Venous Thromboembolism (Canada)

Top 10 priorities

1. What is the optimal prevention and treatment for those who suffer long-term impacts of DVT and PE on their physical health? **Reference note: long term impacts include post-thrombotic syndrome: redness, swelling, ulcers, and chronic leg pain; chronic thromboembolic pulmonary hypertension: high blood pressure in the lungs' arteries caused by blood clots and related scarring; or other functional impairments.
2. Are anticoagulant treatment protocols sufficiently adapted to special populations (elderly, women, extremes of weight, renal failure, liver failure, concurrent need for antiplatelet therapy, such as aspirin)?
3. How long should a patient be treated with anticoagulant (blood thinner) therapy and under what conditions or factors can a person safely stop therapy?
4. What are the psychological impacts of a diagnosis of DVT or PE, how can they be measured, and how can people be supported to reduce anxiety and improve quality of life?
5. Can we better understand why some otherwise healthy people get blood clots?
6. Can direct oral anticoagulants (DOACs, a class of oral medications that do not require regular blood work) be used to treat atypical or less common sites of blood clots? **Reference note: less common sites of blood clots include sites other than DVT of the leg or pulmonary embolism. Examples of the less common site would be in the abdominal or pelvic veins, cerebral (brain) veins, and upper extremity/arm.
7. How should bleeding be managed in a person taking an anticoagulant medication? **Reference note: Bleeding could be serious (significant loss of blood or critical body part like head) or less serious (nose bleeding, heavy menses).
8. What is the best management for a new DVT or PE that occurs while on anticoagulation (blood thinner), i.e. a failure of therapy?
9. What is the recommended short and long-term follow-up of patients after a DVT or PE diagnosis and should this be with a specialized clinic or a primary care provider (e.g. family physician)?
10. Should a blood clot in a person with Antiphospholipid Syndrome (APS) be treated differently compared to other people without this syndrome? **Reference note: Antiphospholipid Syndrome (APS) occurs when your immune system mistakenly creates antibodies that make your blood much more likely to clot or increases the risk for poor outcomes during pregnancy.

The following questions were also discussed and put in order of priority at the workshop:

11. When should thrombolysis (medications that rapidly dissolve clots but increase the risk of bleeding), or surgery, be used to treat DVTs?
12. Should all people with unexplained DVT or PE be screening for cancer and if so how?
13. How should anticoagulant (blood thinner) medications be stopped and restarted for surgeries or invasive medical procedures?
14. What is the optimal diagnosis and treatment (medication and duration) for Cerebral Vein Thrombosis (CVT)? **Reference note: A Cerebral Vein Thrombosis (CVT) is a blood clot in the veins in and surrounding the head/ brain.
15. What is the risk of other conditions such as heart attack or stroke (arterial thrombotic disease) in a person who has a diagnosis of DVT or PE?
16. What are the side effects of anticoagulants (blood thinners)?
17. How to tell the difference between symptoms from previous clots and symptoms of a new clot?
18. Can diet and exercise prevent clots or improve symptoms after the clot has formed?

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For full details of all of the questions identified by this PSP, please see the document below.

Venous Thromboembolism (Canada) PSP final data sheet