Search Results (443)

Background: Gastrointestinal (GI) bleeding is a recognised complication of long-term antithrombotic therapy. Whereas the overall bleeding risk associated with direct oral anticoagulants (DOACs) and low-dose aspirin has been extensively characterised, the anatomical distribution of bleeding lesions between these two pharmacological classes remains incompletely defined. Methods: We retrospectively analysed all consecutive adult patients admitted to the Emergency Department of San Carlo di Nancy Hospital (Rome, Italy) between January 2022 and March 2025 with a clinical diagnosis of acute GI bleeding. Patients were categorised as DOAC monotherapy or aspirin (ASA) monotherapy at presentation. The primary endpoint was the site of bleeding (upper vs. lower GI tract) by drug group. Secondary endpoints included site of bleeding by specific DOAC molecule and indicators of clinical severity (haemoglobin at admission, transfusion requirement, melena, hematochezia). Logistic and linear regression models were adjusted for age and sex. Because the number of transfused units is count data with a right-skewed distribution, the corresponding linear-regression estimate is reported as an exploratory approximation and interpreted with caution. As adjustment was limited to age and sex, all adjusted estimates are associative rather than causal and do not represent an independent effect of drug class. Results: The merged cohort comprised 316 patients; the head-to-head analysis included 179 patients on monotherapy (DOAC n = 100, ASA n = 79). Upper GI bleeding (UGIB) was equally distributed between groups (55% vs. 54%; OR 1.02, 95% CI 0.57–1.85; p = 1.00), whereas identified lower GI bleeding (LGIB) was numerically less frequent in DOAC monotherapy (34% vs. 49%; OR 0.53, 95% CI 0.29–0.97; p = 0.047), an association that was attenuated and no longer significant after adjustment for age and sex (p = 0.076). Restricting to patients who underwent oesophagogastroduodenoscopy (EGDS), the diagnostic yield was substantially lower in DOAC monotherapy (72% vs. 91%; adjusted OR 0.25, 95% CI 0.08–0.79; p = 0.018). DOAC-treated patients presented with lower haemoglobin (7.9 ± 2.4 vs. 9.3 ± 2.9 g/dL; adjusted β = −1.32 g/dL, p = 0.002) and required transfusion more frequently (68% vs. 49%; adjusted OR 2.50, 95% CI 1.29–4.83; p = 0.007). No statistically significant differences were detected among the four DOAC molecules for site of bleeding or specific lesion, although this analysis was substantially underpowered. Conclusions: In a real-world emergency cohort, DOAC and ASA monotherapy were associated with a comparable proportion of upper GI bleeding, while identified LGIB was numerically less frequent in DOAC users. DOAC users presented with lower haemoglobin and more frequently required transfusion, despite a lower diagnostic yield at EGDS. Among the four DOAC molecules, no significant differences emerged. In sensitivity analyses, the lower identified-LGIB frequency and the higher transfusion burden in DOAC users were attenuated and no longer statistically significant when the analysis was restricted to fully evaluated patients or when count-based and comorbidity-adjusted models were applied. Further studies are warranted to clarify the anatomical distribution of bleeding sources in DOAC users with negative initial endoscopy. Full article

Background/Objectives: Ibrutinib is an established treatment for chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), but its use commonly occurs in older patients with polypharmacy, cardiovascular comorbidity and infection vulnerability. CYP3A-modifying drugs and antithrombotic agents are clinically actionable co-exposure domains because they may alter ibrutinib exposure, bleeding risk or the management of atrial arrhythmia. This study evaluated post-marketing reporting patterns for these co-exposures in FAERS. Methods: Adult FAERS reports through 25Q2 with ibrutinib exposure and CLL/SLL-compatible indications were analyzed after false-positive indication captures were removed. Co-exposures were defined at report level using prespecified drug dictionaries, and grouped adverse-event reporting was evaluated using reporting odds ratio, proportional reporting ratio, chi-square and an information-component-style two-by-two metric. Results: The final cohort comprised 20,878 adult CLL/SLL + ibrutinib reports. CYP3A modifier co-exposure was present in 1373 reports (6.6%), and antithrombotic co-exposure in 3701 reports (17.7%). Antithrombotic exposure increased with age, from 9.8% in reports aged 18–64 years to 23.2% in reports aged ≥75 years. CYP3A modifier exposure was associated with enriched reporting of infection and cytopenia phenotypes, particularly severe infection-like events with CYP3A inhibitors and inducers. Antithrombotic exposure showed consistent reporting enrichment for atrial arrhythmia, bleeding and major bleeding-like events, with the strongest grouped signals among anticoagulant-exposed reports. Overlap analyses showed that the co-exposure domains were not mutually exclusive. Conclusions: These findings should be interpreted as reporting disproportionality rather than incidence or causal risk, but they support prioritizing CYP3A-modifying drugs and antithrombotic therapy during medication reconciliation, interaction screening and risk mitigation in older patients receiving ibrutinib. Full article

