Journal Of Thrombosis And Thrombolysis[JOURNAL]
Sun
200 papers
Association of thrombogenicity indices with perioperative cardiovascular events after non-cardiac surgery: a prespecified analysis of the PANDA study.
Hendrianus H, Ahn JH, Kang MG … +8 more , Kim KH, Koh JS, Kim SW, Hwang JY, Tantry US, Gurbel PA, Park JR, Jeong YH
J Thromb Thrombolysis · 2026 May · PMID 42149310 · Publisher ↗
Traditional clinical risk models, such as Revised Cardiac Risk Index (RCRI), have limited predictive value for estimating postoperative cardiovascular complications following non-cardiac surgery. This analysis aimed to e...
Traditional clinical risk models, such as Revised Cardiac Risk Index (RCRI), have limited predictive value for estimating postoperative cardiovascular complications following non-cardiac surgery. This analysis aimed to evaluate prognostic value of thrombogenicity profiles and coronary anatomy for cardiovascular events in patients undergoing non-cardiac surgery. In a prospective cohort of 120 patients who underwent intermediate-to-high risk surgery, thrombogenicity profiles were assessed using thromboelastography (TEG®) and conventional hemostatic measurements before surgery. Coronary artery disease (CAD) was preoperatively defined as presence of significant stenosis (≥ 50% luminal narrowing) on coronary computed tomography angiography (CCTA). Postoperative cardiovascular events were defined as cardiovascular death, non-fatal myocardial infarction, myocardial injury, pulmonary edema, non-fatal stroke, and systemic embolism within 30 days after surgery. Sixteen patients (13.3%) experienced cardiovascular events. In multivariable analysis, presence of CAD (odds ratio [OR]: 5.11; 95% confidence interval [CI]: 1.49-17.53; P = 0.009), D-dimer (per 1-μg/mL increase: OR: 1.22; 95% CI: 1.02-1.47; P = 0.030), and platelet-fibrin clot strength (PFCS) measured by TEG® (per 1-mm increase: OR: 1.10; 95% CI: 1.01-1.20; P = 0.027) were independently associated with cardiovascular events. Discrimination of cardiovascular event risk improved progressively with the sequential addition of the following risk stratification models: RCRI alone, RCRI + CCTA, and RCRI + CCTA + thrombogenicity profiles (C-index: 0.660 vs. 0.731 vs. 0.803). Cardiovascular event rates increased with greater risk burden, ranging from 4.2% in patients with no risk components to 77.8% in those with all components present. Integrating thrombogenicity assessment and CCTA with traditional clinical risk models may improve perioperative risk stratification and help guide tailored preventive strategies for patients undergoing non-cardiac surgery.Clinical trial registration. URL: http://www.clinicaltrials.gov . Unique identifier: NCT02250963.
External validation of established clinical risk scores for cancer-associated venous thromboembolism in a Brazilian registry.
de Abreu MFM, Bannoud MA, Martins S … +23 more , Huber SC, de Moraes Martinelli B, Fernandes MCG, Teixeira JC, Carvalheira JB, Lima CS, Andreollo NA, Etchebehere M, Zambon L, Ferreira U, Tincani AJ, Martins AS, Coy CS, Seabra JC, Mussi RK, Tedeschi H, Ribeiro DD, Filho CC, Martins TD, Ottaiano GY, Filho RM, de Lima Montalvão SA, Annichino-Bizzacchi JM
J Thromb Thrombolysis · 2026 May · PMID 42149309 · Publisher ↗
Cancer-associated thrombosis (CAT) is a relevant cause of morbidity and mortality in oncology patients. Although several venous thromboembolism (VTE) risk assessment models (RAMs) are recommended to guide thromboprophyla...
Cancer-associated thrombosis (CAT) is a relevant cause of morbidity and mortality in oncology patients. Although several venous thromboembolism (VTE) risk assessment models (RAMs) are recommended to guide thromboprophylaxis in ambulatory cancer patients, their performance varies across populations. Data from Brazilian cohorts are limited, and the real-world performance of these models in this setting remains unclear. We conducted a prospective external validation study of four established VTE RAMs-Khorana, PROTECHT, CONKO, and Vienna CATS-in ambulatory cancer patients from a Brazilian tertiary-care registry. A total of 803 adult patients with complete data were followed for 12 months for objectively confirmed symptomatic VTE. Predictors included baseline variables from each RAM, applied according to their original definitions. Discrimination was assessed using the area under the receiver operating characteristic curve (AUC), with 95% confidence intervals (CI) obtained by bootstrap resampling. Vienna CATS was evaluated in a biomarker-defined subcohort of 470 patients. During follow-up, 36 of 803 patients (4.5%) developed VTE. The Khorana (AUC 0.567; 95% CI 0.462-0.672), PROTECHT (AUC 0.575; 95% CI 0.470-0.680), and CONKO (AUC 0.567; 95% CI 0.464-0.671) scores showed limited and comparable discrimination, with sensitivities of approximately 30% at the conventional high-risk threshold (≥3 points). In the Vienna CATS subcohort, 24 of 470 patients (5.1%) developed VTE. Vienna CATS demonstrated modest but statistically significant discrimination (AUC 0.672; 95% CI 0.559-0.779) over chance. However, pairwise comparisons using DeLong's test showed no significant differences in AUC between the clinical-only scores and the same subcohort. Additional analyses suggested heterogeneity in risk across component combinations despite equal point weighting. Among patients with very-high-risk tumors plus one additional component, VTE incidence varied substantially depending on the specific factor present, ranging from 0% for BMI to 38.5% for low hemoglobin. Overall, current RAMs demonstrated limited sensitivity for identifying patients who developed VTE in this Brazilian cohort. These findings indicate that RAMs alone may be insufficient to guide thromboprophylaxis decisions in this setting, particularly given their limited sensitivity and the occurrence of VTE events among patients classified as low risk. Furthermore, the results support the need to develop locally validated models for Brazilian patients, as well as to explore novel biomarkers, alternative predictor thresholds, and potentially nonlinear approaches to variable weighting.
