Agnelli Giancarlo, Becattini Cecilia
1Internal and Cardiovascular Medicine, Stroke Unit, University of Perugia, Perugia, Italy.
Hematology Am Soc Hematol Educ Program. 2013;2013:471-7. doi: 10.1182/asheducation-2013.1.471.
Venous thromboembolism (VTE) has a variable recurrence rate after the discontinuation of anticoagulant treatment. Therefore, the duration of anticoagulation therapy after a first VTE should be tailored to the estimated risk for recurrence. Anticoagulant therapy should be discontinued after the initial 3 to 6 months in those patients who had the first episode in association with temporary risk factors. The duration of anticoagulant therapy in patients who had a first episode of cancer-associated VTE should be reassessed over time based on the persistence of cancer and anticancer therapy. After 3 to 6 months of anticoagulant treatment for VTE, patients with a first unprovoked event and an estimated low risk for bleeding complications should be evaluated for indefinite treatment on an individualized basis. New oral anticoagulants have been evaluated for the extended treatment of VTE. Large phase 3 studies have shown that dabigatran, rivaroxaban, and apixaban are effective and safe in this indication. These agents do not require monitoring for dose adjustment and could make extended treatment more feasible and acceptable to patients.
静脉血栓栓塞症（VTE）在抗凝治疗中断后的复发率各不相同。因此，首次发生VTE后的抗凝治疗时长应根据复发的估计风险进行调整。对于首次发作与临时风险因素相关的患者，在最初3至6个月后应停用抗凝治疗。首次发生癌症相关VTE的患者，抗凝治疗时长应根据癌症的持续情况和抗癌治疗情况随时间重新评估。在对VTE进行3至6个月的抗凝治疗后，对于首次发生无诱因事件且出血并发症估计风险较低的患者，应根据个体情况评估是否进行长期治疗。新型口服抗凝药已被评估用于VTE的延长治疗。大型3期研究表明，达比加群、利伐沙班和阿哌沙班在该适应症中有效且安全。这些药物无需监测剂量调整，可使延长治疗对患者而言更可行且更易接受。
