We assessed the effectiveness of iloprost treatment in the management of symptomatic Buerger disease (BD) and assessed smoking cessation compliance, based on a single-center experience. Thirteen patients with BD were treated with sessions of intravenous (IV) Ilomedin infusion. At 1-year follow-up, pain status alteration, number of analgesics required, ankle-brachial index (ABI) change, compliance with supervised smoking cessation, and amputation-free rate were recorded. The pain status improved considerably according to a visual analog scale, the number of analgesics required was significantly reduced, and all patients improved their pain-free walking distance, the ABI, and their self-reported quality of life. Only 2 patients required minor amputations. Combination of IV Ilomedin infusion, supervised smoking cessation, and a specific follow-up protocol may lead to improvement in pain-free walking distance, pain status, quality of life, and substantial reduction in amputation risk.

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Re: 'Kakkos et al. Efficacy and Safety of the New Oral Anticoagulants Dabigatran, Rivaroxaban, Apixaban, and Edoxaban in the Treatment and Secondary Prevention of Venous Thromboembolism: A Systematic Review and Meta-analysis of Phase III Trials' The systematic review and meta-analysis by Kakkos et al. 1 highlights the non-inferior outcomes and safety of new oral anticoagulants (NOAs) used in venous thromboembolism (VTE) compared with conventional treatment with vitamin K antagonists (VKAs). However, there are few areas that remain unsettled and further analysis of the existing trials may be needed. The results could possibly be different if costeffectiveness and quality of life were analyzed. Although the authors mentioned the presence of cost-effectiveness studies of NOAs used to treat VTE, 2,3 such analysis has not been provided in this meta-analysis to assess the coste benefit ratio. One could reasonably argue that this issue could have an important impact, similar to that of the costeffectiveness of NOAs versus VKAs, on the treatment of atrial fibrillation. 4 Quality of life assessments of oral anticoagulants have been attracting interest since as early as in 1991. 5 As such, a specific instrument has been developed and validated. 6 Therefore, the inclusion of lifetime quality adjusted life years and cost of NOAs compared with VKAs as additional outcomes should be assessed in previous and future clinical trials.