Long-Term Risk of Major Bleeding after Discontinuing Anticoagulation for Unprovoked Venous Thromboembolism:A Systematic Review and Meta-analysis
| Autor: | Charlotte Bradbury, Laurent Pinede, Toshihiko Takada, Grégoire Le Gal, Cecilia Becattini, Gualtiero Palareti, Faizan Khan, Paolo Prandoni, Marc Carrier, Tobias Tritschler, H. R. Büller, Brian Hutton, Kednapa Thavorn, Giuseppe M. Andreozzi, Ranjeeta Mallick, Timothy A. Brighton, Sam Schulman, Geert-Jan Geersing, Francis Couturaud, Clive Kearon, Anthonie W. A. Lensing, Jeffrey I. Weitz, Alvi Rahman, Marc A. Rodger, Sameer Parpia, Giancarlo Agnelli, Dean Fergusson |
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| Přispěvatelé: | Vascular Medicine, ACS - Pulmonary hypertension & thrombosis |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Pediatrics
medicine.medical_specialty venous thromboembolism MEDLINE Hemorrhage 030204 cardiovascular system & hematology law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Recurrence law medicine Humans Cumulative incidence 030212 general & internal medicine Prospective cohort study anticoagulation Blood Coagulation thrombosis business.industry Incidence (epidemiology) Anticoagulants Hematology medicine.disease Thrombosis Confidence interval 3. Good health major bleeding Meta-analysis prognosis business |
| Zdroj: | Khan, F, Rahman, A, Carrier, M, Kearon, C & Bradbury, C A 2021, ' Long-Term Risk of Major Bleeding after Discontinuing Anticoagulation for Unprovoked Venous Thromboembolism : A Systematic Review and Meta-analysis ', Thrombosis and Haemostasis . https://doi.org/10.1055/a-1690-8728 Thrombosis and haemostasis, 122(7), 1186-1197. Schattauer GmbH |
| ISSN: | 0340-6245 |
| Popis: | Background The long-term risk of major bleeding after discontinuing anticoagulant therapy for a first unprovoked venous thromboembolism (VTE) is uncertain. Objectives To determine the incidence of major bleeding up to 5 years after discontinuing anticoagulation for a first unprovoked VTE. Methods We searched MEDLINE, EMBASE, and Cochrane CENTRAL (from inception to January 2021) to identify relevant randomized controlled trials (RCTs) and prospective cohort studies reporting major bleeding after discontinuing anticoagulation in patients with a first unprovoked or weakly provoked VTE who had completed (IMAGE_)3 months of initial treatment. Unpublished data on major bleeding events and person-years were obtained from authors of included studies to calculate study-level incidence rates. Random-effects meta-analysis was used to pool results across studies. Results Of 1,123 records identified by the search, 20 studies (17 RCTs) and 8,740 patients were included in the analysis. During 13,011 person-years of follow-up after discontinuing anticoagulation, the pooled incidence of major bleeding (n = 41) and fatal bleeding (n = 7) per 100 person-years was 0.35 (95% confidence interval [CI]: 0.20–0.54) and 0.09 (95% CI: 0.05–0.15). The 5-year cumulative incidence of major bleeding was of 1.0% (95% CI: 0.4–2.4%). The case-fatality rate of major bleeding after discontinuing anticoagulation was 19.9% (95% CI: 10.6–31.1%). Conclusion The risk of major bleeding once anticoagulants are discontinued in patients with a first unprovoked VTE is not zero. Estimates from this study can help clinicians counsel patients about the incremental risk of major bleeding with extended anticoagulation to guide decision making about treatment duration for unprovoked VTE. |
| Databáze: | OpenAIRE |
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