Journal Of Thrombosis And Thrombolysis[JOURNAL]
Sun
200 papers
The prevalence of FV Hong Kong in patients with thrombotic disorders in South China.
Chen L, Tuo R, Mo Q … +6 more , Chen C, Feng Y, Su H, Luo S, Cai D, Xiao Y
J Thromb Thrombolysis · 2026 Feb · PMID 40879864 · Publisher ↗
To investigate the prevalence of FV Hong Kong(p.Arg306Gly) variant in patients with thrombotic disorders in South China, and to explore the association between FV Hong Kong and thrombosis according to genotype and clinic...
To investigate the prevalence of FV Hong Kong(p.Arg306Gly) variant in patients with thrombotic disorders in South China, and to explore the association between FV Hong Kong and thrombosis according to genotype and clinical manifestations of the patients. A total of 367 patients with thrombotic disorders and 555 healthy volunteers in South China were screened by exon sequencing to identify FV Hong Kong variant carriers. Acquired risk factors for thrombosis of all subjects were also recorded. Among 367 thrombosis patients, 10 (2.72%) carried heterozygous FV Hong Kong mutations. In contrast, 9 of 555 healthy controls (1.62%) harbored the heterozygous mutation. There is no significant differences in the prevalence rate between patients and healthy controls. Among patients with the FV Hong Kong mutation, 90% exhibited concurrent predisposing factors. The FV Hong Kong variant demonstrates a high prevalence in the South Chinese population, with a similar rate in thrombosis patients and healthy population. The variant, when co-occurring with genetic or acquired risk factors, may synergistically elevate thrombotic risk. Further investigations are warranted to elucidate the clinical implications in thrombotic disorders.
Long-term efficacy and safety of direct oral anticoagulants in venous thrombotic antiphospholipid syndrome patients not candidate to warfarin: A pilot prospective case series study.
Pastori D, Menichelli D, Podda GM … +5 more , Clerici B, Birocchi S, Bucci T, Ames PR, Pignatelli P
J Thromb Thrombolysis · 2026 Jan · PMID 40879863 · Full text
Data on direct oral anticoagulants (DOACs) in venous thrombotic antiphospholipid antibody syndrome (APS) are controversial. This pilot study aimed to assess the safety and efficacy of DOACs in APS patients requiring oral...
Data on direct oral anticoagulants (DOACs) in venous thrombotic antiphospholipid antibody syndrome (APS) are controversial. This pilot study aimed to assess the safety and efficacy of DOACs in APS patients requiring oral anticoagulation for venous thromboembolism (VTE) but unsuitable for treatment with vitamin K antagonists (VKAs). We performed a prospective multi-centre case-series including APS patients with previous VTE who were receiving treatment with DOACs due to ineligibility for VKAs. Main outcomes were bleeding, arterial and recurrent venous thrombotic events and all-cause death. We included 18 patients (median age 59.6 years, 66.7% women). The antiphospholipid antibody pattern was single positivity for 33.3% patients, double positivity for 33.3%, and triple positivity for 27.8%. Only one patient had seronegative APS. Apixaban, dabigatran, rivaroxaban and edoxaban were prescribed in 44.4%, 27.8%, 16.7% and 11.1% of patients, respectively. The mean follow-up was 50.1 ± 24.1 months. During the observation period, no recurrent VTE episodes or arterial thrombotic events were recorded. Four bleedings, of which 2 major, were reported. The incidence rate of bleeding was 5.3 per 100 patient-years (95% confidence interval [95%CI] 1.4-13.6). No intracranial bleedings were recorded.In conclusion, our preliminary findings may suggest DOAC as possible option for patients with venous thrombotic APS unsuitable to VKAs. Although these findings are promising, larger cohort studies are needed to confirm this finding.
Measurement of plasma direct oral anticoagulants concentrations in real-world clinical and laboratory settings on a 24/7 basis: a 10-year experience.
Kotnis-Gąska A, Trawińska A, Broniatowska E … +3 more , Konieczyńska M, Undas A, Wypasek E
J Thromb Thrombolysis · 2026 Jan · PMID 40830721 · Full text
Routine direct oral anticoagulant (DOAC) measurements are not recommended; however, they may be useful in some clinical situations. We sought to evaluate the everyday practice in DOAC measurements on a 24/7 basis includi...
Routine direct oral anticoagulant (DOAC) measurements are not recommended; however, they may be useful in some clinical situations. We sought to evaluate the everyday practice in DOAC measurements on a 24/7 basis including the number of tests over 10 years, indications in out- and inpatients, and turnaround time (TAT) in our tertiary center. From 2013 to 2023, we evaluated all consecutive 758 DOAC measurements performed in 628 patients, aged 61.9 ± 17.6 years mostly with venous thromboembolism (n = 211, 33.5%) and atrial fibrillation (n = 207, 33%) using chromogenic methods. The median number of tests was 6 per month (interquartile range (IQR) 3–9). There were parabolic trend lines for rivaroxaban (n = 308, 40.6%) and dabigatran (n = 241, 32.1%) measurements with a peak in 2017, while apixaban (n = 209, 27.3%) measurements were stable over the study period. The most common indications for DOAC measurements were drug-drug interactions (n = 92, 24.2%) and questionable adherence (n = 60, 15.9%) for outpatients (n = 380, 50.1%), while the assessment of residual DOAC concentrations before invasive procedures (n = 98, 28%) and in embolic stroke of undetermined source (n = 74, 19.6%) were for inpatients (n = 378, 49.9%) including 91 (12%) urgent samples. The median TAT was 89 min (63–126 min) and was shorter by 30 min at the night shifts (n = 256, 33.8%). For emergencies in 2023, TAT reached 42 min (34–54 min). To our knowledge, this is the longest study on how often, in whom, and for which reason DOAC measurements were requested over the last 10 years if a 24/7 service is available. We showed that DOAC measurements are stably requested in inpatients and outpatients but obtaining the results within 30 min is hardly feasible.
