Duration of anticoagulation after initial idiopathic venous thrombosis - The swinging pendulum: Risk assessment to predict recurrence

Abstract

Despite considerable advances in the identification of new risk factors for VTE, predicting the risk of recurrence in an individual patient remains a challenge. The impact of many of these risk factors on the recurrence risk is moderate, while the relevance of others is unknown or is regarded controversial. The determination of some markers of thrombophilia either lacks standardization or is too elaborate for routine purposes. Many patients carry more than one risk factor and their combined effect is unknown. Use of global coagulation markers that encompass the effects of clotting and/or fibrinolytic defects may improve risk assessment. In a future step, prothrombotic coagulation alterations need to be integrated with clinical risk factors. Reproducible and simple scoring systems may improve stratification of patients according to their recurrence risk and optimize duration of anticoagulant therapy. © 2009 International Society on Thrombosis and Haemostasis.