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Deep Vein Thrombosis and Pulmonary Embolism: Clinical Treatment and Management

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

Deadline for manuscript submissions: closed (30 November 2024) | Viewed by 10143

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Special Issue Editor

Dr. Pablo Demelo-Rodríguez

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Guest Editor

Venous Thromboembolism Unit, Internal Medicine, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
Interests: internal medicine; deep vein thrombosis; pulmonary embolism; cerebral venous thrombosis; venous thromboembolism; anticoagulation therapy

Special Issue Information

Dear Colleagues,

Deep vein thrombosis (DVT) and pulmonary embolism (PE) continue to be significant medical challenges, with increasing implications in terms of hospitalizations and morbidity. These conditions affect a substantial number of patients worldwide, and their consequences can be devastating if not adequately addressed. In this context, our Special Issue focuses on providing an updated and comprehensive insight into the clinical management and treatment of DVT and PE.

We invite contributions that address a wide range of topics, including the management of DVT, the use of systemic thrombolytic therapies, catheter-directed pulmonary reperfusion, mechanical thrombectomy for DVT, surgical embolectomy and extracorporeal embolectomy. We also explore bleeding risk assessment and management, right ventricular function, outpatient treatment of low-risk PE and/or DVT, and long-term management, encompassing anticoagulation, screening and the treatment of complications. Furthermore, we delve into the relationship between venous thrombosis and cancer, as well as complications associated with COVID-19-related venous thrombosis.

This Special Issue represents a compendium of cutting-edge research and reviews that will provide clinicians with a solid foundation to enhance our understanding of DVT and PE, and improve patient care.

We eagerly await your contributions!

Dr. Pablo Demelo-Rodríguez
Guest Editor

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 100 words) can be sent to the Editorial Office for announcement on this website.

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-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

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Keywords

pulmonary embolism
thrombophilia
deep vein thrombosis
venous thromboembolism
anticoagulation therapy
thrombectomy
bleeding
cancer-associated thrombosis

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Published Papers (5 papers)

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Research

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18 pages, 1018 KiB

Open AccessArticle

Evaluation of the Effect of Management of Drug-Related Problems on Clinical Outcomes of Pulmonary Embolism Outpatients: A Randomized Controlled Trial

by Yunus Emre Ayhan, Müzeyyen Aksoy, Yahya Abdulrahman, Zeynep Safiye Şahin Eröksüz, Duygu Vezir, Berre Mercümek, Muhammed Yunus Bektay, Sait Karakurt and Mesut Sancar

J. Clin. Med. 2025, 14(4), 1202; https://doi.org/10.3390/jcm14041202 - 12 Feb 2025

Viewed by 795

Abstract

Background: Pulmonary embolism (PE) poses significant morbidity and mortality risks, necessitating tailored anticoagulant therapy. Limited studies investigate the drug-related problems (DRPs) in PE. This study aims to evaluate the impact of clinical pharmacist (CP) interventions on drug-related problems (DRPs) and clinical outcomes in outpatients with PE. By addressing DRPs in this specific population, the study seeks to assess the role of CP-led interventions in enhancing patient safety and optimizing treatment outcomes. Methods: A randomized controlled trial was conducted on PE patients at a pulmonology outpatient clinic over the period of 15 January 2022 to January 2023. In this trial, the intervention group (IG) benefited from CP recommendations targeting DRPs, while the control group (CG) was observed without any additional interventions. Follow-ups were conducted at 90 and 180 days post-discharge. The study focused on DRPs, CP interventions, and patient outcomes. Data were systematically recorded and analyzed, adhering to ethical standards and employing the PCNE v9.1 classification system. Results: The study followed 50 PE patients, with 26 in the IG and 24 in the CG. DRPs, mostly in drug and dose selection, affected 84% of participants (3.34 DRPs/patient). In the IG, the CP made 76 recommendations (91.5%) for 83 DRPs at the prescribing physician level. Majority of these recommendations (94.7%) were accepted. At the 90-day follow-up, bleeding occurred in 16.6% of the CG, with none in the IG (odds ratio [OR] = 2.3, 95% confidence interval [CI]: 1.654–3.198, p = 0.046). As indicated by Cramér’s V (0.307), the effect size demonstrated a moderate association between the intervention and the absence of bleeding events in the IG. At the 180-day follow-up, bleeding was 33.3% in the CG and 16.6% in the IG (p = 0.443). Conclusions: PE patients experience common and frequent DRPs, especially in anticoagulation therapy. CP recommendations are widely accepted but need to be better implemented. No bleeding events were observed in the IG where a CP was involved at 90 days, unlike the CG. Including a CP in the PE treatment team seems to influence outcomes positively. Full article

