Abstract
Deep vein thrombosis and pulmonary embolism are clinical manifestations of venous thromboembolism, and they necessitate anticoagulant therapy in most cases. The duration of treatment is predicated on a balance between the risk of recurrent disease and the risk of bleeding inherent to anticoagulant therapy. It is important that physicians are aware of evidence-based guidelines that can enhance decision-making discussions with patients about the risks and benefits of the different durations of treatment. Keeping patients well informed as they consider these difficult choices helps them assume responsibility and may improve compliance in accordance with the tenets of osteopathic principles of care.
Venous thromboembolism (VTE) affects approximately 360,000 patients in the United States each year
1 as either deep vein thrombosis (DVT) or pulmonary embolism (PE). The pathophysiologic characteristics and the treatment of VTE are the same regardless of whether the symptoms manifest in the extremities, the lungs, or both.
2
The duration of anticoagulant therapy with warfarin or another vitamin K antagonist is determined with the goal of preventing recurrent events, which can be fatal. However, the likelihood of VTE recurrence depends on certain clinical attributes or clinical scenarios. VTE theoretically could be classified on the basis of the initial site of manifestation, such as upper extremity, proximal lower extremity, distal lower extremity, pelvis, or visceral veins; cerebral or cavernous vein; or lungs. However, investigations to determine the optimal duration of treatment for VTE have primarly studied DVT of the lower extremities or PE. The clinical scenarios that have been studied and are incorporated into evidence-based guidelines are provoked VTE, cancer-related VTE, idiopathic VTE, recurrent VTE, and thrombophilia-related VTE. This review is not a general overview of the treatments for VTE, but instead focuses on the likelihood of recurrence of each clinical type of VTE to assist clinicians and their patients in optimally balancing the risk of recurrent VTE with the risk of anticoagulation-related bleeding.