Journal Of Thrombosis And Thrombolysis[JOURNAL]
Sun
200 papers
Safety and efficacy of endovascular treatment for pediatric acute ischemic stroke: a systematic review and Meta-analysis.
Kelani H, Elzayat MA, Salamah HM … +14 more , Samir A, Naima M, Enairat ALE, Dway A, Hamad M, Singavarapu J, Desai MJ, Elazim AA, Vulkanov V, Greene-Chandos D, Rosenbaum-Halevi D, Lerner DP, Merlin LR, Raz E
J Thromb Thrombolysis · 2026 Jun · PMID 41663635 · Full text
UNLABELLED: This meta-analysis aimed at evaluating the safety and efficacy of mechanical thrombectomy (MT) compared to the best medical management (BMM) in children after acute ischemic stroke. We conducted a systematic...
UNLABELLED: This meta-analysis aimed at evaluating the safety and efficacy of mechanical thrombectomy (MT) compared to the best medical management (BMM) in children after acute ischemic stroke. We conducted a systematic search of the literature through January 2025. Review Manager Software was used to calculate the odds ratios and their confidence intervals. The primary outcomes of interest were excellent functional recovery (modified Rankin Scale score ≤ 1 (PedmRS 0–1) at 90 days), symptomatic intracranial haemorrhage (sICH), and mortality. A total of eight studies encompassing 8048 patients were included. We found no statistically significant difference between the MT group and the BMM group in terms of mortality (OR 1.17, 95% CI [0.45, 3.05], p-value = 0.75, I = 0%), sICH (OR 1.32, 95% CI [0.40, 4.39], p-value = 0.6, I = 0%) and PedmRS 0–1 (OR 1.31, 95% CI [0.68, 2.53], p-value = 0.41, I = 43%). Furthermore, we performed a subgroup analysis of patients with large vessel occlusion (LVO) stroke and did not find any statistically significant difference between MT and BMM groups in terms of mortality (OR 3.48, 95% CI [0.42, 28.76], p-value = 0.25, I = 0%), sICH (1.09, 95% CI [0.26, 4.47], p-value = 0.90, I = 0%) and PedmRS 0–1 (OR 3.62, 95% CI [0.78, 16.76], p-value = 0.10, I = 59%). However, the BMM group showed increased odds of having a poor functional recovery (PedmRS 3–6) (OR 0.37, 95% CI [0.19, 0.73], p-value = 0.004, I = 0%). Our findings suggest that both MT and BMM have comparable safety and efficacy outcomes in the pediatric population. Further studies with more strict inclusion criteria are needed to confirm these findings. CRD42024609704. GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11239-025-03227-7.
Endovascular reperfusion strategies for pregnancy-related pulmonary embolism: a systematic review.
Pititto GN, De Pascali F, Canale C … +2 more , Squizzato A, Vedovati MC
J Thromb Thrombolysis · 2026 Jun · PMID 41653269 · Publisher ↗
Management of acute pulmonary embolism (PE) during pregnancy or post-partum is challenging especially in women at intermediate or high-risk of adverse outcomes. Catheter-directed therapies (CDTs) are increasingly used gi...
Management of acute pulmonary embolism (PE) during pregnancy or post-partum is challenging especially in women at intermediate or high-risk of adverse outcomes. Catheter-directed therapies (CDTs) are increasingly used given their potential efficacy and relatively low complication rates. We systematically reviewed the evidence on CDTs use in pregnancy and post-partum PE. Literature search was conducted in bibliographic databases, reference lists, and review articles until 2 July 2025, without restrictions. Main efficacy and safety outcomes were maternal all-cause and PE-related mortality, fetal mortality, improved right ventricle dysfunction (RVD) and/or pulmonary artery (PA) pressures, improved lung perfusion/clot burden reduction, and maternal major bleeding (MB). We identified 65 case reports, 4 case series and 1 cohort study for a total of 76 patients. Maternal all-cause mortality within 7 days from CDT was 2.8% (2/72; 95% confidence interval [CI], 0.3-9.7%) with no PE-related deaths. In-hospital fetal mortality was 12.5% (5/40; 95% CI, 4.2-26.8%). Within 72 h from CDT were observed: an improvement of RVD and/or PA pressures in 96.2% (25/26; 95% CI, 80.4-99.9%), and in lung perfusion/reduction in clot burden in 94.4% of cases (34/36; 95% CI, 81.3-99.3%); maternal MB in 17.2% of cases (11/64; 95% CI, 8.9-28.7%), with 10 out of 11 events (90.9%) reported in the post-partum period. Current evidence is limited and of low quality. CDTs should be considered only after a multidisciplinary evaluation of selected cases, balancing potential benefits and bleeding risks, the latter being mainly observed in the post-partum.
