Medical University of Vienna, Dept. of Medicine I, Austria.
Hamostaseologie. 2013 Aug 1;33(3):211-7. doi: 10.5482/HAMO-13-03-0015. Epub 2013 May 29.
Deciding on the optimal duration of anticoagulation is based on the risk of recurrent venous thromboembolism (VTE) and of bleeding during anticoagulation. The duration of anticoagulation should be at least three months since shorter courses double the recurrence rates. At three months anticoagulation can be stopped in patients with a VTE provoked by a transient risk factor, as the recurrence risk is expected to be lower than the bleeding risk during anticoagulation. Patients with unprovoked VTE are at higher risk of recurrence and prolonged anticoagulation is currently recommended. However, attempts are made to stratify these patients according to their recurrence risk and to identify those with a low recurrence risk who would not benefit from extended anticoagulation. Novel approaches to optimize the management of patients with unprovoked VTE are the use of prediction models which link clinical patient characteristics with laboratory testing to discriminate between patients with a low risk (who may discontinue anticoagulation) and those with high risk (in whom long term anticoagulation is justified). Moreover, new antithrombotic concepts including new oral anticoagulants or aspirin both of which potentially confer a lower bleeding risk and are more convenient for the patients have been explored for extended thromboprophylaxis.
决定抗凝的最佳持续时间取决于复发性静脉血栓栓塞 (VTE) 和抗凝期间出血的风险。抗凝时间至少应为三个月，因为较短的疗程会使复发率增加一倍。对于由短暂风险因素引起的 VTE 患者，在三个月时可以停止抗凝，因为预期复发风险低于抗凝期间出血风险。无诱因 VTE 患者复发风险较高，目前建议延长抗凝时间。然而，目前正在尝试根据复发风险对这些患者进行分层，并确定那些复发风险低、延长抗凝治疗不会获益的患者。优化无诱因 VTE 患者管理的新方法是使用预测模型，将临床患者特征与实验室检测相结合，区分低风险（可能停止抗凝）和高风险（需要长期抗凝）患者。此外，还探索了新的抗血栓形成概念，包括新型口服抗凝剂或阿司匹林，两者都可能降低出血风险，并且对患者更方便，可用于延长血栓预防。
