Some patient subgroups with major provoking factors (eg, post-surgical VTE) have a low risk of recurrent VTE (1% at one year)1 and anticoagulants can be safely discontinued after short term treatment.2 However, more than 50% of patients with VTE do not have a major provoking factor.3 In these patients with unprovoked VTE, the risk of recurrent VTE is substantially higher; up to 10% in the first year after stopping short term treatment, 5% in the subsequent year,4 and 30% at eight years.5 Recurrent VTE is fatal in 3.6% of cases.6Oral anticoagulant treatment is effective at reducing the risk of recurrent VTE during treatment; oral anticoagulant treatment reduces the risk of recurrent VTE by 80-90%.7 Longer term oral anticoagulant treatment likely only delays recurrent VTE compared with short term treatment.8910 The highest bleeding risks are observed during initial oral treatment.
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Conclusions Women with a first unprovoked VTE event and none or one of the HERDOO2 criteria have a low risk of recurrent VTE and can safely discontinue anticoagulants after completing short term treatment. Venous thromboembolism (VTE), comprising deep vein thrombosis and pulmonary embolism, is a common, potentially fatal yet treatable condition.
After short term oral anticoagulant treatment, the risk of recurrent VTE after discontinuing anticoagulants is variable, depending on the presence or absence of provoking factors at the time of the initial event.