Chapter Seven Venous Disease Coalition Long-Term Management of VTE VTE Toolkit.

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Presentation transcript:

Chapter Seven Venous Disease Coalition Long-Term Management of VTE VTE Toolkit

Long-Term Treatment of DVT/PE: 2 options VTE Toolkit LMWH S/C Oral Anticoagulation (INR ) 5-7 d 3 mos.- indefinite 1

Long-Term Treatment of DVT/PE: 2 options VTE Toolkit LMWH S/C Oral Anticoagulation (INR ) 5-7 d 3 mos.- indefinite 1 LMWH S/C ? 2 pregnancy, uncontrolled adenocarcinoma, high bleeding risk, patient preference

Treatment of VTE VTE Toolkit Recurrent VTE Anticoagulation Time 0 With anticoagulation, the risk of recurrent VTE is very low. VTE

Treatment of VTE VTE Toolkit Recurrent VTE Anticoagulation Time 0 If the VTE was provoked (surgery, trauma, pregnancy, acute illness, etc.), the risks of recurrent VTE after a period of anticoagulation is low. VTE

Treatment of VTE VTE Toolkit Recurrent VTE Anticoagulation Time 0 If the VTE was unprovoked, associated with cancer or some thrombophilias, the risks of recurrent VTE after a period of anticoagulation is higher. VTE

D-Dimer to Predict VTE Recurrence VTE Toolkit Patients with abnormal D-Dimer one month after discontinuation of anticoagulation have a significantly greater incidence of recurrent VTE than patients with a normal D-dimer. Palareti - D-Dimer testing to determine the duration of anticoagulation therapy. N Engl J Med 2006;355:1780

Predictors of Recurrent VTE VTE Toolkit Ongoing risk factors – cancer, immobility, high risk thrombophilia (APLA, AT deficiency) Unprovoked initial VTE Older age Male gender Obesity Residual DVT Elevated D-dimer 1 month after stopping anticoagulants

Duration of Treatment for VTE VTE Toolkit 1 st Episode: Transient, reversed risk3 - 6 mos. Unprovoked12 mos  indefinite* Ongoing risk (unresolved cancer, AT deficiency, APLA)indefinite* Recurrent Episodes:indefinite* * Periodic reassessment to discuss: 1)Patient risk factors for bleeding and thrombosis 2)New knowledge about risk of recurrence 3)Patient preference

Venous Disease Coalition VTE Toolkit