Hemostasis and thrombosis reflect a delicate balance, regulated by the interplay between procoagulant and anticoagulant mechanisms. Hemophilia is traditionally viewed as a bleeding disorder, but emerging evidence highlights the paradoxical risks of thrombosis in hemophilia patients. We explore the landscape of hemophilia management, emphasizing challenges of balancing hemostasis in the context of aging, novel non-factor replacement therapies (NRTs), and comorbidity-driven thrombotic complications. Therapeutic approaches, including innovative NRTs, such as emicizumab, or rebalancing agents (e.g., concizumab, marstacimab, fitusiran), offer promising advancements in bleeding prophylaxis but may increase thrombotic risks. Conversely, novel anticoagulants, such as FXI inhibitors, offer potential thrombosis protection with minimal bleeding risk. Our review examines the impact of aging-related comorbidities, including cardiovascular disease, atrial fibrillation, HIV-associated complications, and acute coronary syndromes, on thrombotic risk in hemophilia patients. Evidence-based strategies for balancing hemostasis and thrombosis are outlined alongside experimental models, thrombin generation assays, and advancements in rebalancing coagulation through natural anticoagulant modulation. FXI inhibition emerges as a paradigm shift in thrombosis management, offering reduced bleeding risks while preserving vascular health. Finally, this review highlights the need for global laboratory assays to personalize treatments, emphasizing strategies to optimize safety and efficacy, particularly as hemophilia patients live longer with complex comorbidity profiles.

BACKGROUND:The natural history and optimal management of isolated distal deep vein thrombosis (iDDVT) remain uncertain. OBJECTIVES:We assessed the incidence, timing, severity, and predictors of symptomatic pulmonary embolism (PE), recurrent deep vein thrombosis (DVT), major bleeding, and mortality in a large real-world cohort of patients with iDDVT. METHODS:We analyzed 8488 patients with iDDVT from the Registro Informatizado de la Enfermedad TromboEmbólica Registry. Outcomes were evaluated separately during anticoagulation and after its discontinuation using competing-risk models. Multivariable cause-specific Cox regression analyses identified independent predictors for each treatment phase. RESULTS:Over a median follow-up of 190 days, 116 patients (1.4%) developed symptomatic PE, 363 (4.3%) had recurrent DVT, and 137 (1.6%) experienced major bleeding. Thrombotic events occurred more frequently after stopping anticoagulation, while most bleeding episodes occurred during treatment. Major bleeding had the highest 10-day mortality (15%), exceeding that of PE (6%). During anticoagulation, active cancer predicted all 3 complications; male sex predicted PE; and renal impairment, anemia, chronic lung disease, recent bleeding, and psychotropic drug use predicted major bleeding. After discontinuation, psychotropic drug use predicted PE; corticosteroid use predicted recurrent DVT and major bleeding; and renal impairment and cancer remained strong predictors of major bleeding. Transient risk factors were consistently associated with a lower risk of recurrence. CONCLUSION:iDDVT is not a benign condition. Although recurrent DVT was the most frequent complication, PE and especially major bleeding accounted for substantial early mortality. Distinct phase-specific risk profiles may help guide personalized decisions regarding anticoagulation intensity, duration, and posttreatment monitoring.

