Advances in Thrombotic Disorders and Antithrombotic Treatments

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Vascular Medicine".

Deadline for manuscript submissions: 15 August 2024 | Viewed by 3895

Special Issue Editors


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Guest Editor
Medical Center, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, 21100 Varese, Italy
Interests: venous thromboembolism; atherosclerosis; cardiovascular diseases; anticoagulant treatments; antithrombotic treatments

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Guest Editor
Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
Interests: venous thromboembolism; atherosclerosis; cardiovascular diseases; anticoagulant treatments; antithrombotic treatments

Special Issue Information

Dear Colleagues,

Venous thromboembolism (VTE) is a chronic disease that affects nearly 10 million people every year worldwide. Cardiovascular disorders (CVDs) remain the most common cause of death in Europe. Both VTE and CVD are associated with potentially preventable morbidity and mortality. In recent decades, many efforts have been made in order to improve the diagnostic and therapeutic strategies for VTE and with the aim of reducing the burden of CVD. All novel direct oral anticoagulants introduced in the last few years have shown a favourable benefit–risk balance in terms of efficacy and safety profile, both in the prevention of thromboembolic events in atrial fibrillation and in the prevention and treatment of VTE. 

Ongoing research is, nowadays, focused on intensifying the use of oral anticoagulants in different clinical indications and, at the same time, on developing safer anticoagulant drugs, as well as improving diagnostic strategies and further personalizing approaches for the prevention and management of thrombotic disorders.

The aim of this Special Issue is to highlight recent advances related to the prevention, diagnosis, treatment and prognosis of several thrombotic conditions.

Dr. Daniela Mastroiacovo
Dr. Francesco Dentali
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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Keywords

  • venous thromboembolism
  • direct oral anticoagulants
  • cardiovascular diseases
  • antithrombotic treatments
  • prevention
  • management

Published Papers (4 papers)

