The duration of anticoagulant therapy with vitamin K-antagonists (VKA) after pulmonary embolism (PE) is still a matter of debate, most of the evidence coming from post-deep venous thrombosis (DVT) data. Although effective, indeterminate duration anticoagulation benefit is commonly offset by the risk of major bleeding. Our aim is to determine, in patients with idiopathic anatomically extensive PE who had been subjected to fibrinolysis, the safety and efficacy of long-term anticoagulation with VKA, even not guideline-based (whose recommendation is to stop anticoagulation at 3 moths).
A total of 27 patients, with anatomically extensive acute PE due to a reversible risk factor, subjected to fibrinolisys with alteplase, were followed for a mean duration of 2.2 years (0.5 –8.0 years). We created 2 groups, based on the actual duration of anticoagulant (AC) therapy on those patients: group A: 3 months (n = 21; 77.8%) and group B: more than 3 months (n = 6; 22.2%]). Two endpoints were created: recurrence of DVT/PE and bleeding events.
After 3 months, 22.2% of patients with a reversible cause of PE withdrew VKA (in-line with the recommendations), whereas 77.8% maintained it off-label. The incidence of recurrent DVT or PE on those who abandoned VKA after 3-months was four-fold than in those who maintained it after the 3-month period (16.7% vs. 4.8%, p = NS). This better prognosis was slightly offset by a small increase in non-fatal bleeding (23.8 vs. 16.7%, p = NS). Considering all patients taking VKA post-thombolysis in the context of PE in our centre (idiopathic or secondary to a reversible risk factor, n = 72), those who were on VKA by the guidelines had a higher recurrence of DVT or PE, as expected, compared with those taking it off-label (11.8 vs. 4.8%, p = NS).
Although conferring a slightly higher incidence of non-fatal bleeding, prolonged VKA therapy appears to be of value preventing recurrence of DVT/PE in the population with PE secondary to a transient risk factor.
Long-term anticoagulation in this population seems to be effective and safe.
Rui Baptista, No Financial Disclosure Information; No Product/Research Disclosure Information