Search Results (273)

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: 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

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: 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

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: Apixaban is favored over warfarin for atrial fibrillation (Afib) and venous thromboembolism (VTE) due to its effectiveness, safety, and lack of routine monitoring. However, managing anticoagulation in hospitalized patients with acute kidney injury (AKI) is challenging due to altered pharmacokinetics and limited safety data. This study assesses the safety and efficacy of apixaban versus warfarin in these patients. Methods: This retrospective chart review at King Abdulaziz Medical City in Riyadh included adult patients (≥18 years) with AKI, as defined by the Kidney Disease Improving Global Outcome (KDIGO) guideline. Primary outcomes were rates of major and minor bleeding within 30 days, as defined by the International Society on Thrombosis and Haemostasis (ISTH), and thrombotic events. Secondary outcomes included 30-day rates of all-cause mortality and hospital readmissions. Results: Among 513 patients, 294 received apixaban and 219 received warfarin. Major bleeding within 30 days was significantly lower in the apixaban group (3.4%) compared to warfarin (7.3%) (p = 0.0461). Minor bleeding rates were similar (6.5% apixaban vs. 5.5% warfarin; p = 0.616). Thrombotic events occurred in 6.8% of patients, with no significant difference between apixaban (6.5%) and warfarin (7.3%) (p = 0.739). Mortality rates were 8.0%, with no significant difference (8.8% apixaban vs. 6.8% warfarin; p = 0.3846). Readmission rates were comparable (38.8% for apixaban vs. 39.7% for warfarin; p = 0.9499). Conclusions: In hospitalized AKI patients, apixaban was associated with a lower major bleeding risk compared to warfarin, with similar rates of thrombotic events, mortality, and readmissions, suggesting apixaban may be a safer option, warranting further research. Full article

Background/Objectives: Patients with chronic kidney disease (CKD) are associated with a significantly elevated cardiovascular risk. The incidence and prevalence of mediated cardiac disorders and major adverse cardiac events (MACEs), such as heart failure, arrhythmias, acute coronary syndrome (ACS) based on coronary artery disease (CAD), stroke, venous thromboembolism, and peripheral artery disease, are significantly higher in CKD patients as compared with the general population. Methods: This narrative review summarizes the current clinical understanding, the pathophysiological mechanisms, and the clinical consequences in the context of cardiovascular risk and disease in CKD. Results: The impact of CKD on mediated cardiovascular disorders and elevated MACE prevalence is complex and multifactorial. The underlying mechanisms involve various traditional cardiovascular risk factors, such as arterial hypertension, smoking, dyslipidemia, and diabetes. Furthermore, CKD-specific molecular and pathophysiological factors, such as chronic inflammation and associated oxidative stress and endothelial cell dysfunction, pro-coagulatory status, uremic toxins and uremic lipids, progressive vascular calcification, and alterations in the regulation of the renin–angiotensin–aldosterone system (RAAS) and sympathetic activation cause an increased cardiovascular risk. Conclusions: Understanding the complex disease mechanisms between CKD and elevated cardiovascular risk might contribute to optimizing individual patients’ risk stratification and result in individualized diagnostic and treatment strategies via appropriate clinical biomarker application and individualized anti-inflammatory approaches. Full article

Background/Objectives: Venous thromboembolism (VTE) and major hemorrhagic events are significant complications in hospitalized leukemia patients, but contemporary analyses of their epidemiology, predictors, and impact on clinical outcomes remain limited. Methods: We conducted a cross-sectional study using the National Inpatient Sample (NIS) database from 2016 to 2020. Hospitalized leukemia patients were identified using ICD-10 codes. Trends in the incidence of venous thromboembolism (VTE) and bleeding were assessed across the years, and multivariable logistic regression models were used to evaluate the predictors of VTE and bleeding. We assessed the influence thromboembolic and hemorrhagic complications on length of stay, cost, and mortality outcomes. Results: Among 430,780 leukemia hospitalizations, the overall incidence of VTE was 5.4% and remained stable throughout the study period (p = 0.09), while hemorrhagic events = 5.6%) showed a significant upward trend (p = 0.01). Cerebrovascular accidents, central venous catheter insertion, and protein calorie malnutrition (PCM) were significant predictors of both VTE and hemorrhage. PCM demonstrated a dose-dependent relationship with both complications. VTE was associated with a 33.5% increase in length of stay (LOS) and a 35% increase in cost of care (COC). Hemorrhage was associated with 23.2% increase in LOS and 32.6% increase in COC. Only hemorrhagic events were independently associated with increased mortality (adjusted OR 2.88, p < 0.001). Conclusions: The incidence of VTE in hospitalized leukemia patients has remained stable while hemorrhagic complications have increased significantly. Nutritional status represents a potentially modifiable risk factor for both VTE and bleeding complications. The competing risk between thrombosis and hemorrhage varies with age and nutritional status, suggesting the need for nuanced thromboprophylaxis strategies in this vulnerable population. Full article

