In unprovoked VTE, can DOAC therapy be extended beyond 3 months if bleeding risk is low to moderate?

• A. No
• B. Yes
• C. Only with warfarin
• D. Only after 5 years

Answer: (B)

In unprovoked VTE, the risk of recurrence remains substantial after stopping therapy. If the bleeding risk is low to moderate, continuing anticoagulation beyond the initial 3 months is favored because it markedly lowers the chance of another clot, and DOACs offer a favorable balance of efficacy and safety compared with warfarin. DOACs provide strong protection against recurrence without the need for regular INR monitoring and generally have a lower risk of intracranial bleeding. Guidelines and trials support ongoing DOAC therapy beyond 3 months in patients with low to moderate bleeding risk, including extended or even indefinite treatment for some. There’s no requirement to switch to warfarin or to wait a fixed lengthy period like 5 years.