J Thromb Thrombolysis
· 2026 Jun · PMID 41903054
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UNLABELLED: Malignancy is a well-recognised major risk factor for venous thromboembolism (VTE). While anticoagulation is the cornerstone of management for cancer-associated thrombosis (CAT), its use is associated with an...UNLABELLED: Malignancy is a well-recognised major risk factor for venous thromboembolism (VTE). While anticoagulation is the cornerstone of management for cancer-associated thrombosis (CAT), its use is associated with an increased risk of bleeding. This study aimed to determine the incidence of bleeding, patterns of anticoagulant use, and bleeding outcomes, and to identify factors associated with bleeding events during the first 6 months of CAT treatment. We conducted a retrospective study on cancer patients in Hospital Canselor Tuanku Muhriz (HCTM) who were diagnosed with pulmonary embolism (PE) and/or deep vein thrombosis (DVT) and received anticoagulant therapy from January 2015 to January 2025. Medical records and clinical laboratory data were collected and analysed. The primary outcome was the incidence of bleeding events, including major bleeding and clinically relevant non-major bleeding, as defined by the ISTH. A total of 203 patients were included. The most common anticoagulant used during the study period was DOACs (66%), followed by parenteral anticoagulants (low molecular weight heparin [LMWH] and fondaparinux) (28.1%) and warfarin (5.9%). The incidence of bleeding within six months of anticoagulation was 25.1% (51/203). The incidence of bleeding events was 24% among patients with non-haematological malignancies, compared with 33.3% among those with haematological malignancies. Bleeding was most frequently observed among patients receiving vitamin K antagonist, warfarin (41.6%), followed by parenteral anticoagulants (LMWH and fondaparinux) (33.3%), while the lowest proportion occurred among DOAC users (20.2%). The gastrointestinal tract was the most common site of bleeding (45%). During treatment, 6% of patients initially on DOACs were converted to LMWH, predominantly due to bleeding events or increased bleeding risk. Nearly half of bleeding episodes occurred within the first month of treatment (median 31.5 days). Prolonged INR during bleeding event (INR > 1.5) was the only significant associated risk factor for bleeding (OR 2.42, = 0.016). Overall, these findings highlight the need for individualised anticoagulation strategies in cancer-associated thrombosis, particularly in Asian populations. GRAPHICAL ABSTRACT: [Image: see text]
Li S, Chen F, Dong Y
… +5 more, Chai H, Liu Y, Xia L, Jin H, Shou S
J Thromb Thrombolysis
· 2026 Jun · PMID 41903053
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UNLABELLED: A LightGBM model was developed to predict sepsis-induced coagulopathy (SIC) within 72 h of ICU admission using routine clinical data. The model achieved an ROC-AUC of 0.937 (95%CI 0.886–0.963) and a Brier sco...UNLABELLED: A LightGBM model was developed to predict sepsis-induced coagulopathy (SIC) within 72 h of ICU admission using routine clinical data. The model achieved an ROC-AUC of 0.937 (95%CI 0.886–0.963) and a Brier score of 0.106. SHAP analysis identified international normalized ratio, platelet count, and lactate as key predictors. External validation confirmed robustness (ROC-AUC 0.938). Sensitivity analysis excluding SIC diagnostic components yielded an ROC-AUC of 0.754, indicating genuine pathophysiological associations rather than data leakage. To establish a machine learning model for predicting sepsis-induced coagulopathy (SIC) within 72 h of ICU admission. This retrospective cohort study utilized the MIMIC-IV database (2008–2019) to identify first-time ICU admissions with sepsis. Forty variables were extracted. Random Forest importance scores selected the top ten features. Eight machine learning algorithms were compared. Performance was evaluated by ROC-AUC, accuracy, precision, recall, F1 score, and Brier score. SHapley Additive exPlanations (SHAP) analysis was employed for interpretation. Generalizability was assessed using an independent external cohort (2022–2024). A total of 2,237 patients were included (training set: 1,789; external validation: 202). The LightGBM model demonstrated optimal performance (ROC-AUC 0.937, 95%CI 0.886–0.963; accuracy 0.866; Brier score 0.106). SHAP analysis identified international normalized ratio, platelet count, and lactate as the top three predictors. External validation confirmed robust discriminative ability (ROC-AUC 0.938). Sensitivity analysis excluding SIC diagnostic components (INR, PLT, SOFA) yielded ROC-AUC 0.754, indicating genuine pathophysiological associations rather than data leakage. The LightGBM model offers a preliminary tool for early SIC detection. Multi-center prospective validation is warranted to confirm clinical utility. GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11239-026-03272-w.
