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de Winter MA, Xu Y, Stacey D, Wells PS. Qualitative experiences, values, and decisional needs of patients with unprovoked venous thromboembolism who suffer bleeding-"This pill will keep you alive tonight". Res Pract Thromb Haemost 2024; 8:102360. [PMID: 38559571 PMCID: PMC10978529 DOI: 10.1016/j.rpth.2024.102360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 04/04/2024] Open
Abstract
Background Contemporary guidelines recommend extended-duration anticoagulation among patients with a first unprovoked venous thromboembolism (VTE). Little is known about whether this recommendation aligns with patient values after a bleeding complication. Objectives To explore the experiences, values, and decisional needs of patients with unprovoked VTE related to extended-duration treatment after an anticoagulant-associated bleed. Methods In this descriptive, qualitative study, face to face online semistructured interviews were conducted with patients with unprovoked VTE who had experienced bleeding and continued anticoagulant treatment in one academic hospital in Canada. Data were analyzed using directed content analysis to identify themes. Themes were mapped onto the Ottawa Decisional Support Framework to identify decisional needs. Results Between September and December 2021, 14 patients were interviewed (age 41-69 years; 9 females). Many patients were not aware of the option to stop anticoagulation and had limited understanding of the decision about treatment duration. Despite the negative quality-of-life impact of clinically relevant bleeding during VTE treatment, the majority continued anticoagulation due to emotional trauma of VTE diagnosis, a perception that bleeding would be more manageable than VTE recurrence, a desire to maintain a connection to subspecialty care or non-VTE related benefits (eg, cancer diagnosis, protection from COVID-19). Patients' decisional needs included lack of choice awareness, inadequate support for participation, lack of personalized risk stratification, and inadequate information on monitoring and managing heavy menstrual bleeding. Conclusion Despite the impact of anticoagulant-associated bleeding on quality of life, patients preferred continuing with anticoagulation for reasons extending beyond secondary VTE prevention. Effective decision-support interventions are needed to address unmet decisional needs.
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Affiliation(s)
- Maria A. de Winter
- Department of Acute Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Internal Medicine, Diakonessenhuis, Utrecht, The Netherlands
| | - Yan Xu
- Department of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dawn Stacey
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Philip S. Wells
- Department of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Hu W, Ye M. Compliance status and influencing factors of anticoagulation therapy in outpatient undergoing major orthopedic surgery. Arch Orthop Trauma Surg 2024; 144:583-589. [PMID: 37898976 DOI: 10.1007/s00402-023-05106-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/09/2023] [Indexed: 10/31/2023]
Abstract
PURPOSE This study was designed to investigate influencing factors of out-of-hospital anticoagulation therapy compliance among patients undergoing major orthopaedic surgeries. METHODS A cross-sectional, descriptive study was conducted from July 2022 to February 2023 among outpatients who underwent major orthopedic surgery in our hospital. Patients (n = 200) were surveyed using the General Information Questionnaire, the General Self-Efficacy Scale, the Specificity of Medication-Taking Beliefs Scale, and the Morisky Medication Adherence Scale. Factors that influenced patient compliance were also determined using univariate and multivariate regression analyses. RESULTS One hundred eighty-three valid questionnaires were returned, the compliance with outpatient anticoagulation therapy among patients undergoing major orthopaedic surgeries was good in 56.3% (103/183) of all cases and poor in 43.7% (80/183). Multivariate logistic regression analysis showed that medication duration, adverse effects, self-efficacy and medication beliefs influenced adherence to out-of-hospital anticoagulation therapy in patients undergoing major orthopedic surgery (P < 0.05). CONCLUSIONS Poor compliance with out-of-hospital anticoagulation therapy in patients undergoing major orthopedic surgery is mainly associated with a long course of medication, adverse reactions, low self-efficacy and low medication beliefs. Healthcare staff should strengthen post-discharge anticoagulation management based on relevant influencing factors to enhance patient compliance.