(This article belongs to the Special Issue Deep Vein Thrombosis and Pulmonary Embolism: Clinical Treatment and Management)

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15 pages, 542 KiB

Open AccessArticle

Incidence of Venous Thromboembolism and Its Associated Risk Factors in Newly Diagnosed Multiple Myeloma Patients in the Klang Valley, Malaysia

by Nurul Izzati Abdul Aziz, Sivakumar Palaniappan, Nor Saaidah Kamal Rodin, Guang Yong Chong, Tan Tsen Chuen Jerome, Azimatun Noor Aizuddin and Nor Rafeah Tumian

J. Clin. Med. 2025, 14(3), 759; https://doi.org/10.3390/jcm14030759 - 24 Jan 2025

Viewed by 988

Abstract

Background: Venous thromboembolism (VTE) is a potentially severe medical problem among multiple myeloma (MM) patients, with evolving treatment regimens potentially increasing the thrombotic risk. Data on VTE incidence and risk factors in multiethnic Malaysian MM patients are limited. This study aimed to assess VTE incidence and risk factors in newly diagnosed MM (NDMM) patients at two tertiary centres in Klang Valley, Malaysia. Methods: This retrospective cohort study included NDMM patients, aged ≥18, diagnosed between January 2015 and December 2022 at Hospital Canselor Tuanku Muhriz and Hospital Ampang. Patient demographics, clinical characteristics, MM therapies, and thromboprophylaxis data were analysed. VTE is defined as deep vein thrombosis (DVT) or pulmonary embolism (PE), confirmed by imaging. Results: Among the 216 NDMM patients (mean age: 62.4 ± 10.6 years), 22 (10.2%) developed VTE (15 DVT, five PE, and two both). The median time from MM diagnosis to VTE was 3.5 months (IQR 5.3). A univariate analysis identified the female sex, an ECOG performance status ≥ 2, diabetes mellitus, a recent orthopaedic surgery (<6 months), a SAVED score ≥ 2, and an IMPEDE-VTE score > 3 as significant risk factors. In the multivariable logistic regression, the female sex (aOR 8.56, 95% CI: 1.95–37.48), an ECOG status ≥ 2 (aOR 12.74, 95% CI: 3.37–48.17), and a recent orthopaedic surgery (aOR 21.79, 95% CI: 3.10–153.38) were the independent risk factors of VTE among NDMM patients. Conclusions: VTE incidence in our NDMM cohort was 10.2%. Independent risk factors included the female sex, a poor performance status, and a recent orthopaedic surgery. Individualised thromboprophylaxis strategies are crucial, warranting further real-world studies to optimise anticoagulation regimens. Full article

(This article belongs to the Special Issue Deep Vein Thrombosis and Pulmonary Embolism: Clinical Treatment and Management)

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14 pages, 2963 KiB

Open AccessArticle

Thrombosis and Bleeding Risk Scores Are Strongly Associated with Mortality in Hospitalized Patients with COVID-19: A Multicenter Cohort Study

by Kunapa Iam-Arunthai, Supat Chamnanchanunt, Pravinwan Thungthong, Poj Intalapaporn, Chajchawan Nakhahes, Tawatchai Suwanban and Ponlapat Rojnuckarin

J. Clin. Med. 2024, 13(5), 1437; https://doi.org/10.3390/jcm13051437 - 1 Mar 2024

Cited by 2 | Viewed by 1526

Abstract

Background: Internationally established guidelines mention pharmacological prophylaxis for all hospitalized COVID-19 patients. However, there are concerns regarding the efficacy and safety of anticoagulants. This study investigated the associations between thrombosis/bleeding risk scores and clinical outcomes. Methods: We conducted a retrospective review of adult patients admitted to two hospitals between 2021 and 2022. We analyzed clinical data, laboratory results, low molecular weight heparin (LMWH) use, thrombosis, bleeding, and 30-day survival. Results: Of the 160 patients, 69.4% were female, and the median age was 59 years. The rates of thrombotic complications and mortality were 12.5% and 36.3%, respectively. LMWH prophylaxis was administered to 73 of the patients (45.6%). The patients with high Padua prediction scores (PPS) and high IMPROVE_VTE scores had a significantly higher risk of venous thromboembolism (VTE) compared to those with low scores (30.8% vs. 9.0%, p = 0.006 and 25.6% vs. 7.7%, p = 0.006). Similarly, elevated IMPROVE_VTE and IMPROVE_BRS scores were associated with increased mortality (hazard ratios of 7.49 and 6.27, respectively; p < 0.001). Interestingly, LMWH use was not associated with a decreased incidence of VTE when stratified by risk groups. Conclusions: this study suggests that COVID-19 patients with high thrombosis and bleeding risk scores have a higher mortality rate. Full article