Subject: letter to the editor: platelet single-cell RNA sequencing.
Washington AV, Wolfsberger WW, Oleksyk TK
J Thromb Thrombolysis · 2026 Apr · PMID 41636979 · Publisher ↗
Abstract loading — click title to view on PubMed.
Correction: Immune checkpoint inhibitors and cardiovascular toxicity: immunology, pathophysiology, diagnosis, and management.
Becker RC
J Thromb Thrombolysis · 2026 Feb · PMID 41622394 · Full text
Abstract loading — click title to view on PubMed.
The coagulation-inflammation axis in advanced cancer: associations with cardiovascular-thrombotic complications.
Wagner C, Bruns F, Maletzki C … +7 more , Wolff A, Alammar M, Seifert A, Kriesen U, Rischmüller K, Oehmcke-Hecht S, Junghanss C
J Thromb Thrombolysis · 2026 Apr · PMID 41622393 · Full text
Cardiovascular–thrombotic complications (CVTCs) are common in advanced malignancies and contribute substantially to morbidity and mortality. The relationships between inflammation, coagulation abnormalities, and extracel...
Cardiovascular–thrombotic complications (CVTCs) are common in advanced malignancies and contribute substantially to morbidity and mortality. The relationships between inflammation, coagulation abnormalities, and extracellular vesicle (EV) profiles in palliative-stage disease remain insufficiently understood. In this exploratory cross-sectional study, clinical characteristics, coagulation parameters, inflammatory markers, and EV profiles were assessed at a single time point in 80 patients with advanced solid tumors receiving palliative care. Patients with a history of CVTCs were compared with those without. Patients with CVTCs showed higher levels of IL-6 and CRP, prolonged coagulation times, and lower activities of several coagulation factors, including FII, FVII, FX, FXII, and FXIII. Fibrinogen and d-dimer levels were elevated in the overall cohort and were higher in patients with CVTCs. Exploratory regression analyses indicated associations between lower FII activity, higher platelet counts, older age, and the presence of CVTCs. Cancer patients exhibited higher concentrations of small EV–like particles and shorter EV-associated clotting times compared with healthy donors; however, EV-related measures did not differ between patients with and without CVTCs. Palliative cancer patients demonstrate heterogeneous alterations in inflammatory and coagulation parameters, with more pronounced abnormalities in those with CVTCs. EV concentrations were elevated overall but did not distinguish between clinical subgroups. These findings are descriptive and hypothesis-generating, underscoring the need for longitudinal studies to clarify temporal relationships, potential mechanistic pathways, and the clinical relevance of coagulation and EV-associated alterations in advanced cancer.
The emerging role of heparanase in cardiovascular diseases: Pathophysiology, clinical outcomes, and therapeutic perspectives.
Bayam E, Kalçık M, Gürbüz AS … +1 more , Özkan M
J Thromb Thrombolysis · 2026 Jun · PMID 41604106 · Full text
UNLABELLED: Endothelial dysfunction, inflammation, atherosclerosis, thrombosis, and extracellular matrix remodeling represent the key pathophysiological processes underlying cardiovascular diseases. Heparanase, the sole...
