Early diagnosis of anticoagulation failure: can recurrent pulmonary embolism be prevented?

Propagating thrombosis, occurring in spite of full anticoagulation, is an early indication of the failure of anticoagulation therapy. Its detection can be successfully accomplished by routinely monitoring all heparinized patients with serial fibrinogen uptake tests or serial Doppler ultrasound venous flow evaluation in selected lower extremity veins. If anticoagulation therapy failure is detected, it should be corrected immediately. In already fully anticoagulated patients who nevertheless develop propagating thrombosis, inferior vena cava interruption should be performed before potentially lethal pulmonary embolism occurs.