The management of recurrent VTE in cancer patients receiving therapeutic anticoagulation: the use of dual anticoagulant therapy combined with an IVC filter.

Recurrent venous thromboembolism (VTE) occurs frequently in cancer patients, yet there is little published literature to guide clinicians in the management of these patients who are already receiving therapeutic anticoagulation. We report two patients with progressive solid malignancies who presented with recurrent VTE despite therapeutic anticoagulation with once-daily dalteparin. We describe how a novel aggressive strategy using a combination of therapeutic dalteparin twice daily and a vitamin K antagonist (warfarin) prevented further VTE.