Correct!
2. More important than screening for a hypercoaguable state is evaluating whether the VTE event was provoked or unprovoked.

In a review of the topic published in 2010, Dalen (4) points out than with the exception of anti-phospholipid antibody syndrome the majority of thrombophilic states including factor V Leiden and the prothrombin gene mutation do not significantly raise the risk of a second VTE event. Dalen points out that routine thrombophilic work-up following an initial VTE event is unlikely to confer a clinical benefit. An idiopathic or unprovoked VTE event is more important than the heritable states assigning risk. Baglin and colleagues (5) found that the two-year rate of recurrence of an idiopathic VTE event was 19.4%. For additional risk stratification, a post event d-dimer may be more important in risk stratification. Palareti and colleagues (6) found that after completing three months of conventional anticoagulation, patients with a persistently abnormal D-dimer had a one-year recurrence rate of 10%.

References

  1. Tatco VR, Piedad HH. The validity of hyperdense lumen sign in non-contrast chest CT scans in the detection of pulmonary thromboembolism. Int J Cardiovasc Imaging. 2011;27(3):433-40. [CrossRef] [PubMed] 
  2. Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e419S-94S. [CrossRef] [PubMed]
  3. Meyer G, Vicaut E, Danays T, et al. Fibrinolysis for patients with intermediate-risk pulmonary embolism. N Engl J Med. 2014;370(15):1402-11. [CrossRef] [PubMed]
  4. Dalen JE. Should patients with venous thromboembolism be screened for thrombophilia? Am J Med. 2008;121(6):458-63. [CrossRef] [PubMed] 
  5. Baglin T, Luddington R, Brown K, Baglin C. Incidence of recurrent venous thromboembolism in relation to clinical and thrombophilic risk factors: prospective cohort study. Lancet. 2003;362(9383):523-6. [CrossRef]  [PubMed]
  6. Palareti G, Cosmi B, Legnani C, et al. D-dimer testing to determine the duration of anticoagulation therapy. N Engl J Med. 2006;355(17):1780-9. [CrossRef] [PubMed]

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