How to determine the optimal duration of anticoagulation for VTE: an evidence-based decision-analytical approach

ABSTRACT: When advising patients on the optimal duration of anticoagulation for venous thromboembolism (VTE), current management often relies on the intuition of treating physicians and guideline panels, an approach that remains opaque to outside observers. We present a decision-analytical framework adopted in our practice. This approach formalizes the intuition of physicians and guideline panels, providing an explicit and transparent integration of the best available evidence on benefits and harms. It also incorporates a systematic method for eliciting patient values and preferences to determine the optimal duration of anticoagulation. To demonstrate the practical utility of the decision-analytical approach, we apply it to 3 clinical scenarios: unprovoked VTE, VTE related to long-haul travel, and portal vein thrombosis in cirrhosis. By transparently synthesizing evidence and patient values, this method supports individualized, evidence-based, patient-centered recommendations for the duration of anticoagulation, and it is applicable to solving similar clinical problems in hematology and medicine.