Ottawa Blood Disease Centre, Ottawa Hospital, Ottawa, Ontario, Canada.
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; and.
Hematology Am Soc Hematol Educ Program. 2018 Nov 30;2018(1):426-431. doi: 10.1182/asheducation-2018.1.426.
After an initial 3 to 6 months of anticoagulation for venous thromboembolism (VTE), clinicians and patients face an important question: "Do we stop anticoagulants or continue them indefinitely?" The decision is easy in some scenarios (eg, stop in VTE provoked by major surgery). In most scenarios, which are faced on a day-to-day basis in routine practice, it is a challenging decision because of uncertainty in estimates in the long-term risks (principally major bleeding) and benefits (reducing recurrent VTE) and the tight trade-offs between them. Once the decision is made to continue, the next question to tackle is "Which anticoagulant?" Here again, it is a difficult decision because of the uncertainty with regard to estimates of efficacy and the safety of anticoagulant options and the tight trade-offs between choices. We conclude with the approach that we take in our clinical practice.
在静脉血栓栓塞症 (VTE) 初始抗凝治疗 3 至 6 个月后，临床医生和患者面临一个重要问题：“我们是否停止抗凝治疗，还是无限期地继续抗凝？”在某些情况下（例如，由大手术引起的 VTE），这个决定很容易做出。但在大多数情况下，这是一个具有挑战性的决定，因为长期风险（主要是大出血）和获益（减少复发性 VTE）的估计存在不确定性，并且两者之间存在严格的权衡。一旦决定继续抗凝，下一个需要解决的问题是“选择哪种抗凝剂？”这同样也是一个艰难的决定，因为对于抗凝药物疗效和安全性的估计存在不确定性，并且选择之间存在严格的权衡。我们将以我们在临床实践中采取的方法作为结论。