Abstract:Treatment of catheter-related thrombosis (CRT) in acute leukemia patients is challenging due to concomitant thrombocytopenia. Although modified-dose anticoagulation is frequently used in this setting, several vital outcomes remain unclear. The current study evaluated clinical outcomes of a platelet-count-guided low molecular weight heparin (LMWH) regimen in these patients. Data on all newly diagnosed acute leukemia patients, who developed CRT, were retrieved from the institutional database. Upon CRT diagnosis, patients received either a full or modified dose of LMWH, based on their platelet counts. Outcomes included recurrent venous thromboembolism (VTE), hemorrhagic events. Competing risk analyses were performed, with death considered a competing risk. All-cause mortality and blood product utilization (per patient; pre- and postanticoagulation commencement) were compared. A total of 193 acute leukemia patients diagnosed with CRT between November 2004 and May 2022 were included. Eighty-seven patients (45%) received full-dose LMWH. Modified-dose LMWH treatment was associated with hazard ratio (HR) of 0.642 (95% confidence interval [CI]: 0.268-1.540; p = 0.320) in terms of CRT recurrence and HR of 0.975 (95% CI: 0.439-2.170; p = 0.950) in terms of hemorrhage. Mortality was not significantly higher in the modified-dose group (HR: 1.47, 95% CI: 0.93-2.32; p = 0.092). Notably, platelet requirement did not differ before and after the CRT diagnosis, irrespective of LMWH doses used (full-dose group: median pre-CRT 0.09 [interquartile range, IQR: 0-0.27] vs. post-CRT 0.05 [IQR: 0.01-0.14] units/day, p = 0.059; modified-dose group: median pre-CRT 0.03 [IQR: 0-0.24] vs. post-CRT 0.07 [IQR: 0.01-0.18] units/day, p = 0.720). In acute leukemia patients with CRT, a platelet-count-guided LMWH regimen was not associated with higher rates of recurrent VTE, hemorrhagic complications, mortality, or platelet transfusion requirements.

Dear Colleagues, We are pleased to present this volume of the Proceedings of the 13 International Conference on Thrombosis and Hemostasis Issues in Cancer (ICTHIC) being held in Bergamo, Italy, April 17-19, 2026. Cancer-associated thrombosis, known since the nineteenth century, remains a major cause of morbidity and mortality in people with cancer. The hypercoagulable state of malignancy reflects a complex interplay between cancer biology, the hemostatic system, platelets, inflammation, and the tumor microenvironment. Newer treatments for cancer, including immune checkpoint inhibitors, targeted agents, and small molecules, continue to be associated with high rates of both venous and arterial thromboembolism in the context of cancer. Since its inception, ICTHIC has been dedicated to integrating diverse perspectives from basic science, clinical research, and patient-centered care, with the overarching aim of reducing the burden and consequences of thrombotic and bleeding complications in cancer. An equally important objective of the conference is to foster the development of emerging investigators and innovative research themes that will advance the field. The 2026 scientific program opens with a set of articles focused on risk assessment, diagnosis, and epidemiology of cancer-associated thrombosis, including evolving approaches to thrombotic event reporting, occult cancer screening, and the novel application of artificial intelligence and natural language processing in this field. A second set of articles addresses bleeding and thrombosis in hematologic malignancies, highlighting the ongoing challenges of balancing thromboprophylaxis, anticoagulation, and bleeding risk in diseases such as acute promyelocytic leukemia, acute lymphoblastic leukemia, multiple myeloma, and the growing field of CAR-T therapies. The next set of papers explores novel prevention and treatment settings and strategies for cancer-associated thrombosis, including optimal anticoagulant duration, postoperative thromboprophylaxis, splanchnic vein thrombosis, and atrial fibrillation in patients with cancer. A major highlight of the meeting is the Simon Karpatkin Memorial Lecture, honoring the late Professor Simon Karpatkin for his seminal contributions to the understanding of platelets, immunity, and cancer. The 2026 Lecture, delivered by Jeffrey Zwicker, addresses the thromboinflammatory links underscoring the critical links between inflammation, coagulation, and malignancy. Challenging conditions in cancer are addressed by a set of papers, which include the epidemiology of bleeding, thrombocytopenia, microangiopathies, and bleeding complications associated with anticoagulant therapy. The papers devoted to hemostasis-cancer crosstalk give mechanistic insights into tumor biology, novel experimental models, and the evolving role of factor XI inhibitors. Returning to clinical aspects, a set of papers addresses the management of acquired bleeding disorders, outpatient management, pharmacokinetic interactions, balancing bleeding/thrombotic risk in palliative care settings, and the role of aspirin and antiplatelet therapy in cancer prevention. A multidisciplinary set of papers emphasizes implementation strategies for cancer-associated thrombosis prevention and highlights a team-based approach. Advances in predicting thrombosis as well as bleeding in this setting are discussed, including the role of next-generation biomarkers and genomic profiling. Future directions, including the role of repurposing old drugs such as statins, optimizing thromboprophylaxis, and the roles of hormones, are reviewed. We are deeply grateful to the faculty, abstract authors, reviewers, sponsors, and participants whose contributions made this meeting both scientifically rigorous and clinically meaningful. As cancer medicine continues to evolve, researchers are finally understanding the roles of the hemostatic system and antithrombotic therapies in shaping cancer outcomes. We are proud that ICTHIC remains at the forefront of this evolving landscape and continues to serve as a vital platform for collaboration across disciplines. The Conference Chairmen Anna Falanga, Benjamin Brenner, Alok A. Khorana

