Recurrent VTE During Anticoagulation: Diagnosis, Systematic Evaluation, and Management.

Although the incidenceof breakthrough events under adequate anticoagulant therapy is relatively low, their occurrence is associated with increased short-term mortality, heightened bleeding risk related to treatment escalation, and long-term morbidity.

尽管在充分的抗凝治疗下突破性事件的发生率相对较低，但它们的发生与短期死亡率增加、与治疗升级相关的出血风险增加以及长期发病率有关。

Accurate diagnosis is critical and should rely on careful comparison with prior imaging studies.

准确的诊断至关重要，应依赖于与先前影像学研究的仔细比较。

Residual thrombosis and early clot propagation are relatively frequent findings during follow-up and may mimic true recurrence, leading to potential misclassification.

随访期间，残余血栓和早期血栓扩展是相对常见的发现，可能会模仿真正的复发，导致潜在的误分类。

Management of recurrent VTE during anticoagulation is largely informed by observational studies, guideline recommendations, and expert consensus, as robust randomized trial data are lacking.

在抗凝治疗期间复发性静脉血栓栓塞症（VTE）的管理主要基于观察性研究、指南建议和专家共识，因为缺乏强有力的随机试验数据。

A structured approach is essential and should begin with confirmation of adherence, appropriate dosing, drug-drug interactions, and possible absorption issues.

结构化的方法至关重要，应从确认患者依从性、适当的剂量、药物相互作用以及可能的吸收问题开始。

Targeted evaluation for underlying prothrombotic conditions, including malignancy and antiphospholipid syndrome, is recommended.

建议对潜在的促血栓形成状况进行针对性评估，包括恶性肿瘤和抗磷脂综合征。

Low-molecular-weight heparin remains central to acute management, although supporting evidence is limited.

尽管支持证据有限，低分子量肝素仍然是急性管理的核心。

Special populations require individualized strategies balancing thrombotic and bleeding risks.

特殊人群需要个体化的策略，以平衡血栓形成和出血风险。

Routine use of inferior vena cava filters should be avoided, and intensified anticoagulation should generally be time-limited with planned reassessment.

应避免常规使用下腔静脉滤器，并且通常应限制强化抗凝治疗的时间，并计划进行重新评估。

Significant gaps remain in the evidence base.

证据基础中仍存在显著的空白。

Prospective registries and well-designed randomized trials are needed to refine diagnostic criteria, clarify mechanisms of anticoagulant failure, and define optimal management strategies in this high-risk population.

需要前瞻性登记和设计良好的随机试验来完善诊断标准，阐明抗凝剂失败的机制，并为这一高风险人群定义最佳的管理策略。