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Venous thromboembolism (VTE), consisting of both deep vein thrombosis (DVT) and pulmonary embolism (PE), is an extremely common condition both in the United States and worldwide. Not only is the diagnosis associated with significant morbidity and mortality for patients but it also imposes a deleterious financial burden on the US healthcare system. Diagnosis may be challenging due to variability in clinical presentation and requires a sequential workup including assessment of clinical pretest probability for VTE, D-dimer testing, and imaging. Following diagnosis, proper risk stratification is necessary to determine the appropriate treatment as well as the need for inpatient care. Elucidation of underlying major or minor risk factors at the time of diagnosis is essential as the presence of which may influence the duration of therapy. First-line treatment for most patients is anticoagulation with a direct oral anticoagulant (DOAC) for a minimum of 3-6 months. In multiple clinical trials, DOACs have proven to be non-inferior to vitamin K antagonists for the treatment of VTE with a lower risk of bleeding. Special consideration should be taken in the choice of agent and duration of treatment for patients who have underlying thrombophilias or malignancy and who are pregnant.

Background: Deep venous thrombosis (DVT) is a kind of vascular obstruction, that commonly and widely occurs in lower limbs. Due to the lack of obvious symptoms in the early stage, the rate of misdiagnosis and missed diagnosis is high. This study evaluated the expression and significance of lncRNA ASB16-AS1 (ASB16-AS1) in DVT aiming to identify a novel biomarker for its screening and monitoring., Methods: There were 77 DVT patients and 62 healthy individuals included in this study. Plasma ASB16-AS1 level was evaluated using PCR and compared between DVT and healthy groups. The diagnostic and prognostic values of ASB16-AS1 were assessed with ROC and Cox analyses. The correlation of ASB16-AS1 with patients' conditions, inflammation, and oxidative stress was evaluated by Spearman correlation analysis., Results: ASB16-AS1 was significantly upregulated in DVT (P < 0.001), which could discriminate DVT patients from healthy individuals with high sensitivity and specificity (AUC of ROC = 0.858). Increased ASB16-AS1 was associated with the incidence of complications (P = 0.033) and especially for pulmonary embolism in patients (P = 0.029). ASB16-AS1 was negatively correlated with prothrombin time (PT, r = -0.763), antithrombin level (AT, r = -0.711), and international normalized ratio (INR, r = -0.764), and showed positive correlation with fibrinogen (FIB, r = 0.793) and D-dimer (D-D, r = 0.731). Additionally, ASB16-AS1 was positively correlated with pro-inflammation cytokines (r IL-6 = 0.853, r IL-10 = -0.836, r hsCRP = 0.787) and pro-oxidative stress factors (r SOD = -0.751, r MDA = 0.842, r 8-isoPGF 2α = 0.840)., Conclusion: Upregulated ASB16-AS1 was identified as a diagnostic and prognostic biomarker of DVT and was closely associated with inflammation and oxidative stress during DVT., Competing Interests: Declarations. Ethics approval and consent to participate: The study protocol was approved by The Ethics Committee of Zibo Central Hospital (No. 201711010) and followed the principles outlined in the Declaration of Helsinki. In addition, informed consent has been obtained from the participants involved. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Clinical trial number: Not Applicable., (© 2025. The Author(s).)

Epstein-Barr virus (EBV) is a common herpesvirus that affects more than 90% of people worldwide. It is usually spread through saliva. Although most infections show no symptoms or only lead to mono, uncommon complications such as respiratory issues can arise, particularly in individuals with weakened immune systems. While rare, cases of EBV-related pneumonia, lung nodules, and venous thromboembolism have been occasionally reported. A 17-year-old male came in with fever, dyspnea, massive hemoptysis, and sore throat. Numerous pulmonary nodules were shown in imaging. According to broncho-alveolar lavage, and biopsy results EBV-induced pneumonia was diagnosed. During hospitalization, the patient also experienced deep vein thrombosis and needed heparin treatment. The current study contributes to the increasing amount of research on unusual displays of EBV in healthy adults. It highlights the significance of considering EBV in the differential diagnosis for healthy adults with unexplained pulmonary nodules and venous thromboembolism., (© 2025 Wiley Periodicals LLC.)

Hepatocellular carcinoma (HCC) stands as the predominant type of primary liver cancer, frequently accompanied by portal vein tumor thrombosis (PVTT). PVTT is a harbinger of a grim prognosis, with current treatment modalities falling short of expectations. Delving deeper into the pathophysiology of PVTT, researchers have come to recognize that PVTT and HCC may originate from different clones. Previous clinical investigations have proposed various PVTT classification systems, offering a scientific basis for individualized and precise treatment. The innovative surgical approach of "thrombectomy first" is designed to mitigate the risk of tumor spread, thereby enhancing patient outcomes. Moreover, the multidisciplinary and integrated treatment model, including targeted therapy, immunotherapy and radiotherapy, has demonstrated promising efficacy for the treatment of PVTT. With the continuous progress and optimization of PVTT diagnostic technology, classification systems and precision treatment strategies, the prospects for long-term survival in HCC patients with PVTT are poised to see a significant uplift.

Background: Cerebral venous thrombosis (CVT) is a rare condition in children, and its description remains limited in North Africa. The objective of our study was to describe the clinical, etiological, radiological, therapeutic, and evolutionary characteristics of children with CVT in western Algeria., Methods: This was a retrospective observational study involving children with CVT. The study was conducted at the unit of intensive care of Canastel Children's Hospital and the pediatric intensive care unit (PICU) of Oran Hospital Center (Algeria) from January 2012 to December 2022., Results: A total of 23 children were included in the study, with an average age of 48±57 months. The most frequent clinical signs were fever (61 %), altered consciousness (61 %), seizures (56.6 %), and headaches (36.8 %). The primary risk factors were head and neck infections (36.8 %). Thrombosis mainly affected the transverse sinus (65.2 %), followed by the superior sagittal sinus (39 %). Associated cerebral complications primarily included hemorrhagic lesions (52 %), hydrocephalus (26 %), and venous ischemic infarction (13 %). Overall, 21 % of children with CVT died while 34 % of our cohort had unfavorable outcomes. Predictors of an unfavorable outcome in multivariate analysis were , parenchymal hemorrhage (aOR: 16.04; 95 % CI: 1.28-201.5), and mechanical ventilation (aOR: 10.50; 95 % CI: 1.02-108.6)., Conclusion: Due to the nonspecific nature of CVT clinical signs and considering the risk factors, it is essential to perform cerebral imaging to confirm the diagnosis and initiate early and effective treatment aimed at reducing potential neurological sequelae and the risk of death., Competing Interests: Conflict of Interest The authors declare no conflicts of interest. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (Copyright © 2024 Société française de pédiatrie. Published by Elsevier Masson SAS. All rights reserved.)

Background: Current clinical guidelines suggest home treatment for patients diagnosed with acute deep venous thrombosis (DVT). A prognostic score has been proposed to identify low-risk patients; however, its validation remains limited., Method: This prospective observational study aimed to externally validate the prognostic score in selecting low-risk outpatients with acute DVT in the lower limbs. Consecutive outpatients diagnosed with acute DVT in a tertiary hospital were included. The score included 6 variables: heart failure, kidney failure, recent major bleeding, altered platelet count, immobilization, and cancer. The primary outcome was the incidence of a composite outcome, including confirmed diagnosis of PE, major bleeding, or all-cause death at 7 days. Patients meeting zero criteria were considered low risk., Results: Among the 1035 patients included, 485 (46.9 %) met zero criteria. Of these, 0.2 % (95 % CI 0.0-1.1 %) and 0.4 % (95 % CI, 0.0-1.5 %) patients experienced the composite outcome at 7 and 30 days, respectively. Among patients who met 1 or more criteria for admission, 344 patients (62.5 %) were discharged. Among these, the composite outcome at 7 and 30 days occurred in 2 (0.6 %) and 5 (1.4 %) patients, respectively. The C-statistics of the score were 0.68 (95 % CI, 0.57-0.79) and 0.69 (95 % CI, 0.64-0.76) at 7 and 30 days, respectively., Conclusion: This study demonstrates the efficacy of the prognostic score in identifying low-risk outpatients with acute DVT. It also suggests that a considerable proportion of patients with acute DVT may benefit from outpatient treatment despite having some risk criteria, highlighting the potential for optimizing ambulatory care pathways., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2024. Published by Elsevier B.V.)

