Arterial and venous thromboses differ in pathophysiology but share overlapping risk factors such as obesity, metabolic syndrome, and aging. Patients with established arterial disease, such as coronary artery disease, stroke, and peripheral artery disease, may develop venous thromboembolism (VTE) during the acute or chronic phase of their illness. This creates therapeutic tension when anticoagulation for VTE overlaps with antiplatelet therapy. We propose a stepwise clinical approach that first identifies precipitating factors for VTE, then modifies antiplatelet therapy according to the chronicity of the arterial condition and finally estimates thrombosis against bleeding risk aided by scoring systems, available evidence for combination treatment, and interdisciplinary collaboration. Two clinical cases exemplify this stepwise approach.

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