CAR-T cell therapy is efficient in relapsed/refractory B-cell lymphoma; yet, cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) remain major and potentially life-threatening complications, which makes their prediction and prevention crucial. This international, retrospective study analyzed the predictive value of coagulation parameter dynamics for ICANS and CRS development in 265 B-cell lymphoma patients at two tertiary-care centers. Platelet counts, fibrinogen, PT, PTT, international normalized ratio, and D-dimer, were recorded daily from pre-lymphodepletion through 2 weeks post-infusion. ICANS occurred in 34% of patients, with high-grade events documented in 13%. Patients with ICANS had significantly lower median platelet (67 vs. 123 × 103/μL) and fibrinogen (263 vs. 379 mg/dL) levels than those without ICANS. During high-grade ICANS days, fibrinogen and platelet levels were significantly reduced (p = 0.003 and p = 1.6 × 10-14, respectively). In > 75% of high-grade ICANS cases, 1 day before its onset, platelet counts were < 100 × 109/L (median decrease: 11.6% versus 1.6% on other days; p = 0.001). Conversely, on the day preceding ICANS onset, higher fibrinogen concentrations were observed, with median values of 448 mg/dL in the ICANS group versus 376 mg/dL in the non-ICANS group (p = 0.03). These findings suggest that platelet and fibrinogen dynamics could be early indicators of ICANS development in lymphoma patients.

Abstract:Amniotic fluid embolism (AFE) and placental abruption represent two of the most catastrophic obstetric emergencies, sharing a common pathway of severe coagulopathy while differing fundamentally in their underlying pathophysiology. AFE is characterized by sudden cardiovascular collapse, respiratory distress, and disseminated intravascular coagulation (DIC), likely triggered by an anaphylactoid-like reaction to fetal antigens entering maternal circulation. The condition manifests with both consumptive coagulopathy and hyperfibrinolysis, with platelet counts frequently falling below 50,000/μL and precipitous drops in fibrinogen levels. Management requires immediate advanced cardiac life support and aggressive hemodynamic support, mechanical ventilation, and massive transfusion protocols guided by viscoelastic testing. Emerging therapies include extracorporeal membrane oxygenation for refractory cardiopulmonary collapse and recombinant factor VIIa for intractable hemorrhage. Placental abruption results from premature placental separation and presents vaginal bleeding, abdominal pain, and fetal compromise. The condition arises from chronic uteroplacental ischemia and decidual arteriopathy, with retroplacental hematomas serving as massive sources of tissue factors that trigger the coagulation cascade. Abruption-related DIC primarily manifests consumption coagulopathy. Unlike AFE, urgent delivery of the fetus and placenta can eliminate the source of thromboplastic material, often resolving the coagulopathy. Both conditions demand, among others, institutional preparedness with established massive transfusion protocols and multidisciplinary teams trained in obstetric critical care. While advances in viscoelastic testing, targeted factor concentrates, and life support technologies have improved outcomes, AFE and placental abruption continue to challenge even experienced obstetric teams.

