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Managements of Venous Thromboembolism
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Managements of Venous Thromboembolism

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

Deadline for manuscript submissions: 24 June 2026 | Viewed by 3991

Special Issue Editor

Dr. Anabel Franco Moreno

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Guest Editor
Venous Thromboembolism Unit, Internal Medicine Department, Hospital Universitario Infanta Leonor, Madrid, Spain
Interests: venous thromboembolism; deep vein thrombosis; pulmonary embolism; anticoagulation therapy; direct oral anticoagulants; risk stratification; bleeding risk; hematology; medical informatics; cardiac and cardiovascular; peripheral vascular diseases
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Venous thromboembolism (VTE), encompassing deep vein thrombosis and pulmonary embolism, remains a major cause of morbidity and mortality worldwide. Despite significant advances in diagnostic and therapeutic strategies, VTE continues to present major clinical challenges. In recent years, the introduction of direct oral anticoagulants (DOACs), the development of individualized risk assessment tools, and advances in imaging techniques have substantially reshaped the management landscape. Moreover, the application of artificial intelligence (AI) and machine learning (ML) algorithms is emerging as a promising approach to enhance prediction, diagnosis, and clinical decision making in VTE. Nevertheless, unresolved questions persist, including the optimal duration of anticoagulation, strategies for recurrence risk stratification, bleeding risk mitigation, and the management of special populations such as the elderly, pregnant individuals, or patients with thrombosis in unusual locations.

This Special Issue aims to provide an updated overview of current evidence and emerging research in the management of VTE, with a focus on advances in pharmacologic therapies, predictive models—including AI-driven tools—and personalized approaches. We welcome original research articles, clinical studies, systematic reviews, and expert commentaries addressing clinical decision making, biomarkers, prevention strategies, and novel therapeutic interventions. Contributions from multidisciplinary perspectives are strongly encouraged to foster a comprehensive understanding of this complex and evolving field.

Dr. Anabel Franco Moreno
Guest Editor

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Keywords

  • venous thromboembolism
  • deep vein thrombosis
  • pulmonary embolism
  • anticoagulation therapy
  • direct oral anticoagulants
  • risk stratification
  • bleeding risk
  • artificial intelligence
  • personalized medicine

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Published Papers (4 papers)

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Research

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16 pages, 1076 KB  
Article
A Digital Twin Strategy to Predict Thrombotic Recurrence in Antiphospholipid Syndrome Patients Treated with Direct Oral Anticoagulants vs. Vitamin K Antagonists Using Data from Real-World Populations
by Miguel Ángel Casado-Suela, Juan Torres-Macho, Aida Izquierdo-Martínez, Cristina Lucía Ancos-Aracil, Luis Ferreira-Burguillos, Elena Madroñal-Cerezo, Tamar Talaván-Zañón, Adela Castañeda-Mata, Luis Escobar-Curbelo, Ana Martínez de la Casa-Muñoz, Eva Ruiz-Navío, Ana Bustamante-Fermosel and Anabel Franco-Moreno
J. Clin. Med. 2025, 14(16), 5716; https://doi.org/10.3390/jcm14165716 - 12 Aug 2025
Cited by 1 | Viewed by 851
Abstract
Background/Objectives: The role of direct oral anticoagulants (DOACs) vs. vitamin K antagonists (VKAs) in preventing recurrent thrombosis in patients with antiphospholipid syndrome (APS) remains uncertain. Using real-world data, we aimed to evaluate the effectiveness and internal validity of a digital twin (DT) approach [...] Read more.
Background/Objectives: The role of direct oral anticoagulants (DOACs) vs. vitamin K antagonists (VKAs) in preventing recurrent thrombosis in patients with antiphospholipid syndrome (APS) remains uncertain. Using real-world data, we aimed to evaluate the effectiveness and internal validity of a digital twin (DT) approach for modeling thrombotic recurrence risk in APS patients treated with DOACs or VKAs. Methods: We conducted a multicenter observational study that included thrombotic APS patients treated with DOACs or VKAs. Clinical data were used to generate DT via conditional generative adversarial networks (CGANs), incorporating a directed acyclic graph (DAG) to preserve causal relationships. Validation metrics included absolute standardized mean differences (ASMD), mean ASMD (MASMD), and Spearman correlation matrices to assess structural fidelity. Treatment effects were estimated in a CGAN-conditioned cohort matched on key covariates. Results: Eighty-nine thrombotic APS patients were included: 70 (78.7%) received VKAs and 19 (21.3%) received DOACs. Thrombotic recurrences occurred in 5 DOAC patients (26.3%) and 17 AVK patients (24.3%). The CGAN-generated synthetic cohort closely mirrored the original data (MASMD = 0.073 ± 0.041), with 85.4% of pairwise correlations differing by <0.1 in absolute value. In the conditioned DT cohort, predicted recurrence was 24.2% for DOACs and 19.9% for VKAs. Recurrence risk increased with antibody burden, reaching 41.3% in triple-positive patients and 46.8% in those with index arterial thrombosis treated with DOACs. Conclusions: DT technology accurately replicated the clinical structure of APS patients, supporting its application for simulating counterfactual scenarios and estimating individualized treatment effects. Full article
(This article belongs to the Special Issue Managements of Venous Thromboembolism)
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Review

