Inferior vena cava thrombosis (IVCT) is an uncommon manifestation of venous thromboembolism, characterized by heterogeneous clinical presentation and limited disease-specific evidence. Owing to its rarity, diagnostic and therapeutic strategies are largely extrapolated from studies in proximal lower-limb deep vein thrombosis, resulting in substantial variability in clinical practice. This guidance document, developed by the Italian Society for the Study of Haemostasis and Thrombosis (SISET), aims to provide pragmatic, evidence-informed recommendations for the identification, diagnosis, thrombophilia work-up, and management of IVCT. The guidance is based on a structured review of the available literature and expert consensus. The document addresses key clinical questions, including which patients should be investigated for IVCT, the most appropriate diagnostic imaging strategies, indications for thrombophilia testing, and optimal pharmacological and interventional management. Particular attention is given to clinical scenarios that should prompt dedicated evaluation of the inferior vena cava, such as bilateral lower-extremity deep vein thrombosis, atypical abdominal or lumbar pain, and extensive venous obstruction. Anticoagulation is recommended as the cornerstone of IVCT treatment, while endovascular or surgical interventions should be reserved for selected patients with acute extensive thrombosis or chronic symptomatic ilio-caval obstruction. Given the paucity of high-quality, IVCT-specific evidence, these recommendations emphasize individualized decision-making and highlight the need for prospective studies in this field.

Mondor disease is a rare, benign and self-limiting entity, characterized by superficial thrombophlebitis of veins of the anterior thoracoabdominal wall. Its etiology is unknown, although predisposing factors are associated. Clinical presentation is a unilateral painful cordlike subcutaneous induration. The diagnosis is clinical, although can be confirmed with imaging studies. Symptomatic treatment is suggested and its evolution is selflimited. We present the case of a patient with Mondor disease triggered after physical exertion. Diagnosis was confirmed by ultrasound. Thrombophilia or neoplasm were ruled out. Condition improvement was complete.

BackgroundManagement of extensive inferior vena cava (IVC) thrombosis following trauma is challenging, particularly when IVC filter placement is unsuitable. The presence of concomitant injuries requiring surgical intervention further complicates decisions regarding anticoagulation and pulmonary embolism prevention.Case PresentationA 40-year-old man presented following a high-velocity motorcycle accident with multiple facial fractures and a left radial shaft fracture. Contrast-enhanced computed tomography demonstrated no solid organ or major vascular injury but revealed extensive thrombosis extending from the infrarenal IVC into the bilateral common iliac veins. Following hemodynamic stabilization and exclusion of intracranial and intra-abdominal hemorrhage, therapeutic unfractionated heparin infusion was initiated. Despite anticoagulation, progressive lower limb swelling developed. Given the extensive thrombus burden and the need for subsequent surgical procedures, further intervention was considered. The suprarenal IVC measured 32 mm in diameter, and concerns regarding filter stability, migration, and reduced efficacy rendered IVC filter placement suboptimal.Intervention and OutcomeFollowing multidisciplinary discussion, percutaneous mechanical thrombectomy was performed using a combined ClotTriever BOLD and FlowTriever system. A 25-mm FlowTriever disc was deployed in the retrohepatic IVC for temporary embolic protection during thrombectomy. Successful thrombus extraction restored caval patency without complications. Lower limb swelling resolved within three days, allowing staged orthopedic and maxillofacial reconstruction. Thrombophilia screening was negative, and the patient completed nine months of rivaroxaban therapy without recurrence.ConclusionCombined ClotTriever and FlowTriever mechanical thrombectomy may be an effective treatment option for extensive traumatic iliocaval thrombosis when IVC filter placement is not feasible or considered suboptimal.

A 32-year-old woman with panhypopituitarism following surgical resection, chemotherapy, and radiotherapy for a pituitary germinoma underwent assisted reproductive treatment. Management involved comprehensive hormone replacement therapy, ovulation induction with exogenous gonadotropins, in vitro fertilization (IVF), and thromboprophylaxis with low molecular weight heparin due to a diagnosed thrombophilia. A fresh embryo transfer resulted in a successful singleton pregnancy. The pregnancy progressed uneventfully and reached full term and a healthy neonate was delivered. This case highlights the feasibility of pregnancy in women with complex endocrine and thrombotic conditions and adds to the limited literature supporting IVF in women with significant hypothalamic-pituitary axis compromise.

