Epidemiology of venous thromboembolism: implications for clinical practice.

Venous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common disorder with annual incident rates of 150 (95% confidence interval (CI) 131-169) / 100 000 (VTE), 90 (95% CI 72-109) / 100 000 (DVT) and 67 (95% CI 54-80) / 100 000 (PE), respectively in Western countries. Of note, reported VTE incidences are approximately 7-fold lower in East Asia. VTE incidence increases with age and is comparable between sexes, although men exhibit a higher risk of recurrence.

Real life application of the ESMO Guidelines for the prevention and treatment of cancer associated thrombosis: challenges and perspectives.

Cancer-associated thrombosis (CAT) is the second leading cause of death in cancer patients, significantly affecting quality of life, survival, and healthcare costs. This review summarizes key recommendations from the 2023 ESMO guidelines on CAT prevention and treatment, illustrated by a real-world case, and examines barriers to implementation. CAT risk is multifactorial, shaped by tumor-related factors (type, stage, time since diagnosis), treatment exposures (anticancer agents, surgery, central venous catheters), and comorbidities, captured by the "4TS" rule.

Venous thromboembolism in pregnancy: recent advances.

Venous thromboembolism (VTE) is notably more common in pregnancy, with at least a 5‑fold higher risk than in nonpregnant women, and an even greater surge postpartum. Pregnancy induces a hypercoagulable state with venous stasis and vascular changes, making VTE a leading cause of maternal morbidity and mortality, particularly in the postpartum period. Clinical presentation is often subtle or nonspecific, highlighting the need for objective diagnostic strategies adapted to pregnancy.

A comparison of the effects of direct oral anticoagulants versus vitamin K antagonists and antiplatelet agents on the timing and outcomes of hip fracture surgery in patients older than 65 years: the ORTHO-GER-DOAC study.

Introduction: The use of direct oral anticoagulants (DOACs) may delay surgery in older hip fracture patients.

Aim: To assess whether preoperative DOAC activity measurement enables surgery within 48 h in hip fracture patients at a similar prevalence compared to patients receiving other antithrombotics or no antithrombotics.

Methods: A retrospective observational cohort study of hip fracture patients older than 65 years admitted to three Orthogeriatrics units in Italy from 2015 to 2022 was conducted.

Semi-empirical Anticoagulation Model (SAM): Dose prediction during warfarin therapy.

Management of oral anticoagulant therapy is essential to ensure a good quality of life for patients. To assist clinicians, several computerized dosing algorithms were developed to determine optimal anticoagulant doses. However, these algorithms have several limitations that can lead to inaccuracies in dosing recommendations.

Transitioning between therapeutic anticoagulants: a clinicians guide to switching patients to or from DOAC therapy.

Introduction: The transition to or from direct oral anticoagulants (DOACs) is common in clinical practice.

Areas Covered: A literature search was conducted on PubMed, Google Scholar, and UpToDate up to March 2024 for conditions and approaches for transitioning from one agent to the other. No randomized clinical trials were retrieved except for two studies regarding switching to DOAC in well-conducted vitamin K antagonist (VKA) therapy.

Padua Prediction Score and Hospital-Acquired Proximal and Isolated Distal Deep Vein Thrombosis in Symptomatic Patients.

Background: Hospital-acquired deep vein thrombosis (DVT) is an important cause of morbidity and mortality.

Objectives: The purpose of this study was to evaluate the prevalence of proximal lower limb DVT and isolated distal DVT (IDDVT) and their relationship to the Padua Prediction Score (PPS) in acutely ill, hospitalized patients.

Methods: In a single-center cross-sectional study, all inpatients from medical departments with suspected lower-extremity DVT were evaluated with whole-leg ultrasonography during 183 days from 2016 to 2017.

Risk assessment tools for bleeding in patients with unprovoked venous thromboembolism: an analysis of the PLATO-VTE study.

Background: Guidelines suggest indefinite anticoagulation after unprovoked venous thromboembolism (VTE) unless the bleeding risk is high, yet there is no consistent guidance on assessing bleeding risk.

