Paolo Prandoni

..Few reports have addressed the value of unfractionated heparin (UFH) or low-molecular-weight heparin in treating the full spectrum of patients with venous thromboembolism (VTE), including recurrent VTE and pulmonary embolism...

..The aim of this investigation was to assess the rate of recurrent VTE after withdrawal of vitamin K antagonists, and to identify clinical parameters associated with a higher likelihood of recurrence...

..Contributing to the controversy is uncertainty about whether residual venous thrombosis, as assessed by repeated ultrasonography over time, increases the risk for recurrent thromboembolism...

..These risks correlate with the extent of cancer. Possibilities for improvement using the current paradigms of anticoagulation seem limited and new treatment strategies should be developed...

..The risk is lower with PTM and is difficult to interpret since it varies according to the assessment method used...

..Because only limited evidence suggests that elastic stockings prevent the post-thrombotic syndrome in patients with symptomatic deep venous thrombosis (DVT), these stockings are not widely used...

....

..In view of the persisting high risk for recurrent thrombotic events in cancer patients, and the acceptable risk of bleeding, prolonged warfarin treatment should be considered in such patients for as long as the cancer is active...

..Although the frequency of HIT in hospitalized medical patients treated with subcutaneous heparin is lower than that observed in other clinical settings, this complication is associated with a similarly high rate of thromboembolic events...

..In up to 80% of patients with pulmonary embolism (PE) no peripheral symptomatic thrombosis can be identified. Whether the heart may represent a source of PE is unknown...

..Finally, new categories of drugs are emerging that have the potential to replace conventional anticoagulants in the near future. They include compounds that inhibit factor Xa or thrombin...

..The optimal duration of oral anticoagulant therapy in patients with deep venous thrombosis (DVT) of the lower extremities remains uncertain...

..Anticoagulant drugs appear to be an attractive strategy in cancer treatment because there is growing evidence for their possible benefits in terms of cancer prognosis and patient survival...

..In all the examined districts, the mean IMT was significantly lower in patients with hemophilia than in controls. Hemophilia protects against asymptomatic atherosclerosis...

..Venous thromboembolism (VTE) and its complications result in a high rate of morbidity and mortality...

..Additional clinical trials are needed to provide an important step forward in this challenging setting...

..3; 95% CI, 1.3 to 8.6). Since aPT antibodies are more commonly identifiable in patients with multiple thrombotic episodes, they are a likely risk factor for recurrent thromboembolism...

..However, the issue of whether screening for occult malignant disease ultimately improves prognosis and survival remains to be resolved...

....

..In conclusion, it is safe to withhold anticoagulant treatment from patients with suspected recurrent ipsilateral DVT in whom compression ultrasonography showed improved or stable vein diameters...

....

..Prolongation of anticoagulation should be considered for as long as the malignant disorder is active...

..Whether atherosclerosis is associated with an increased risk of venous thrombosis is unknown...

..017), and led to premature discontinuation of their use in 29 (21.5%) and 18 (13.6%) patients, respectively. We conclude that thigh-length CES do not offer a better protection against PTS than below-knee CES and are less well tolerated...

..Clinical presentation helps predict the prognosis; the outcome of patients who refer with initially severe manifestations is more favorable than that of patients whose symptoms deteriorate progressively over time...

..Whether this conclusion also applies to patients whose thrombosis involves the sapheno-femoral junction remains to be demonstrated...

..Several heart diseases are promoters of left-side cardiac thrombosis and could lead to arterial embolism. The same mechanism may be responsible for right-side cardiac thrombosis and therefore be a direct source of pulmonary embolism...

..The evidence of lowered cancer mortality in patients on LMWH has stimulated renewed interest in these agents as antineoplastic drugs and raises the distinct possibility that cancer and thrombosis share common mechanisms...

..The aim of this review is to explore the state of the art knowledge on the possible association between venous thromboembolism, especially idiopathic venous thromboembolism, and occult cancer, and to speculate on its implications...

..Idraparinux is a synthetic pentasaccharide that binds to antithrombin with high affinity. In view of its long half-life, it is suitable for once-a-week administration...

..Nevertheless, due to limitations in current therapies, the management of PTS is demanding and often frustrating. Further research is required to optimize the prevention and management of this common and burdensome complication of DVT...

..Accordingly, screening for thrombophilia in otherwise healthy children younger than 15 years who belong to families with inherited defects predisposing to thrombosis seems unjustified...