Edoxaban for treatment of cancer-related isolated distal deep vein thrombosis: harnessing evidence, seeking equipoise.
Minghini A, Szmit S, Ameri P
J Thromb Thrombolysis · 2026 May · PMID 42149308 · Publisher ↗
Abstract loading — click title to view on PubMed.
Prediction of venous thromboembolism after spontaneous intracerebral hemorrhage based on machine learning.
Yang L, Zhou F, Xia Y … +6 more , Yao H, Chen Y, Shangguan Y, Wu G, Hu J, Wang MH
J Thromb Thrombolysis · 2026 May · PMID 42149307 · Publisher ↗
Patients with intracerebral hemorrhage (ICH) are at high risk of venous thromboembolism (VTE). Current risk assessment tools are limited and not tailored for neurocritical care populations. This study aimed to develop an...
Patients with intracerebral hemorrhage (ICH) are at high risk of venous thromboembolism (VTE). Current risk assessment tools are limited and not tailored for neurocritical care populations. This study aimed to develop and validate machine learning-based models to predict VTE in ICH patients. Clinical data of 872 ICH patients admitted to the Neurosurgical ICU of Huashan Hospital from June 2018 to July 2023 were analysed. After univariate analysis, feature selection was performed using Random Forest Importance Ranking and LASSO regression. Three machine learning models (random forest, logistic regression, and LASSO logistic regression) were trained using 10-fold cross-validation. The dataset was randomly split into training (80%) and validation (20%) sets. Model performance was evaluated using accuracy, sensitivity, specificity, F1 score, AUC, calibration curves, and decision curve analysis. Among 421 patients included in the final analysis, 215 (51.1%) developed VTE. Five independent predictors (BMI, D-dimer, homocysteine, triglycerides, albumin) were identified. All three models showed strong discriminatory performance, with the random forest model achieving the highest AUC (0.98) and PR-AUC (0.98), followed by logistic regression (AUC 0.94, PR-AUC 0.91) and LASSO-LR (AUC 0.93, PR-AUC 0.91). Machine learning-based models incorporating metabolic and clinical predictors can accurately stratify VTE risk in ICH patients. The random forest model demonstrated superior performance and clinical applicability, highlighting potential for guiding early prophylactic interventions.
Clinical outcomes of anemia in patients with spontaneous coronary artery dissection: a retrospective cohort analysis.
Olumuyide E, Rahman E, Zheng S … +4 more , Yanni M, Aneni E, Samuels B, Hu JR
J Thromb Thrombolysis · 2026 May · PMID 42149306 · Publisher ↗
Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome, especially in younger patients and women. Anemia, a common comorbidity in patients with cardiovascular disease...
Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome, especially in younger patients and women. Anemia, a common comorbidity in patients with cardiovascular disease, may modulate outcomes in SCAD, but its influence remains poorly defined. We identified adult hospitalizations for SCAD in the Nationwide Inpatient Sample (2016-2022), stratified by anemia status. Multivariable logistic regression models were constructed to examine the relationship between anemia and in-hospital outcomes, while adjusting for demographics, comorbidities, and hospital characteristics. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included cardiac arrest (CA), mechanical circulatory support (MCS), cardiogenic shock (CS), heart failure reduced ejection fraction (HFrEF), heart failure preserved ejection fraction (HFpEF), blood transfusion (BT), vasopressor use (VU), mechanical ventilation (MV), acute kidney injury (AKI), atrial fibrillation (AF), length of stay (LOS) and total hospital charges (THC). Among 63,450 SCAD hospitalizations, 24.8% had comorbid anemia. Patients with anemia were older (63.4 vs. 59.7 years) and had a higher comorbidity burden. While no significant difference in in-hospital mortality was observed (10.8% vs. 4.6%; adjusted odds ratio [aOR] 1.15, 95% confidence interval [CI]: 0.96-1.38; p = 0.115), anemia was associated with significantly greater odds of MCS (28.2% vs. 9.5%; aOR 2.64, CI: 2.34-2.99; p < 0.001), CS (23.5% vs. 6.9%; aOR 2.27, CI: 1.98-2.61; p < 0.001), HFrEF (20.7% vs. 12.1%; aOR 0.99, CI: 0.88-1.14; p = 0.324), HFpEF (8.8% vs. 4.3%; aOR 1.26, CI: 1.04-1.52; p = 0.020), VU (9.3% vs. 2.1%; aOR 2.56, CI: 2.04-3.20; p < 0.001) AKI (33.2% vs. 9.5%; aOR 2.28, CI: 2.02-2.59; p < 0.001) AF (27.0% vs. 12.9%; aOR 1.74, CI: 1.55-1.97; p < 0.001) BT (17.8% vs. 1.3%; aOR 12.71, CI: 10.07-16.04; p < 0.001). Anemia was associated with increased hospital length of stay (LOS) (10 vs. 4 days; β = 3.9; p < 0.001) and higher THC ($285,660 vs. $114,861; β = $117,902; p < 0.001). Among patients hospitalized with SCAD, anemia was associated with higher risks of hemodynamic compromise, acute kidney injury, atrial fibrillation, and greater resource utilization, although mortality differences were not statistically significant. Recognition of anemia may help identify high-risk SCAD patients needing closer monitoring and tailored management.