Despite major advances in reperfusion strategies and guideline-directed medical therapy, patients surviving myocardial infarction (MI) remain at substantial risk of recurrent cardiovascular events. Among the multiple determinants of post-MI cardiovascular risk, persistent atherothrombotic vulnerability remains a major therapeutic challenge despite guideline-directed secondary prevention. This review provides an integrated overview of residual atherothrombotic risk after MI, focusing on the complementary roles of lipid, inflammatory, and thrombotic pathways. Current evidence supports the use of biomarkers such as apolipoprotein B, lipoprotein(a), remnant cholesterol, triglyceride-rich lipoproteins, and high-sensitivity C-reactive protein to improve risk stratification beyond LDL-C. Landmark clinical trials have demonstrated that intensive lipid-lowering therapy, selected anti-inflammatory agents, and individualized antithrombotic strategies can further reduce recurrent cardiovascular events in appropriately selected patients. However, these pathogenic pathways rarely occur in isolation and frequently overlap, generating heterogeneous residual risk phenotypes. We propose a pragmatic multi-layered model in which lipid, inflammatory, and thrombotic mechanisms are viewed as interconnected biological processes rather than independent entities. This framework supports a personalized approach to secondary prevention based on comprehensive risk assessment, targeted therapeutic intensification, and longitudinal reassessment. Integrating these complementary domains may provide a framework for more individualized secondary prevention after MI, although its clinical utility requires prospective validation. Full article

Management of acute coronary syndromes (ACS) in the cardiac intensive care unit (CICU) requires rapid diagnosis, timely reperfusion or invasive assessment, appropriate antithrombotic therapy, and early recognition of haemodynamic, electrical, and mechanical complications. This narrative review examines contemporary evidence across ST-segment elevation and non-ST-segment elevation presentations, with emphasis on decisions during hospitalisation and early secondary prevention. High-sensitivity cardiac troponin algorithms support accelerated assessment of suspected non-ST-segment elevation ACS, whereas next-generation assays require further implementation validation. Twelve-month dual antiplatelet therapy remains the default after ACS in patients without high bleeding risk; abbreviated regimens, de-escalation, cangrelor, and combined antiplatelet–anticoagulant treatment are selective strategies. Contemporary care also includes risk-based invasive timing, complete revascularisation in suitable haemodynamically stable patients, culprit-lesion-only initial PCI in cardiogenic shock, and individualised management of frailty and renal impairment. High-intensity statin therapy, with early ezetimibe when needed, is guideline-supported. Early PCSK9 inhibition and low-dose colchicine are selective strategies, whereas SGLT2 inhibitors and GLP-1RAs are established for specific comorbid indications. hs-cTnT Gen 6 and AI-assisted tools remain evidence-evolving, while multiomics and targeted anti-inflammatory therapies remain investigational. Clear separation of guideline-supported, selective, evidence-evolving, and investigational approaches is essential for clinically appropriate ACS care. Full article

