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ApoA-1 (apolipoprotein A-1) is the main component of HDL (high-density lipoprotein) and stabilizes PON-1 (paraoxonase-1), which prevents lipid peroxidation and oxLDL (oxidized low-density lipoprotein) formation. Autoantibodies against apoA-1 [anti-(apoA-1) IgG] have been found in antiphospholipid syndrome and systemic lupus erythematosous, two diseases with an increased risk of thrombotic events, as well as in ACS (acute coronary syndrome). OxLDL levels are also elevated in these diseases. Whether anti-(apoA-1) IgGs exist in other prothrombotic conditions, such as APE (acute pulmonary embolism) and stroke, has not been studied and their potential association with oxLDL and PON-1 activity is not known. In the present study, we determined prospectively the prevalence of anti-(apoA-1) IgG in patients with ACS (n=127), APE (n=58) and stroke (n=34), and, when present, we tested their association with oxLDL levels. The prevalance of anti-(apoA-1) IgG was 11% in the ACS group, 2% in the control group and 0% in the APE and stroke groups. The ACS group had significantly higher median anti-(apoA-1) IgG titres than the other groups of patients. Patients with ACS positive for anti-(apoA-1) IgG had significantly higher median oxLDL values than those who tested negative (226.5 compared with 47.7 units/l; P<0.00001) and controls. The Spearman ranked test revealed a significant correlation between anti-(apoA-1) IgG titres and serum oxLDL levels (r=0.28, P<0.05). No association was found between PON-1 activity and oxLDL or anti-(apoA-1) IgG levels. In conclusion, anti-(apoA-1) IgG levels are positive in ACS, but not in stroke or APE. In ACS, their presence is associated with higher levels of oxLDL and is directly proportional to the serum concentration of oxLDL. These results emphasize the role of humoral autoimmunity as a mediator of inflammation and coronary atherogenesis. [ABSTRACT FROM AUTHOR]

Abstract  During the past 2 decades, the diagnostic and therapeutic approach to deep vein thrombosis (DVT) has greatly evolved. First, the assessment of the clinical probability has gained wide acceptance. Second, novel noninvasive diagnostic tools such as venous compression ultrasonography and D-dimer measurement have become available, drastically reducing the need for invasive tools such as phlebography. Third, new anticoagulant drugs, in particular low-molecular-weight heparins (LMWHs), have become available and have made DVT treatment a lot easier by allowing out-ofhospital management.Several diagnostic algorithms, based on the assessment of clinical probability, D-dimer measurement and venous compression ultrasonography, have shown to be safe in management studies. In addition to improvements in diagnostic algorithms and anticoagulant treatment, compression therapy by elastic stockings to diminish the prevalence of the postthrombotic syndrome has been validated in prospective studies.The dilemma of the need or no need for looking for and treating isolated calf DVT with anticoagulants remains a controversial issue, as do the optimal length and intensity of anticoagulation. In the near future, the emergence of several new, totally synthetic, orally active anticoagulant compounds, such as direct thrombin or factor Xa inhibitors that are presently being tested in clinical studies, could profoundly change the therapeutic approach to DVT. [ABSTRACT FROM AUTHOR]

Recent advances in the management of patients with suspected VTE have both improved diagnostic accuracy and made management algorithms safer, easier to use and well standardised. These diagnostic algorithms are mainly based on the assessment of clinical pretest probability, D-dimer measurement and imaging tests, mainly represented by compression ultrasound (CUS) for suspected DVT and computed tomography pulmonary angiography (CTPA) or lung ventilation-perfusion scan for pulmonary embolism. These diagnostic algorithms allow a safe and cost-effective diagnosis for most patients with suspected VTE. In this review, we focus on the challenge of diagnosing VTE in special patient populations, such as elderly patients, pregnant women, or patients with a prior VTE. Some additional challenges are arising that might require adjustments to current diagnostic strategies, such as the reduced clinical suspicion threshold, resulting in a lower proportion of VTE among suspected patients; the overdiagnosis and overtreatment of VTE, especially regarding calf deep-vein thrombosis (DVT) and subsegmental pulmonary embolism (SSPE).