Recurrent VTE
Of the 21 patients, 16 (76%) were followed for 5 years or more since the time of index VTE. Of the 5 patients who were not followed for at least 5 years, 3 were transitioned to adult care and 2 were lost to follow-up. Among the 16 patients with long-term follow-up data, there were no documented recurrences at 1-year follow-up after the index VTE, but 2 patients (13%) had recurrent thrombosis by 5-year follow-up after the index VTE, neither CVC-related. One of these 2 patients with recurrent VTE had PE on initial presentation and recurrent PE 13 months later while on prophylactic LMWH. Additional thrombotic risk factors in this patient were systemic lupus erythematosus (SLE) and antiphospholipid antibody syndrome (APLAS). This patient had a previous history of pulmonary hemorrhage secondary to capillaritis in the setting of SLE, and she was kept on prophylactic dose of LMWH rather than the recommended therapeutic dosage for APLAS to prevent recurrent pulmonary hemorrhage. The other patient with recurrent VTE had CSVT on initial presentation and presented with PE in the setting of brachial vein thrombosis 4 years and 3 months after the index VTE. Additional thrombotic risk factor in this patient was protein C deficiency confirmed by genetic testing and managed on warfarin (goal INR of 2.0-3.0) prior to the recurrent VTE. At the time of recurrent VTE, he was admitted to the hospital for a hip surgery. Prior to the procedure, he was bridged from warfarin to LMWH, which was held for 24 hours before and after the surgery. He was on a therapeutic dose, confirmed by anti-Xa levels, at the time of PE.