Introduction: Staphylococcus aureus bacteraemia (SAB) is the most common cause of sepsis, contributing to paediatric intensive care unit admission in Australia and New Zealand. While deep venous thrombosis (DVT) has been reported in children with invasive S. aureus infections, the actual frequency and possible effects of thrombosis on disease severity and outcome in paediatric SAB remain unknown. Moreover, guidance regarding imaging for paediatric SAB management are poorly defined., Methods and Analysis: We report the protocol for the SNOOPY (Staphylococcus aureus Network; ultrasOund for diagnOsis of endovascular disease in Paediatrics and Youth) study. SNOOPY is a pilot prospective single-arm interventional study that aims to investigate the proportion of children with SAB that have venous thrombosis detected using whole body doppler ultrasound., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Description: Portal vein thromboses (PVTs) are common in patients with cirrhosis and are associated with advanced portal hypertension and mortality. The treatment of PVTs remains a clinical challenge due to limited evidence and competing risks of PVT-associated complications vs bleeding risk of anticoagulation. Significant heterogeneity in PVT phenotype based on anatomic, host, and disease characteristics, and an emerging spectrum of therapeutic options further complicate PVT management. This Clinical Practice Update (CPU) aims to provide best practice advice for the evaluation and management of PVT in cirrhosis, including the role of direct oral anticoagulants and endovascular interventions., Methods: This expert review was commissioned and approved by the American Gastroenterological Association (AGA) Institute CPU Committee and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership, and underwent internal peer review by the CPU Committee and external peer review through standard procedures of Gastroenterology. These Best Practice Advice statements were drawn from a review of the published literature and from expert opinion. Because systematic reviews were not performed, these Best Practice Advice statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations. Best Practice Advice Statements BEST PRACTICE ADVICE 1: Asymptomatic patients with compensated cirrhosis do not require routine screening for PVT. BEST PRACTICE ADVICE 2: Patients with cirrhosis with PVTs identified on Doppler ultrasound should undergo cross-sectional imaging with computed tomography or magnetic resonance imaging to confirm the diagnosis, evaluate for malignancy, and document the degree of lumen occlusion, clot extent, and chronicity. BEST PRACTICE ADVICE 3: Patients with cirrhosis and PVT do not require a hypercoagulable workup in the absence of additional thromboemboli or laboratory abnormalities or family history suggestive of thrombophilia. BEST PRACTICE ADVICE 4: Patients with cirrhosis and PVT with evidence of intestinal ischemia require urgent anticoagulation to minimize ischemic injury. If available, these patients should be managed by a multidisciplinary team, including gastroenterology and hepatology, interventional radiology, hematology, and surgery. BEST PRACTICE ADVICE 5: Consider observation, with repeat imaging every 3 months until clot regression, in patients with cirrhosis without intestinal ischemia and recent (<6 months) thrombosis involving the intrahepatic portal vein branches or when there is <50% occlusion of the main portal vein, splenic vein, or mesenteric veins. BEST PRACTICE ADVICE 6: Anticoagulation should be considered in patients with cirrhosis without intestinal ischemia who develop recent (<6 months) PVT that is >50% occlusive or involves the main portal vein or mesenteric vessels. Patients who have increased benefit of recanalization include those with involvement of more than 1 vascular bed, those with thrombus progression, potential liver transplantation candidates, and those with inherited thrombophilia. BEST PRACTICE ADVICE 7: Anticoagulation is not advised for patients with cirrhosis with chronic (>6 months) PVT with complete occlusion with collateralization (cavernous transformation). BEST PRACTICE ADVICE 8: Patients with cirrhosis and PVT warrant endoscopic variceal screening if they are not already on nonselective beta-blocker therapy for bleeding prophylaxis. Avoid delays in the initiation of anticoagulation for PVT, as this decreases the odds of portal vein recanalization. BEST PRACTICE ADVICE 9: Vitamin K antagonists, low-molecular-weight heparin, and direct oral anticoagulants are all reasonable anticoagulant options for patients with cirrhosis and PVT. Decision making should be individualized and informed by patient preference and Child-Turcotte-Pugh class. Direct oral anticoagulants may be considered in patients with compensated Child-Turcotte-Pugh class A and Child-Turcotte-Pugh class B cirrhosis and offer convenience as their dosages are independent of international normalized ratio monitoring. BEST PRACTICE ADVICE 10: Patients with cirrhosis on anticoagulation for PVT should have cross-sectional imaging every 3 months to assess response to treatment. If clot regresses, anticoagulation should be continued until transplantation or at least clot resolution in nontransplantation patients. BEST PRACTICE ADVICE 11: Portal vein revascularization with transjugular intrahepatic portosystemic shunting may be considered for selected patients with cirrhosis and PVT who have additional indications for transjugular intrahepatic portosystemic shunting, such as those with refractory ascites or variceal bleeding. Portal vein revascularization with transjugular intrahepatic portosystemic shunting may also be considered for transplantation candidates if recanalization can facilitate the technical feasibility of transplantation., (Published by Elsevier Inc.)

Splanchnic vein thrombosis (SpVT) is an uncommon site of venous thrombosis that is associated with complications including portal hypertension and hepatic dysfunction. The evaluation and management of this patient population has evolved in recent years, but there are limited data from clinical trials to guide management. Given the various acquired and biologic risk factors leading to the development of SpVT and the potential complications that can arise from it, input from a multidisciplinary team can be valuable in managing such patients, including thrombosis specialists or hematologists, gastroenterologists or hepatologists, interventional radiologists, and surgeons. In this article, we present 4 cases that highlight important issues and considerations in the evaluation of SpVT, including initial diagnostic approach in a patient with a new diagnosis of SpVT, considerations for anticoagulant therapy, management of SpVT in patients with myeloproliferative neoplasms, and the role of interventional vascular procedures in the management of SpVT. By reviewing the current literature, we address clinically relevant questions that are posed to clinicians managing patients with SpVT; we also point out gaps in our current knowledge that merit future investigation., Competing Interests: Declaration of competing interests R.P. serves as a consultant to Merck Research, outside the submitted work. Other authors declare no conflicts of interest., (Copyright © 2024 International Society on Thrombosis and Haemostasis. Published by Elsevier Inc. All rights reserved.)

Background: Post-thrombotic syndrome (PTS) is a common complication of deep vein thrombosis (DVT) that occurs in 20-50% of patients and results in a decreased quality of life. Even with the progressive identification of PTS risk factors, clinically useful predictors of PTS continue to be limited, unobjective, and ill-defined. The neutrophil-to-lymphocyte ratio (NLR) is an emerging prognostic biomarker used in a variety of diseases that reflects acute systemic inflammation. This pilot study aimed to evaluate the utility of the NLR at the time of iliofemoral DVT diagnosis in predicting PTS incidence in patients., Methods: A retrospective chart review was performed on patients identified with iliofemoral DVT at the University of Maryland Medical Center between 2020 and 2022. Patients with at least one follow-up visit between 3 and 6 months after initial DVT diagnosis were included. Diagnosis of PTS was determined based on Villalta Score. The Youden index with receiver operating characteristic curve analysis was used to determine the NLR cut-off value that may be predictive of PTS. A multivariable logistic regression model was then performed to assess the utility of this NLR cut-off value and other common clinical markers in predicting the presence of PTS symptoms., Results: Four hundred and eighteen patients with positive iliofemoral DVT venous duplex ultrasounds were screened for eligibility. One hundred and eighteen patients were eligible with a mean age of 53.18 ± 15.45 years. A total of 43 patients (36.44%) were found to have PTS. An NLR cut-off of 7.71 was determined with an area under the receiver operating characteristic curve (area under the curve) of 0.63 (P = 0.046). When the NLR was assessed jointly with other clinical markers at the time of DVT diagnosis, NLR was a statistically significant positive predictor, measured using odds ratio (1.83; 95% confidence interval, 1.20-2.78; P = 0.005)., Conclusions: Our study found that when stratified by a determined cutoff value, the NLR at the time of DVT diagnosis was significantly associated with the development of PTS in patients with iliofemoral DVT. This result is consistent with one prior research finding yet is novel in its specificity for iliofemoral DVTs and its acute lab collection for NLR calculation. The NLR should be further investigated as a potential inexpensive prognostic tool to aid in the improvement of treatment and prophylactic strategies for PTS., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To determine whether there was a possible predictive relationship between systemic immune-inflammation index (SII) and recurrence of deep venous thrombosis (DVT)., Methods: A total of 231 patients with DVT who met the study criteria and whose data could be accessed were enrolled to this retrospective single-centered cross-sectional study. Of them 26 patients with DVT recurrence consisted of the study group (Group 1) while remaining 205 cases without recurrence were considered as the control population (Group 2). The patients' basic clinical features and laboratory results from the complete blood count (CBC) test were recorded and compared between groups. Following univariate analyses, a multivariate logistic regression analysis was performed to identify the independent predictors of the recurrence of DVT. Additionally, a receiver-operating characteristic (ROC) curve analysis was performed to detect the cut-off values of the predictors with sensitivity and specificity rates., Results: There were no significant differences between the groups for basic clinical features, except for diabetes mellitus, pulmonary embolism, and atrial fibrillation. Although the univariate analysis revealed that the median values of NLR, PLR, and SII were significantly higher in the DVT recurrence group, only SII was determined to be a significant and independent predictor of DVT recurrence in the multivariate logistic regression analysis. According to ROC curve analysis, SII of 1685 × 10 3 /mm 3 constituted the cut-off value for predicting DVT recurrence with 61.5% sensitivity and 76.6% specificity (AUC = 0.686, p = .001)., Conclusion: The present study demonstrated for the first time in the literature that SII significantly predicted the recurrence of DVT., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

&lt;b&gt;Introduction:&lt;/b&gt; Central venous thrombosis (CVT) represents a well-documented complication of acute otitis media (AOM) and acute mastoiditis (AM). Despite widespread antibiotic utilization, which has significantly reduced the incidence of severe AOM/AM complications, recent years have witnessed an increasing frequency of thrombotic complications in pediatric patients, not invariably presenting with classical neurological manifestations.&lt;b&gt;Aim:&lt;/b&gt; This study aimed to investigate the potential correlation between COVID-19 infection and increased CVT incidence, while sharing therapeutic experiences, given the absence of standardized treatment protocols for otogenic CVT in pediatric populations.&lt;b&gt;Materials and methods:&lt;/b&gt;A retrospective observational analysis was conducted on patients admitted to the Department of Pediatric Otolaryngology at the Medical University of Warsaw for otogenic CVT between 2018 and 2023, with treatment completion by January 2024. The investigation encompassed the extent of thrombotic changes, concurrent complications, anticoagulation therapy modalities and duration, and therapeutic monitoring protocols.&lt;b&gt;Results:&lt;/b&gt; The study cohort comprised 13 patients, with complete follow-up data available for 11 subjects. Low-molecular-weight heparin (LMWH) monotherapy achieved a 60% success rate (defined as complete recanalization), while combination anticoagulation therapy demonstrated a 16.67% success rate. Notably, all cases exhibited regression of active thrombosis, constituting a satisfactory therapeutic outcome.&lt;b&gt;Conclusions:&lt;/b&gt; Anticoagulation therapy demonstrated both efficacy and safety, with no significant hemorrhagic complications observed. These findings underscore the necessity for multicenter analysis to establish evidence-based clinical guidelines.

