Pulmonary vascular disease & thromboembolismResearch article
Continued versus discontinued oral anticoagulant treatment for unprovoked venous thromboembolism: target trial emulation
- Target trial emulation
- propensity-score matched
- Optum CDM and Medicare claims
Authors' conclusion
Based on two US nationally representative routine care databases, continuing versus discontinuing OAC after initial anticoagulation of ≥90 days was associated with lower risk of recurrent VTE, higher risk of major bleeding, and a net clinical benefit. This observation persisted among those using OACs for at least three years after VTE.
Study context
- Population
- Adults with unprovoked venous thromboembolism (VTE) (≥18 y Optum CDM; ≥65 y Medicare) starting OAC within 30 days of first VTE admission and treated ≥90 days, US, 2009–202530,554 matched pairs
- Comparison
- Continued vs discontinued OAC after ≥90 days of initial treatment
- Outcome
- Hospital admission for recurrent VTE (effectiveness) and major bleeding (safety)
Main finding
As reported in the abstract
Recurrent VTE
Each group vs discontinuedAdjusted hazard ratio (95% CI)
Continued
0.19(0.13–0.29)
Each group vs discontinuedAdjusted rate difference, per 1000 person years (95% CI)
Continued
−25.50(−39.38 to −11.63)
Secondary outcomes
| Outcome | adjusted HR (95% CI) | |
|---|---|---|
| Mortality — Continued vs Discontinued | 0.74 (0.69–0.79) | |
| Net clinical benefit (recurrent VTE and bleeding) — Continued vs Discontinued | 0.39 (0.36–0.42) | |
| 0.20.5125Adjusted hazard ratio (log scale) |
| Outcome | adjusted rate difference (per 1000 person years) (95% CI) | |
|---|---|---|
| Mortality — Continued vs Discontinued | −14.31 (−22.02 to −6.59) | |
| Net clinical benefit (recurrent VTE and bleeding) — Continued vs Discontinued | −21.01 (−32.31 to −9.71) | |
| −40−20020Difference, per 1000 person years (linear scale) |
Net clinical benefit (recurrent VTE and bleeding)
- Consistent across OAC types and length of initial OAC treatment
Safety
| Outcome | adjusted HR (95% CI) | |
|---|---|---|
| Major bleeding — Continued vs Discontinued · primary safety outcome | 1.75 (1.52–2.02) | |
| 0.512Adjusted hazard ratio (log scale) |
| Outcome | adjusted rate difference (per 1000 person years) (95% CI) | |
|---|---|---|
| Major bleeding — Continued vs Discontinued · primary safety outcome | 4.78 (1.95–7.61) | |
| −50510Difference, per 1000 person years (linear scale) |
Original publication
Continued versus discontinued oral anticoagulant treatment for unprovoked venous thromboembolism: target trial emulation. BMJ. Published 12 November 2025. doi:10.1136/bmj-2025-084380
Summarised from the published abstract; every number is checked against it