BACKGROUND:Randomized trials have shown that direct oral anticoagulants (DOACs) are as effective as vitamin K antagonists (VKAs) for treating venous thromboembolism (VTE), with less major bleeding. Whether these findings apply to routine clinical practice remains uncertain. OBJECTIVES:To compare recurrent VTE and bleeding during anticoagulation in patients with symptomatic lower-limb deep vein thrombosis (DVT) treated with DOACs or VKAs, and to assess outcomes according to approximate eligibility for pivotal randomized trials. METHODS:We analyzed consecutive patients with symptomatic lower-limb DVT enrolled in the RIETE registry who received therapeutic-dose VKAs or DOACs. Follow-up was restricted to the treatment period. Outcomes were recurrent VTE, major bleeding, and clinically relevant non-major bleeding (CRNMB). Hazard ratios (HRs) were estimated using Cox proportional hazards models with inverse probability of treatment weighting. RESULTS:Among 24,728 patients (11,349 DOACs; 13,379 VKAs), DOACs were associated with lower risks of recurrent VTE (HR 0.71; 95%CI, 0.58-0.87) and major bleeding (HR 0.78; 95%CI, 0.63-0.97), but a higher risk of CRNMB (HR 1.35; 95%CI, 1.17-1.55). Median times to recurrent VTE, major bleeding, and CRNMB were 105, 88, and 81 days, respectively. Among patients approximating eligibility for randomized trials, DOACs were associated with lower risks of recurrent VTE and major bleeding, whereas no significant reduction was observed in trial-ineligible patients. CONCLUSIONS:In routine clinical practice, DOACs were associated with lower risks of recurrent VTE and major bleeding, but higher CRNMB rates than VKAs. Their safety advantage appeared more evident in patients with characteristics similar to those enrolled in pivotal randomized trials.

Background Upper extremity deep vein thrombosis (UEDVT) is common in patients with cancer. Data on recurrence and bleeding after cancer-associated UEDVT are limited. Objectives The objectives were to identify factors associated with venous thromboembolism (VTE) recurrence and bleeding in patients with cancer and UEDVT, overall and by cancer site, during and after anticoagulation. Methods We analyzed patients from the Registro Informatizado de Pacientes con Enfermedad TromboEmbólica (RIETE), an international, prospective, observational registry of objectively confirmed VTE. We estimated cumulative incidence functions at 6, 12, 18, and 24 months and used proportional subdistribution hazard models to assess associations. Analyses were performed during and after discontinuation, using a landmark at the day of discontinuation if anticoagulation was stopped within 180 days or at day 180 if anticoagulation continued more than 180 days. Results Of 5,195 patients with UEDVT, 2,210 had cancer. At 24 months, the cumulative incidence of recurrent VTE was 3.9% (95% CI: 3.1-4.9) in patients with cancer vs 2.5% (95% CI: 1.8-3.5) in those without cancer, and the cumulative incidence of bleeding was 6.8% (95% CI: 5.7-8.1) vs 4.3% (95% CI: 3.4-5.3), respectively (both P < 0.001). Among patients with cancer, 24-month recurrence varied by cancer site: lung, 6.4% (95% CI: 4.0-9.5); gastrointestinal, 4.0% (95% CI: 2.6-6.0); genitourinary, 3.6% (95% CI: 1.6-6.8); breast, 2.5% (95% CI: 1.2-4.5); and hematologic, 1.4% (95% CI: 0.5-3.4). During anticoagulation, lung cancer (subdistribution hazard ratio [sHR]: 10.1; 95% CI: 1.31-78.06) and younger age (per-year sHR: 0.97; 95% CI: 0.95-0.99) were associated with recurrence, whereas genitourinary cancer (sHR: 4.95; 95% CI: 1.16-21.17) and transient risk factors (sHR: 1.75; 95% CI: 1.16-2.64) were associated with bleeding. After anticoagulation discontinuation, 91 to 180 days (sHR: 0.49; 95% CI: 0.24-1.00) and more than 180 days (sHR: 0.35; 95% CI: 0.17-0.71) of anticoagulation were associated with lower recurrence vs 30 days or less. Conclusions Cancer-associated UEDVT carries higher risks of recurrence and bleeding than noncancer UEDVT. Lung cancer showed the greatest recurrence during treatment. Anticoagulation beyond 90 days was associated with a lower post-treatment recurrence. (Computerized Registry of Patients With Venous Thromboembolism [RIETE]; NCT02832245)

