Changing paradigms in the management of deep vein thrombosis.

In adults diagnosed with deep vein thrombosis (DVT), challenges remain in the management of the acute event whilst remaining alert to long-term morbidity. The addition of non-vitamin K antagonist oral anticoagulants (NOACs) to the pharmacopoeia represents the first of a number of recent advancements in the management of DVT. Worldwide, uptake of these agents has been avid, although drug selection, reversal and chronic treatment effects continue to be controversial areas. Multi-centre studies to evaluate the impact of NOACs on long-term outcomes, including thrombosis recurrence and post-thrombotic syndrome (PTS), are ongoing. Validation of tools capable of predicting PTS would enable patient selection for early aggressive intervention, such as local thrombolysis. Such interventional strategies are gaining momentum as initial approaches and would benefit from large randomized controlled trials.

Under-representation of the elderly in cancer clinical trials.

Cancer predominantly affects the elderly, but those over 65 years of age are significantly and consistently under-represented in clinical trials of potential new treatments. How important is this to cancer care in the elderly, are there identifiable reasons for the disparity and can anything be done to redress the imbalance?