..However, whether screening for occult malignancies ultimately improves prognosis and prolongs survival remains to be demonstrated...

..Recognition of the incidence and clinical importance of thrombosis will most likely encourage more widespread use of antithrombotic prophylaxis in medical patients...

..Screening families of symptomatic probands with the factor V Leiden mutation has the potential to identify those asymptomatic carriers who might benefit from thromboprophylaxis during risk periods...

..This review highlights current inadequacies in the provision of thromboprophylaxis, and considers the clinical implications of the European guidelines on the prevention and treatment of VTE...

..The previous administration of heparin increases the rate of HIT...

..These agents do not have the drawbacks of the vitamin K antagonists and hold promise for more effective treatment of DVT, possibly resulting in a reduction in the incidence of post-thrombotic syndrome...

..Although oral anticoagulants are still widely used for the prevention of venous thromboembolism after hip replacement, to our knowledge no study has assessed the benefit of prolonging anticoagulation beyond the hospital stay...

..However, when carefully supervised and instructed to wear proper ECS, more than 50% of patients either remain quiescent or improve during long-term follow-up...

..They include anti-Xa inhibitors, such as pentasaccharide, and antithrombin inhibitors, such as ximelagatran...

..Recognition of the incidence and clinical importance of thrombosis will probably encourage more widespread use of antithrombotic prophylaxis in medical patients and especially in some particular types of malignancies...

..Study design and key results are re-evaluated in the context of previous work and future perspectives...

..Further work is needed to provide physicians with specific guidelines for a systematic management of thrombosis in patients with hematologic malignancies...

..A filter had to be inserted in each vena cava to prevent pulmonary embolism. A review of the literature dealing with the few reported cases of filter insertion in congenital duplicated IVC is presented...

....

..4 (95% CI, 1.3 to 4.4; p =0.004) for persistent residual thrombosis versus early vein recanalization. In conclusion, residual venous thrombosis should be regarded as an important risk factor of recurrent thromboembolism...

..This procedure may be difficult when distal branches of pulmonary vascular tree are involved. In selected cases, alternative therapies may be the arterial pulmonary vessel angioplasty and lung transplantation...

....

..Extensive screening for cancer in patients with idiopathic venous thrombosis allows early detection of malignancies and identification of malignancy at an early stage...

....

..Since activated protein C (APC) is also profibrinolytic we wanted to determine whether the presence of antibodies interfering with the anticoagulant activity of APC also inhibits its profibrinolytic effect...

..In a double-blind study, we evaluated the effect of low molecular weight heparin on survival in patients with advanced malignancy without venous thromboembolism...

....

..The optimal duration of oral anticoagulant treatment after a first episode of pulmonary embolism remains uncertain...

....

....

..The combination of a low clinical pretest probability with a normal result of compression ultrasonography or the D-dimer assay appears to be equally safe in refuting the diagnosis of deep vein thrombosis...

..70). CONCLUSIONS: CTPH is a relatively common, serious complication of pulmonary embolism. Diagnostic and therapeutic strategies for the early identification and prevention of CTPH are needed...

..2; 95% CI: 1.5-3.4), had an increased incidence of major bleeding. With some variables available at entry we may identify those cancer patients with VTE at a higher risk for recurrences or major bleeding...

..4 deaths). In conclusion, arterial events are more common in patients with previous idiopathic VTE than in the general population. These findings may have practical implications...

....

..The present review focuses on the relative values of low-molecular-weight heparin and subcutaneous unfractionated heparin for the initial treatment of venous thromboembolism...

..The role of thrombophilia in the long-term management of venous thromboembolism should be addressed in prospective management studies...

..Other studies, however, do not show this association. To help clarify these discrepant findings, we aimed to investigate the risk of arterial cardiovascular events in patients who were diagnosed with venous thromboembolism...

..The long-term risk for fatal pulmonary embolism (PE) after treatment of venous thromboembolism (VTE) may be an important factor in the decision to discontinue this treatment...

..Further evaluation of the LMWHs for effects on cancer outcome is indicated...

..Knee arthroscopy, the most common orthopedic operation worldwide, carries a definite risk for deep venous thrombosis; however, postsurgical thromboprophylaxis is not routinely recommended...

..49 (95% CI, 0.38 to 0.63). These findings suggest that thrombophilia is an independent predictor of persistent residual vein thrombosis...