recurrent VTE after discontinuation of anticoagulation for a first unprovoked deep vein thrombosis (DVT).10 The strengths of the study are the registration of the study protocol and adherence to most of the preset criteria in the protocol. The authors focused on symptomatic events, which are clinically more relevant than asymptomatic ones, and provided risk estimates …