Color coded cells show the estimated net difference in deaths due to VTE and major bleeding. With the ACCP recommendations, for extended anticoagulation, dark green indicates a strong recommendation in favor (>1 lives saved over 5 y), light green indicates a weak recommendation in favor (0.5 to 1.0 lives saved over 5 y), light red indicates a weak recommendation against (0 to 0.5 lives saved over 5 y) and dark red indicates a strong recommendation against (lives lost over 5 y).

Despite an average estimated increase of +0.6 deaths, a weak recommendation against extended therapy is provided in recognition that the bleeding risk will be lower than the average value in many patients.

Assumptions:

Percentage risk for recurrent VTE without anticoagulation (after 1 and 5 years) in patients with: first VTE provoked by surgery (1%, 3%); first VTE provoked by nonsurgical factor or unprovoked isolated distal DVT (5%, 15%); unprovoked proximal DVT or PE (10%, 30%); 2nd episode of unprovoked VTE (15%, 45%).

Case fatality proportion for an episode of recurrent VTE after stopping anticoagulation: 3.6%.

Reduction in recurrent VTE with anticoagulation: 88%.

Percentage risk for major bleeding without anticoagulation (annual, not including within 3 mo of VTE diagnosis): low (0.3%); moderate (0.6%); high (≥2.5%, acknowledging that there is a broad range of risks within this subgroup). See ”Influence of bleeding risk on the decision to anticoagulate indefinitely.”

Increase in major bleeding with anticoagulation: 2.6 fold risk or a 160% increase. Assuming that use of a DOAC would be associated with two-thirds the risk of major bleeding would only change one recommendation for extended anticoagulation; strong in favor instead of weak in favor for patients with a second unprovoked VTE who had a moderate risk of bleeding.

Case fatality proportion for an episode of major bleeding: 11.3%.