Patients with cerebral venous thrombosis (CVT) may experience poor response to anticoagulant therapy and delayed surgical treatment may lead to clinical deterioration. However, the factors contributing to clinical deterioration remain poorly understood. Patients with CVT from three centers between January 2017 and October 2023 were included and grouped as the development cohort and validation cohort. The danger triangle was defined as the posterior two-thirds of the superior sagittal sinus, confluence of sinuses, straight sinus, and deep venous system. The primary endpoint was clinical deterioration, characterized by new or progressive bleeding or infarctions or worsened neurological conditions post-admission. Using the results of multivariable logistic analysis, the Cerebral venOus thrombosis DEterioration (CODE) score was developed within the development cohort and validated within the validation cohort. The score' performance in predicting clinical deterioration was evaluated using the area under the receiver operating characteristic curve (AUC). The development cohort included 194 CVT patients (101 males, and the median age was 38 years). clinical deterioration occurred in 45 (23.2%) patients. Multivariate logistic analysis defined D-dimer > 1.5 mg/L, Glasgow coma scale ≤ 8, intracerebral hemorrhage, danger triangle as risk factors of clinical deterioration. The CODE score integrating these factors performed well to predict patients suffering from clinical deterioration within the validation cohort (n = 79, 11 deteriorations) with an AUC of 0.83 (95%CI, 0.71-0.96) and an accuracy of 88.6% (95%CI, 81.4-95.8%). CODE score could evaluate the risk of clinical deterioration in CVT patients and may serve as a useful tool for decision-making for CVT. Clinical Deterioration in Cerebral Venous Thrombosis: A Predictive Study (CVT deterioration cohort), ClinicalTrials.gov number: NCT06266585, link: https://classic.clinicaltrials.gov/ct2/show/NCT06266585 )., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Deep vein thrombosis (DVT) is one of the important factors leading to death in patients undergoing fracture surgery. This study aims to investigating the predictive value of the Caprini score combined with thrombus molecular markers for the risk of DVT in patients after traumatic fracture surgery. A total of 342 patients who underwent surgery for traumatic fractures were included in the study. The patients were divided into two groups based on the occurrence of DVT after surgery: the DVT group (n = 57) and the non-DVT group (n = 285). A univariate analysis and logistic regression analysis were conducted on clinical factors and laboratory indicators that might be associated with DVT in patients with traumatic fractures. A predictive model for DVT risk was then constructed by combining thrombus molecular markers with the Caprini score. The median age of all patients was 65 years (54-75 years), the postoperative Caprini score was 9 (6-11), and the length of hospital stay was 11 days (8-16 days). In univariate analysis, age (P = 0.029), postoperative Caprini score (P < 0.001), and length of hospital stay (P = 0.009) were significantly associated with the occurrence of DVT. Logistic regression analysis showed that the risk of developing DVT increased with higher postoperative Caprini scores (P < 0.001), longer hospital stays (P = 0.024), and higher PIC levels (P = 0.046). Among these, the postoperative Caprini score was the most effective factor for diagnosing DVT, with an area under the curve (AUC) of 0.814 (P < 0.001) and a diagnostic cutoff of 11 points. The overall diagnostic efficacy of individual thrombus molecular markers from highest to lowest was TM, DD, PIC, t-PAIC, and TAT, with all except TAT showing statistical significance. The combined diagnostic efficacy of the postoperative Caprini score and PIC also showed statistical significance (AUC = 0.869, P < 0.001). Thrombus molecular markers combined with the postoperative Caprini score have potential predictive value for the risk of DVT in patients after traumatic fracture surgery., Competing Interests: Declarations. Ethical approval: Ethical approval of this study was approved by the ethics committee of Zhejiang Provincial People’s Hospital (approval NO. 2024 − 106). Informed consent was waived by Zhejiang Provincial People’s Hospital ethics committee. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Screening of deep vein thrombosis (DVT) is an NHS priority for improving community health service. Effective DVT screening and documentation improve patient outcomes, prevent prolonged hospitalisation and lead to fewer expenses. The lack of evidence of DVT screening in the community requires action. This Quality Improvement Project focuses on improving DVT screening and documentation for housebound patients in the community., Aim: To improve screening and documentation of DVT in four months by introducing several interventions in collaboration with one care community., Methods: The authors used a fishbone analysis and driver diagram to form three 'Plan, Do, Study and Act' cycles. The authors also developed a Wells' template, delivered a training session, had a team meeting with community nurses, audited their screening records and collected their feedback., Findings: There was a 74% increase in staff using the National Institute for Health and Care Excellence guidelines and 100% documentation of DVT assessment, of which 82% used the Wells' score template., Conclusions: DVT screening and documentation in community services can be optimised and sustained with training and monitoring., Competing Interests: Declaration of interest: None

Background: Prognostic nutritional index (PNI) has recently been identified as a novel marker of nutritional status. However, existing evidences on the association between PNI and the risk of lower extremity deep venous thrombosis (LEDVT) are limited and conflicting., Objective: To determine the association between PNI and the risk of LEDVT, and further evaluate its diagnostic value., Methods: Over a 10-year period (2012-2022), a total of 12790 patients who underwent compression ultrasonography examinations were consecutively included, and 1519 (11.9%) LEDVT events occurred. Multivariate logistic regression analysis was used to investigate the association, and receiver operating characteristic (ROC) curve was constructed to evaluate its diagnostic performance., Results: After full adjustment, patients in third quartile (odds ratio [OR] = 1.486, 95% confidence interval [CI]: 1.205-1.832), second quartile (OR = 2.436, 95% CI: 1.993-2.978) and first quartile (OR = 3.422, 95% CI: 2.791-4.195) of PNI were at higher risk of LEDVT compared with those in fourth quartile, and the test for trend was significant. Consistently, each unit decrease in PNI was associated with a 6.0 % (95% CI: 1.052-1.069) increased risk of LEDVT. Moreover, adding PNI to a base model improved the area under the curve (AUC) from 0.721 (95% CI: 0.709-0.734) to 0.746 (95% CI: 0.734-0.758)., Conclusion: PNI is inversely associated with the risk of LEDVT, and provides significant incremental diagnostic value for the identification of LEDVT events. These findings suggest that PNI may be a potential biomarker to help clinicians identify patients at risk of thrombosis and make clinical decisions timely., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Deep vein thrombosis (DVT) is a commonly occurring problem-causing tissue damage, pain, immobility, and even death. This article describes the risk factors and pathophysiology associated with DVT; related signs, symptoms, and complications; diagnosing and treating DVT; and the role of the home care clinician when a patient suffers from this potentiallly debilitating and life-threatening condition., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

Post thrombotic syndrome (PTS) is a frequent complication occurring in patients with deep venous thrombosis (DVT). This chronic condition is associated with a negative impact on quality of life and substantial economic costs. Despite current treatment with anticoagulants and compression therapy, a significant proportion of DVT patients develop PTS. Optimising the diagnosis and identification of high-risk patients is important to provide more appropriate individualised treatment. In addition, a better understanding of the pathogenesis is leading to the necessary improvement of both current treatment strategies and the development of new treatment modalities. Treatments aimed at prevention as well as those aimed at reducing the symptoms of already manifested PTS should be further investigated. Research is currently taking place on promising therapeutical targets including pharmacological (anti-inflammatory and venoactive drugs), and interventional approaches (e.g. mechanical thrombectomy) in patients at different stages of PTS. Progress in all these areas is needed to solve the complex problem of PTS.

Background: To investigate the power of inflammation/immune indices in-hospital deep vein thrombosis (DVT) and any venous thromboembolism (VTE) event (VTE: DVT + pulmonary embolism [PE]) that may occur after trauma or surgery and to identify the strongest predictors., Methods: This was a retrospective study conducted between January 2020 and December 2022. A total of 216 patients with suspicion of DVT or PE during their hospital stay for trauma or surgery were included in the study. Monocyte-lymphocyte ratio, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, systemic inflammatory index, systemic inflammation response index, and aggregate index of systemic inflammation (AISI) were calculated. Participants were divided into the following 3 groups: those without DVT or PE (control group, n = 70), only DVT (DVT group, n = 71), and both DVT and PE (VTE group, n = 75)., Results: The median D-dimer, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, monocyte-lymphocyte ratio, systemic inflammatory index, systemic inflammation response index, and AISI values of VTE group were significantly higher than both the control and DVT groups (P < 0.001 for all). The DVT group also had significantly higher values for these parameters compared to controls (P < 0.001 for all). All of these indices had significantly high performance to detect DVT or PE (P < 0.001 for all). Despite very high performance (some exceeding D-dimer measurement) detected for all examined parameters, AISI was the best predictor in both DVT and VTE (DVT + PE) prediction (area under receiver operating characteristic curve = 0.995 and 0.959, respectively)., Conclusions: These indices, especially AISI, can play a role in the initial screening and risk stratification of patients at high risk of DVT or VTE after surgery or trauma., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Postthrombotic syndrome (PTS) is a chronic condition following deep vein thrombosis (DVT) and is associated with pain, swelling, and restricted use of the affected limb. In pediatric age groups, its incidence and risk factors are not well-known., Methods: This observational cohort study of all consecutive children (≤18 years) with DVT treated at the Emma Children's Hospital Amsterdam between January 2001 and January 2021 was conducted to identify incidence and risk factors for PTS in neonates aged ≤2 months and children aged >2 months. PTS was diagnosed using the modified Villalta scale., Results: In total, 315 patients were included. The 20-year incidence of PTS was 20.0% in neonates and 40.0% in children. In neonates, involvement of ≥3 vessels (odds ratio [OR], 6.6; 95% CI, 1.6-26.4) and incomplete thrombus resolution (OR, 3.0; 95% CI, 1.1-8.0) were risk factors for PTS. In children, involvement of ≥3 vessels (OR, 6.2; 95% CI, 2.2-17.8), recurrent DVT (OR, 3.7; 95% CI, 1.3-10.3), and incomplete thrombus resolution (OR, 5.2; 95% CI, 1.6-17.0) were associated with PTS. Exercise ≥3 times/wk (OR, 0.4; 95% CI, 0.2-0.9), central venous catheter-related DVT (OR, 0.2; 95% CI, 0.1-0.5), and provoked DVT (OR, 0.4; 95% CI, 0.1-0.97) were protective factors for PTS., Conclusion: This study demonstrated a high incidence of pediatric PTS. Additionally, risk factors for PTS differed between neonates and children. These findings provide a basis for better prevention and management of PTS that may differ between neonates and children., Competing Interests: Declaration of competing interests There are no competing interests to disclose., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Deep vein thrombosis is a common complication after surgery, particularly in cancer patients, ‎necessitating efficient diagnostic methods for timely intervention., Objective: This study aimed to investigate the potential of combining C-reactive protein (CRP) and interleukin-6 (IL-6) tests in diagnosing deep vein thrombosis (DVT) following endometrial cancer surgery., Methods: A cohort of 60 patients who developed DVT post-endometrial cancer surgery and were admitted to the First Hospital of Hebei Medical University between March 2018 and March 2022 constituted the DVT group. Additionally, 60 patients who underwent endometrial cancer surgery during the same period but did not develop DVT formed the non-DVT group. Serum levels of CRP and IL-6 were quantified and compared between the two groups using reliable laboratory techniques. Subsequently, the diagnostic accuracy of single-parameter testing (CRP or IL-6 alone) versus combined testing (CRP and IL-6) for postoperative DVT was assessed., Results: Analysis revealed significantly elevated levels of CRP and IL-6 in the serum of patients in the DVT group compared to those in the non-DVT group (P < .05). Furthermore, combined testing of CRP and IL-6 exhibited heightened sensitivity (0.85%), specificity (0.917%), and area under the curve (AUC) (0.952) compared to single-parameter testing alone, indicating its superiority in diagnosing postoperative DVT., Conclusions: The combination of CRP and IL-6 testing presents a promising diagnostic strategy for identifying postoperative DVT in endometrial cancer patients. Implementing this approach in clinical practice could facilitate early detection and prompt management of DVT, thereby potentially reducing associated morbidity and mortality.

