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Duration of Anticoagulation

Deep Vein Thrombosis. Duration of Anticoagulation. 5 Patients Categories. 1. First Episode:. Transient risk. 2. First Episode:. Concurrent cancer. 3. First Episode:. Idiopathic. 4. First Episode:. Thrombophilia or prognostic marker. 5. Recurrent DVT. Deep Vein Thrombosis.

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Duration of Anticoagulation

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  1. Deep Vein Thrombosis Duration of Anticoagulation 5 Patients Categories 1. First Episode: Transient risk 2. First Episode: Concurrent cancer 3. First Episode: Idiopathic 4. First Episode: Thrombophilia or prognostic marker 5.Recurrent DVT

  2. Deep Vein Thrombosis Duration of Anticoagulation Patient Category Duration Transient 3 months Idiopathic 6-12 months Consider indefinite Cancer LMWH x 3-6 months Anticoag. Indefinitely or cancer cured Thrombophilia 12 months (consider indefinite) Recurrent DVT Indefinite ACCPCHEST 2004

  3. Acute DVT Stopping Anticoagulation Considerations • Does patient have persistent venous thrombosis? • Is there persistent thrombus activity? • ….impact on duration of anticoagulation

  4. Recurrent VTE Residual Venous Thrombus Cumulative Proportion of Patients with Recurrent VTE Time after Initial DVT, mo Prandoni, P et al Ann Intern Med 2002;137:955

  5. Recurrent VTE: Prospective Study Patient Characteristics Recurrence @ 2 years US Normal US Abnormal All Characteristic Secondary 4% 0% 7.1% 7% 4.4% 7.5% Idiopathic Thrombophilia 15% 10.3% 23% Prandoni, P et al Ann Intern Med 2002;137:955

  6. Recurrent VTE D-Dimer Probability of Recurrence at 3 Years > 250 ng/ml < 250 ng/ml 3.7%* 11.5% P = 0.001 60% lower risk of recurrence* Eichinger S et al JAMA 2003; 290: 1071

  7. Iliofemoral DVT Natural History Associated with Severe Postthrombotic Morbidity! • O'Donnell T Mavor GE Beyth RJ • J Surg Res. 1977 Br J Surg 1969 Arch Int Med 1995

  8. Iliofemoral DVT Anticoagulation Long-Term Venous Function • 20 patients with iliofemoral DVT • Conventional anticoagulation • Followed 5 years Akesson H, Eur J Vasc Surg 1990

  9. Iliofemoral DVT Anticoagulation % 50% 95% 90% 15% 15% Parameter @ 5 yrs Calf Muscle Dysfunction Ambulatory Venous Hypertension Venous Insufficiency Venous Claudication Venous Ulceration Akesson H, Eur J Vasc Surg 1990

  10. Iliofemoral DVT Rationale for Thrombus Removal A strategy of thrombus removal reduces the risk of postthrombotic syndrome!

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