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VTE Treatment Duration — ABIM Board MCQ

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ModerateHematologyVTE Treatment DurationABIM Board

A 58-year-old man is seen after completing 3 months of apixaban for a first proximal (femoropopliteal) lower-extremity deep venous thrombosis. The event was unprovoked: there was no preceding surgery, trauma, hospitalization, immobilization, or estrogen use, and age-appropriate cancer screening is up to date with no evidence of malignancy. He has no prior bleeding events, no anemia or thrombocytopenia, no antiplatelet or NSAID use, and normal renal and hepatic function (creatinine clearance 95 mL/min). His estimated risk of anticoagulant-associated bleeding is low, and he tolerated therapy without difficulty. Leg symptoms have resolved. Which of the following is the most appropriate management of his anticoagulation?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Continue apixaban with no predefined stop date

Explanation lettering: D = shown as A · A = shown as B · E = shown as D · B = shown as E

C is correct. US guidance (ASH 2020) divides therapy into primary treatment (first 3–6 months) and secondary prevention thereafter; for VTE that is unprovoked or linked to a chronic risk factor, indefinite anticoagulation is preferred over stopping, provided bleeding risk is not high, with periodic reassessment of bleeding risk, tolerability and preferences. Fixed courses—A (3 months), B (6 months) and D (12 months)—apply chiefly to VTE provoked by a major transient risk factor; recurrence risk after unprovoked VTE (roughly 10% at 1 year, 30% at 5 years) resumes once anticoagulation stops, and no fixed duration reduces later recurrence. E is inferior: aspirin lowers recurrence only modestly compared with placebo and is substantially less effective than continued anticoagulation, without a clear bleeding advantage at reduced-dose DOAC regimens.

Reference: American College of Cardiology summary of the American Society of Hematology 2020 guidelines for management of VTE: treatment of DVT and PE — duration of anticoagulation (2020). https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2020/10/08/15/01/american-society-of-hematology-2020-guidelines