Disseminated intravascular coagulation (DIC) in the postpartum period is a rare but potentially life-threatening complication arising from various obstetric conditions, including postpartum hemorrhage (PPH), placental abruption, intrauterine fetal demise (IUFD), and amniotic fluid embolism. This review explores pathophysiology, risk factors, diagnostic challenges, and management strategies of postpartum DIC. The delicate balance of hemostasis during pregnancy predisposes women to thromboembolic events, which, when disrupted, may lead to rapid consumption of coagulation factors and subsequent coagulopathy. The incidence of obstetric-related DIC varies globally, with higher rates reported in low-resource settings due to delayed diagnosis and management. Diagnostic criteria, including the International Society on Thrombosis and Haemostasis (ISTH), Japanese obstetric DIC, and pregnancy-specific DIC scores, are evaluated, emphasizing their applicability and limitations in obstetric practice. Preventive strategies, primarily targeting the early identification and treatment of PPH, are discussed, with particular focus on active management of the third stage of labor, the administration of uterotonic agents, and the use of antifibrinolytic medications like tranexamic acid. Timely recognition, standardized diagnostic protocols, and multidisciplinary management are essential for improving maternal outcomes and reducing the burden of postpartum DIC.

Venous thromboembolism (VTE) outcomes are influenced by various factors, including race and geographic location. This study aimed to evaluate the associations between race, geographic location, and VTE-related outcomes using real-world data.We analyzed data from 42,206 patients with acute VTE enrolled in the RIETE registry between June 2016 and June 2024. Patients were categorized by self-reported race/ethnicity: White (40,258), Arab (995), Asian (689), and Black (264). Baseline characteristics, comorbidities, treatment strategies, and outcomes (including recurrences, major bleeding, and mortality) were compared across groups and regions. Multivariable analyses were performed to adjust for confounders, including geographic location and comorbidities.Arabic and Asian patients were generally younger, had fewer comorbidities, and were more likely to receive direct oral anticoagulants than White patients. In unadjusted analysis, non-White patients had higher rates of deep vein thrombosis (DVT) recurrence and mortality. After multivariable adjustment, most differences disappeared. Notably, White patients enrolled in Asian centers had higher DVT recurrence (4.54 vs. 1.10/100 patient-years, respectively) and mortality rates (27.9 vs. 8.88/100 patient-years, respectively) than those in European centers, and Arab patients in Asia had higher mortality compared to those in Europe (24.1 vs. 8.26/100 patient-years, respectively).Geographic location, likely representing healthcare infrastructure, had a greater influence on VTE outcomes than self-reported race alone.

Venous thromboembolism (VTE) outcomes are influenced by various factors, including race and geographic location. This study aimed to evaluate the associations between race, geographic location, and VTE-related outcomes using real-world data. We analyzed data from 42,206 patients with acute VTE enrolled in the RIETE registry between June 2016 and June 2024. Patients were categorized by self-reported race/ethnicity: White (40,258), Arab (995), Asian (689), and Black (264). Baseline characteristics, comorbidities, treatment strategies, and outcomes (including recurrences, major bleeding, and mortality) were compared across groups and regions. Multivariable analyses were performed to adjust for confounders, including geographic location and comorbidities. Arabic and Asian patients were generally younger, had fewer comorbidities, and were more likely to receive direct oral anticoagulants than White patients. In unadjusted analysis, non-White patients had higher rates of deep vein thrombosis (DVT) recurrence and mortality. After multivariable adjustment, most differences disappeared. Notably, White patients enrolled in Asian centers had higher DVT recurrence (4.54 vs. 1.10/100 patient-years, respectively) and mortality rates (27.9 vs. 8.88/100 patient-years, respectively) than those in European centers, and Arab patients in Asia had higher mortality compared to those in Europe (24.1 vs. 8.26/100 patient-years, respectively). Geographic location, likely representing healthcare infrastructure, had a greater influence on VTE outcomes than self-reported race alone.

