Ann Intern Med: Patients with venous thromboembolism prolong the risk of major bleeding during oral anticoagulation therapy

Venous thromboembolism (VTE) is one of the main factors causing the global burden of disease.
The annual incidence of acute venous thromboembolism is 1-2 cases/1000 persons
.

After venous thromboembolism, anticoagulant therapy should be carried out for at least 3-6 months

thrombus

To date, the long-term risk of major bleeding in patients with unprovoked venous thromboembolism (VTE) for the first time after receiving prolonged anticoagulation therapy (more than 3-6 months) is uncertain
.

The purpose of this study was to determine the incidence of major bleeding (total and clinically important subgroups) in patients with first-time unprovoked venous thromboembolism with anticoagulation therapy extended to 5 years
.

The researchers searched the MEDLINE, Embase, and Cochrane Central Registered Controlled Trials that included reports before July 23, 2021 that received oral anticoagulation therapy (after completing at least 3 months of initial anticoagulation therapy, they received at least 6 months of additional anticoagulation.
Coagulation therapy) randomized controlled trial (RCT) and prospective cohort study of massive bleeding data in patients with unprovoked venous thrombosis for the first time
.

The incidence of major bleeding

The incidence of major bleeding

In total, 14 RCTs and 13 cohort studies were included, covering 9982 patients receiving vitamin K antagonist (VKA) treatment and 7220 patients receiving direct oral anticoagulant (DOAC) treatment
.

The incidence of major bleeding in patients receiving VKA or DOAC treatment was 1.

The incidence of major bleeding in patients receiving VKA or DOAC treatment was 1.

The fatality rate of hemorrhage

The fatality rate of hemorrhage

Among patients treated with VKA or DOAC, the incidence of major bleeding was significantly increased in patients over 65 years of age, with a creatinine clearance rate of less than 50 mL/min, a history of bleeding, concurrent use of antiplatelet therapy, or a hemoglobin level of less than 100 g/L High
.

The fatality rate of major bleeding in the VKA group was 8.

Among patients treated with VKA or DOAC, the incidence of major bleeding was significantly increased in patients over 65 years of age, with a creatinine clearance rate of less than 50 mL/min, a history of bleeding, concurrent use of antiplatelet therapy, or a hemoglobin level of less than 100 g/L High In patients receiving VKA or DOAC treatment, patients over 65 years of age, with a creatinine clearance rate of less than 50 mL/min, a history of bleeding, concurrent use of antiplatelet therapy, or a hemoglobin level of less than 100 g/L, have a significant incidence of major bleeding Elevated

In summary, in patients with unprovoked venous thromboembolism for the first time, the long-term risk of hemorrhage associated with anticoagulation therapy is greater, and the consequences are relatively serious
.

The results of this study can help inform patients' prognosis and guide decisions about the treatment time of unprovoked venous thromboembolism

In patients with unprovoked venous thromboembolism for the first time, the long-term risk of major bleeding associated with anticoagulation therapy is greater, and the consequences are relatively serious.

Original source:

Khan Faizan, Tritschler Tobias, Kimpton Miriam et al.

Long-Term Risk for Major Bleeding During Extended Oral Anticoagulant Therapy for First Unprovoked Venous Thromboembolism: A Systematic Review and Meta-analysis in this message