ArticleResearch and practice in thrombosis and haemostasis2025
Effects on mortality of extended versus short-term anticoagulation in venous thromboembolism: a systematic review and meta-analysis of randomized trials.
Article in Research and practice in thrombosis and haemostasis, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Venous thromboembolism (VTE) is a common disease, particularly in older age. In 30% of cases the VTE is unprovoked, with a risk of recurrence and therefore of mortality that is higher in these patients. The duration of anticoagulation is still a matter of debate: standard or short-term (3-6 months) versus extended (no end date). Objectives: To analyze the potential benefit of prolonged anticoagulation on overall mortality, according to type and duration of treatments. Methods: PubMed, EMBASE, and Cochrane were searched to identify randomized controlled trials. They had to be designed to compare 2 anticoagulation strategies in patients with unprovoked VTE: short versus extended. No date restrictions were applied the search was last updated on September 30, 2023. Results: Sixteen articles were included in the meta-analysis. Four studies evaluated full dose of direct oral anticoagulants (DOACs), one of them also considered the half dose of DOACs. One study used idraparinux and the others used vitamin K antagonists. The overall risk of bias in individual studies was considered low using the Rob 2 tool. Overall deaths occurred in 88 patients (1.51%) in the extended treatment group and 99 patients (1.88%) in the short-term group. Extended anticoagulation therapy does not significantly reduce total mortality (relative risk [RR]: 0.81 [95% CI: 0.61-1.08]). Subgroup analysis showed a significant reduction of deaths in the extended treatment group with DOACs (RR: 0.49 [95% CI: 0.28-0.86]), but the absolute risk of death was low (<1% in the short-term DOACs subgroup). Conclusion: Extended anticoagulation has no benefit on overall mortality compared with short-term treatment. However, subgroup analysis shows a benefit of DOACs that reduces overall mortality, contrary to vitamin K antagonists..
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