J Thromb Thrombolysis
· 2026 Jun · PMID 41894124
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Isolated distal deep vein thrombosis (IDDVT) is the most prevalent form of deep vein thrombosis (DVT), comprising up to 50% of all DVT cases. The incidence of IDDVT varies depending on cancer type, patient-specific chara...Isolated distal deep vein thrombosis (IDDVT) is the most prevalent form of deep vein thrombosis (DVT), comprising up to 50% of all DVT cases. The incidence of IDDVT varies depending on cancer type, patient-specific characteristics, and cancer treatment factors. Cancer-associated isolated distal deep vein thrombosis (CA-IDDVT) is a specific form of IDDVT, which has serious clinical outcomes, including death, VTE recurrence, and major bleeding. Despite its clinical importance, few studies have focused on the management of CA-IDDVT. Emerging evidence supports an individualized anticoagulation strategy, and extended-duration therapy is recommended. Notably, the ONCO-DVT trial demonstrates that extended treatment with edoxaban significantly reduces thrombotic risk without increasing major bleeding, highlighting its potential in CA-IDDVT management. This article reviews recent advances in the clinical factors, manifestations, and treatment strategies for CA-IDDVT, providing new insights to guide its effective management.
Prandin G, Furlanis G, Mancinelli L
… +10 more, Vincis E, Quagliotto M, Ricci E, Malesani M, Farina G, Cattaruzza L, Caruso P, Naccarato M, Ukmar M, Manganotti P
J Thromb Thrombolysis
· 2026 Jun · PMID 41854832
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UNLABELLED: Atrial fibrillation detected after stroke (AFDAS) may be either newly emergent or previously undiagnosed, with potential neurogenic origin. The ability to predict AFDAS through early imaging remains limited....UNLABELLED: Atrial fibrillation detected after stroke (AFDAS) may be either newly emergent or previously undiagnosed, with potential neurogenic origin. The ability to predict AFDAS through early imaging remains limited. This study investigates whether hyperacute CT perfusion imaging can identify patients at higher risk for AFDAS. We retrospectively analyzed data of patients with acute ischemic stroke admitted to the University Hospital of Trieste between January 2019 and March 2020. Patients with known AF, hemorrhagic stroke, or TIA were excluded. Lesion volumes and locations were assessed using perfusion and follow-up CT imaging. Among the 242 patients included, AFDAS was more frequently identified in those of older age, female sex, with higher NT-proBNP levels, and worse functional outcomes. Frontal-parietal-insular hypoperfusion was more prevalent in patients with AFDAS. After multiple adjustments, frontal lobe hypoperfusion remained independently associated with AFDAS (OR 2.836, 95% CI 1.406–5.719, = 0.004), while no significant associations were found with final infarct volume or location on follow-up imaging. This finding was confirmed in a sub-analysis restricted to non-lacunar strokes (OR 2.286, 95% CI 1.068–4.894, = 0.033). NT-proBNP levels, non-current smoking status, and frontal hypoperfusion on hyperacute CT perfusion imaging may predict AFDAS, suggesting that early central autonomic dysregulation, rather than infarcted tissue, plays a role in the pathogenesis of atrial fibrillation. These findings support the integration of perfusion imaging and cardiac biomarkers into AFDAS risk stratification models; however, validation through prospective multicenter studies is warranted. GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11239-026-03267-7.
