1. Wie hoch muss das jährliche VTE-Rezidivrisiko sein,
damit eine Langzeitantikoagulation sinnvoll ist?
Sabine Eichinger
Univ. Klinik für Innere Medizin I
Medizinische Universität Wien

2. Inzidenz (%), n= 28 781
<180 Tage 5.6
181 - 365 Tage 4.1
1 - <2 Jahre 4.6
2 - <3 Jahre 3.2
3 - <4 Jahre 2.9
4 - <5 Jahre 2.6
5 - <6 Jahre 2.1
6 - <7 Jahre 2.2
7 - <8 Jahre 2.4
8 - <9 Jahre 1.6
9 - <10 Jahre 1.4
Jährliches Risiko
Martinez, Thromb Haemost 2014
Rezidivrisiko nach venöser Thromboembolie

3. Duration of anticoagulation
Boutitie, BMJ 2011
Recurrence risk after VTE
6 12 18 months

4. Iorio, Arch Int Med 2010
Transient risk factor
Recurrence risk after VTE
3.3%/year

5. ISTH/SSC Recommendation
Kearon, J Thromb Haemost 2010
• In patients with VTE provoked by a transient provoking
factor, the recurrence risk of 5% at 1 year and 15% at 5
years is acceptable by most physicians.

6. ISTH/SSC Recommendation
Kearon, J Thromb Haemost 2010
• In patients with VTE provoked by a transient provoking
factor, the recurrence risk of 5% at 1 year and 15% at 5
years is acceptable for most physicians.
STOP after 3 months

7. Spontane venöse Thromboembolie
Kyrle & Eichinger, Lancet 2010
Rezidivrisiko nach VTE

8. ISTH/SSC Recommendation
Kearon, J Thromb Haemost 2010
• In patients with unprovoked VTE a recurrence risk of 10%
at 1 year and 30% at 5 years is unacceptably high for many
physicians.
GO, GO, GO

9. Prandoni, Blood 2002
Cancer patients
Recurrence during VKA
Anticoagulation after VTE
Major bleeding during VKA

10. Anticoagulation after venous thrombosis
• We suggest that a risk of recurrence appreciably higher
than 5% at 1 year and 15% at 5 years would not be
acceptable to many physicians and patients, and would
usually discourage stopping anticoagulant therapy.
Kearon, J Thromb Haemost 2010

11. Anticoagulation after venous thrombosis
3 months long term
distal DVT
provoked* VTE unprovoked VTE
* Surgery, trauma, immobilisation, pregnancy/puerperium, female hormone intake, long haul travel
AWMF online, 6/20109th
ACCP Consensus Conference on Antithrombotic Therapy; Kearon, Chest 2012

12. Linkins, Ann Intern Med 2003
Time period of AC
Major bleeding
(%, 95% CI)
Intracranial bleeding
(%, 95% CI)
Initial 3 months 2.06 (2.04-2.08) 1.48 (1.40–1.56)
> 3 months 2.74 (2.71-2.77)/yr 0.65 (0.63–0.68)/yr
Bleeding during anticoagulation for VTE
Case fatality rate after 3 mo 9.1% (95% CI 2.5–21.7%)

13. Any Bleeding
REMEDY – dabigatran vs warfarin for long term prophylaxis after VTE
Schulman, N Engl J Med 2013

14. Case fatality of recurrent VTE
Schulman; EINSTEIN Investigators; Agnelli; all N Engl J Med 2013, 2010, 2013
Study
Recurrences,
n
Fatal, n (%) Case fatality (%)
RESONATE
(Dabigatran)
37 2 (0.3) 0.54
EINSTEIN
ext.
(Rivaroxaban)
56 1 (0.2) 0.17
AMPLIFY ext.
(Apixaban)
73 7 (0.8) 0.96

15. Rezidivrisiko 
Mortalität 
H. Nitsch, 1992
Blutungsrisiko 
Mortalität 

16. Risk factors for bleeding in VTE patients
Kearon, Chest 2012
Kein validiertes Model zur Abschätzung des Blutungsrisikos

17. Validierung: VALID-Studie
Ende der Antikoagulation bei
Patienten mit < 180 Punkten
Vienna Prediction Model
Eichinger, Circulation 2010

18. VALID - Studie
Einschlusskriterien
 Erste spontane tiefe Beinvenenthrombose oder Pulmonalembolie
 Laufende orale Antikoagulation von weniger als 7 Monaten
Kontakt: Dr. Eischer 40400-4496 oder 4522; Email: lisbeth.eischer@meduniwien.ac.at
Prof. Eichinger 40400-4410
Prof. Kyrle 40400-4951