Abstract
For patients with first pulmonary embolism secondary to a major transient/reversible risk factor, discontinuation of therapeutic oral anticoagulation is recommended after 3 monthshttp://bit.ly/2Pp68Ti
From the authors:
We would like to thank H. Slabbynck and co-workers for their interest in the 2019 European Society of Cardiology/European Respiratory Society guidelines on the diagnosis and management of acute pulmonary embolism (PE), and for their interesting comment on the treatment duration of patients with a high-risk PE secondary to a major transient/reversible risk factor.
Patients with a PE not related to a major transient provoking factor have a 8 to 10% cumulative recurrence risk 1 year after the end of anticoagulant treatment. In these patients, the initial pulmonary vascular obstruction is associated with an increased risk of residual pulmonary vascular obstruction at 6 months, and patients with a residual vascular obstruction have a higher risk of recurrent PE [1,2]. On the other hand, patients with PE provoked by a major transient risk factor, such as surgery, have a much lower risk of recurrence after the end of anticoagulant treatment, and this is why guidelines recommend 3 months of anticoagulant treatment [3,4]. For these patients, we are not aware of any data suggesting that either the initial vascular obstruction or the severity of the initial PE may be associated with the risk of recurrence. In addition, there are no data to suggest that the severity of the initial episode may predict the severity of a possible recurrent event. Because of this, the guidelines task force agreed to recommend a short, 3-month treatment duration of anticoagulation after PE provoked by a major provoking factor, regardless of the severity of the index episode [5]. We do acknowledge that, in clinical practice, when a high-risk, life-threatening PE has been suffered, this results in persisting uncertainty and fears for the patients and their families, and that the wish of some of these patients to prolong anticoagulation needs to be taken into account in the decision. In such cases, the questionable benefits of continuing anticoagulation should be explained to the patient along with the bleeding risk of prolonging this treatment.
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Supplementary Material
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Footnotes
Conflict of interest: G. Meyer reports grants and non-financial (travel) support from Leo Pharma, BMS-Pfizer, Stago and Bayer Healthcare, outside the submitted work.
Conflict of interest: S. Konstantinides reports grants and personal fees from Boehringer Ingelheim, Daiichi-Sankyo, Bayer AG, Biocompatibles Group UK andActelion, personal fees from BMS-Pfizer and MSD, outside the submitted work.
- ReceivedDecember 4, 2019.
- AcceptedDecember 10, 2019.
- Copyright ©ERS 2020