[New evidence in the secondary prevention of thromboembolic disease].

The risk of recurrent venous thromboembolism is nearly 40% of all patients after 10 years of follow up. The risk is higher in patients with permanent risk factors, who should receive indefinite anticoagulation with acenocoumarol or warfarin, except cancer patients who should receive lower doses of low molecular weight heparin The remaining patients should receive a 3-month course of treatment, after which the need to continue this treatment should be reevaluated. The decision to continue should be individually tailored and balanced against hemorrhagic risk. Determination of D-dimer values at the end of treatment and the presence of residual vein thrombosis or right ventricular dysfunction could be useful to identify patients at low risk of recurrence, who can safely discontinue anticoagulation. The emergence of new oral anticoagulants has opened up a new scenario for secondary prevention in the next few years.

Marchena Yglesias PJ 《-》

The risk of recurrent thromboembolic disorders in patients with unprovoked venous thromboembolism: new scenarios and opportunities.

The risk of recurrent thromboembolic disorders in the 10-year period following an episode of unprovoked venous thromboembolism (VTE) ranges between 30 and 50%, the rate being higher in patients with primary deep venous thrombosis (DVT) than in those with primary pulmonary embolism (PE). The clinical presentation with primary PE increases by more than three times the risk of a new PE episode over that with isolated DVT. Baseline parameters that increase this risk are the proximal location of DVT, obesity, old age and male sex, whereas the role of thrombophilia is controversial. An increasing role is played by post-baseline parameters such as the ultrasound assessment of residual vein thrombosis and the determination of D-dimer. While the latest international guidelines suggest indefinite anticoagulation for most patients with the first episode of unprovoked VTE, new scenarios are being offered by the identification of risk stratification models and by strategies that have the potential to help identify patients in whom anticoagulation can be safely discontinued, such as those that incorporate the assessment of D-dimer and residual vein thrombosis. New opportunities are being offered by low-dose aspirin, which has recently been reported to decrease by more than 30% the risk of recurrent events without increasing the bleeding risk; and especially by a few emerging anti-Xa and anti-IIa oral compounds, which are likely to induce fewer haemorrhagic complications than vitamin K antagonists while preserving at least the same effectiveness, do not require laboratory monitoring, and can be used immediately after the thrombotic episode.

Prandoni P ，Barbar S ，Milan M ，Vedovetto V ，Pesavento R ... -  《-》

[New oral anticoagulants in the treatment of venous thromboembolic disease].

Rivaroxaban is a direct inhibitor of activated factor X, and dabigatran is a direct inhibitor of thrombin. These new oral anticoagulants have demonstrated to be effective and safe in clinical trials on the treatment of venous thromboembolic disease (deep vein thrombosis and pulmonary thromboembolism).

Calvo Romero JM ，Lima Rodríguez EM 《-》

Prophylaxis of venous thromboembolism: low molecular weight heparin compared to the selective anticoagulants rivaroxaban, dabigatran and fondaparinux.

Welzel D ，Hull R ，Fareed J 《-》

[New oral anticoagulant agents: the quandary of anticoagulation in the elderly].

Páramo JA 《-》