Recurrent Venous Thromboembolism: What Is the Risk and How to Prevent It

Table 4

Suggested management of anticoagulation (AC) for secondary prophylaxis in patients with VTE (DVT and/or PE).

Clinical condition	Management
Secondary* isolated distal DVT	6 weeks AC^#
Unprovoked isolated distal DVT	3 months AC
Secondary proximal DVT and/or PE	3–6 months AC
Unprovoked first proximal DVT and/or PE	3–6 months AC, then stratify for individual risk of recurrence
Life-threatening PE as index event	Consider extended^£ AC
VTE associated to active cancer	AC until cancer is no longer active
Unprovoked VTE associated with antiphospholipid syndrome	Consider extended AC
Unprovoked VTE associated with antithrombin, deficiency	Extended AC
Unprovoked VTE associated with other major thrombophilic alteration (protein C or S deficiency, homozygous factor V Leiden or G20210A prothrombin mutation or double heterozygous)	Consider extended AC
Second unprovoked VTE	Extended AC
Third VTE	Extended AC

∗Secondary when associated with one of the following triggering factors: major surgery, serious trauma, immobilization, bed resting for >4 days, pregnancy, and puerperium.
#Consider treatment with LMWH.
£Extended: a continueous anticoagulation without a scheduled stop date, but with periodic reassessments to verify that the patient’s bleeding risk is not increased and his preference is not changed.