Question

I've been put on anticoagulant treatment (Warfarin) because I had a deep vein thrombosis which caused an embolism after flying from Australia. I'm only 45.

Do I have to stay on it for life?
 

Answer

Deep vein thrombosis is a serious condition - part of the clot may break off and travel through the great veins to the lungs, causing what is known as a pulmonary embolism. That's why you were treated with anticoagulants - to prevent more pieces of the clot breaking off. Some risk factors for developing deep vein thrombosis are: inactivity, such as prolonged sitting; pregnancy or recent childbirth; contraceptive use; a family history; and cancer. Treatment involves anticoagulation with heparin (by injection) or warfarin (by mouth); long-term anticoagulation requires fairly frequent blood tests to ensure that the dosage is just right. How long should you go on with anticoagulation? That depends if you have any of the risk factors outlined above. An analysis of medical publications on the benefits of extended anticoagulation following a pulmonary embolism has just been reported (for reference, see below). Long-term use (months rather than weeks) results in a reduced risk of recurrent embolism - a reduction of about 84% over one year. After stopping long-term anticoagulation, risk reduction was still present, but less - about 28% over one year. The risk of bleeding with anticoagulant therapy remained the same during short-term and long-term anticoagulation. Present recommendations for treatment of pulmonary embolism may be summarized: for a first episode - 3-6 months. For someone with a high risk of recurrent embolism - lifelong. Ost D, Tepper J, Mihara H, et al. Duration of anticoagulation following venous thromboembolism. Journal of the American Medical Association 2005;294:706-715
 

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