UNLABELLED: Endothelial dysfunction, inflammation, atherosclerosis, thrombosis, and extracellular matrix remodeling represent the key pathophysiological processes underlying cardiovascular diseases. Heparanase, the sole mammalian endo-β-D-glucuronidase that cleaves heparan sulfate chains, serves as a key mediator linking these interrelated processes. Through glycocalyx disruption, it enhances vascular permeability, facilitates inflammatory cell recruitment, and promotes tissue factor–driven thrombosis, thereby promoting vascular inflammation and a prothrombotic state. The enzyme contributes to multiple cardiovascular pathologies, including atherosclerosis, thrombosis, restenosis, calcific valvular heart disease, diabetic cardiomyopathy, pulmonary vascular remodeling, and ischemia–reperfusion injury. Notably, its effects are context-dependent, reflecting a “dual role”: excessive activity enhances vascular injury and plaque instability, whereas basal expression may support cardiomyocyte survival and adaptive remodeling under stress conditions. This review discusses molecular mechanisms and therapeutic implications, integrating data from experimental and clinical studies to provide a unified understanding of heparanase biology in the cardiovascular system. Emphasis is placed on translational prospects, highlighting heparanase modulation as both a diagnostic biomarker and a potential therapeutic target for preventing or attenuating cardiovascular disease progression. GRAPHICAL ABSTRACT: Heparanase acts as a central mediator linking endothelial dysfunction, inflammation, thrombosis, and extracellular matrix remodeling in cardiovascular pathology. By degrading heparan sulfate chains within the vascular glycocalyx and matrix, it increases permeability, promotes inflammatory cell recruitment, and enhances tissue factor–driven coagulation. These mechanisms contribute to the progression of atherosclerosis, thrombosis and restenosis, valvular calcification, diabetic cardiomyopathy, and myocardial injury. The enzyme thus represents a unifying molecular link among diverse cardiovascular disorders, serving both as a pathogenic effector and a potential biomarker and therapeutic target. [Image: see text]
Sonothrombolysis as an adjunct to primary PCI in STEMI: a systematic review and meta-analysis of randomized trials.
Rath S, Saleh AO, Ahmad O … +3 more , Sayed MS, Arshad MA, Hassan Abdullah H
J Thromb Thrombolysis · 2026 Mar · PMID 41575727 · Publisher ↗
This study evaluates the role of ultrasound-mediated thrombolysis (sonothrombolysis) as an adjunct to percutaneous coronary intervention (PCI) in patients with ST-elevated myocardial infarction (STEMI). A comprehensive l...
This study evaluates the role of ultrasound-mediated thrombolysis (sonothrombolysis) as an adjunct to percutaneous coronary intervention (PCI) in patients with ST-elevated myocardial infarction (STEMI). A comprehensive literature search was conducted across five databases, identifying randomized controlled trials (RCTs) assessing sonothrombolysis in addition to PCI in STEMI patients. Data analysis employed a random effects model in R, focusing on outcomes like left ventricular ejection fraction (LVEF), end diastolic volume (LVEDV), systolic volume (LVESV), left ventricular global longitudinal strain (LV-GLS), and infarct size, evaluated at multiple time points. Six RCTs evaluated sonothrombolysis combined with PCI (241 patients) versus PCI alone (232 patients). LVEF was significantly higher in the sonothrombolysis group immediately post-PCI (MD: 4.00; 95% CI: 1.62, 6.38; P = 0.001) and at subsequent time points (MD: 4.06-4.39; P < 0.01). LVEDV and LVESV were significantly lower at 48-72 h and 6 months in the sonothrombolysis group. LV-GLS was consistently higher across all time points. Infarct size was notably smaller in the sonothrombolysis arm across all time points (MD: - 5.41, 95%CI: [- 8.82, - 2.00]; p = 0.0018). Sonothrombolysis significantly improves cardiac outcomes following PCI in STEMI patients, showcasing better LVEF, lower LVEDV and LVESV, and reduced infarct size. Further exploration of its standalone and adjunctive potential with PCI is warranted.
Thrombus histopathology in distal versus proximal vessel occlusion: insights and future directions for stroke reperfusion.