Pulmonary embolism is a leading cause of cardiovascular death. Given the increased use of catheter directed therapies (CDT), tools for patient selection have become more impactful today. Several parameters have been used...Pulmonary embolism is a leading cause of cardiovascular death. Given the increased use of catheter directed therapies (CDT), tools for patient selection have become more impactful today. Several parameters have been used to identify vulnerable patients. These include demographic, physical, imaging and laboratory findings which can be used collectively to risk stratify patients. Left ventricular outflow tract (LVOT) velocity time index (VTI) is not incorporated in these calculators, but data suggests it is effective in prognostication. Using a retrospective review, we assessed 105 consecutive pulmonary embolism response team (PERT) patients who underwent either thrombectomy with a FlowTriever Device (Inari Medical) or ultrasound assisted thrombolysis with EKOS (Boston Scientific) and compared their pre-procedural LVOT VTI indexed to body surface area to markers of pulmonary embolism severity. Of the 105 patients, 57 were male, 80 were Caucasian, 70 were ESC intermediate-high risk and 16 were ESC high risk, 76 were sPESI positive, and 62 were PESI class III or higher. Traditional demographic markers of increased risk, including heart and lung disease, along with cancer, were low. RV strain was present in 96 patients. VTI indexed to BSA, HR and LVOT diameter had a significant negative correlation with imaging parameters of RV dysfunction, ESC and sPESI classification and a significant positive correlation with pulse pressure and TAPSE. There were no procedural deaths, with three mortalities (2.9%) at 30 days in patients with available follow up. Indexed LVOT VTI correlates with established predictors of increased pulmonary embolism severity in a group of pulmonary embolism response team patients who underwent CDT. An analysis of indexed LVOT VTI in pulmonary embolism patients who did not undergo CDT will enhance our knowledge on patient selection.
Toale KM, Marten CA, Crouch A
… +3 more, Andersen CR, Ullah F, Rojas Hernandez CM
J Thromb Thrombolysis
· 2026 Jun · PMID 41790331
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The purpose of this study is to describe the safety and efficacy of direct oral anticoagulants (DOACs) and low molecular weight heparin (LMWH) for the treatment of cancer-associated thrombosis in patients with extreme bo...The purpose of this study is to describe the safety and efficacy of direct oral anticoagulants (DOACs) and low molecular weight heparin (LMWH) for the treatment of cancer-associated thrombosis in patients with extreme bodyweights. This was a single center, retrospective cohort study of adult patients on therapy for at least 6 months. The primary efficacy outcome of this study was to describe the time to first recurrent venous thromboembolism (VTE) within 6 months, compared between treatment and across weight cohorts. The primary safety objective was to describe the time to first major bleeding (MB) event within 6 months of starting therapy, between treatment types and among the weight groups. Secondary outcomes included incidence of recurrent VTE, MB, clinically relevant non-major bleeding (CRNMB) and the rate of VTE- or bleeding-related mortality. The time to recurrent VTE was comparable between all groups. In the BMI cohort, the time to first MB was 19.5 times longer for DOACs compared to LMWH in the overweight population (p = 0.007) and to first MB or CRNMB was 11.98 times longer (p = < 0.0001). In the weight cohort, the time to first MB or CRNMB was 14.63 times longer for DOACs compared to LMWH in the overweight population (p = 0.011) and 6.41 times longer in the normal weight population (p = 0.0009). There was an insufficient number of patients in the underweight group to perform statistical analysis. The results suggest that in overweight patients, DOACs have similar efficacy and fewer bleeding complications than LMWHs.
High on P2Y12 inhibitor platelet reactivity (HPR) is frequent at the time of percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI) even in patients pre-treated with potent oral inhibitor...High on P2Y12 inhibitor platelet reactivity (HPR) is frequent at the time of percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI) even in patients pre-treated with potent oral inhibitors. HPR is associated with increased thrombus burden, impaired myocardial reperfusion and poorer post-PCI outcomes. We aimed to assess the impact of cangrelor, an intravenous P2Y12 inhibitor, on myocardial reperfusion in STEMI patients with HPR. Patients pre-treated with ticagrelor and aspirin with residual HPR (platelet reactivity unit (PRU) > 208) were randomly assigned in a 1:1 ratio to receive cangrelor (experimental group) or no additional treatment (standard group) immediately before PCI. The primary endpoint was optimal myocardial reperfusion defined as a final myocardial blush grade (MBG) 3 assessed by an independent core laboratory. Post-PCI atherothrombotic burden (ATB) was evaluated using intracoronary optical frequency domain imaging. A total of 60 patients with HPR were enrolled. A final normal MBG was observed in 21/30 (70%) patients in the experimental group versus 17/30 (57%) in the standard group (p = 0.28). Residual ATB and post PCI PRU were significantly lower in the experimental group compared to the standard group (4.5% [3.4; 7.2] vs. 6.9% [5; 8.7], p = 0.03 and 4 [3;53] vs. 242 [116;279], p < 0.001, respectively). In STEMI patients pre-treated with ticagrelor with residual HPR at the time of PCI, cangrelor use did not significantly improve final myocardial blush grade but was associated with more effective platelet inhibition and lower residual thrombus burden.