Timing, indications and transition patterns associated with cangrelor use in patients undergoing PCI.
Oliva A, Cao D, Shneyderman M … +18 more , Serrao G, Gitto M, Di Muro FM, Sartori S, Feng Y, Vogel B, Nicolas J, Sweeny J, Krishnan P, Bay B, Johnson J, Melarcode P, Stefanini G, Moreno P, Kini A, Dangas G, Sharma S, Mehran R
J Thromb Thrombolysis · 2026 Jan · PMID 40813532 · Publisher ↗
Optimal antiplatelet therapy is crucial in percutaneous coronary intervention (PCI) to balance thrombotic and bleeding risk. Cangrelor, a rapid-acting intravenous P2Y12 inhibitor, is particularly effective in high-risk P...
Optimal antiplatelet therapy is crucial in percutaneous coronary intervention (PCI) to balance thrombotic and bleeding risk. Cangrelor, a rapid-acting intravenous P2Y12 inhibitor, is particularly effective in high-risk PCI scenarios, including acute coronary syndrome (ACS) or patients unable to take oral medications. The SMILE study evaluated real-world timing, indications, and outcomes of cangrelor use, along with transition to oral P2Y12 inhibitors, in high-risk patients undergoing PCI. A retrospective analysis of Mount Sinai PCI registry was conducted, examining consecutive patients receiving cangrelor from January 2018 to March 2024. Transition to oral P2Y12 inhibitors (ticagrelor, clopidogrel, or prasugrel) followed institutional protocols based on guidelines and expert consensus. The primary endpoint was in-hospital major adverse cardiac and cerebrovascular events (MACCE), including myocardial infarction, stroke, and all-cause death. Among 493 patients, 78.7% presented with ACS (29.6% STEMI; 14.8% cardiogenic shock) and 79.3% underwent complex PCI. Of these, 80.5% were subsequently transitioned to ticagrelor (N=397) and 19.5% to a thienopyridine (clopidogrel N=85, prasugrel N=11). MACCE incidence was 12.6%, while bleeding occurred in 4.3%. A lower risk of MACCE was associated with transition to ticagrelor (9.8% vs. 24.0%; adjusted OR 0.35, 95%CI 0.20-0.62, p < 0.001) and adherence to protocol for transition to oral P2Y12 inhibitors (10.9% vs. 19.4%; adjusted OR 0.51, 95%CI 0.28-0.94). Extended low-dose cangrelor infusion was well-tolerated in critically ill patients requiring prolonged parenteral antiplatelet therapy. Overall, the SMILE study demonstrated that adherence to standardized transition protocols enhances clinical outcomes in high-risk PCI patients receiving cangrelor, particularly when transitioned to ticagrelor. Further research is needed to validate these results across diverse populations and clinical settings.
Impact of antithrombin III deficiency on clinical outcomes in trauma patients: a systematic review and meta-analysis.
Silva Correia JV, de Carvalho PL, Salles MMM … +2 more , Massoud RO, Melo RH
J Thromb Thrombolysis · 2026 Jan · PMID 40813531 · Publisher ↗
BACKGROUND: Antithrombin III (ATIII) is a key regulator of coagulation, playing a vital role in maintaining hemostatic balance. Reduced ATIII levels have been observed in trauma patients, potentially contributing to an i...
BACKGROUND: Antithrombin III (ATIII) is a key regulator of coagulation, playing a vital role in maintaining hemostatic balance. Reduced ATIII levels have been observed in trauma patients, potentially contributing to an increased risk of mortality, thromboembolic events, and coagulopathy. While ATIII deficiency has been associated with worse clinical outcomes in critically ill patients, less is known about its impact on trauma patient populations. PURPOSE: This meta-analysis aims to evaluate the association between ATIII deficiency and clinical outcomes, including mortality, thromboembolism, disseminated intravascular coagulation (DIC), and shock in trauma patients. METHODS: PubMed, Embase, and the Cochrane Library databases were searched for randomized trials and observational studies that compared trauma patients with ATIII deficiency with those with normal ATIII levels and reported outcomes related to mortality, thromboembolic events, DIC, and shock. Heterogeneity was assessed using the I² statistic. A random-effects model was applied to all outcomes to account for potential variations across studies. RESULTS: We included nine observational studies with a total of 1,629 trauma patients, all of which contributed data to at least one analyzed outcome. Compared with trauma patients with normal ATIII levels, those with ATIII deficiency had an association with a higher risk of mortality (pooled OR 3.61; 95% CI 2.36–5.50; p < 0.01), thromboembolic events (pooled OR 2.14; 95% CI 1.21–3.80; p = 0.009), and shock (pooled OR 4.65; 95% CI 3.16–6.83; p < 0.01). However, no difference was found for DIC between groups (pooled OR 6.63; 95% CI 0.89–49.44; p = 0.06). CONCLUSION: These findings suggest that ATIII deficiency is associated with worse clinical outcomes in trauma patient populations. Further research is needed to determine whether targeted ATIII management strategies could improve outcomes in trauma patients.
