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Question answered:23/04/08
The CKS guideline on DVT [1] states:
“Anticoagulation
Warfarin is the most commonly used anticoagulant for long-term therapy following a venous thromboembolic event.
The usual treatment strategy is to aim for an international normalization ratio (INR) of 2.5 and to keep it within 2.0–3.0.
The duration of treatment is usually 3 to 6 months, but may be shorter or longer, depending on the risk of recurrence.”
It later reports:
“The standard duration and intensity of anticoagulant treatment may vary according to the clinical features balancing the benefits of treatment against the risks of treatment and the risk of recurrence without treatment. Minimum recommended durations are shown in Table 1.
There is some debate about the benefits of anticoagulation for people who have had a first distal DVT. The British Committee for Standards in Haematology recommends (grade A) that they be given at least 6 weeks' therapy [Baglin et al, 2005]. However, an editorial in Thrombus questions the evidence that there are benefits in terms of both (i) preventing the thrombus extending and embolizing; and (ii) preventing the development of post-thrombotic syndrome [Rose, 2006].
Anticoagulants may need to be continued beyond the planned treatment period if there are ongoing risk factors for venous thromboembolism, for example, if the person has:
- Inherited coagulation defects (e.g. factor V Leiden)
- Acquired coagulation defects (e.g. antiphospholipid syndrome)
- Malignancy
- Chronic infection
- Inflammatory bowel disease
- Nephrotic syndrome
- Thromboembolic pulmonary hypertension”
Reference
1) http://www.cks.library.nhs.uk/deep_vein_thrombosis/view_whole_guidance
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