Description:
Ongoing Challenges in the Management of Venous Thromboembolism Hematologists are frequently asked to evaluate and manage patients with thrombosis. While categorizing venous thromboembolism (VTE) as "provoked" vs "unprovoked" is an important determinant of recurrence risk, it is not always straightforward to classify thrombotic events as some risk factors are minor and transient (i.e., "minimally" provoked) while others are persistent. Furthermore, multiple risk factors may be present. This has led some to recommend that the terms be abandoned. Dr. Cecilia Becattini will discuss the role of major, minor, and persistent risk factors in the development of VTE. Clinical assessment of the risk factors in an individual patient allows for an estimate of the recurrence risk and a decision as to the need for long-term anticoagulation. Hematologists are often referred patients with abnormal coagulation tests (elevated D-dimer or Factor VIII coagulant activity, low levels of protein C or protein S); they will also encounter abnormal results of tests (e.g., MTHFR, PAI-1 promoter polymorphisms) with which they may be unfamiliar that carry little if any thrombotic risk. Through a series of cases, Dr. Kenneth Bauer will discuss the ramifications of such testing (“do’s, don’ts, and nuances”) on management. Dr. Keith McCrae will review three clinical cases that raise perplexing questions about management of the antiphospholipid syndrome, including the significance of IgM antiphospholipid antibodies, whether to switch from a DOAC to warfarin, and considerations on how to treat an asymptomatic patient with antiphospholipid antibodies. Definitive data to inform management of such patients is often lacking, forcing the practitioner to rely upon expert opinion and patient preference in decision making.