Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa Hospital, General Campus, Ottawa, ONT, Canada.
Blood Rev. 2010 Jul-Sep;24(4-5):171-8. doi: 10.1016/j.blre.2010.06.001. Epub 2010 Jul 14.
Whether to continue oral anticoagulant therapy indefinitely after completing 3 to 6 months of oral anticoagulant therapy for "unprovoked" venous thromboembolism (VTE), is one of the most important unanswered questions in VTE management. This long-term decision should be based on balancing the long-term mortality risk from recurrent VTE, largely preventable with oral anticoagulant therapy, against the long-term mortality risk of major bleeding, the principle complication of oral anticoagulant therapy. There exist important knowledge gaps in estimating the long-term mortality risk of recurrent VTE in patients with unprovoked VTE who discontinue therapy and the long-term mortality risk from major bleeding in those who continue oral anticoagulant therapy. These knowledge gaps, reviewed herein, are the source of uncertainty for patients and health care providers wrestling with this important question. One promising solution is recurrent VTE risk stratification where unprovoked VTE patients are categorised as low or high risk for recurrent VTE and clinical decision making is less ambiguous and ultimately will likely lead to better outcomes.
对于“无诱因”静脉血栓栓塞症（VTE）患者，在完成 3 至 6 个月的口服抗凝治疗后，是否无限期继续口服抗凝治疗，是 VTE 管理中最重要的未解决问题之一。这一长期决策应基于平衡复发性 VTE的长期死亡率风险与口服抗凝治疗可大大预防的大出血的长期死亡率风险，口服抗凝治疗的主要并发症。对于停止治疗的无诱因 VTE 患者，以及继续接受口服抗凝治疗的患者，估计复发性 VTE 的长期死亡率风险和大出血的长期死亡率风险存在重要的知识空白。本文回顾了这些知识空白，它们是患者和医疗保健提供者在解决这一重要问题时感到不确定的原因。一种有前途的解决方案是复发性 VTE 风险分层，根据复发性 VTE 的风险将无诱因 VTE 患者分为低风险或高风险，临床决策就不那么模糊，最终可能会导致更好的结果。