(This article belongs to the Special Issue Deep Vein Thrombosis and Pulmonary Embolism: Clinical Treatment and Management)

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11 pages, 714 KiB

Open AccessArticle

Prognostic Significance of Heart Failure in Acute Pulmonary Embolism: A Comprehensive Assessment of 30-Day Outcomes

by Mariam Farid-Zahran, Manuel Méndez-Bailón, José María Pedrajas, Rubén Alonso-Beato, Francisco Galeano-Valle, Vanesa Sendín Martín, Javier Marco-Martínez and Pablo Demelo-Rodríguez

J. Clin. Med. 2024, 13(5), 1284; https://doi.org/10.3390/jcm13051284 - 24 Feb 2024

Cited by 2 | Viewed by 1849

Abstract

Introduction: Patients with heart failure (HF) are known to have an increased risk of pulmonary embolism (PE), but there is limited evidence regarding the prognostic implications of HF in patients with acute PE and the relationship between PE prognosis and left ventricular ejection fraction (LVEF). The primary objective of this study was the development of a composite outcome (mortality, major bleeding, and recurrence) within the first 30 days. The secondary objective was to identify the role of LVEF in predicting the development of early complications in patients with both HF and reduced LVEF. Material and Methods: A prospective study was conducted at two tertiary hospitals between January 2012 and December 2022 to assess differences among patients diagnosed with acute PE based on the presence or absence of a history of HF. Cox regression models were employed to assess the impact of HF and reduced LVEF on the composite outcome at 30 days. Results: Out of 1991 patients with acute symptomatic PE, 7.13% had a history of HF. Patients with HF were older and had more comorbidities. The HF group exhibited higher mortality (11.27% vs. 4.33%, p < 0.001) and a higher incidence of major bleeding (9.86% vs. 4.54%, p = 0.005). In the multivariate analysis, HF was an independent risk factor for the development of the composite outcome (HR 1.93; 95% CI 1.35–2.76). Reduced LVEF was independently associated with a higher risk of major bleeding (HR 3.44; 95% CI 1.34–8.81). Conclusion: In patients with acute pulmonary embolism, heart failure is independently associated with a higher risk of early complications. Additionally, heart failure with reduced LVEF is an independent risk factor for major bleeding. Full article

(This article belongs to the Special Issue Deep Vein Thrombosis and Pulmonary Embolism: Clinical Treatment and Management)

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Review

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22 pages, 2597 KiB

Open AccessReview

A Comprehensive Review of Catheter-Related Thrombosis

by Marina López-Rubio, Marta-Olimpia Lago-Rodríguez, Lucía Ordieres-Ortega, Crhistian-Mario Oblitas, Sergio Moragón-Ledesma, Rubén Alonso-Beato, Luis-Antonio Alvarez-Sala-Walther and Francisco Galeano-Valle

J. Clin. Med. 2024, 13(24), 7818; https://doi.org/10.3390/jcm13247818 - 21 Dec 2024

Viewed by 4257

Abstract

Catheter-related thrombosis (CRT) is a frequent and potentially serious complication associated with the widespread use of intravascular devices such as central venous catheters, including peripherally inserted central catheters and implantable port systems, pacemakers or implantable cardioverter-defibrillators. Although CRT management has been informed by guidelines extrapolated from lower extremity deep vein thrombosis (DVT), unique challenges remain due to the distinct anatomical, pathophysiological, and clinical characteristics of upper extremity DVT. Risk factors for CRT are multifactorial, encompassing patient-related characteristics such as cancer, prior venous thromboembolism, and infection, as well as catheter-specific factors like device type, lumens, and insertion site. The diagnosis of CRT relies primarily on ultrasonography; however, computed tomography angiography and magnetic resonance imaging play a complementary role, particularly in anatomically challenging cases or when complications such as pulmonary embolism or superior vena cava syndrome are suspected. Treatment strategies for CRT include anticoagulation, catheter removal when feasible, and, in select cases, local thrombolysis or catheter-directed interventions. Anticoagulation remains the cornerstone of therapy, with direct oral anticoagulants increasingly favored due to their safety profile and efficacy. This article provides a detailed review of CRT, focusing on clinical features, diagnostic methods, and treatment strategies while addressing specific challenges in managing pacemaker and hemodialysis catheter-related thrombosis. Full article

(This article belongs to the Special Issue Deep Vein Thrombosis and Pulmonary Embolism: Clinical Treatment and Management)

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