Comment on Long-Term Risk for Major Bleeding During Extended Oral Anticoagulant Therapy for First Unprovoked Venous Thromboembolism: A Systematic Review and Meta-analysis

One of the greatest challenges in the management of pulmonary embolism and deep vein thrombosis after the acute phase remains the assessment of the long-term risks of recurrent and major bleeding events. If a patient is deemed to have a high risk of recurrence and a lower risk of bleeding, anticoagulation should be continued. Vice versa, anticoagulation can be stopped if the risk of recurrence is estimated to be lower to that of bleeding. All other combinations are more difficult to interpret, particularly if both risks are substantial. Indeed, risk assessment is even more complicated in the absence of firm risk estimates to base our reasoning on.

This international collaboration study promoted by colleagues from the University of Ottawa (Dr. Khan, Dr. Roger) focuses on the incidence of major bleeding during extended anticoagulation among patients with a first unprovoked VTE and across important subgroups. By completing a tetralogy of works focusing on bleeding and recurrent thromboembolic (both on and off anticoagulation), it informs patient prognosis and provides us with important clinical data to guide decision making about anticoagulant treatment duration.