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Venous thromboembolism (VTE), including deep venous thrombosis and pulmonary embolism, is the third most common cause of cardiovascular death. The management of the acute phase of VTE is well described in several papers and guidelines, whereas the management of the follow-up of the patients affected from VTE is less defined. This position paper of the Italian Association of Hospital Cardiologists (ANMCO) tries to fill the gap using currently available evidence and the opinion of the experts to suggest the most useful way to manage patients in the chronic phase.The clinical and laboratory tests acquired during the acute phase of the disease drives the decision of the following period. Acquired or congenital thrombophilic factors may be identified to explain an apparently not provoked VTE. In some patients, a not yet clinically evident cancer could be the trigger of VTE and this could lead to a different strategy. The main target of the post-acute management is to prevent relapse of the disease and to identify those patients who could worsen or develop chronic thromboembolic pulmonary hypertension. The knowledge of the etiopathogenetic ground is important to address the therapeutic approach, choosing the best antithrombotic strategy and deciding how long therapy should last. During the follow-up period, prognostic stratification should be updated on the basis of new evidences eventually acquired.Treatment of VTE is mainly based on oral or parenteral anticoagulation. Oral direct inhibitors of coagulation represent an interesting new therapy for the acute and extended period of treatment.

Background: Pulmonary hypertension is characterized by an increase in pulmonary vascular resistance and premature death. Echocardiography is useful in the screening of patients with suspected pulmonary hypertension by estimation of the systolic regurgitant tricuspid flow velocity according to the simplified Bernoulli equation. On this basis, the survey INCIPIT was created aiming at evaluating the frequency of suspected pulmonary hypertension among Italian patients., Methods: From November 10 to 29, 2008, echo laboratories were invited to report on a special electronic file the number of echocardiographic examinations performed and the number of those showing a peak tricuspid regurgitant flow velocity > or = 3 m/s., Results: 123 echo labs participated in the study. 21 483 echocardiograms were evaluated from 110 centers (58, 17 and 35 in North, Center and South Italy, respectively); 1410 (6.6%) exams showed a systolic regurgitant flow velocity > or = 3 m/s (median value 3.3 and interquartile range 0.46). Patients were predominantly female (female to male ratio 734/676), with a mean age of 71.8 +/- 11.8 years, median body mass index of 25.7 kg/m2 (interquartile range 5.5). Overall, 21.4% patients had no symptoms, 48.7% had dyspnea, 11.2% had asthenia, 3.9% had chest pain, and 7.4% had dyspnea and asthenia. Among the 1410 patients with a tricuspid regurgitant flow velocity > or = 3 m/s, 52.62% had left heart disease, 7.52% lung disease, 1.35% chronic thromboembolic pulmonary hypertension, 0.92% collagen disease, 0.43% congenital heart disease, 0.14% liver disease, 0.07% HIV, 26.45% more than one disease, and 10.5% presented suspected pulmonary hypertension of unknown cause., Conclusions: In the Italian echo labs, the occurrence of suspected pulmonary hypertension is not uncommon. Cardiologists should be encouraged to refer patients with suspected pulmonary hypertension of unknown origin to specialized centers in order to define the cause of pulmonary hypertension and to institute the appropriate therapy.

Acute pulmonary embolism is the third most common cardiovascular disease in Italy with approximately 65 000 new cases a year. Appropriate medical therapy does not necessarily prevent evolution of acute pulmonary embolism into chronic thromboembolic pulmonary hypertension (CTEPH), which occurs in 0.1-4.0% of cases. In our country, there are approximately up to 2600 new CTEPH patients a year. CTEPH is a progressive and potentially lethal disease. Medical therapy is palliative and only surgery can modify its natural history. Pulmonary endarterectomy (PEA) is the treatment of choice and lung transplantation should be considered only when PEA is contraindicated. Currently, nearly 4000 PEAs have been performed worldwide. Approximately ten centers are able to carry out this intervention with excellent and permanent results. Solid experience and close multidisciplinary collaboration allow appropriate patient selection, rigorous surgical technique, and adequate postoperative management. All these aspects represent the key to the success in the treatment of CTEPH. After PEA, quality and expected length of life are similar to the age-matched general population and the only therapy required is oral anticoagulation.