Survey among vascular specialists reveals distinct approaches for extended secondary prophylaxis of venous thromboembolism (VTE) in patients with strong persisting or permanent risk factors

Introduction After 3–6 months of VTE therapy, continued oral anticoagulation (OAC) for secondary prophylaxis is recommended if relevant VTE risk factors persist [ 1 ]. Randomized controlled trials in patients, in whom discontinuation and continuation of OAC were equivalent options, showed a comparable reduction in VTE recurrence rates for the low dose (i.e. apixaban 2,5 mg twice daily or rivaroxaban 10 mg once daily) and the therapeutic (full) dose. The extent to which the results are transferable to specific subgroups, e.g. patients with strong persistent or permanent risk factors, has not yet been investigated. Method An online survey on secondary prevention practices was sent to vascular specialists in the DACH region. The current analysis presents the responses of 315 participants on their preferred strategy for secondary VTE prevention in patients with a strong persisting or permanent risk factor, i.e., active cancer, severe hereditary thrombophilia, or thrombotic antiphospholipid syndrome (APS) without the detection of lupus anticoagulants (LA-negative). Of note, the survey was conducted after publication of the EVE trial (n=360), but before availability of findings from the API-CAT trial (n=1.766), both investigating the safety and efficacy of low-dose vs. full-dose apixaban for extended secondary VTE prophylaxis in patients with active cancer [ 2 ] [ 3 ]. Results Among the 315 participants of the survey were 159 angiologists (51%), 98 hemostaseologists (31%), and 53 phlebologists (17%; [ Fig. 1 ]). The proportion of respondents who favored secondary VTE prevention with a direct factor Xa inhibitor (DXI) at low doses in patients with cancer-associated thromboembolism (CAT) was significantly higher (31%) than the proportion of respondents who favored continuation of OAC with a low-dose DXI in patients with severe hereditary thrombophilia or LA-negative APS (15% and 17%, respectively; p