• Timothy M Fernandes, Manreet Kanwar, and Richard White.
• From the Division of Pulmonary and Critical Care Medicine, University of California, San Diego, San Diego (TMF); Cardiovascular Institute at Allegheny Health Network, Pittsburgh, PA (MK); and the Anticoagulation Service, UC Davis Health, Sacramento, CA (RW). tfernandes@ucsd.edu.
• J Am Board Fam Med. 2021 Mar 1; 34 (2): 409-419.

BackgroundVenous thromboembolism (VTE) is a common medical problem seen in primary care settings. The most common long-term adverse sequelae are recurrent thromboembolism and incomplete resolution of the embolic material, which may result in pulmonary hypertension after pulmonary embolism and post-thrombotic changes in the leg after deep vein thrombosis. Although there are detailed guidelines for diagnosing and treating acute VTE, there are few focused articles that provide recommendations for primary care physicians (PCPs) about how to manage VTE patients after completion of the initial period of anticoagulation treatment.ObservationsIn this article, we highlight several important clinical decisions that must be addressed after the first 3 months of anticoagulation treatment is complete, with a focus on particular management issues for PCPs.ConclusionsThe 2 most important decisions the PCP must make are to determine, first, if symptoms of acute VTE have indeed resolved, and second, if they have resolved, to assess the long-term risk of recurrent VTE versus the risk of potential bleeding and decide if anticoagulation should be stopped, or if indefinite anticoagulation treatment is indicated. Among higher-risk patients who may benefit from indefinite anticoagulation, the PCP should discuss both the risks and benefits of anticoagulation treatment, empowering the patient to actively participate in this important shared decision-making process.© Copyright 2021 by the American Board of Family Medicine.

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