Antithrombotic Therapy for VTE Disease

Treatment ÎThe ACCP suggests treatment with anticoagulation for 3 months over extended therapy if there is a low or moderate bleeding risk (2-B). ÎIn patients with an unprovoked PE, the ACCP recommends treatment with anticoagulation for at least 3 months over treatment for a shorter duration (1-B). After 3 months of treatment, patients with unprovoked PE should be evaluated for the risk-benefit ratio of extended therapy. ÎIn patients with a first VTE that is an unprovoked PE and who have a low or moderate bleeding risk, the ACCP suggests extended anticoagulant therapy over 3 months of therapy (2-B). ÎIn patients with a first VTE that is an unprovoked PE and who have a high bleeding risk, the ACCP recommends 3 months of anticoagulant therapy over extended therapy (1-B). ÎIn patients with a second unprovoked VTE, the ACCP recommends extended anticoagulant therapy over 3 months of therapy in those who have a low bleeding risk (1-B), and the ACCP suggests extended anticoagulant therapy in those with a moderate bleeding risk (2-B). ÎIn patients with a second unprovoked VTE who have a high bleeding risk, the ACCP suggests 3 months of therapy over extended therapy (2-B). ÎIn patients with PE and active cancer, if there is a low or moderate bleeding risk, the ACCP recommends extended anticoagulant therapy over 3 months of therapy (1-B), and if there is a high bleeding risk the ACCP suggests extended anticoagulant therapy (2-B). Remark: In all patients who receive extended anticoagulant therapy, the continuing use of treatment should be reassessed at periodic intervals (eg, annually). ÎIn patients with PE who are treated with VKA, the ACCP recommends a therapeutic INR range of 2.0-3.0 (target INR – 2.5) over a lower (INR < 2) or higher (INR 3.0-5.0) range for all treatment durations (1-B). ÎIn patients with PE and no cancer, the ACCP suggests VKA therapy over LMWH for long-term therapy (2-C). For patients with PE and no cancer who are not treated with VKA therapy, the ACCP suggests LMWH over dabigatran or rivaroxaban for long-term therapy (2-C).a ÎIn patients with PE and cancer, the ACCP suggests LMWH over VKA therapy (2-B). In patients with PE and cancer who are not treated with LMWH, the ACCP suggests VKA over dabigatran or rivaroxaban for long-term therapy (2-C).a ÎIn patients with PE who receive extended therapy, the ACCP suggests treatment with the same anticoagulant chosen for the first 3 months (2-C). ÎIn patients who are incidentally found to have asymptomatic PE, the ACCP suggests the same initial and long-term anticoagulation as for comparable patients with symptomatic PE (2-B). a 8 Choice of treatment in patients with and without cancer is sensitive to the individual patient's tolerance for daily injections, need for laboratory monitoring, and treatment costs.

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