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Affiliation(s)
- Wenqi Hu
- School of Nursing, China Medical University, Liaoning, 110122, China
- Department of Surgical Clinic, The First Affiliated Hospital of China Medical University, Liaoning, 110001, China
| | - Mao Ye
- Department of Surgical Clinic, The First Affiliated Hospital of China Medical University, Liaoning, 110001, China.
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Ingemann-Molden S, Caspersen CK, Rolving N, Højen AA, Klok FA, Grove EL, Brocki BC, Andreasen J. Comparison of important factors to patients recovering from pulmonary embolism and items covered in patient-reported outcome measures: A mixed-methods systematic review. Thromb Res 2024; 233:69-81. [PMID: 38029548 DOI: 10.1016/j.thromres.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/25/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE Up to 50 % of patients recovering from pulmonary embolism (PE) experience negative long-term outcomes. Patient-reported outcome measures (PROMs) are important in identifying what matters to patients. We aimed to identify PROMs used in clinical studies and recommended by the International Consortium of Health Outcomes (ICHOM) and compare individual items with factors considered important by patients recovering from PE. METHODS This was a convergent mixed-methods systematic review, including quantitative studies, using PROMs and qualitative studies with non-cancer-related PE patients. Items from each PROM and qualitative findings were categorised using an International Classification of Function linking process to allow for integrated synthesis. RESULTS A total of 68 studies using 34 different PROMs with 657 items and 13 qualitative studies with 408 findings were included. A total of 104 individual ICF codes were used, and subsequently sorted into 20 distinct categories representing patient concerns. Identified PROMs were found to adequately cover 17/20 categories, including anxiety, fear of bleeding, stress, depression, dizziness/nausea, sleep disturbance, pain, dyspnea, fatigue, activity levels, family and friends, socializing, outlook on life, and medical treatment. PROMs from the ICHOM core set covered the same categories, except for dizziness/nausea. CONCLUSIONS No single PROM covered all aspects assessed as important by the PE population. PROMs recommended in the ICHOM core set cover 16/20 aspects. However, worrisome thoughts, hypervigilance around symptoms, and uncertainty of illness were experienced by patients with PE but were not covered by PROMS.
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Affiliation(s)
- Stian Ingemann-Molden
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark.
| | | | - Nanna Rolving
- Department of Physical and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark; Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Anette Arbjerg Højen
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University Hospital and Aalborg University, Aalborg, Denmark
| | - Frederikus A Klok
- Department of Medicine, Thrombosis and Haemostasis Leiden University Medical Centre, Leiden, the Netherlands
| | - Erik L Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University Hospital, Aarhus, Denmark
| | - Barbara Cristina Brocki
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark
| | - Jane Andreasen
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark; Department of Health Science and Technology, Aalborg University, Aalborg, Denmark; Aalborg Health and Rehabilitation Centre, Aalborg Municipality, Aalborg, Denmark
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de Winter MA, Thavorn K, Hageman SH, Nijkeuter M, Wells PS. Balancing risks of recurrent venous thromboembolism and bleeding with extended anticoagulation: a decision analysis. Res Pract Thromb Haemost 2024; 8:102274. [PMID: 38222076 PMCID: PMC10784302 DOI: 10.1016/j.rpth.2023.102274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/25/2023] [Accepted: 11/11/2023] [Indexed: 01/16/2024] Open
Abstract
Background A decision to stop or continue anticoagulation after 3 months of anticoagulation for venous thromboembolism (VTE) should be made by weighing individual risks of recurrence and bleeding. Objectives To determine the optimal ratio of recurrence risk reduction to increase the risk of bleeding in terms of maximizing quality-adjusted life years (QALYs) gained. Methods Using a microsimulation model, outcomes within 5 years were simulated after assigning extended treatment if absolute recurrence risk reduction outweighed absolute increase in clinically relevant bleeding risk (International Society on Thrombosis and Haemostasis definition), weighted by a certain ratio. Data were simulated based on the Bleeding Risk Study, a prospective cohort including patients after ≥3 months of anticoagulation for unprovoked VTE or provoked VTE with history of VTE. The VTE-PREDICT risk score was used to estimate 5-year risks of recurrent VTE and clinically relevant bleeding. Results Among 10,000 individuals (mean age, 60.2 years, 36% female), the ratio of 0.90 (95% CI, 0.51-3.40; ie, bleeding is considered 0.90 the severity of recurrent VTE), with 99% of patients assigned extended anticoagulation, was considered optimal and resulted in 93 (95% CI, -23 to 203) additional QALYs compared with the least favorable ratio (5.10, 0% extended anticoagulation). At the optimal ratio, treatment based on VTE-PREDICT yielded 44 (95% CI, -69 to 157) additional QALYs versus standard of care. Conclusion With the current evidence, the optimal ratio between relevant bleeding risk and absolute recurrence risk reduction remains uncertain. Our results confirm that clinical equipoise exists regarding the decision to stop or continue anticoagulation after initial VTE treatment, emphasizing the importance of shared decision-making.
