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Poor Early Anticoagulation Control Associated with Near 3-fold Increase in DVT Recurrence and Post-thrombotic Syndrome

Alex C. Spyropoulos, MD, FACP, FCCP
January, 2006

Review: van Dongen CJ, Prandoni P, Frulla M, Marchiori A, Prins MH, Hutten BA. Relation between quality of anticoagulant treatment and the development of the postthrombotic syndrome. J Thromb Haemost. 2005 May;3(5):939-42.

Van Dungen and colleagues evaluated 244 DVT patients on oral anticoagulation therapy (OAT). During a median follow-up of 4.9 years, and using a validated post-thrombotic syndrome (PTS) scoring system, they found that patients whose INRs were less than 2 more than 50% of the time were 2.7 times as likely to develop PTS (odds ratio 2.71, 95% confidence interval 1.44 - 5.10). Specifically, 81 patients (33%) developed PTS when INR < 2.0 more than 50% of the time.

Review: Palareti G, Legnani C, Cosmi B, Guazzaloca G, Cini M, Mattarozzi S. Poor anticoagulation quality in the first 3 months after unprovoked venous thromboembolism is a risk factor for long-term recurrence. J Thromb Haemost. 2005 May;3(5):955-61.

Palareti and colleagues reported on 297 patients with idiopathic venous thrombosis followed for 21 months after oral anticoagulation therapy (OAT) was stopped. Patients whose INRs were less than 1.5 the most often during the first 90 days of warfarin therapy were about 2.8 times as likely to have a recurrent venous thrombosis after OAT was stopped (relative risk 2.77, 95% confidence interval 1.49 - 5.18).

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