SVM at AVF: Managing VTE in Special Patient Populations

VTE in the Elderly and in Pregnancy

Registry data show that patients over 70 face significantly higher bleeding risk with anticoagulation but comparable or even lower rates of VTE recurrence than younger patients, favoring direct oral anticoagulants and individualized dosing. In pregnancy, prophylaxis decisions depend on prior VTE history and thrombophilia status, low molecular weight heparin is preferred throughout, and anticoagulation timing must be coordinated closely with delivery and neuraxial anesthesia.

Transgender Care and VTE Risk

Estrogen therapy for gender affirming care raises VTE risk two to four fold, so clinicians favor transdermal over oral formulations and weigh anticoagulation against the importance of continuing hormone therapy through shared decision making rather than reflexively discontinuing it.

Cerebral Sinus and Splanchnic Vein Thrombosis

Both conditions are uncommon, carry higher bleeding risk than typical DVT or PE, and often reveal an underlying thrombophilia or myeloproliferative disorder. Current guidance reserves thrombophilia testing for patients considering discontinuation of anticoagulation, since a positive result favors continuing treatment indefinitely.