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Unprovoked VTE Duration — RACP Adult Medicine MCQ

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ModerateHaematologyUnprovoked VTE DurationRACP Adult Medicine

A 60-year-old man with a recent PE is being assessed for provocation. He has no clear reversible provoking factor (no surgery, immobilisation, or travel). D-dimer remains elevated at 0.8 mg/L 4 weeks after completing 3 months of anticoagulation. What does this suggest about his risk of recurrence?

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Correct answer: D — Elevated D-dimer post-anticoagulation cessation suggests high recurrence risk

Persistently elevated D-dimer after completing anticoagulation for unprovoked VTE is associated with a significantly higher risk of recurrence (2–3 fold). The PROLONG trial demonstrated that continuing anticoagulation in patients with elevated D-dimer reduced recurrence. Combined with the unprovoked nature, extended (potentially indefinite) anticoagulation should be strongly considered, balancing against bleeding risk. Men with unprovoked VTE generally have higher recurrence risk than women.

Reference: eTG – 2025 – Haematology; ISTH – 2023 – VTE Duration Guidance