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Affiliation(s)
- Maria A. de Winter
- Department of Acute Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Internal Medicine, Diakonessenhuis, Utrecht, The Netherlands
| | - Kednapa Thavorn
- School of Epidemiology and Public Health, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Steven H.J. Hageman
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mathilde Nijkeuter
- Department of Acute Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Philip S. Wells
- School of Epidemiology and Public Health, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Agbemaple KM, Tromeur C, Le Mao R, Le Goff D, Leroyer C, Couturaud F. [Approaching patient experience following pulmonary embolism: A systematic review]. Rev Mal Respir 2023; 40:540-554. [PMID: 37598016 DOI: 10.1016/j.rmr.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/07/2023] [Indexed: 08/21/2023]
Abstract
INTRODUCTION Pulmonary embolism (PE) is the major complication of thromboembolic disease. While a few qualitative studies have explored patient experience after PE, to our knowledge no literature review is available to date. The aim of this work was to explore patient experience after a PE episode through a systematic review of the literature comprising: patient experience, clinicians' perception of the patients' attitude and knowledge, and the patients' perception of VTE prevention strategies. METHODS A search of PubMed, Web of science, Cochrane and EMBASE databases. The search was conducted without filters. Search results were combined and duplicates were removed. The selection was blinded by two independent researchers using the Rayyan application. RESULTS Fifty studies were assessed for quality and 23 were included. Individual semi-structured interviews and focus groups were widely used to explore patient experience after a PE episode. Patients described deterioration in their quality of life, their psychological state and an initial feeling of carer abandonment. The trends observed appear to be more pronounced in patients with an episode characterized as unprovoked. CONCLUSION These preliminary results call for further longitudinal studies, the objective being to better understand the evolution of these factors in the short and long terms.
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Affiliation(s)
- K M Agbemaple
- Département de médecine interne et pneumologie, centre hospitalo-universitaire de Brest, université de Bretagne Occidentale, Inserm U1304-GETBO, Inserm CIC1412, FCRIN INNOVTE, 90, rue du Cap Horn, 29200 Brest, France.
