Risks of recurrent VTE after stopping anticoagulant therapy which justify strong or weak recommendations to either stop anticoagulants at 3 months or to treat indefinitely
| Effect of 5 y of anticoagulation on mortality* . | Recommendation . | Risk of recurrent VTE without anticoagulation† (%) . | |||
|---|---|---|---|---|---|
| Low bleeding risk‡ . | Intermediate bleeding risk§ . | ||||
| 5 y . | First y . | 5 y . | First y . | ||
| Any increase | Strong for 3 mo | <9 | <3 | <18 | <6 |
| 0%-0.5% decrease | Weak for 3 mo | 9-24 | 3-8 | 18-33 | 6-11 |
| 0.5%-1% decrease | Weak for indefinite | 24-39 | 8-13 | 33-48 | 11-16 |
| >1% decrease | Strong for indefinite | >39 | >13 | >48 | >16 |
| Effect of 5 y of anticoagulation on mortality* . | Recommendation . | Risk of recurrent VTE without anticoagulation† (%) . | |||
|---|---|---|---|---|---|
| Low bleeding risk‡ . | Intermediate bleeding risk§ . | ||||
| 5 y . | First y . | 5 y . | First y . | ||
| Any increase | Strong for 3 mo | <9 | <3 | <18 | <6 |
| 0%-0.5% decrease | Weak for 3 mo | 9-24 | 3-8 | 18-33 | 6-11 |
| 0.5%-1% decrease | Weak for indefinite | 24-39 | 8-13 | 33-48 | 11-16 |
| >1% decrease | Strong for indefinite | >39 | >13 | >48 | >16 |
Assumptions as described in text and in the ACCP guidelines1 for: case fatality of recurrent VTE (3.6%) and major bleeding (11.3%); proportion of major bleeds attributable to anticoagulation (62%); risk reduction for VTE with anticoagulation (88%).
Net effect of decrease in recurrent VTE and increase in bleeding.
Calculations based on a 5-year period, with one-third of recurrences in the first year and two-thirds in the next 4 years.
Risk of major bleeding of 0.8% for each of the 5 years.
Risk of major bleeding of 1.6% for each of the 5 years.