Frol S, Bendok BR
J Thromb Thrombolysis · 2026 Mar · PMID 41575726 · Publisher ↗
Acute ischemic stroke is a leading cause of disability and death worldwide. This commentary highlights the role of thrombus composition in influencing treatment outcomes and therapeutic strategies. Rapid reperfusion thro...
Acute ischemic stroke is a leading cause of disability and death worldwide. This commentary highlights the role of thrombus composition in influencing treatment outcomes and therapeutic strategies. Rapid reperfusion through intravenous thrombolysis and mechanical thrombectomy is critical to salvage brain tissue. Distal medium vessel occlusions, accounting for approximately 30% of strokes, often result in persistent disability despite optimal therapy, emphasizing the need to understand factors affecting reperfusion success. Stroke thrombi exhibit marked heterogeneity, comprising red blood cells, fibrin, platelets, neutrophils, and von Willebrand factor. Distal occlusions tend to contain more platelet- and fibrin-rich thrombi and fewer red blood cells compared with proximal occlusions. Platelet- and fibrin-dense thrombi are more resistant to thrombolysis and are associated with longer, more complex thrombectomy procedures, while red blood cell-rich thrombi respond better. Anticoagulation may influence thrombus composition, and novel strategies, including fibrin-specific thrombolytics and combination approaches targeting multiple thrombus components, hold promise for improving reperfusion and functional outcomes.
Toward platelet-count-adaptive anticoagulation in cancer thrombocytopenia: a standards-first, equity-aware proposal.
Vijayasimha M
J Thromb Thrombolysis · 2026 Mar · PMID 41575725 · Publisher ↗
Cancer-associated thrombosis (CAT) with thrombocytopenia (TP) poses concurrent risks of bleeding and recurrence. Guidance is fragmented by nonuniform platelet thresholds, tumor-context effects on agent choice, and scarce...
Cancer-associated thrombosis (CAT) with thrombocytopenia (TP) poses concurrent risks of bleeding and recurrence. Guidance is fragmented by nonuniform platelet thresholds, tumor-context effects on agent choice, and scarce prospective data for DOACs specifically in TP. We outline a platelet-count-adaptive framework: (i) standardized platelet bands linked to dose/agent actions; (ii) tumor-biology-aware selection; (iii) transfusion-sparing triggers; and (iv) a core outcome set that indexes events to time spent within platelet bands ("platelet-adjusted bleeding rate"). The schema is evidence-aligned, feasible in resource-constrained settings, and offers testable standards for pragmatic trials. Translating recent syntheses into implementable, equity-aware standards can reduce unwarranted variation and accelerate learning across diverse care settings.
miR-493-3p alleviates carotid artery stenosis by targeting YTHDF2.
Li C, Sun S, Yu K … +2 more , Tong C, Lei S
J Thromb Thrombolysis · 2026 Apr · PMID 41553620 · Publisher ↗
Carotid artery stenosis (CAS) is the primary cause of ischemic stroke, and its pathological feature is the abnormal activation of vascular smooth muscle cells (VSMCs). Research has confirmed that miRNA plays a significan...
Carotid artery stenosis (CAS) is the primary cause of ischemic stroke, and its pathological feature is the abnormal activation of vascular smooth muscle cells (VSMCs). Research has confirmed that miRNA plays a significant role in this pathological change. This study aims to explore the mechanism of miR-493-3p in CAS and its regulatory relationship with YTHDF2. Firstly, the association between the serum miR-493-3p levels of patients with CAS and the degree of stenosis was analyzed, and the diagnostic value was evaluated through the ROC curve. A pathological model was constructed by inducing VSMCs with Ox-LDL. The proliferation and migration abilities of the cells, as well as inflammatory factors, were detected by using the CCK-8, Transwell assay and ELISA. Dual-luciferase reporter gene assay and RNA immunoprecipitation were used to verify the targeting relationship between miR-493-3p and YTHDF2. Patients with low expression of miR-493-3p had a more severe degree of carotid artery stenosis. The sensitivity of miR-493-3p in diagnosing CAS was 90.12%, and the specificity was 86.21%. In VSMCs induced by Ox-LDL, overexpression of miR-493-3p could inhibit the proliferation, migration, and release of inflammatory factors. YTHDF2 is a direct target of miR-493-3p. Overexpression of YTHDF2 could reverse the inhibitory effect of miR-493-3p on the pathological behavior of VSMCs. miR-493-3p regulates the abnormal proliferation and migration of VSMCs by inhibiting YTHDF2. This not only provides a basis for it to be used as a diagnostic marker for CAS, but also indicates its potential as a new therapeutic target.