| | - C Tromeur
- Département de médecine interne et pneumologie, centre hospitalo-universitaire de Brest, université de Bretagne Occidentale, Inserm U1304-GETBO, Inserm CIC1412, FCRIN INNOVTE, 90, rue du Cap Horn, 29200 Brest, France
| | - R Le Mao
- Département de médecine interne et pneumologie, centre hospitalo-universitaire de Brest, université de Bretagne Occidentale, Inserm U1304-GETBO, Inserm CIC1412, FCRIN INNOVTE, 90, rue du Cap Horn, 29200 Brest, France
| | - D Le Goff
- ER 7479 SPURBO, université de Bretagne Occidentale, 29200 Brest, France
| | - C Leroyer
- Département de médecine interne et pneumologie, centre hospitalo-universitaire de Brest, université de Bretagne Occidentale, Inserm U1304-GETBO, Inserm CIC1412, FCRIN INNOVTE, 90, rue du Cap Horn, 29200 Brest, France
| | - F Couturaud
- Département de médecine interne et pneumologie, centre hospitalo-universitaire de Brest, université de Bretagne Occidentale, Inserm U1304-GETBO, Inserm CIC1412, FCRIN INNOVTE, 90, rue du Cap Horn, 29200 Brest, France
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Becattini C, Agnelli G. Residual Thrombosis: Still Relevant in the Direct Oral Anticoagulant (DOAC) Era? Thromb Haemost 2023; 123:747-749. [PMID: 37236228 DOI: 10.1055/a-2102-0376] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Cecilia Becattini
- Internal and Cardiovascular Medicine, Stroke Unit, University of Perugia, Perugia, Italy
| | - Giancarlo Agnelli
- Internal and Cardiovascular Medicine, Stroke Unit, University of Perugia, Perugia, Italy
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Khan F, Coyle D, Thavorn K, van Katwyk S, Tritschler T, Hutton B, Le Gal G, Rodger MA, Fergusson DA. Indefinite Anticoagulant Therapy for First Unprovoked Venous Thromboembolism : A Cost-Effectiveness Study. Ann Intern Med 2023. [PMID: 37364263 DOI: 10.7326/m22-3559] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Clinical practice guidelines recommend indefinite anticoagulation for a first unprovoked venous thromboembolism (VTE). OBJECTIVE To estimate the benefit-harm tradeoffs of indefinite anticoagulation in patients with a first unprovoked VTE. DESIGN Markov modeling study. DATA SOURCES Systematic reviews and meta-analyses for the long-term risks and case-fatality rates of recurrent VTE and major bleeding. Published literature for costs, quality of life, and other clinical events. TARGET POPULATION Patients with a first unprovoked VTE who have completed 3 to 6 months of initial anticoagulant treatment. TIME HORIZON Lifetime. PERSPECTIVE Canadian health care public payer. INTERVENTION Indefinite anticoagulation with direct oral anticoagulants. OUTCOME MEASURES Recurrent VTE events, major bleeding events, costs in 2022 Canadian dollars (CAD), and quality-adjusted life-years (QALYs). RESULTS OF BASE-CASE ANALYSIS When compared with discontinuing anticoagulation after initial treatment in a hypothetical cohort of 1000 patients aged 55 years, indefinite anticoagulation prevented 368 recurrent VTE events, which included 14 fatal pulmonary emboli, but induced an additional 114 major bleeding events, which included 30 intracranial hemorrhages and 11 deaths from bleeding. Indefinite anticoagulation cost CAD $16 014 more per person and did not increase QALYs (-0.075 per person). RESULTS OF SENSITIVITY ANALYSIS Model results were most sensitive to the case-fatality rate of major bleeding and the annual risk for major bleeding during extended anticoagulation. LIMITATION The model assumed that risks for recurrent VTE and major bleeding measured in clinical trials at 1 year remained constant during extended anticoagulation. CONCLUSION Clinicians should use shared decision making to incorporate individual patient preferences and values when considering treatment duration for unprovoked VTE. PRIMARY FUNDING SOURCE Canadian Institutes of Health Research.
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Affiliation(s)
- Faizan Khan
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada (F.K.)
| | - Doug Coyle
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada (D.C.)
| | - Kednapa Thavorn
- School of Epidemiology and Public Health, University of Ottawa; and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (K.T.)
| | | | - Tobias Tritschler
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.T.)
| | - Brian Hutton
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (B.H.)
| | - Grégoire Le Gal
- Clinical Epidemiology Program, Ottawa Hospital Research Institute; and Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada (G.L.G.)
| | - Marc A Rodger
- Department of Medicine, McGill University, Montreal, Québec, Canada (M.A.R.)
| | - Dean A Fergusson
- School of Epidemiology and Public Health, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute; and Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada (D.A.F.)
