Choosing Wisely:

Don’t treat with an anticoagulant for more than three months in a patient with a first VTE occurring in the setting of a major transient risk factor.

Rationale and Comments: Anticoagulation is potentially harmful and costly. Patients with a first VTE triggered by a major, transient risk factor such as surgery, trauma, or an intravascular catheter are at low risk for recurrence once the risk factor has resolved and an adequate treatment regimen with anticoagulation has been completed. Evidence-based and consensus guidelines recommend three months of anticoagulation over shorter or longer periods of anticoagulation in patients with VTE in the setting of a reversible provoking factor. By ensuring a patient receives an appropriate regimen of anticoagulation, clinicians may avoid unnecessary harm, reduce health care expenses, and improve quality of life. This Choosing Wisely recommendation is not intended to apply to VTE associated with non-major risk factors (e.g., hormonal therapy, pregnancy, travel-associated immobility), as the risk of recurrent VTE in these groups is either intermediate or poorly defined.
Sponsoring Organizations:
  • American Society of Hematology
  • Sources:
  • American College of Chest Physicians guidelines
  • Disciplines:
  • Hematologic
  • References: • Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, Nelson ME, Wells PS, Gould MK, Dentali F, Crowther M, Kahn SR; American College of Chest Physicians. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines [erratum appears in Chest. 2012;142(6):1698-1704]. Chest. 2012;141(2 Suppl):e419S–94S.
    • Chalmers E, Ganesen V, Liesner R, Maroo S, Nokes T, Saunders D, Williams M; British Committee for Standards in Haematology. Guideline on the investigation, management and prevention of venous thrombosis in children. Br J Haematol. 2011;154(2):196–207.
    • Monagle P, Chan AK, Goldenberg NA, Ichord RN, Journeycake JM, Nowak-Göttl U, Vesely SK; American College of Chest Physicians. Antithrombotic therapy in neonates and children: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e737S–801S.

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