Despite thromboprophylaxis, neurosurgical patients remain at high post-operative thromboembolic risk, but early diagnosis of deep vein thrombosis (DVT) is challenging. To investigate whether elevated D-dimer levels may a...Despite thromboprophylaxis, neurosurgical patients remain at high post-operative thromboembolic risk, but early diagnosis of deep vein thrombosis (DVT) is challenging. To investigate whether elevated D-dimer levels may assist to diagnose post-surgery DVT in neurosurgical patients. A retrospective observational study was performed involving all patients who received venous ultrasound assessment (US) for suspected DVT, prompted by elevated D-dimer levels observed after neurosurgery. We compared clinical characteristics and D-dimer levels in patients with and without venous thrombosis. Logistic regression analysis was used to ascertain any association between elevated D-dimer levels and the risk of developing DVT in patients investigated between the 3rd and 15th day after surgery. The ROC curve was used to identify the cut-offs values for suspected DVT. Among 556 consecutive neurosurgical patients, 73 underwent post-surgery venous US for increased D-dimer levels and 35 had venous thrombosis; among these, DVT occurred in 20 out of 43 (46.5%) patients investigated between the 3rd and 15th post-operative day. Among variables considered, only D-dimer levels were significantly higher in patients with DVT. Logistic regression analysis revealed an odds ratio (OR) of 1.98 (CI 1.04-3.78, p = 0.03) for each 1000 µg/L D-dimer increase. The ROC curve identified an optimal D-dimer cut-off value of 1334 µg/L (sensitivity 0.90, specificity 0.52, negative likelihood ratio 0.2) (OR 9.8, CI 1.8-5.7, p = 0.007). D-dimer threshold of 2200 µg/L was associated with the best positive predictive value (77%; specificity 0.87, positive likelihood ratio 3.8). Elevated D-dimer levels were associated with increased risk of DVT after neurosurgery.
Shah K, Gadelrab M, Brennan EA
… +5 more, Westfal ML, Donahue CA, Gaizo JD, Kilic A, Curran T
J Thromb Thrombolysis
· 2026 Jun · PMID 41790327
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Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a significant complication in surgical patients. Artificial intelligence (AI) and machine learning (ML) may enhance VTE r...Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a significant complication in surgical patients. Artificial intelligence (AI) and machine learning (ML) may enhance VTE risk stratification by leveraging novel parameters in electronic medical records (EMRs). We aim to systematically review the role of AI and ML in stratifying the risk of postoperative VTE in surgical patients. A systematic literature search was conducted in PubMed, Scopus, and CINAHL Complete through May 24, 2024, and registered in PROSPERO (CRD420250522393). Eligible studies included primary research on postoperative adult patients undergoing any surgery that reported VTE risk assessment using the area under the receiver operating characteristic curve (AUC). Risk of bias was assessed, and the Wilcoxon signed-rank test was used to compare AUCs. 34 studies met the inclusion criteria, of which 22 directly compared AI models with non-AI models and were used for analysis. AI models showed higher discrimination than non-AI comparators within the same cohorts, with a median ΔAUC of + 0.10 (IQR 0.03-0.21; Wilcoxon signed-rank test, n = 22, p < 0.001). 31 studies were found to have a high risk of bias in model development, with only 12 reporting calibration metrics. Studies were limited to the United States (17) and China (17), with substantial surgical heterogeneity. Across head-to-head studies, AI models consistently showed higher discrimination than their non-AI comparators within the same cohorts. Future research should prioritize external validation, standardized reporting of calibration metrics, and generalizability.
