{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T09:45:17Z","timestamp":1792403117399,"version":"4.4.0"},"reference-count":66,"publisher":"American Society of Hematology","issue":"5","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,1,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>The most important decision in the long-term treatment of venous thromboembolism (VTE) is how long to anticoagulate. VTE provoked by a reversible risk factor, or a first unprovoked isolated distal deep vein thrombosis (DVT), generally should be treated for 3 months. VTE provoked by a persistent or progressive risk factor (eg, cancer), or a second unprovoked proximal DVT or PE, is generally treated indefinitely. First unprovoked proximal DVT or PE may be treated for 3 to 6 months or indefinitely. Male sex, presentation as PE (particularly if concomitant proximal DVT), a positive d-dimer test after stopping anticoagulation, an antiphospholipid antibody, low risk of bleeding, and patient preference favor indefinite anticoagulation. The type of indefinite anticoagulation is of secondary importance. Low-dose oral Xa inhibitors are convenient and are thought to have a lower risk of bleeding; they are less suitable if there is a higher risk for recurrence. For cancer-associated VTE, we now prefer full-dose oral Xa inhibitors over low-molecular-weight heparin, with gastrointestinal lesions being a relative contraindication. Graduated compression stockings are not routinely indicated after DVT, but are encouraged if there is persistent leg swelling or if a trial of stockings improves symptoms. Medications have a limited role in the treatment of postthrombotic syndrome. After PE, patients should have clinical surveillance for chronic thromboembolic pulmonary hypertension (CTEPH), with ventilation-perfusion scanning and echocardiography being the initial diagnostic tests if CTEPH is a concern. Patients with CTEPH and other symptomatic patients with extensive residual perfusion defects should be evaluated for endarterectomy, balloon pulmonary angioplasty, or vasodilator therapies.<\/jats:p>","DOI":"10.1182\/blood.2019002364","type":"journal-article","created":{"date-parts":[[2020,1,9]],"date-time":"2020-01-09T09:50:09Z","timestamp":1578563409000},"page":"317-325","update-policy":"https:\/\/doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":98,"title":["Long-term treatment of venous thromboembolism"],"prefix":"10.1182","volume":"135","author":[{"given":"Clive","family":"Kearon","sequence":"first","affiliation":[{"name":"Department of Medicine, McMaster University, Hamilton, ON, Canada;"},{"name":"Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan R.","family":"Kahn","sequence":"additional","affiliation":[{"name":"Department of Medicine and Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"234","reference":[{"issue":"4","key":"2020013011595090200_B1","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1111\/j.1538-7836.2012.04629.x","article-title":"A conceptual framework for two phases of anticoagulant treatment of venous thromboembolism","volume":"10","author":"Kearon","year":"2012","journal-title":"J Thromb Haemost"},{"issue":"2 Suppl","key":"2020013011595090200_B2","doi-asserted-by":"crossref","first-page":"53S","DOI":"10.1378\/chest.11-2288","article-title":"Methodology for the development of antithrombotic therapy and prevention of thrombosis guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines","volume":"141","author":"Guyatt","year":"2012","journal-title":"Chest"},{"issue":"2","key":"2020013011595090200_B3","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/j.chest.2015.11.026","article-title":"Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report [published correction appears in Chest. 2016;150(4):988]","volume":"149","author":"Kearon","year":"2016","journal-title":"Chest"},{"issue":"may24 2","key":"2020013011595090200_B4","doi-asserted-by":"crossref","first-page":"d3036","DOI":"10.1136\/bmj.d3036","article-title":"Influence of preceding length of anticoagulant treatment and initial presentation of venous thromboembolism on risk of recurrence after stopping treatment: analysis of individual participants\u2019 data from seven trials","volume":"342","author":"Boutitie","year":"2011","journal-title":"BMJ"},{"issue":"aug30 1","key":"2020013011595090200_B5","doi-asserted-by":"crossref","first-page":"f5133","DOI":"10.1136\/bmj.f5133","article-title":"Efficacy and safety outcomes of oral anticoagulants and antiplatelet drugs in the secondary prevention of venous thromboembolism: systematic review and network meta-analysis","volume":"347","author":"Castellucci","year":"2013","journal-title":"BMJ"},{"issue":"7","key":"2020013011595090200_B6","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1136\/heartjnl-2018-313617","article-title":"Extended treatment of venous thromboembolism: a systematic review and network meta-analysis","volume":"105","author":"Wang","year":"2019","journal-title":"Heart"},{"issue":"1","key":"2020013011595090200_B7","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1001\/jama.2015.7046","article-title":"Six months vs extended oral anticoagulation after a first episode of pulmonary embolism: the PADIS-PE randomized clinical trial","volume":"314","author":"Couturaud","year":"2015","journal-title":"JAMA"},{"issue":"7","key":"2020013011595090200_B8","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.3324\/haematol.2018.210971","article-title":"Six months versus two years of oral anticoagulation after a first episode of unprovoked deep-vein thrombosis. 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