Background: Patients with atrial fibrillation (AF) and a history of gastrointestinal (GI) bleeding represent a particularly challenging clinical population due to the coexistence of elevated thromboembolic and hemorrhagic risks. Percutaneous left atrial appendage occlusion (LAAO) has emerged as an alternative strategy for stroke prevention in patients in whom long-term oral anticoagulation is contraindicated or poorly tolerated. However, evidence specifically addressing clinical outcomes and optimal postprocedural antithrombotic management in this subgroup remains limited. Methods: A comprehensive systematic literature search was conducted across PubMed, Scopus, Web of Science, and Cochrane CENTRAL from database inception to April 2026. Studies were eligible if they included patients with prior gastrointestinal bleeding as the primary study population or reported separately extractable outcomes for a predefined gastrointestinal bleeding subgroup. The primary outcomes were recurrent GI bleeding, thromboembolic events, and all-cause mortality, while secondary outcomes included procedural success, device-related thrombosis, and postprocedural antithrombotic strategies. Owing to substantial clinical and methodological heterogeneity, findings were synthesized qualitatively in accordance with PRISMA 2020 recommendations. Results: Five observational studies reporting GI bleeding-specific outcomes were included in the systematic evidence synthesis. Procedural success rates were consistently high, and LAAO was associated with acceptable thromboembolic outcomes during follow-up. Nevertheless, recurrent GI bleeding remained a clinically relevant complication, particularly in patients with a prior bleeding history. Postprocedural antithrombotic regimens varied widely, ranging from short-term oral anticoagulation to dual or single antiplatelet therapy and reduced-intensity strategies. Less intensive regimens appeared feasible in carefully selected patients at very high bleeding risk; however, no universally optimal approach could be identified. Conclusions: Available observational evidence suggests that LAAO may represent a stroke prevention option in selected patients with AF and prior GI bleeding, although firm conclusions regarding net clinical benefit and the optimal postprocedural antithrombotic strategy cannot currently be drawn. Its net clinical benefit is closely linked to individualized postprocedural management, particularly the choice and intensity of antithrombotic therapy. These findings highlight the importance of a multidisciplinary, patient-centered approach and underscore the need for prospective studies to establish evidence-based treatment strategies in this high-risk population. Full article

High-sensitivity cardiac troponin has made the diagnosis of myocardial infarction (MI) faster and more precise, but it does not measure the broader biological vulnerability that often determines the outcome after an acute coronary syndrome (ACS). Growth differentiation factor-15 (GDF-15) is induced by ischemic stress, inflammation, oxidative injury, renal dysfunction, metabolic disease, and ageing. This biology explains its appeal in ACS, but also its diagnostic limitation: GDF-15 is not cardiac-specific and should not be used as an alternative to electrocardiography and high-sensitivity troponin algorithms for early MI diagnosis. Its better supported role is prognostic. Across emergency department chest pain cohorts, non-ST elevation MI, ST elevation MI, post-ACS trial populations, and serial biomarker studies, higher GDF-15 concentrations are most consistently associated with all-cause mortality, cardiovascular mortality, heart failure, and major bleeding, while associations with recurrent ischemic events alone are less specific. The key unresolved issue is incremental clinical value. GDF-15 may improve discrimination and reclassification beyond clinical predictors, troponin, natriuretic peptides, renal function and GRACE or GRACE 2.0 in selected settings, but statistical association is not equivalent to clinical utility. Its possible role in bleeding risk estimation and antithrombotic benefit–risk assessment is clinically important, especially after the PLATO biomarker analyses, yet routine GDF-15-guided dual antiplatelet therapy decisions remain unsupported. Future implementation requires validated thresholds, calibration, decision curve evidence, health economic evaluation, and trials in which GDF-15-guided management changes care and improves outcomes. Full article

PNH is an acquired ultrarare disease caused by a somatic mutation of PIGA gene located at band 22 of the short arm of the X chromosome, which is unable to carry out the synthesis of glycosil-phosphatidyl-inositol. The loss of complement regulators CD55 and CD59 is associated with the lack of the protective complement regulators in RBCs that become highly susceptible to complement-mediated lysis. PNH is characterized by intravascular hemolysis, high prevalence of thrombotic events, and a variable degree of bone marrow failure. It may arise from aplastic anemia, myelodysplasia and myeloproliferative neoplasms. Recently, a new clinical variant of PNH has been reported, the so-called “ahemolytic white blood cell PNH”, which may be associated with thrombotic episodes. In 2006, the introduction of eculizumab therapy has revolutionized the treatment for PNH patients. More recently, ravulizumab, crovalimab, iptacopan, danicopan, and pegcetacoplan have been introduced in the marketplace, with short/medium-term data supporting their safety and effectiveness. However, no trial has directly compared the clinical outcomes of the new drugs, and also the inclusion criteria in the various phase 3 trials were different, making a comparison between them difficult and unsatisfactory. It is conceivable that artificial intelligence and machine learning-based scoring models may be crucial for predicting the effectiveness of the anti-complement therapy. Full article

