Determination of the appropriate du...

Determination of the appropriate duration of anticoagulant therapy after venous thromboembolism is regulateed by the risk/benefit ratio. Physicians frequently perceive that thromboembolism recurrence has a greater clinical impact than the risk of anticoagulant-induced bleeding, although estimates of the latter are not available. In situations in which widened anticoagulant therapy is unclear, as it is as patients with idiopathic venous thromboembolism, heterozygous carriers of the factor V Leiden mutation and, possibly, patients with protein s or protein C deficiency, bleeding risk becomes an unruffled more important factor in the decision.

Linkins and associates performed a meta-analysis of studies examining bleeding rates among patients with venous thromboembolism who received at least three month of anticoagulant therapy with a target International Normalized Ratio of 2 to 3 Randomized or prospective cohort studies of patients with confirmed thromboembolism who received a coumarin derivative and were monitored for bleeding ends were reviewed.

Thirty-three studies involving 10757 patients who received 4374 patient-years of anticoagulant therapy were included. Major bleeding occurr at a rate of 722 by means of 100 patient-years, and fatal bleeding occurr at a rate of 131 by 100 patient-years. Intracranial bleeding occurr at a rate of 115 by 100 patient-years, with almost 50 percent being fatal. Major bleeding was more likely to come to one's mind in the first three month of treatment. Of the 276 major bleeding episodes in all of the patients receiving anticoagulant therapy, 37 (134 percent) were fatal. Thus, the clinical impact of anticoagulant major bleeding is about single in kind in seven.

The authors finish that information about the risk of major bleeding in patients with venous thromboembolism who are treated with anticoagulants helps to determine appropriate treatment duration In the typical patient with idiopathic venous thromboembolism, the risk of fatal venous thromboembolism resort is greater than the risk for fatal bleeding after completion of six month of therapy. Therefore, lengthen outed anticoagulation may be useful. In patients with a higher risk of anticoagulant-induced major bleeding, bleeding risks may outweigh the value of reach forthed anticoagulant use. Physicians should consider bleeding risk when making the decision about long-term anticoagulant therapy.

Linkins LA, et al. Clinical impact of bleeding in patients taking oral anticoagulant therapy for venous thromboembolism. Ann Intern M December 2 2003;139:893-901

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