Cecilia Becattini

As the global population ages and individuals live longer with chronic diseases associated with venous thromboembolism, acute pulmonary embolism (PE) is expected to remain a major public health challenge. Like myocardial infarction and stroke, PE is linked to established cardiovascular risk factors, including advancing age, obesity, smoking, and chronic inflammatory conditions. Despite this, population-based primary and secondary prevention strategies for PE remain limited, highlighting the need for an updated epidemiological understanding. A comprehensive public health approach to PE should encompass not only the management of acute events and transient risk factors but also a detailed appreciation of epidemiology and risk patterns across populations and communities, to support clinician education, public awareness, long-term individual and community risk assessment, ultimately preventive efforts. In this review, we summarize current epidemiological evidence, highlighting trends on modifiable and non-modifiable risk factors for acute PE, with the goal of informing strategies for improved prevention and population health management.

Aims: Clinical complexity (CC) in atrial fibrillation (AF) reflects overlapping risk factors that raise vulnerability to both thromboembolism and bleeding. Ethnic differences in the expression of CC remain poorly characterized. Methods and results: We performed a post hoc analysis of the EORP-AF and APHRS-AF registries. CC was defined as a CHA₂DS₂–VASc score ≥2 plus ≥1 of: (i) age ≥75 and BMI <23 kg/m², (ii) chronic kidney disease, or (iii) prior major bleeding. Multivariable logistic regression identified predictors of CC, oral anticoagulant (OAC) use, and rhythm control. The primary outcome was a composite of all-cause death and major adverse cardiovascular events (MACE), defined as cardiovascular death, acute coronary syndromes, and thromboembolic events. Secondary outcomes included each individual component and major bleeding. Associations were assessed using Cox regression models. Among 14 055 patients, 2794 (19.9%) met CC criteria (mean age 77 ± 9 years; 46% female). Compared to Europeans, Asian patients with CC had a distinct clinical profile and were less likely to receive OAC (OR 0.75, 95% CI 0.57–1.01) or rhythm control (OR 0.53, 95% CI 0.41–0.69). CC was independently associated with increased risk of composite outcome (HR 1.55, 95% CI 1.35–1.77), all-cause death (HR 1.65, 95% CI 1.42–1.93), MACE (HR 1.50, 95% CI 1.26–1.80), cardiovascular death (HR 1.81, 95% CI 1.40–2.36), and major bleeding (HR 2.02, 95% CI 1.47–2.77). The excess risk of the composite outcome was greater in Asians (HR 2.28, 95% CI 1.57–3.32) than in Europeans (HR 1.51, 95% CI 1.31–1.75; P-interaction = 0.036). Conclusion: Among AF patients with CC, those enrolled in Asia exhibited marked differences in clinical profiles, management strategies, and outcomes, suggesting greater vulnerability to CC in the Asian population.

The antithrombotic therapy (AT) regime for patients with atrial fibrillation (AF) or venous thromboembolism (VTE) who are in the chronic phase after percutaneous coronary intervention (PCI), either elective or in the context of an acute coronary syndrome (ACS), i.e. 6 and 12 months later respectively, is currently standardised. On the contrary, no specific data nor trial evidence are available as regards the opposite clinical scenario, i.e. patients with chronic coronary syndrome (CCS) on long-term antithrombotic therapy (with either single or dual antiplatelet therapy or dual antithrombotic therapy with aspirin and low-dose rivaroxaban) who develop AF or VTE and therefore an indication for oral anticoagulation (OAC), especially with direct oral anticoagulants (DOAC). In this article, the current recommendations for AT in AF and VTE patients with CCS are summarised, and management strategies for the AT regimes to be applied to CCS patients with new-onset AF or VTE (with indication or not for indefinite OAC) are proposed.

It has been brought to the publisher's attention that the name of the author “Brian Mac Grory” was incorrectly tagged in the HTML version of the above article in the Journal Thrombosis and Haemostasis, published in Volume 124, Number 8 (DOI: 10.1055/a-2261-1811). The tagging has been corrected in the HTML version of the article. Article published online: 27 November 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany