Search Results (969)

Objectives: To evaluate the association between antidepressant use and the risk of venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism (PE), through a systematic review and meta-analysis of observational studies. Methods: A comprehensive literature search was conducted in Medline, Embase^®, and Web of Science^® up to December 2024. Eighteen studies (cohort, case-control, and nested case-control designs) meeting inclusion criteria were analyzed. Study quality was assessed using the Newcastle–Ottawa Scale. Pooled relative risks (RR) with 95% confidence intervals (CIs) were calculated using a random-effects model. Subgroup analyses were performed based on recency of antidepressant use, VTE onset type (first vs. recurrent), and VTE subtype (PE). Results: Antidepressant use was associated with a significantly increased risk of VTE (RR = 1.22; 95% CI: 1.12–1.32; p < 0.001). Subgroup analyses revealed a stronger association for recent use (within 90 days), first-onset VTE, recurrent VTE, and PE. Heterogeneity was high (I² = 87.92%), but sensitivity analysis confirmed result robustness. No publication bias was detected. Conclusions: This meta-analysis indicates a modest but statistically significant increase in the risk of VTE associated with antidepressant use, particularly among recent users, individuals experiencing either first-time or recurrent VTE, and those with PE-type events. These findings highlight the importance of individualized VTE risk assessment when initiating antidepressant therapy. Full article

The association between COVID-19 vaccination and thromboembolic events has garnered significant research attention, particularly with the advent of vaccines based on adenoviral vectors, including AstraZeneca’s and Johnson & Johnson’s vaccines. This review underscores the uncommon occurrence of venous thromboembolism (VTE), arterial thromboembolism (ATE), and vaccine-induced thrombotic thrombocytopenia (VITT) following COVID-19 vaccination. Although these complications are extremely rare compared to the heightened risk of thrombosis from COVID-19 infection, elements like age, biological sex, type of vaccine and underlying health conditions may contribute to their development. In addition, rare renal complications such as acute kidney injury and thrombotic microangiopathy have been documented, broadening the spectrum of potential vaccine-associated thrombotic manifestations. Current guidelines emphasize early detection, individualized risk assessment, and use of anticoagulation therapy to mitigate risks. Despite these events, the overwhelming majority of evidence supports the continued use of COVID-19 vaccines, given their proven efficacy in reducing severe illness and mortality. In addition, recent comparative data confirm that mRNA-based vaccines are associated with a significantly lower risk of serious thrombotic events compared to adenoviral vector platforms. Ongoing research is essential to further refine preventive and therapeutic strategies, particularly for at-risk populations. Full article

Background: Cardiac surgery patients with pre- or post-operative atrial fibrillation are at an increased risk for thromboembolic stroke, often due left atrial appendage (LAA) thrombus. Surgical LAA exclusion (LAAE) can be performed and must be complete to avoid increased thrombus formation. Methods: This prospective, multi-center, post-market study (NCT05101993) evaluated the long-term safety and performance of the epicardial V-shape AtriClip device. Patients ≥18 years who had received V-shape AtriClip devices during non-emergent cardiac surgery consented to a prospective 12-month follow-up visit and LAA imaging. The primary performance was LAAE without residual left atrium-LAA communication, assessed by imaging at the last follow-up visit. The primary safety was device- or implant procedure-related serious adverse events (SAEs) (death, major bleeding, surgical site infection, pericardial effusion requiring intervention, myocardial infarction) within 30 days. Results: Of 155 patients from 11 U.S. centers, 151 patients had evaluable imaging. Complete LAAE was obtained in all patients. Primary performance in the intent-to-treat population was met, with 97% (95% CI 93.52%, 99.29%; p = 0.0001) complete LAAE. Primary safety was met, with 100% (95% CI 97.75%, 100%; p < 0.0001) of patients free from pre-defined SAEs within 30 days. One device-related SAE was reported, which resolved intraprocedurally. Conclusions: AtriClip V-Clip showed safe and successful LAAE through 12 months of follow-up. Full article

