Advances in Diagnosis and Management of Venous Thromboembolic Disorders

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Vascular Medicine".

Deadline for manuscript submissions: closed (20 August 2023) | Viewed by 8664

Special Issue Editors


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Guest Editor
Vascular Surgery Service, University Hospital, School of Medicine, Salamanca University, 37007 Salamanca, Spain
Interests: acute and chronic venous diseases; carotid surgery (paraganglioma); aortic surgery (systemic inflammatory response)

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Guest Editor
Thrombosis and Hemostasis Unit, University Clinical Hospital of Salamanca, Paseo de San Vicente, 58-182, 37007 Salamanca, Spain
Interests: venous thromboembolism; thrombophilia; cancer-associated thrombosis; direct oral anticoagulants

Special Issue Information

Dear Colleagues,

Venous thromboembolic disorders are a set of clinical states —pulmonary embolism, deep-vein thrombosis (DVT) and superficial, post-thrombotic syndrome, etc.— all of which are permanent hot topics. Their frequency and impact on morbidity and mortality, and their social implications (altered quality of life) and economic burdens on health systems attest to this.

On the other hand, venous thromboembolic diseases create a cross-cutting clinical situation because they affect numerous medical and surgical specialities. This, along with the vast amount of research and innovation regarding these issues, makes VTDs one of the most frequent topics in the medical literature. As if all this were not enough, the interruption due to COVID-19 has given an even greater impetus—if that were possible—to medical research on the conditions and their social impact. In this sense, the etiopathogenesis of VTDs is under permanent review. Our diagnostic and therapeutic knowledge about venous thromboembolic disease is very extensive and constantly evolving. A good example of this is the case of DVT, for which the historical therapeutic pendulum, swinging between antithrombotics and thrombectomies, has recently been analysed and updated. Finally, the outpatient treatment of most of these disorders has allowed a before and after in the management of these diseases.

Dr. Francisco S. Lozano Sánchez
Dr. José Ramón González-Porras
Guest Editors

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Keywords

  • pulmonary embolism
  • deep venous thrombosis
  • superficial venous thrombosis
  • post-thrombotic syndrome for thrombophilia
  • COVID thrombosis
  • cancer-associated thrombosis
  • risk assessment models of thrombosis
  • direct oral anticoagulants (DOACs)
  • percutaneous venous thrombectomy
  • vein thrombosis ambulatory treatment
  • quality of life and cost-effectiveness of the prevention and treatment of deep-vein thrombosis and pulmonary embolism

Published Papers (4 papers)

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Research

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9 pages, 236 KiB  
Article
Low-Dose Rivaroxaban to Prevent Recurrences of Venous Thromboembolism in Cancer: A Real-Life Experience with a Focus on Female Patients
by Paolo Santini, Carolina Mosoni, Alessandro D’Errico, Enrica Porceddu, Andrea Lupascu, Emanuele Valeriani, Paolo Tondi, Roberto Pola and Angelo Porfidia
J. Clin. Med. 2023, 12(19), 6427; https://doi.org/10.3390/jcm12196427 - 9 Oct 2023
Viewed by 1420
Abstract
Background: The way in which to prevent recurrent venous thromboembolism (VTE) is an unmet clinical need in cancer patients. International guidelines only provide conditional recommendations and do not specify which anticoagulant and dose should be used. In the last 2 years, we have [...] Read more.
Background: The way in which to prevent recurrent venous thromboembolism (VTE) is an unmet clinical need in cancer patients. International guidelines only provide conditional recommendations and do not specify which anticoagulant and dose should be used. In the last 2 years, we have been using low-dose rivaroxaban to prevent VTE recurrences in cancer patients. The results of this real-life experience are presented in this study. Methods: All patients had cancer and had previously completed a cycle of at least six months of full-dose anticoagulation for the treatment of a VTE index event, before receiving a prescription of low-dose rivaroxaban (10 mg once daily) for secondary prevention of VTE. Effectiveness and safety of this therapeutic regimen were evaluated in terms of VTE recurrences, major bleedings (MB), and clinically relevant non-major bleedings (CRNMB). Results: The analysis included 106 cancer patients. Their median age was 60 years (IQR 50–69). Metastatic cancer was present in 87 patients (82.1%). Six patients (5.7%) had brain metastases. Over a median follow-up time of 333 days (IQR 156–484), the incidence of VTE recurrences was 3.8% (95%CI 1.0–9.4), with a recurrence rate of 4.0 per 100 person-years (95%CI 1.1–10.2). We observed no MB (0.0%) and three CRNMB (2.8%) (95%CI 0.6–8.1). Conclusions: Low-dose rivaroxaban is potentially effective and safe in cancer patients that require prevention of recurrent VTE. Large-scale studies are needed to confirm these findings. Full article
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12 pages, 602 KiB  
Article
Comparative Effectiveness of Apixaban and Rivaroxaban Lead-in Dosing in VTE Treatment: Observational Multicenter Real-World Study
by Omar A. Alshaya, Ghazwa B. Korayem, Majed S. Al Yami, Asma H. Qudayr, Sara Althewaibi, Lolwa Fetyani, Shaden Alshehri, Fai Alnashmi, Maram Albasseet, Lina Alshehri, Lina M. Alhushan and Omar A. Almohammed
J. Clin. Med. 2023, 12(1), 199; https://doi.org/10.3390/jcm12010199 - 27 Dec 2022
Cited by 1 | Viewed by 2778
Abstract
Apixaban and rivaroxaban require lead-in dosing for 7 and 21 days, respectively, when treating venous thromboembolism (VTE). However, no evidence exists to support subtracting parenteral anticoagulation days from total lead-in dosing. A multicenter study was conducted, including adult patients with acute VTE who [...] Read more.
Apixaban and rivaroxaban require lead-in dosing for 7 and 21 days, respectively, when treating venous thromboembolism (VTE). However, no evidence exists to support subtracting parenteral anticoagulation days from total lead-in dosing. A multicenter study was conducted, including adult patients with acute VTE who received apixaban or rivaroxaban. The patients were grouped as follows. The recommended group received oral lead-in anticoagulant for the full recommended duration. The mixed group received lead-in therapy as parenteral with oral anticoagulant. The incidence of recurrent VTE (rVTE) and major bleeding (MB) within 90 days were the main outcomes. Of the 368 included patients, 47.8% received apixaban, and 52.2% received rivaroxaban. The recommended lead-in was used in 296 patients (80.4%), whereas 72 (19.6%) received the mixed-lead-in regimen. Five patients had rVTE events within 90 days; two occurred during hospitalization in the recommended group versus none in the mixed group (0.7% vs. 0.0%; p = 1.000). After discharge, two events occurred in the recommended group and one in the mixed group (0.7% vs. 1.4%; p = 0.481). In terms of MB, 24 events occurred in 21 patients within 90 days. During hospitalization, 11 events occurred in the recommended group and seven in the mixed group (3.7% vs. 9.7%; p = 0.060). After discharge, five more events occurred in the recommended group and one in the mixed group (1.4% vs. 1.7%; p = 1.000). The mixed-lead-in regimen is safe and effective in comparison with the recommended-lead-in regimen. Full article
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Review

