{"id":3876,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/durationofanticoagulanttherapy\/"},"modified":"2026-04-20T08:43:41","modified_gmt":"2026-04-20T07:43:41","slug":"durationofanticoagulanttherapy","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/haematology\/anticoagulation\/durationofanticoagulanttherapy\/","title":{"rendered":"Duration of anticoagulant therapy"},"content":{"rendered":"\n<p><strong>Please note <\/strong><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/MEMO-re-HAEMATOLOGY-TESTS-clinically-important-information-9-Dec-2021.pdf\"><strong>changes in coagulation testing<\/strong><\/a><strong> \u2013 in particular that there can be occasional spuriously&nbsp;high INR readings in patients with&nbsp;antiphospholipid syndrome.&nbsp;<\/strong><\/p>\n\n\n\n<p>Many patients will not need referral following a DVT or PE: please see \u2018Who not to refer\u2019 for details of anticoagulation duration in uncomplicated cases.<\/p>\n\n\n\n<p>Management of patients with pulmonary embolism should be discussed with Respiratory Medicine to determine the need for assessment re thromboembolic pulmonary hypertension.<\/p>\n\n\n\n<p>In cases of single massive PE or extensive proximal DVT extending into the pelvis (especially if unprovoked), discuss with the hospital physician managing the patient, or consider referral to Haematology <strong><em>before<\/em><\/strong> discontinuing anticoagulation.<\/p>\n\n\n\n<p>Cancer-related thrombosis: anticoagulation must be continued in liaison with the patient\u2019s oncologist whilst active cancer is present.<\/p>\n\n\n\n<p><strong>C.M &amp; L.W 31-07-23<\/strong><\/p>\n\n\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patients with a significant contraindication indication to anticoagulation.<\/li>\n\n\n\n<li>Patients with persistent sub- or supra-therapeutic INR, except when due to poor compliance or alcohol abuse.<\/li>\n\n\n\n<li>Patients with major haemorrhage on anticoagulation.<\/li>\n\n\n\n<li>Patients with DVT\/PE where there is clinical doubt about duration of anticoagulation after consulting guidelines documented below, and\/or the hospital physician with primary responsibility for the patient<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Calf DVT \u2013 anticoagulate for&nbsp;<strong>at least<\/strong>&nbsp;6 weeks<\/li>\n\n\n\n<li>Single provoked DVT\/PE \u2013 anticoagulate for&nbsp;<strong>at least<\/strong>&nbsp;3 months<\/li>\n\n\n\n<li>Spontaneous or provoked DVT\/PE \u2013 anticoagulate for&nbsp;<strong>at least<\/strong>&nbsp;6 months<\/li>\n\n\n\n<li>Two spontaneous or unprovoked DVT\/PE: anticoagulate long-term<\/li>\n<\/ul>\n\n\n\n<p><strong>All patients should be evaluated for continuing clinical risk factors before stopping anticoagulation<\/strong><\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>How to refer<\/strong>:<\/h4>\n\n\n\n<p>SCI Gateway to Department of Haematology RIE or SJH.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Please note changes in coagulation testing &ndash; in particular that there can be occasional spuriously&nbsp;high INR readings in patients with&nbsp;antiphospholipid syndrome.&nbsp; Many patients will not need referral following a DVT or PE: please see &lsquo;Who not to refer&rsquo; for details of anticoagulation duration in uncomplicated cases. Management of patients with pulmonary embolism should be discussed<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":15981,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[255],"class_list":["post-3876","page","type-page","status-publish","hentry","category-durationofanticoagulanttherapy"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/haematology\/coagulopathy\/durationofanticoagulanttherapy\/\" rel=\"tag\">Duration of Anticoagulant Therapy<\/a>","rttpg_excerpt":"Please note changes in coagulation testing &ndash; in particular that there can be occasional spuriously&nbsp;high INR readings in patients with&nbsp;antiphospholipid syndrome.&nbsp; Many patients will not need referral following a DVT or PE: please see &lsquo;Who not to refer&rsquo; for details of anticoagulation duration in uncomplicated cases. Management of patients with pulmonary embolism should be discussed","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3876","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3876"}],"version-history":[{"count":9,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3876\/revisions"}],"predecessor-version":[{"id":27685,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3876\/revisions\/27685"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/15981"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3876"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3876"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}