Background: Risk assessment in hyperthyroidism remains challenging. The aim of the present study is to determine the influence of hyperthyroid metabolic status on blood clotting and an increased risk of thrombosis. Methods: This prospective study included 50 patients after radical thyroidectomy and ablative radioiodine therapy because of thyroid carcinoma who were compared with 50 control subjects in a euthyroid metabolic state. Latent hyperthyroid patients with basal thyroid-stimulating hormone (TSH) ≤ 0.15 mU/L on levothyroxine hormone therapy were included. The control group was selected to match the patient group based on age and sex. The evaluation data were collected using laboratory coagulation tests and patient questionnaires. A bleeding and a thrombosis score were determined. Results: The coagulation parameters between the patient and control groups showed statistically significant differences. In particular, the patients’ group showed a significantly shortened activated partial thromboplastin time (aPTT/p = 0.009) and a significantly higher plasminogen activator inhibitor 1 (PAI-1/p < 0.001) compared to the control group. Age, sex, and medication use were not found to influence the patients’ laboratory results. Only body mass index was higher in the patient group than in the control group. Conclusions: Our results support a shift in the coagulation system in latent hyperthyroid metabolism towards increased coagulability and reduced fibrinolysis. A latent hyperthyroid metabolic state appears to be associated with an increased risk of thrombosis. Further prospective cohort studies with large patient populations are needed to verify the association between (latent) hyperthyroidism and thromboembolic events as well as to determine therapeutic anticoagulation or to adjust the indication for exogenous administration of thyroid hormone. Full article

Subclinical atrial fibrillation (SCAF) episodes are frequently detected in patients with cardiac implantable electronic devices (CIEDs). These asymptomatic arrhythmias are increasingly recognized as potential harbingers of clinical atrial fibrillation and thromboembolic events. However, the management of SCAF—particularly regarding the use of oral anticoagulation (OAC)—remains controversial. This literature review (Medline, Scopus, Goggle scholar, Embase) focuses on using current literature and clinical studies to guide decision-making regarding anticoagulation therapy and other treatment options that can limit complications for patients with SCAF. The decision to initiate anticoagulation in patients with atrial high-rate episodes (AHREs) should be individualized, balancing stroke risk against bleeding potential. Ongoing research and post hoc analyses will further clarify which subgroups may benefit most from therapy, informing future guideline recommendations. Full article

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare, progressive form of pre-capillary pulmonary hypertension characterized by persistent, organized thromboemboli in the pulmonary vasculature, leading to vascular remodeling, elevated pulmonary artery pressures, right heart failure, and significant morbidity and mortality if untreated. Despite advances, CTEPH remains underdiagnosed due to nonspecific symptoms and overlapping features with other forms of pulmonary hypertension. Basic Methodology: This review synthesizes data from large international registries, epidemiologic studies, translational research, and multicenter clinical trials. Key methodologies include analysis of registry data to assess incidence and risk factors, histopathological examination of lung specimens, and molecular studies investigating endothelial dysfunction and inflammatory pathways. Diagnostic modalities and treatment outcomes are evaluated through observational studies and randomized controlled trials. Recent Advances and Affected Population: Research has elucidated that CTEPH arises from incomplete resolution of pulmonary emboli, with subsequent fibrotic transformation mediated by dysregulated TGF-β/TGFBI signaling, endothelial dysfunction, and chronic inflammation. Affected populations are typically older adults, often with prior venous thromboembolism, splenectomy, or prothrombotic conditions, though up to 25% have no history of acute PE. The disease burden is substantial, with delayed diagnosis contributing to worse outcomes and higher societal costs. Microvascular arteriopathy and PAH-like lesions in non-occluded vessels further complicate the clinical picture. Conclusions: CTEPH is now recognized as a treatable disease, with multimodal therapies—surgical endarterectomy, balloon pulmonary angioplasty, and targeted pharmacotherapy—significantly improving survival and quality of life. Ongoing research into molecular mechanisms and biomarker-driven diagnostics promises earlier identification and more personalized management. Multidisciplinary care and continued translational investigation are essential to further reduce mortality and optimize outcomes for this complex patient population. Full article

