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). Other treatment factors that are associated with recurrent VTE and will suggest speci c approaches to management include: (1) was LMWH being used; (2) was the patient adherent; (3) was VKA subtherapeutic; (4) was anticoagulant therapy prescribed correctly; (5) was the patient taking an NOAC and a drug that reduced anticoagulant effect; and (6) had anticoagulant dose been reduced (drugs other than VKA)? There is moderate-quality evidence that LMWH is more effective than VKA therapy in patients with VTE and cancer. A switch to full-dose LMWH, therefore, is often made if there has been an unexplained recurrent VTE on VKA therapy or an NOAC. If the recurrence happened on LMWH, the dose of LMWH can be increased. If the dose of LMWH was previously reduced (eg, by 25% after 1 month of treatment), it is usually increased to the previous level. If the patient was receiving full-dose LMWH, the dose may be increased by about 25%. In practice, the increase in dose is often in uenced by the LMWH pre lled syringe dose options that are available. Once-daily LMWH may also be switched to a twice- daily regimen, particularly if two injections are required to deliver the increase in LMWH dose. 