Association of IgA antiphospholipid antibodies with hypercoagulability and inflammation in antiphospholipid syndrome.
de Andrade ICS, Pinto LRF, Montalvão SAL … +5 more , Colella MP, Yamaguti-Hayakawa GG, Annichino-Bizzacchi JM, De Paula EV, Orsi FA
J Thromb Thrombolysis · 2026 May · PMID 42149305 · Publisher ↗
Although IgA isotype testing does not enhance diagnostic accuracy of antiphospholipid syndrome (APS), recent studies suggest that IgA aCL/aβ2GPI are associated with systemic lupus erythematosus (SLE) and thrombosis, cont...
Although IgA isotype testing does not enhance diagnostic accuracy of antiphospholipid syndrome (APS), recent studies suggest that IgA aCL/aβ2GPI are associated with systemic lupus erythematosus (SLE) and thrombosis, contributing to thromboinflammatory responses and potentially serving as prognostic markers. This study's objective is to determine whether IgA aCL/aβ2GPI are associated with coagulation and inflammatory responses, as well as a high-risk thrombotic APS (t-APS) profile. A total of 81 patients with t-APS were included. IgA aCL and IgA aβ2GPI were measured using chemiluminescence. Coagulation and inflammatory markers (TNF-α, IL-6, IL-8, IFN-α, TF, VWF, ADAMTS13) were measured by ELISA, and then, their levels and activity compared between IgA-positive and negative patients. The association of IgA and relevant outcomes (antiphospholipid [aPL] profile, recurrent thrombosis, SLE), was assessed by logistic models adjusted for age and sex. IgA aCL or aβ2GPI positivity was observed in 24 patients (29.6%), mostly with both antibodies (n = 23). IgA positivity was not associated with demographics, comorbidities or pregnancy complications, but correlated with triple aPL positivity (48% vs. 13%, P = 0.004) and higher risk of progression to SLE (17% vs. 0%, P = 0.004). IgA-positive patients showed significantly elevated TNF-α, IL-8, and TF levels (P = 0.03, P = 0.03 and P = 0.05, respectively). In conclusion, IgA aCL/aβ2GPI positivity is associated with triple aPL positivity, progression to SLE, and altered thromboinflammatory markers, thus highlighting their association with a pronounced thromboinflammatory APS profile. This emphasizes the association of IgA antibodies with a high-risk serological profile and the potential utility of IgA testing in APS. Clinical trial registration: This study is not a clinical trial that requires registration.
Platelet FcɣRIIa: a novel biomarker of risk for thromboembolism and death in cancer.
Holmes CE, Davis GA, Taatjes-Sommer HS … +5 more , Sai-Hardebeck NE, Callas PW, Chidobem I, Thomas R, Schneider DJ
J Thromb Thrombolysis · 2026 May · PMID 42149304 · Publisher ↗
Cancer is associated with arterial and venous thrombotic events (ATE/VTE). Platelet FcγRIIa (pFCG) impacts platelet activation that contributes to ATE/VTE. Recurrent myocardial infarction (MI) and death are predicted by...
Cancer is associated with arterial and venous thrombotic events (ATE/VTE). Platelet FcγRIIa (pFCG) impacts platelet activation that contributes to ATE/VTE. Recurrent myocardial infarction (MI) and death are predicted by pFCG in patients with MI. Crosstalk between platelets and malignant cells that may promote cell invasion and cancer progression is mediated by pFCG. The objective is to determine whether pFCG (high vs. low) identifies cancer patients at greater risk of thrombosis and death. Ambulatory patients with cancer (n = 219) initiating cancer directed therapy were enrolled in a prospective translational study. The pFCG test was performed at study initiation and used flow cytometry to quantify mean fluorescence intensity that was translated to molecules of FCG/platelet. Outcomes of VTE/ATE and all cause death were abstracted from the Electronic Health Record at least 6 months after enrollment. Hazard ratios (HR) were analyzed with Kaplan-Meier analysis. Risk of the composite endpoint (ATE/VTE/death) was increased in patients with high pFCG (HR 1.9, 95% confidence interval [CI] 1.1-3.2, p = 0.02). A consistent non-significant trend for increased composite of ATE/VTE was associated with high pFCG (HR 1.7, 95% CI 0.8-3.3, p = 0.14). High pFCG identified patients at greater risk of all-cause death (HR 2.5, 95% CI 1.3-5.0, p = 0.009). Among patients who died (n = 50), ATE/VTE was a cause of death in 4 (8%) and temporally not associated with death in 19 (38%). The pFCG test identifies cancer patients at greater risk of death and could predict risk of thromboembolism. Additional studies are warranted to evaluate this novel biomarker of risk. Clinical trial registration: NCT05240508.
