In patients with acute upper extremity DVT (UEDVT) that involves the axillary or more proximal veins, we suggest anticoagulant therapy alone over thrombolysis (Grade 2C). Remarks: Patients who (i) are most likely to bene t from thrombolysis (see text); (ii) have access to CDT; (iii) attach a high value to prevention of PTS; and (iv) attach a lower value to the initial complexity, cost, and risk of bleeding with thrombolytic therapy are likely to choose thrombolytic therapy over anticoagulation alone. 28. In patients with UEDVT who undergo thrombolysis, we recommend the same intensity and duration of anticoagulant therapy as in patients with UEDVT who do not undergo thrombolysis (Grade 1B). Management of Recurrent VTE on Anticoagulant Therapy Summary of Evidence There are no randomized trials or prospective cohort studies that have evaluated management of patients with recurrent VTE on anticoagulant therapy. Consequently, management is based on low-quality evidence and an assessment of the probable reason for the recurrence. Risk factors for recurrent VTE while on anticoagulant therapy can be divided into two broad categories: (1) treatment factors and (2) the patient s intrinsic risk of recurrence. How a new event should be treated will depend on the reason(s) for recurrence. Treatment Factors: The risk of recurrent VTE decreases rapidly after starting anticoagulant therapy, with a much higher risk during the rst week (or month) compared with the second week (or month).169,170 A recurrence soon after starting therapy can generally be managed by a time-limited (eg, 1 month) period of more aggressive anticoagulant intensity (eg, switching from an oral agent back to LMWH, an increase in LMWH dose). 