Vascular Disease (H Gornik and E Kim, Section Editors)

Current Treatment Options in Cardiovascular Medicine

, Volume 15, Issue 2, pp 224-239

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Management of Patients With Unprovoked Venous Thromboembolism: An Evidence-Based and Practical Approach

  • Maura MarcucciAffiliated withDepartments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University
  • , Alfonso IorioAffiliated withDepartments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University
  • , James DouketisAffiliated withDepartments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University Email author 

Opinion statement

The management of patients with unprovoked venous thromboembolism is a common and challenging clinical problem. Although the initial antithrombotic management is well-established, there is uncertainty about the optimal long-term anticoagulant management, specifically whether patients should receive a short (i.e., 3- to 6-month) duration of anticoagulant therapy or indefinite anticoagulation. Factors that may be considered to estimate patients' risk for recurrent thromboembolism include the mode of initial clinical presentation, as deep vein thrombosis or pulmonary embolism, patient sex, antecedent hormonal therapy use, thrombophilia, D-dimer levels, and residual vein occlusion in patients with deep vein thrombosis. Many of these factors have been integrated into clinical prediction guides which stratify patients with unprovoked venous thromboembolism according to their risk for disease recurrence and, thereby, can assist clinicians in decisions about the duration of anticoagulation. The objective of this review is to consider the evidence relating to the clinical significance of purported risk factors and provide a practical case-based approach to guide decisions on duration of anticoagulation for patients with unprovoked venous thromboembolism.

Keywords

Venous thromboembolism Unprovoked Extended anticoagulation Risk factors Inherited thrombophilia Residual vein occlusion D-Dimer Clinical prediction guide