Background/Objectives: Atrial fibrillation (AF) is a very common arrhythmia and the main cause of embolic events. Early diagnosis and treatment are crucial to prevent thromboembolic events. Although DOACs are an important advance in AF management, optimization is required. This study aims to evaluate the newly available evidence and experts’ opinions on the clinical care of AF patients and to develop a set of practical recommendations to improve the management of patients with AF. Methods: A questionnaire was developed on the topics of AF diagnosis, stroke prevention, rate and rhythm control, and management of comorbidities, based on the scientific committee’s judgment and a rapid literature review. The level of agreement of the panelists with each statement was evaluated using the Likert 5-point scale. The results of the questionnaire were discussed in a final meeting and practical recommendations were made. Results: Thirty-five Spanish panelists, all experts in AF management, answered the questionnaire. Most of the statements (78%) reached the levels of agreement or unanimity. Discrepancy (9%) and rejection (13%) were also reported. Conclusions: This study underscores the importance of a 12-lead electrocardiogram to diagnose AF, with wearable devices serving as useful tools; catheter ablation as a superior strategy for restoring and maintaining sinus rhythm compared to pharmacotherapy; the importance of comorbidity management to reduce incidence and recurrence of AF; adherence and persistence as critical factors for the efficacy and safety of anticoagulation; and the preference for DOACs, particularly apixaban and edoxaban, for stroke prevention in patients ≥75 years old or with chronic kidney disease. Full article

Background: Venous thromboembolism (VTE) is conventionally treated with anticoagulant therapy. In contrast, the core treatment for peripheral artery disease (PAD) is antiplatelet therapy. VTE and PAD share common risk factors and may occur in the same patient. Nonetheless, there is little evidence of the best antithrombotic regimen to use when the two conditions coexist, especially in terms of the extended prevention of major adverse cardiovascular events (MACE), major adverse limb events (MALE), and VTE recurrences. Methods: We conducted an online survey of members of the Italian Society of Angiology and Vascular Medicine (SIAPAV) to explore current prescribing habits for extended antithrombotic therapy in patients with PAD and unprovoked VTE. The survey included four clinical scenarios with variations in age, gender, bleeding risk, index VTE event, and severity of PAD. In all cases, patients had received anticoagulation for 6 months, and the key question was how to continue treatment beyond 6 months from the index VTE event. Results: A total of 174 clinicians participated to the survey. The most common choice was combining antiplatelet therapy with a direct oral anticoagulant (DOAC) at a low dose. Full-dose DOAC alone or antiplatelet therapy alone were less frequently chosen. Older age and high bleeding risk increased the preference for antiplatelet therapy alone. Conclusions: This survey highlights the marked variability in antithrombotic prescribing patterns among specialists in vascular medicine for patients with unprovoked VTE and concomitant PAD, reflecting the lack of evidence on optimal management in this specific setting. More research is needed to define the safest and most effective treatment strategies for patients with concurrent PAD and VTE. Full article

Post-acute sequelae of COVID-19 have been associated with an elevated risk of thromboembolism and adverse cardiovascular events (CVEs). We aim to evaluate whether alterations in poorly studied hemostatic and endothelial proteins are associated with CVEs in patients previously admitted to the ICU and evaluated one year post-discharge. We carried out a cross-sectional study involving 63 COVID-19 patients previously admitted to the ICU one year post-discharge. Plasma levels of factor IX (coagulation factor), protein C, protein S (natural anticoagulant), and von Willebrand factor (VWF, an endothelial marker) were measured using a Luminex 200™ analyzer. Generalized linear models (GLMs) were used to assess the association of these coagulation proteins with CVEs and N-terminal pro-B-type natriuretic peptide (NT-proBNP). We found that lower levels of factor IX (p = 0.011), protein C (p = 0.028), and protein S (p = 0.008) were associated with CVEs one year after ICU discharge. Additionally, at the one-year follow-up, we found lower levels of factor IX (p = 0.002) and higher levels of VWF (p = 0.006) associated with higher levels of NT-proBNP, underscoring the involvement of both hemostatic imbalance and persistent endothelial dysfunction. Our findings revealed a gender-specific pattern of associations with NT-proBNP levels. These findings highlight the significant role of persistent hemostatic imbalance and endothelial dysfunction in the development of cardiovascular abnormalities among COVID-19 survivors discharged from the ICU. Full article

