Venous Thromboembolism and Atherothrombosis An Integrated Approach

C ase presentation 1: A 45-year- old man with a history of obesity, hypertension, dyslipidemia, deep vein thrombosis (DVT) complicated by pulmonary embolism (PE) 12 years earlier, and non-STelevation myocardial infarction treated with angioplasty and stenting of the left anterior descending coronary artery 4 years earlier presented to the emergency department with sudden onset of substernal chest pain.His ECG showed anterolateral ST-segment elevation, and emergent coronary angiography demonstrated in-stent thrombosis of his left anterior descending coronary artery (Figure 1A). Case Presentation 2:A 39-year-old man with a history of cigarette smoking, hypertension, dyslipidemia, and non-ST-elevation myocardial infarction 3 years earlier presented with progressive dyspnea and several hours of chest pressure.His ECG was unchanged, but his cardiac troponin I was elevated at 1.33 ng/mL (normal Ͻ0.1 ng/mL).Contrast-enhanced chest computed tomography demonstrated a large saddle PE (Figure 2). OverviewVenous thromboembolism (VTE), including DVT and PE, is the third most common cardiovascular disorder after coronary artery disease and stroke.Furthermore, patients with acute coronary syndromes or stroke have an increased risk of VTE as a complication of hospitalization. 1 Many risk factors for VTE, such as obesity, hypertension, dyslipidemia, diabetes, and smoking, overlap with those for atherothrombosis.Data from registry analyses and clinical trials suggest that clinicians should abandon "silo thinking" regarding VTE risk factors and integrate cardiovascular risk reduction strategies from coronary artery disease and stroke into the prevention of DVT and PE.As a novel paradigm, VTE is best considered as part of a pan-cardiovascular syndrome that includes coronary artery disease, peripheral artery disease, and cerebrovascular disease.