Background: Optimal antithrombotic therapy in patients with AF undergoing PCI while receiving OAC remains a clinical challenge. Although clopidogrel is generally recommended as the preferred P2Y12 inhibitor in this setting, evidence comparing clopidogrel with ticagrelor in real-world AF–PCI populations is limited. Objective: To evaluate ischemic and bleeding outcomes in AF patients treated with DOAC combined with clopidogrel, ticagrelor, or TAT following PCI for ACS. Methods: This study involved 248 consecutive patients with non-valvular AF who underwent PCI for ACS and were discharged on DOAC plus clopidogrel (Group 1), DOAC plus ticagrelor (Group 2), or aspirin + clopidogrel + DOAC (Group 3). Cox regression analysis was used to determine the difference in survival rates among the three groups regarding the composite ischemic endpoint (stroke, MI, and stent restenosis) and bleeding. Results: In the Cox regression analysis performed, no statistically significant effect of the variables representing the antiplatelet treatment groups on ischemic outcomes was observed during the 1-year follow-up (Wald = 3.681; df = 2; p = 0.159). Conclusions: In this retrospective real-world cohort of AF patients undergoing PCI for ACS, clopidogrel-based dual therapy appeared to provide clinical outcomes comparable to ticagrelor with respect to thromboembolic and bleeding events. No clear ischemic advantage of ticagrelor was observed, although a numerical increase in minor bleeding was noted. Full article

Background/Objectives: ADAMTS13 is a plasma metalloprotease that cleaves von Willebrand Factor (vWF), a multimeric glycoprotein involved in platelet recruitment during primary hemostasis. Inhibition of ADAMTS13 activity by autoantibodies causes immune thrombotic thrombocytopenic purpura (iTTP). Growing evidence has established allostery as a key contributor to iTTP pathophysiology. This review summarizes the current understanding of how ADAMTS13 structure contributes to its function and regulation and examines anti-ADAMTS13 antibodies as pathological allosteric modulators in iTTP and their associated allosteric mechanisms. Methods: We searched the published literature investigating the role of allostery in iTTP, with special emphasis on studies that satisfy the functional definition of allostery, which addresses how a ligand binding to a protein influences a second ligand-binding event at a distinct site. Results: Anti-ADAMTS13 antibodies primarily affect catalytic turnover as opposed to substrate binding affinity, consistent with their characterization as V-type allosteric ligands. Biophysical studies have revealed extensive and distal structural changes upon antibody binding, including near the enzyme’s active site. However, more recent work utilizing full-length Immunoglobulin G (IgG) molecules and polyclonal iTTP patient plasma suggests that the mechanistic complexity is greater than initially appreciated, with multiple mechanisms likely coexisting. Conclusions: While significant progress has been made to understand allostery in ADAMTS13 and iTTP, many questions remain unresolved. Further elucidation of these underlying mechanisms could help inform the development of diagnostic strategies and targeted therapies for this potentially fatal disorder. Full article

Chylopericardium is an extremely rare disorder in dogs, and its underlying mechanisms and optimal management strategies remain poorly defined. This report describes a dog with chylopericardium complicated by concurrent chylothorax, bilateral brachiocephalic vein thrombosis, and mesothelioma. A 6-year-old neutered male Shiba Inu presented with respiratory distress and was diagnosed with chylothorax and chylopericardium based on fluid analysis. Computed tomography revealed multiple thoracic ducts and bilateral brachiocephalic vein thrombosis but no definitive site of lymphatic leakage. Surgical management included thoracic duct ligation, subtotal pericardiectomy, and cisterna chyli ablation. Histopathological examination of resected pericardial and mediastinal tissues confirmed mesothelioma. Postoperatively, pleural effusion initially decreased but subsequently recurred, and intrathoracic chemotherapy with carboplatin was administered, resulting in long-term control of chylous effusion. Antithrombotic therapy was also initiated for venous thrombosis. The dog remained free of chylous fluid accumulation until death from an unrelated disease. This case highlights the complex interactions among lymphatic, vascular, and neoplastic disorders and suggests that a comprehensive, multimodal diagnostic and therapeutic approach may be effective for managing complicated cases of chylopericardium in dogs. Full article

