Article Impact Level: HIGH Data Quality: STRONG Summary of British Medical Journal (BMJ) https://doi.org/10.1136/bmj-2025-084380 Dr. Kueiyu Joshua Lin et al.
Points
- Extended anti-clotting treatment for unprovoked venous thromboembolism significantly reduces the risk of recurrent VTE events.
- Continuing oral anticoagulants was associated with a 0.19 adjusted hazard ratio for recurrent VTE compared to discontinuation.
- While effective, extended treatment carried a higher risk of major bleeding, with an adjusted hazard ratio of 1.75.
- Despite increased bleeding, continued anticoagulation showed a greater net clinical benefit and lower mortality rates.
- This benefit persisted even among patients continuing oral anticoagulants for at least three years after their initial VTE event.
Summary
This target trial emulation study utilized two national US claims databases (Optum Clinformatics Data Mart and Medicare fee-for-service) to compare the health outcomes of continuing versus discontinuing oral anticoagulants (OACs) in 30,554 propensity score-matched patients (mean age 73.9 years, 57.0% women) with a first unprovoked venous thromboembolism (VTE) who had received initial OAC treatment for at least 90 days. The primary outcomes were hospital admission for recurrent VTE (effectiveness) and major bleeding (safety), with secondary outcomes including net clinical benefit and mortality.
Compared to discontinuing OACs, continuing treatment was associated with markedly lower rates of recurrent VTE (adjusted hazard ratio [aHR] 0.19, 95% CI 0.13 to 0.29; adjusted rate difference per 1000 person-years −25.50, 95% CI −39.38 to −11.63). However, continued OAC use also led to higher rates of major bleeding (aHR 1.75, 95% CI 1.52 to 2.02; adjusted rate difference 4.78, 95% CI 1.95 to 7.61). Notably, continuing treatment was associated with lower mortality rates (aHR 0.74, 95% CI 0.69 to 0.79; adjusted rate difference −14.31, 95% CI −22.02 to −6.59).
Overall, continuing OACs resulted in a greater net clinical benefit (aHR 0.39, 95% CI 0.36 to 0.42; adjusted rate difference −21.01, 95% CI −32.31 to −9.71), which remained consistent across different OAC types and initial treatment durations, even for those treated for at least three years. These findings from routine care databases underscore the significant protective effect of extended OACs against recurrent VTE and mortality, despite an increased risk of major bleeding, supporting a net clinical benefit for long-term management of unprovoked VTE.
Link to the article: https://www.bmj.com/content/391/bmj-2025-084380
References
Lin, K. J., Kim, D. H., Singer, D. E., Zhang, Y., Cervone, A., Kehoe, A. R., & Bykov, K. (2025). Continued versus discontinued oral anticoagulant treatment for unprovoked venous thromboembolism: Target trial emulation. BMJ, 391, e084380. https://doi.org/10.1136/bmj-2025-084380
