Abstract
The most effective therapy in preventing venous thromboembolism recurrence is anticoagulation. However, it is associated with the risk of bleeding.
The extension of anticoagulation beyond 3, 6 or 12 months to indefinite duration or even lifelong should be considered in the patients with high risk of recurrence provided they do not have high risk of bleeding. The highest risk of recurrence has been demonstrated in unprovoked venous thromboembolism.
In provoked events the risk is variable, depending on the character of a risk factor - major or minor, permanent or transient. There is a choice of anticoagulant drugs for secondary prevention of venous thromboembolism - warfarin or novel (direct) oral anticoagulants, in full or reduced doses.
Acetylsalicylic acid has proven a modest effect in this indication, and sulodexid reduced recurrence rate in the patients with deep vein thrombosis in one study. The importance of patient's education and shared decision making is emphasized in the guidelines as well as the need of regular re-evaluation of treatment benefits.