From the Guidelines
For a patient with a provoked deep vein thrombosis (DVT) that occurred 3 years ago, anticoagulation therapy can typically be discontinued if it hasn't been stopped already. The standard recommendation for provoked DVT is 3-6 months of anticoagulation therapy with medications such as warfarin, apixaban, rivaroxaban, dabigatran, or edoxaban 1. Since your DVT was provoked (meaning it had an identifiable trigger like surgery, immobilization, or hormonal therapy) and occurred 3 years ago, the risk of recurrence is significantly lower than for unprovoked DVT.
Some key points to consider:
- The American Society of Hematology guidelines suggest that the risk for recurrent VTE is low following completion of a course of anticoagulant therapy as primary treatment for patients who sustain a thromboembolism in the setting of a transient risk factor 1.
- A longer course of therapeutic anticoagulation for the primary treatment phase may decrease the risk of recurrent VTE while on treatment, but this is offset by an increased risk for bleeding complications 1.
- After completion of the primary treatment phase, anticoagulant therapy is typically discontinued for patients with VTE provoked by transient risk factors, and secondary prevention does not need to be considered 1.
If you're still on anticoagulants after this extended period, you should consult with your healthcare provider about discontinuation. Before stopping, your doctor may want to assess your current risk factors and ensure the provoking factor is no longer present. After discontinuation, it's essential to remain vigilant for symptoms of recurrent DVT such as leg pain, swelling, or redness, and to take preventive measures during high-risk situations like long flights or periods of immobility. These might include:
- Staying hydrated
- Performing leg exercises
- Wearing compression stockings
- Avoiding prolonged sitting
It's also important to note that the decision to discontinue anticoagulation therapy should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history 1.
From the FDA Drug Label
There is no information in the provided drug label that directly addresses the use of anticoagulants after a provoked Deep Vein Thrombosis (DVT) that occurred 3 years ago.
The FDA drug label does not answer the question.
From the Research
Anticoagulation Therapy after Provoked DVT
- The risk of recurrence of venous thromboembolism (VTE) persists after interruption of the initial anticoagulation therapy 2.
- Direct oral anticoagulants (DOACs) such as rivaroxaban, apixaban, and dabigatran have been studied for extended treatment of VTE and may reduce the risk of all-cause mortality 2.
- The optimal duration of anticoagulation after VTE is controversial and requires individualized assessment and balance between thrombosis and bleeding risks 2.
Comparison of DOACs
- Apixaban seems to be more effective than rivaroxaban in preventing the development of recurrent VTE and major bleeding events 3.
- Dabigatran was shown to be safer than vitamin K antagonists and similarly effective for the prevention of recurrent VTE 2.
- Rivaroxaban, apixaban, and dabigatran resulted in significant decreases in the rate of recurrent symptomatic VTE when compared to placebo, without a statistically significant difference in the risk of major bleeding 2.
Bleeding Risk
- Apixaban and dabigatran were associated with lower major bleeding risk compared with warfarin or rivaroxaban 4.
- Apixaban had a lower risk of major gastrointestinal bleeding than dabigatran 4.
- The risk of major bleeding differs between potential treatments, with apixaban reporting the most favorable profile compared with other NOACs, warfarin, and aspirin 5.
Extended Treatment
- NOACs are an effective treatment for prevention of VTE or VTE-related death in the extended treatment setting 5.
- The latest guidelines of the American College of Chest Physicians suggest the use of low-dose aspirin to prevent VTE recurrence in patients who want to stop anticoagulation 2.
- Either a treatment dose or a prophylactic dose of rivaroxaban significantly reduced the risk of VTE recurrence without a significant increase in bleeding risk compared with aspirin 2.