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Clinics and Practice
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Advances in Thromboembolism: Precision Prevention and Clinical Management
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Advances in Thromboembolism: Precision Prevention and Clinical Management

A special issue of Clinics and Practice (ISSN 2039-7283).

Deadline for manuscript submissions: 31 August 2026 | Viewed by 8283

Editors

Dr. Anabel Isabel Franco-Moreno

E-Mail Website
Guest Editor
1. Servicio de Medicina Interna, Hospital Universitario Infanta Leonor-Virgen de la Torre, 28031 Madrid, Spain
2. Unidad de Tromboembolismo Venoso, Hospital Universitario Infanta Leonor-Virgen de la Torre, 28031 Madrid, Spain
Interests: venous thromboembolism; precision risk stratification; thrombosis in special populations; radiomics; digital twin simulation models; explainable machine learning approaches
Special Issues, Collections and Topics in MDPI journals
Dr. Cristina Lucía de Ancos Aracil

E-Mail Website
Guest Editor Assistant
Department of Internal Medicine, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
Interests: venous thromboembolism; thrombotic risk stratification; anticoagulant therapy

Special Issue Information

Dear Colleagues,

Venous thromboembolism remains a leading cause of morbidity and mortality worldwide. In recent years, the field has advanced toward individualized approaches through a better understanding of pathophysiological mechanisms, risk stratification tools, and the emergence of precision medicine. The incorporation of biomarkers, machine learning, and refined clinical prediction models has paved the way for more accurate risk assessment and the development of tailored prevention strategies.

This Special Issue aims to gather original research and high-quality reviews that explore the full spectrum of thromboembolism, from molecular mechanisms and innovative diagnostic tools to novel therapeutic strategies. We particularly welcome contributions focusing on special clinical scenarios, such as cancer-associated thrombosis, thrombosis in transgender populations, and pregnancy, as well as studies incorporating artificial intelligence or real-world data.

We invite you to submit original articles, reviews, meta-analyses, and clinical studies related to the mechanisms, diagnosis, risk prediction, and personalized management of thromboembolic disease.

Dr. Anabel Isabel Franco-Moreno
Guest Editor

Dr. Cristina Lucía de Ancos Aracil
Guest Editor Assistant

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Clinics and Practice is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • venous thromboembolism
  • biomarkers
  • risk stratification
  • anticoagulation
  • artificial intelligence
  • precision medicine
  • special populations
  • real-world evidence
  • thrombosis prevention

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Published Papers (5 papers)

