When to Stop Anticoagulation Following a DVT or Pulmonary Embolus?
Major venous thromboembolism (VTE) requires minimum 3 to 6 months of anticoagulation, but when is it time to stop? Uncertainty remains around unprovoked VTE which accounts for approximately 50% of cases. This study by Rodger et al. (BMJ, 2017) sought to validate the use of the HERDOO2 rule which states that women with ≥ 2 HERDOO predictors [ (i) Hyperpigmentation, (ii) Edema, or Redness in either leg; (iii) D-dimer level ≥250 μg/L; (iv) Obesity with body mass index ≥30; or (v) Older age, ≥65 years] can safely discontinue anticoagulants.
Prospective Cohort Management Study
2,785 participants with a first unprovoked VTE (DVT and pulmonary embolus) at 44 centers in seven countries were enrolled. All participants completed 5-12 months of short-term anticoagulant treatment. Of 1213 women in this cohort, 51.3% were defined as low risk (0 or 1 HERDOO2 criteria) and had stopped oral anticoagulant treatment (intervention arm). Men and women at high risk (≥2 HERDOO2 criteria) remained on anticoagulant treatment at the discretion of patients and their clinicians (observation arm). In the intervention (low risk) arm, 17 women developed recurrent VTE during 564 patient years of follow-up (3.0% per patient year, 95% CI 1.8% to 4.8%). When the high risk cohort was analyzed 25 of 323 high risk women and men who stopped anticoagulants had VTE during 309 patient years of follow-up (8.1% per patient year, 95% CI 5.2% to 11.9%) and 28 of 1,802 high risk women and men who continued anticoagulant treatment experienced recurrent VTE during 1,758 patient years of follow-up (1.6% per patient year, 95% CI 1.1% to 2.3%). The ISTH suggests to stop anticoagulants in subgroups when recurrent risk for VTE at one year is < 5% and the upper bound of the 95% confidence interval is less than 8%. The data in this study fall within this guidance and suggest that for women with a first unprovoked VTE and have none or 1 HERDOO2 criteria, anticoagulants can be safetly stopped after short term treatment.
Please log in to access ObGFirst and the 2T US Atlas
Media - Internet
Computer System Requirements
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
NOT ENOUGH CME HOURS
It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan