ABSTRACT

Purpose: Limited evidence exists regarding managing recurrent venous thromboembolism (VTE) that occurs during ongoing anticoagulation therapy. We aimed to describe patient characteristics, drug therapy management, and outcomes of patients with VTE recurrence during ongoing anticoagulant therapy.

Methods: Adult patients admitted between January 2017 and December 2018 with a diagnosis of recurrent VTE during ongoing anticoagulant therapy were included. Manual medical record reviews were performed to summarize information on patient characteristics, recurrent VTE therapy, and associated outcomes.

Results: We identified 30 episodes of VTE recurrence. Mean age was 48.9 (15.9) years, 56.7% were male, and 93.3% were White. Common VTE risk factors included cancer (46.6%), recent surgery (33.3%), and prolonged immobility (30.0%). At the time of recurrent VTE, 40% were receiving enoxaparin, 30.0% warfarin, and 23.3% direct oral anticoagulants. Potential causes for VTE recurrence included indwelling catheters (40.0%), cancer (33.3%), subtherapeutic anticoagulation (26.7%), and nonadherence (23.3%). Recurrent VTE management strategies included switching anticoagulants (26.7%), increasing the anticoagulant dose (20.0%), temporarily adding enoxaparin or unfractionated heparin (13.3%), or no change in anticoagulation therapy (43.3%). Only 4 adverse 90-day outcome occurred among the 17 patients who received anticoagulant therapy changes in response to VTE recurrence, whereas 8 adverse outcomes occurred in the 13 patients who received no change in anticoagulation therapy in response to a recurrent VTE episode (P-value 0.035).

Conclusions: Regardless of the potential causes associated with recurrent VTE during anticoagulation therapy, switching anticoagulants, temporarily adding injectable anticoagulants, or increasing anticoagulant intensity appears to be preferable to continuing current anticoagulant therapy unchanged.