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D-dimer testing after anticoagulant discontinuation to predict recurrent venous thromboembolism

  • Stefano Barco
    Correspondence
    Corresponding author at: Clinic of Angiology, University Hospital Zurich, Raemistrasse 100, RAE C 19, 8091 Zurich, Switzerland.
    Affiliations
    Clinic of Angiology, University Hospital Zurich, Rämistrasse 100, RAE C 04, Zurich 8091, Switzerland

    Center for Thrombosis and Hemostasis, Johannes Gutenberg University, Mainz, Germany
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  • Frederikus A Klok
    Affiliations
    Center for Thrombosis and Hemostasis, Johannes Gutenberg University, Mainz, Germany

    Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
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      The duration of anticoagulant treatment after a first venous thromboembolism (VTE) depends on the risk of a VTE recurrence, which is mostly determined by the presence, type, persistence, and severity of VTE provoking factors [
      • Kearon C.
      • Akl E.A.
      • Ornelas J.
      • et al.
      Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report.
      ,
      • Konstantinides S.V.
      • Meyer G.
      • Becattini C.
      • et al.
      ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): the Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC).
      ]. In particular, if a major provoking factor persists over time, i.e. as it is often the case for cancer and cancer treatment, an indefinite anticoagulant treatment is usually considered in the absence of active bleeding or severe bleeding risk factors. Vice versa, if the VTE provoking risk factor is transient, for instance a major surgical intervention or trauma, anticoagulation can be discontinued after a standard short 3-month course of anticoagulation, as the risk of recurrence is deemed to be minimal.
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