dauer antikoagulationögho14
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Wie hoch muss das jährliche VTE-Rezidivrisiko sein, damit eine Langzeitantikoagulation
sinnvoll ist?
Sabine Eichinger
Univ. Klinik für Innere Medizin IMedizinische Universität Wien
Inzidenz (%), n= 28 781
<180 Tage 5.6
181 - 365 Tage 4.1
1 - <2 Jahre 4.6
2 - <3 Jahre 3.2
3 - <4 Jahre 2.9
4 - <5 Jahre 2.6
5 - <6 Jahre 2.1
6 - <7 Jahre 2.2
7 - <8 Jahre 2.4
8 - <9 Jahre 1.6
9 - <10 Jahre 1.4
Jährliches Risiko
Martinez, Thromb Haemost 2014
Rezidivrisiko nach venöser Thromboembolie
Duration of anticoagulation
Boutitie, BMJ 2011
Recurrence risk after VTE
6 12 18 months
Iorio, Arch Int Med 2010
Transient risk factor
Recurrence risk after VTE
3.3%/year
ISTH/SSC Recommendation
Kearon, J Thromb Haemost 2010
• In patients with VTE provoked by a transient provoking factor, the recurrence risk of 5% at 1 year and 15% at 5 years is acceptable by most physicians.
ISTH/SSC Recommendation
Kearon, J Thromb Haemost 2010
• In patients with VTE provoked by a transient provoking factor, the recurrence risk of 5% at 1 year and 15% at 5 years is acceptable for most physicians.
STOP after 3 months
Spontane venöse Thromboembolie
Kyrle & Eichinger, Lancet 2010
Rezidivrisiko nach VTE
ISTH/SSC Recommendation
Kearon, J Thromb Haemost 2010
• In patients with unprovoked VTE a recurrence risk of 10% at 1 year and 30% at 5 years is unacceptably high for many physicians.
GO, GO, GO
Prandoni, Blood 2002
Cancer patients
Recurrence during VKA
Anticoagulation after VTE
Major bleeding during VKA
Anticoagulation after venous thrombosis
• We suggest that a risk of recurrence appreciably higher than 5% at 1 year and 15% at 5 years would not be acceptable to many physicians and patients, and would usually discourage stopping anticoagulant therapy.
Kearon, J Thromb Haemost 2010
Anticoagulation after venous thrombosis
3 months long term
distal DVT provoked* VTE
unprovoked VTE
* Surgery, trauma, immobilisation, pregnancy/puerperium, female hormone intake, long haul travel
AWMF online, 6/20109th ACCP Consensus Conference on Antithrombotic Therapy; Kearon, Chest 2012
Linkins, Ann Intern Med 2003
Time period of AC
Major bleeding (%, 95% CI)
Intracranial bleeding(%, 95% CI)
Initial 3 months 2.06 (2.04-2.08) 1.48 (1.40–1.56)
> 3 months 2.74 (2.71-2.77)/yr 0.65 (0.63–0.68)/yr
Bleeding during anticoagulation for VTE
Case fatality rate after 3 mo 9.1% (95% CI 2.5–21.7%)
Any Bleeding
REMEDY – dabigatran vs warfarin for long term prophylaxis after VTE
Schulman, N Engl J Med 2013
Case fatality of recurrent VTE
Schulman; EINSTEIN Investigators; Agnelli; all N Engl J Med 2013, 2010, 2013
StudyRecurrences,
nFatal, n (%)
Case fatality (%)
RESONATE(Dabigatran)
37 2 (0.3) 0.54
EINSTEIN ext.(Rivaroxaban)
56 1 (0.2) 0.17
AMPLIFY ext.(Apixaban)
73 7 (0.8) 0.96
Rezidivrisiko
Mortalität
H. Nitsch, 1992
Blutungsrisiko
Mortalität
Risk factors for bleeding in VTE patients
Kearon, Chest 2012
Kein validiertes Model zur Abschätzung des Blutungsrisikos
Validierung: VALID-Studie
Ende der Antikoagulation beiPatienten mit < 180 Punkten
Vienna Prediction Model
Eichinger, Circulation 2010
VALID - Studie
Einschlusskriterien
Erste spontane tiefe Beinvenenthrombose oder Pulmonalembolie Laufende orale Antikoagulation von weniger als 7 Monaten
Kontakt: Dr. Eischer 40400-4496 oder 4522; Email: lisbeth.eischer@meduniwien.ac.at
Prof. Eichinger 40400-4410Prof. Kyrle 40400-4951
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