Recurrent Venous Thromboembolism: Life-Long Oral Anticoagulation?

MedicalResearch.com Interview with:

Matteo Nicola Dario Di Minno, MD Dept. of Clinical Medicine and Surgery Regional Reference Center for Coagulation Disorders Federico II University, Naples, ItalyMedicalResearch.com:
Matteo Nicola Dario Di Minno, MD
Dept. of Clinical Medicine and Surgery
Regional Reference Center for Coagulation Disorders
Federico II University, Naples, Italy

 

MedicalResearch.com: What are the main findings of the study?


Answer: In our study, patients with unprovoked VTE treated for a definite time with oral anticoagulants (ie, 3–12 months) had annual recurrence rates >5% in the presence of both overt and mild antithrombin deficiency and <5% with normal antithrombin levels, with these differences being statistically significant. Although these findings should be confirmed in further studies, a life-long oral anticoagulation might be considered in patients with unprovoked VTE.

MedicalResearch.com: 
Were any of the findings unexpected?

Answer: It has been interesting to find that the risk of recurrence was similar among patients with overt antithrombin deficiency as compared with those with the mild deficiency

MedicalResearch.com: What should clinicians and patients take away from your report?

Answer: Patients with mild antithrombin deficiency have a risk of recurrent VTE that is significantly higher than patients with normal antithrombin levels (>80%) and similar to that observed in patients with overt antithrombin deficiency. These findings have some important clinical implications for decisions about the optimal duration of secondary prevention of VTE, and, because this association is particularly relevant in patients with unprovoked VTE, mild antithrombin deficiency may be considered an additional variable to determine the optimal individual duration of secondary prevention with anticoagulant drugs.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Answer: Although our study was focused on patients with inherited AT deficiency, it is noteworthy that some clinical conditions (i.e. hepatic cirrhosis, hormonal treatments, etc) are able to determine an acquired mild antithrombin deficiency. Data about the thrombotic risk in these clinical settings are currently lacking.

Citation:

Mild Antithrombin Deficiency and the Risk of Recurrent Venous Thromboembolism: A Prospective Cohort Study

Di Minno MN, Dentali F, Lupoli R, Ageno W.

Federico II University, Naples, Italy.
Circulation. 2013 Oct 21. [Epub ahead of print]