Consensus on the Management of the Clinical Challenges of Venous Thromboembolism in Special Situations
Cristina Marzo 1, Teresa Solanich 2, Dolors Tassies 3, Elena Pina 4, Maite Antonio Rebollo 5, Enrique Gallardo 6 7, Sonia Serradell 8, Marta Merino 9, Marina Carrasco 10, Albert Tugues 11
1) Hematology and Hemotherapy Department, Hospital Universitari Arnau de Vilanova, Lleida, Catalunya, Spain.
2) Vascular Surgery Department, Hospital Universitari Parc Taulí, Sabadell, Spain.
3) Hemotherapy and Hemostasis Department, Hospital Clinic Barcelona, Barcelona, Catalunya, Spain.
4) Thrombosis and Haemostasis Department, Hospital Universitari Bellvitge, Hospitalet de Llobregat, Barcelona, Spain.
5) Oncogeriatrics Unit, Institut Català d’Oncologia, Barcelona, Spain.
6) Oncology, Parc Taulí Hospital Universitari, Sabadell, Barcelona, Spain.
7) Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain.
8) Medical Oncology Department, Vall d’Hebron University Hospital, Barcelona, Spain.
9) Medical Affairs Thrombosis, LEO Pharma Spain, Barcelona, Spain.
10) Unitat d’Hemostasia i Trombosi, Servei d’Hematologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
11) Hematology and Hemotherapy Department, Hospital Universitario Arnau de Vilanova de Lleida, Barcelona, Spain.
Venous thromboembolism(VTE) can present different challenging situations for which high-quality evidence to guide optimal preventive and therapeutic management is lacking and for which clinical practice guidelines have not established solid recommendations. The aim of this article is to achieve consensus on a proposal of action for the clinical management of complex, clinically relevant situations with a low level of evidence which generate great uncertainty—the duration of VTE treatment and the role of thrombus recanalization, the prevention of VTE within the context of pregnancy, management of anticoagulant treatment in patients with VTE and special characteristics, such as renal insufficiency and obesity, the therapeutic management of pluripathological and polymedicated older patients with VTE, and finally, primary ambulatory thromboembolic prevention in cancer patients. This consensus article arose from a collaboration of experts in VTE from different medical specialties.