Tom Nolan’s research reviews—6 July 2023

Anticoagulants for life?People with an unprovoked venous thromboembolism often continue taking anticoagulants for their whole lives. A 2020 NICE guideline made a carefully worded recommendation to “consider continuing anticoagulation beyond three months after an unprovoked deep vein thrombosis (VTE) or pulmonary embolism,” to base this on a balance between the risk of VTE recurrence and the risk of bleeding, and to take the patient’s preferences into account. A new modelling study shows how finely balanced the decision is: continuing treatment indefinitely after initial anticoagulation in a hypothetical group of 1000 people aged 55 would prevent 14 fatal pulmonary emboli, the model predicted. However, 11 of the 1000 would die from bleeding as a result of anticoagulation, and the cost to the Canadian health system, where the model was set, was over Can$16 000 per person, with no gain in quality adjusted life years (QALYs).Ann Intern Med doi:10.7326/M22-3559Once weekly insulin goes…
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