Aims: This study aimed to investigate the predictive value of the platelet indices for the diagnosis of acute deep vein thrombosis (DVT) in pregnant women., Materials and Methods: Pregnant women aged 20-45 years who presented to the emergency room with leg pain and edema and underwent bilateral lower extremity venous Doppler examination for DVT were included in the study. Platelet large cell ratio (P-LCR), platelet distribution width (PDW) and mean platelet volume (MPV) values, which provide information on current platelet activity in the hemogram parameters recorded at first presentation in the emergency department, were analyzed between the two groups. Pregnant women with a history of venous thromboembolism, anticoagulant medication, heart disease, cancer, essential thrombocytopenia, gestational thrombocytopenia, pulmonary embolism, and multiple pregnancies were excluded., Results: A total of 125 participants were included in the study. Acute DVT was diagnosed in 37 participants using venous Doppler of the lower extremities. In the remaining 88 patients, the diagnosis of DVT was excluded. There was no significant difference between the groups in terms of age, body mass index, parity, and gestational age at diagnosis. Although platelet counts were similar between groups, P-LCR, PDW, and MPV values, which provide information on platelet shape and volume, were statistically significantly lower in Group DVT (p < 0.05)., Conclusion: According to this study, low MPV, PDW and P-LCR values in pregnant women can be evaluated as independent markers in the diagnosis of acute DVT or these markers can be included in the DVT scoring system for pregnant women., (© 2025 Japan Society of Obstetrics and Gynecology.)

Purpose: This retrospective cohort study aimed to identify factors associated with preoperative deep venous thrombosis (DVT) in elderly patients with femoral neck fractures, and to investigate whether combining these factors could improve the ability to predict DVT., Method: Medical records and laboratory test results were reviewed patients presenting with a femoral neck fracture and receiving routine chemoprophylaxis for DVT between January 2020 and December 2023 in a tertiary referral, university-affiliated hospital. Preoperative DVT was confirmed by Doppler ultrasound or CT venography. Demographic, injury, comorbidity, and laboratory variables were analyzed using univariate and multivariate approaches. The performance of combined predictive factors was evaluated using receiver operating characteristic (ROC) curve analysis., Results: Among the 499 patients included, 47 (9.4%) were diagnosed with a preoperative DVT. In the univariate analysis, five variables were found to be statistically significant, including alcohol consumption (P = 0.017), history of renal disease (P < 0.001), elevated D-dimer level (both traditional and age-adjusted cut-off used) (P = 0.007 or < 0.003), increased platelet distribution width (PDW) (P < 0.001) and reduced albumin in continuous or categorical variable (P = 0.027, P = 0.002). Multivariate analysis confirmed all except alcohol consumption as independent predictors (all P < 0.05). ROC curve analysis showed that combining these four significant variables with age improved the ability to predict preoperative DVT, with an area under the curve of 0.749 (95% CI: 0.676-0.822, P < 0.001), sensitivity of 0.617, and specificity of 0.757., Conclusion: This study identified several factors associated with preoperative DVT, and combining them demonstrated improved performance in predicting DVT, which can facilitate risk assessment, stratification and improved management in clinical practice., Competing Interests: Declarations. Ethics approval and consent to participate: The authors confirmed that all experiments were performed in accordance with relevant guidelines and regulations. The study protocol was approved by the ethics committee of the local hospital, which waived the need for informed consent from participants due to the deidentified data used herein. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

A 37-year-old pregnant woman presented to the emergency department with central facial palsy, ipsilateral right hemiparesis, and seizures. Brain Computed Tomogram (CT) showed intracerebral hemorrhage (ICH) and bilateral frontal edema. Magnetic resonance imaging (MRI) revealed multifocal hemorrhages consistent with a diagnosis of multiple simultaneous ICH (MSICH) (Figure 1). We suspected cerebral venous thrombosis (CVT) and performed a MR angiogram confirming this diagnosis (Figure 2). Upon admission, the patient was treated with low-molecular-weight heparin and transitioned to direct oral anticoagulation at discharge. Non traumatic MSICH is a rare imaging finding with high mortality, usually arterial in origin (1). However, since treatment options vary, cerebral venous thrombosis should always be considered in the differential diagnosis, especially in young female patients with known risk factors, such as pregnancy and puerperium (2-4). MRI modalities (Echo-GRE) are valuable tools in identifying ICH when CT is inconclusive (5).

A new era for diagnosing and treating Deep Vein Thrombosis (DVT) relies on precise segmentation from medical images. Our research introduces a novel algorithm, the Modified-Net architecture, which integrates a broad spectrum of architectural components tailored to detect the intricate patterns and variances in DVT imaging data. Our work integrates advanced components such as dilated convolutions for larger receptive fields, spatial pyramid pooling for context, residual and inception blocks for multiscale feature extraction, and attention mechanisms for highlighting key features. Our framework enhances precision of DVT region identification, attaining an accuracy of 98.92%, with a loss of 0.0269. The model also validates sensitivity 96.55%, specificity 96.70%, precision 98.61%, dice 97.48% and Intersection over Union (IoU) 95.10% offering valuable insights into DVT segmentation. Our framework significantly improves segmentation performance over traditional methods such as Convolutional Neural Network , Sequential, U-Net, Schematic. The management of DVT can be improved through enhanced segmentation techniques, which can improve clinical observation, treatment planning, and ultimately patient outcomes., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Deep venous thrombosis of the lower extremity is a common and fatal complication of hip fracture in the elderly. However, there is a lack of targeted laboratory diagnostic methods. Although traditional laboratory indicators can provide some reference, the diagnostic efficiency is relatively limited This study aimed to investigate the diagnostic accuracies of thromboelastography (TEG) combined with traditional coagulation parameters for early diagnosis of newly occurring lower extremity deep vein thrombosis (DVT) in elderly patients with hip fractures., Methods: We conducted a retrospective cohort study including seventy-four elderly patients with hip fractures without lower extremity DVT at admission between 2022 and 2023. Disease history, laboratory tests including blood routine, six coagulation parameters at admission, and TEG on the day after the operation were collected using validated methods. Color Doppler ultrasonography of lower extremity venous was performed at admission and discharge to confirm the diagnosis of perioperative new thrombosis. A logistic regression model was used to construct joint diagnostic indexes using traditional parameters, including coagulation parameters and patient histories, combined with TEG indicators, and the receiver operating characteristic (ROC) curve was used to evaluate the discriminatory ability of each single TEG indicator and joint diagnostic indicators for newly occurring thrombosis in elderly patients with hip fracture., Results: The incidence of lower extremity DVT was 33.78%. The average age was 82.0 years, and 7.0% were male. The TEG R values at discharge were 5.8 min and 6.3 min for the DVT and without VTE groups, respectively, showing a significant difference (p = 0.035). D-dimer levels in the DVT group were significantly higher than in the non-VTE group (4.3 vs. 2.9 mg/L, p = 0.029). The multivariate-adjusted model showed significant correlations between newly occurring DVT and TEG indicators, including R values, D-dimer, and BMI, with odd ratio values of 0.43, 1.43, and 1.25, respectively (all p value < 0.05). Among each traditional coagulation parameter and TEG indicators, D-dimer and R-value had the highest diagnostic accuracy (ROC area under the curve, AUC for D-dimer: 67.7%; AUC for R: 67.6%), respectively. For joint indicators, the combination of R + CI + αangle + D-dimer had the highest AUC (0.7475), followed by R + CI + αangle + BMI (0.7123). R + CI + αangle + gender had the lowest AUC (0.5920)., Conclusion: TEG demonstrates diagnostic value for newly occurring lower extremity DVT in elderly hip fracture patients. When combined with traditional coagulation parameters and patient histories, its diagnostic value is further enhanced, providing robust support for the establishment of a more comprehensive diagnostic and predictive scoring system for DVT in elderly hip fracture patients., Competing Interests: Declarations. Ethics approval and consent to participate: The study complied with all the relevant national regulations and institutional policies and was by the tenets of the Helsinki Declaration. It was approved by the ethical committee of China-Japan Friendship Hospital (ref. number: 2023-KY-145), and although the study was considered to have a minimal risk for patients since the blood samples for the TEG analysis were collected as part of routinely performed blood draws and no additional blood draws were performed, written consent was obtained from every patient. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: To explore the correlation between the levels of D-dimer (D-D), fibrinogen (FIB), fibrinogen degradation products (FDP) and platelets (PLT) in peripheral blood of patients with lower limb fractures and the formation of deep vein thrombosis in lower limbs, and to establish a new thrombosis prediction model for patients with lower limb fractures., Methods: The patients were divided into DVT group and non DVT group according to whether there was deep vein thrombosis of the lower extremity. The differences in the levels of D-D, FIB, FDP and platelets between the two groups were analyzed and compared. ROC curve was used to evaluate the levels of D-D, FIB, FDP and PLT in the peripheral blood of patients with lower extremity fracture to predict the formation of deep vein thrombosis of the lower extremity. Logistic regression analysis was used to analyze the related risk factors of deep vein thrombosis, and the corresponding nomogram risk prediction model of lower limb deep vein thrombosis in patients with lower limb fractures was drawn according to the regression coefficient, which was verified by calibration curve, receiver operating characteristic curve (ROC) and consistency index (C-index)., Results: The levels of D-D, FIB, FDP, and PLT in the DVT group were higher than those in the non DVT group, with statistical significance (P < 0.05); Moreover, FIB is superior to D-D, FDP, and PLT in predicting the risk of fractures and thrombosis, while PLT has the weakest predictive power. Multivariate logistic analysis showed that platelet, D-D, FIB and FDP were independent risk factors for deep vein thrombosis in patients with lower limb fractures (P < 0.05); Based on the independent risk factors mentioned above, the complex logistic regression formula was transformed into a visual column chart, and the consistency index (C-index) was 0.962 and 0.936, and the external verification C-index was 0.841. The calibration curve showed that the nomogram is in high agreement with the actual results. The AUC value of ROC curve indicated that the nomogram has high prediction value., Conclusions: The levels of D-D, FIB, FDP and PLT in peripheral blood of patients with lower limb fracture and DVT were significantly increased. Early monitoring of D-D, FIB, FDP and PLT levels in patients with lower limb fracture can effectively screen for lower limb deep vein thrombosis., Competing Interests: Declarations. Ethics approval and consent to participate: This study was conducted according to the ethical principles of medical research involving human subjects in the Declaration of Helsinki and have been approved by the biomedical ethics committee of the 900th Hospital of Joint Logistics Support Force (Number: 2024–093). Patients and their families signed informed consent before operation. Written consent has been received from the subject. Consent for publication: Written informed consent for publication was obtained from the participant. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Deep vein thrombosis (DVT) is an obstructive disease with a hindering venous reflux mechanism. The aim of this study was to identify independent risk factors for deep vein thrombosis (DVT) in patients with traumatic lower extremity fractures and assess the diagnostic value of thromboelastogram (TEG) and thrombus molecular markers., Methods: Reviewed patients with lower extremity fractures were admitted from October 2022 to September 2023. DVT was screened using color Doppler ultrasonography postoperation. Patients were categorized into two groups: those with DVT (n = 61) and those without (n = 191). Logistic regression was utilized to analyze DVT risk factors in these patients, and the diagnostic effectiveness of each marker was determined using the receiver operating characteristic curve (ROC curve)., Results: Significant differences were found in the incidence of hip (44.8%), and tibia (16.4%) fractures in the DVT groups (P < 0.001). Elevated levels of tPAIC, PIC, sTM, TAT, APTT, and TEG parameters (angle, MA, and CI) were observed in the DVT group (P < 0.05). Multivariate logistic regression revealed that PIC, sTM, TAT, angle, MA, CI, Caprini score, and hip fracture were significant risk factors for DVT., Conclusions: Patients with hip fractures showed a higher incidence of perioperative DVT. Factors such as PIC, sTM, TAT, angle, MA, CI, Caprini score, and hip fracture significantly contributed to the risk of DVT in traumatic lower limb fractures. Both thromboelastogram and thrombus molecular markers demonstrated strong diagnostic capabilities in the early detection of DVT, with comparable diagnostic efficiency., Competing Interests: Declarations. Ethics approval and consent to participate: This study was in accordance with the institutional Ethics Committee of People’s Hospital of Deyang City (Approval No. 2023–06-013-K01). Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Objective: To review and analyze the clinical diagnosis and treatment of renal Ewing's sarcoma with venous tumor embolus, to follow up the survival and prognosis of the patients, and to provide help for the diagnosis and treatment of the disease., Methods: Clinical data (including general data, surgical data and postoperative pathological data) of patients diagnosed with renal Ewing's sarcoma with venous tumor embolus in Peking University Third Hospital from June 2016 to June 2022 were collected, and the prognosis of the patients was followed up to analyze the influence of diagnosis and treatment process on the prognosis of the disease., Results: There were 6 patients, including 1 male and 5 females. There were 4 cases of left renal tumor and 2 cases of right renal tumor. The median age at diagnosis was 28 years (16-52 years). The imaging findings were all exogenous tumors with internal necrotic tissue and hemorrhage. The mean maximum tumor diameter was 12.6 cm, and the mean tumor thrombus length was 7.8 cm. Four patients underwent open surgery and 2 patients underwent laparoscopic surgery. The postoperative pathological results were renal Ewing sarcoma. Immunohistochemical results showed 3 cases of CD99 (+), 2 cases of FLI-1 (+), and 1 case of CD99, FLI-1 (-). 3 patients received chemotherapy (cyclophosphamide, doxorubicin, vincristine/ifosfamide, etoposide), 1 case received chemotherapy combined with radiotherapy, and 2 cases received no adjuvant therapy. The mean overall survival (OS) of the 6 patients was 37 months, and the mean OS of the 4 patients (47 months) who received chemotherapy was significantly higher than that of the 2 patients (16 months) who did not receive chemotherapy ( P =0.031)., Conclusion: Renal Ewing's sarcoma with venous tumor embolus is rare in clinic, and it is common in young female patients. The operation is difficult and the prognosis is poor. Surgical resection, adjuvant radiotherapy and chemotherapy can improve the overall survival rate of the patients.