Background/Objectives: Germ cell tumors are the most common neoplasia in males < 50 y. In two case series, thromboembolic events (TEs) were reported in 8% and 13% of patients undergoing chemotherapy, whereas arterial thromboembolic events (ATEs) in other types of cancer treated with cisplatin had a frequency of 2% in a retrospective series and 0.67% in a meta-analysis. Recent data found a frequency of 2.4% for ATE in a large cohort of testicular cancer patients. Risk factors are not clearly identified, and given the severity of these events, further exploration is needed to determine appropriate preventive measures. Methods: We performed a retrospective cohort study of 171 patients undergoing chemotherapy for germ cell tumors in two centers in Switzerland and recorded the occurrence of ATE or venous thromboembolic events (VTEs) during chemotherapy or in the 3 months after its completion. Results: of 171 patients, 33.3% underwent adjuvant chemotherapy for stage I disease. Overall, 32 patients had a TE (18.7%, 95% CI 13.3–25.5%), 26 (15.2%, 95% CI 10.3–21.7%) had VTEs, and 11 (6.4%, 95% CI 3.4–11.5%) had ATEs. Five patients had both a VTE and ATE. VTEs were associated with disease stage (II, III, or relapse, with OR 15.6, p = 0.0002), retroperitoneal lymph nodes ≥ 3.5 cm (OR 3.2, p = 0.012), LDH > 500 UI/L (OR 5.3, p = 0.0025), and age > 35 y (OR 3.4, p = 0.005). The Khorana Score (KS) varied between 1 and 2 in 96% of the patients. ATEs were associated with active smoking (OR 6.5 p = 0.010), KS of ≥2 (OR 6.4 p = 0.004), and age > 35 y (OR 6.3, p = 0.01). Conclusions: Our findings show that ATEs are more frequent in our cohort than previous reports. We found a strong association between smoking and ATEs, which should be further assessed. Platinum-induced endothelial damage may be amplified by smoking in young patients in the absence of other risk factors and preventive medication. Full article

Background: Pulmonary thromboembolism (PTE) is a preventable yet potentially fatal condition with significant morbidity and mortality. Several clinical scoring systems, including the Wells and modified Geneva scores, have been developed to assess the likelihood of PTE and guide further diagnostic evaluation. The Padua prediction score, primarily used to assess venous thromboembolism (VTE) risk in hospitalized patients, has also been considered for its potential utility in suspected PTE cases. Methods: This retrospective study included 257 patients with suspected acute PTE. Diagnosis was confirmed by computed tomography pulmonary angiography (CTPA) in 140 patients (patient group), while 117 patients without radiologic evidence of PTE served as controls. All participants were evaluated using Wells, modified Geneva, and Padua scores. Sensitivity, specificity, predictive values, and the effect of combining scores with age-adjusted D-dimer levels were analyzed. Results: The Wells score demonstrated a sensitivity of 60% and specificity of 91%, with a positive predictive value of 88%. Modified Geneva and Padua scores showed lower diagnostic accuracy. Negative predictive values increased significantly when combined with age adjusted D-dimer levels. Conclusions: The Wells score was the most reliable tool among the three for predicting PTE. Combining clinical scoring with D-dimer testing enhances diagnostic accuracy and may reduce unnecessary imaging in patients with low to moderate risk. Full article

Background: The optimal anticoagulation strategy for obese patients with superficial vein thrombosis (SVT) remains unclear. This study evaluates the impact of obesity on anticoagulation patterns and clinical outcomes in patients with lower limb SVT. Methods: We conducted a prospective observational study including consecutive patients with SVT in a tertiary hospital from 2014 to 2024. Patients with SVT ≥ 5 cm in length and ≥3 cm from the saphenofemoral junction were included. Obese (BMI ≥ 30) and non-obese (BMI < 30) patients were compared. Patients were followed for one year. Outcomes were assessed at 90 and 365 days. The primary outcomes were venous thromboembolism (VTE) recurrence (SVT, deep vein thrombosis [DVT], or pulmonary embolism [PE]). The secondary outcomes were major bleeding and all-cause mortality. Results: Of 136 patients, 58 (42.6%) were obese. Both groups had similar baseline characteristics, except for younger age and higher smoking prevalence in obese patients. Most patients received anticoagulation (91.9%), primarily a prophylactic dose of low molecular weight heparin or a prophylactic dose of fondaparinux. No significant differences were found in VTE recurrence at 90 or 365 days (p = 0.505), and no major bleeding events occurred. Female sex was associated with a higher risk of VTE recurrence (OR 4.33, 95% CI 1.17–15.98, p = 0.028), but obesity did not influence outcomes. Conclusions: Obesity was not associated with increased VTE recurrence in patients with lower limb SVT. No major bleeding events were observed. These findings suggest that standard anticoagulation regimens may be appropriate for obese patients with SVT, but further studies are needed to confirm these results. Full article

