What is the follow-up for Venous Compression and Thromboembolism Evaluation (VCTE)?

From the Guidelines

Patients with acute VTE should be assessed for extended-phase therapy upon completion of the 3-month treatment phase of anticoagulation. This recommendation is based on the most recent and highest quality study, which suggests that a 3-month treatment phase is sufficient for most patients, and extended-phase therapy should be considered on a case-by-case basis 1. The decision to extend anticoagulation therapy should be based on the individual patient's risk of recurrent VTE and bleeding complications.

Key Considerations

• The risk of recurrent VTE is low after completion of a 3-month treatment phase, but it varies depending on the presence of transient or persistent risk factors 1.
• The American Society of Hematology 2020 guidelines recommend a shorter course (3-6 months) of therapy over a longer duration (6-12 months) for the primary treatment phase, based on moderate certainty in the evidence of effects 1.
• The choice of anticoagulant therapy, such as vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs), may also influence the decision to extend therapy, as newer studies using DOACs may alter the balance of benefits and harms associated with a longer course of therapy 1.

Monitoring and Follow-up

• Patients with acute VTE should be monitored regularly to assess their risk of recurrent VTE and bleeding complications.
• The use of clinical prediction rules and risk assessment tools can help guide decisions about extended-phase therapy 1.
• Regular follow-up appointments with a healthcare provider are essential to assess the patient's response to treatment and adjust the treatment plan as needed.

Treatment Adjustments

• Treatment adjustments should be based on the individual patient's response to therapy and their risk of recurrent VTE and bleeding complications.
• The healthcare provider should consider the patient's medical history, lifestyle, and preferences when making decisions about extended-phase therapy.
• Patients should be educated about the risks and benefits of extended-phase therapy and involved in the decision-making process.

From the FDA Drug Label

The primary efficacy outcome generally shows homogeneous results across subgroups. Table 28 displays the primary and secondary efficacy results Primary efficacy outcome: Symptomatic recurrent VTE 4 (1.2) (0.4%, 3.0%) 5 (3.0) (1.2%, 6.6%) -1.8% (-6.0%, 0.6%) 0.40 (0.11,1. 41)

• VCTE follow-up: The FDA drug label provides information on the treatment of venous thromboembolism (VTE) and reduction in the risk of recurrent VTE in pediatric patients.
• The study results show that symptomatic recurrent VTE occurred in 4 (1.2%) patients in the XARELTO group and 5 (3.0%) patients in the comparator group.
• The hazard ratio for symptomatic recurrent VTE was 0.40 (0.11,1.41) 2.
• Key findings:
  • Symptomatic recurrent VTE or asymptomatic deterioration on repeat imaging occurred in 5 (1.5%) patients in the XARELTO group and 6 (3.6%) patients in the comparator group.
  • Complete resolution of thrombus on repeat imaging without recurrent VTE occurred in 128 of 335 children (38.2%) in the XARELTO group and 43 of 165 children (26.1%) in the comparator group.

From the Research

VCTE Follow-up

• The follow-up treatment for Venous Thromboembolism (VTE) typically involves anticoagulation therapy to reduce the risk of recurrence and mortality 3, 4.
• The choice of anticoagulant depends on various factors, including the patient's risk of bleeding, renal function, and cancer status 4, 5.
• Low-molecular-weight heparin (LMWH) and direct oral anticoagulants (DOACs) are commonly used for VTE treatment, with DOACs being preferred for patients without gastric or gastroesophageal lesions 5.
• The duration of anticoagulation therapy varies, but it is generally recommended for at least 6 months, and indefinitely if the patient has active cancer or persistent risk factors for recurrent VTE 5.
• Heparin lead-in is not always necessary for DOAC initiation, but it is often used in clinical practice, especially for patients with a high risk of bleeding or those who require a transition from heparin to DOAC 6.
• Clinical guidelines for VTE treatment are not always adhered to in clinical practice, highlighting the need for awareness and education among physicians 6.

Anticoagulation Options

• LMWH is a commonly used anticoagulant for VTE treatment, especially for patients with cancer or those who require a predictable anticoagulant response 3, 5.
• DOACs, such as apixaban, edoxaban, and rivaroxaban, are increasingly used for VTE treatment due to their convenience and efficacy 4, 5.
• Vitamin K antagonists (VKAs) are also used for VTE treatment, but they require regular monitoring and have a narrower therapeutic window compared to DOACs 3, 4.

Patient Selection and Treatment Duration

• Patient selection for VTE treatment depends on various factors, including the patient's risk of bleeding, renal function, and cancer status 4, 5.
• The treatment duration for VTE varies, but it is generally recommended for at least 6 months, and indefinitely if the patient has active cancer or persistent risk factors for recurrent VTE 5.
• The decision to extend or stop anticoagulation therapy should be based on individual patient factors and the risk-benefit ratio of continued treatment 5.