The von Willebrand factor/ADAMTS13 ratio as an indicator of venous thromboembolism risk: results from the RETROVE project.
Llobet D, Mojal S, Vallvé C … +7 more , Carrasco M, Vilalta N, Mateo J, Moret C, Millón J, Soria JM, Souto JC
J Thromb Thrombolysis · 2026 Jan · PMID 40813530 · Publisher ↗
The von Willebrand factor/ADAMTS13 ratio and shortened PFA-100 values have been associated with the risk of venous thromboembolism (VT). Our objective was to confirm the association of the VWF/ADAMTS13 ratio with VT risk...
The von Willebrand factor/ADAMTS13 ratio and shortened PFA-100 values have been associated with the risk of venous thromboembolism (VT). Our objective was to confirm the association of the VWF/ADAMTS13 ratio with VT risk and to assess the correlation between this ratio and PFA-100 values. We determined ADAMTS13 and VWF plasma levels, as well as PFA-100 values in 800 individuals (400 with VT and 400 healthy controls) from the RETROVE project. Using binary logistic regression and multivariate analyses, we evaluated the relationship between the VWF/ADAMTS13 ratio and VT risk. Quartile cut-offs of this ratio were calculated in controls, after which we estimated odds ratios (ORs) with 95% CIs. The risk of VT increased progressively with increasing quartiles of the VWF/ADAMTS13 ratio, with an OR of 4.12 (95% CI, 2.47-6.88) for the highest vs lowest quartiles in an age-adjusted analysis. When we analyzed the ROC curve for the VWF/ADAMTS13 ratio, we found similar results: we obtained three ranges of this ratio, with an increasingly progressive risk (ORs from 2.59 to 6.54). Values of the VWF/ADAMTS13 ratio correlated negatively with PFA-100 (R = - 0.5 p < 0.001). These findings indicate that the VWF/ADAMTS13 ratio is an indicator of VT risk and that a high ratio correlates negatively with PFA-100 values.
Impact of time in therapeutic range (TTR) within the first 72 h on prognosis in patients with pulmonary embolism treated with unfractionated heparin.
Ifergan A, Loutati R, Tvito A … +17 more , Shuvy M, Carasso S, Deeb D, Taha L, Karmi M, Manassra M, Brin A, Rabi O, Fink N, Sabouret P, Moatz A, Qadan A, Levi N, Bdolah-Abram T, Glikson M, Asher E, Jerusalem Platelets Thrombosis, Intervention in Cardiology (JUPITER-19) Study Group
J Thromb Thrombolysis · 2026 Jan · PMID 40813529 · Full text
Pulmonary embolism (PE) is a life-threatening condition often treated with unfractionated heparin (UFH) in intermediate high-risk patients. Activated Partial Thromboplastin Time (aPTT) is used to monitor UFH efficacy. We...
Pulmonary embolism (PE) is a life-threatening condition often treated with unfractionated heparin (UFH) in intermediate high-risk patients. Activated Partial Thromboplastin Time (aPTT) is used to monitor UFH efficacy. We sought to evaluate the correlation between time in therapeutic range (TTR) and prognosis in patients with pulmonary embolism treated with unfractionated heparin. A prospective cohort study included 203 patients admitted to a tertiary care center between July 2019 and August 2024 with a confirmed diagnosis of intermediate risk PE treated with UFH. TTR was calculated based on aPTT values during the first 72 h of hospitalization. The correlation between TTR and mortality rates was assessed. Out of the 203 patients, 116 (57%) achieved therapeutic range at least once, with a mean TTR of 43.1% (± 22.4) and a median of 39%. Nevertheless, the overall mean TTR for all patients was 24.6% (± 27.3), with a median of 18.8%. During the study period 25 (12.3%) patients have died, of them 9 (4.4%) within 30 days and 16 (7.9%) within one year. Higher TTR was associated with reduced 30-day (p = 0.051) and one-year (p = 0.045) mortality rates. Receiver Operating Characteristic (ROC) analysis identified a TTR threshold of 21.5% for predicting one-year mortality, demonstrating a high negative predictive value (NPV) of 96.8% but a low positive predictive value (PPV) of 12%. Patients with acute PE who achieved higher TTR exhibited better outcomes at 30 days and one year. However, most patients did not reach adequate TTR levels, leaving its role as an independent prognostic indicator uncertain. Larger studies are necessary to optimize therapeutic strategies and improve outcomes in intermediate-risk PE patients.
Postoperative venous thromboembolism risk following lung cancer surgery: a systematic review and meta-analysis.
