https://www.um.edu.mt/library/oar/handle/123456789/485 Fri, 22 May 2026 10:25:07 GMT 2026-05-22T10:25:07Z https://www.um.edu.mt/library/oar/handle/123456789/146720 Title: Prescribing patterns and clinician preferences for direct oral anticoagulant use in unusual site venous thromboembolism : a cross-sectional analysis from the Direct oral anticoagulants in Unusual Site venous Thromboembolism (DUST) study Authors: Riva, Nicoletta; Bertoletti, Laurent; Chistolini, Antonio; De Stefano, Valerio; Barbar, Sofia; Donadini, Marco Paolo; Sartori, Maria Teresa; Couturaud, Francis; Sartori, Michelangelo; Gatt, Alexander; Cohen, Omri; Fantoni, Chiara; Kaatz, Scott; Mavri, Alenka; Mahé, Isabelle; Catella, Judith; Ruiz-Artacho, Pedro; Ghigliotti, Giorgio; Jara-Palomares, Luis; Podda, Gian Marco; Squizzato, Alessandro; Rojnuckarin, Ponlapat; Leentjens, Jenneke; Sevestre, Marie Antoinette; Ageno, Walter Abstract: Background: Unusual site venous thromboembolism (USVTE) presents therapeutic challenges. Direct oral anticoagulants (DOACs) are increasingly prescribed despite limited evidence from clinical trials. Objectives: This cross-sectional analysis aimed to describe DOAC prescription patterns and rationale for choosing DOACs for USVTE treatment in real-life clinical practice. Methods: The Direct oral anticoagulants in Unusual Site venous Thromboembolism study (NCT03778502) is an international, multicenter, prospective, observational registry. Adult patients with objectively diagnosed USVTE (years 2018-2023) treated with DOACs were included. Information was collected on patient characteristics, USVTE location, anticoagulant treatment, and rationale for starting DOACs. Results: In total, 349 patients were included from 23 centers in 9 countries. The most common USVTE were splanchnic vein thrombosis (n = 219, 62.8%) and cerebral vein thrombosis (n = 103, 29.5%). The most prescribed DOACs were apixaban (n = 186, 53.3%) and rivaroxaban (n = 101, 28.9%). The median delay between USVTE diagnosis and DOAC initiation was 24 days, with 219 patients (62.8%) starting DOACs >14 days after diagnosis. Indeed, 320 (91.7%) patients received other anticoagulants before switching to DOACs (mainly low-molecular-weight heparin, n = 217, 67.8%). The main reasons for prescribing DOACs were oral administration (145/336, 43.2%), no need for blood monitoring (131/336, 39.0%), favorable safety profile (116/336, 34.5%), and prescriber-reported patient's preference (96/336, 28.6%). Apixaban was the most prescribed DOAC in splanchnic vein thrombosis (133/219, 60.7%), while dabigatran was the most prescribed DOAC in cerebral vein thrombosis (38/103, 36.9%). Conclusion: DOACs are increasingly prescribed for USVTE owing to their ease of use and perceived safety, but mainly after initial treatment with parenteral anticoagulation. Further evidence is still needed to support their use in the acute phase. Thu, 01 Jan 2026 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/146720 2026-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/146477 Title: International society on thrombosis and haemostasis conflict of interest management and tools : presentation of a case study Authors: Casanegra, Ana I.; Sharif, Sobia; Rothschild, Cynthia; Riva, Nicoletta; Sarkar, Amrita; Orsi, Fernanda A.; Ariëns, Robert A. S. Abstract: Management of conflicts of interest (COIs) is a critical element in supporting the mission, core values, and code of conduct of the International Society on Thrombosis and Haemostasis (ISTH). The ISTH Ethics Committee and Council recently developed clear guidelines and educational materials to help members at all levels appropriately manage COIs. COI refers to the existence of material or intellectual interests outside the ISTH in the fields of thrombosis and hemostasis, hematology, or cardiology that could influence an individual’s actions or decisions in ways not aligned with the ISTH mission or values. The primary measures that can be implemented whenever a COI arises are disclosure, recusal, resignation, or divestment. To better illustrate the nature of COI considerations and the possible application and consequences of each measure, we present the following hypothetical case: “Professor Baker is a recognized expert in platelet physiology, with more than 200 publications as a lead author. He has recently joined the speakers’ bureau of a large pharmaceutical company that is preparing for the launch of a new antiplatelet agent. He was invited to