#Anticoagulant therapy for symptomatic calf deep vein #thrombosis (CACTUS): a randomised, double-blind, placebo-controlled trial

http://thelancet.com/journals/lanhae/article/PIIS2352-3026(16)30131-4/fulltext

Nadroparin was not superior to placebo in reducing the risk of proximal extension or venous thromboembolic events in low-risk outpatients with symptomatic calf DVT, but did increase the risk of bleeding. Avoidance of systematic anticoagulation for calf DVT could have a substantial impact on individual patients and from a public health perspective.

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Benefits and Harms of Oral #Anticoagulant Therapy in Chronic #Kidney Disease: A Systematic Review and Meta-analysis

https://annals.org/aim/article-abstract/2738158/benefits-harms-oral-anticoagulant-therapy-chronic-kidney-disease-systematic-review

All but the 8 trials involving patients with ESKD excluded participants with creatinine clearance less than 20 mL/min or estimated glomerular filtration rate less than 15 mL/min/1.73 m2. In AF, compared with VKAs, NOACs reduced risks for stroke or systemic embolism (risk ratio RR, 0.79 95% CI, 0.66 to 0.93; high-certainty evidence) and hemorrhagic stroke (RR, 0.48 CI, 0.30 to 0.76; moderate-certainty evidence). Compared with VKAs, the effects of NOACs on recurrent VTE or VTE-related death were uncertain (RR, 0.72 CI, 0.44 to 1.17; low-certainty evidence). In all trials combined, NOACs seemingly reduced major bleeding risk compared with VKAs (RR, 0.75 CI, 0.56 to 1.01; low-certainty evidence).

Conclusion:
In early-stage CKD, NOACs had a benefit–risk profile superior to that of VKAs. For advanced CKD or ESKD, there was insufficient evidence to establish benefits or harms of VKAs or NOACs.

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Long term risk of symptomatic recurrent venous #thromboembolism after discontinuation of #anticoagulant treatment for first unprovoked venous thromboembolism event: systematic review and meta-analysis

https://www.bmj.com/content/366/bmj.l4363

.. Compared to patients with isolated pulmonary embolism, the rate of recurrent VTE was higher in patients with proximal deep vein thrombosis (rate ratio 1.4, 95% confidence interval 1.1 to 1.7) and in patients with pulmonary embolism plus deep vein thrombosis (1.5, 1.1 to 1.9). In patients with distal deep vein thrombosis, the pooled rate of recurrent VTE per 100 person years was 1.9 events in the first year after anticoagulation had stopped. The case fatality rate for recurrent VTE was 4% (95% confidence interval 2% to 6%).

Conclusions In patients with a first episode of unprovoked VTE who completed at least three months of anticoagulant treatment, the risk of recurrent VTE was 10% in the first year after treatment, 16% at two years, 25% at five years, and 36% at 10 years, with 4% of recurrent VTE events resulting in death. These estimates should inform clinical practice guidelines, enhance confidence in counselling patients of their prognosis, and help guide decision making about long term management of unprovoked VTE.