How would you manage someone with antithrombin deficiency who has recurrent VTE on a DOAC?

There are no large scale controlled studies demonstrating outcomes of use of oral direct-acting anticoagulants (DOACs) in patients with hereditary thrombophilia. One can find published case reports demonstrating success, but the 'failures' likely do not get published. The general approach would be t...

I would consider Coumadin or an alternative NOAC.

Repeat eval to make sure there is not a second gene defect. Also consider antithrombin III prophylaxis.