Duration of warfarin for first DVT is hotly debated. In this multi-center trial of patients with new first DVT, patients were randomized to fixed-duration or flexible-duration (based on consecutive USG findings at 3 months). The fixed-group received 3 months of warfarin for secondary DVT, and 6 months for unprovoked DVT. The flexible-group received 3 months (if their 3 month USG showed vein re-canalization). For those not re-canalized at 3 months, they received additional USG at 3 and 9 months (for secondary DVT) and at 3, 9, 15, and 21 months (for unprovoked DVT). The 33 month f/u recurrent DVT risk was 12% in the flexible-group, which was significantly lower than the 17% in the fixed group. This indicates an advantage of continuing warfarin in patients without re-canalization. However, an editorialist points out that patients with idiopathic DVT need indefinite warfarin, and those with provoked DVT need “time-limited” warfarin. The latter may be a reasonable group to schedule f/u USG to determine length of warfarin treatment (abstract).
I am coming up on my two year anniversary. Not my wedding anniversary (soon to be 15 years – thanks Maia!), but two years since I joined the ranks of the patients. It was two years ago this week that my day was interrupted by a page from my internist saying, “I don’t know how […]
As you can see, no glamour shots for this month’s post. I knew it would come at some point, and my first hospitalization related to my CLL came in a big way in mid-July. Given my interest in global health, it was only fitting that I managed to get sick while out of the […]
This large multicenter trial randomized patients with acute VTE to apixaban (10mg BID for 1 week, followed by 5mg BID for 6 months) versus conventional therapy (lovenox-warfarin). The primary outcome was similar between groups (symptomatic VTE or death related to VTE), but major and minor bleeding occurred significantly less often with apixaban. Apixaban is a […]