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Invited Commentary
July 2015

Overuse of Bridging Anticoagulation for Patients With Venous Thromboembolism: First, Do No Harm

Author Affiliations
  • 1Hospitalist Program, Division of General Internal Medicine, School of Medicine, The Johns Hopkins University, Baltimore, Maryland
  • 2Division of General Internal Medicine, School of Medicine, The Johns Hopkins University, Baltimore, Maryland
  • 3Division of Hematology, School of Medicine, The Johns Hopkins University, Baltimore, Maryland
  • 4Department of Medicine, School of Medicine, The Johns Hopkins University, Baltimore, Maryland
JAMA Intern Med. 2015;175(7):1169-1170. doi:10.1001/jamainternmed.2015.1858

Patients receiving anticoagulation for venous thromboembolism (VTE) have varying risks of recurrence on cessation of the therapy. Time from the most recent thrombotic event is perhaps the most important determinant of short-term VTE recurrence because patients who stop anticoagulation therapy before the stabilization of an active thrombus are particularly prone to propagation and embolization. If use of anticoagulation is stopped during the first 4 weeks of treatment, the risk of recurrent VTE is 0.3% to 1.3% per day, dropping to 0.03% to 0.2% per day over the next 4 to 12 weeks.1 After 3 months, many patients can safely discontinue anticoagulation therapy, particularly if the thrombotic event occurred in the setting of a reversible precipitant.

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