Anticoagulation Management After Central Venous Thrombosis Resolution

Introduction to Anticoagulation Therapy

• The American Society of Hematology recommends indefinite anticoagulation for unprovoked deep vein thrombosis, not just 3-6 months 1
• The patient should continue with dabigatran (or another oral anticoagulant) indefinitely, and should not discontinue anticoagulant therapy after thrombus resolution 1

Discontinuation of Anticoagulation

• Anticoagulation should only be discontinued in cases of critical bleeding or high risk of rebleeding with death/disability, as stated by the American College of Cardiology 2
• The American College of Cardiology also recommends considering patient preference after a detailed discussion of the risks when deciding to discontinue anticoagulation 2

Monitoring and Dose Adjustment

• Periodic evaluation of renal function is essential, with assessments as clinically indicated (more frequently in situations that may be associated with declining renal function) 1
• The American College of Cardiology suggests that when necessary, anticoagulant activity should be evaluated using aPTT or ECT, not INR, in patients using dabigatran, although the specific citation for this is not provided, the general principle of monitoring is supported by 1