Background: The relationship between thromboelastogram (TEG) hypercoagulation status and perioperative deep vein thrombosis (DVT) in patients with femoral and pelvic fractures is not well understood. We aimed to investigate the relationship between hypercoagulation status identified by thromboelastography and postoperative DVT formation in patients with femoral and pelvic fractures, as well as to evaluate the role of thromboelastography in assessing hypercoagulation status and predicting postoperative DVT formation., Methods: Data from 2,065 patients with femoral and pelvic fractures who underwent surgical treatment at a hospital in China between May 2018 and December 2023 were retrospectively analysed. Hypercoagulable TEG was defined as reaction time (R) < 5 min, coagulation time (K) < 1 min, alpha angle (α) > 72 degrees, maximum amplitude (MA) > 70 mm, and/or coagulation index (CI) > 3. The correlation between preoperative hypercoagulability identified by TEG and postoperative DVT formation was assessed using multivariate logistic regression. Propensity score matching (PSM) was performed to control for confounding factors., Results: Compared to the non-DVT group, the DVT group had decreased R and K values, while the α, MA, and CI values significantly increased (P < 0.05). Multivariate logistic regression analysis demonstrated that hypercoagulable TEG findings were predictive of postoperative DVT formation. PSM, using a 0.1 calliper value, matched 296 patients from the hypercoagulation and non-hypercoagulation groups in a 1:1 ratio. Before PSM, hypercoagulable TEG was associated with DVT in femoral and pelvic fractures (P < 0.001, odds ratio [OR]:1.860, 95% confidence interval: 1.389-2.492). After PSM, these two variables remained correlated (P = 0.001, OR = 1.878, 95% confidence interval:1.301 - 2.709)., Conclusions: The hypercoagulable state identified by TEG can predict thromboembolic events in patients with femoral and pelvic fractures., Trial Registration: The study was registered in the Chinese Clinical Trial Register ( https://www.chictr.org.cn/bin/home ) on April 16, 2024, with registration number ChiCTR2400083135., Competing Interests: Declarations. Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of the First Affiliated Hospital at Chongqing Medical University (K2023-526) on October 12, 2023, which waived the need for written informed consent. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

To explore the clinical manifestations and factors leading to misdiagnosis in pulmonary embolism (PE) patients in a cardiology department. We retrospectively analyzed 74 patients diagnosed with PE at our hospital from March 2018 to March 2022, comparing them to 136 patients suspected of PE but excluded by computed tomography pulmonary angiography during the same period. Both groups received the same basic care, including disease counseling, nutritional planning, and monitoring. We compared general information, clinical manifestations, risk factors, and auxiliary examinations to identify correlations between specific manifestations and misdiagnosis factors. The male-to-female ratio in the PE group was approximately 3:4, which was statistically significant compared to the control group (P < .05), though its impact on PE incidence was low. Common symptoms in the PE group included chest tightness, shortness of breath, sweating, and chest pain, with no significant difference from the control group (P > .05). Notable risk factors included deep vein thrombosis (DVT) (43.24%), prolonged bed rest (32.43%), lower limb varicose veins (18.92%), trauma (21.62%), pulmonary infections (62.16%), coronary heart disease (37.84%), respiratory failure (32.43%), and chronic obstructive pulmonary disease (13.51%). DVT was significantly associated with PE (P < .05). Multivariate logistic regression identified DVT (OR = 118.528, 95% CI: 6.959-2018.906, P = .001) and lower limb varicose veins (OR = 212.766, 95% CI: 6.584-6875.950, P = .003) as independent predictive factors for suspected PE. Clinical manifestations strongly correlated with PE included pulmonary rales, cyanosis, tachycardia, hypotension, elevated D-dimer, positive N-terminal pro-brain natriuretic peptide, and sinus tachycardia on echocardiogram. PE in cardiology patients may present with pulmonary rales, hypotension, shortness of breath, and abdominal symptoms, warranting reexamination for PE. Misdiagnosis factors typically involve chest pain, tightness, and shortness of breath. Lower limb varicose veins and DVT are reliable predictors of suspected PE., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Venous thromboembolism (VTE) is a rare event in children and does not usually trigger investigation for malignancy. We report the case of a previously healthy female teenager presenting with unilateral leg swelling. Colour-Doppler ultrasound confirmed deep vein thrombosis (DVT), and the thrombophilia workup was negative. Cross-sectional imaging identified multiple liver and lung lesions, diagnosed as epithelioid haemangioendothelioma (EHE) at biopsy. Lifelong anticoagulation was commenced; the patient was initially observed and then started on sirolimus at disease progression. We describe the first published case of EHE presenting with DVT in a child. Clinicians need to be mindful of the association between cancer and thrombosis, even in paediatric patients., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

