[Diagnosis of recurrent venous thromboembolism]

A correct diagnosis of recurrent venous thromboembolism (VTE) is essential as patients diagnosed with a recurrence are mostly treated with lifelong anticoagulant treatment. However, the diagnosis of recurrent VTE is complex as routine diagnostic tests for suspected VTE are less accurate in patients without a prior VTE. Clinical decision rules (CDR) and D-dimer tests have a lower specificity in suspected recurrent VTE, leading to an increase in required diagnostic imaging tests. In contrast to suspected recurrent pulmonary embolism (PE), the safety of a CDR and D-dimer test in excluding recurrent deep vein thrombosis (DVT) is debated. A CDR in combination with D-dimer testing followed by computed tomography pulmonary angiography is the preferred diagnostic management for suspected recurrent PE. In suspected recurrent DVT, compression ultrasonography is the imaging technique of choice and in case of a suspected recurrent ipsilateral DVT and an inconclusive ultrasonography, magnetic resonance direct thrombus imaging is decisive.