Annals for Hospitalists Inpatient Notes - Can I Withdraw Anticoagulants in This Patient With Prior Venous Thromboembolism?
Authors: Miriam Kimpton, Marc Alan Rodger
Journal: Annals of Internal Medicine (2020)

Web Exclusives16 June 2020Annals for Hospitalists Inpatient Notes - Can I Withdraw Anticoagulants in This Patient With Prior Venous Thromboembolism?Miriam Kimpton, MD and Marc Alan Rodger, MD, MScMiriam Kimpton, MDThe Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada (M.K.)Search for more papers by this author and Marc Alan Rodger, MD, MScMcGill University and McGill University Health Center Research Institute, Montréal, Quebec, Canada (M.A.R.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-1253 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Venous thromboembolism (VTE) is the second most common cardiovascular disorder. Hospitalists frequently encounter patients receiving anticoagulants for a prior VTE event and must decide on the appropriateness of continuing anticoagulant therapy, taking into consideration the reasons for hospitalization. Consequently, hospitalists often ask themselves the following question: “Can I withdraw anticoagulants in this patient with prior VTE?” This article will focus on how to address this issue in patients receiving long-term anticoagulation for VTE (that is, beyond the initial 3 to 6 months of treatment).To answer this question, hospitalists must estimate the net benefit by balancing the risk for recurrent ...References1. Khan F, Rahman A, Carrier M, et al; MARVELOUS Collaborators. Long term risk of symptomatic recurrent venous thromboembolism after discontinuation of anticoagulant treatment for first unprovoked venous thromboembolism event: systematic review and meta-analysis. BMJ. 2019;366:l4363. [PMID: 31340984] doi:10.1136/bmj.l4363 CrossrefMedlineGoogle Scholar2. Rodger MA, LeGal G. Who should get long-term anticoagulant therapy for venous thromboembolism and with what? Hematology Am Soc Hematol Educ Program. 2018;2018:426-431. [PMID: 30504342] doi:10.1182/asheducation-2018.1.426 CrossrefMedlineGoogle Scholar3. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016;149:315-352. [PMID: 26867832] doi:10.1016/j.chest.2015.11.026 CrossrefMedlineGoogle Scholar4. Carrier M, Le Gal G, Wells PS, et al. Systematic review: case-fatality rates of recurrent venous thromboembolism and major bleeding events among patients treated for venous thromboembolism. Ann Intern Med. 2010;152:578-89. [PMID: 20439576]. doi:10.7326/0003-4819-152-9-201005040-00008 LinkGoogle Scholar5. Rodger MA, Le Gal G, Anderson DR, et al; REVERSE II Study Investigators. Validating the HERDOO2 rule to guide treatment duration for women with unprovoked venous thrombosis: multinational prospective cohort management study. BMJ. 2017;356:j1065. [PMID: 28314711] doi:10.1136/bmj.j1065 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada (M.K.)McGill University and McGill University Health Center Research Institute, Montréal, Quebec, Canada (M.A.R.)Grant Support: Dr. Kimpton received grant funding from Thrombosis Canada and the CanVECTOR Network for her fellowship in adult thrombosis medicine (Canadian Institutes of Health Research funding reference CDT-142654). Dr. Rodger is supported by the Harry Webster Thorp Chair of Medicine.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-1253.Corresponding Author: Miriam Kimpton, MD, The Ottawa Hospital Research Institute, University of Ottawa, 501 Smyth Road, Box 201A, Ottawa, ON K1H 8L6, Canada; e-mail, [email protected]ca.Current Author Addresses: Dr. Kimpton: The Ottawa Hospital Research Institute, University of Ottawa, 501 Smyth Road, Box 201A, Ottawa, ON K1H 8L6, Canada.Dr. Rodger: McGill University and McGill University Health Center Research Institute, 1001 Boulevard Decarie, Montréal, QC H4A 3J1, Canada. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals for Hospitalists - 16 June 2020 David H. Wesorick and Vineet Chopra Metrics Cited byProtocol for a modelling study to assess the clinical and cost-effectiveness of indefinite anticoagulant therapy for first unprovoked venous thromboembolismLong-Term Risk for Major Bleeding During Extended Oral Anticoagulant Therapy for First Unprovoked Venous Thromboembolism A Systematic Review and Meta-analysisFaizan Khan, MSc, Tobias Tritschler, MD, Miriam Kimpton, MD, Philip S. Wells, MD, Clive Kearon, MD, PhD, Jeffrey I. Weitz, MD, Harry R. Büller, MD, PhD, Gary E. Raskob, PhD, Walter Ageno, MD, Francis Couturaud, MD, PhD, Paolo Prandoni, MD, PhD, Gualtiero Palareti, MD, Cristina Legnani, PhD, Paul A. Kyrle, MD, Sabine Eichinger, MD, Lisbeth Eischer, MD, Cecilia Becattini, MD, PhD, Giancarlo Agnelli, MD, PhD, Maria Cristina Vedovati, MD, Geert-Jan Geersing, MD, PhD, Toshihiko Takada, MD, PhD, Benilde Cosmi, MD, PhD, Drahomir Aujesky, MD, Letizia Marconi, MD, PhD, Antonio Palla, MD, Sergio Siragusa, MD, Charlotte A. Bradbury, MD, PhD, Sameer Parpia, PhD, Ranjeeta Mallick, PhD, Anthonie W.A. Lensing, MD, PhD, Martin Gebel, PhD, Michael A. Grosso, MD, Kednapa Thavorn, PhD, Brian Hutton, PhD, Gregoire Le Gal, MD, PhD, Dean A. Fergusson, PhD, and Marc A. Rodger, MD, for the MAJESTIC Collaborators 16 June 2020Volume 172, Issue 12Page: HO2-HO3KeywordsAnticoagulant therapyAnticoagulantsHemorrhageHospitalistsHospitalizationsMedical risk factorsObesitySurgeryThrombosisVenous thromboembolism ePublished: 16 June 2020 Issue Published: 16 June 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...