Extended anticoagulation in provoked VTE with persistent risk factors: A meta-analysis of randomised trials

Mohsin Raj Mantoo; Saadat Raj Mantoo; Mir Wajid Majeed; Anushka Kulkarni; Haziq Parveez Lone; Mazin Mansoor; Ambuj Roy

doi:10.2478/rjc-2026-0014

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Extended anticoagulation in provoked VTE with persistent risk factors: A meta-analysis of randomised trials

Romanian Journal of Cardiology

AHEAD OF PRINT

By: Mohsin Raj Mantoo, Saadat Raj Mantoo, Mir Wajid Majeed, Anushka Kulkarni, Haziq Parveez Lone, Mazin Mansoor and Ambuj Roy

Open Access

|Jun 2026

Abstract

Background

Patients with venous thromboembolism (VTE) triggered by transient factors are typically treated with anticoagulants for 3–6 months. However, those with coexisting long-term non-malignant conditions may continue to carry a meaningful risk of recurrence beyond the initial treatment period. The benefit of extended anticoagulation in this subgroup remains uncertain.

Objectives

To evaluate the efficacy and safety of continued and reduced-dose direct oral anticoagulant (DOAC) therapy compared with no extended anticoagulation or aspirin in patients with provoked VTE and persistent non-malignant risk factors.

Methods

We performed a systematic review and meta-analysis of randomised controlled trials in accordance with PRISMA guidelines. MEDLINE, Embase and CENTRAL were searched from inception through 15 October 2025. Eligible trials enrolled adults with provoked VTE and persistent non-malignant risk factors who had completed initial anticoagulation and compared extended DOAC therapy with placebo, aspirin or discontinuation. Primary outcomes were recurrent VTE and major bleeding. Risk ratios (RRs) were pooled using random-effects models, with fixed-effects analyses as sensitivity.

Results

Three trials, including 2498 participants, were analysed. Continued DOAC therapy was associated with a lower incidence of recurrent VTE compared with placebo or aspirin (RR 0.25, 95% confidence interval [CI] 0.07–0.98; I² 34%). Reduced-dose regimens demonstrated comparable effectiveness (RR 0.21, 95% CI 0.11–0.41). Major bleeding events were infrequent across all groups, and no clear excess risk was observed with extended therapy (RR 2.38, 95% CI 0.87–6.53; I² 0%).

Conclusion

Among patients with provoked VTE and ongoing non-malignant risk factors, extended DOAC therapy appears to reduce recurrence without a definite increase in major bleeding. These findings support a more individualised approach to treatment duration in this intermediate-risk population.

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Articles in this issue

DOI: https://doi.org/10.2478/rjc-2026-0014 | Journal eISSN: 2734-6382 | Journal ISSN: 1220-658X

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Language: English

Published on: Jun 1, 2026

Published by: Romanian Society of Cardiology

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

venous thromboembolism,

direct oral anticoagulants,

persistent risk factors,

secondary prevention,

Related subjects:

Surgery,

Pediatrics and juvenile medicine,

Paediatric cardiology

© 2026 Mohsin Raj Mantoo, Saadat Raj Mantoo, Mir Wajid Majeed, Anushka Kulkarni, Haziq Parveez Lone, Mazin Mansoor, Ambuj Roy, published by Romanian Society of Cardiology
This work is licensed under the Creative Commons Attribution 4.0 License.

AHEAD OF PRINT