Empowering patients with venous thromboembolism

Determining the best diagnostic and treatment pathways for patients with blood clots is a challenge. For patients with suspected pulmonary embolism—where timely diagnosis and treatment are essential but often challenging due to unspecific clinical presentations—there are more than a dozen different international guidelines on best practice. Although a comparison of these guidelines, published in The Lancet Haematology, has shown reasonable concordance for diagnosis and treatment in haemodynamically unstable patients, major discrepancies regarding empirical treatment and the role of ultrasound in haemodynamically stable patients with suspected pulmonary embolism were found. The authors conclude that well designed prospective studies on management are warranted to explore these aspects of pulmonary embolism diagnostics. Clear insight for when to measure D-dimer and what cutoffs to apply could aid physicians to avoid diagnosis delays. Reducing time to diagnosis for suspected deep vein thrombosis has been shown to be feasible if patients receive point-of-care ultrasonography from trained emergency care doctors and specialists, rather than being referred to the hospital's imaging departments. Halving diagnosis time could potentially reduce emergency room crowding and result in better clinical outcomes and experiences for patients. Patient experience and empowerment is at the heart of this year's World Thrombosis Day on October 13. This year sees a series of programmes focused on exercise challenges to combat sedentary lifestyles, webinars on mental health, and awareness and discussion forums across social media, aiming to educate, empower, and inspire individuals worldwide. By drawing attention to the signs and symptoms of thrombosis, which contribute to the deaths of 1 in 4 people worldwide each year, events like World Thrombosis Day aim to reduce that statistic. Better understanding of risk factors associated with venous thromboembolism is crucial to define the target populations that public health campaigns should be aimed at. Research on risk factors in women has provided insight into those who are at high risk of developing a clot. In an observational study, Danish researchers showed that women who use non-steroidal anti-inflammatory drugs alongside hormonal contraception containing third or fourth generation progestins were at a greater risk of developing venous thromboembolism than those taking progestin-only tablets, implants, and coils. Information about these risk factors should be communicated at the time of prescription, so that women using hormonal birth control are informed about thrombosis risk, although the absolute risk of developing a serious blood clot is low. Another risk factor is Factor V Leiden, which has a synergistic effect in venous thromboembolism risk with exogenous oestrogen use. The prevalence of Factor V Leiden varies across races. In an analysis of the Genes & Health British-South Asian cohort from the UK (n=20 048), researchers were interested in the Asian population, as these individuals are under represented in research cohorts and have high rates of cardio-metabolic morbidity. Of the 439 (2%) participants who had a venous thromboembolism event, prevalence increased with obesity, hypertension, dyslipidemia, chronic kidney disease, oestrogen use, and in the presence of Factor V Leiden. Multimorbidity and presence of Factor V Leiden compounded this risk of clot development with oestrogen use, indicating that good communication is required when prescribing contraceptives to inform and empower patients regarding their clinical care. Better understanding of diagnosis and risk factors associated with thrombosis are offering patients more control over their thrombosis journey, and new treatments are offering more options. The past decades have seen the wide-spread application of direct oral anticoagulants, which offers a treatment advantage over low-molecular-weight heparins, but are still associated with a bleeding risk. The Phase 2 AZALEA-TIMI 71 trial on the monoclonal antibody abelacimab was halted ahead of schedule after showing a reduction in bleeding events in patients with atrial fibrillation compared with rivaroxaban. Although the complete data are to be released, this new drug could be pivotal if the minimal bleeding risk is confirmed. The thrombosis field has made great strides in recent years. Alongside the latest ground-breaking research, clear communication is needed to put the patient at the centre of understanding their thrombosis risk, diagnosis pathway, and treatment. Every patient feeling knowledgeable and empowered with respect to their thrombosis care is crucial.