European-American Forum: DOACs, Thrombectomy and Ulcers
Anticoagulation Choices Across DVT Treatment Phases
Stavros Konstantinides outlined 2021 guidelines favoring direct oral anticoagulants over vitamin K antagonists across DVT treatment phases, recommending three months for provoked proximal DVT and individualized extended therapy for unprovoked cases based on bleeding risk.
Selecting Patients for Early Thrombus Removal
Manj Gohel reviewed new European guidelines built on Cavent, Attract, and Kiva trial data, finding early thrombus removal reduces post-thrombotic syndrome only in iliofemoral DVT with low bleeding risk, while femoropopliteal-only disease showed no benefit and more bleeding.
The Search for Reliable Duplex Obstruction Criteria
Elna Masuda reviewed candidate duplex parameters for iliac obstruction, including monophasic waveforms, persistent cephalad flow with Valsalva, velocity ratios above 2.5, and reduced diameters, concluding no single measure is sensitive enough and provocative maneuvers help detection.
A Call to Update Venous Leg Ulcer Guidelines
Bill Marston argued current venous leg ulcer guidelines predate the EVerEST trial, showing early superficial vein ablation shortens healing, and called for new international, multispecialty guidelines and studies validating perforator ablation and outflow correction.
