How I treat recurrent venous thromboembolism in patients receiving anticoagulant therapy

Schulman, Sam

doi:10.1182/blood-2017-03-742304

Cited by 62Venous Thromboembolism Diagnosis and ManagementBlood Coagulation and Thrombosis MechanismsAtrial Fibrillation Management and Outcomes

How I treat recurrent venous thromboembolism in patients receiving anticoagulant therapy

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Schulman, Sam·2017·Blood

DOI 10.1182/blood-2017-03-742304

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Abstract

Oral anticoagulant therapy for venous thromboembolism is very effective. When oral anticoagulants are managed well, the risk of recurrence is approximately 2 per 100 patient-years. The main reasons for a breakthrough event are underlying disease and subtherapeutic drug levels. The most common underlying disease that results in recurrence on treatment is cancer. Subtherapeutic drug levels can be caused by poor adherence to the drug regimen, interactions with other drugs or food, or inappropriate dosing. It is important to investigate and understand the cause whenever such an event occurs and to improve management of anticoagulants thereby avoiding further recurrences. Here we present 4 illustrative cases together with a discussion of the underlying pathology. Whereas the mechanisms are usually quite well understood, the management of further anticoagulation after a breakthrough event is based on minimal or no clinical trial evidence.

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Frequent reasons associated with breakthrough thromboembolic events include the underlying condition or disease (eg, cancer, antiphospholipid syndrome, or vasculitis) or inappropriate selection and/or dosing of the anticoagulant (eg, noncompliance, drug-drug interactions, and drug-food interactions).
“Frequent reasons associated with breakthrough thromboembolic events include the underlying condition or disease (eg, cancer, antiphospholipid syndrome, or vasculitis) or inappropriate selection and/or dosing of the anticoagulant (eg, noncompliance, drug-drug interactions, and drug-food interactions). 322”
From American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism (2020) · cites this paper as [322]

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Recurrent venous thrombosis despite 'optimal anticoagulation therapy' for antiphospholipid syndrome--could new oral anticoagulants solve the problem?
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Sorted by citations

American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism
Ortel, T. L., Neumann, I., Ageno, W., Beyth, R., Clark, N. P., Cuker, A., Hutten, B. A., Jaff, M. R., Manja, V., Schulman, S., et al. (2020) · Blood Advances · doi:10.1182/bloodadvances.2020001830 · Cited by 1,489 · see citing works
“Frequent reasons associated with breakthrough thromboembolic events include the underlying condition or disease (eg, cancer, antiphospholipid syndrome, or vasculitis) or inappropriate selection and/or dosing of the anticoagulant (eg, noncompliance, drug-drug interactions, and drug-food interactions).(322) An initial a…”
BackgroundSelf-citation

Authors: Schulman, S.
Affiliations: Karolinska Institutet (SE)
Corresponding author: Schulman, Sam
ORCID: Schulman, Sam
Venue: Blood
Publisher: American Society of Hematology
Published: 2017-06-22
Volume: 129
Issue: 25
Pages: 3285-3293
ISSN: 0006-4971 (ISSN-L)
1528-0020
DOI: 10.1182/blood-2017-03-742304
OpenAlex: W2612885052
Cited by: 62
References: 76
Citations by year: 2026: 7 · 2025: 4 · 2024: 11 · 2023: 6 · 2022: 8 · 2021: 8 · 2020: 9 · 2019: 5 · 2018: 4
FWCI: 5.20
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Blood (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
Keywords: recurrent venous thromboembolism, oral anticoagulants, subtherapeutic drug levels, cancer-associated thrombosis, anticoagulation adherence, drug interactions, anticoagulation management, anticoagulant dosing
MeSH terms: Adult, Anticoagulants, Behcet Syndrome, Blood Coagulation, Female, Heparin, Low-Molecular-Weight, Humans, Male, Middle Aged, Neoplasms, Recurrence, Antiphospholipid Syndrome, Venous Thromboembolism, Secondary Prevention

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How I treat recurrent venous thromboembolism in patients receiving anticoagulant therapy

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