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13 pages, 600 KB  
Article
Trends in Comorbidity for Patients with Venous Thromboembolism in a General Hospital: 2018 to 2022
by Luisa Jiménez Reyes, José Javier Jareño Esteban, Lara Almudena Fernández Bermejo, Carlos Gutiérrez Ortega and Javier de Miguel-Díez
Clin. Pract. 2026, 16(6), 113; https://doi.org/10.3390/clinpract16060113 - 15 Jun 2026
Viewed by 468
Abstract
Background/Objectives: Recent trends show a rising incidence of venous thromboembolism (VTE) that does not correlate with increased mortality; however, population aging and the proliferation of comorbidities are fundamentally reshaping the VTE patient landscape. The aim of this study is to evaluate potential [...] Read more.
Background/Objectives: Recent trends show a rising incidence of venous thromboembolism (VTE) that does not correlate with increased mortality; however, population aging and the proliferation of comorbidities are fundamentally reshaping the VTE patient landscape. The aim of this study is to evaluate potential differences in clinical characteristics, comorbidities, and survival rates between patients diagnosed with pulmonary embolism (PE) during the pre-pandemic period (2018–2019) and those diagnosed during the pandemic era (2020–2022). Additionally, as a secondary objective, we analyze the clinical profiles, risk factors, and survival outcomes of patients with and without COVID-19 infection during the 2020–2022 period. Methods: A retrospective observational study was conducted to analyze survival and comorbidities in patients admitted for PE at the Hospital Central de la Defensa ‘Gómez Ulla’ between 2018 and 2022, comparing two periods (2018–2019 and 2020–2022). In addition, a sub-analysis was performed within the second period group comparing patients with and without COVID-19. Results: It was observed that the majority of patients in the first period were men, while in the second period, 55% were women. With regard to comorbidity and risk factors, thrombophilia and dementia were more prevalent in the first period, while asthma was more prevalent in the second period. No differences were found with regard to mortality. Conclusions: Significant differences were observed between the two periods of the study with regard to some comorbidities. Patients with COVID-19 showed a greater tendency toward immobilization and a higher prescription of thromboprophylaxis during hospitalization. Full article
(This article belongs to the Special Issue Advances in Thromboembolism: Precision Prevention and Clinical Management)
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15 pages, 774 KB  
Article
Burden and Determinants of Drug–Drug Interactions at Hospital Discharge: Warfarin as a Model for High-Risk Medication Safety
by Kanthida Methaset and Arom Jedsadayanmata
Clin. Pract. 2026, 16(1), 8; https://doi.org/10.3390/clinpract16010008 - 31 Dec 2025
Cited by 1 | Viewed by 1930
Abstract
Background: Potential drug–drug interactions (pDDIs) present substantial challenges to medication safety during care transitions. Warfarin, with its narrow therapeutic index and extensive interaction profile, provides a strategic model for examining pDDIs at discharge. This study aimed to characterize the burden and determinants [...] Read more.
Background: Potential drug–drug interactions (pDDIs) present substantial challenges to medication safety during care transitions. Warfarin, with its narrow therapeutic index and extensive interaction profile, provides a strategic model for examining pDDIs at discharge. This study aimed to characterize the burden and determinants of major warfarin pDDIs among patients discharged from a tertiary-care hospital. Methods: This retrospective cross-sectional study analyzed electronic health records of 1667 patients discharged home on warfarin. Major pDDIs were identified using the Micromedex® Drug Interaction database. Log-binomial regression was used to assess predictors of ≥1 major pDDIs, and generalized Poisson regression was used to model the number of pDDIs per patient. Results: Major warfarin pDDIs were identified in 81.6% (95% CI: 79.6–83.4%) of patients at hospital discharge. The burden was considerable: 35.1% (95% CI: 32.8–37.4%) of patients had one major pDDI, while 46.5% (95% CI: 44.1–48.9%) had two or more. Polypharmacy (≥5 concurrent medications) was the strongest predictor, associated with a higher risk of any major pDDI (adjusted risk ratio 1.72, 95% CI: 1.46–2.02) and nearly three times the burden of interactions per patient (adjusted incidence rate ratio (IRR) 2.87, 95% CI: 2.36–3.49). When modeled as a continuous variable, each additional discharge medication was associated with a 9% increase in predicted pDDI burden (IRR 1.09, 95% CI: 1.08–1.10). Conclusions: Using warfarin as a model for high-risk medication safety, major pDDIs were highly prevalent at hospital discharge, with polypharmacy as a significant predictor of both the presence and burden of interactions. These findings emphasize the importance of identifying polypharmacy-related pDDIs to reduce potential drug interaction risk during care transitions. Full article
