10.1177/0897190004272571WITTKOWSKYAN IC AGULATION IN HYPERCOAGULABLE CONDITIONS Anticoagulation in Hypercoagulable Conditions: Special Considerations in the Treatment and

Patients with hypercoagulable conditions, including malig-nancy, are at increased risk of recurrent venous thrombo-embolic events (VTE). The general approach to treatment and prevention of VTE in patients with thrombophilia is sim-ilar to that of patients who present with VTE associated with transient risk factors, including immobility, trauma, and sur-gery. However, several important issues must be considered in the initialmanagement of acute VTE, in the long-termpre-vention ofVTE following an initial event, and inVTEprophy-laxis in patients with hypercoagulable conditions. Patients with antithrombin deficiency are prone to heparin resistance and may require concurrent antithrombin concentrates or anticoagulation with direct thrombin inhibitors for adequate treatment of acute VTE. In patients with malignancy, low-molecular-weight heparins have been found to bemore effec