Refining the evidence base for anticoagulation in HALT following TAVR.
Ng S, Vavalle JP
J Thromb Thrombolysis · 2026 Feb · PMID 41553619 · Publisher ↗
Abstract loading — click title to view on PubMed.
Oxidized phospholipids on plasminogen are associated with reduced platelet surface marker expression and intrinsic reactivity.
Kille A, Kaier K, Nührenberg T … +8 more , Franke K, Valina CM, Yang X, Leibundgut G, Neumann FJ, Westermann D, Hochholzer W, Tsimikas S
J Thromb Thrombolysis · 2026 Feb · PMID 41525016 · Publisher ↗
Elevated levels of oxidized phospholipids (OxPL) on plasminogen (OxPL-PLG) are associated with reduced time to fibrinolysis and reduced risk of cardiovascular events, but their effect on platelet function is unknown. We...
Elevated levels of oxidized phospholipids (OxPL) on plasminogen (OxPL-PLG) are associated with reduced time to fibrinolysis and reduced risk of cardiovascular events, but their effect on platelet function is unknown. We aimed to evaluate the association of OxPL-PLG with platelet surface marker expression, intrinsic and on‑dual anti-platelet (DAPT, aspirin plus clopidogrel)) platelet reactivity and cardiovascular events. OxPL-PLG levels were measured in pre-procedure blood samples in 2040 patients undergoing coronary angiography with or without PCI. The association of OxPL-PLG to pre-procedure and 24-hour platelet surface expression of CD62P, CD41 and PAC-1 and intrinsic and on-DAPT platelet reactivity in response to collagen and adenosine diphosphate (ADP) were assessed. The relationship of OxPL-PLG to myocardial infarction(MI)-free survival over a median 7-year follow-up was assessed using multivariable Cox regression models. Elevated levels of OxPL-PLG were significantly and inversely associated with age, male sex, severity of coronary obstruction, previous MI, PCI, and CABG. OxPL-PLG was inversely associated with platelet surface expression of CD41 (p < 0.001), CD62P (p = 0.0012) and PAC-1 (p < 0.001) at baseline and with CD41 (p = 0.001) and CD62P (p = 0.020) after DAPT. A significant inverse association was present between OxPL-PLG and intrinsic platelet reactivity in response to ADP (p < 0.001) at baseline but not after DAPT. OxPL-PLG was not associated with MI-free survival. In conclusion, elevated OxPL-PLG levels are independently associated with lower-risk clinical profile, less severe coronary disease, and reduced platelet activation and reactivity prior to DAPT. These findings suggest OxPL-PLG may modulate platelet activation and reactivity and warrant further mechanistic and clinical evaluation. EXCELSIOR study (Impact of Extent of Clopidogrel-Induced Platelet Inhibition during Elective Stent Implantation on Clinical Event Rate; ClinicalTrials.gov Identifier: NCT00457236).
Impact of biological age versus chronological age on clinical outcomes in patients with atrial fibrillation: insights from the COOL-AF registry.
Krittayaphong R, Buraphat P, Yindeengam A … +2 more , Komoltri C, Lip GYH
J Thromb Thrombolysis · 2026 Mar · PMID 41525015 · Publisher ↗
Because patients with atrial fibrillation (AF) often exhibit heterogeneous risks that are not fully captured by traditional clinical factors, identifying a more accurate measure of physiological ageing could improve risk...
