What are the ACCP guidelines for duration of anticoagulation therapy for pulmonary embolism (PE)?

Updated: Sep 18, 2020
  • Author: Daniel R Ouellette, MD, FCCP; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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A patient with a first thromboembolic event occurring in the setting of reversible risk factors, such as immobilization, surgery, or trauma, should receive warfarin therapy for at least 3 months. No difference in the rate of recurrence was observed in either of 2 studies comparing 3 versus 6 months of anticoagulant therapy in patients with idiopathic (or unprovoked) first events. [104, 105] The current recommendation is anticoagulation for at least 3 months in these patients; the need for extending the duration of anticoagulation should be reevaluated at that time.

The current ACCP guidelines recommend that all patients with unprovoked PE receive three months of treatment with anticoagulation over a shorter duration of treatment and have an assessment of the risk-benefit ratio of extended therapy at the end of three months (grade 1B). [5] Patients with a first episode of venous thromboembolism and with a low or moderate risk of bleeding should have extended anticoagulant therapy (grade 2B). Patients with a first episode of venous thromboembolism who have a high bleeding risk should have therapy limited to three months (grade 1B).

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