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de Winter MA, Büller HR, Carrier M, Cohen AT, Hansen JB, Kaasjager KAH, Kakkar AK, Middeldorp S, Raskob GE, Sørensen HT, Visseren FLJ, Wells PS, Dorresteijn JAN, Nijkeuter M. Recurrent venous thromboembolism and bleeding with extended anticoagulation: the VTE-PREDICT risk score. Eur Heart J 2023; 44:1231-1244. [PMID: 36648242 PMCID: PMC10079391 DOI: 10.1093/eurheartj/ehac776] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 10/23/2022] [Accepted: 12/07/2022] [Indexed: 01/18/2023] Open
Abstract
AIMS Deciding to stop or continue anticoagulation for venous thromboembolism (VTE) after initial treatment is challenging, as individual risks of recurrence and bleeding are heterogeneous. The present study aimed to develop and externally validate models for predicting 5-year risks of recurrence and bleeding in patients with VTE without cancer who completed at least 3 months of initial treatment, which can be used to estimate individual absolute benefits and harms of extended anticoagulation. METHODS AND RESULTS Competing risk-adjusted models were derived to predict recurrent VTE and clinically relevant bleeding (non-major and major) using 14 readily available patient characteristics. The models were derived from combined individual patient data from the Bleeding Risk Study, Hokusai-VTE, PREFER-VTE, RE-MEDY, and RE-SONATE (n = 15,141, 220 recurrences, 189 bleeding events). External validity was assessed in the Danish VTE cohort, EINSTEIN-CHOICE, GARFIELD-VTE, MEGA, and Tromsø studies (n = 59 257, 2283 recurrences, 3335 bleeding events). Absolute treatment effects were estimated by combining the models with hazard ratios from trials and meta-analyses. External validation in different settings showed agreement between predicted and observed risks up to 5 years, with C-statistics ranging from 0.48-0.71 (recurrence) and 0.61-0.68 (bleeding). In the Danish VTE cohort, 5-year risks ranged from 4% to 19% for recurrent VTE and 1% -19% for bleeding. CONCLUSION The VTE-PREDICT risk score can be applied to estimate the effect of extended anticoagulant treatment for individual patients with VTE and to support shared decision-making.
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Affiliation(s)
- Maria A de Winter
- Department of Acute Internal Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - Harry R Büller
- Department of Vascular Medicine, Amsterdam UMC, Meibergdreef 9 1105 AZ Amsterdam, The Netherlands
| | - Marc Carrier
- Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, 501 Smyth Rd, K1H8L6 Ottawa, Ontario, Canada
| | - Alexander T Cohen
- Department of Haematological Medicine, Guys and St Thomas’ Hospitals, King's College London, Westminster Bridge Road, London, SE1 7EH, UK
| | - John-Bjarne Hansen
- Thrombosis Research Center (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, 9037, Tromsø and Thrombosis Research Center (TREC), Division of internal medicine, University hospital of North Norway, 9038, Tromsø, Norway
| | - Karin A H Kaasjager
- Department of Acute Internal Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - Ajay K Kakkar
- Thrombosis Research Institute London, 1B Manresa Road Chelsea, SW3 6LR, London, UK
| | - Saskia Middeldorp
- Department of Internal Medicine & Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands
| | - Gary E Raskob
- Hudson College of Public Health, University of Oklahoma Health Sciences Center, 801 N.E. 13th Street, Oklahoma City, OK 73104, USA
| | - Henrik T Sørensen
- Department of Clinical Medicine - Department of Clinical Epidemiology, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
| | - Philip S Wells
- Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, 501 Smyth Rd, K1H8L6 Ottawa, Ontario, Canada
| | - Jannick A N Dorresteijn
- Department of Vascular Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
| | - Mathilde Nijkeuter
- Department of Acute Internal Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
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Piazza G. Walking the tightrope: a balanced discussion of the benefits and harms of extended duration anticoagulation for venous thrombo-embolism. Eur Heart J 2023; 44:1245-1247. [PMID: 36656796 DOI: 10.1093/eurheartj/ehac731] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Gregory Piazza
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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