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16 pages, 509 KiB  
Review
A Review of the Prevalence of Thromboembolic Complications among Pregnant Women Infected with COVID-19
by Nurul Syafiqah Mohd Ariff, Izzati Abdul Halim Zaki, Zakiah Mohd Noordin, Nur Sabiha Md Hussin, Khang Wen Goh, Long Chiau Ming and Hanis Hanum Zulkifly
J. Clin. Med. 2022, 11(19), 5934; https://doi.org/10.3390/jcm11195934 - 8 Oct 2022
Cited by 1 | Viewed by 1848
Abstract
Background: Thrombotic conditions triggered by SARS-CoV-2 virus can result in high mortality, especially in pregnant women as they are already in a hypercoagulability state. This thereby leads to excessive inflammation that will increase the risk of thromboembolic (TE) complications. Objective: The aim of [...] Read more.
Background: Thrombotic conditions triggered by SARS-CoV-2 virus can result in high mortality, especially in pregnant women as they are already in a hypercoagulability state. This thereby leads to excessive inflammation that will increase the risk of thromboembolic (TE) complications. Objective: The aim of this study is to review the prevalence of thromboembolic complications such as deep venous thrombosis, pulmonary embolism, and intervillous thrombosis, and their preventive strategies among pregnant women infected with COVID-19. Method: The articles were retrieved from online databases PubMed and ScienceDirect published from February 2020 to April 2022. Findings: A total of 5249 participants including 5128 pregnant women and 121 placentas from 19 studies were identified for having TE complications after being infected with COVID-19. The types of TE complications that developed within pregnant women were disseminated intravascular coagulation (DIC) (n = 44, 0.86%), unmentioned thromboembolic complications (TE) (n = 14, 0.27%), intervillous thrombosis (IVT) (n = 9, 0.18%), pulmonary embolism (PE) (n = 6, 0.12%), COVID-19 associated coagulopathy (CAC) (n = 5, 0.10%), and deep venous thrombosis (DVT) (n = 2, 0.04%). Whereas the prevalence of TE complications reported from studies focusing on placenta were IVT (n = 27, 22.3%), subchorionic thrombus (SCT) (n = 9, 7.44%), and placental thrombosis (n = 5, 4.13%). Thromboprophylaxis agent used among pregnant women include low molecular weight heparin (LMWH) at prophylactic dose (n = 9). Conclusions: The prevalence of thromboembolic complications among pregnant women infected by COVID-19 is low with DIC being the most common form and placental thrombosis being the least common form of TE complications that occurred within pregnant women infected with COVID-19. Anticoagulation, in particular LMWH (variable dose), is frequently used to prevent TE complications. Full article
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Other

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11 pages, 625 KiB  
Perspective
Immunothrombosis: Molecular Aspects and New Therapeutic Perspectives
by María Marcos-Jubilar, Ramón Lecumberri and José A. Páramo
J. Clin. Med. 2023, 12(4), 1399; https://doi.org/10.3390/jcm12041399 - 9 Feb 2023
Cited by 8 | Viewed by 2147
Abstract
Thromboinflammation or immunothrombosis is a concept that explains the existing link between coagulation and inflammatory response present in many situations, such as sepsis, venous thromboembolism, or COVID-19 associated coagulopathy. The purpose of this review is to provide an overview of the current data [...] Read more.
Thromboinflammation or immunothrombosis is a concept that explains the existing link between coagulation and inflammatory response present in many situations, such as sepsis, venous thromboembolism, or COVID-19 associated coagulopathy. The purpose of this review is to provide an overview of the current data regarding the mechanisms involved in immunothrombosis in order to understand the new therapeutic strategies focused in reducing thrombotic risk by controlling the inflammation. Full article
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