Introduction: Patients with hemoglobinopathies, such as sickle-cell disease and thalassemia, are associated with higher rates of venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism. However, there are currently no data on the risk of VTE recurrence in patients with hemoglobinopathies compared with those without hemoglobinopathies who have already experienced a VTE event. Methods: Data from patients with a VTE event enrolled in the Computerized Registry of Patients with Venous Thromboembolism (RIETE) between January 1, 2001, and June 16, 2025, were extracted. Patients were stratified based on the presence of any hemoglobinopathy. The primary endpoint was 2-year net adverse clinical events (NACE), defined as the composite of all-cause death, VTE recurrence, and any bleeding. Secondary endpoints included the individual components of the primary endpoint and major bleeding. Bleeding events were classified according to the criteria of the International Society on Thrombosis and Haemostasis (ISTH). Clinical outcomes were compared between groups after propensity score matching in a 1:2 ratio to account for baseline differences in age, sex, weight, inpatient evaluation at diagnosis, intensive care unit admission, and use of antiplatelet therapy. Cox regression models were used to calculate hazard ratios (HRs) and corresponding 95% confidence intervals (CIs). Results: From the original sample of 132,679 patients with a VTE event, 309 patients were diagnosed with a hemoglobinopathy. Baseline characteristics were generally similar between groups, although patients with hemoglobinopathies were younger (60.0 [40.0–73.0] vs. 68.0 [54.0–78.0] years). After propensity score matching, 927 patients were included in the analysis, of whom 618 were classified as non-hemoglobinopathy. At 2 years, no significant difference in NACE was observed between groups (54.3% vs. 50.3%; HR 1.04, 95% CI 0.74–1.47, p=0.809). Similarly, there were no significant differences in all-cause mortality (23.2% vs. 26.1%; HR 0.64, 95% CI 0.39–1.05, p=0.078) or VTE recurrence (34.2% vs. 21.6%; HR 1.40, 95% CI 0.80–2.45, p=0.235). Patients with hemoglobinopathies experienced higher rates of any bleeding (24.0% vs. 10.6%; HR 2.52, 95% CI 1.51–4.21, p<0.001) and major bleeding (10.0% vs. 3.5%; HR 2.85, 95% CI 1.38–5.86, p=0.005) compared with those without hemoglobinopathies. Conclusions: Among patients presenting with VTE, those with hemoglobinopathies appear to be younger and have a higher incidence of 2-year bleeding, including major bleeding, without significant differences in NACE, VTE recurrence, or all-cause mortality compared to those without hemoglobinopathies.

Background:Low-molecular-weight heparins (LMWHs) are widely used in the treatment of cancer-associated venous thromboembolism (VTE), yet their long-term safety profiles remain insufficiently compared in clinical practice. Objectives:The primary outcome was major bleeding over a 6-month follow-up. Secondary outcomes included VTE recurrence, non-major clinically relevant bleeding, and all-cause mortality. Methods:We analyzed 7287 patients with active cancer and acute VTE from the RIETE registry (2009-2022) who were treated with full-dose enoxaparin (n = 5628) or tinzaparin/dalteparin (n = 1659). Analyses were adjusted using multivariable Cox models, Fine-Gray competing risk models, frailty models clustered by center, and propensity score approaches. Results:Major bleeding occurred in 3.84% of patients receiving enoxaparin versus 2.53% in the tinzaparin/dalteparin group (adjusted hazard ratio [aHR] 1.56; 95% CI: 1.11-2.19), with consistent findings across all sensitivity analyses. Enoxaparin was also associated with higher all-cause mortality (28.3% vs 25.1%; aHR 1.22; 95% CI: 1.09-1.37). No significant differences were observed in VTE recurrence (3.59% vs 3.07%) or non-major bleeding (3.98% vs 3.25%). Importantly, during the first 10 days of therapy, major bleeding occurred in 1.2% of patients treated with enoxaparin twice-daily, compared to 0.4% with once-daily dosing and 0.1% in the tinzaparin/dalteparin group (P < .001). Conclusion:In this large, observational study, enoxaparin, particularly in twice-daily regimens, was associated with significantly increased risks of bleeding and mortality compared to tinzaparin/dalteparin. These findings may help refine LMWH selection and dosing strategies in patients with cancer-associated VTE and warrant further investigation in prospective studies.