Edoxaban for atrial fibrillation in patients with atherosclerotic disease in daily clinical practice.
de Vries TAC, de Groot JR, Pisters R … +9 more , Hemels MEW, Komen JJ, Smolnik R, Fronk EM, Steffel J, Weiss T, de Asmundis C, Kirchhof P, De Caterina R
J Thromb Thrombolysis · 2026 May · PMID 42149303 · Publisher ↗
To estimate major clinical event rates for patients with atrial fibrillation (AF) and atherosclerotic disease treated with edoxaban in routine practice, and to evaluate how well such patients were represented in ENGAGE A...
To estimate major clinical event rates for patients with atrial fibrillation (AF) and atherosclerotic disease treated with edoxaban in routine practice, and to evaluate how well such patients were represented in ENGAGE AF-TIMI 48, the seminal randomized trial comparing edoxaban against warfarin for AF. ETNA-AF-Europe is a prospective cohort of AF patients receiving edoxaban in routine care. We compared patients with coronary or peripheral artery disease (CAD/PAD) to: (1) those without CAD/PAD in ETNA-AF-Europe, and (2) CAD/PAD patients in ENGAGE AF-TIMI 48. Of 13,164 patients in ETNA-AF-Europe, 23.3% had CAD/PAD. Compared with those without, patients with CAD/PAD had higher rates of stroke/systemic embolism (0.87%/year vs. 0.59%/year; HR 1.5, 95%-CI 1.14-1.88), acute coronary syndrome (1.24%/year vs. 0.37%/year; HR 3.3, 95%-CI 2.60-4.27), major bleeding (1.06%/year vs. 0.81%/year; HR 1.3, 95%-CI 1.04-1.63), cardiovascular death (1.59%/year vs. 0.85%/year; HR 1.9, 95%-CI 1.54-2.26), and all-cause death (6.02%/year vs. 3.53%/year; HR 1.7, 95%-CI 1.55-1.89). Compared with CAD/PAD patients in ENGAGE-AF TIMI-48, those in ETNA-AF-Europe had fewer cardiovascular comorbidities, less prevalent aspirin use (20.2% vs. 50.3%), and lower rates of stroke/systemic embolism (0.87%/year vs. 1.5%/year), major bleeding (1.04%/year vs. 3.0%/year), and cardiovascular death (1.59%/year vs. 3.7%), but higher non-cardiovascular mortality (4.43%/year vs. 1.6%/year). In routine practice, deaths and bleeding were the most common events in edoxaban-treated patients with AF. This pattern was consistent between those with and without atherosclerosis. ENGAGE-AF TIMI-48 participants with CAD/PAD had substantially higher cardiovascular but lower non-cardiovascular risks than those treated in daily practice.Trial registration number: NCT02944019 (ClinicalTrials.gov Identifier).
Extended anticoagulation with DOACs in patients affected by hematologic malignancies and venous thromboembolism: a monocentric experience.
Biglietto M, Sorella S, Cappelli LV … +5 more , Mandelli B, Kasmi D, Baldacci E, Breccia M, Chistolini A
J Thromb Thrombolysis · 2026 May · PMID 42149302 · Publisher ↗
The management of cancer-associated thrombosis (CAT) in hematologic malignancies is particularly challenging due to the high competing risks of recurrence and bleeding. While international guidelines recommend extended a...
The management of cancer-associated thrombosis (CAT) in hematologic malignancies is particularly challenging due to the high competing risks of recurrence and bleeding. While international guidelines recommend extended anticoagulation for patients with active cancer, the optimal dose intensity beyond the initial six months remains uncertain. We retrospectively evaluated a risk-adapted strategy using vein recanalization to guide direct oral anticoagulant (DOAC) dosing in a monocentric cohort of 148 onco-hematologic patients. During the extended phase, patients with persistent thrombosis remained on full-dose DOACs, while those with vein recanalization and active cancer were switched to low-dose DOACs. Over a median extended treatment follow-up of 35.3 months, the incidence rate of bleeding adverse events was 9.9 per 100 patient-years for full-dose therapy compared to 0.8 for low-dose therapy. Specifically, clinically relevant non-major bleeding rates were 9.2 vs. 0.4 per 100 patient-years, respectively. Recurrent VTE incidence was 4.3 per 100 patient-years in the full-dose group and 1.3 in the low-dose group. Our findings could suggest that a "low dose fits all" approach may be inappropriate for this high-risk population. Onco-hematologic patients with persistent venous thrombosis may benefit from continued full-dose anticoagulation, while dose de-escalation appears safe and effective once recanalization occurs. These results should be interpreted with caution given the retrospective, single-center design and small sample size.
