Prevalence of venous thromboembolic disease among patients with patent foramen ovale-related arterial ischemic events.

Venous thrombo-embolic events as the probable cause of arterial ischemic event in patients with patent foramen ovale

Arterial disease and venous thrombosis: are they related, and if so, what should we do about it?

Association between venous and arterial thrombosis

Incidence of venous and arterial thromboembolic complications in COVID-19: A systematic review and meta-analysis

Acute Venous and Arterial Thromboembolic Events in Patients with Monoclonal Gammopathy of Undetermined Significance: A Nation Wide Analysis

Arterial and Venous Thromboembolism in Critically Ill, COVID-19 Positive Patients Admitted to Intensive Care Unit

Outcomes Following Patent Foramen Ovale Percutaneous Closure According to the Delay From Last Ischemic Event.

Growing evidence supports an association between venous thromboembolism (VTE) and arterial thrombotic diseases (ie, myocardial infarction and ischemic stroke). We aimed to study the association between VTE and future arterial events and to determine the population attributable risk of arterial events by VTE in a large prospective cohort recruited from the general population. In 1994 to 1995 and 1993 to 1997, 81 687 subjects were included in the Tromsø Study and in the Diet, Cancer and Health Study and followed up to the date of incident venous and arterial events (myocardial infarction or ischemic stroke), death or migration, or to the end of the study period (2010 and 2008, respectively). There were 1208 cases of VTE and 90 subsequent arterial events during a median follow-up of 12.2 years. An association between VTE and future arterial events was found in all women and men aged <65 years but not in men aged >65 years. Women <65 years old with VTE had 3.3-fold higher risk of arterial disease (adjusted hazard ratio, 3.28; 95% confidence interval, 1.69-6.35) compared with women of the same age without VTE. The corresponding hazard ratio in men aged <65 years was 2.06 (95% confidence interval, 1.32-3.20). Only 0.9% of the arterial events were attributed to VTE, and the VTE explained 63.8% of the risk of arterial events among VTE patients. Our findings imply that women and young men with VTE have higher risk of arterial thrombotic disease than those without VTE. However, only 1% of the arterial thrombotic events in the population are attributed to VTE.

Thromb Haemost 2006; 96: 111–2 Arterial and venous thromboembolic diseases have historically been viewed as separate pathophysiological entities until recently, partly as a result of the obvious anatomical differences and divisions of the arterial and venous systems, as well as their separate, distinct clinical presentations. However, it has become increasingly clear that this dichotomy of vascular disease is over simplistic and probably hinders rather than promotes our understanding of the underlying pathogenesis of the condition. Indeed, some generalisations are often readily made by the uninitiated.Agreed, venous thromboembolic disease is predominantly fibrin-rich clot (‘red clot’), related to stasis or venous wall damage in deep veins, and embolising to the pulmonary vasculature; thus, ‘venous clots’respond well to anticoagulation therapy. In contrast, arterial thrombus within the coronary or peripheral artery is considered predominantly platelet-rich clot (‘white clot’) and in this ‘high flow’ arterial system, antiplatelet therapies are beneficial, for example, in the setting of acute coronary syndromes (ACS). As always, these generalisations can be overtly misleading. In atrial fibrillation (AF), which is a common and important cause of intracardiac thrombus – resulting in stroke and systemic (arterial) thromboembolism – stasis within the left atrial appendage and a preponderance of coagulation abnormalities results in fibrin-rich thrombus (‘red clot’) formation (1). Hence, the superiority of anticoagulation as thromboprophylaxis inAF and in keeping with the observation that the benefit of antiplatelet therapy in AF is not much beyond what would be expected from the effect of co-existant vascular disease. Similarly, anticoagulation can sometimes be complementary or an alternative to antiplatelet therapy in ACS (2). As another example, subjects who sustain a retinal vein thrombosis commonly have associated cardiovascular risk factors and the causes of mortality on follow-up are usually arterial vascular events, such as myocardial infarction and stroke (3). Perhaps an appreciation of the underlying prothrombotic mechanisms may improve our understanding of the common pathophysiological features with both venous and arterial thromboembolism. With arterial disease, the processes of endothelial damage/dysfunction, inflammation and thrombogenesis (with coagulation/platelet abnormalities) are well-recognised, resulting in the dynamic, progressive disease of atherothrombotic disease (4). Indeed, thrombogenesis and atherogenesis are closely related. Compared to arterial thrombosis, the pathogenesis of venous thromboembolism (VTE) is probably less well understood, where the classic risk factors (such as malignancy, pregnancy, oestrogen use, immobilization) are absent. As atherosclerosis is known to involve platelet and coagulation activation, as well as fibrin turnover, it is not unreasonable to suggest that a plausible pathophysiological link exists between VTE and atherosclerosis. This notion is given further credence as both conditions have many risk factors in common, including older age, obesity, diabetes mellitus, hyperlipidaemia and hypertension (5). In this issue of Thrombosis and Haemostasis, Bova et al. (see pages 132-6) explore the potential association between idiopathicVTE and adverse arterial events.Their choice of idiopathic VTE is significant, as it represents 25%-50% of all VTEs (7). Their case-control study is well-designed, with the patient and control groups being evenly-matched for number and gender, as well as known arteriovenous disease risk factors, whilst followup was prospective and lasted an average of 40 months. Bova et al. (6) conclude that there is a higher risk of adverse cardiovascular outcomes in idiopathic VTE patients (HR:2.84; 95% CI:1.11–7.27; p=0.03), compared to the control population. Of note, all VTE patients were treated with anticoagulation for approximately 13.9 months, thereby further reducing the risk of cardiovascular adverse events, such as ischaemic stroke and myocardial infarction. Their findings are in keeping with their previous report (8), where the risk of atherosclerosis (as defined by carotid ultrasonography) was higher in spontaneous (idiopathic) VTE when compared to secondary VTE patients (OR: 2.3; 95%CI:1.4–3.7) or controls (OR: 1.8; 95%CI: 1.1–2.9). However, the obvious limitations of a cross-sectional analysis apply, and such a study design reveals associations rather than causality. Also, statistical © 2006 Schattauer GmbH, Stuttgart

75-Year-Old Woman With Chest Pain and Shortness of Breath

Arterial Ischemic Events Are a Major Complication in Cancer Patients with Venous Thromboembolism

Venous disease is a term that broadly covers both venous thromboembolic disease and chronic venous disease. The basic pathophysiology of venous thromboembolism and chronic venous disease differ as venous thromboembolism results from an imbalance of hemostasis and thrombosis while chronic venous disease occurs in the setting of tissue damage because of prolonged venous hypertension. Both diseases are common and account for significant mortality and morbidity, respectively, and collectively make up a large health care burden. Despite both diseases having well-characterized environmental components, it has been known for decades that family history is an important risk factor, implicating a genetic element to a patient's risk. Our understanding of the pathogenesis of these diseases has greatly benefited from an expansion of population genetic studies from pioneering familial studies to large genome-wide association studies; we now have multiple risk loci for each venous disease. In this review, we will highlight the current state of knowledge on the epidemiology and genetics of venous thromboembolism and chronic venous disease and directions for future research.

Predicting and accounting for VTE in phase I cancer studies

High Rates of Venous and Arterial Thrombotic Events in POEMS Patients: Results from the UK-Based POEMS Registry, Highlighting the Need for Therapeutic Guidelines

Introduction