Chen J, Mao Y, Peng Z
J Thromb Thrombolysis · 2025 Dec · PMID 40779190 · Full text
Venous thromboembolism (VTE) remains a major contributor to postoperative morbidity and mortality in patients undergoing lung cancer surgery. This study aims to identify perioperative risk factors associated with VTE dev...
Venous thromboembolism (VTE) remains a major contributor to postoperative morbidity and mortality in patients undergoing lung cancer surgery. This study aims to identify perioperative risk factors associated with VTE development following such procedures. We performed an exhaustive search of PUBMED and EMBASE from inception to November 1, 2023, using terms related to VTE following lung cancer surgery. A random-effects meta-analysis was performed to calculate the pooled incidence and odds ratios (ORs) for risk factors. Of 3,576 screened studies, 13 met eligibility criteria for qualitative synthesis, and 11 studies (53,382 patients) were included in the meta-analysis. The pooled incidence of postoperative VTE was 1.82% (971 cases). Significant risk factors included advanced age (standardized mean difference [SMD] 0.43, 95% CI 0.22-0.63; I = 59.9%), prolonged surgical duration (SMD 0.58, 95% CI 0.24-0.92; I = 81.2%), open thoracotomy (OR 1.77, 95% CI 1.50-2.09; I = 19.9%), TNM stage > 1 (OR = 1.81, 95% CI 1.53-2.13; I = 39.8%), adenocarcinoma histology (OR = 1.29, 95% CI 1.08-1.53; I = 1.2%), and major lung resection (OR = 1.51, 95% CI 1.24-1.83; I2 = 0.0%). This study highlights key modifiable and non-modifiable risk factors for postoperative VTE in lung cancer surgery patients. These findings support individualized risk stratification and targeted thromboprophylaxis strategies to improve clinical outcomes.
Safety and efficacy of Cangrelor versus GPIIb/IIIa inhibitors as adjunctive therapy in endovascular treatment of acute ischemic stroke: a systematic review and meta-analysis.
Ellebedy M, Mohamed RG, Lamie MI … +3 more , Abbas OF, Hegazi A, Kashbour M
J Thromb Thrombolysis · 2026 Jan · PMID 40760292 · Full text
Endovascular treatment (EVT) plays a critical role in the management of acute ischemic stroke (AIS). To enhance reperfusion outcomes, intravenous antiplatelet agents such as glycoprotein IIb/IIIa inhibitors (GPIs) are co...
Endovascular treatment (EVT) plays a critical role in the management of acute ischemic stroke (AIS). To enhance reperfusion outcomes, intravenous antiplatelet agents such as glycoprotein IIb/IIIa inhibitors (GPIs) are commonly administered during EVT. cangrelor, a fast-acting, reversible P2Y12 inhibitor, has emerged as a potential alternative due to its rapid onset and offset of action. However, comparative data on its efficacy and safety relative to GPIs in this context are limited. This study aimed to systematically evaluate the efficacy and safety of cangrelor versus GPIs as adjunctive antiplatelet therapies during EVT in AIS patients. We conducted a systematic review and meta-analysis following PRISMA guidelines, with protocol registration on PROSPERO (CRD420251047232). A comprehensive literature search was performed in PubMed, Scopus, and Web of Science, through May 4, 2025. Studies comparing cangrelor and GPIs during EVT in AIS were included. Data on procedural success, intracranial hemorrhage, and mortality were extracted and analyzed using Review Manager 5.4. Five studies including 616 participants (cangrelor: 318, GPIs: 298) were included. No significant difference was observed between groups in achieving the modified treatment in cerebral infarction (mTICI) score ≥ 2b (RR = 1.04, 95% CI [1.00–1.09], P = 0.07), mTICI ≥ 2c (RR = 1.19 (95% CI [0.87, 1.61], P = 0.27), or mTICI ≥ 3 (RR = 1.07 (95% CI [0.81 to 1.42], p = 0.62). Safety outcomes, including symptomatic intracranial hemorrhage and mortality, were comparable. Despite limited data, current evidence indicates that cangrelor may serve as a viable alternative to GPIs in the EVT of AIS, with comparable efficacy and safety profiles. However, definitive conclusions require validation through well-designed prospective randomized trials.
The abnormal coagulation status in endometriosis patients: a systematic review and meta-analysis.
Zeng X, Zhang J, Peng Y … +2 more , Zhuang K, Huang Y
J Thromb Thrombolysis · 2026 Jan · PMID 40745408 · Publisher ↗
OBJECTIVES: This study aimed to comprehensively examine coagulation parameters in patients with endometriosis versus those without to determine hematologic alterations associated with endometriosis. METHODS: Embase, PubM...