Background The risk of recurrent venous thromboembolism (VTE) and bleeding during anticoagulation may vary by cancer type. We assessed outcomes during anticoagulation in women with breast, ovarian, or uterine cancer and VTE. Methods We analyzed data from the RIETE registry on 4,721 women with active breast (n=2,929), ovarian (n=886), or uterine (n=906) cancer and acute VTE. We assessed VTE recurrences, bleeding, and mortality according to cancer type and anticoagulant type. Multivariate Cox models adjusted for age, metastases, anemia, renal function, and treatment at VTE onset. Results Uterine cancer patients had the highest rates of major bleeding (11.1 per 100 patient-years) and fatal bleeding (1.07 per 100 patient-years), while ovarian cancer patients had the highest rate of VTE recurrences (7.29 per 100 patient-years). In contrast, breast cancer patients had the lowest event rates overall. Among LMWH-treated patients, major bleeding was higher in uterine (6.37 per 100 patient-years) and ovarian (4.62 per 100 patient-years) cancer than breast cancer patients (1.89 per 100 patient-years). DOAC use was associated with low recurrence rates in breast cancer (0.58 per 100 patient-years), but outcomes in uterine cancer remained less favorable. Multivariable models confirmed cancer-specific risks. Conclusions VTE outcomes vary significantly by cancer type. Patients with uterine cancer face an elevated bleeding risk, potentially impacting anticoagulant continuity and contributing to VTE recurrence. These findings support the need for cancer-specific risk assessment and individualized anticoagulation strategies adapted to the specific cancer type.

Background:The risk of recurrent venous thromboembolism (VTE) and bleeding during anticoagulation may vary by the cancer type. Objectives:We assessed outcomes during anticoagulation in women with breast, ovarian, or uterine cancer and VTE. Methods:We analyzed data from the Registro Informatizado Enfermedad TromboEmbólica registry on 4721 women with active breast (n = 2929), ovarian (n = 886), or uterine (n = 906) cancer and acute VTE. We assessed VTE recurrences, bleeding, and mortality according to cancer type and anticoagulant type. Multivariate Cox models were adjusted for age, metastases, anemia, renal function, and treatment at VTE onset. Results:Uterine cancer patients had the highest rates of major bleeding (11.1 per 100 patient-years) and fatal bleeding (1.07 per 100 patient-years), while ovarian cancer patients had the highest rate of VTE recurrences (7.29 per 100 patient-years). In contrast, breast cancer patients had the lowest event rates overall. Among low-molecular-weight heparin-treated patients, major bleeding was higher in uterine (6.37 per 100 patient-years) and ovarian (4.62 per 100 patient-years) cancer than breast cancer patients (1.89 per 100 patient-years). Direct oral anticoagulant use was associated with low recurrence rates in breast cancer (0.58 per 100 patient-years), but outcomes in uterine cancer remained less favorable. Multivariable models confirmed cancer-specific risks. Conclusions:VTE outcomes vary significantly by cancer type. Patients with uterine cancer face an elevated bleeding risk, potentially impacting anticoagulant continuity and contributing to VTE recurrence. These findings support the need for cancer-specific risk assessment and individualized anticoagulation strategies adapted to the specific cancer type.

[This corrects the article DOI: 10.1055/s-0041-1736037.].

Travel-related thrombosis (TRT), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), poses a significant health risk associated with long-haul travel. Prolonged immobility, dehydration, and cabin pressure changes during flights contribute to venous stasis, hypoxia, and hypercoagulability, collectively increasing the risk of venous thromboembolism (VTE). While the absolute risk of TRT is relatively low in the population overall, it rises significantly among high-risk groups, including individuals with a history of VTE, thrombophilia, pregnancy, or recent surgery. This review explores the epidemiology, pathophysiology, clinical presentation, and diagnostic evaluation of TRT while highlighting the importance of early recognition and prevention. Risk assessment models can provide guidance for identifying at-risk travelers. Preventive strategies include pharmacological prophylaxis with low-molecular-weight heparin (LMWH) for high-risk individuals and nonpharmacological measures such as compression stockings, intermittent pneumatic compression, mobility exercises, and hydration. Guidelines from international societies recommend tailored interventions based on individual risk profiles, as randomized controlled trials are scarce. Given that long-haul travel dramatically expands, this review critically analyzes the available TRT management strategies in various clinical settings, aiming to increase awareness of this global health issue.