Bleeding is one of the most common and feared complications after coronary angiography and percutaneous coronary intervention (PCI). It is associated with longer hospital stays, higher mortality, and worse clinical outcomes. As the number of patients at high bleeding risk (HBR) continues to grow, preventing bleeding has become an important part of PCI management. This practical review summarizes current evidence on how to assess bleeding risk and reduce bleeding before, during, and after PCI. Several tools, including the BARC classification, ARC-HBR criteria, PRECISE-DAPT, and DAPT scores, help identify patients who may benefit from tailored treatment. Current strategies include the use of radial access, optimized anticoagulation, appropriate selection of antiplatelet therapy, newer-generation drug-eluting stents, and shorter durations of dual antiplatelet therapy in selected HBR patients. We also discuss the management of patients with atrial fibrillation requiring oral anticoagulation, as well as those with anemia or thrombocytopenia. Although significant progress has been made, several questions remain unanswered, particularly regarding transfusion thresholds, antithrombotic therapy in complex patients, and the best balance between bleeding and ischemic risks. Ongoing clinical trials are expected to provide further evidence and help improve the management of patients undergoing PCI. Full article

Background/Objectives: Thrombotic microangiopathies are rare, life-threatening hematological disorders characterized by microangiopathic hemolytic anemia, thrombocytopenia, and end-organ injury. This study was conducted in a setting where ADAMTS13 activity testing became available only from 2015 onward and complement-targeted therapy (eculizumab) had limited accessibility throughout most of the study period, conditions that shaped both diagnostic classification and treatment outcomes. Their clinical presentation, treatment response, and prognosis vary according to etiology, making early recognition and subtype classification clinically important. This study aimed to evaluate the etiological distribution, clinical features, treatment responses, and outcomes of adult patients with thrombotic microangiopathy at a tertiary-center real-world cohort. Methods: This retrospective cohort study included 47 adult patients (≥18 years) hospitalized with thrombocytopenia and microangiopathic hemolytic anemia (MAHA) in a nine-year period. Patients were classified as thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), or secondary TMA based on clinical and laboratory evaluation. Demographic characteristics, clinical manifestations, laboratory parameters, treatments, and outcomes were analyzed. Results: The mean age was 45.3 ± 15.2 years, and 72.3% of patients were female. Primary thrombotic microangiopathy accounted for 74.5% of cases, including thrombotic thrombocytopenic purpura in 53.2% and hemolytic uremic syndrome in 21.2%; secondary thrombotic microangiopathy accounted for 25.5%. Hemodialysis was required in all patients with hemolytic uremic syndrome compared with 16% of those with thrombotic thrombocytopenic purpura. The complete response rate was 74.5%, and in-hospital mortality was 25.5%. In multivariable Cox regression analysis, treatment non-response and reduced post-treatment estimated glomerular filtration rate independently predicted mortality. Conclusions: Adult TMAs are characterized by considerable etiological and clinical heterogeneity, which makes differential diagnosis challenging, particularly in settings where access to contemporary diagnostic tests and targeted treatments is limited. In this cohort, in the absence of ADAMTS13 testing, TTP was the most frequent subtype, while treatment non-response and renal impairment emerged as the main factors associated with mortality. These findings emphasize the need for early clinical recognition and careful subtype-based differential diagnosis, which will reduce morbidity and mortality by permitting rapid initiation of pathophysiology-based appropriate interventions, i.e., PEx, immune suppression and caplacizumab for immune TTP and anti-complement therapy for aHUS, and limiting the inappropriate use of PEx with its complications, including sepsis. Full article

Background/Objectives: Hallux valgus is a common forefoot deformity whose surgical correction generally yields favorable functional outcomes. However, postoperative complications remain a clinically relevant concern, and the contribution of preoperative risk factors has not been comprehensively characterized in the context of the Spanish population. This study aimed to analyze the relationship between preoperative risk factors and the occurrence of complications after hallux valgus surgery, and to assess whether their accumulation follows a dose–response pattern of increased postoperative risk. Methods: A retrospective observational study was conducted in 123 consecutive patients who underwent hallux valgus surgery between 1 January 2017 and 31 December 2018, with a mean follow-up of 12 months. Variables analyzed included age, sex, deformity severity, active smoking, diabetes mellitus, and antiplatelet or anticoagulant therapy. An accumulated risk factor index based on three clinical risk factors was constructed. Statistical analysis included descriptive statistics, the Cochran–Armitage trend test, and multivariate logistic regression. Results: The mean age was 57.4 years; 82.1% were female. Active smokers accounted for 31.7%, 14.6% had diabetes mellitus, and 13.0% were receiving antithrombotic therapy. The overall complication rate was 20.3%, comprising recurrence (12.2%), chronic residual pain (6.5%), joint stiffness (4.1%), and infection (4.1%). Complication frequency increased progressively from 15.9% in patients without risk factors to 50.0% in those with three concurrent factors (p-trend = 0.038). In multivariate analysis, male sex (odds ratio [OR] 5.39; 95% confidence interval [CI] 1.41–21.19; p = 0.014) and diabetes mellitus (OR 8.37; 95% CI 1.42–63.60; p = 0.026) were independently associated with a higher risk of complications. Conclusions: Hallux valgus surgery generally has a favorable prognosis; however, the presence of preoperative risk factors significantly influences postoperative risk. Diabetes mellitus and the accumulation of risk factors identify patients who could benefit from more rigorous preoperative evaluation, metabolic optimization, and closer postoperative follow-up. Full article

