{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T11:46:44Z","timestamp":1787312804802,"version":"build-2736575974"},"reference-count":49,"publisher":"BMJ","license":[{"start":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T00:00:00Z","timestamp":1762905600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ"],"accepted":{"date-parts":[[2025,9,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare the effect on health outcomes of continuing or discontinuing oral anticoagulants (OACs) among patients with unprovoked venous thromboembolism (VTE) after initial treatment for at least 90 days.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Target trial emulation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Optum Clinformatics Data Mart (Optum CDM) from 1 January 2009 to 28 Februray 2025, and Medicare fee-for-service claims from 1 January 2009 to 31 December 2022, United States.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Adults with VTE aged \u226518 years (Optum CDM) or \u226565 years (Medicare) initiating OACs (warfarin or direct OACs) within 30 days after a first hospital admission with VTE without reversible provoking factors and who continued treatment for \u226590 days. Propensity score one-to-one matching was performed between patients who continued and those who discontinued treatment (ie, absence of a refilled prescription within 30 days).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>The primary outcomes were hospital admission for recurrent VTE (effectiveness) and major bleeding (safety). Secondary outcomes were net clinical benefit (a composite of recurrent VTE and bleeding) and mortality. Cox proportional hazards models estimated hazard ratios and generalized linear models estimated rate differences per 1000 person years. Analyses were stratified by length of initial OAC treatment (90-179, 180-359, 360-719, 720-1079, or \u22651080 days).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The study cohort included 30\u2009554 propensity score matched pairs who had continued or discontinued an OAC (mean age 73.9 years, 57.0% women). After initial anticoagulation of \u226590 days, compared with those who discontinued treatment, those who continued treatment had markedly lower rates of recurrent VTE (adjusted hazard ratio 0.19, 95% confidence interval (CI) 0.13 to 0.29; adjusted rate difference per 1000 person years \u221225.50, 95% CI \u221239.38 to \u221211.63), higher rates of major bleeding (1.75, 1.52 to 2.02; 4.78, 1.95 to 7.61), lower mortality rates (0.74, 0.69 to 0.79; \u221214.31, \u221222.02 to \u22126.59), and greater net clinical benefit (0.39, 0.36 to 0.42; \u221221.01, \u221232.31 to \u22129.71). The greater net clinical benefit was consistent across OAC types and length of initial OAC treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Based on two US nationally representative routine care databases, continuing versus discontinuing OAC after initial anticoagulation of \u226590 days was associated with lower risk of recurrent VTE, higher risk of major bleeding, and a net clinical benefit. This observation persisted among those using OACs for at least three years after VTE.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmj-2025-084380","type":"journal-article","created":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T01:05:48Z","timestamp":1762995948000},"page":"e084380","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Continued versus discontinued oral anticoagulant treatment for unprovoked venous thromboembolism: target trial emulation"],"prefix":"10.1136","volume":"391","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4564-3715","authenticated-orcid":false,"given":"Kueiyu Joshua","family":"Lin","sequence":"first","affiliation":[{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA 02120, USA"},{"name":"Division of General Internal Medicine, Department of Medicine, 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