(This article belongs to the Special Issue Advances in Thromboembolism: Precision Prevention and Clinical Management)
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16 pages, 1636 KB  
Article
A Digital Twin Strategy Combined with a Monte Carlo Simulation Framework to Predict Outcomes in Patients with Unusual-Site Venous Thrombosis Treated with Direct Oral Anticoagulants Versus Vitamin K Antagonists Using Data from Real-World Populations
by Anabel Franco-Moreno, Luis Escobar-Curbelo, Juan Torres-Macho, Nuria Muñoz-Rivas, Cristina Lucía Ancos-Aracil, Ana Martínez de la Casa-Muñoz, Ana Bustamante-Fermosel, Paz Arranz-García and Miguel Ángel Casado-Suela
Clin. Pract. 2025, 15(12), 237; https://doi.org/10.3390/clinpract15120237 - 17 Dec 2025
Cited by 1 | Viewed by 975
Abstract
Background/Objectives: Unusual-site venous thrombosis (USVT) lacks robust evidence guiding anticoagulant selection between vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs). This study aimed to evaluate recanalization, recurrence, and major bleeding outcomes in real-world USVT patients and to replicate these findings through a [...] Read more.
Background/Objectives: Unusual-site venous thrombosis (USVT) lacks robust evidence guiding anticoagulant selection between vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs). This study aimed to evaluate recanalization, recurrence, and major bleeding outcomes in real-world USVT patients and to replicate these findings through a validated digital twin model with Monte Carlo simulation. Methods: We conducted a retrospective study of 90 USVT patients (72% VKAs, 28% DOACs). A conditional generative adversarial network was used to generate digital twins matched on age, sex, thrombosis site, and malignancy. Logistic regression was applied to estimate treatment-specific outcome probabilities for recanalization, recurrence, and major bleeding. A nested stochastic simulation framework simulated 500 iterations across clinical scenarios, including increased DOAC use, cancer prevalence, cerebral vein thrombosis proportion, and optimized VKA control. Results: The mean age was 67.5 years, and 54.4% were female. 61.1% of splanchnic vein thrombosis, 36.7% of upper extremity deep vein thrombosis, and 2.2% of cerebral vein thrombosis were included. In the real cohort, complete recanalization occurred in 40.0% of patients with DOACs and 36.0% with VKAs. Recurrence was 8.0% with DOACs and 7.7% with VKAs, and major bleeding occurred in 8.0% and 10.8% of cases, respectively. All-cause mortality was 20% in DOAC-treated patients and 60% in those receiving VKAs. Digital Twin-based predictions replicated these results (recanalization 40.3% versus 38.0%; recurrence 10.9% versus 8.6%; bleeding 7.6% versus 9.1%). Simulated scenarios preserved the directionality effect, with the most significant differences observed in high-cerebral vein thrombosis and cancer-enriched patients. Conclusions: DOACs showed comparable efficacy and slightly lower bleeding risk than VKAs in USVT. Digital twin and Monte Carlo modeling provided robust, reproducible simulations of treatment effects under varying clinical conditions. Separating empirical and simulation-based findings, the digital twin supported the internal consistency of real-world observations and demonstrated the potential of in silico modeling as a complementary tool in rare thrombotic diseases. Full article
(This article belongs to the Special Issue Advances in Thromboembolism: Precision Prevention and Clinical Management)
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12 pages, 1208 KB  
Article
Impact of Carotid Artery Tortuosity on Technical Aspects of Endovascular Thrombectomy in a Newly Established Thrombectomy-Capable Stroke Center
by Katja Lovoković, Vjekoslav Kopačin, Mihael Mišir, Mateo Grigić, Domagoj Matijević, Tatjana Rotim, Domagoj Kretić, Damir Štimac, Anja Tomić, Lucija Čolaković and Tajana Turk
Clin. Pract. 2025, 15(10), 183; https://doi.org/10.3390/clinpract15100183 - 1 Oct 2025
Viewed by 1162
Abstract
Background/Objectives: Blood vessel tortuosity can complicate endovascular procedures such as endovascular thrombectomy in acute ischemic stroke. This study aimed to assess the morphometric characteristics of carotid arteries and investigate the association between the tortuosity of the carotid arteries and the technical aspects [...] Read more.