Cryofibrinogenemia (CF) may be secondary to COVID-19. To establish this relationship, in PRECOVID-19 and COVID-19 periods we assess: (a) frequency and clinical features in patients with CF; (b) study of CF syndrome. We study all cryofibrinogen tests performed in a single university hospital in Northern Spain, comparing two periods: PRECOVID-19 (July 2017–February 2020) and COVID-19 (March 2020–October 2022). CF syndrome was established with two positive cryofibrinogen tests plus compatible cutaneous manifestations and/or thrombotic events (TE). CF was found in 129/279 patients. In the COVID-19 period, they had more positive tests (50.2% vs. 28%; p = 0.0047), younger age (33 vs. 55 years, p = 0.054) and fewer cardiovascular (CV) risk factors (39.1% vs. 78.6%, p = 0.005). Cutaneous manifestations were the most frequent in both periods (81.4%), particularly purpuric macules (29.5%). Skin ulcers showed statistically significant differences, being more frequent in the PRECOVID-19 era (35.7% vs. 7.8%, p = 0.008). Thrombotic CV events were also observed (13.2%), particularly venous thromboembolisms (12.2%). Severe complications were more frequent in the PRECOVID-19 era, although this difference did not reach statistical significance (35.7% vs. 19.1%; p = 0.169). CF was secondary in 68/129 cases, mainly to SARS-CoV-2 (n = 45). CF syndrome was found in 27.9% of patients. After one year, most patients were clinically stable or in remission. Mild dermatological lesions were the most frequent manifestations, and most patients recovered. Full article

Venous thromboembolic events (VTEs), especially in the form of portal vein thrombosis (PVT), are common complications of cirrhosis and are associated with significant morbidity. These patients can also be easily tipped toward bleeding because of deficiencies in procoagulant factors and pharmacokinetic and pharmacodynamic changes that occur during disease progression. Therefore, the understanding of how to use pharmacotherapy to treat VTE is a key to success in achieving VTE resolution without potentiating adverse bleeding events (AEs). Based on a review of the literature and the authors’ clinical experience, it was determined that unfractionated heparin (UFH), low molecular weight heparin (LMWH), fondaparinux, argatroban, warfarin, and direct oral anticoagulants all have evidence of use in patients with cirrhosis and VTE. However, the available literature is mostly limited to retrospective studies and case reports. There appears to be a paucity of prospective, randomized trials that compare the available pharmacotherapy at typical and adjusted doses. Overall, the decision as to the choice of agent and dose prescribed for anticoagulant therapy should include assessment on clot burden, bleeding risk, drug-drug/disease interactions, and the risk of presence of AEs. Full article

Background: A popliteal vein aneurysm (PVA) is a rare vascular abnormality that can lead to the formation of venous thrombi, resulting in potentially life-threatening pulmonary embolism (PE). Methods: We present the case of a 30-year-old female who presented with recurrent pulmonary embolism complicated by cardiorespiratory arrest. Emergency thrombolysis was initiated, which successfully stabilized the patient. Further diagnostic evaluation, including imaging studies, revealed the presence of a giant popliteal vein aneurysm (60/70 mm) as the underlying cause of recurrent embolism. Results: The patient underwent surgical repair of the popliteal vein aneurysm to prevent further thromboembolic events. The procedure was performed successfully, and the patient recovered favorably. Conclusions: This case underscores the importance of recognizing PVA as a potential cause of recurrent PE, particularly in young patients without typical risk factors. Full article

Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment, but their association with thrombosis presents significant clinical challenges. Patients with cancer already exhibit elevated risks for venous thromboembolism and arterial thrombosis, with treatment modalities like chemotherapy further exacerbating this risk. Emerging evidence suggests that ICIs contribute to thrombotic events through multifactorial mechanisms, including immune dysregulation, T cell activation, endothelial dysfunction, elevated tissue factor expression, and impaired fibrinolysis. Additional risk factors such as obesity, smoking, prior thrombotic events, and combination ICI therapy further increase thrombosis susceptibility. The literature reports varying incidence rates of ICI-associated thrombosis, with some studies indicating comparable risks to chemotherapy, while others highlight higher rates, particularly during the initial treatment phase. Management aligns with standard protocols for cancer-associated thrombosis, using low-molecular-weight heparin or direct oral anticoagulants, though optimal treatment duration and the role of prophylactic anticoagulation require further investigation. This review provides a comprehensive overview of the mechanisms, incidence rates, and clinical management strategies of ICI-associated thrombosis, emphasizing the importance of proactive risk assessment to optimize patient outcomes. Full article

Background/Objectives: Rivaroxaban is widely used to prevent thrombotic events in cardiovascular diseases (CVD). While various doses and combinations with aspirin have been evaluated across CVD subtypes, the optimal regimen remains unclear. This network meta-analysis aims to identify the most effective and safe rivaroxaban regimens, with or without aspirin, for patients with CVD. Methods: A systematic search of PubMed, Scopus, Cochrane Library, and Web of Science identified randomized-controlled trials (RCTs) assessing rivaroxaban, with or without aspirin, in CVD. Key outcomes included thromboembolic, hemorrhagic, and mortality events. A frequentist network meta-analysis (MetaInsight tool) was performed, using aspirin monotherapy as the reference. Subgroup analyses for coronary artery disease (CAD) were conducted. Results: Seven RCTs were included. Rivaroxaban 2.5 mg twice daily (“bis in die” (BID)) with aspirin showed the most significant venous thromboembolism (VTE) prevention (RR = 0.61, 95% CI [0.43–0.86]) but had the highest major bleeding risk (RR = 1.58, 95% CI [1.26–2]). Rivaroxaban 5 mg BID with aspirin showed the lowest myocardial infarction risk (RR = 0.78). Higher doses (20 mg BID) with aspirin were associated with an increased fatal bleeding risk (RR = 7.14, 95% CI [2.83–17.98]). Rivaroxaban 5 mg BID monotherapy had the highest hemorrhagic stroke risk (RR = 2.7, 95% CI [1.31–5.58]). In CAD, rivaroxaban 2.5 mg BID plus aspirin offered the lowest all-cause mortality (RR = 0.76, 95% CI [0.63–0.93]). Conclusions: Rivaroxaban 2.5 mg BID plus aspirin reduces VTE and lowers mortality in CAD but carries higher bleeding risks. Optimal regimen selection requires a careful risk–benefit balance. Full article

Direct oral anticoagulants (DOACs) have emerged as a preferred alternative to vitamin K antagonists (VKAs) for the prevention and treatment of thromboembolic disorders, offering improved safety, predictable pharmacokinetics, and ease of administration. Despite these advantages, their use in complex clinical scenarios presents significant challenges that necessitate individualized therapeutic strategies. This comprehensive review explores the efficacy, safety, and limitations of DOAC therapy in special populations, including patients with renal or hepatic impairment, obesity, cancer-associated thrombosis, and antiphospholipid syndrome. Additionally, we examine their role in uncommon thrombotic conditions such as superficial venous thrombosis, embolic stroke of undetermined source, upper extremity vein thrombosis, inferior vena cava thrombosis, pelvic vein thrombosis, and cerebral vein thrombosis. The pharmacokinetic variability of DOACs in renal and hepatic dysfunction requires caution to balance the bleeding and thrombotic risks. In obesity, altered drug distribution and metabolism raise concerns regarding appropriate dosing and therapeutic efficacy. Cancer-associated thrombosis presents a complex interplay of prothrombotic mechanisms, necessitating careful selection of anticoagulant therapy. Furthermore, the use of DOACs in antiphospholipid syndrome remains controversial due to concerns about recurrent thrombotic events. Finally, in some unusual scenarios like inferior vena cava, pelvic vein, and cerebral vein thrombosis, the use of DOACs has scarce evidence. This review aims to guide clinicians in optimizing anticoagulation management in challenging patient populations by synthesizing current evidence and providing practical recommendations. Full article