Thrombophilia: How To Test? How To Manage?

By Julie Hambleton, MD

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Treatment of Thrombotic Disorders

Once acute VTE disease is confirmed, therapy is initiated with an immediate-acting agent, such as heparin. The patient then transitions to warfarin therapy for a duration of 3 to 6 months.^8,9 Recent studies evaluating the recurrence rate after a longer duration of therapy, such as 1 or 2 years, demonstrate similar recurrence rates once anticoagulant therapy is stopped.^10,11 The risk of recurrent VTE after a treated, unprovoked event is 10 to 25% for the first 2 years after therapy is stopped. The yearly risk appears to decrease thereafter. Patients who have DVT after surgery, trauma, or another clearly predisposing event have a much lower risk for recurrence after anticoagulant treatment is stopped. Patients who experience recurrent episodes of VTE, regardless of whether they have an identifiable underlying thrombophilic defect or not, generally receive lifelong therapy. Nonetheless, the potential benefits of prolonged warfarin therapy must be balanced against the risks of major hemorrhage, estimated to be 2 to 3% per year.⁸

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