Long-term risk of recurrence after discontinuing anticoagulants for a first unprovoked venous thromboembolism: protocol for a systematic review and meta-analysis
Open accessAbstract
Introduction: For patients with a first unprovoked venous thromboembolism (VTE), the optimal duration of anticoagulation is a crucial clinical dilemma which has yet to be resolved. The decision to stop anticoagulant therapy (AT) after the initial 3–6 months or to continue AT indefinitely, is primarily governed by the long-term risk of recurrence when treatment is discontinued. This risk however, is not well established, hindering decision making. Methods and analysis: We will conduct a systematic review and a meta-analysis of studies involving patients diagnosed with a first, symptomatic unprovoked VTE or VTE provoked by minor transient risk factors, who have completed at least 3 months of initial AT; and who were followed-up for standardised time intervals of 1, 2, 5, 10 and 20 years (±3 months) after stopping AT. We will search (from inception to January 2017) MEDLINE, Embase and the Cochrane library for randomised controlled trials and prospective observational studies. Two reviewers will conduct all screening and data collection independently. The primary outcome of the rate of recurrent VTE at the standardised time intervals will be calculated for each study from the total number of recurrent events and the corresponding number of patient-years of follow-up. We will use a random-effects model to pool study results and report a weighted estimate of the absolute rate of recurrent VTE (events per 100 patient-years) over standardised time intervals of 1, 2, 5, 10 and 20 years after discontinuing anticoagulants. Ethics and dissemination: Ethical approval is not applicable for this study. Findings from this study will be disseminated through peer-reviewed journal publication as well as relevant national and international conference presentations. PROSPERO registration number: CRD42017056309.
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The study protocol was developed using PRISMA-P guidance, registered in PROSPERO, and published.
“The study protocol was developed using guidance from the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) statement,14 registered in PROSPERO and published.15”
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- Authors
- Khan, F., Rahman, A., Carrier, M., Kearon, C., Schulman, S., Couturaud, F., Prandoni, P., Eichinger, S., Becattini, C., Agnelli, G., Büller, H. R., Brighton, T. A., Palareti, G., Pinede, L., Sabri, E., Hutton, B., Wells, G. A., & Rodger, M. A.
- Affiliations
- University of Ottawa (CA)
- McMaster University (CA)
- Departmentof Internal Medicine and Chest Diseases, Brest University Hospital, Brest, France
- University of Padua (IT)
- Medical University of Vienna (AT)
- University of Perugia (IT)
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
- Prince of Wales Hospital (AU)
- University of Bologna (IT)
- Department of Internal Medicine, Infirmerie Protestante, Lyon, France
- Ottawa Hospital Research Institute (CA)
- Corresponding author
- Khan, Faizan
- ORCID
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2017-09
- Volume
- 7
- Issue
- 9
- Pages
- 016950
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC5623531
- OpenAlex
- W2759233833
- Cited by
- 11
- References
- 37
- Citations by year
- 2024: 2 · 2022: 3 · 2021: 2 · 2019: 3 · 2016: 1
- FWCI
- 0.21
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- HighWire Press Open Archive (acceptedVersion)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc)
- Funders
- Bristol-Myers Squibb
- Pfizer
- AstraZeneca
- GlaxoSmithKline
- Sanofi
- Bayer HealthCare
- Daiichi-Sankyo
- Novo Nordisk
- LEO Pharma
- Canadian Institutes of Health Research
- Daiichi Sankyo Europe
- Topics
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Keywords
- unprovoked venous thromboembolism, anticoagulation duration, anticoagulation discontinuation, recurrent venous thromboembolism
- MeSH terms
- Systematic Reviews as Topic, Anticoagulants, Drug Administration Schedule, Humans, Recurrence, Research Design, Risk Factors, Meta-Analysis as Topic, Venous Thromboembolism
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