OBJECTIVES: This study aimed to comprehensively examine coagulation parameters in patients with endometriosis versus those without to determine hematologic alterations associated with endometriosis. METHODS: Embase, PubMed, CINAHL, Web of Science, the Cochrane Library, CBM, CNKI, VIP, and Wanfang Database were searched through June 2024. The Newcastle-Ottawa Scale was used to evaluate the quality of the studies. Statistical analyses were performed using Stata 16.0 software. RESULTS: 22 studies with 6,258 participants were included. The results showed significant abnormalities in coagulation parameters in patients with endometriosis compared to those without. Specifically, fibrinogen (FIB) (SMD = 0.57; 95%CI, 0.45 ~ 0.69; P < 0.001), D-dimer (D-D) (SMD = 0.62; 95%CI, 0.27 ~ 0.96; P < 0.001), and platelet count (PLT) (SMD = 0.28; 95%CI, 0.11 ~ 0.45; P = 0.001) were significantly elevated, while activated partial thromboplastin time (APTT) (SMD = -0.13; 95%CI, -0.22~-0.03; P = 0.010), prothrombin time (PT) (SMD = -0.31; 95%CI, -0.54~-0.08; P = 0.009), and thrombin time (TT) (SMD = -0.41; 95%CI, -0.63~-0.20; P < 0.001) were significantly reduced. Moreover, FIB (SMD = 0.47; 95%CI, 0.23 ~ 0.71; P < 0.001), D-D (SMD = 0.38; 95%CI, 0.10 ~ 0.66; P = 0.009), PT (SMD = -0.21; 95%CI, -0.41~-0.02; P = 0.030), and TT (SMD = -0.20; 95%CI, -0.38 ~ 0.01; P = 0.037) also vary between patients with stage I-II and stage III-IV endometriosis. CONCLUSION: Multiple coagulation parameters were abnormal in endometriosis patients, indicating a hypercoagulable state, particularly pronounced in those with stage III-IV endometriosis. Large, globally representative prospective cohorts are needed to elucidate the causal relationship between endometriosis and hypercoagulability.
Association between elevated plasma levels of factor VIII and risk of recurrent venous thromboembolism: a systematic review and meta-analysis.
Teymoori S, Dezfouli M, Feizi A … +2 more , Hashemi H, Shirzadi M
J Thromb Thrombolysis · 2026 Jan · PMID 40745407 · Publisher ↗
Although several studies have examined the relationship between factor VIII levels and recurrent venous thromboembolism (VTE), findings remain inconsistent. This systematic review and meta-analysis aimed to assess the as...
Although several studies have examined the relationship between factor VIII levels and recurrent venous thromboembolism (VTE), findings remain inconsistent. This systematic review and meta-analysis aimed to assess the association between elevated plasma factor VIII levels and VTE recurrence. A comprehensive search was conducted in PubMed, Web of Science, Scopus, and Embase databases, and Google Scholar up to May 2025 to identify observational studies evaluating the association between elevated factor VIII levels and recurrent VTE. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated using random-effects model. Eighteen studies (12 cohort and 6 case-control studies) involving 9835 participants and 1554 recurrent events were included. Plasma factor VIII levels > 200 IU/dL were associated with an increased risk of VTE recurrence (RR = 1.70; 95% CI: 1.32-2.19; I = 85.0%, P < 0.001). Subgroup analyses based on the type of effect measures indicated increased risk of VTE recurrence across studies reporting hazard ratios (HRs), odds ratios (Ors), and RRs. Similarly, the association remained significant in both cohort and case-control studies. Elevated factor VIII levels were associated with recurrence only in patients not receiving anticoagulation (RR = 1.64; 95% CI: 1.28-2.10), whereas no significant association was observed among those receiving anticoagulation (RR = 1.89; 95% CI: 0.36-9.87). This meta-analysis demonstrates a possible relationship between elevated factor VIII levels and VTE recurrence. These findings highlight the potential of factor VIII as a prognostic marker. Further prospective studies are needed to confirm this association and support clinical decision-making.
Comparison of outcomes in autoimmune acquired factor XIII deficiency with and without underlying diseases: a systematic review.
Song J, Liu L, Ding B … +5 more , Xia A, Liu J, Han Y, Xie A, Zhou H
J Thromb Thrombolysis · 2026 Jan · PMID 40745406 · Publisher ↗
Autoimmune acquired factor XIII deficiency (AiF13D) is an exceptionally rare and serious bleeding disorder. This condition may occur idiopathically or in association with comorbidities, such as malignancies or autoimmune...
Autoimmune acquired factor XIII deficiency (AiF13D) is an exceptionally rare and serious bleeding disorder. This condition may occur idiopathically or in association with comorbidities, such as malignancies or autoimmune diseases. Data comparing these distinct etiological subgroups remain limited. Therefore, we conducted a systematic literature review of published case reports, case series, and cohort studies on AiF13D indexed in PubMed, Web of Science, and Scopus up to December 2023. We compared the clinical characteristics, treatment modalities, and outcomes between patients with AiF13D associated with underlying disorders and those with idiopathic AiF13D. Our analysis revealed a higher proportion of female patients in the AiF13D group with underlying diseases compared to the idiopathic group. Statistically significant differences were observed that patients with underlying diseases exhibited slightly higher inhibitor levels and a greater frequency of Grade III bleeding events. Furthermore, fewer AiF13D patients with underlying diseases received combination therapy (prednisone plus rituximab or cyclophosphamide) compared to the idiopathic group. Additionally, this group experienced higher rates of relapse and/or mortality. Collectively, these findings indicated that AiF13D patients with underlying diseases experience more severe bleeding manifestations and poorer outcomes. Consequently, clinicians managing concomitant conditions should maintain vigilance for potential AiF13D development. Regular monitoring of FXIII activity and inhibitor titers is essential, coupled with prompt initiation of anti-inhibitor therapy when indicated.
Single-cell RNA sequencing of platelets: challenges and potential.
