Diagnosis aim management of venous thromboembolism: an update a decade into the new millennium

Venous thromboembolism refers to thrombotic events in the venous system that are most commonly manifested as deep vein thromboses in the upper or lower extremity and/or pulmonary embolism. Venous thromboembolism is a common disorder that is associated with significant mortality, morbidity and health care-related cost. An array of hereditary and acquired risk factors are associated with venous thromboembolism. In recent years, a number of pivotal studies have expanded our understanding of the pathophysiology of venous thromboembolism, and served as the basis for evidence-based guidelines on prevention, diagnosis and treatment of venous thromboembolism. Furthermore, several novel therapeutic agents with different pharmacokinetics, pharmacodynamics and safety profiles have recently become available for treatment and prevention of venous thromboembolism. The purpose of the current paper is to review the pathogenesis and epidemiology of venous thromboembolism as well as an evidence-based approach to the diagnosis and management of venous thromboembolism

Management of acquired thrombophilic disorders in 2011: focus on heparin-induced thrombocytopenia, antiphospholipid syndrome, myeloproliferative neoplasms and paroxysmal nocturnal hemoglobinuria

Arterial and venous thrombosis are interrelated disorders at the interplay of platelets and fibrin. Arterial thrombi are platelet-rich and occur at sites vulnerable to atherosclerotic plaque rupture where blood shear rates are high; on the contrary, venous thrombi occur in association with slow blood flow and shear rates. These differences may underlie why anti-platelet agents are more effective in prevention of arterial thrombosis, while anticoagulants are preferred for venous thrombosis. Although some common thrombophilic disorders [e.g., Factor V Leiden, prothrombin gene mutation, etc.] are almost exclusively associated with venous thromboembolism, there are several disorders that are important to consider when caring for patients with both arterial and venous thromboembolism. This article will review the evidence-based management of heparin induced thrombocytopenia with thrombosis, anti-phospholipid antibody syndrome and catastrophic anti-phospho-lipid antibody syndrome, thrombohemorrhagic manifestations of Philadelphia chromosome-negative chronic myeloproliferative neoplasms including polycythemia vera, essential thrombocythemia and primary myelofibrosis, as well as paroxysmal nocturnal hemoglobinuria