Background/Objectives: Blood vessel tortuosity can complicate endovascular procedures such as endovascular thrombectomy in acute ischemic stroke. This study aimed to assess the morphometric characteristics of carotid arteries and investigate the association between the tortuosity of the carotid arteries and the technical aspects of endovascular thrombectomy, patient demographics and clinical characteristics, and treatment outcome. Methods: This retrospective study included 84 patients with ischemic stroke treated by endovascular thrombectomy at the newly established thrombectomy-capable stroke center. The following data were collected from prethrombectomy computed tomography angiography: aortic arch type, type of carotid artery tortuosity, and tortuosity index (TI). The technical aspects of the procedure, as well as patient demographics, were collected from the radiological information system. Results: Time from arterial puncture to the first pass was significantly shorter in patients with a nontortuous carotid artery compared to a tortuous one (p = 0.006). There were no significant differences in the number of passes, total duration of the procedure, and the difference in National Institutes of Health Stroke Scale (NIHSS) score before and after the procedure regarding the form of tortuosity. Patients with hypertension had significantly higher tortuosity index values compared to those without hypertension (p = 0.008), and patients with a nontortuous carotid tree were significantly younger compared to those with all forms of tortuosity (p = 0.003). Conclusions: The majority of patients had tortuous carotid arteries, which were associated with older age and hypertension. A high index of tortuosity was associated with a longer time from arterial puncture to the first pass, but not to the treatment outcome. Preprocedural recognition of carotid artery tortuosity may aid in endovascular thrombectomy procedural planning. Full article
(This article belongs to the Special Issue Advances in Thromboembolism: Precision Prevention and Clinical Management)
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15 pages, 930 KB  
Systematic Review
Preventive Strategies for Upper Extremity Deep Venous Thrombosis Following Elective Upper Limb Surgery: A Systematic Review
by Aeshah Salem Alsharidah, Alya Ali Aljubran, Maha Alkharisi, Taif Alnafie, Dhai Almuteri, Zahra Almarhabi, Noor Alawami, Shaykhah Alkulaib, Hashmiah Aljarash, Zain Abdullah and Abdullah Almaqhawi
Clin. Pract. 2025, 15(12), 221; https://doi.org/10.3390/clinpract15120221 - 26 Nov 2025
Viewed by 2701
Abstract
Background/Objectives: Upper extremity deep vein thrombosis (UEDVT) is a harmful complication of elective upper limb surgeries. Different strategies are employed to prevent this condition. The aim of the review is to quantify the effectiveness of various preventive interventions and investigate correlated factors that [...] Read more.
Background/Objectives: Upper extremity deep vein thrombosis (UEDVT) is a harmful complication of elective upper limb surgeries. Different strategies are employed to prevent this condition. The aim of the review is to quantify the effectiveness of various preventive interventions and investigate correlated factors that affect the incidence of UEDVT (upper extremity deep vein thrombosis). Methods: We performed a systematic search using the PubMed, EBSCO, Ovid, EMBASE, Cochrane, and Google Scholar databases. Randomized controlled trials (RCTs), prospective or retrospective cohort studies, or case–control studies were examined. We included adult patients over 18 years old undergoing elective upper limb surgery and receiving Prophylactic measures for Upper Extremity Deep Venous Thrombosis. Results: After a literature search and quality assessment, 6 studies were included. All the studies were of good quality but significantly heterogeneous in terms of sample size, population size, treatment modalities, and baseline characteristics. In these studies, the reported incidence of symptomatic venous thromboembolism (VTE) varied widely, ranging from 0.41% to 13%. However, thromboprophylaxis did not have a significant impact on the rates of deep vein thrombosis (DVT). Certain factors such as older age and trauma as the cause of surgery were identified as notable risk factors for symptomatic VTE. Conclusions: This systematic review highlights the complexity of preventing upper extremity deep vein thrombosis (UEDVT) following elective upper limb surgeries. The reported incidence of symptomatic VTE varies considerably across studies, and thromboprophylaxis was not associated with a significant reduction in its rates. The evidence is characterized by substantial heterogeneity in patient populations and surgical contexts. More research is needed to better understand the role of thromboprophylaxis in preventing DVT. Full article
(This article belongs to the Special Issue Advances in Thromboembolism: Precision Prevention and Clinical Management)
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