Page 23 - 2019_07 resto del Mondo-web

Editorials
6. the placebo group.13 Another limitation, although inherent
Douketis JD, Kearon C, Bates S, Duku EK, Ginsberg JS. Risk of fatal pulmonary embolism in patients with treated venous thromboem- bolism. JAMA. 1998;279(6):458-462. DouketisJD,GuCS,SchulmanS,GhirarduzziA,PengoV,PrandoniP. The risk for fatal pulmonary embolism after discontinuing anticoagu- lant therapy for venous thromboembolism. Ann Intern Med. 2007;147(11):766-774. VanderWallSJ,vanderPolLM,Ende-VerhaarYM,etal.Fatalrecurrent VTE after anticoagulant treatment for unprovoked VTE; a systematic review. Eur Resp Rev. 2018;27:180094. KearonC,AklEA,OrnelasJ,etal.AntithrombotictherapyforVTEdi- sease: CHEST Guideline and Expert Panel Report. Chest. 2016;149(2):315-352. KearonC,GentM,HirshJ,etal.Acomparisonofthreemonthsofanti- coagulation with extended anticoagulation for a first episode of idio- pathic venous thromboembolism. N Engl J Med. 1999;340(12):901-907. Agnelli G, Prandoni P, Santamaria MG, et al. Warfarin Optimal Duration Italian Trial Investigators. Three months versus one year of oral anticoagulant therapy for idiopathic deep venous thrombosis. Warfarin Optimal Duration Italian Trial Investigators. N Engl J Med. 2001;345(3):165-169.
Agnelli G, Prandoni P, Becattini C, et al; Warfarin Optimal Duration Italian Trial Investigators. Extended oral anticoagulant therapy after a first episode of pulmonary embolism. Ann Intern Med. 2003;139(1):19- 25.
Couturaud F, Sanchez O, Pernod G, et al; PADIS-PE Investigators. Six months vs extended oral anticoagulation after a first episode of pul- monary embolism: The PADIS-PE Randomized Clinical Trial. JAMA. 2015;314(1):31-40. CouturaudF,SanchezO,PernodG,etal;PADIS-DVTInvestigators.Six months versus extended oral anticoagulation after a first episode of unprovoked deep-vein thrombosis. The PADIS-DVT randomized clinical trial. Haematologica 2019;104(7):1493-1501. TanM,VelthuisSI,WesterbeekRE,VanRoodenCJ,VanDerMeerFJ, Huisman MV. High percentage of non-diagnostic compression ultra- sonography results and the diagnosis of ipsilateral recurrent proximal deep vein thrombosis. J Thromb Haemost. 2010;8(4):848-850.
Tan M, Mol GC, van Rooden CJ, et al. Magnetic resonance direct thrombus imaging differentiates acute recurrent ipsilateral deep vein thrombosis from residual thrombosis. Blood. 2014;124(4):623-627.
bleeding rate in the treated group was 2.2% versus 0.5 % in
due to the time the study was designed, was the use of vita- min K antagonists. Whether direct oral anticoagulants, in full or reduced dose, will provide the same results has to be demonstrated in future studies.
7.
8. In conclusion, prolonging anticoagulant therapy after an
initial period of 6 months leads to a significant reduction of recurrent venous thromboembolism in patients with unprovoked deep-vein thrombosis, a benefit, which is not maintained after stopping the anticoagulant treatment. This study underlines the relevance of current guidelines that recommend considering indefinite anticoagulation in patients with unprovoked venous thromboembolism.9 Indeed, only prolongation of anticoagulant treatment is not enough in these high-risk patients.
References
1. Huisman MV, Barco S, Cannegieter SC, et al. Pulmonary embolism. Nat Rev Dis Primers. 2018;4:18028.
2. SchulmanS,KearonC,KakkarAK,etal.Dabigatranversuswarfarinin the treatment of acute venous thromboembolism. N Engl J Med. 2009;361(24):2342–2352.
3. EINSTEIN Investigators, Bauersachs R, Berkowitz SD, et al. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med. 2010;363(26):2499–2510.
4. Agnelli G, Buller HR, Cohen A, et al. Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med. 2013;369(9):799– 808.
5. Hokusai-VTE Investigators, Büller HR, Décousus H, et al. Edoxaban versus warfarin for the treatment of symptomatic venous thromboem- bolism. N Engl Med. 2013;369(15): 1406–1415.
9. 10. 11.
12.
13.
14.
15.
16.
haematologica | 2019; 104(7)
1301