The association of angiostatin and plasminogen plasma levels with Charlson comorbidity burden and mortality in COVID-19.
Franczak A, Calistrate-Petre P, Dinu I … +1 more , Jurasz P
J Thromb Thrombolysis · 2026 May · PMID 42149301 · Publisher ↗
Severe COVID-19 is associated with thrombotic complications. Dysregulated fibrinolysis, marked by increased plasminogen activator inhibitor-1 (PAI-1) and reduced plasmin generation, has been linked to adverse outcomes in...
Severe COVID-19 is associated with thrombotic complications. Dysregulated fibrinolysis, marked by increased plasminogen activator inhibitor-1 (PAI-1) and reduced plasmin generation, has been linked to adverse outcomes including death. Plasmin(ogen) is also the precursor of angiostatin, an angiogenesis inhibitor with dual roles both preventing SARS-CoV-2 infection and promoting cell death. While alterations in fibrinolytic markers are associated with disease severity, the relationship between plasminogen and angiostatin with survival outcomes remains unclear. Therefore we compared plasma angiostatin and plasminogen levels between COVID-19 survivors and non-survivors and assessed their association with mortality. The observational cohort study included age- and sex-matched hospitalized COVID-19 survivors and non-survivors. Plasma samples were collected during hospitalization, and angiostatin and plasminogen levels were quantified by immunoblotting. Cox regression, adjusted for Charlson comorbidity score and time from symptom onset to sample collection, assessed their association with mortality. Non-survivors had a higher Charlson score and significantly lower plasma angiostatin and plasminogen levels compared to survivors. Angiostatin was not associated with mortality after multivariate analysis. However, exploratory Kaplan-Meier survival curve analysis suggested that individuals with lowest Charlson score and angiostatin within the lower tertile exhibit lowest survival probability, while individuals with high Charlson score and with angiostatin in the middle tertile exhibit longest survival probability. By contrast, lower plasminogen was independently associated with mortality after adjustments, supporting a role for impaired fibrinolysis in poor outcomes, while a more complex potential association between angiostatin and COVID-19 mortality is emerging consistent with its dual roles in SARS-CoV-2 infection.
Validity of ICD-10 codes for identifying gastrointestinal bleeding in anticoagulated patients: an encounter-level diagnostic accuracy study.
Tawfik AG, Gomez-Lumbreras A, Gilbert SJ … +6 more , Hong H, Ye X, Patterson V, Del Fiol G, Malone DC, Witt DM
J Thromb Thrombolysis · 2026 May · PMID 42142293 · Publisher ↗
International Classification of Diseases, Tenth Revision (ICD-10) encounter diagnosis codes are commonly used to identify gastrointestinal bleeding (GIB) in electronic health record (EHR)-based research and clinical deci...
International Classification of Diseases, Tenth Revision (ICD-10) encounter diagnosis codes are commonly used to identify gastrointestinal bleeding (GIB) in electronic health record (EHR)-based research and clinical decision-support (CDS) tools. However, variability in coding accuracy may introduce misclassification bias, particularly among patients receiving oral anticoagulants (OACs). Contemporary, institution-specific validation of ICD-10 GIB codes is needed in the post-ICD-10 implementation era. We conducted a diagnostic accuracy study of ICD-10 encounter diagnosis codes for GIB among adults receiving warfarin or direct oral anticoagulants (DOACs) within a large academic healthcare system. A random sample of inpatient and emergency department encounters between June and December 2024 was identified. Manual chart review served as the reference standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic odds ratio (DOR) were calculated overall and stratified by anatomic bleeding site, anticoagulant class, and admission status. Among 656 anticoagulated encounters, 26 (4.0%) had chart-confirmed GIB. Overall sensitivity was 81% (95% CI, 60%-93%), specificity 98% (95% CI, 96%-99%), PPV 64% (95% CI, 45%-79%), and NPV 99% (95% CI, 98%-100%). The DOR was 215.6 (95% CI, 69.6-667.6). Sensitivity was higher for upper versus lower GIB (86% vs. 50%), while specificity remained high across subgroups. Diagnostic performance was similar between DOAC- and warfarin-treated encounters, though estimates for warfarin were imprecise due to small event counts. PPV varied across individual ICD-10 codes, with symptom-specific codes demonstrating higher predictive accuracy. ICD-10 encounter diagnosis codes demonstrated high specificity and NPV for identifying GIB among patients receiving OACs, supporting their use for ruling out bleeding events in EHR-based research and CDS. However, moderate PPV and heterogeneity across codes and clinical contexts indicate that ICD-10 codes alone should be used cautiously when defining GIB outcomes. Local validation remains essential to ensure reliable bleeding identification in anticoagulated populations.
