Why the study?
Suspected recurrent VTE during anticoagulant therapy is a common clinical challenge complicated by residual prior thrombosis, non-compliance, and controversial short-term management of therapeutic failures.
For recurrent VTE on anticoagulant therapy, diagnosis requires comparing current and past imaging, and management of true therapeutic failure is best supported by full-dose or escalated-dose LMWH.
Suspected recurrent venous thromboembolism (VTE) is a common and vexing clinical problem. Confounding the diagnosis of recurrent VTE is a high frequency of residual VTE from prior VTE. The diagnosis of recurrent VTE must be established by comparing current imaging with past imaging to distinguish acute from chronic thrombosis. Next, we must ascertain if non-compliance was the cause of "apparent therapeutic failure" and if non-compliance is at play then re-initiate anticoagulant therapy. Therapeutic failure is relatively uncommon. As such, we must consider underlying causes of therapeutic failures including malignancy and potent thrombophilias. Finally, short term anticoagulant management of therapeutic failures is controversial, and requires further research, but the best current evidence supports a course of full-dose low-molecular-weight heparin (LMWH) (and dose escalated LMWH if failure occurs while on full-dose LMWH).
No takes yet. Share an insight, caveat, or question.
Rodger et al. (2019) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: