Low Intensity Warfarin Anticoagulation is Safe and Effective as a Long-Term Venous Thromboembolism Prevention Strategy |
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Authors: | Samuel Z Goldhaber MD |
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Institution: | (1) Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115 |
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Abstract: | Longitudinal studies indicate a high rate of recurrence of venous thromboembolism after an episode of deep venous thrombosis
or pulmonary embolism. Extended anticoagulant therapy will decrease the recurrence rate, but there is controversy as to the
optimal intensity of therapy that will be effective, yet safe. The PREVENT trial addresses the question of whether long-term
low intensity therapy (INR 1.5–2.0) will effectively prevent recurrence compared to placebo treatment, yet be safe without
a significant increase in major bleeding. The results of this trial show a significant reduction in recurrent venous thromboembolism
with a major bleeding rate that is no different than the placebo arm of the study (0.9 vs 0.4 per 100 patient years; p = 0.25). Although the ELATE trial showed greater effectiveness with no increase in bleeding in the standard intensity arm
vs the low intensity arm, the question remains whether such safety can be obtained in the real world management of oral anticoagulation. |
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Keywords: | warfarin venous thromboembolism INR treatment |
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