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how long to continue anticoagulation for provoked pe

Answer

The duration of anticoagulation therapy for a provoked pulmonary embolism (PE) is generally recommended to be at least 3 months, with the possibility of extending the duration based on specific patient factors and risk profiles.

Initial treatment duration

Considerations for extending therapy

  • The ASH 2020 guidelines suggest offering indefinite antithrombotic therapy over stopping anticoagulation after completion of primary treatment in patients who develop DVT and/or PE provoked by a transient risk factor and have a history of previous unprovoked VTE or VTE provoked by a chronic risk factor
  • The ASH 2023 guidelines suggest obtaining testing for thrombophilia to guide anticoagulant treatment duration after primary short-term treatment in patients with VTE provoked by a non-surgical major transient risk factor. Consider continuing anticoagulant treatment indefinitely in patients with thrombophilia and discontinuing it in patients without thrombophilia

Evidence from clinical trials

In summary, the recommended duration of anticoagulation therapy for a provoked PE is generally at least 3 months. Extension of therapy beyond this period should be considered based on individual patient factors, risk of recurrence, bleeding risk, and guideline recommendations. Individualized assessment is crucial to determine the optimal duration of anticoagulation therapy for each patient.

References

1

Pulmonary embolism

Medical management

Guidelines

Duration of anticoagulation, provoked PE

Pathway
ESC 2019