Objectives: This study aimed to evaluate the performance of 5 bleeding risk tools (RIETE, VTE-BLEED, CHAP, VTE-PREDICT, and ABC-Bleeding).

Methods: PLATO-VTE, a prospective cohort study, included patients aged ≥40 years with a first unprovoked VTE.

Enhancing stroke risk prediction in patients with transient ischemic attack: insights from a prospective cohort study implementing fast-track care.

Background And Aims: Fast-track care have been proved to reduce the short-term risk of stroke after transient ischemic attack (TIA). We aimed to investigate stroke risk and to characterize short- and long-term stroke predictors in a large cohort of TIA patients undergoing fast-track management.

Methods: Prospective study, enrolling consecutive TIA patients admitted to a Northern Italy emergency department from August 2010 to December 2017.

Gynecological Cancer and Venous Thromboembolism: A Narrative Review to Increase Awareness and Improve Risk Assessment and Prevention.

The prevention and appropriate management of venous thromboembolism in cancer patients is of paramount importance. However, the literature data report an underestimation of this major problem in patients with gynecological cancers, with an inconsistent venous thromboembolism risk assessment and prophylaxis in this patient setting. This narrative review provides a comprehensive overview of the available evidence regarding the management of venous thromboembolism in cancer patients, focusing on the specific context of gynecological tumors, exploring the literature discussing risk factors, risk assessment, and pharmacological prophylaxis.

D-dimer and risk of venous thromboembolism recurrence: Comparison of two studies with similar designs but different laboratory and clinical results.

Background: D-dimer testing may help deciding the duration of anticoagulation in subjects at high risk of venous thromboembolism (VTE) recurrence. Two management studies on this issue have been published (DULCIS in 2014 and APIDULCIS in 2022). They had similar designs but had important different results.

Inappropriate Underdosing of Direct Oral Anticoagulants in Atrial Fibrillation Patients: Results from the START2-AF Registry.

Direct oral anticoagulants (DOACs) are recommended for stroke prevention in non-valvular atrial fibrillation (NVAF) patients. We aimed to describe the prevalence of inappropriate DOACs dose prescription in the START2-AF Registry, the outcomes according to the appropriateness of the dosage, and the factors associated with inappropriate dose prescription. Patients' demographics and clinical data were prospectively collected as electronic files in an anonymous form on the website of the START2-Registry; DOACs dosage was determined to be appropriate when prescribed according to the European Heart Rhythm Association Guidelines.

Sex Differences in Clinical Presentation of Lower Extremity Deep Vein Thrombosis.

Differences between men and women in the clinical features and extent of lower limb deep vein thrombosis (DVT) may influence DVT diagnostic algorithms involving pretest clinical probability (PTP) assessment, D-dimer, and compression ultrasonography (CUS). To assess differences in DVT clinical presentation between men and women and their effect on PTP and D-dimer. We conducted a retrospective study in outpatients referred for suspected DVT of the lower limbs to our vascular emergency department from January 2005 to December 2019.

D-Dimers in diagnosis and prevention of venous thrombosis: recent advances and their practical implications.

D‑Dimers derive from degradation of cross‑linked fibrin by plasmin, and thus their level is a marker of coagulation and fibrinolytic system activation. Guidelines recommend that D‑dimers are determined if the pretest probability (PTP) is low or intermediate, to exclude venous thromboembolism (VTE), either deep vein thrombosis or pulmonary embolism, and to avoid imaging tests. If the PTP is high or D‑dimer level is above the suggested thresholds, imaging is recommended.

Age-adjusted D-dimer, clinical pre-test probability-adjusted D-dimer, and whole leg ultrasound in ruling out suspected proximal and calf deep venous thrombosis.

D-dimer (DD) and ultrasonography (US) are part of the diagnostic workup for lower-extremity deep vein thrombosis (DVT). Recent studies have shown that adjusting DD level cut-offs by age or clinical pre-test probability (PTP) decreases the use of US. We compared diagnostic accuracy of PTP-adjusted DD and age-adjusted DD in 3883 patients (F: 61.