Evaluation of anticoagulation management in patients with suspected heparin-induced thrombocytopenia awaiting diagnosis confirmation.
George AR, Sylvester KW, Kanaan DM … +4 more , Brooks DM, Lupi KE, Schuler BR, Connors JM
J Thromb Thrombolysis · 2026 May · PMID 42126779 · Publisher ↗
The 2018 American Society of Hematology (ASH) guidelines recommend discontinuation of heparin products upon suspicion of heparin-induced thrombocytopenia (HIT) and initiation of therapeutic non-heparin anticoagulation. T...
The 2018 American Society of Hematology (ASH) guidelines recommend discontinuation of heparin products upon suspicion of heparin-induced thrombocytopenia (HIT) and initiation of therapeutic non-heparin anticoagulation. This practice may be influenced by various factors, including diagnostic method. Our institution recently switched from an enzyme-linked immunosorbent assay (ELISA) that was run once daily to a chemiluminescence immunoassay (CLIA) that is run on-demand to detect anti-platelet factor 4 (PF4)/heparin antibodies. The objective was to evaluate if implementation of an on-demand anti-PF4/heparin antibody CLIA assay changed the timing of initiating a non-heparin anticoagulant compared with the traditional ELISA assay. A retrospective analysis was performed at our single academic medical center. Eligible subjects included patients ordered for an ELISA or CLIA anti-PF4/heparin assay upon suspicion of HIT. The major endpoint was the percentage of patients transitioned to a therapeutic non-heparin anticoagulant at the time of testing. Minor endpoints included the development of new or worsening thrombosis and/or bleeding within 72 h of testing. Overall, 227 patients were included in the analysis (n = 123 (ELISA), n = 104 (CLIA)). Significantly fewer patients in the CLIA group were switched to non-heparin anticoagulation at the time of testing as compared to the ELISA group (10.4% vs. 23.6%, p = 0.006). There were no differences between groups for the development of the minor endpoints. Significantly fewer patients were switched to therapeutic non-heparin anticoagulation at the time of testing after converting to an on-demand anti-PF4/heparin antibody CLIA assay. These findings may aid in optimizing institutional guidelines.
Thrombotic molecular markers after intravenous thrombolysis are associated with early neurological deterioration in acute ischemic stroke.
Sun W, Li B, Xie S … +5 more , Liu F, Lu Z, Ye J, Zeng G, Liu X
J Thromb Thrombolysis · 2026 May · PMID 42126778 · Publisher ↗
Early neurological deterioration (END) is a frequent and serious complication after intravenous thrombolysis in acute ischemic stroke (AIS), yet the clinical relevance of thrombotic molecular markers related to coagulati...
Early neurological deterioration (END) is a frequent and serious complication after intravenous thrombolysis in acute ischemic stroke (AIS), yet the clinical relevance of thrombotic molecular markers related to coagulation, fibrinolysis, and endothelial dysfunction remains incompletely understood. In this retrospective cohort study, 91 patients with AIS treated with intravenous thrombolysis were included between November 2022 and February 2025. Plasma levels of thrombin-antithrombin complex (TAT), plasmin inhibitor-plasmin complex (PIC), thrombomodulin (TM), and tissue-type plasminogen activator-plasminogen activator inhibitor-1 complex (t-PAIC) were measured before thrombolysis and at 1, 6, and 24 h thereafter. Stroke etiology was classified according to the Trial of Org 10,172 in Acute Stroke Treatment criteria into large artery atherosclerosis (LAA) and small vessel disease (SVD) subtypes, and patients were further categorized into END and non-END groups. Patients with LAA exhibited significantly higher plasma TAT levels at all time points and a higher incidence of END than those with SVD. Plasma TM levels were higher in the non-END group, with statistically significant differences observed at 24 h after thrombolysis. Multivariable analysis identified higher TM levels at 24 h as an independent protective factor against END, whereas elevated t-PAIC levels were independently associated with increased END risk. Given that END may occur early after thrombolysis, these associations should be interpreted cautiously in terms of temporal sequence. A combined model incorporating TM and t-PAIC demonstrated good discriminative performance for END, with an area under the curve of 0.849. These findings indicate distinct coagulation-endothelial response patterns between AIS subtypes and suggest that TM and t-PAIC may serve as complementary biomarkers associated with END risk following intravenous thrombolysis, although further validation is required.
Revisiting bleeding risk in cancer-associated thrombosis: Beyond the asian paradox.
Poenou G, Fevre N, Marie-Sainte C
J Thromb Thrombolysis · 2026 May · PMID 42126777 · Publisher ↗
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Clinician-artificial intelligence concordance in venous thromboembolism management: An unmet research need and the regulatory barriers that stand in its way.
William J
J Thromb Thrombolysis · 2026 May · PMID 42126776 · Publisher ↗
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Evaluating the indirect interaction between glucagon-like peptide-1 receptor agonists and warfarin using real-world data.