participate in several educational activities related to the introduction of the new agent. In this role, he is expected to prepare written materials and deliver presentations at medical meetings and company-sponsored educational events.” Thu, 01 Jan 2026 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/146477 2026-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/146476 Title: Thrombosis after surgical splenectomy - why, in whom and can we prevent it? Authors: Gurumurthy, Gerard; Swan, Dawn; Roberts, Lara; Riva, Nicoletta; Gatt, Alexander; Thachil, Jecko Abstract: Splenectomy remains a common operation performed in the setting of trauma, haematological disease, malignancy and diagnostic purposes. Contemporary evidence indicates an increased risk of thromboembolism after splenectomy. This includes both systemic venous thromboembolism (deep vein thrombosis and pulmonary embolism) and splanchnic thrombosis involving the portal-splenic-mesenteric axis. Comparator-based population studies demonstrate a pronounced early postoperative risk and disease-matched cohorts suggest that risk can persist beyond the immediate perioperative period. This suggests a durable post-splenectomy prothrombotic phenotype. Mechanistically, this phenotype may reflect the loss of splenic functions that are intrinsically antithrombotic, including clearance of procoagulant cellular substrates and microparticles, sequestration and regulation of platelet mass, modulation of portal haemodynamics, and facilitation of thrombus remodelling and resolution. Splenectomy as a risk factor is over-represented among patients with chronic thromboembolic pulmonary hypertension (CTEPH) with evidence for biological links between thrombotic risk and impaired thrombus resolution. Anticoagulation strategies in splenectomised patients remain heterogeneous and evidence for its use is largely based on observational studies. Most guidance supports routine perioperative pharmacologic thromboprophylaxis and consideration of extended prophylaxis in selected cases. When post-splenectomy thrombosis occurs, therapeutic anticoagulation is the mainstay for the first three to six months. Extended therapy is reserved for persistent risk factors and those who develop CTEPH. Thu, 01 Jan 2026 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/146476 2026-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/146418 Title: Managing coagulation abnormalities, bleeding, and thrombosis in patients with cirrhosis Authors: Tripodi, Armando; La Mura, Vincenzo; Piscaglia, Fabio; Stefaninin, Bernardo; Riva, Nicoletta; Ageno, Walter Abstract: Cirrhosis is associated with a narrow balance between procoagulant and anticoagulant factors that may lead to potentially serious complications. Interpretation of laboratory tests, prevention of bleeding during invasive procedures, and use of anticoagulant drugs for the prevention and treatment of thromboembolism are often challenging. After reviewing the most contemporary literature, we hereby provide guidance to navigate the evidence and support clinical decisions. Based on current knowledge, prothrombin time and activated partial thromboplastin time do not accurately describe hemostasis in patients with cirrhosis and should not be used to predict bleeding. Rather, a careful assessment of patient and procedure-related variables better helps to identify patients at increased bleeding risk. Because procedure-related bleedings are uncommon in patients with cirrhosis, the use of prophylactic strategies is seldom necessary in daily practice. In case of perioperative bleeding, viscoelastometry may be useful to drive decisions on the use of transfusion products. Portal vein thrombosis is a common complication in patients with cirrhosis and requires a timely start of anticoagulant treatment, especially when vessel obstruction exceeds 50% of the lumen diameter. Treatment should be continued for at least 6 months. The direct oral anticoagulants are increasingly used in this setting, representing a valid alternative to the heparins and vitamin K antagonists. Atrial fibrillation in cirrhosis is associated with a high risk of ischemic stroke and treatment-related major bleeding. The benefit of anticoagulants is supported by the results of observational studies, and the direct oral anticoagulants are suggested as the first line of treatment also for this population. Thu, 01 Jan 2026 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/146418 2026-01-01T00:00:00Z