The transgender population is growing, with more people seeking gender-affirming care. While estrogen-based gender-affirming hormone therapy (E-GAHT) is essential for transfeminine individuals, most evidence on associated venous thromboembolism (VTE) risks is outdated and no longer used in clinical practice. Routine primary anticoagulant prophylaxis is not recommended for low-risk individuals initiating E-GAHT. In selected patients with prior VTE, known thrombophilia, or multiple major thrombotic risk factors, prophylactic anticoagulation may be considered on an individualized basis after assessment of bleeding risk and shared decision-making, although this approach is not currently supported by high-quality prospective evidence. Contemporary 17β-estradiol regimens show substantially lower VTE rates, with transdermal formulations showing the most favorable safety profile. In the perioperative setting, continuation of E-GAHT or a reduced dose in high-risk groups with standard VTE prophylaxis, guided by Caprini scoring, is recommended, as no increase in postoperative VTE was observed in multiple retrospective cohorts and meta-analyses. In the transgender population, discontinuation of GAHT following a VTE event can cause significant emotional and psychological distress. Recent studies support continuing GAHT, preferably at a reduced dose, while initiating therapeutic anticoagulation, with extended or indefinite duration considered through shared decision-making.

Stroke during pregnancy is uncommon but poses a significant threat to both mother and fetus, requiring rapid, carefully balanced interventions. We describe a 46-year-old woman at 24 weeks' gestation who presented with sudden speech difficulties, facial droop, and weakness on one side of her body. Imaging revealed an acute right middle cerebral artery occlusion, and extensive evaluation ruled out cardioembolic, thrombophilia, and vascular causes. She underwent urgent mechanical thrombectomy under monitored anesthesia care, achieving partial revascularization without complications. Her neurological function improved progressively, and both maternal and fetal outcomes were favorable. This case highlights the complexity of managing acute stroke in pregnancy, where timely decision-making must integrate standard stroke protocols with pregnancy-specific considerations, including imaging, anesthesia, and multidisciplinary care. Sharing such experiences is essential to expand knowledge on the safety and effectiveness of endovascular interventions in this rare but critical setting.

Despite increasing knowledge over the last several decades of the factors contributing to delayed cerebral ischemia (DCI), it remains a significant cause of morbidity after aneurysmal subarachnoid hemorrhage (aSAH). The hypercoagulable state induced by aneurysm rupture is critical to most proposed mechanisms of DCI either through its direct contribution to microthrombi formation, or through the indirect effects of the products of coagulation on vasospasm, and inflammation. In this review we summarize clinical evidence of hypercoagulability after aSAH as well as both the clinical and pre-clinical evidence of its role in DCI, highlighting the developing role that microthrombi and NETosis are thought to play.

Postpartum haemorrhage is the leading cause of maternal mortality worldwide, accounting for a substantial proportion of preventable deaths, particularly in settings with limited resources. Despite its clinical significance, understanding the haemostatic changes underpinning postpartum haemorrhage has historically been limited, with management strategies largely extrapolated from trauma related bleeding. Important physiological differences exist between these conditions, however, which has implications for diagnosis and treatment. Normal pregnancy is characterised by increased coagulation factors and reduced fibrinolysis, resulting in a hypercoagulable state. These adaptations are protective but influence the haemostatic response to bleeding. Recent evidence has refined our understanding of coagulopathy in postpartum haemorrhage. In most cases, haemostasis is preserved despite major blood loss, but fibrinogen depletion is an early and important predictor of severe haemorrhage. A distinct and rare entity, acute obstetric coagulopathy, has been described, characterised by hyperfibrinolysis, hypofibrinogenaemia, dysfibrinogenaemia, and depletion of selective coagulation factors, and is associated with poor maternal and neonatal outcomes. Traditional laboratory coagulation tests are limited by turnaround time and insensitivity to key abnormalities, such as fibrinolysis. Viscoelastic haemostatic assays (eg, thromboelastography (TEG) and rotational thromboelastometry (ROTEM)) offer rapid, point-of-care assessment of clot formation and stability, allowing earlier identification of coagulopathy and more targeted transfusion strategies. Evidence suggests that their use may reduce unnecessary administration of blood products without compromising outcomes. Management strategies are evolving. Tranexamic acid has shown a clear benefit in terms of mortality when given early, and is now widely recommended. In contrast, routine empiric use of fresh frozen plasma is increasingly questioned, given the relative preservation of coagulation factors in most patients with postpartum haemorrhage and the potential risks of over-transfusion. Instead, targeted correction of coagulopathy, especially hypofibrinogenaemia, and judicious use of blood components is gaining interest, guided by clinical and laboratory findings. In summary, advances in the understanding of haemostatic changes in postpartum haemorrhage support a shift towards individualised targeted transfusion strategies. Wider adoption of point-of-care testing and further high quality research are needed to optimise transfusion approaches and improve maternal outcomes globally.