Viggiani G, Kirmes K, Han J … +9 more , Klug M, Kühne S, Condorelli G, Laugwitz KL, Bloxham CJ, Peano C, Raake P, Bernlochner I, Bongiovanni D
J Thromb Thrombolysis · 2026 Jan · PMID 40745405 · Full text
Platelets are small, anuclear cells crucial for hemostasis, coagulation, immune responses, and vascular diseases. While unable to produce their own RNA, platelets inherit RNA from their megakaryocyte precursors, exchange...
Platelets are small, anuclear cells crucial for hemostasis, coagulation, immune responses, and vascular diseases. While unable to produce their own RNA, platelets inherit RNA from their megakaryocyte precursors, exchange RNA with other cells, and possess all the necessary machinery for protein synthesis. However, several challenges, including their limited RNA content, high reactivity of these small cells leading to their activation, have hindered single-cell transcriptomic studies of these cells. The primary objective of this study is to perform single-cell RNA sequencing (scRNA-seq) on platelets obtained from whole blood. Peripheral whole blood from a healthy donor was obtained by venipuncture and was purified to obtain platelet-rich plasma (PRP). ScRNA-seq was performed using the 10X genomics platform on PRP for the first time. Data normalization and UMAP clustering with cluster-specific differential gene expression analysis were performed. ScRNA-seq performed on platelets identified three distinct clusters, with one enriched for platelet-specific lineage markers, such as PPBP and PF4. Mitochondrial RNA was highly expressed accounting for approx. 14% of the total RNA counts. Despite procedural challenges and technical considerations including high exhaustion potential and sensitivity to handling, small cell size and limited RNA content, this pilot study demonstrates feasibility of scRNA-seq of platelets from whole blood. This advancement paves the way for groundbreaking insights into platelet biology and more focus for clinician researchers on potential research avenues.
Management of cancer-associated venous thromboembolism: Perspectives on optimizing current therapeutics with a focus on factor XI inhibition.
Camilli M, Occhipinti G, Potere N … +9 more , Laudani C, Freixa X, Lombardo A, Burzotta F, Di Nisio M, Carrier M, Lopez-Fernandez T, Maurea N, Rocca B
J Thromb Thrombolysis · 2025 Dec · PMID 40730735 · Full text
Cancer-associated thrombosis (CAT) encompasses manifestations of deep venous thrombosis and/or pulmonary embolism occurring during the evolution of cancer. CAT represents one of the major cardiovascular complications ass...
Cancer-associated thrombosis (CAT) encompasses manifestations of deep venous thrombosis and/or pulmonary embolism occurring during the evolution of cancer. CAT represents one of the major cardiovascular complications associated with cancer and anti-cancer treatments, and the second leading cause of death after cancer progression. The rate of venous thromboembolism (VTE) recurrence is augmented in patients with cancer, together with the risk of bleeding, when compared with subjects without malignancy. Thus, decisions on optimal anticoagulation strategy should carefully balance both thrombotic and bleeding risk. While low-molecular weight heparins and direct oral anticoagulants now represent the standard-of-care in patients with cancer, newer pharmacologic compounds able to prevent VTE recurrence while minimizing the hemorrhagic risk are needed, and currently under investigation. In particular, factor XI inhibitors have emerged as potentially safe drugs in this highly vulnerable population, although results from dedicated clinical trials are waited to confirm this hypothesis. This review aims to summarize current management, controversies, and latest developments in pharmacotherapeutic approaches for patients with CAT.
Comparison of early vs late anticoagulation for secondary stroke prevention in patients with atrial fibrillation: a systematic review and meta-analysis of randomized controlled trials.
Pereira V, Marino M, Hornik A … +4 more , Hornik J, Henson J, Wesler J, Loggini A
J Thromb Thrombolysis · 2025 Oct · PMID 40730734 · Publisher ↗
Patients with acute ischemic stroke (AIS) and atrial fibrillation (AF) have an increased risk of stroke recurrence. The optimal timing for initiating oral anticoagulation (OAC) for secondary stroke prevention remains unc...
Patients with acute ischemic stroke (AIS) and atrial fibrillation (AF) have an increased risk of stroke recurrence. The optimal timing for initiating oral anticoagulation (OAC) for secondary stroke prevention remains uncertain. The recent OPTIMAS trial, the largest randomized controlled trial (RCT) to date on this topic, provides new insights. We therefore conducted a systematic review and meta-analysis of RCTs only, comparing early versus late initiation of OAC. We searched PubMed, Scopus, and Cochrane Central up to October 2024 for RCTs comparing early vs. late OAC initiation in AF patients with AIS. The Mantel-Haenszel method was used to calculate pooled odds ratios (ORs) for each outcome, with 95% confidence intervals (CI). We included three RCTs involving 6,442 patients; 50.17% received early OAC. There was no significant difference between groups in the composite outcome (OR 0.82; 95% CI: 0.63-1.06; p = 0.12). Stroke recurrence risk was similar (OR 0.80; 95% CI: 0.55-1.15; p = 0.23). Early OAC did not increase risk of mortality (OR 0.96; 95% CI: 0.79-1.16; p = 0.82), sICH (OR 0.93; 95% CI: 0.43-1.97; p = 0.84), or major extracranial bleeding (OR 0.73; 95% CI: 0.27-1.96; p = 0.54). Subgroup analysis showed early OAC in female patients reduced composite outcome risk (OR 0.51; 95% CI: 0.32-0.82; p = 0.005). Early OAC initiation after AIS in AF patients is safe but its benefit in reducing stroke recurrence is inconclusive and may be limited to specific subgroups. The addition of OPTIMAS, as the largest trial to date, strengthens the evidence base, confirming prior findings and providing additional confidence in the safety of early initiation. Until larger trials provide guidance, early OAC initiation should be considered case-by-case.
