Comparison of 1 month with 3 months of anticoagulation for a first episode of venous thromboembolism associated with a transient risk factor

被引:107
作者
Kearon, C
Ginsberg, JS
Anderson, DR
Kovacs, MJ
Wells, P
Julian, JA
Mackinnon, B
Demers, C
Douketis, J
Turpie, AG
Nguyen, PV
Green, D
Kassis, J
Kahn, SR
Solymoss, S
Desjardins, L
Geerts, W
Johnston, M
Weitz, JI
Hirsh, J
Gent, M
机构
[1] McMaster Univ, Hamilton, ON, Canada
[2] Henderson Res Ctr, Hamilton, ON, Canada
[3] Dalhousie Univ, Halifax, NS, Canada
[4] Univ Western Ontario, London, ON, Canada
[5] Univ Ottawa, Ottawa, ON, Canada
[6] Univ Laval, Quebec City, PQ, Canada
[7] Northwestern Univ, Sch Med, Chicago, IL USA
[8] Univ Montreal, Montreal, PQ, Canada
[9] McGill Univ, Montreal, PQ, Canada
[10] Univ Toronto, Toronto, ON, Canada
关键词
anticoagulation; randomized trial; risk factor; transient venous thromboembolism; treatment; warfarin;
D O I
10.1046/j.1538-7836.2004.00698.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: The risk of recurrence is lower after treatment of an episode of venous thromboembolism associated with a transient risk factor, such as recent surgery, than after an episode associated with a permanent, or no, risk factor. Retrospective analyses suggest that 1 month of anticoagulation is adequate for patients whose venous thromboembolic event was provoked by a transient risk factor. Methods: In this double-blind study, patients who had completed 1 month of anticoagulant therapy for a first episode of venous thromboembolism provoked by a transient risk factor were randomly assigned to continue warfarin or to placebo for an additional 2 months. Our goal was to determine if the duration of treatment could be reduced without increasing the rate of recurrent venous thromboembolism during 11 months of follow-up. Results: Of 84 patients assigned to placebo, five (6.0%) had recurrent venous thromboembolism, compared with three of 81 (3.7%) assigned to warfarin, resulting in an absolute risk difference of 2.3% [95% confidence interval (0) - 5.2, 10.0]. The incidence of recurrent venous thromboembolism after discontinuation of warfarin was 6.8% per patient-year in those who received warfarin for 1 month and 3.2% per patient-year in those who received warfarin for 3 months (rate difference of 3.6% per patient-year; 95% Cl - 3.8, 11.0). There were no major bleeds in either group. Conclusion: Duration of anticoagulant therapy for venous thromboembolism provoked by a transient risk factor should not be reduced from 3 months to 1 month as this is likely to increase recurrent venous thromboembolism without achieving a clinically important decrease in bleeding.
引用
收藏
页码:743 / 749
页数:7
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