The 3 most important recent advances in the management of venous thrombosis

James Douketis

Dr James Douketis is a staff physician in general internal medicine and clinical thromboembolism at St. Joseph’s Healthcare Hamilton, Ontario, and holds the David Braley-Nancy Gordon Chair in Thromboembolic Disease at McMaster University.

If you were to name the 3 most important recent advances in the management of venous thrombosis, what would they be?

James Douketis, MD: An important question that I’ve been asked is what I think is the most important advance in anticoagulant/antithrombotic management over the last decade. I can safely say that the emergence of DOACs, or direct oral anticoagulants, that came on to the clinical practice scene just over 10 years ago, has really revolutionized how we deal with anticoagulant management by improving safety, by improving efficacy, but most importantly by offering clinicians and patients a choice in regard to which anticoagulant to use. And it’s always good to have options. So, I would say that [it] is by far the biggest advance within the past decade.

Having said that, within the past few weeks, it has been astonishing how rapidly we have gained knowledge on this new entity of VITT, or vaccine-induced immune thrombotic thrombocytopenia, associated with the coronavirus disease 2019 (COVID-19) vaccines. We’ve learned how to diagnose VITT and we also know that it’s challenging to treat it, but we have ways to do that with nonheparin anticoagulants.

And, of course, everybody knows the broader story of the association between COVID-19 and thrombosis, how it uses a very different mechanism and paradigm in terms of thrombogenesis and, of course, how that affects how we treat patients with COVID-19 pneumonitis.

So, [the most recent advances in the management of venous thrombosis include] a long-term revolution in anticoagulant therapy and, more recently, an incredible amount of knowledge gained, in such a short period of time, on COVID-19 and associated thrombosis and vaccine-associated thrombosis.

See also
  • COVID-19 resource hub Resources helpful in addressing the coronavirus disease 2019 (COVID-19) epidemic.
  • To anticoagulate or not to anticoagulate? Part 1 Dr Ryan Zarychanski from University of Manitoba, Canada, joins Dr Roman Jaeschke to discuss the latest trial results regarding anticoagulation in critically ill patients with COVID-19.
  • Publications of the Week, August 19 A digest of noteworthy publications curated by editors from McMaster University. This week’s focus: anticoagulation in critically and noncritically ill patients with COVID-19.
  • COVID-19 vs thrombosis: Who should receive anticoagulation? Dr Roman Jaeschke, an intensivist, and Dr James Douketis, an expert in thrombosis, discuss the paradigm-changing results of the latest clinical trials on therapeutic anticoagulation in patients with COVID-19.
  • Publications of the Week, July 12 A digest of noteworthy publications curated by editors from McMaster University. This week’s focus: tofacitinib in the in-hospital treatment of COVID-19 pneumonia.
  • COVID-19 McMaster Survival Guide The COVID-19 McMaster Survival Guide is a concise, comprehensive, and practical manual addressing a broad range of topics related to COVID-19. Updated on an ongoing basis.
  • COLCORONA: Colchicine for COVID-19 Dr Nishma Singhal, associate professor in the Divisions of Infectious Diseases and General Internal Medicine at McMaster University, discusses recent updates on colchicine in the outpatient treatment of COVID-19.
  • The role of high-intensity walking in PAD management Recent findings on the effects of different types of walking exercise on patients with PAD explained by Dr Sonia Anand, professor of medicine at McMaster University, in a new episode of McMaster Perspective.
  • COVID-19: May 2021 update. VTE prophylaxis and anticoagulation Dr Menaka Pai, associate professor of hematology and thromboembolism at McMaster University, talks about VTE prophylaxis and anticoagulation in hospitalized COVID-19 patients.
  • Publications of the Week, April 27 A digest of noteworthy publications curated by editors from McMaster University. This week’s focus: thrombotic thrombocytopenia following administration of the ChAdOx1 nCov-19 vaccine.
  • COVID-19: April 2021 update. Part 2: Vaccines (thrombosis) Dr Zain Chagla, associate professor at the Faculty of Health Sciences at McMaster University, discusses the reports of thrombotic events following administration of the AstraZeneca vaccine against COVID-19.

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