Research and practice in thrombosis and haemostasis · 2026
Risks of anticoagulation discontinuation after first venous thromboembolism in inherited thrombophilia: a long-term cohort study.
СтатьяНазвание и аннотация: Перевод в очереди
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Kim Sang-A, Park Sin Young, Lee Ji Yun, Hong Junshik, Na Sang-Hoon, Lee Jeong-Ok, Bang Soo-Mee
Аннотация
BACKGROUND: Inherited thrombophilia confers high venous thromboembolism (VTE) recurrence risk, and guidelines generally recommend indefinite anticoagulation after first VTE. However, long-term data comparing outcomes between patients who continue versus discontinue therapy are scarce.
OBJECTIVES: To compare recurrent VTE and major bleeding (MB) risks between patients who continued versus discontinued anticoagulation after first VTE in inherited thrombophilia.
METHODS: We conducted a retrospective cohort study of 103 patients with protein S, protein C, or antithrombin deficiency who experienced first VTE between 1987 and 2023. Patients were grouped by anticoagulation status: 49 continued, 54 discontinued. The primary endpoint was recurrent VTE or MB.
RESULTS: Median age was 39 years (range, 11-81); 68% were male. Over median 6.0-year follow-up (interquartile range, 4.9-17.9 years), the composite endpoint occurred far more often in the discontinued versus continued group (66.7% vs 4.1%; HR, 20.23; 95% CI, 4.86-84.27; P < .001). Ten-year event-free survival was 95.1% versus 42.1% (P < .001), yielding a number needed to treat of 2. This difference was driven by VTE recurrence (63.0% vs 4.1%; adjusted HR, 19.85; P < .001). MB occurred only in the discontinued group (5.6% vs 0%). Anticoagulation discontinuation was the only independent predictor of recurrence. Time-dependent Cox and competing risk analyses confirmed these findings.
CONCLUSIONS: In patients with inherited thrombophilia, discontinuing anticoagulation markedly increased VTE recurrence without reducing bleeding. Our data support indefinite anticoagulation after first VTE in this population.
OBJECTIVES: To compare recurrent VTE and major bleeding (MB) risks between patients who continued versus discontinued anticoagulation after first VTE in inherited thrombophilia.
METHODS: We conducted a retrospective cohort study of 103 patients with protein S, protein C, or antithrombin deficiency who experienced first VTE between 1987 and 2023. Patients were grouped by anticoagulation status: 49 continued, 54 discontinued. The primary endpoint was recurrent VTE or MB.
RESULTS: Median age was 39 years (range, 11-81); 68% were male. Over median 6.0-year follow-up (interquartile range, 4.9-17.9 years), the composite endpoint occurred far more often in the discontinued versus continued group (66.7% vs 4.1%; HR, 20.23; 95% CI, 4.86-84.27; P < .001). Ten-year event-free survival was 95.1% versus 42.1% (P < .001), yielding a number needed to treat of 2. This difference was driven by VTE recurrence (63.0% vs 4.1%; adjusted HR, 19.85; P < .001). MB occurred only in the discontinued group (5.6% vs 0%). Anticoagulation discontinuation was the only independent predictor of recurrence. Time-dependent Cox and competing risk analyses confirmed these findings.
CONCLUSIONS: In patients with inherited thrombophilia, discontinuing anticoagulation markedly increased VTE recurrence without reducing bleeding. Our data support indefinite anticoagulation after first VTE in this population.