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Unprovoked VTE Duration — RACP Adult Medicine MCQ

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EasyHaematologyUnprovoked VTE DurationRACP Adult Medicine

A 55-year-old man with recently diagnosed PE on rivaroxaban asks about duration of anticoagulation. His PE was unprovoked (no identifiable risk factor). He has no bleeding risk factors. D-dimer is elevated after completing 3 months of anticoagulation. HERDOO2 score (if female) would not apply. What is the recommended duration?

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Correct answer: D — Extended (indefinite) anticoagulation

Unprovoked PE — extended (indefinite) anticoagulation is recommended (ESC 2019, CHEST 2024) as recurrence risk is ~10%/year after stopping. After 6 months of therapeutic dose, consider reduced-dose anticoagulation (rivaroxaban 10 mg daily or apixaban 2.5 mg BD — EINSTEIN CHOICE/AMPLIFY-EXT trials showed reduced recurrence without increased bleeding vs placebo). Positive D-dimer after stopping anticoagulation further supports continued treatment (DULCIS trial). Annual reassess risk-benefit.

Reference: ESC – 2019 – PE; CHEST 2024 VTE Duration; EINSTEIN CHOICE