Gilbert SJ, Vazquez SR, Gouripeddi R … +3 more , Millar A, Facelli JC, Witt DM
J Thromb Thrombolysis · 2026 May · PMID 42115581 · Publisher ↗
Increasing use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) raises concern for interactions with warfarin. Although GLP-1 RAs do not affect warfarin pharmacokinetics, their appetite-reducing effects may decre...
Increasing use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) raises concern for interactions with warfarin. Although GLP-1 RAs do not affect warfarin pharmacokinetics, their appetite-reducing effects may decrease vitamin K intake and increase International Normalized Ratio (INR) variability. Large-scale real-world data (RWD) are needed to evaluate these effects. To evaluate changes in time-in-therapeutic INR range (TTR) among warfarin patients initiated on GLP-1 RA therapy. This retrospective cohort study evaluated TTR 6 months before and after GLP-1 RA initiation using RWD from the TriNetX Research Network. Included patients were required to have evidence of warfarin use before and after GLP-1 RA initiation. Primary outcomes included changes in TTR, INR, and INR recheck frequency. Secondary outcomes included time below and above the therapeutic range and INR variability. Of 53,943 patients screened, 1,021 met inclusion criteria. Mean TTR decreased by 2.1% (95% CI, -3.7% to -0.6%; p = 0.01), decreasing from 64.2% to 62.1%. Mean INR did not change (0.00; 95% CI, -0.02 to 0.03; p = 0.79). INR recheck frequency increased slightly, with a mean interval decrease of 0.7 days (95% CI -1.4 to 0.0; p = 0.049). Time below therapeutic range increased by 0.8% (p = 0.25), time above therapeutic range increased by 1.3% (p = 0.04), and INR standard deviation increased by 0.03 (p = 0.051). GLP-1 RA initiation was associated with a modest decrease in TTR and increased INR variability among warfarin-treated patients. Clinicians may consider closer INR monitoring following GLP-1 RA initiation.
CircRNA_0007444 modulates cardiomyocyte inflammation and apoptosis induced by myocardial ischemia-reperfusion injury via miR-16-5p/MFN2.
Teng Z, Fan L, Li S … +2 more , Lv Z, Wang Y
J Thromb Thrombolysis · 2026 May · PMID 42113414 · Publisher ↗
Myocardial ischemia-reperfusion injury (MIRI) seriously affects myocardial function, with circular RNA's mechanism in MIRI under exploration. This study seeks to elucidate the clinical value and function of circRNA_00074...
Myocardial ischemia-reperfusion injury (MIRI) seriously affects myocardial function, with circular RNA's mechanism in MIRI under exploration. This study seeks to elucidate the clinical value and function of circRNA_0007444 in MIRI. The levels of circRNA_0007444 in the serum of 94 non-MIRI patients and 80 MIRI patients were compared. The clinical significance of circRNA_0007444 was evaluated from the perspectives of differentiating MIRI patients and identifying independent risk factors for MIRI. In vitro experiments, a hypoxia/reoxygenation (H/R)-induced human cardiomyocytes AC16 cell model was used to evaluate the regulatory effects of circRNA_0007444 on cell viability, apoptosis, myocardial injury and inflammation. In mechanism, the downstream miRNAs and target genes of circRNA_0007444 were predicted, and the participation of miR-16-5p and MFN2 was evaluated through the recovery experiment. Decreasing circRNA_0007444 could discriminate MIRI patients and severs as an independent risk factor for MIRI onset. CircRNA_0007444 was negatively correlated with myocardial injury indicators. In AC16 cells, H/R induced significant downregulation of circRNA_0007444, suppressed cell viability, promoted cell apoptosis, enhanced inflammation, and induced myocardial injury. Promoting circRNA_0007444 could protect AC16 cells from H/R-induced injury. CircRNA_0007444 could target and negatively regulate miR-16-5p. miR-16-5p could target and negatively regulate MFN2. The overexpression of miR-16-5p could reverse the protective effect of circRNA_0007444 overexpressing, while overexpression of MFN2 could eliminate this effect. circRNA_0007444 can be used as a biomarker for the early screening and identification of independent risk factors of MIRI. Promoting circRNA_0007444 could alleviate H/R-induced AC16 cell injury through the miR-16-5p/MFN2 axis.
Impact of an Anticoagulation Management Service-Led Annual Review on Antiplatelet Use and Gastrointestinal Bleeding Prophylaxis in Ambulatory Patients on Background Direct Oral Anticoagulants.
Hoang C, Collins P, DeiCicchi D … +3 more , McNicol E, Hawkins D, Zaiken K
J Thromb Thrombolysis · 2026 Apr · PMID 42050246 · Publisher ↗
Patients on long-term anticoagulation face increased bleeding risk when antiplatelets are co-prescribed, especially upper gastrointestinal (GI) bleeding. Guidelines recommend limiting antiplatelet use to highly select pa...