Brodin N, Nymberg P, Bolmsjö BB
… +4 more, Svensson PJ, Elf J, Zöller B, Calling S
J Thromb Thrombolysis
· 2026 Mar · PMID 41790326
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Metabolic syndrome (MetS) is a cluster of cardiovascular risk factors, including abdominal obesity, insulin resistance, dyslipidemia, and hypertension. Its association with venous thromboembolism (VTE) has been inconsist...Metabolic syndrome (MetS) is a cluster of cardiovascular risk factors, including abdominal obesity, insulin resistance, dyslipidemia, and hypertension. Its association with venous thromboembolism (VTE) has been inconsistently reported. We investigated the association between MetS and VTE, and the influence of sex and abdominal obesity. We included 12,788 middle-aged and older adults from the re-examination phase of the Swedish prospective cohort Malmö Preventive Project (2002-2006). VTE events were collected using national registers until 31 December 2018. MetS was defined as the presence of three or more of the following factors: abdominal obesity, elevated triglycerides, low high-density lipoprotein cholesterol, hypertension, and impaired fasting glucose. During a mean follow-up of 11 years, 730 first VTE events occurred. The prevalence of MetS was higher in men than in women (p < 0.001). In analyses adjusted for age, height, and smoking, MetS was not associated with increased risk of VTE in men (HR 1.10; 95% CI 0.90-1.34) or women (HR 1.15; 95% CI 0.91-1.45). In women, higher VTE risk was found in those with multiple MetS factors compared to zero. Abdominal obesity was associated with VTE risk in women only (HR 1.80; 95% CI 1.43-2.27). MetS was not associated with VTE risk in men or women. The higher VTE risk observed with multiple MetS components in women appeared largely attributable to abdominal obesity, with little contribution from other components. Risk factors for VTE may differ by sex, with abdominal obesity appearing particularly relevant for women.
Gaetani E, Di Martino L, Agostini F
… +5 more, Feliciani D, Funaro B, Barberio A, Gasbarrini A, Pola R
J Thromb Thrombolysis
· 2026 Jun · PMID 41790325
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Hereditary Hemorrhagic Telangiectasia (HHT) is a rare vascular disease (1/5,000 prevalence) characterized by mucocutaneous telangiectasias and visceral arteriovenous malformations. Although hemorrhagic manifestations pre...Hereditary Hemorrhagic Telangiectasia (HHT) is a rare vascular disease (1/5,000 prevalence) characterized by mucocutaneous telangiectasias and visceral arteriovenous malformations. Although hemorrhagic manifestations predominate, patients may also be at increased risk of thrombotic events. Previous studies on this topic have been mostly retrospective, and prospective data are lacking. We conducted a prospective registry-based study using a validated adjudication system to assess the incidence of venous thromboembolism (VTE) in subjects with a definite diagnosis of HHT. A total of 315 patients were included (mean age 54.3 ± 17.8 years; median 57, IQR 18-93; 42.2% > 65 years; 172 men, 143 women). Median follow-up was 14 months (IQR 6-99). Fifteen VTE events occurred, yielding an overall incidence of 23.1/1,000 patient-years. Incidence was 45.1/1,000 patient-years in subjects > 65 years-old and 11.6/1,000 patient-years in those ≤ 65 years-old. Four events were unprovoked, and eleven had identifiable provoking factors. In 4 cases, the provoking factor was hospitalization for an acute disease or the exacerbation of a chronic condition; none of these patients received in-hospital thromboprophylaxis. The observed VTE incidence in HHT appears higher than in the general population, particularly among older individuals. Underuse of prophylaxis may contribute to this excess risk. These findings underscore the need for individualized strategies that balance hemorrhagic and thrombotic complications in HHT.
