Recurrent Venous Thromboembolism

Venous thromboembolism (VIE) recurrence rates are three times higher in patients with chronic or no risk factors compared with those who have transient risk factors after stopping anticoagulation therapy. In patients with unprovoked VTE, age-appropriate screening is sufficient evaluation for occult malignancy. Thrombophilia evaluation should be considered only in selected patients because routine evaluation has not been shown to improve outcomes. Patients with VTE should receive three months of anticoagulation therapy. The context of the initial VTE, risk of bleeding and recurrence, and patient preference should be considered when determining whether to continue treatment beyond the initial three months. There is growing evidence regarding the use of risk assessment models to determine risk of recurrence, but this has not been incorporated into guidelines. All pregnant patients with a prior VTE should receive postpartum prophylaxis for six weeks. Antepartum prophylaxis should be used in pregnant people with a history of unprovoked or hormonally induced VTE. High-risk patients undergoing surgery may require extended VTE prophylaxis postoperatively. Copyright (C) 2022 American Academy of Family Physicians.

Automated summary

Venous thromboembolism (VTE) recurrence rates are higher in patients with chronic or no risk factors compared to those with transient risk factors after anticoagulation therapy. Age-appropriate screening is sufficient for evaluating occult malignancy in patients with unprovoked VTE. Routine thrombophilia evaluation has not shown improved outcomes and should be considered only in selected patients. A three-month course of anticoagulation therapy is recommended for VTE patients, with the decision to continue beyond three months based on the initial VTE context, bleeding and recurrence risk, and patient preference. Risk assessment models have shown promise for predicting recurrence risk but have not been incorporated into guidelines. Pregnant patients with a prior VTE should receive postpartum prophylaxis for six weeks, and antepartum prophylaxis is recommended for pregnant individuals with a history of unprovoked or hormonally induced VTE. High-risk surgical patients may require extended postoperative VTE prophylaxis. Copyright (C) 2022 American Academy of Family Physicians.