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Research

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14 pages, 2513 KiB  
Article
Efficacy and Safety of Combination Therapy with Low-Dose Rivaroxaban in Patients with Cardiovascular Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
by Tommaso Bucci, Francesco Del Sole, Danilo Menichelli, Gioacchino Galardo, Flavio Giuseppe Biccirè, Alessio Farcomeni, Gregory Y. H. Lip, Pasquale Pignatelli and Daniele Pastori
J. Clin. Med. 2024, 13(7), 2033; https://doi.org/10.3390/jcm13072033 - 31 Mar 2024
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Abstract
Objectives: To review the evidence on the effectiveness and safety of low-dose-rivaroxaban 2.5 mg twice daily (LDR) in patients with coronary artery disease (CAD) and/or peripheral artery disease (PAD) taking antiplatelets. Methods: We performed a systematic review and meta-analysis of randomized [...] Read more.
Objectives: To review the evidence on the effectiveness and safety of low-dose-rivaroxaban 2.5 mg twice daily (LDR) in patients with coronary artery disease (CAD) and/or peripheral artery disease (PAD) taking antiplatelets. Methods: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs). Efficacy endpoints were cardiovascular events (CVEs), myocardial infarction, stroke, all-cause, and cardiovascular death. Any, major, fatal bleeding, and intracranial hemorrhage (ICH) were safety endpoints. Numbers needed to treat (NNT), and numbers needed to harm (NNH) were also calculated. Results: Seven RCTs were included with 45,836 patients: 34,276 with CAD and 11,560 with PAD. Overall, 4247 CVEs and 3082 bleedings were registered. LDR in association with either any antiplatelet drug or aspirin (ASA) alone reduced the risk of CVEs (hazard ratio [HR] 0.86, 95% confidence interval [95%CI] 0.78–0.94) and ischemic stroke (HR 0.68, 95%CI 0.55–0.84). LDR + ASA increased the risk of major bleeding (HR 1.71, 95%CI 1.38–2.11) but no excess of fatal bleeding or ICH was found. The NNT to prevent one CVE for LDR + ASA was 63 (43–103) and the NNH to cause major bleeding was 107 (77–193). Conclusions: The combination of LDR with either antiplatelet drugs or low-dose aspirin reduces CVEs and ischemic stroke in patients with CAD/PAD. There was an increased risk of major bleeding but no excess of fatal or ICH was found. LDR seems to have a favorable net clinical benefit compared to ASA treatment alone. Full article
(This article belongs to the Special Issue Advances in Thrombotic Disorders and Antithrombotic Treatments)
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11 pages, 229 KiB  
Article
Inappropriate Underdosing of Direct Oral Anticoagulants in Atrial Fibrillation Patients: Results from the START2-AF Registry
by Daniela Poli, Emilia Antonucci, Walter Ageno, Martina Berteotti, Anna Falanga, Vittorio Pengo, Paolo Chiarugi, Benilde Cosmi, Carmelo Paparo, Antonio Chistolini, Antonio Insana, Domenico Lione, Giuseppe Malcangi, Giuliana Martini, Lucilla Masciocco, Simona Pedrini, Eugenio Bucherini, Daniele Pastori, Pasquale Pignatelli, Andrea Toma, Sophie Testa, Gualtiero Palareti and START AF Study Groupadd Show full author list remove Hide full author list
J. Clin. Med. 2024, 13(7), 2009; https://doi.org/10.3390/jcm13072009 - 29 Mar 2024
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Abstract
Background: Direct oral anticoagulants (DOACs) are recommended for stroke prevention in non-valvular atrial fibrillation (NVAF) patients. We aimed to describe the prevalence of inappropriate DOACs dose prescription in the START2-AF Registry, the outcomes according to the appropriateness of the dosage, and the factors [...] Read more.
Background: Direct oral anticoagulants (DOACs) are recommended for stroke prevention in non-valvular atrial fibrillation (NVAF) patients. We aimed to describe the prevalence of inappropriate DOACs dose prescription in the START2-AF Registry, the outcomes according to the appropriateness of the dosage, and the factors associated with inappropriate dose prescription. Methods: Patients’ demographics and clinical data were prospectively collected as electronic files in an anonymous form on the website of the START2-Registry; DOACs dosage was determined to be appropriate when prescribed according to the European Heart Rhythm Association Guidelines. Results: We included 5943 NVAF patients on DOACs; 2572 (46.3%) were female patients. The standard dose (SD) was prescribed to 56.9% of patients and the low dose (LD) was prescribed to 43.1% of patients; 38.9% of all NVAF patients received an inappropriate LD DOAC and 0.3% received inappropriate SD. Patients treated with LD DOAC had a significantly higher rate of all bleedings (RR 1.5; 95% CI 1.2–2.0), major bleedings (RR 1.8; 95% CI 1.3–1.7), and mortality (RR 2.8; 95% CI 1.9–4.1) with respect to patients treated with SD DOAC. No difference was found among patients treated with appropriate and inappropriate LD regarding bleeding, thrombotic, and mortality rates. Age, body weight <60 kg, and renal failure were significantly associated with inappropriate LD DOAC prescription. Conclusions: Inappropriate LD DOACs in NVAF patients is not associated with a reduction in bleeding risk, nor with an increased thrombotic risk. Instead, it is associated with higher mortality rate, suggesting that, in clinical practice, underdosing is preferred for patients at particularly high risk for adverse events. Full article
(This article belongs to the Special Issue Advances in Thrombotic Disorders and Antithrombotic Treatments)
12 pages, 655 KiB  
Article
Long-Term Outcomes in Two-Year Follow-Up after Primary Treatment in Patients with a Prior Venous Thromboembolic Event: A Prospective, Observational, Real-Life Study
by Gualtiero Palareti, Emilia Antonucci, Eugenio Bucherini, Antonella Caronna, Antonio Chistolini, Angela Di Giorgio, Rosella Di Giulio, Anna Falanga, Vittorio Fregoni, Mariagrazia Garzia, Daniela Mastroiacovo, Marco Marzolo, Roberta Pancani, Daniele Pastori, Gian Marco Podda, Anna Maria Rigoni, Luigi Ria, Piera Sivera, Sophie Testa, Adriana Visonà, Roberto Parisi, Daniela Poli and on behalf of the START POST VTE Investigatorsadd Show full author list remove Hide full author list
J. Clin. Med. 2024, 13(5), 1343; https://doi.org/10.3390/jcm13051343 - 27 Feb 2024
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Abstract
Background: Patients with acute venous thromboembolism (VTE) need anticoagulation (AC) therapy for at least 3/6 months (primary treatment); after that period, they should receive a decision on the duration of therapy. Methods: This study examined the complications occurring during two years of follow-up [...] Read more.
Background: Patients with acute venous thromboembolism (VTE) need anticoagulation (AC) therapy for at least 3/6 months (primary treatment); after that period, they should receive a decision on the duration of therapy. Methods: This study examined the complications occurring during two years of follow-up (FU) in patients with a first VTE who were recruited in 20 clinical centers and had discontinued or prolonged AC. They were included in the START2-POST-VTE prospective observational study. Results: A total of 720 patients (53.5% males) who, after the completion of primary treatment, had received the decision to continue (n = 281, 39%; 76.1% with a DOAC) or discontinue (n = 439, 61%) AC were followed up for 2 years (total FU = 1318 years). The decision to prolong or suspend AC was made in similar proportions in patients with unprovoked or provoked index events. Courses of sulodexide treatment or Aspirin (100 mg daily) were prescribed to 20.3% and 4.5%, respectively, of the patients who discontinued AC. The bleeding rate was significantly higher in patients who extended AC (1.6% pt/y) than in those who stopped AC (0.1% pt/y; p = 0.001) and was higher in patients using standard-dose DOACs (3.1% pt/y) than in those using reduced-dose DOACs (0.4% pt/y). The recurrent VTE rates were similar between the two groups (2.2% pt/y during AC vs. 3% pt/y off AC). Conclusion: Physicians’ decisions about AC duration were independent of the unprovoked/provoked nature of the index event. The bleeding rate was higher in patients who continued AC using standard-dose DOACs. Surprisingly, the rate of thrombotic recurrence was not different between those who continued or discontinued AC. Randomized studies comparing different procedures to decide on the duration of AC after a first VTE are needed. Full article
(This article belongs to the Special Issue Advances in Thrombotic Disorders and Antithrombotic Treatments)
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Review