When a deep vein thrombosis (DVT) is suspected, management should begin with a well-defined diagnostic approach based on clinical evaluation and pre-test probability, D-dimer testing, and venous ultrasound. Once the diagnosis is confirmed, it is important to differentiate between proximal and distal DVT, as their treatment strategies differs. While numerous robust studies with a high level of evidence are available for proximal DVT, the optimal management of distal DVT remains debated. Overall, treatment is based on elastic compression and therapeutic anticoagulation, with direct oral anticoagulants used in most cases. The duration of anticoagulation mainly depends on the risk of venous thromboembolism recurrence., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Objectives: Patients with cerebral venous thrombosis (CVT) may present with early intracerebral hemorrhage (EICH). The objective of this study was to identify predictors for EICH in CVT patients via a systematic review and meta-analysis of observational studies. Additionally, we aimed to evaluate the clinical outcomes associated with the presence of EICH in these patients., Methods: Literature search on PubMed, EMBASE and Cochrane Library databases from inception up to 1 February 2024 was conducted. Five studies with predictors of EICH were included in qualitative synthesis and meta-analysis., Results: Pooled analysis demonstrated a statistically significant association between female gender and EICH (odd ratios (OR) = 1.51, 95 % confidence interval (CI) = 1.23-1.85, p < 0.01). The ICH patients had higher likelihood of seizures (OR = 3.07, 95 % CI = 1.69-5.58, p < 0.01), focal neurological deficits (OR = 4.07, 95 % CI = 2.57-6.44, p < 0.01), and decreased level of consciousness (OR = 3.89, 95 % CI = 2.53-5.87, p < 0.01). Superior Sagittal Sinus thrombosis was associated with higher likelihood of EICH (OR: 1.49, 95 % CI 1.05-2.13, P = 0.03). No statistically significant association was demonstrated between presence of EICH and pregnancy, presence of hematological diseases or thrombophilia, or other site of venous thrombosis (deep venous system, or multiple sinuses involvement). Furthermore, patients who exhibited early EICH were notably less likely to attain a favorable functional outcome (mRS 0-2) (OR: 0.28; 95 % CI 0.16-0.49; p < 0.001)., Conclusion: This meta-analysis demonstrates that among CVT patients, female patients with new onset seizures, focal neurological deficits and decreased level of consciousness are more likely to present with EICH., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective: To investigate the independent predictive factors for post-thrombotic syndrome (PTS) and to construct a risk prediction model for PTS by incorporating a novel inflammatory response parameter (NPM score) scoring., Methods: A retrospective study analyzed patients diagnosed with lower extremity deep vein thrombosis (LEDVTs at the Affiliated Hospital of Chengde Medical College from January 2018 to January 2022. The Villalta scale was used to assess the occurrence of PTS 6-24 months after discharge. Patients were randomly divided into a training set and a validation set at a ratio of 7:3. In the training set, univariate analysis was performed on meaningful continuous variables, and those with differences were converted into dichotomous variables based on optimal cutoff values. Variable selection was performed using Log Lambda and Least Absolute Shrinkage and Selection Operator 10-fold cross-validation, followed by multivariable logistic regression analysis on selected variables for model construction. The model underwent internal validation in the validation set and external validation in an independent external cohort, including discriminative analysis, calibration analysis, and clinical decision curve analysis (DCA), with the model's rationale being evaluated lastly., Results: A total of 356 patients with lower extremity DVT were included, with 249 in the training set for model construction and 107 in the validation set for internal validation, along with 37 external patients for external validation. A composite score of inflammatory response parameters, including the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and monocyte to high-density lipoprotein cholesterol ratio (MHR) (NLR-PLR-MHR score, NPM score), was developed, showing a significantly higher NPM score in the PTS group compared to the non-PTS group (P < 0.05). Predictive factors related to the risk of PTS occurrence included staging (OR = 6.83, 95% CI: 2.74-18.04), varicose veins (OR = 7.30, 95% CI: 2.29-25.75), homocysteine (Hcy) (OR = 1.12, 95% CI: 1.04-1.22), NPM score (OR = 3.13, 95% CI: 1.94-5.36), standardized anticoagulant therapy (OR = 5.77, 95% CI: 1.25-27.62), and one-stop treatment (OR = 0.04, 95% CI: 0.00-0.35) were incorporated into the Nomogram model. The model showed good discrimination with a concordance index of 0.918 (95% CI: 0.876-0.959) for model construction, 0.843 (95% CI: 0.741-0.945) for internal validation, and 0.823 (95% CI: 0.667-0.903) for external validation. In the Nomogram model, internal and external validation calibration curves showed good agreement between observed and predicted values. DCA indicated that the Nomogram model predicted PTS risk probability thresholds ranging from 3% to 98% for model construction, 5%-97% for internal validation, and 10%-80% for external validation, demonstrating better net benefit for predicting PTS risk in the model, internal, and external validation. Rationality analysis showed the model and internal validation had higher discrimination and clinical net benefit than other clinical indices., Conclusions: The NPM score combined with stage, varicose veins, Hcy, standardized anticoagulant therapy, and one-stop treatment in the Nomogram model provides a practical tool for health care professionals to assess the risk of PTS in DVT patients, enabling early identification of high-risk patients for effective PTS prevention., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Few epidemiological data are available for venous thromboembolism (VTE) at French national and subnational levels., Aims: To quantify VTE events in France in 2022 and describe the features of hospital management and outcomes., Methods: Adults hospitalized for a VTE as the primary reason for hospitalization or treatment in a medical unit in 2022 were identified from medical administrative data. Data were stratified as pulmonary embolism (PE) and deep vein thrombosis (DVT), and by French department and various sociodemographic indicators. VTE prevalence at 1 January 2023 was defined as the number of people alive at that date with a history of hospitalization for VTE or a chronic long-term disease status due to VTE (2012-2022)., Results: VTE cases reached 896,846 adults on 1 January 2023. VTE was the primary diagnosis for a hospital stay or medical unit in 62,055 patients hospitalized in 2022. The age-standardized rate of hospitalized patients was 23.0% higher for men versus women. There were considerable variations between departments of residence, while Martinique had the highest age-standardized rate. The prevalence of triggering factors was high, with almost 30% having cancer and 20% a recent long hospitalization. One-year mortality was approximately 20% for both PE and DVT, despite rehospitalization rates <5%., Conclusion: The high prevalence of cancer among patients hospitalized due to VTE partly explains the high 1-year mortality. As VTE is partially avoidable, the prevention of VTE needs to be improved in France and whether thromboprophylaxis guidance is being followed should regularly be assessed., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Background: Optimal anticoagulation management in patients with myeloproliferative neoplasms (MPN) experiencing splanchnic vein thrombosis (SpVT) requires balancing risks of bleeding and recurrent thrombosis., Objectives: We conducted a systematic review and meta-analysis to assess the incidence of bleeding and thrombosis recurrence in patients with MPN-SpVT., Methods: We included retrospective or prospective studies in English with ≥10 adult patients with MPN-SpVT. Outcomes included recurrent venous thrombosis (SpVT and non-SpVT), arterial thrombosis, and major bleeding. Pooled rates per 100 patient years with 95% CIs were calculated by DerSimonian-Laird method using random-effects model., Results: Out of 4624 studies screened, 9 studies with a total of 443 patients were included in the meta-analysis with median follow-up of 3.5 years. In the 364 patients with MPN-SpVT treated with anticoagulation, pooled event rate for major bleeding was 2.8 (95% CI, 1.5-5.1; I 2  = 95%), for recurrent venous thrombosis was 1.4 (95% CI, 0.8-2.2; I 2  = 72%), and for arterial thrombosis was 1.4 (95% CI, 0.6-3.3; I 2  = 92%) per 100 patient years. Among 79 patients (n = 4 studies) who did not receive anticoagulation, pooled event rate for major bleeding was 3.2 (95% CI, 0.7-12.7; I 2  = 97%), for recurrent venous thrombosis 3.5 (95% CI, 1.8-6.4; I 2  = 88%), and for arterial thrombosis rate 1.6 (95% CI, 0.4-6.6; I 2  = 95%) per 100 patient years., Conclusion: Patients with MPN-SpVT treated with anticoagulation have significant risks for both major bleeding and thrombosis recurrence. Further studies are necessary to determine the optimal anticoagulation approach in patients with MPN-SpVT., Competing Interests: Declaration of competing interests P.C., K.B., G.M.G., T.C., A.N., M.M., N.R., G.S., S.A., M.L., and J.B. have no conflict of interest. B.S. received grant support from AstraZeneca and Eisai, speaker honoraria from Eisai, and travel support from AbbVie, AstraZeneca, Ipsen, and Gilead, all not related to this study. P.E.R. has received research funding from Terrafirma; acted as a consultant for Hemostod, Mursla, Genfit, Boehringer Ingelheim, and Abbelight; received speaker fees from Tillots Pharma and AbbVie; and is supported by the Fondation pour la Recherche Médicale (FRM EQU202303016287), “Institut National de la Santé et de la Recherche Médicale” (ATIP AVENIR), the “Agence Nationale pour la Recherche” (ANR-18-CE14-0006-01, RHU QUID-NASH, ANR-18-IDEX-0001, ANR-22-CE14-0002), the “Émergence, Ville de Paris,” the Fondation ARC, the European Union’s Horizon 2020 research and innovation program under grant agreement number 847949, and by France 2030 Recherche Hospitalo-Universitaire Liver-Track, all not related to this study. W.A. has received research support from Bayer and has participated in advisory boards for AstraZeneca, Bayer, BMS-Pfizer, Leo Pharma, Norgine, Sanofi, and Viatris, all not related to this study. J.I.Z. has received research funding from Incyte and Quercegen; consultancy services to Sanofi, CSL, and Parexel; and honoraria from/advisory board participation with Pfizer/Bristol Myers Squibb (BMS), all outside current work. R.P. has received consultancy services from Merck Research Laboratory-Consultant, all outside the current work., (Copyright © 2024 International Society on Thrombosis and Haemostasis. Published by Elsevier Inc. All rights reserved.)

Background: Patients with venous thromboembolism (VTE) are at risk of psychological consequences. However, as opposed to physical sequelae of VTE, mental health issues are understudied., Objectives: To assess anxiety after VTE and investigate associated clinical characteristics., Methods: We conducted a prospective cohort study, including patients with acute deep vein thrombosis (DVT) and/or pulmonary embolism. Patients with cancer, pregnancy, or puerperium were excluded. Anxiety was assessed with the Patient-Reported Outcome Measurement Information System short form 8a. Standardized T-scores were calculated (reference, 50; SD, 10), with higher values indicating more anxiety. We associated clinical characteristics at baseline with T-scores at 3-month follow-up in a multivariable linear regression model. Patient clusters depending on anxiety trajectories were explored., Results: We included 257 patients (38.5% women) with a median (IQR) age of 54.1 (42.2-63.5) years. While mean (SD) T-scores decreased from baseline to follow-up (51.03 [9.18] to 46.74 [8.89]; P < .001), we observed an increase in 23.7% of all patients. Female sex (T-score change, 3.09; 95% CI, 0.96-5.22), older age until 45 years, and anxiety at baseline were associated with increased T-scores at follow-up. VTE history (-1.55; 95% CI, -3.62 to 0.52) and pulmonary embolism (-1.23; 95% CI, -3.16 to 0.69) were associated with reduced T-scores, albeit not reaching statistical significance. In a cluster of older female patients with DVT, anxiety tended to increase over time., Conclusion: While most patients with VTE reported reduced anxiety over time, some patients experienced worsening. Female sex, older age, more anxiety at baseline, no VTE history, and DVT were associated with increased anxiety 3 months after VTE., Competing Interests: Declaration of competing interests C.A. reports honoraria for lectures from Bayer, Daiichi Sankyo, BMS/Pfizer, and Sanofi and participation in advisory boards for Bayer, Daiichi Sankyo, BMS/Pfizer, and Sanofi outside the current work. D.S., S.N., T.H., I.P., and B.W. have no conflicts of interest to declare with regard to the present study., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: The ONCO DVT study (Edoxaban for 12 Months Versus 3 Months in Patients With Cancer With Isolated Distal Deep Vein Thrombosis) revealed superiority of 12-month relative to 3-month edoxaban treatment for the thrombotic risk in cancer-associated isolated distal deep vein thrombosis. However, it is unknown whether the superiority could be common in different modified Ottawa score subgroups., Objectives: To identify more preferable candidates for extended anticoagulation in patients with cancer-associated isolated distal deep vein thrombosis using the modified Ottawa score., Methods: In this post-hoc subgroup analysis of the ONCO DVT study, we stratified 601 patients into the low (≤-1, N = 126), intermediate (0, N = 323), and high (≥1, N = 152) modified Ottawa score subgroups and compared clinical outcomes between the 12-month and 3-month edoxaban treatment groups., Results: The cumulative incidence of symptomatic recurrent venous thromboembolism or venous thromboembolism-related death was not different between the 12-month and 3-month edoxaban treatment groups in the low score subgroup (0.0% vs 2.2%), whereas it was lower in the 12-month than in the 3-month edoxaban treatment group in the intermediate (0.8% vs 7.6%) and high (3.1% vs 15.6%) score subgroups. There were no significant differences in the cumulative incidences of the major bleeding between the 12-month and 3-month edoxaban treatment groups in the low (10.1% vs 7.6%), intermediate (8.8% vs 5.0%), and high (13.9% vs 12.6%) score subgroups., Conclusion: A 12-month compared with 3-month edoxaban treatment showed a lower risk of thrombotic events in patients with cancer-associated isolated distal deep vein thrombosis in the intermediate and high modified Ottawa score subgroups but not in the low score subgroup, suggesting a limited benefit of extended anticoagulation therapy beyond 3 months in patients with low modified Ottawa score., Competing Interests: Declaration of competing interests Y.Y. received lecture fees from Bayer Healthcare, Bristol-Myers Squibb, Pfizer, and Daiichi Sankyo and grant support from Bayer Healthcare and Daiichi Sankyo. T.M. reports lecturer's fees from AstraZeneca, Bristol-Myers Squibb, Daiichi Sankyo, Japan Lifeline, Kowa, Pfizer, and Tsumura; manuscript fees from Bristol-Myers Squibb and Pfizer; and advisory board for Novartis and Teijin. Y.N. received lecture fees from Bayer Healthcare, Bristol-Myers Squibb, Pfizer, and Daiichi Sankyo. Y.O. received lecture fees from Bayer Healthcare, Bristol-Myers Squibb, Pfizer, and Daiichi Sankyo and research funds from Bayer Healthcare and Daiichi Sankyo. N.I. received lecture fees from Bayer Healthcare, Bristol-Myers Squibb, and Daiichi Sankyo. Y.T. received lecture fees from AstraZeneca, Chugai Pharmaceutical, Bristol-Myers Squibb, Kyowa Kirin, Pfizer, Taiho Pharmaceutical, Takeda Pharmaceutical, and Daiichi Sankyo and grant support from Daiichi Sankyo, AstraZeneca, and Ono Pharmaceutical. S.I. received lecture fees from Bayer Healthcare, Bristol-Myers Squibb, and Daiichi Sankyo. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 International Society on Thrombosis and Haemostasis. Published by Elsevier Inc. All rights reserved.)