The clot cases conference: a proposed model to enhance multidisciplinary thrombosis care.
Parks AL, Jenkins SL, Vazquez SR … +4 more , Swenson E, Lim MY, Moser KA, Witt DM
J Thromb Thrombolysis · 2026 Jan · PMID 40681804 · Full text
Care of patients with thrombosis requires application of rapidly advancing science, complex decisions balancing risks and benefits, interpretation of multiple data sources, and coordination across fields. To meet these c...
Care of patients with thrombosis requires application of rapidly advancing science, complex decisions balancing risks and benefits, interpretation of multiple data sources, and coordination across fields. To meet these challenges, we describe our collaborative meeting for discussion and coordination of complex thrombosis cases, the Clot Cases Conference. Based loosely on the tumor board model from oncology, we describe the multidisciplinary nature, with attendees from multiple disciplines and institutions, and hybrid format, including both case- and topic-based sessions. We present survey data on how conference participants perceive their attendance affected learning, patient care, and professional satisfaction. Finally, we discuss opportunities for improvement and expansion of the Clot Cases Conference model to meet the complexity of modern thrombosis care.
Coronary plaque healing: a safety net or a hazard indicator?
Dimitriadis K, Adamopoulou E, Pyrpyris N … +9 more , Dri E, Vaina S, Beneki E, Tsioufis P, Kasiakogias A, Antonopoulos A, Aznaouridis K, Aggeli K, Tsioufis K
J Thromb Thrombolysis · 2026 Jan · PMID 40681803 · Full text
Coronary atherosclerotic plaques can lead to acute coronary syndrome (ACS) occurrence through three main mechanisms: plaque rupture, plaque erosion and calcified nodule. Many destabilized plaques, however, do not cause c...
Coronary atherosclerotic plaques can lead to acute coronary syndrome (ACS) occurrence through three main mechanisms: plaque rupture, plaque erosion and calcified nodule. Many destabilized plaques, however, do not cause cardiovascular events. Instead, thrombus formation is confined, lumen patency is preserved and the arterial wall is restored in a process termed as plaque healing. Early studies regarding coronary plaque healing used arterial specimens to determine its prevalence and histological characteristics. Advances in imaging modalities later enabled the implementation of in vivo studies, which have used optical coherence tomography (OCT) to identify the repaired plaques. They are visualized as lesions with a heterogeneous signal-rich layered or multilayered pattern and a distinct optical density from underlying plaque components. On one hand, plaque healing acts as a protective mechanism against myocardial infarction and unstable angina. On the other hand, the presence of layered plaques indicates previous plaque destabilization and therefore increased cardiovascular risk. Clinicians ought to bear these in mind in order to better apply patient risk stratification and adjust medical interventions. The aim of this review is to discuss the physiology of coronary plaque healing, determine its prevalence and clinical significance, as well as propose possible pathophysiological mechanisms behind impaired plaque healing along with therapeutic options.
Atrial cardiopathy and thrombus composition in acute ischemic stroke: histological examination reveals insights into etiology and outcomes.
Zhao Y, Lian J, Wei M … +4 more , Chen W, Zhang G, Luo G, Liu F
J Thromb Thrombolysis · 2026 Jan · PMID 40681802 · Publisher ↗
INTRODUCTION: In a subset of acute ischemic stroke (AIS) patients, particularly those with large-artery atherosclerosis (LAA) and atrial cardiopathy, multiple embolic sources may coexist. Histological analysis of thrombi...
INTRODUCTION: In a subset of acute ischemic stroke (AIS) patients, particularly those with large-artery atherosclerosis (LAA) and atrial cardiopathy, multiple embolic sources may coexist. Histological analysis of thrombi presents an opportunity for discerning insights into both etiology and prognosis. METHODS: In our investigation, we meticulously examined 97 retrieved thrombi through histological staining and immunohistological techniques. RESULTS: Thrombi originating from patients diagnosed with atrial fibrillation (AF) (n = 43) presented notably elevated levels of fibrin (54.16 ± 18.57% vs. 36.07 ± 18.23%, P < 0.001) and neutrophil extracellular traps (NETs) [13.21 (9.42, 15.36)% vs. 7.96 (4.98, 15.13)%, P = 0.01], alongside reduced red blood cell content (35.09 ± 16.74% vs. 51.58 ± 19.67%, P < 0.001). Within the subgroup of AIS patients with LAA, those presenting with atrial cardiopathy (n = 29) presented higher platelet levels within the thrombus (12.44 (7.59, 19.25)% vs. 8.90 (0.60, 12.37)%, P = 0.04), with the association remaining significant after generalized linear model (GLM) adjustments (P = 0.004). Notably, NETs identified within the thrombus emerged as an independent prognostic indicator for poor outcomes, defined as the modified Rankin scale (mRS) score > 2 at 90 days (OR: 1.12, 95% CI: 1.02-1.25; P = 0.02). CONCLUSIONS: These observations provide histopathological evidence supporting the presence of overlapping mechanisms contributing to thromboembolism that are potentially associated with underlying atrial cardiopathy. Consequently, histopathological evaluation of thrombi holds promise as a valuable tool for distinguishing between various etiologies and predicting clinical outcomes in AIS patients.