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14 pages, 540 KB  
Review
The Crucial Role of Tinzaparin in Managing Venous Thromboembolism in the Cancer Population
by Alfredo Mauriello, Adriana Correra, Anna Chiara Maratea, Celeste Fonderico, Arianna Amata, Vincenzo Quagliariello, Vincenzo Russo, Antonello D’Andrea and Nicola Maurea
J. Clin. Med. 2025, 14(19), 6695; https://doi.org/10.3390/jcm14196695 - 23 Sep 2025
Cited by 2 | Viewed by 1368
Abstract
Background: Venous thromboembolism (VTE) is a serious and common complication in cancer patients, and it is the second leading cause of death after cancer itself. Cancer-associated thrombosis (CAT) is an indicator of a poorer prognosis and can lead to treatment delays and increased [...] Read more.
Background: Venous thromboembolism (VTE) is a serious and common complication in cancer patients, and it is the second leading cause of death after cancer itself. Cancer-associated thrombosis (CAT) is an indicator of a poorer prognosis and can lead to treatment delays and increased healthcare costs. This review aims to provide a comprehensive update on the efficacy and safety of tinzaparin in the treatment and prophylaxis of VTE in cancer patients. Methods: This is a narrative review that examines the pharmacological properties of tinzaparin, as well as the results from clinical studies and meta-analyses. It includes a discussion of tinzaparin’s role in special patient populations and its comparison with other anticoagulants. Results: Tinzaparin is a low-molecular-weight heparin (LMWH) that does not accumulate in patients with renal insufficiency, eliminating the need for dose adjustments. Studies have shown that tinzaparin is a safe and effective treatment for CAT, with a favorable safety profile regarding hemorrhagic complications. In the CATCH study, tinzaparin showed a significant reduction in clinically relevant non-major bleeding compared to warfarin. Tinzaparin has also been shown to be more effective than vitamin K antagonists (VKAs) in promoting the recanalization of venous thrombi. A meta-analysis confirmed that tinzaparin was superior to VKAs in preventing VTE recurrence in the long term. Conclusions: While direct oral anticoagulants (DOACs) offer convenience, LMWHs like tinzaparin remain crucial, especially for patients with specific characteristics such as renal insufficiency, complex drug interactions, or a high risk of gastrointestinal bleeding. Tinzaparin’s favorable safety and efficacy, along with its unique pharmacological properties, make it a valuable option for managing VTE in the complex oncology population. Full article
(This article belongs to the Special Issue Managements of Venous Thromboembolism)
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Other

