Klok F A, Huisman M V
Leids Universitair Medisch Centrum, afd. Trombose en Hemostase, Leiden.
Ned Tijdschr Geneeskd. 2017;161:D1679.
Recent American, European and Dutch guidelines recommend indefinite anticoagulation after a diagnosis of unprovoked venous thromboembolism in the absence of a high bleeding risk. The recommended approach would be to only stop anticoagulant therapy after three months in patients with one or more untreatable risk factors for bleeding such as prior major bleeding, uncorrectable hypertension or deep thrombocytopenia. Vitamin K-antagonists and direct oral anticoagulants (DOACs) were found to protect against recurrent venous thromboembolism at cost of major bleedings, although at a lower frequency than the number of prevented thrombotic events. Due to the lower risk of major bleeding than associated with vitamin K-antagonists, DOACs are the preferred treatment option for the long term treatment of unprovoked venous thromboembolism. Apixaban is available in a reduced dose for long-term treatment, and rivaroxaban in a reduced dose was recently shown to be more effective than aspirin.
最近美国、欧洲和荷兰的指南建议，对于诊断为不明原因静脉血栓栓塞且无高出血风险的患者，应进行长期抗凝治疗。推荐的方法是，对于有一个或多个不可治疗的出血风险因素（如既往大出血、无法纠正的高血压或严重血小板减少症）的患者，仅在三个月后停止抗凝治疗。维生素K拮抗剂和直接口服抗凝剂（DOACs）被发现可预防复发性静脉血栓栓塞，但代价是发生大出血，尽管大出血的频率低于预防的血栓形成事件数量。由于与维生素K拮抗剂相比大出血风险较低，DOACs是不明原因静脉血栓栓塞长期治疗的首选治疗选择。阿哌沙班有低剂量剂型用于长期治疗，最近有研究表明，低剂量利伐沙班比阿司匹林更有效。