Patients on long-term anticoagulation face increased bleeding risk when antiplatelets are co-prescribed, especially upper gastrointestinal (GI) bleeding. Guidelines recommend limiting antiplatelet use to highly select patients on background anticoagulants and promoting GI prophylaxis with proton pump inhibitors (PPIs) for those requiring dual antithrombotic therapy. To assess the impact of an anticoagulation management service (AMS)-led intervention on reducing excess antiplatelet use and increasing PPI prescribing in patients who require continued antiplatelet therapy. This study of retrospective chart review included adults (≥ 18 years) on long-term direct oral anticoagulant (DOAC) therapy from October 2023 to September 2024. The intervention group included AMS-enrolled patients who received structured annual anticoagulation review. The control group consisted of DOAC patients receiving usual care outside AMS. The AMS annual review aims to optimize antithrombotic therapy by deprescribing unnecessary antiplatelets and initiating PPIs when clinically indicated. Of 8,462 eligible patients, 3,125 were in the AMS group and 5,337 in the non-AMS group. Antiplatelet use was significantly lower in AMS patients at baseline (9% vs. 15%) and study end (7% vs. 16%) (p < 0.0001). PPI use was significantly higher in AMS patients at both time points (50% vs. 30% for baseline, 67% vs. 38% at the end of study) (p < 0.0001). Acceptance rates for AMS recommendations were 18.8% for antiplatelet discontinuation and 33% for PPI initiation. AMS-led interventions effectively reduced concurrent antiplatelet use in patients on background DOAC and increased PPI prescribing in those on dual therapy, demonstrating the value of centralized anticoagulation services in primary care.
Combined circuit-directed (pre-oxygenator) nafamostat and low-dose systemic unfractionated heparin anticoagulation in ecmo patients with high bleeding risk: A case series and safety evaluation.
Hu Y, Lin S, Zhang M … +4 more , Ye L, Zhang Z, Fan J, Xu F
J Thromb Thrombolysis · 2026 Apr · PMID 42050245 · Publisher ↗
Systemic anticoagulation with unfractionated heparin (UFH) is the standard of care during extracorporeal membrane oxygenation (ECMO). However, in patients with coagulation disorders or high bleeding risk, UFH may lead to...
Systemic anticoagulation with unfractionated heparin (UFH) is the standard of care during extracorporeal membrane oxygenation (ECMO). However, in patients with coagulation disorders or high bleeding risk, UFH may lead to life-threatening hemorrhage. To evaluate the safety and feasibility of a combined anticoagulation strategy using circuit-directed (pre-oxygenator) nafamostat mesilate and low-dose systemic UFH in selected high bleeding-risk ECMO patients. We conducted a retrospective case series of 8 adult ECMO patients with coagulopathy between January 2023 and December 2024 at a tertiary ICU. Patients received continuous pre-oxygenator nafamostat mesilate (0.5–0.75 mg/kg/h) and low-dose systemic UFH (4–8 U/kg/h), guided by predefined activated clotting time (ACT) and activated partial thromboplastin time (APTT) targets. No oxygenator exchange for circuit thrombosis or confirmed systemic thromboembolic events were observed. Three patients experienced minor bleeding (37.5%), and no major hemorrhage occurred. ACT and APTT measurements were generally within protocol-defined target ranges. In this descriptive case series, circuit-directed nafamostat combined with low-dose systemic UFH appeared feasible in selected high bleeding-risk ECMO patients. Controlled comparative studies are needed to determine effectiveness, optimal monitoring, and safety.
Four-factor prothrombin complex concentrate for the reversal of apixaban prior to deceased donor kidney transplant: A case series.
Dierker MS, Przybylski A, Cotiguala L … +2 more , Lopez-Soler R, Ferguson K
J Thromb Thrombolysis · 2026 Apr · PMID 42050244 · Publisher ↗
Direct oral anticoagulants (DOACs) including apixaban are often utilized in patients with end-stage renal disease (ESRD) awaiting kidney transplantation, but the unpredictable timing of deceased donor kidney transplantat...
Direct oral anticoagulants (DOACs) including apixaban are often utilized in patients with end-stage renal disease (ESRD) awaiting kidney transplantation, but the unpredictable timing of deceased donor kidney transplantation (DDKT) complicates peri-operative management. This case series aims to explore the efficacy and safety outcomes associated with four-factor prothrombin complex concentrate (4 F-PCC) use to induce hemostasis prior to DDKT for Veterans taking apixaban. We retrospectively reviewed Veterans who underwent DDKT between November 2020 to October 2023 with confirmed apixaban use within 48 h prior. All received weight-based 4 F-PCC at doses of 25–50 units/kg before transplantation. Hemostatic efficacy, categorized as excellent, good, or poor based on hemoglobin changes and transfusion requirements, served as the primary outcome. Secondary outcomes included estimated blood loss, return to operation room, 30-day thromboembolic events, and 30-day all-cause mortality. Among 14 Veterans (mean age 65 years; 92.9% male), 10 (71.4%) achieved excellent or good hemostasis. The mean estimated blood loss was 181.2 ± 66.8 mL. One Veteran required re-operation for hematoma. Two deaths occurred within 30 days, including one death with pulmonary embolism identified on autopsy. Although 4 F-PCC may support hemostasis for apixaban reversal prior to DDKT, the thromboembolic event observed in this series highlight the need for further evaluation of safety outcomes and criteria for reversal in the DDKT population.
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