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12 pages, 1152 KB  
Systematic Review
Outpatient Management of Pulmonary Embolism Patients with Direct Oral Anticoagulants: A Systematic Review
by Alvina S. Khachatryan, Denis V. Rylnikov, Sevara A. Mirakhmedova, Evgeny I. Seliverstov, Evgeny S. An and Igor A. Zolotukhin
J. Clin. Med. 2025, 14(24), 8931; https://doi.org/10.3390/jcm14248931 - 17 Dec 2025
Viewed by 541
Abstract
Background: Pulmonary embolism (PE) patients are generally admitted to the hospital, which leads to significant burden on healthcare systems. Many PE patients are hemodynamically stable and can be ambulated safely. Direct oral anticoagulants (DOACs) do not need routine laboratory monitoring, which makes them [...] Read more.
Background: Pulmonary embolism (PE) patients are generally admitted to the hospital, which leads to significant burden on healthcare systems. Many PE patients are hemodynamically stable and can be ambulated safely. Direct oral anticoagulants (DOACs) do not need routine laboratory monitoring, which makes them a convenient option for outpatient care. Data on the outpatient management of PE patients using DOACs are scarce. Methods: We conducted a systematic search of MECENTRAL databases to identify randomized controlled trials (RCTs), non-randomized studies (non-RCTs), retrospective studies, reviews, systematic reviews, meta-analyses, and clinical guidelines evaluating the use of DOACs for outpatient treatment of PE patients. Results: A total of 833 publications were identified, and eight studies—two RCTs and six non-RCTs (two retrospective and four prospective)—were finally included. These studies reported rates of bleeding events, recurrent venous thromboembolism (VTE), PE-related mortality, and all-cause mortality among outpatients who received DOACs. No PE-related deaths were reported in any of the included studies. Bleeding events were reported in five studies, and recurrent VTE rates were reported in two studies. Study findings showed that the sPESI score has some disadvantages in selecting patients for home treatment. The quality of the studies varied considerably. A meta-analysis could not be performed due to heterogeneity in the study designs, patient populations, and outcome reporting. While the treatment results favored outpatient management of selected PE patients, no robust conclusions could be drawn from the published data. Conclusions: Outpatient treatment of PE with DOACs has some potential as an approach for managing selected patients. Hestia, POMPE-C and RESI scores are preferable for selecting PE patients for home treatment, but utilizing sPESI as the only tool has to be avoided. Apixaban and rivaroxaban are both safe, with a low bleeding risk. Large-scale prospective studies are required to establish the efficacy and safety of outpatient PE management using DOACs. Full article
(This article belongs to the Special Issue Managements of Venous Thromboembolism)
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13 pages, 708 KB  
Systematic Review
Spontaneous Retroperitoneal Hematoma in SARS-CoV-2 Patients: Diagnostic and Management Challenges—A Literature Review
by Alexandra Sandu, Dan Bratu, Alin Mihețiu, Dragos Serban and Ciprian Tănăsescu
J. Clin. Med. 2025, 14(19), 6999; https://doi.org/10.3390/jcm14196999 - 3 Oct 2025
Viewed by 886
Abstract
Background: Spontaneous retroperitoneal hematomas constitute a rare clinical entity, yet their incidence has markedly increased during the SARS-CoV-2 pandemic. The pathophysiological substrate is incompletely elucidated, being influenced by anticoagulant therapy, vascular inflammatory alterations induced by SARS-CoV-2 infection, and comorbidities in critically ill patients [...] Read more.
Background: Spontaneous retroperitoneal hematomas constitute a rare clinical entity, yet their incidence has markedly increased during the SARS-CoV-2 pandemic. The pathophysiological substrate is incompletely elucidated, being influenced by anticoagulant therapy, vascular inflammatory alterations induced by SARS-CoV-2 infection, and comorbidities in critically ill patients that exacerbate hemorrhagic risk. Methods: We performed a comprehensive literature review of published case reports and case series on spontaneous retroperitoneal hematomas in COVID-19 patients, complemented by our institutional experience, in order to synthesize current diagnostic and therapeutic approaches. Results: Available evidence indicates that most cases occur in anticoagulated patients, with clinical manifestations often limited to nonspecific abdominal or lumbar pain. Diagnosis relies primarily on contrast-enhanced CT imaging. Reported therapeutic strategies include conservative management, endovascular embolization, and surgical intervention, with outcomes ranging from complete recovery to fatal progression, particularly in elderly and comorbid individuals. Conclusions: Spontaneous retroperitoneal hematomas in the setting of SARS-CoV-2 infection represent a diagnostic and therapeutic challenge associated with considerable morbidity and mortality. Early recognition, prompt imaging, and individualized multidisciplinary management are essential, while further research is needed to clarify incidence, risk factors, and preventive strategies. Full article
(This article belongs to the Special Issue Managements of Venous Thromboembolism)
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