Background: Evidence for guideline recommendations for the treatment of venous thromboembolism (VTE) during anticoagulant therapy is scarce. We aimed to observe and to describe the management of VTE occurring during anticoagulant therapy. Methods: This prospective multi-center, observational study included patients with objectively confirmed VTE during anticoagulant therapy (breakthrough event), with a follow-up of 3 months, after the breakthrough event. Results: We registered 121 patients with a breakthrough event, with a mean age of 56 years (range, 19 to 90); 61 were male (50%). Fifty-eight patients (48%) had an active malignancy. At the time of the breakthrough event, 57 patients (47%) were treated with a vitamin K antagonist (VKA), 53 patients (44%) with low-molecular-weight heparin (LMWH) and 11 patients (9%) with direct oral anticoagulants, unfractionated heparin, or VKA plus LMWH. A total of 21 patients (17%) were receiving a subtherapeutic dose of an anticoagulant. The main regimens to treat recurrence in patients on VKA were: switch to LMWH (33%), temporary double treatment with LMWH and VKA (23%), and VKA with a higher target INR (19%). In patients with a breakthrough on LMWH, the most frequently chosen regimen was a permanent dose increase (74%). During 3-month follow-up, 7% of patients had a second breakthrough event and 8% experienced major or clinically relevant non-major bleeding. Conclusion: There is wide variation in the management of VTE during anticoagulant treatment, reflecting a heterogeneous and complex clinical situation. Despite intensifying anticoagulation, the risk of a second breakthrough event in this population is 7%.

Additional Metadata
Keywords Anticoagulation, Breakthrough thrombotic events, Malignancy, Venous thrombo-embolism
Persistent URL dx.doi.org/10.1016/j.thromres.2020.01.010, hdl.handle.net/1765/124164
Journal Thrombosis Research: vascular obstruction, hemorrhage and hemostasis
Citation
van Es, J, Cheung, Y.W. (Y. W.), van Es, N, Klok, F.A, Dronkers, C.E.A. (C. E.A.), ten Wolde, M, … Middeldorp, S. (2020). Short-term prognosis of breakthrough venous thromboembolism in anticoagulated patients. Thrombosis Research: vascular obstruction, hemorrhage and hemostasis, 187, 125–130. doi:10.1016/j.thromres.2020.01.010