How would you manage a patient with PV or ET who is experiencing breakthrough thrombosis?

The first question I would ask in this clinical situation is, "does the patient have PV or ET?"; a patient cannot have both. Unfortunately, I encounter this situation too often in my clinical practice. There appears to be a curious but dangerous belief in the medical community that ET is a more sero...

Regardless of the underlying condition, such as either ET or PV in this example, my approach is similar to that described by Dr. Sam Schulman in this excellent review in the Blood "How I Treat Series" on recurrent VTE.

The primary question I think of is, "Why did prophylaxis fail and can I use this i...