Would you restart prophylactic anticoagulation in a patient with a history of unprovoked PE who received short term anticoagulation with a prior physician?
In a patient with a history of unprovoked PE who completed short term anticoagulation, would you restart prophylactic anticoagulation?
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The decision on duration of anticoagulation should balance the risk of hemorrhage vs risk of recurrent VTE. The annual risk of recurrence with unprovoked venous thromboembolism (VTE) is definitely higher than provoked VTE and seems to be higher in males than females.
According to one study (Rodger et al., PMID 18725614), males had an annual risk of recurrence of 13.7% (95% CI10.8-17), females with a HERDOO score of >2 14.1 (95%CI10.9-17.3) whereas females with HERDOO score of 1 or 0: 1.3% (95% CI 0.3-4.6).
According to a metanalysis (Ortel et al., PMID 33007077), the annualized major bleeding rate is approximately 2.1%.
In the end, this is a shared decision making process and needs to take into account the patient's values/preferences and pre...
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