Evidence map›Paper›PMID 40198201›Full record

SynthesisBlood advances2025

Duration of primary/secondary treatment to prevent recurrent venous thromboembolism: a systematic review and meta-analysis.

Anqi Li, Rasha Khatib, Luciane Cruz Lopes, Fazila Aloweni, Liming Lu, Qingyong He, Jiaming Wu, Peiming Zhang, Yuyuan Tang, Sureka Pavalagantharajah and 12 more

Abstract readSystematic ReviewMeta-Analysis
In one paragraph

Synthesis in Blood advances, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
  4. Article
  5. Article
  6. Cerebral venous thrombosis: Current management, recent advances and future directions.International journal of stroke : official journal of the International Stroke Society · 2025
    Review
  7. Article
  8. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

22 authors.

Anqi LiGuang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
Rasha KhatibAdvocate Aurora Research Institute, Downers Grove, IL.
Luciane Cruz LopesPharmaceutical Sciences Graduate Course, University of Sorocaba, São Paulo, Brazil.
Fazila AloweniNursing Division, Singapore General Hospital, Singapore, Singapore.
Liming LuClinical Research and Big Data Laboratory, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China.
Qingyong HeGuang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
Jiaming WuZhongshan Hospital of Traditional Chinese Medicine affiliated to Guangzhou University of Chinese Medicine, Zhongshan, China.
Peiming ZhangClinical Research and Big Data Laboratory, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China.
Yuyuan TangClinical Research and Big Data Laboratory, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China.
Sureka PavalagantharajahDepartment of Pediatrics, McMaster University, Hamilton, Canada.
Nigar SekerciogluDepartment of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.
Carlos A Cuello GarciaDepartment of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.
Serge KoujanianDepartment of Laboratory Hematology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, ON, Canada.
Arnav AgarwalDepartment of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.ORCID 0000-0002-0931-7851
Sean Alexander KennedyDepartment of Medicine, McMaster University, Hamilton, ON, Canada.
Ignacio NeumannDepartment of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.
Sam SchulmanThrombosis and Atherosclerosis Research Institute, McMaster University Medical Centre, Hamilton, Canada.ORCID 0000-0002-8512-9043
Wojtek WierciochDepartment of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.ORCID 0000-0001-6576-1650
Gabriel RadaEpistemonikos Foundation, Santiago, Chile.
Andrew M PeseskiDivision of Hematology, Department of Medicine, Duke University, Durham, NC.
Thomas L OrtelDivision of Hematology, Department of Medicine, and Department of Pathology, Duke University, Durham, NC.ORCID 0000-0001-6193-4585
Yu-Qing ZhangDepartment of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

abstractAntithrombotic therapy can prevent recurrent deep vein thrombosis (DVT) and pulmonary embolism (PE). It is, however, associated with an increased risk for major bleeding. This meta-analysis systematically reviewed the evidence regarding the duration of antithrombotic therapy to assess benefits and harms. We systematically searched for randomized controlled trials (RCTs) that compared shorter (3-6 months) with longer (>6 months) courses of anticoagulation for the primary treatment of venous thromboembolism (VTE) or that compared discontinued with indefinite antithrombotic therapy for the secondary prevention of VTE. Pairs of reviewers screened the eligible trials and collected data. This study included 22 RCTs (11 617 participants). Pooled estimates showed that, for the primary treatment of unprovoked VTE, VTE provoked by chronic risk factors or transient risk factors, treating patients with a longer course (>6 months) of anticoagulation, as opposed to a shorter course (3-6 months), probably reduced recurrent PE (risk ratio [RR], 0.66; 95% confidence interval [CI], 0.42-1.02) and DVT (RR, 0.85; 95% CI, 0.63-1.14), but it was associated with increased mortality (RR, 1.43; 95% CI, 0.85-2.41) (moderate certainty) and a higher risk for major bleeding (RR, 2.02; 95% CI, 1.02-3.98; high certainty). For the secondary prevention of unprovoked VTE and VTE provoked by chronic risk factors, when compared with discontinuing treatment, indefinite anticoagulation therapy was associated with decreased mortality (RR, 0.54; 95% CI, 0.36-0.81), a reduction in recurrent PE (RR, 0.25; 95% CI, 0.16-0.41) and DVT (RR, 0.15; 95% CI, 0.10-0.21), and an increase in the risk for bleeding (RR, 1.98; 95% CI, 1.18-3.30), all supported by high certainty. Indefinite antiplatelet therapy may be associated with decreased mortality (RR, 0.95; 95% CI: 0.53-1.68; low certainty), probably a reduction in recurrent PE (RR, 0.65; 95% CI, 0.41-1.03) and DVT (RR, 0.44; 95% CI, 0.17-1.13) (moderate certainty), and may increase the risk for bleeding (RR, 1.28; 95% CI, 0.48-3.41; low certainty). In summary, for the primary treatment of all types of VTE, shorter (3-6 months) duration of anticoagulation is more beneficial. For the secondary prevention of unprovoked VTE or VTE provoked by chronic risk factors, indefinite antithrombotic treatment is more beneficial.

Indexed as

AnticoagulantsFibrinolytic AgentsVenous ThromboembolismHemorrhageHumansRandomized Controlled Trials as TopicRecurrenceRisk FactorsSecondary PreventionTime FactorsAnticoagulantsFibrinolytic Agents

Identifiers

PMID40198201
PMCPMC12138518

What OpenQuestion holds

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LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.