Essence of this Article

Anticoagulants are effective in treating deep vein thrombosis (DVT) and pulmonary embolism (PE) but can be associated with an increased risk of bleeding and other adverse events. The balance between benefit and risk can depend on the duration of anticoagulant treatment. Longer-term treatment can increase the risk of bleeding and it should generally be given to patients at high risk of venous thromboembolism (VTE) recurrence. Other adverse events that should be considered include heparin-induced thrombocytopenia (HIT) and osteoporosis.

Balancing the benefits and risks of treatment

Anticoagulants are effective in treating DVT and PE but can be associated with an increased risk of bleeding and, in some cases, other adverse events. The balance between benefit and risk often centres on the duration of anticoagulation treatment. Because longer-term treatment can increase the risk of bleeding, it should generally be given to patients at high risk of VTE recurrence or for specific patient subgroups. For patients whose DVT or PE is linked to transient factors such as surgery, trauma or immobilization, 3–6 months’ treatment appears adequate. Patients with idiopathic VTE may benefit from treatment beyond 12 months, but treatment decisions in these patients must be individualized. The 2012 ACCP and the 2014 ESC guidelines recommend that the risk–benefit ratio of continuing anticoagulation treatment should be reassessed at regular intervals.149, 565