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After receiving a standard 6-month course of anticoagulation with warfarin, a patient with unprovoked venous thromboembolism (VTE) is at high risk for recurrence unless anticoagulation is continued. Indefinite therapy with warfarin prevents most cases of recurrent VTE (e.g., during the first year, risk is reduced from around 10% to 1%); however, cumulative risk for serious bleeding complications is not trivial, and patients must tolerate the inconvenience of ongoing international normalized ratio (INR) monitoring and dose adjustments. These observations raise the following question: After 6 months of standard anticoagulation, can we find an alternative that falls somewhere between long-term warfarin therapy and doing nothing?
In 2012, two st…