Management of suspected and confirmed recurrent venous thrombosis while on anticoagulant therapy. What next?

Marc A Rodger; Sebastien Miranda; Aurelien Delluc; Marc Carrier

doi:10.1016/j.thromres.2019.06.017

Management of suspected and confirmed recurrent venous thrombosis while on anticoagulant therapy. What next?

Thromb Res. 2019 Aug:180:105-109. doi: 10.1016/j.thromres.2019.06.017. Epub 2019 Jun 26.

Authors

Marc A Rodger¹, Sebastien Miranda², Aurelien Delluc², Marc Carrier²

Affiliations

¹ Hematology, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. Electronic address: mrodger@ohri.ca.
² Hematology, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.

PMID: 31279158
DOI: 10.1016/j.thromres.2019.06.017

Abstract

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).

Keywords: Anticoagulant; Diagnosis; Treatment; Venous thromboembolism.

Publication types

Review

MeSH terms

Acute Disease
Anticoagulants / therapeutic use*
Chronic Disease
Heparin, Low-Molecular-Weight / therapeutic use*
Humans
Recurrence
Secondary Prevention / methods*
Venous Thromboembolism / diagnosis*
Venous Thromboembolism / drug therapy*
Venous Thromboembolism / prevention & control

Substances

Anticoagulants
Heparin, Low-Molecular-Weight