A modeling study suggests that continuing anticoagulation therapy indefinitely, which is recommended in all patients with a first unprovoked venous thromboembolism (VTE), has little chance of improving life expectancy for most patients and is unlikely to ever be cost-effective. 

Clinicians should use shared decision-making to incorporate individual patient preferences and values when considering treatment duration for unprovoked VTE, according to the analysis published in Annals of Internal Medicine.  

In some patients who develop blood clots, or VTE, there is no clear reason why the clot formed. In these cases, guidelines recommend treating with anticoagulation for at least three months. Thereafter, a lifelong decision must be made to either discontinue anticoagulation or continue it indefinitely. The tradeoffs between benefits, harms, and costs of indefinite anticoagulation have not been formally assessed.

Researchers from the University of Calgary and the University of Ottawa conducted a modeling study of a hypothetical cohort of 1,000 persons aged 55 years to evaluate long-term outcomes of indefinite anticoagulation treatment. They also analyzed data related to treatment costs and quality-adjusted life-years. 

The authors found that indefinite anticoagulation prevented 368 recurrent VTE events, including 14 fatal pulmonary emboli, but induced 114 additional major bleeding events, which included 30 intracranial hemorrhages and 11 deaths from bleeding. Indefinite anticoagulation cost CAD $16,014 more per person and did not increase quality-adjusted life-years. 

According to the authors, their findings can help clinicians better understand and explain to their patients the tradeoffs between recurrent VTE and major bleeding events when choosing to discontinue or continue anticoagulation indefinitely. They also emphasize that the close tradeoffs demonstrated in the analysis highlight the need for clinicians to incorporate patient preferences and values when considering treatment duration for unprovoked VTE.