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Venous Thromboembolism: Review of Clinical Challenges, Biology, Assessment, Treatment, and Modeling

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Abstract

Venous thromboembolism (VTE) is a massive clinical challenge, annually affecting millions of patients globally. VTE is a particularly consequential pathology, as incidence is correlated with extremely common risk factors, and a large cohort of patients experience recurrent VTE after initial intervention. Altered hemodynamics, hypercoagulability, and damaged vascular tissue cause deep-vein thrombosis and pulmonary embolism, the two permutations of VTE. Venous valves have been identified as likely locations for initial blood clot formation, but the exact pathway by which thrombosis occurs in this environment is not entirely clear. Several risk factors are known to increase the likelihood of VTE, particularly those that increase inflammation and coagulability, increase venous resistance, and damage the endothelial lining. While these risk factors are useful as predictive tools, VTE diagnosis prior to presentation of outward symptoms is difficult, chiefly due to challenges in successfully imaging deep-vein thrombi. Clinically, VTE can be managed by anticoagulants or mechanical intervention. Recently, direct oral anticoagulants and catheter-directed thrombolysis have emerged as leading tools in resolution of venous thrombosis. While a satisfactory VTE model has yet to be developed, recent strides have been made in advancing in silico models of venous hemodynamics, hemorheology, fluid–structure interaction, and clot growth. These models are often guided by imaging-informed boundary conditions or inspired by benchtop animal models. These gaps in knowledge are critical targets to address necessary improvements in prediction and diagnosis, clinical management, and VTE experimental and computational models.

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Authors and Affiliations

  1. Department of Biomedical Engineering, The Pennsylvania State University, 122 Chemical and Biomedical Engineering Building, University Park, PA, 16802-4400, USA

    Connor Watson, Hicham Saaid & Keefe B. Manning

  2. Department of Mechanical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, New York, NY, USA

    Vijay Vedula

  3. Department of Surgery and the Center for Translational Injury Research, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA

    Jessica C. Cardenas

  4. Section of Vascular Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA

    Peter K. Henke

  5. CNRS, IMAG, Université de Montpellier, Montpellier, France

    Franck Nicoud

  6. Institut Universitaire de France, Paris, France

    Franck Nicoud

  7. Department of Chemical Engineering, Imperial College London, London, UK

    Xiao Yun Xu

  8. Department of Thrombosis and Haemostasis, King’s College, London, UK

    Beverley J. Hunt

  9. Thrombosis and Haemophilia Centre, Guy’s & St Thomas’ NHS Trust, London, UK

    Beverley J. Hunt

  10. Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA

    Keefe B. Manning

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JCC has received research funding from Grifols Biopharma and holds a patent (17/146,912) related to use of antithrombin for improving chemoprophylaxis and mitigating the incidence of venous thromboembolism after traumatic injury. All other authors have no competing interests or conflicts related to this manuscript.

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Watson, C., Saaid, H., Vedula, V. et al. Venous Thromboembolism: Review of Clinical Challenges, Biology, Assessment, Treatment, and Modeling. Ann Biomed Eng 52, 467–486 (2024). https://doi.org/10.1007/s10439-023-03390-z

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