Venous thromboembolism risk stratification should consider provoking factors, malignancy, inherited thrombophilia, and prior episodes of thrombosis when planning treatment duration.

In complex haematological disorders, anticoagulation decisions should account for recurrence risk, competing bleeding risk, and the impact of disease-modifying therapy on future thrombotic burden.

Paroxysmal nocturnal haemoglobinuria (PNH) is a rare haematological disease caused by somatic mutations in the phosphatidylinositol glycan A gene (PIGA) in haematopoietic stem cells. Complement action at the surface of haematopoietic cells, including platelets and leucocytes, induces an increased risk of thromboembolic events. Traditionally, PNH was managed by supportive care and allogeneic stem cell transplant. Use of eculizumab, an anti-C5 monoclonal antibody, has significantly changed PNH management and clinical outcomes. However, for patients with PNH with a history of VTE, anticoagulation should be maintained indefinitely.

Follow-up should reassess symptomatic improvement, adherence, and bleeding complications while maintaining clear documentation of the evidence used to support long-term management decisions.

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