Objective: Deep vein thrombosis (DVT) is a common complication in obstetrics that needs early interaction. The study examined the expression change and clinical value of long non-coding RNA (lncRNA) colorectal neoplasia differentially expressed (CRNDE) in DVT early diagnosis., Methods: One hundred patients with DVT after delivery and 100 healthy parturients without DVT were enrolled. Serum samples were collected one day before delivery and received qRT-PCR for mRNA detection. Prenatal coagulation markers including prothrombin time (PT), activated partial prothrombin time (APTT), fibrinogen (FIB) and thrombin time (TT), D-dimer (D-D), thrombomodulin (TM), and peroxidase anti-peroxidase soluble complex (PAP) were tested. The receiver operating characteristic (ROC) curve was drawn for the diagnostic value assessment., Results: LncRNA CRNDE levels increased remarkably in the serum of DVT patients compared with the healthy controls, which were negatively correlated with serum concentration of PT, APTT, and TT while positively correlated with FIB, D-D, TM, and PAP. Serum CRNDE (HR = 5.973, 95% CI = 2.990-11.933, p  < .001) was independently related to the occurrence of DVT after delivery. Then, ROC curve using serum CRNDE showed a good diagnostic value for DVT with the AUC of 0.899. ROC curve of ultrasonography combined with CRNDE produced an AUC of 0.968, and both sensitivity and specificity were enhanced compared to a single indicator., Conclusions: The increase of CRNDE level was an independent risk factor for postpartum DVT. Prenatal ultrasonography combined with CRNDE can improve the predictive efficacy for DVT.

Congenital protein C (PC) deficiency is a mostly autosomal dominant hereditary thrombophilia associated with early onset arterial and venous thrombotic diseases. In newborns, PC deficiency results in severe complications such as cerebral hemorrhage, cerebral infarction, and purpura fulminans, leading to death in some cases. We report two cases of deep vein thrombosis diagnosed during pregnancy that prompted genetic testing confirming definitive congenital PC deficiency. One patient with deep vein thrombosis at 30 weeks of gestation underwent anticoagulation therapy with the placement of an inferior vena cava filter. Genetic testing revealed a missense mutation in the PC gene. Another patient developed deep vein thrombosis at 9 weeks of gestation and received anticoagulant therapy, revealing a frameshift mutation in the gene. Genetic testing confirming congenital PC deficiency facilitates tailored postpartum management, including long-term anticoagulation therapy, based on the mother's thrombosis risk. For newborns, early diagnosis allows timely preparation of treatments, such as freshly thawed frozen plasma or PC replacement therapy and ensures closer monitoring through imaging evaluations, enabling early intervention to decrease the severity of potential complications. Given its utility in managing maternal and neonatal outcomes, early genetic testing in suspected cases of maternal PC deficiency is crucial before delivery., (© 2024 Japan Society of Obstetrics and Gynecology.)

Background Objective: Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common complication in craniotomy patients and is associated with increased morbidity and mortality. The duration of surgery is a known risk factor. Other factors such as positioning and tumor entity have hardly been investigated or are controversial. In two pilot studies, the determination of plasma D-dimer concentration led to a high detection rate of DVT, while the use of intermittent pneumatic venous compression (IPC) drastically reduced the incidence of VTE. In the present study we investigated the efficacy of the two approaches, either alone or in combination, in a large patient cohort., Methods: 1759 patients who underwent elective craniotomy between 2009 and 2023 were retrospectively analyzed. The staggered use of D-dimer determination and intraoperative use of IPC resulted in 3 groups: Group 1: no procedure; Group 2: D-dimer evaluation; Group 3: IPC and D-dimer evaluation. If the D-dimer level was ≥ 2 mg/l (Fibrinogen equivalent units; FEU), venous ultrasound was performed. Age, gender, tumor entity, duration and extent of surgery, patient positioning, type of VTE were also recorded and analyzed., Results: The introduction of postoperative D-dimer evaluation increased the rate of detection of thrombosis from 1.7% in group 1 to 22.6% in group 2. The addition of IPC reduced the rate of thrombosis to 4.4%. Age, gender and patient positioning did not affect the rate of VTE. We were able to confirm the duration of surgery as an individual risk factor and showed that WHO grade 4 tumors and metastasis have an increased VTE risk., Conclusions: If D-Dimer levels are not analyzed routinely about 20% of craniotomy patients suffer from a clinically silent thrombosis. Each with the risk of fate PE. Intraoperative use of IPC during craniotomy dramatically reduces the risk of VTE., Competing Interests: Declarations. Disclosures: The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. Competing interest: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Chronic obstructive pulmonary disease (COPD) is associated with airflow obstruction that threatens global health. During the hospitalization of patients with acute exacerbations of COPD (AECOPD), the high prevalence of pulmonary embolism (PE) seriously affects the prognosis of disease. This study aims to assess the differences in clinical data between patients with AECOPD and patients with AECOPD-PE, and to identify the relevant factors of PE., Methods: We performed a retrospective case-control study in AECOPD patients between January 2018 and December 2021. Due to suspected PE, all patients underwent radiological examination. Patients without PE were included as controls. Clinical data and laboratory tests were recorded. Univariate analysis and multivariate logistic regression analysis were used to investigate the independent predictors of PE. Receiver operating characteristics (ROC) curves was performed to evaluate the effect of risk factors on PE prediction., Results: A total of 191 patients were included for analysis, divided into the AECOPD group (96 cases) and AECOPD-PE group (95 cases). No statistic differences were detected in demographic characteristics between patients with AECOPD and patients with AECOPD and PE. Average PO 2 and PCO 2 levels, lung function, and Echocardiographic indicator were not associated with PE. The concentration of D-dimer, the proportion of simplified wells score ≥ 2, and the incidence rate of lower extremity deep vein thrombosis (DVT) remarkably increased in AECOPD-PE group than AECOPD individuals. At multivariate analysis, the above three indicators were closely relevant to the occurrence of PE. The AUC value for D-dimer combined with lower extremity DVT and Simplified Wells Score was 0.729., Conclusions: D-dimer, lower extremity DVT, and simplified wells score ≥ 2 were relevant to higher risks of PE, which will help to improve clinicians' understanding of PE secondary to AECOPD., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dengyuan Li reports financial support was provided by The Joint Application Foundation Project of Kunming Medical University and Yunnan Provincial Science and Technology Department and Open Project of Yunnan Provincial Clinical Medical Center for Respiratory System Diseases. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 SPLF and Elsevier Masson SAS. All rights reserved.)

Introduction: Deep vein thrombosis (DVT) is a medical condition characterized by forming a blood clot, or thrombus, in one of the deep veins, typically in the legs. It is a type of venous thromboembolism, which refers to the formation of blood clots in the veins. It is caused by Virchow's triad (stasis, hypercoagulation, and endothelial injury)., Objective: Our main objective is to explore the effectiveness and safety of rivaroxaban and edoxaban in treating lower extremity DVT., Methods: We conducted a retrospective study involving 406 patients subjected to DVT treatment using direct oral anticoagulants (edoxaban and rivaroxaban) at our hospital. We recruited adult patients (aged 18 years and more) diagnosed with lower extremity DVT and received treatment with either rivaroxaban or edoxaban as the primary anticoagulant therapy for DVT. We excluded patients who received treatment with other anticoagulant medications (warfarin and heparin) as the primary therapy for DVT., Results: The groups showed statistically significant differences in red blood cell count and hemoglobin levels, with the edoxaban group having high values. However, the 2 groups observed no statistically significant differences in creatinine clearance, white blood cell count, platelet count, C-reactive protein, and D-dimer levels. The difference in the incidence of pulmonary embolism between the 2 groups was statistically significant (P value < 0.001). The edoxaban group had fewer pulmonary embolism patients than the rivaroxaban group. The reduction in recurrent thrombosis was significantly higher in the rivaroxaban group compared to the edoxaban group. There were no significant differences in the major bleeding at various sites across the 2 treatment groups (P > 0.05)., Conclusions: Rivaroxaban's pharmacokinetic profile includes rapid absorption and a relatively short half-life. It means that once administered, rivaroxaban quickly reaches its peak concentration in the blood and is subsequently eliminated from the body within a relatively short period. Edoxaban's pharmacokinetic profile may include slower absorption and a longer half-life than rivaroxaban. It can result in a slower rate of achieving peak concentration and a more prolonged presence in the bloodstream. These results emphasize the need for careful consideration of anticoagulant therapy in patients with underlying cancer and underscore the importance of managing risks while providing adequate anticoagulation to prevent thrombotic events., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Ovarian vein thrombosis (OVT) is a rare but potentially serious condition. We conducted a scoping review of published data to provide a better understanding of OVT management. MEDLINE and Cochrane databases were searched. The eligibility criterion was original articles including women with OVT until May 2024. Quantitative data were pooled via Comprehensive Meta-Analysis software (Biostat, Inc). Quality of the primary studies was assessed via the Newcastle‒Ottawa Scale. Out of 1007 identified records, 19 primary studies including 1128 patients were selected. Mean age at OVT diagnosis was 37 years old. Frequency of OVT depended on the clinical situation: cancer (37%) and postpartum (0.06%), including cesarean (0.19%), or persistent fever despite antibiotics (23%). Magnetic resonance imaging was associated with the best diagnostic performance, followed by computed tomography. Pulmonary embolism and extension to the iliac vein, inferior vena cava, or left renal vein occurred in 6.5%, 5.9%, 10.3%, and 9.6% of patients, respectively. Among anticoagulants, low-molecular-height heparin with/without oral anticoagulant was preferred for 3 to 6 months. Among the women tested, thrombophilia was present in 18% of the patients. Recanalization, recurrent thrombosis, or major bleeding occurred in 70%, 8%, and 2% of patients, respectively. The majority of studies had poor evidence. This scoping review provides a comprehensive evaluation of available data. Frequency of OVT depends on the clinical setting. Physicians should be aware of OVT in postpartum women with persistent fever despite the use of antibiotics. OVT belongs to the spectrum of venous thromboembolism and should be considered both in puerperal settings and in cancer patients., Competing Interests: Declaration of competing interests There are no competing interests to disclose., (Copyright © 2024 International Society on Thrombosis and Haemostasis. Published by Elsevier Inc. All rights reserved.)