Background and Objectives: Obesity is a major global public health problem associated with numerous complications. Likewise, the use of antiplatelet and anticoagulant agents has increased with population aging and the growing burden of cardiovascular diseases. This study aimed to evaluate the effects of obesity and antiplatelet/anticoagulant therapy on the clinical presentation, bleeding severity, and short-term clinical outcomes of patients with gastrointestinal bleeding. Materials and Methods: A prospective cohort study was conducted in consecutive patients admitted with upper or lower gastrointestinal bleeding to a tertiary referral center between January 2024 and January 2025. Patients were categorized according to body mass index (BMI) and antithrombotic therapy status. Clinical characteristics, bleeding severity scores, treatment requirements, and short-term clinical outcomes were compared. Multivariable multinomial logistic regression analysis was performed to identify independent associations. Results: A total of 177 patients were included. Obese and overweight patients were significantly older than normal-weight patients (p = 0.001), whereas no significant differences were observed among BMI groups regarding the Glasgow–Blatchford score, pre-endoscopic Rockall score, transfusion requirements, endoscopic intervention, or short-term clinical outcomes. Patients receiving antiplatelet or anticoagulant therapy had significantly higher Charlson Comorbidity Index, bleeding severity scores, and packed red blood cell transfusion requirements than those receiving no antithrombotic therapy (all p < 0.01). However, after multivariable adjustment, these associations did not remain independent, and advanced age remained the only independent factor common to both treatment groups. Conclusions: Obesity was not independently associated with bleeding severity or short-term clinical outcomes in patients with gastrointestinal bleeding. Although antiplatelet and anticoagulant therapy were associated with more severe bleeding-related clinical findings, these associations were not independent after multivariable adjustment. Full article

Cardiovascular and vascular diseases remain major causes of morbidity and mortality worldwide, despite substantial advances in prevention, diagnosis, and treatment. In recent years, cardiovascular imaging has moved beyond the traditional assessment of anatomy and morphology toward a multidimensional evaluation of function, tissue composition, haemodynamics, inflammation, and individualized risk. This evolution has been driven by technological progress in echocardiography, cardiovascular magnetic resonance, computed tomography, nuclear imaging, intravascular imaging, and point-of-care ultrasound, together with the rapid development of artificial intelligence, radiomics, and predictive analytics. Advanced echocardiographic techniques, including contrast stress echocardiography and emerging methods for myocardial scar detection, may improve functional and prognostic assessment in patients with suspected or established coronary artery disease. Cardiac magnetic resonance, through tissue mapping, late gadolinium enhancement, and 4D flow imaging, provides unique information on myocardial fibrosis, perfusion, ventricular remodelling, and vascular haemodynamics. Computed tomography, particularly with the introduction of photon-counting technology, is expanding the non-invasive characterization of coronary plaques, vascular calcification, and thromboembolic disease. Hybrid imaging with PET/CT and PET/MR offers additional insight into vascular inflammation, myocardial metabolism, and active disease processes. At the same time, intravascular ultrasound, optical coherence tomography, and augmented-reality-supported imaging are refining interventional guidance, while point-of-care ultrasound is broadening access to rapid bedside cardiovascular and vascular assessment. The integration of imaging findings with circulating biomarkers, clinical scores, lipid profiles, coagulation parameters, and machine-learning models represents a promising strategy for personalized risk stratification, particularly in complex conditions such as coronary artery disease, venous thromboembolism, pulmonary embolism, and bleeding risk during antithrombotic therapy. This review summarizes current advances in cardiovascular imaging, discusses their translational implications, and highlights future directions for integrating imaging, artificial intelligence, and precision medicine into daily clinical practice. Full article