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Article: VTE management in special cases

Venous thromboembolism (VTE) in liver or renal diseases is an increasingly encountered complication associated with high mortality and morbidity rates. However, VTE management is highly challenging as these patients have an increased risk for both “typical” and “atypical” thrombosis. Further, treating thrombosis can be complex due to high bleeding risk and the effect of these diseases on pharmacokinetics and pharmacodynamics of anticoagulants. 

There is still a debate on the ideal measures to be followed for both VTE risk assessment and its management among this population. Latest guideline recommends to consider benefit-risk ratio of anticoagulants on case-by-case basis both for VTE prevention and treatment in these populations.

Specific anticoagulants may require dose reductions or be contraindicated in liver and renal diseases due to varied degrees of metabolism. To minimize the bleeding risk, while ensuring an adequate therapeutic effect, both appropriate anticoagulant drug choices, anti-Xa monitoring and dose reductions are also necessary. 

This article highlights the various clinical challenges faced and latest recommendations for optimal VTE management in liver or renal diseases.

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