Pancreatic cancer is one of the most thrombogenic malignancies. Venous thromboembolism (VTE) is a frequent and very severe complication. The risk of thrombosis and postoperative hemorrhage, especially post-pancreatectomy...Pancreatic cancer is one of the most thrombogenic malignancies. Venous thromboembolism (VTE) is a frequent and very severe complication. The risk of thrombosis and postoperative hemorrhage, especially post-pancreatectomy, makes thromboprophylaxis difficult to implement in clinical practice depending on what component dominates. A review was conducted using PubMed, Scopus, Web of Science, Elsevier, and Google Scholar databases. Studies published in English focusing on VTE pathophysiology, prevention, and treatment in pancreatic cancer were included. The evidence was summarized descriptively. Two randomized trials (FRAGEM and CONKO-004) have shown that intensified, weight-adjusted low-molecular-weight heparin (LMWH) significantly decreases the incidence of VTE in advanced pancreatic cancer (PC) without significantly increasing major bleeding or enhancing survival rates. Direct oral anticoagulants (DOACs) such as rivaroxaban and apixaban present potential as oral alternatives; however, they are associated with a greater risk of gastrointestinal bleeding. Following pancreatectomy, VTE occurs in 20-25% of patients-frequently after discharge-highlighting the necessity for extended prophylaxis lasting at least 28 days. Minimally invasive surgical techniques are linked to a marginally elevated risk of VTE when compared to open surgery. Nevertheless, the available data concerning dosing, timing, and the resumption of anticoagulation after post-pancreatectomy hemorrhage (PPH) is still inadequate. Current evidence supports the use of LMWH-based anticoagulation strategies for VTE prevention in pancreatic cancer; however, direct evidence for standard prophylactic dosing is lacking, as available randomized trials evaluated intensified regimens. DOACs may be used selectively, considering bleeding risk. The lack of pancreatic-cancer-specific dosing protocols and perioperative guidelines highlights the need for dedicated trials defining optimal anticoagulation strategies and safe timing of therapy after PPH.
Coronary artery bypass grafting (CABG) is a common surgical treatment for coronary artery disease; however, long-term success is limited by saphenous vein graft (SVG) occlusion. Aspirin remains the standard lifelong anti...Coronary artery bypass grafting (CABG) is a common surgical treatment for coronary artery disease; however, long-term success is limited by saphenous vein graft (SVG) occlusion. Aspirin remains the standard lifelong antiplatelet therapy; however, graft failure and adverse events persist after its use. More potent agents, such as ticagrelor, have been proposed, although the evidence is inconsistent, and concerns about bleeding risk remain. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing ticagrelor-based therapy with aspirin monotherapy in patients who underwent CABG. A comprehensive literature search of major databases was performed until August 2025. The primary endpoints were major bleeding, MACE, and all-cause mortality. The secondary outcomes included saphenous vein graft failure, stroke, myocardial infarction, and repeat revascularization. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model. Five randomized controlled trials comprising 4,208 patients (ticagrelor-based therapy ≈ 2,108; aspirin monotherapy ≈ 2,100) were included. Across the primary clinical endpoints, ticagrelor-based therapy showed no significant advantage over aspirin, with comparable rates of MACE (RR 1.05, 95% CI 0.78-1.41; p = 0.75; I² = 20%), all-cause mortality (RR 1.02, 95% CI 0.74-1.40; p = 0.93; I² = 0%), and major bleeding (RR 1.09, 95% CI 0.68-1.74; p = 0.73; I² = 51%). Similarly, no significant differences were observed for stroke (RR 1.10, 95% CI 0.70-1.75; p = 0.67; I² = 0%), myocardial infarction (RR 1.52, 95% CI 0.94-2.46; p = 0.09; I² = 27%), or repeat revascularization (RR 1.02, 95% CI 0.71-1.45; p = 0.93; I² = 7%). In contrast to the neutral clinical outcomes, ticagrelor-based therapy was associated with a significant reduction in saphenous vein graft (SVG) failure compared with aspirin monotherapy (RR 0.62, 95% CI 0.50-0.78; p < 0.0001; I² = 0%). Subgroup analysis revealed no meaningful differences between ticagrelor monotherapy and ticagrelor plus aspirin for major clinical events. Ticagrelor-based therapy did not reduce major clinical outcomes (MACE, mortality, MI, stroke, revascularization, or major bleeding) compared with aspirin after CABG, although it was associated with improved SVG patency. Routine use cannot be recommended; ticagrelor may be considered in selected high-risk patients. Further large, long-term trials are needed to determine whether patency benefits translate into improved clinical outcomes.
