Diagnosis, treatment and long-term effects of venous thromboembolism

Venous thromboembolism (VTE) is a common and potentially fatal disease. Despite numerous achievements, there are still many knowledge gaps in VTE treatment and even more on long-term effects of deep venous thrombosis (DVT). This thesis addressed some of these unsolved issues. The first part evaluated two novel diagnostic strategies (ADJUST and YEARS algorithm) in patients with suspected pulmonary embolism (PE) and concluded that both strategies reduce the number of CT-scans needed to exclude PE. Part II focused on VTE treatment in special patient groups. First, we concluded that the favorable risk/benefit-balance of direct oral anticoagulants (DOACs) is preserved in the elderly. Second, DOACs might be an attractive alternative to subcutaneous low-molecular-weight heparin or intravenous warfarin in patients with short bowel syndrome, who frequently need lifelong anticoagulants. Third, our registry on VTE occurring despite anticoagulation treatment showed there is a wide practice variation in the management of these “breakthrough events” reflecting the heterogeneous and complex nature of this clinical situation. Particularly in patients with cancer, these “breakthrough events” are accompanied by high morbidity and mortality. Part III addressed the treatment of DOAC-associated bleeding complications and suggest that prothrombin complex concentrate can - at least in part - overcome the anticoagulant effect of direct oral factor Xa-inhibitors. Part IV studied a common complication of DVT of the leg, called post-thrombotic syndrome (PTS). We showed that patients with PTS had more pronounced coagulation activity than patients without PTS. Finally, a post-hoc analysis of a large randomized clinical trial suggests that DOACs might reduce PTS occurrence as compared to vitamin K antagonists