Current guidelines on VTE: recommendation on secondary prevention
| Risk factor at index VTE . | ESC 201930 . | ASH 20207 . | NICE31 . | CHEST 20218 . |
|---|---|---|---|---|
| Unprovoked | Extended oral anticoagulation of indefinite duration should be considered. | Suggests indefinite antithrombotic therapy over stopping anticoagulation, except for high-risk of bleeding. In certain circumstances . . . clinicians and patients may use prognostic scores, or tests . . . to aid in reaching a final decision. | Consider continuing anticoagulation, taking bleeding risk, risk of recurrence, and patient preference into account. In low bleeding risk patient the benefits of continuing anticoagulation treatment are likely to outweigh the risks. | We recommend offering extended-phase anticoagulation. Patient preference and predicted risk of recurrent VTE or bleeding should influence the decision. |
| Transient risk factor | Major transient risk factor, discontinuation of oral anticoagulation is recommended after 3 months. Extended oral anticoagulation of indefinite duration should be considered after a first PE associated with a minor transient risk factor. | Temporary risk factors discontinue anticoagulant therapy after completion of the primary treatment. Chronic risk factorsa suggests indefinite antithrombotic therapy over stopping anticoagulation. | Consider stopping anticoagulation treatment at 3 months following a provoked DVT or PE if the provoking factor is no longer present and the clinical course has been uncomplicated. | Major transient risk factor, we recommend against offering extended-phase anticoagulation. Minor transient risk factor, we suggest against offering extended-phase anticoagulation. |
| Persistent risk factor | Extended oral anticoagulation of indefinite duration should be considered for patients with a first episode of PE associated with a persistent risk factor. | Chronic risk factors may continue anticoagulant therapy indefinitely for secondary prevention after completion of the primary treatment. | We recommend offering extended-phase anticoagulation. |
| Risk factor at index VTE . | ESC 201930 . | ASH 20207 . | NICE31 . | CHEST 20218 . |
|---|---|---|---|---|
| Unprovoked | Extended oral anticoagulation of indefinite duration should be considered. | Suggests indefinite antithrombotic therapy over stopping anticoagulation, except for high-risk of bleeding. In certain circumstances . . . clinicians and patients may use prognostic scores, or tests . . . to aid in reaching a final decision. | Consider continuing anticoagulation, taking bleeding risk, risk of recurrence, and patient preference into account. In low bleeding risk patient the benefits of continuing anticoagulation treatment are likely to outweigh the risks. | We recommend offering extended-phase anticoagulation. Patient preference and predicted risk of recurrent VTE or bleeding should influence the decision. |
| Transient risk factor | Major transient risk factor, discontinuation of oral anticoagulation is recommended after 3 months. Extended oral anticoagulation of indefinite duration should be considered after a first PE associated with a minor transient risk factor. | Temporary risk factors discontinue anticoagulant therapy after completion of the primary treatment. Chronic risk factorsa suggests indefinite antithrombotic therapy over stopping anticoagulation. | Consider stopping anticoagulation treatment at 3 months following a provoked DVT or PE if the provoking factor is no longer present and the clinical course has been uncomplicated. | Major transient risk factor, we recommend against offering extended-phase anticoagulation. Minor transient risk factor, we suggest against offering extended-phase anticoagulation. |
| Persistent risk factor | Extended oral anticoagulation of indefinite duration should be considered for patients with a first episode of PE associated with a persistent risk factor. | Chronic risk factors may continue anticoagulant therapy indefinitely for secondary prevention after completion of the primary treatment. | We recommend offering extended-phase anticoagulation. |
Cancer patients are excluded from this recommendation.