Immune checkpoint inhibitors and cardiovascular toxicity: immunology, pathophysiology, diagnosis, and management.
Becker RC
J Thromb Thrombolysis · 2025 Dec · PMID 40673965 · Full text
Immune checkpoint inhibitors (ICIs) are pivotal in cancer therapy, particularly but not solely for metastatic and advanced lung cancer. These monoclonal antibodies, targeting programmed cell death (PD)-1, ligand PD-L1, a...
Immune checkpoint inhibitors (ICIs) are pivotal in cancer therapy, particularly but not solely for metastatic and advanced lung cancer. These monoclonal antibodies, targeting programmed cell death (PD)-1, ligand PD-L1, and cytotoxic T-lymphocyte antigen (CTLA)-4, enhance immune responses against tumors but can also trigger immune-related adverse events, including cardiotoxicity and vascular toxicity. Cardiotoxic effects, such as myocarditis, pericarditis, atrial arrhythmias, thrombosis, and vasculitis are significant concerns, particularly myocarditis that can be fatal. ICIs like pembrolizumab, nivolumab, and atezolizumab are widely used, with combination immunotherapy showing improved survival but higher myocarditis risk. Effective management of ICI-induced cardiovascular toxicity involves regular monitoring for physical findings, cardiac, inflammatory, and autoimmune biomarkers, electrocardiograms, CT angiograms, echocardiograms, and cardiac MRI as needed. Emergent treatment for ICI myocarditis and vasculitis includes immediate discontinuation of ICIs, high-dose corticosteroids, and supportive care. In severe or steroid-refractory cases, additional immunosuppressive therapies should be considered.
Elevated remnant cholesterol predicts poor outcome in patients with premature acute coronary syndrome: a retrospective, single-center study.
Zhang M, Chen J, Xia W … +5 more , Yu Z, Zhang C, Wang W, Shao Y, Wang B
J Thromb Thrombolysis · 2025 Oct · PMID 40673964 · Full text
BACKGROUND: The association between remnant cholesterol (RC) and recurrent cardiovascular events following acute coronary syndrome (ACS) is well-documented. However, RC-stratified analysis specifically focusing on patien...
BACKGROUND: The association between remnant cholesterol (RC) and recurrent cardiovascular events following acute coronary syndrome (ACS) is well-documented. However, RC-stratified analysis specifically focusing on patients with premature ACS (PACS), defined as initial disease onset occurring at ≤ 55 years of age in men or ≤ 65 years of age in women, remains limited. OBJECTIVES: This study aimed to elucidate the clinical characteristics and subsequent cardiovascular events in patients with PACS, comparing those with high RC levels to those with low RC levels. METHODS: In this retrospective cohort study, 820 PACS patients were consecutively recruited between January 2019 and January 2020. RC was calculated as total cholesterol minus high-density lipoprotein cholesterol minus low-density lipoprotein cholesterol. Patients with RC levels ≥ 66.6 percentile were classified as high RC. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), including cardiovascular death, myocardial infarction (MI), stroke, ischemia-driven revascularization, or hospitalization for unstable angina or heart failure. RESULTS: Among the 820 patients enrolled, 277 (33.8%) were classified as high RC and 543 (66.2%) as low RC. The high RC group exhibited a higher prevalence of traditional risk factors, including diabetes (33.6% vs. 27.3%, p = 0.04), hypertension (68.2% vs. 61.3%, p = 0.04), and hyperlipidemia (43.3% vs. 31.3%, p = 0.001). Levels of glucose (p < 0.001), hemoglobin A1C (p = 0.005), triglyceride (p < 0.001), total cholesterol (p < 0.001) and LDL-C (p = 0.017) were significantly higher in the high RC group, while HDL-C levels were lower (p = 0.001). Over 3 years of follow-up, the high RC group had a significantly higher cumulative incidence of MACCE (16.2% vs. 10.9%; adjusted HR 1.68, 95% CI 1.10-2.59; p = 0.02). The increased risk was primarily driven by higher rates of hospitalization for unstable angina (12.3% vs. 7.9%; adjusted HR 1.69, 95% CI 1.03-2.75; p = 0.03) and composite cardiac events (14.8% vs. 9.8%; adjusted HR 1.75, 95% CI 1.12-2.73; p = 0.01). CONCLUSIONS: In hospitalized PACS patients, the cumulative incidence of MACCE was significantly higher in the high RC group compared to the low RC group over a median follow-up of nearly 3 years. The incremental risk in the high RC group was mainly attributable to higher rates of hospitalization for unstable angina and composite cardiac events. Therefore, close attention should be paid to RC levels, and further exploration is warranted.
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