The optimum duration of anticoagulation following idiopathic deep venous thrombosis and pulmonary embolism is controversial. The JRCPE is delighted to publish a debate written by three international experts. Dr Shetty and Dr Campbell recommend that three months’ anticoagulation is sufficient, while Professor Hyers recommends anticoagulation for longer than three months.
KearonCKahnSRAgnelliG Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest 2008; 133;454S–545S. doi:10.1378/chest.08-0658
2.
CampbellIABentleyDPPrescottRJ Anticoagulation for three versus six months in patients with deep vein thrombosis or pulmonary embolism, or both: randomised trial. BMJ 2007; 334:674–7. doi:10.1136/bmj.39098.583356.55
3.
PinedeL.Ninet J. Duhaut P Comparison of 3 and 6 months of oral anticoagulant therapy after a first episode of proximal deep vein thrombosis or pulmonary embolism and comparison of 6 and 12 weeks of therapy after isolated calf deep vein thrombosis. Circulation2001; 103:2453–60.
4.
AgnelliGPrandoniPSantamariaMG Three months versus one year of oral anticoagulant therapy for idiopathic deep venous thrombosis. Warfarin Optimal Duration Italian Trial Investigators. N Engl J Med 2001; 345:165–9. doi:10.1056/NEJM200107193450302
5.
SchulmanSGranqvistSHolmstromM The duration of oral anticoagulant therapy after a second episode of venous thromboembolism. N Engl J Med 1997; 336:393–8. doi:10.1056/NEJM199702063360601
6.
KearonCGentMHirshJ A comparison of three months of anticoagulation with extended anticoagulation for a first episode of idiopathic venous thromboembolism. N Engl J Med 1999; 340:901–7. doi:10.1056/NEJM199903253401201
7.
PalaretiGCosmiBLegnaniC D-dimer testing to determine the duration of anticoagulation therapy. N Engl J Med 2006; 355:1780–9. doi:10.1056/NEJMoa054444
8.
RidkerPMGoldhaberSZDanielsonE Long-term lowintensity warfarin therapy for prevention of recurrent venous thromboembolism. N Engl J Med 2003; 348:1425–34. doi:10.1056/NEJMoa035029
9.
KearonCGinsbergJSKovacsMJ Comparison of lowintensity warfarin therapy with conventional-intensity warfarin therapy for long-term prevention of recurrent venous thromboembolism. N Engl J Med 2003; 34:631–9. doi:10.1056/NEJMoa035422
10.
PrandoniPPrinsMHLensingAWResidual thrombosis on ultrasonography to guide the duration of anticoagulation in patients with deep venous thrombosis: a randomized trial. Ann Intern Med2009; 150:577–85.
