Thrombosis and anticoagulant treatment in special populations

In this thesis, we evaluate the burden of venous thromboembolism and bleeding, as well as the efficacy and safety of anticoagulation and anticoagulation reversal strategies in subgroups of rare subjects. These include: healthy subjects treated with direct oral factor-Xa inhibitors rivaroxaban or apixaban, patients receiving home parenteral nutrition for intestinal failure, and individuals with unusual site thrombosis. Moreover, we present the first European study of total, direct and preventable costs of venous thromboembolism and its related complications.
We conclude that: 1) prothrombin complex concentrate restores coagulation parameters dose-dependently in subjects treated with rivaroxaban or apixaban, and seems to be safe with respect to thrombotic complications; 2) subjects with intestinal failure treated with home parenteral nutrition are at a very high risk of thrombotic and bleeding complications; moreover, crucial gaps of knowledge regard the efficacy, safety, quality of management and pharmacokinetics of anticoagulants in this specific population; 3) selected patients with short bowel syndrome show a substantial absorption of dabigatran etexilate and rivaroxaban, rendering them an oral alternative to often used parenteral heparins; 4) similarly to venous thromboembolism, cerebral venous thrombosis is strongly associated with the presence of thrombophilia, but thrombophilia testing has a marginal role for the prediction of recurrent thrombotic events; 5) significant cost savings could be achieved if better preventive measures for venous thromboembolism are taken into place within the European Union.