Incidence and clinical outcomes of heparin-induced thrombocytopenia: 11 year experience in a tertiary care university hospital.

Heparin-induced thrombocytopenia (HIT) is a rare immuno-mediated adverse reaction with high thrombotic and mortality risk. To evaluate incidence and outcomes of HIT cases diagnosed at a tertiary care hospital from 2007 to 2018. A retrospective study was conducted.

Platelet RNA sequencing for cancer screening in patients with unprovoked venous thromboembolism: a prospective cohort study.

Background: Platelet RNA sequencing has been shown to accurately detect cancer in previous studies.

Objectives: To compare the diagnostic accuracy of platelet RNA sequencing with standard-of-care limited cancer screening in patients with unprovoked venous thromboembolism (VTE).

Methods: Patients aged ≥40 years with unprovoked VTE were recruited at 13 centers and followed for 12 months for cancer.

Capsular Warning Syndrome: Features, Risk Profile, and Prognosis in a Large Prospective TIA Cohort.

Introduction: Features and prognosis of capsular warning syndrome (CWS) have been poorly investigated prospectively.

Aims: The study aimed to characterize CWS clinical features, risk profile, short- and long-term prognosis, among a large TIA cohort.

Methods: Prospective cohort study of consecutive TIAs was conducted from August 1, 2010, to December 31, 2017.

D-dimer and reduced-dose apixaban for extended treatment after unprovoked venous thromboembolism: the Apidulcis study.

D-dimer assay is used to stratify patients with unprovoked venous thromboembolism (VTE) for the risk of recurrence. However, this approach was never evaluated since direct oral anticoagulants are available. With this multicenter, prospective cohort study, we aimed to assess the value of an algorithm incorporating serial D-dimer testing and administration of reduced-dose apixaban (2.

Thromboembolic Disease in Patients With Cancer and COVID-19: Risk Factors, Prevention and Practical Thromboprophylaxis Recommendations-State-of-the-Art.

Cancer and COVID-19 are both well-established risk factors predisposing to thrombosis. Both disease entities are correlated with increased incidence of venous thrombotic events through multifaceted pathogenic mechanisms involving the interaction of cancer cells or SARS-CoV2 on the one hand and the coagulation system and endothelial cells on the other hand. Thromboprophylaxis is recommended for hospitalized patients with active cancer and high-risk outpatients with cancer receiving anticancer treatment.

Thrombotic burden, D-dimer levels and complete compression ultrasound for diagnosis of acute symptomatic deep vein thrombosis of the lower limbs.

Background: Diagnostic algorithms for deep vein thrombosis (DVT) include D-dimer for its high negative predictive value, thus reducing the need for imaging. Small thrombi may be associated with low D-dimer levels, increasing false negatives.

Aim: To assess the sensitivity and thus the false negative rates of standard and age-adjusted D-dimer cut offs for isolated distal DVT (IDDVT) in outpatients.

The Post-thrombotic Syndrome-Prevention and Treatment: VAS-European Independent Foundation in Angiology/Vascular Medicine Position Paper.

Importance: The post-thrombotic syndrome (PTS) is the most common long-term complication of deep vein thrombosis (DVT), occurring in up to 40-50% of cases. There are limited evidence-based approaches for PTS clinical management.

Objective: To provide an expert consensus for PTS diagnosis, prevention, and treatment.

Do women with venous thromboembolism bleed more than men during anticoagulation? Data from the real-life, prospective START-Register.

Background: Venous thromboembolism (VTE) is a frequent and serious disease that requires immediate and long-term anticoagulant treatment, which is inevitably associated with a risk of bleeding complications. Some studies, though not all, reported a higher risk of bleeding in female patients treated with either old anticoagulants [vitamin k antagonists (VKAs)] or recent anticoagulants [direct oral anticoagulants (DOACs)]. Furthermore, analyses of clinical trials reported an abnormal vaginal bleeding in women of reproductive age treated with DOACs.