Reduced-Dose vs. Full-Dose Anticoagulation to Prevent Recurrent Venous Thromboembolism

For patients at high risk for recurrent venous thromboembolism (VTE), the American College of Chest Physicians (ACCP) recommends extended treatment with reduced-dose anticoagulation (NEJM JW Gen Med Nov 1 2021 and Chest 2021; 160:545). Although the recommendation is based on two randomized trials (NEJM JW Gen Med Jan 15 2013 and N Engl J Med 2013; 368:699; NEJM JW Gen Med Apr 15 2017 and N Engl J Med 2017; 376:1211), it is labeled “weak … very-low certainty evidence.” Now, we have another trial that addresses this common clinical situation.

Researchers in France enrolled 2800 patients with recent acute VTE who were at high risk for recurrence (i.e., those with unprovoked VTE or persistent predisposing factors); all participants already had r…