Because patients with atrial fibrillation (AF) often exhibit heterogeneous risks that are not fully captured by traditional clinical factors, identifying a more accurate measure of physiological ageing could improve risk stratification and clinical management compared to chronological aging.This study aimed to determine the clinical outcome in relation to biological ageing in patients with AF. We used the data from the COOL-AF registry which is a multicentre nationwide registry of AF patients. The enrolment period was 2014-2017. Patients were followed-up for 3 years. Biological ageing was calculated from the Klemera-Doubal method (KDM) is a based on chronological age and blood chemistry and body function factors. The main outcome of this study was the composite of all-cause death, major bleeding, ischemic stroke/systemic embolism (SSE), and heart failure. We included total of 3405 patients, with a mean chronological age of 67.8 ± 11.3 years, and 1424 (41.8%) were female. During the median follow-up duration of 35.9 (IQR 34.8, 36.0) months, the composite outcomes, death, major bleeding, SSE, and heart failure developed in 726 (21.3%), 380 (11.2%), 199 (5.8%), 134 (3.9%), and 247 (7.3%) patients, respectively. Restricted cubic spline analysis showed that KDM bioage had higher hazard ratios compared to chronological age, with the adjusted Hazard ratios and 95% confidence interval (CI) of Quartile 4 (Q4) KDM for the composite outcomes, death, major bleeding, SSE, and heart failure were 2.11 (1.82-2.45), 2.53 (2.06-3.11), 2.12 (1.60-2.83), 1.96 (1.37-2.78), and 1.83 (1.42-2.38), respectively (all p < 0.001). In conclusion, KDM bioage is an independent predictor for clinical outcome and performs better than chronological age. These findings highlight the clinical value of incorporating biological ageing metrics into AF risk assessment models and suggest that KDM bioage may enhance personalized prognostication beyond conventional age-based evaluation.
Comparison of activated and 4-factor prothrombin complex concentrates for reversal of apixaban- and rivaroxaban-associated major bleeding.
Crawley RM, Sheikh-Taha M
J Thromb Thrombolysis · 2026 Mar · PMID 41525014 · Publisher ↗
Factor Xa inhibitor (FXaI)-associated major bleeding presents a critical management challenge. Although andexanet alfa is the targeted reversal agent, its limited availability and high cost has sustained the use of proth...
Factor Xa inhibitor (FXaI)-associated major bleeding presents a critical management challenge. Although andexanet alfa is the targeted reversal agent, its limited availability and high cost has sustained the use of prothrombin complex concentrates (PCCs). Activated PCC (aPCC) may provide effective reversal at lower doses due to its inclusion of activated factor VII. This study compared the effectiveness and safety of aPCC versus 4-factor PCC (4 F-PCC) for reversal of apixaban- and rivaroxaban-associated major bleeding. A retrospective cohort study was conducted at Huntsville Hospital. Adult patients who received aPCC or 4 F-PCC for major bleeding while on apixaban or rivaroxaban were included. Major bleeding and clinical hemostasis were defined using International Society on Thrombosis and Haemostasis (ISTH) criteria. The primary outcome was hemostatic effectiveness; the secondary outcome was in-hospital thromboembolic complications. Among 293 patients (252 aPCC, 41 4 F-PCC), baseline characteristics were similar except for more intracranial hemorrhage in the 4 F-PCC group (75.6% vs. 46.8%, p < 0.001). Hemostasis was achieved in 77.0% of aPCC-treated and 70.7% of 4 F-PCC-treated patients (p = 0.376). Thromboembolic events were infrequent (1.6% vs. 4.9%, p = 0.156), with no significant difference between groups. In FXaI-associated major bleeding, aPCC and 4 F-PCC achieved comparable hemostatic outcomes with low thromboembolic event rates. These results support either agent as a reasonable reversal option when andexanet alfa is unavailable, with aPCC potentially effective at lower doses.
Association of factor V leiden and ischemic stroke in young adults: a national inpatient sample analysis.
