Idiopathic venous thrombosis

Summary

Idiopathic venous thromboembolism has been shown to be associated with a high frequency of recurrence. Therefore, the most important aim of long-term treatment is secondary prevention. It has also been shown that long-term anticoagulation with vitamin K antagonists can impressively reduce the rate of recurrence. However, this effect was only maintained during anticoagulation and disappeared after cessation of anticoagulant therapy. Unfortunately, the individual risk of recurrence is not predictable. Therefore, longterm anticoagulation appears beneficial across all subgroups of patients suffering from venous thromboembolism, regardless of the presence of thrombophilia or other burden of the disease. Despite the increasing body of evidence regarding the advantages of long-term anticoagulation, bleeding complications may limit the net clinical benefit of this strategy. Thus, the development of anticoagulants having a low potential for adverse reactions and providing similar beneficial antithrombotic effects to vitamin K antagonists will enhance the readiness for their wide spread use and life long administration.

Zusammenfassung

Idiopathische venöse Thromboembolien gehen mit einer hohen Rate von Rezidiven einher und deshalb ist die sekundäre Prävention das vorrangige Ziel einer Langzeitbehandlung. Durch Langzeitantikoagulation mit Vitamin-K-Antagonisten konnte eindrucksvoll eine Abnahme der Rezidivraten gezeigt werden, jedoch war dieser Effekt nur während der gerinnungshemmenden Therapie nachweisbar und verschwand wieder nach Beendigung der Antikoagulation. Leider ist eine Abschätzung des individuellen Rezidivrisikos nicht möglich, weshalb eine Langzeitantikoagulation vorzugsweise bei allen Patienten mit venösen Thromboembolien unabhängig von zusätzlichen Risikofaktoren wie Thrombophilie oder dem Schweregrad der Thrombose erfolgen sollte. Trotz der zunehmenden Evidenz hinsichtlich der Vorteile einer Langzeitantikoagulation können Blutungskomplikationen den Nettogewinn einer derartigen Strategie einschränken. Die Entwicklung von neuen Antikoagulanzien mit einem geringeren Nebenwirkungsprofil aber im Vergleich zu Vitamin-K-Antagonisten mindestens ebenso guter antithrombotischer Wirksamkeit würde die Bereitschaft einer weit verbreiteten und zeitlich unbegrenzten Anwendung deutlich erhöhen.

Keywords

Venous thromboembolism - long-term anticoagulation - secondary prevention - deep vein thrombosis - pulmonary embolism

Schlüsselwörter

Venöse Thromboembolie - Langzeitantikoagulation - sekundäre Prävention - tiefe Venenthrombose - Lungenembolie

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