Background: Myocarditis and pericarditis are recognised risks following COVID-19 vaccination, including the mRNA-1273 vaccine. Most cases occur shortly following the second dose of this vaccine, and incidence is highest among young males. However, little is known about risk factors beyond age and sex and about the longer-term clinical course. This study aims to identify possible risk factors for myocarditis and pericarditis following mRNA-1273 vaccination, to characterise the clinical course of myocarditis and pericarditis, both associated with mRNA-1273 vaccination and not associated with vaccination, and to identify risk factors for severe outcomes (i.e., cardiac or thromboembolic complications, severe hospital outcomes, all-cause hospital readmission, and death). Methods: This study is being conducted within the Vaccine Monitoring Collaboration for Europe (VAC4EU) association using routinely collected healthcare data from five data sources from four European countries (Denmark, Norway, Spain, and the United Kingdom). The study is being performed using a common data model, and all analyses are performed separately in each data source in a federated manner following a common protocol. A case–cohort analysis set is identified within each data source for identifying potential risk factors for myocarditis and pericarditis following mRNA-1273 vaccination using logistic regression analysis. The clinical course of myocarditis and pericarditis is being assessed using a cohort study design and describes all cases (i.e., cases associated with mRNA-1273 and unexposed cases). Cox regression analysis is applied to assess the associations between risk factors and several follow-up outcomes. Conclusions: This protocol describes the study methodology of an international collaborative initiative with the aim of assessing the risk factors and clinical course of myocarditis and pericarditis following mRNA-1273 vaccination using a federated network of five European data sources. Full article

Venous thromboembolism (VTE) represents a significant complication of cancer immunotherapy, with emerging evidence suggesting distinct pathophysiological mechanisms compared to traditional chemotherapy-associated thrombosis. This narrative review examines the epidemiology and pathogenesis of VTE in patients receiving immunotherapies for cancer including immune checkpoint inhibitors (ICIs), chimeric antigen receptor (CAR) T-cell therapy, bispecific T-cell engagers (BiTEs), among others. Real-world studies demonstrate a wide range of VTE incidence rates in ICI recipients, with potential mechanisms including exacerbated underlying interleukin-8-mediated inflammatory pathways and consequent neutrophil extracellular trap (NET) formation. CAR T-cell therapy is associated with unique hemostatic challenges, including concurrent thrombotic and bleeding risks related to cytokine release syndrome. Current risk assessment tools show limited predictive utility in patients receiving immunotherapies for cancer, highlighting the need for novel stratification models. Future research priorities include developing immunotherapy-specific risk prediction tools, elucidating mechanistic pathways linking immune activation to thrombosis, and establishing evidence-based and tailored thromboprophylaxis strategies. As cancer immunotherapy continues to evolve, understanding and mitigating thrombotic complications remains crucial for optimizing patient outcomes. Full article

Background/Objectives: Patients with advanced ovarian cancer face a high risk of venous thromboembolism (VTE). This study evaluates the incidence and risk factors for pulmonary thromboembolism (PE) in patients with advanced high-grade serous ovarian carcinoma (HGSOC) undergoing primary treatment, with a focus on personalized risk stratification. Methods: A retrospective analysis was conducted on women with FIGO stage IIIA-IVB HGSOC treated at the University Hospital of Parma between January 2012 and May 2023. All patients underwent CT-based staging prior to primary treatment. When resectability was uncertain, diagnostic laparoscopy and the Fagotti score were performed. Based on cytoreductive potential, patients received either primary debulking surgery (PDS) followed by adjuvant chemotherapy (AC) or neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) and AC. The Khorana score, a thromboembolic risk model, was calculated prior to chemotherapy. Logistic regression was used to assess the association between baseline characteristics and PE. Results: Among 167 HGSOC patients analyzed, 13 (7.8%) experienced PE. Among the 115 patients undergoing diagnostic laparoscopy, each 2-point increase in the Fagotti score above 8 raised PE risk by 76% (OR 1.76, p = 0.006, 95% CI: 1.17–2.63). Patients undergoing NACT-IDS had a significantly higher risk of PE (OR 4.04, 95% CI: 1.19–13.74, p = 0.02) than patients who underwent PDS. A Khorana score of 3 was an independent predictor of PE (OR 37.66, 95% CI: 2.43–582.36, p = 0.009). Conclusions: Based on our results, NACT followed by IDS or a Fagotti score greater than 8 were associated with increased PE risk in HGSOC patients. Khorana score was the strongest predictor of PE in HGSOC patients. Full article