ArticleTH open : companion journal to thrombosis and haemostasis2026
Bleeding and Recurrence in Patients with Venous Thromboembolism with Changing Anticoagulant Treatment Patterns: Findings from the TROLL Registry.
Article in TH open : companion journal to thrombosis and haemostasis, 2026. 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: Treatment for venous thromboembolism (VTE) has shifted from vitamin K antagonists (VKAs) to direct oral anticoagulants (DOACs), with increased use of indefinite therapy. However, data on bleeding and recurrence outcomes associated with these changes remain limited. Objective: To evaluate the risk of major bleeding (MB), clinically relevant nonmajor bleeding (CRNMB), and recurrence with changing treatment patterns. Methods: Cancer-free VTE patients were identified in the Venous Thrombosis Registry in Østfold Hospital, Norway, from January 2005 to May 2020, and categorized into period 1 (2005-2012), period 2 (2013-2016), and period 3 (2017-2020). MB and CRNMB rates during anticoagulant treatment, and recurrence rates after anticoagulant discontinuation were assessed. Subhazard ratios (sHRs) were calculated using Fine-Gray analysis for time-period comparisons. Results: Among 3,839 patients (48% female, median age: 67 years; IQR, 54-78), VKA use decreased from 76% in period 1 to 2% in period 3, while DOAC use increased from 1 to 85%. The MB rate ranged from 5.6 (95% confidence interval [CI]: 3.9-6.4) per 100 person-years in period 2 to 3.1 (2.3-4.2) in period 3. The CRNMB rate increased from 5.4 (95% CI: 4.3-6.9) per 100 person-years in period 1 to 7.7 (6.3-9.5) in period 3, sHR: 1.87 (1.36-2.56). Conversely, the recurrence rate decreased from 5.1 (95% CI: 4.6-5.6) per 100 person-years after anticoagulant discontinuation in period 1 to 3.9 (3.2-4.9) in period 3, sHR: 0.51 (0.41-0.65). Conclusion: VTE recurrences after anticoagulant discontinuation have declined, likely due to indefinite treatment in patients at high risk of recurrence, while CRNMB rates have increased over time.
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