Prolonged anticoagulation in VTE with direct oral anticoagulants: towards an individual analysis of net clinical benefit?

Venous thromboembolism (VTE) is a common, multifactorial and capricious disease. Its incidence is estimated at between 1 and 1.84 per 1000 person-years, half of cases consisting of isolated distal or proximal deep vein thrombosis (DVT), a quarter of isolated pulmonary embolism (PE) and the rest being PE associated with DVT [1, 2]. The direct severity depends on the mortality risk due to haemodynamic instability in massive PE, and risk of midor long-term thromboembolism recurrence and associated sequelae [3]. Population-based studies have revealed that the recurrence risk is significant in the first days, intermediate during the next 3–6 months, then falls to approximately 3–5% per year, though varies widely depending on the thromboembolism context and patient characteristics [1, 3]. We can thus distinguish three therapeutic stages: initial treatment (acute phase), maintenance treatment (consolidation phase) and, at least for some patients, long-term treatment (secondary prevention phase) [4–6].