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.