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13 pages, 252 KiB  
Review
Inferior Vena Cava Filters: A Clinical Review and Future Perspectives
by Raffaella Benedetti, Simone Marino, Flavio Tangianu and Davide Imberti
J. Clin. Med. 2024, 13(6), 1761; https://doi.org/10.3390/jcm13061761 - 19 Mar 2024
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Abstract
Anticoagulation represents the first line treatment for venous thromboembolism (VTE). However, inferior vena cava (IVC) filter insertion can be considered as a possible therapeutic strategy when anticoagulant therapy is contraindicated, to avoid embolization from the lower limbs to pulmonary circulation. Other possible indications [...] Read more.
Anticoagulation represents the first line treatment for venous thromboembolism (VTE). However, inferior vena cava (IVC) filter insertion can be considered as a possible therapeutic strategy when anticoagulant therapy is contraindicated, to avoid embolization from the lower limbs to pulmonary circulation. Other possible indications are debated among experts. Both permanent and retrievable caval filters are available in clinical practice. Retrievable filters can be removed when no longer necessary, as their use may be indicated only for a limited amount of time. Moreover, caval filter insertion is not devoid of possible complications, particularly in cases of permanent or long-dwelling filters. A multidisciplinary approach is recommended to review the appropriateness of caval filter use and to define the best timing for retrieval. Full article
(This article belongs to the Special Issue Advances in Thrombotic Disorders and Antithrombotic Treatments)
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