Extended secondary prophylaxis after venous thrombosis

Summary

The drug therapy of thromboembolic diseases is considered standardized and effective in most cases. Recurrence has been known for years after discontinuing anticoagulation, both after DVT, after PE and also after SVT. Only recently has this particular patient clientele, the specific medical history and the potential triggering risk factors been dealt with in more detail. It became necessary to formulate a more precise differentiation of the risk factors and to specify in terms of the way and duration of secondary pharmacological prophylaxis. In addition to VKA, new registrations of NOAKs are helpful for this indication. ASS has no significance in this regard. Against this background, a „traffic light system” was developed, which should help the treating physicians in the estimation of the individual recurrence risk.

Keywords

Thromboembolic diseases - maintenance therapy - recurrence frequency - prolonged secondary prophylaxis - trigger factor - provoked - unprovoked - traffic light principle

• Literatur

• 1 Hach-Wunderle V, Gerlach H, Konstantinides S. et al. Interdisziplinäre S2k: Leitlinie: Diagnostik und Therapie der Bein- und Beckenvenenthrombose und der Lungenembolie; Registernummer 065 – 002. VASA 2016; 45: 1-48.
• 2 Kearon C, Akl EA, Ornelas J. et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest 2016; 149: 315-352.
• 3 Limone BL, Hernandez AV, Michalak D, Bookhart BK, Coleman Cl. Timing of recurrent venous thromboembolism early after the index event: a meta-analysis of randomized controlled trials. Thromb Res 2013; 132: 420-426.
• 4 Agnelli G, Buller HR, Cohen A. et al. Apixaban for Extended Treatment of Venous Thromboembolism. N Engl J Med 2012; 368: 699-708.
• 5 Brighton TA, Eikelboom JW, Mann K. et al. Lowdose aspirin for preventing recurrent venous thromboembolism. N Engl J Med 2012; 367: 1979-1987.
• 6 Becattini C, Agnelli G, Schenone A. et al. Aspirin for preventing the recurrence of venous thromboembolism. N Engl J Med 2012; 366: 1959-1967.
• 7 Brighton TA, Eikelboom JW, Mann K. et al. Lowdose aspirin for preventing recurrent venous thromboembolism. N Engl J Med 2012; 367: 1979-1987.
• 8 Kearon C, Ageno W, Cannegieter SC. et al. Categorization of patients as having provoked or unprovoked venous thromboembolism: guidance from the SSC of ISTH. J Thromb Haemost 2016; 14: 1480-1483.
• 9 Bauersachs R. Akuttherapie und prolongierte Sekundärprävention Venöser Thromboembolien. In: Lindhoff-Last E, Debus ES, Kellersmann R, Tepe G. eds, Angio Update: Handbuch Gefässmedizin 2017. Wiesbaden: med publico GmbH; 2017: 1-37.
• 10 Weitz JI, Lensing AW, Prins MH. et al. Rivaroxaban or Aspirin for Extended Treatment of Venous Thromboembolism. N Engl J Med 2017; 376: 1211-1222.
• 11 Prins MH, Lensing AWA, Prandoni P. et al. OC 39.1 Long-term Risk of Recurrent Venous Thromboembolism with and without Effective Antithrombotic. Therapy Res Pract Thromb Haemost 2017; 01: 187.
• 12 Bauersachs R, Agnelli G, Gitt AK. et al. The role of heparin lead-in in the real-world management of acute venous thromboembolism: The PREFER in VTE registry. Thromb Res 2017; 157: 181-188.
• 13 Bauersachs R. Verlängerte Sekundärprophylaxe nach venöser Thromboembolie. Dtsch Med Wochenschr 2018; 143: 1-6.
• 14 Cohen AT, Gitt AK, Bauersachs R. et al. The management of acute venous thromboembolism in clinical practice. Results from the European PREFER in VTE Registry. Thromb Haemost 2017; 117: 1326-1337.