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Recurrent venous thromboembolism: diagnosis and management
1Department of General Internal Medicine, Leiden University Medical Center, The Netherlands. m.v.huisman@lumc.nl
Current Opinion in Pulmonary Medicine
|July 27, 2000
Summary
Recurrent venous thromboembolism (VTE) diagnosis requires objective testing, as many first-time events are misdiagnosed. Prolonged anticoagulant treatment should be guided by bleeding risk, not solely by genetic mutations.
Area of Science:
- Cardiology
- Hematology
- Diagnostic Imaging
Background:
- Recurrent venous thromboembolism (VTE) is often suspected but infrequently confirmed objectively.
- Misdiagnosis of thrombophilia can lead to unnecessary, prolonged anticoagulant therapy.
Purpose of the Study:
- To review diagnostic strategies for suspected recurrent VTE.
- To clarify treatment duration and the role of genetic mutations in recurrent VTE risk.
Main Methods:
- Compression ultrasonography for suspected recurrent deep vein thrombosis.
- Ventilation/perfusion lung-imaging and pulmonary angiography for suspected recurrent pulmonary embolism.
- Review of current evidence regarding D-dimer testing and genetic mutations (Factor V Leiden, prothrombin G20210A) in recurrent VTE.
Main Results:
- Objective testing is crucial to avoid misdiagnosing thrombophilia.
- Compression ultrasonography is preferred for venous thrombosis; V/Q scans and angiography for pulmonary embolism.
- Evidence is insufficient for D-dimer utility in thrombophilia diagnosis; Factor V Leiden and prothrombin mutations do not appear to increase recurrent VTE risk.
Conclusions:
- Accurate diagnosis of recurrent VTE relies on appropriate objective testing.
- Anticoagulant therapy duration should exceed six months, individualized by bleeding risk.
- Current evidence does not support increased recurrent VTE risk associated with Factor V Leiden or prothrombin mutations.