Background: Postthrombotic syndrome (PTS) refers to manifestations of chronic venous insufficiency after a deep vein thrombosis (DVT). The risk of developing moderate-to-severe PTS in the very long term is largely unknown and particularly in case of distal DVT. Furthermore, the impact of DVT vs other causes of chronic venous insufficiency on long-term manifestations of PTS is also unknown., Objectives: To assess the very long-term risk of moderate-to-severe PTS after DVT and the role that DVT plays in PTS symptoms., Methods: Patients with lower-limb DVT enrolled in the multicenter Optimisation de l'interrogatoire dans l'evaluation du risque thromboembolique veineux (OPTIMEV) study underwent a very long-term telephone follow-up. We assessed i) the proportion of moderate-to-severe PTS (assessed with the patient-reported Villalta score) according to DVT extent and ii) the population attributable fraction that DVT plays in patients' moderate-to-severe PTS manifestations., Results: Fourteen years after DVT, moderate-to-severe PTS developed in 35 of 185 patients with distal DVT (18.9%; 95% CI, 13.5%-25.3%), 11 of 47 patients with popliteal DVT (23.4%; 95% CI, 12.3%-38.0%), and 27 of 74 patients with iliofemoral DVT (36.5%; 95% CI, 25.6%-48.5%). The population attributable fraction of DVT in moderate-to-severe symptoms of PTS was 25.7% (-18.1% to 53.3%) in patients with distal DVT, 27.3% (-63.7% to 67.7%) in patients with popliteal DVT, and 43.1% (+0.7%-67.4%) in patients with iliofemoral DVT., Conclusion: In the very long term after DVT, a quarter of patients have moderate-to-severe PTS manifestations. However, the impact of the DVT on these manifestations appears nonpredominant and varies according to DVT extent. Distal DVT does not significantly increase the risk of developing moderate-to-severe PTS., Competing Interests: Declaration of competing interests There are no competing interests to disclose., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Patients with hereditary antithrombin deficiency (HAD) have an increased risk of venous thromboembolism (VTE). The American Thrombosis and Hemostasis Network (ATHN) 12: HAD Pilot Project established a registry to collect data on patients with HAD., Objectives: To inform current practice and serve as a platform to design a multicenter global registry for patients with HAD., Methods: The HAD registry was designed in 2020 to identify 100 patients with HAD receiving care at ATHN-affiliated centers. Demographics, type of HAD, thrombotic events, risk factors, anticoagulants, and antithrombin (AT) concentrate administration were recorded., Results: Ninety-four patients were included; 65% were females; 51% had type 1 HAD. Mean age at diagnosis was 26 years (SD, 18 years); 61% had VTE: 55% deep vein thrombosis and 27% pulmonary embolisms. Eight patients had arterial thrombosis. Recurrent thrombosis occurred in 58.6% of patients (44.8%) despite anticoagulation. The main risk factor for thrombosis in females was estrogen. Direct oral anticoagulants were prescribed in 30%, heparin in 34%, and warfarin in 32%. There were 139 pregnancies. Low-molecular-weight heparin was administered in 33% and AT concentrate in 19% and 11% prior to and after delivery, respectively. Twelve patients developed thrombosis in pregnancy. Seventy-nine patients underwent 239 surgeries or procedures, mainly gastrointestinal and vascular. Overall, 35% of participants received AT concentrate without adverse events., Conclusion: In ATHN 12, VTE was the predominant manifestation, frequently recurrent. There was a trend toward using direct oral anticoagulants. Low-molecular-weight heparin was administered in one-third of pregnancies and AT concentrate in one-fifth without adverse events. These data should encourage prospective studies to optimize the management of these patients., Competing Interests: Declaration of competing interests M.T.D.: participation on Pharmacosmos Advisory Board and member of American Society of Hematology Panel on Practice Guidelines for Anticoagulation in COVID-19. E.S.: no conflict of interest. J.C.R.: has received honorarium from F. Hoffman-La Roche AG, Genentech, Novo Nordisk, Octapharma, Pfizer, Sanofi, and Takeda. M.D.T.: received consulting fees from Pfizer, Sanofi, Sobi-Swedish Orphan, Biovitrum, Takeda Amgen, Octapharma Inc, Genentech, BioMarin, UCB Biosciences Dova Pharmaceuticals, and Novo Nordisk and payment/honoraria for lectures, presentations, speakers’ bureaus, manuscript writing, or educational event from Sobi-Swedish Orphan Biovitrum, Genentech, Amgen, Novartis, BioMarin, and Sanofi. J.S.: no conflict of interest. J.C.: no conflict of interest. M.R.: consulting for Catalyst Biosciences, CSL Behring, Genentech, Hema Biologics, Kedrion, Novo Nordisk, Pfizer, Sanofi, Takeda, and uniQure and leadership or fiduciary role in Foundation for Women and Girls with Blood Disorders; Partners in Bleeding Disorders, Thrombosis and Hemostasis Societies of North America., (Copyright © 2024 International Society on Thrombosis and Haemostasis. Published by Elsevier Inc. All rights reserved.)

Background: Prophylactic dose of rivaroxaban is often used in treatment of isolated calf muscle vein thrombosis (ICMVT); nevertheless, its effect is less reported. This study aims to evaluate short-term outcomes in patients with ICMVT who received prophylactic dose of rivaroxaban or warfarin therapy., Methods: A retrospective analysis of 472 ICMVT patients who received 2 different treatment regimens was undertaken. Propensity score matching method was used to balance the confounding effect of baseline clinical data. Chi-squared test and logistic regression analysis were used to compare outcomes (venous thromboembolism events, bleeding events, complete clot resolution) according to the type of treatment regimens before and after propensity score matching. Univariate and multivariable analysis were used to investigate risk factors for incomplete clot resolution of ICMVT after propensity score matching., Results: 242 ICMVT patients received prophylactic dose of rivaroxaban (rivaroxaban group, RG), and 230 received warfarin (warfarin group, WG). After propensity score matching, 156 patients were included in each group; Venous thromboembolism (VTE) events occurred in 14 (9.0%) patients in the RG and 10 (6.4%) in the WG (P = 0.395); no major bleeding events occurred in each group, and clinically relevant nonmajor bleeding events occurred in 5 (3.2%) patients in the RG and 10 (6.4%) in the WG (P = 0.186); complete clot resolution at 3 months occurred in 80 (51.3%) patients in the RG and 100 (64.1%) in the WG (P = 0.022). Logistic regression analysis showed that there were no significant differences between RG and WG in VTE events (odds ratio 1.439, 95% confidence interval 0.619-3.347, P = 0.397) and clinically relevant nonmajor bleeding events (odds ratio 0.483, 95% confidence interval 0.161-1.449, P = 0.194); it revealed that complete clot resolution rate at 3 months was different in the 2 groups (odds ratio 0.589, 95% confidence interval 0.375-0.928, P = 0.022). Treatment regimens (prophylactic dose of rivaroxaban), thrombosis (maximum diameter >7 mm), and risk factors for VTE (nonsurgery risk factors, mainly referring to active malignancy) were risk factors for incomplete clot resolution of ICMVT (P < 0.05)., Conclusions: In this retrospective study with a short-term follow-up, ICMVT patients who received prophylactic dose of rivaroxaban had no significant differences in VTE and bleeding events compared to those who received warfarin therapy (the overall INR >2.0 for >50% of the time); but it was not conducive to complete clot resolution., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Although there are reports on the recurrence prevention in the chronic phase using direct oral anticoagulants (DOACs) for deep vein thrombosis (DVT) in patients with cancer, acute thrombus regression effect using DOACs has not been assessed. This study aimed to assess the thrombus regression effect of initial treatment using edoxaban for acute lower-extremity DVT in patients with active cancer., Methods and Results: In this observational study, among the inpatients with cancer and lower-extremity DVT who underwent initial treatment with edoxaban at our hospital from November 2019 to December 2021, 34 consenting patients were recruited in this study. The quantitative ultrasound thrombus (QUT) score of thrombus volume was calculated at baseline (before administration) and 7-14 days after the start of edoxaban administration, using lower-extremity venous ultrasound to evaluate changes in thrombus volume. The primary and secondary endpoints were the acute thrombus regression effect of edoxaban and the impact of patients' clinical frailty on the thrombus regression effect, respectively. Anticoagulant therapy with edoxaban significantly reduced QUT score (p < 0.001). In addition, regardless of the Clinical Frailty Scale scores, QUT score decreased significantly., Conclusion: Initial treatment with edoxaban was effective for lower-extremity DVT in patients with cancer. In addition, the effect was the same independent of the degree of frailty., (© 2024. Springer Nature Japan KK, part of Springer Nature.)

Background: Thrombosis of the superior ophthalmic vein (SOV) is rare. It can present with heterogeneous symptoms and requires a careful diagnostic work-up., Methods: This article reports on a case series of three female patients with thrombosis of the SOV and performed an extensive review of the existing literature in PubMed., Results: All three patients showed different leading symptoms but all had a triad of restricted eye motility, exophthalmos and a difference in intraocular pressure with the higher pressure on the side of the protruded eyeball. The pathophysiological background differed in all cases: in the two first cases a pre-existing anticoagulation treatment had been paused shortly before the event. Cofactors were an intraorbital venous outflow obstruction due to an unclear mass in the orbital apex in one case and hypercoagulability due to a malignant disease in the other case. In the third case, there was a cavernous sinus fistula., Conclusion: The diagnosis should be considered not only in patients with dilated vessels of the anterior segment but also in unclear cases of exophthalmos or unilateral elevated intraocular pressure (IOP)., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)