The concomitant occurrence of pulmonary embolism (PE) and lung cancer (LC) poses a significant mortality risk in the United States. Though both diseases are well studied across the literature individually, their combined...The concomitant occurrence of pulmonary embolism (PE) and lung cancer (LC) poses a significant mortality risk in the United States. Though both diseases are well studied across the literature individually, their combined burden remains unexplored. To evaluate the temporal trends in PE-related mortality among US adults ≥ 65 years with lung cancer from 1999 to 2020, stratified by demographic and geographic variables, by analyzing death certificates related to PE and lung cancer from the CDC WONDER database. We queried the CDC WONDER database for mortality trend analysis with multiple causes of death, having PE and LC, both as either contributing or underlying causes of death, from 1999 to 2020. AAMRs were calculated per 1,000,000 people, stratified by sex, race, geography, and metropolitan status. AAPCs and APCs with 95% CI were evaluated through Joinpoint regression. Between 1999 and 2020, there were 32,409 deaths among adults (aged ≥ 65) with PE and LC, with the majority of fatalities manifesting in medical facilities (60.52%). The overall AAMR increased significantly from 26 (95% CI: 24.3 to 27.7) in 1999 to 41.2 (95% CI: 39.4 to 42.9) in 2020, with an AAPC of 1.92 (95% CI: 1.10 to 2.76, p < 0.001). Men had higher mortality rates with an AAMR of 44.4 (95% CI: 43.8 to 45.1) than 28.4 (95% CI: 27.9 to 28.8) in females. In race/ethnicity, NH-Blacks possessed the highest AAMRs of 44.4 (95% CI: 42.9 to 45.8) among other races. In regional stratification, the Midwest region showed the highest AAMRs of 39.3 (95% CI: 38.4 to 40.1), with the highest AAMRs of 58 (95% CI: 47.5 to 68.4) in Vermont, and non-metropolitan areas had higher AAMRs of 36.06 (95% CI: 35.1 to 37) (Graphical abstract). This study highlights the potential demographic disparities in PE and LC-related mortalities among older adults, underscoring the necessity for improved interventions, early screening, public health awareness programs, and equity in healthcare access.Clinical trial registration: Not applicable, as this is a retrospective observational study that relies on publicly available data.
Thrombocytopenia, a common side effect of chronic liver disease (CLD), increases bleeding risk during invasive procedures. Thrombopoietin receptor agonists (TPO-RAs) offer an effective alternative to platelet transfusion...Thrombocytopenia, a common side effect of chronic liver disease (CLD), increases bleeding risk during invasive procedures. Thrombopoietin receptor agonists (TPO-RAs) offer an effective alternative to platelet transfusions. A systematic review and meta-analysis assessed the efficacy and safety of TPO-RAs in thrombocytopenia patients undergoing elective procedures. A systematic search (PubMed, Google Scholar, Cochrane Library, up to August 2024) evaluated perioperative thrombopoietin receptor agonists in patients with thrombocytopenia undergoing elective procedures. Primary and secondary outcomes included platelet count ≥50 x 10^9/L, bleeding/thrombotic events, platelet transfusions, adverse effects, rescue treatment, discontinuation, death, and serious adverse effects, analyzed via random-effects model. This meta-analysis synthesized evidence from nine trials and 1,409 patients (819 TPO-RAs vs 590 placebo; mean age ~59 years). TPO-RAs significantly increased the likelihood of achieving platelet counts ≥50×10⁹/L compared with placebo (RR 3.93, 95% CI 2.24-6.90; p<0.00001). They also reduced the need for preoperative platelet transfusions (RR 0.34, 95% CI 0.27-0.44; p<0.00001) and lowered the risk of surgical bleeding (RR 0.64, 95% CI 0.49-0.85; p=0.002). In contrast, no statistically significant differences were observed for thrombotic events (RR 1.24, 95% CI 0.57-2.67; p=0.59), treatment-emergent adverse events (RR 0.99, 95% CI 0.89-1.09; p=0.83), study drug discontinuation (RR 0.74, 95% CI 0.32-1.70; p=0.47), rescue treatment use (RR 0.82, 95% CI 0.34-2.03; p=0.67), all-cause mortality (RR 1.23, 95% CI 0.35-4.35; p=0.75), or serious adverse events (RR 1.13, 95% CI 0.70-1.84; p=0.62). TPO-RAs raise platelet counts and reduce transfusions in CLD patients undergoing invasive procedures. However, close monitoring for thrombotic risks is necessary, and further research is needed to optimize dosing.