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Notably, both recurrence and bleeding were directly related to cancer severity, and could not be explained by over- or under-anticoagulation (Prandoni et al, 2002).
Both recurrence and bleeding were related to cancer severity, occurred primarily during the first month of anticoagulant therapy, and were not adequately explained by over- or undercoagulation.
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The AMPLIFY study with apixaban, the EINSTEIN-DVT study with rivaroxaban and Hokusai-VTE with edoxaban suggested lower absolute rates of both VTE recurrence and bleeding compared with VKA treatment (Fig. 1).
The duration of VTE treatment is a key issue for every patient to balance the risk of recurrence and bleeding effectively.
Phase II studies of apixaban for the treatment of DVT showed low recurrence and bleeding rates, warranting a phase III trial.
Sequelae of both stroke and bleeding outcomes are also described.
VTE and anticoagulation are two of the main independent risk factors for recurrence of VTE and bleeding.
In a retrospective analysis that included DVT patients with and without malignancy who received vitamin K antagonists for 3 months with a target INR of 2.0 3.0, patients with malignancy had a clinically and significantly increased incidence of recurrence (27.1/100 vs 9.0/100 patient-years) and bleeding (13.3/100 vs 2.1/100 patient-years) compared with those without cancer (Hutten et al, 2000).
In Cox's multivariate analysis including 164 patients with a complete set of data, only high tumour thickness and bleeding predicted poor recurrence-free survival (P= 0.0042 and 0.0087 respectively) or overall survival (P= 0.0147 and 0.0033 respectively).
Notably, outpatient or home treatment of acute PE and/or DVT represents a first step towards lowering patients' burden, and it may be effective and safe in appropriately selected patients with predefined and easy-to-use criteria as observed VTE recurrence, mortality and bleeding rates are low.
Sticking and bleeding out.
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