Table 1.

Checklist of Important Management Decisions That Should Be Addressed after the Initial 3 Months of Anticoagulation Treatment

Essential Issues That Must Be Addressed
☐Assess if signs and symptoms of the recent VTE event have resolved.
☐Decide if anticoagulation therapy should be discontinued vs continued (see Table 2).
☐If continued, select the duration and the dose of the anticoagulant.
☐Educate the patient.
☐Address patient concerns, which likely include the risk of recurrent VTE, the risk of bleeding, indications for VTE prophylaxis in the future, and the benefits of direct oral anticoagulant (DOAC) agents vs warfarin.
☐Review signs and symptoms of recurrent VTE.
☐Inform the patient about the radiation risks associated with repeated chest CT scanning. Inform patients about the usefulness of D-dimer testing.
Ancillary Issues
☐Consider testing for antiphospholipid antibody syndrome if the results will affect future patient management.
☐Order the retrieval of an inferior vena cava filter (if the patient has a deployed retrievable filter).
☐Consider whether a work-up for an underlying malignancy needs to be undertaken or completed.
☐Consider re-imaging the affected venous segments (upper or proximal lower extremity compression ultrasound) if the index event was a DVT and consider obtaining a D-dimer to further prognosticate the risk of VTE recurrence.
☐For complex cases, is a formal thrombosis/anticoagulation consultation needed?
  • CT, computed tomography; DVT, deep vein thrombosis; VTE, venous thromboembolism.

  • *Table is based on recommendations from the authors.