Duration of vitamin K antagonist therapy for venous thromboembolism: A systematic review of the literature

Michael B. Streiff, Jodi B. Segal, Leonardo Tamariz, Mollie W. Jenckes, Dennis T. Bolger, John Eng, Jerry A. Krishnan, Eric B. Bass

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Purpose: The aim of this study was to evaluate the evidence on the optimal duration of vitamin K antagonist (VKA) therapy for venous thromboembolism (VTE). Methods: Randomized controlled trials of VKA for VTE were identified by a computerized database search. Summary event rates for relevant outcomes were calculated using a random effects model with 95% confidence intervals (95% CI). Results: Ten studies met inclusion criteria. The incidence of recurrent VTE (3 months, 7.9 VTE per 100 patient-years [95% CI, 5.2 to 10] versus 4-12 months, 4.9 VTE per 100 patient-years [95% CI, 3.6 to 6.2] versus continuous therapy, 0.7 VTE per 100 patient-years [95% CI, 0.3 to 1.1]) and total adverse events (3 months, 11.2 events per 100 patient-years [95%CI, 7.1 to 15.4] versus 4-12 months, 7.4 events per 100 patient-years [95%CI, 6.2 to 8.5] versus continuous therapy 3.1 events per 100 patient-years [95%CI, 2.2 to 4.0] declined as VKA therapy duration increased. Continuous reduced intensity therapy (INR 1.5-2) was associated with more recurrent VTE (2.3 VTE per 100 patient-years [95%CI, 1.5 to 3.0]). Continuous VKA therapy (INR 2-3) was beneficial for patients with a second VTE and antiphospholipid antibodies. The incidence of recurrent VTE was similar with 6 or 12 weeks of therapy for isolated calf DVT. Conclusion: Randomized controlled trials indicate that continuous VKA therapy (INR 2-3) for VTE is associated with better clinical outcomes than shorter durations. Patients with a second VTE or antiphospholipid antibodies also benefit from continuous anticoagulation. Patients with calf DVT should be treated for at least 6 weeks.

Original languageEnglish
Pages (from-to)684-691
Number of pages8
JournalAmerican Journal of Hematology
Volume81
Issue number9
DOIs
StatePublished - Sep 1 2006
Externally publishedYes

Fingerprint

Vitamin K
Venous Thromboembolism
International Normalized Ratio
Therapeutics
Confidence Intervals
Antiphospholipid Antibodies
Randomized Controlled Trials
Incidence
Databases

Keywords

  • Duration of therapy
  • Oral anticoagulation
  • Systematic review
  • Venous thromboembolism
  • Vitamin K antagonist

ASJC Scopus subject areas

  • Hematology

Cite this

Duration of vitamin K antagonist therapy for venous thromboembolism : A systematic review of the literature. / Streiff, Michael B.; Segal, Jodi B.; Tamariz, Leonardo; Jenckes, Mollie W.; Bolger, Dennis T.; Eng, John; Krishnan, Jerry A.; Bass, Eric B.

In: American Journal of Hematology, Vol. 81, No. 9, 01.09.2006, p. 684-691.

Research output: Contribution to journalArticle

Streiff, MB, Segal, JB, Tamariz, L, Jenckes, MW, Bolger, DT, Eng, J, Krishnan, JA & Bass, EB 2006, 'Duration of vitamin K antagonist therapy for venous thromboembolism: A systematic review of the literature', American Journal of Hematology, vol. 81, no. 9, pp. 684-691. https://doi.org/10.1002/ajh.20691
Streiff, Michael B. ; Segal, Jodi B. ; Tamariz, Leonardo ; Jenckes, Mollie W. ; Bolger, Dennis T. ; Eng, John ; Krishnan, Jerry A. ; Bass, Eric B. / Duration of vitamin K antagonist therapy for venous thromboembolism : A systematic review of the literature. In: American Journal of Hematology. 2006 ; Vol. 81, No. 9. pp. 684-691.
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abstract = "Purpose: The aim of this study was to evaluate the evidence on the optimal duration of vitamin K antagonist (VKA) therapy for venous thromboembolism (VTE). Methods: Randomized controlled trials of VKA for VTE were identified by a computerized database search. Summary event rates for relevant outcomes were calculated using a random effects model with 95{\%} confidence intervals (95{\%} CI). Results: Ten studies met inclusion criteria. The incidence of recurrent VTE (3 months, 7.9 VTE per 100 patient-years [95{\%} CI, 5.2 to 10] versus 4-12 months, 4.9 VTE per 100 patient-years [95{\%} CI, 3.6 to 6.2] versus continuous therapy, 0.7 VTE per 100 patient-years [95{\%} CI, 0.3 to 1.1]) and total adverse events (3 months, 11.2 events per 100 patient-years [95{\%}CI, 7.1 to 15.4] versus 4-12 months, 7.4 events per 100 patient-years [95{\%}CI, 6.2 to 8.5] versus continuous therapy 3.1 events per 100 patient-years [95{\%}CI, 2.2 to 4.0] declined as VKA therapy duration increased. Continuous reduced intensity therapy (INR 1.5-2) was associated with more recurrent VTE (2.3 VTE per 100 patient-years [95{\%}CI, 1.5 to 3.0]). Continuous VKA therapy (INR 2-3) was beneficial for patients with a second VTE and antiphospholipid antibodies. The incidence of recurrent VTE was similar with 6 or 12 weeks of therapy for isolated calf DVT. Conclusion: Randomized controlled trials indicate that continuous VKA therapy (INR 2-3) for VTE is associated with better clinical outcomes than shorter durations. Patients with a second VTE or antiphospholipid antibodies also benefit from continuous anticoagulation. Patients with calf DVT should be treated for at least 6 weeks.",
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