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Vol. 217. Issue 6.
Pages 359-364 (August - September 2017)
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Vol. 217. Issue 6.
Pages 359-364 (August - September 2017)
For and against
Extended anticoagulation in venous thromboembolism disease. In favor
Anticoagulación extendida en la enfermedad tromboembólica venosa. A favor
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M.C. Fernández
Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, Spain
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Tables (3)
Table 1. Estimated risk of recurrence of venous thromboembolism disease.
Table 2. Studies in preventing the recurrence of venous thromboembolism.
Table 3. Direct oral anticoagulants versus vitamin K antagonists in the extended treatment of venous thromboembolism.
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Abstract

Venous thromboembolism disease can be considered a chronic disease because, after the first episode, there is a life-long risk of recurrence. Recurrence is a severe complication. Anticoagulation is effective while it is maintained, but when it is discontinued, the risk of new thrombotic events persists indefinitely. Clinical practice guidelines offer specific recommendations on the treatment duration for patients with provoked or recurrent disease but are not specific for those with a first unprovoked episode. The decision should be made after a careful individual assessment of the risk-benefit of anticoagulation. This article reviews the evidence in favor of extending the anticoagulation and the current therapeutic options.

Keywords:
Venous thromboembolism disease
Unprovoked
Recurrence
Hemorrhage
Extended anticoagulation
Anticoagulants
Resumen

La enfermedad tromboembólica venosa puede considerarse una enfermedad crónica ya que, tras un primer episodio, el riesgo de recurrencia permanece toda la vida. La recurrencia es una complicación grave. La anticoagulación es eficaz mientras se mantiene, pero al suspenderla el riesgo de nuevos eventos trombóticos persiste indefinidamente. Las guías de práctica clínica ofrecen recomendaciones específicas sobre la duración del tratamiento en pacientes con enfermedad provocada o recurrente, pero son poco precisas para aquellos con un primer episodio no provocado. La decisión debe tomarse tras una cuidadosa valoración individual del riesgo-beneficio de la anticoagulación. Este artículo repasa las evidencias a favor de prolongar la anticoagulación y las opciones terapéuticas actuales.

Palabras clave:
Enfermedad tromboembólica venosa
No provocado
Recurrencia
Hemorragia
Anticoagulación extendida
Anticoagulantes

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