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Interventions Women with none or one of the HERDOO2 criteria were classified as at low risk of recurrent VTE and discontinued anticoagulants (intervention arm), whereas anticoagulant management for high risk women (≥2 HERDOO2 criteria) and men was left to the discretion of the clinicians and patients (observation arm).
The baseline assessment took place 5-12 months after the index VTE event, while patients were still receiving oral anticoagulant treatment.
Some patient subgroups with major provoking factors (eg, post-surgical VTE) have a low risk of recurrent VTE (1% at one year)1 and anticoagulants can be safely discontinued after short term treatment.2 However, more than 50% of patients with VTE do not have a major provoking factor.3 In these patients with unprovoked VTE, the risk of recurrent VTE is substantially higher; up to 10% in the first year after stopping short term treatment, 5% in the subsequent year,4 and 30% at eight years.5 Recurrent VTE is fatal in 3.6% of cases.6Oral anticoagulant treatment is effective at reducing the risk of recurrent VTE during treatment; oral anticoagulant treatment reduces the risk of recurrent VTE by 80-90%.7 Longer term oral anticoagulant treatment likely only delays recurrent VTE compared with short term treatment.8910 The highest bleeding risks are observed during initial oral treatment.
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