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The optimal long-term treatment of venous thromboembolism.

Patients with acute venous thromboembolism are currently treated with full-dose heparin followed by a 3-6-month period of oral anticoagulation. The long-term prognosis of patients with temporary risk factors is excellent. Accordingly, they do not require further anticoagulation following the initial 6-12-week period. Patients with continuous risk factors (including those with idiopathic venous thromboembolism) have a two- to three-fold increased risk of recurrence. Long-term anticoagulation is effective in these patients but carries an unpredictable risk of bleeding and is inconvenient. Low-intensity warfarin therapy, after the initial 6-month period of conventional anticoagulation, may confer an additional protection without an excessive bleeding risk. New categories of drugs, such as pentasaccharides and thrombin-inhibitors, have the potential to simplify the long-term treatment. Furthermore, the risk for late recurrences can be predicted on an individual basis by strategies that include the ultrasound assessment of thrombotic burden or the laboratory evaluation of D-dimer.