Singh J, Walters RW, Rausch JT … +2 more , Al-Salahat A, Bernitsas E
J Thromb Thrombolysis · 2026 Apr · PMID 41525013 · Publisher ↗
The association between Factor V Leiden (FVL) and ischemic stroke in young adults remains uncertain. We compared the prevalence of FVL coding in ischemic stroke versus non-stroke hospitalizations and examined in-hospital...
The association between Factor V Leiden (FVL) and ischemic stroke in young adults remains uncertain. We compared the prevalence of FVL coding in ischemic stroke versus non-stroke hospitalizations and examined in-hospital outcomes among young adults with ischemic stroke in the United States.Using the 2016-2022 National Inpatient Sample, we identified hospitalizations for patients aged 18-49 years with a primary diagnosis of ischemic stroke and a secondary diagnosis of FVL. We compared survey-weighted FVL prevalence between stroke and non-stroke hospitalizations. Among stroke hospitalizations, we evaluated discharge disposition, length of stay, and inflation-adjusted costs with survey-weighted regression models adjusted for demographics and comorbidities. Among 67.8 million hospitalizations of adults aged 18-49 years, 297,905 (0.44%) were for ischemic stroke. FVL coding was more frequent in stroke than non-stroke hospitalizations (0.85% vs. 0.25%, p < .001). Among stroke admissions, FVL prevalence increased from 0.81% in 2016 to 0.95% in 2022 (relative increase 18.3%; p for trend = 0.14), while also rising among non-stroke hospitalizations. Stroke hospitalizations with FVL coding involved patients who were younger, more often female and White, and had fewer recorded traditional vascular risk factors. After adjustment, FVL coding was associated with longer length of stay (9.5% increase) and higher hospital costs (11.2% increase); discharge disposition did not differ meaningfully by FVL status. In this large, cross-sectional inpatient sample, FVL was more frequently coded among young adults hospitalized with ischemic stroke than among other hospitalizations and was associated with greater resource use. However, the design, reliance on ICD-10 codes, and likely differential thrombophilia testing limit causal inference and may partially explain the higher FVL prevalence in stroke admissions. These findings highlight the need for prospective, mechanistically focused studies with standardized thrombophilia testing and detailed stroke phenotyping to clarify the contribution of FVL to arterial ischemic stroke and to identify which patients, if any, might benefit from targeted FVL evaluation and tailored prevention strategies.
Adjunct tirofiban after intravenous thrombolysis in acute ischemic stroke: a GRADE-guided meta-analysis of randomized trials with trial sequential analysis.
Gadelmawla AF, Emara A, El-Farargy SH … +6 more , Diaa A, Abdallfatah A, Albukhari AF, Almasri MS, Elgendy MS, Awashra A
J Thromb Thrombolysis · 2026 Apr · PMID 41466170 · Publisher ↗
Early platelet-mediated re-occlusion and microvascular "no-reflow" can blunt the benefits of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS). Tirofiban, a short-acting GP IIb/IIIa inhibitor, may stabilize p...
Early platelet-mediated re-occlusion and microvascular "no-reflow" can blunt the benefits of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS). Tirofiban, a short-acting GP IIb/IIIa inhibitor, may stabilize post-lysis reperfusion. Our analysis assessed the efficacy and safety of adjunct tirofiban after IVT versus IVT alone (alteplase or Tenecteplase) in patients with AIS. We conducted a meta-analysis of randomized controlled trials (RCTs) identified through searches of PubMed, Cochrane, Scopus, and Web of Science up to August 2025. Dichotomous outcomes were pooled as risk ratios (RRs), and continuous outcomes as mean differences (MDs), each with 95% confidence intervals (CIs). Three RCTs with 1,132 patients were included. Tirofiban improved excellent outcome (64.09% vs. 54.24%, RR 1.19, 95% CI 1.07 to 1.33, P = 0.002) and functional independence (80.67% vs. 70.45%, RR 1.20, 95% CI 1.04 to 1.38, P = 0.01) and reduced poor outcome (19.32% vs. 29.54%, RR 0.61, 95% CI 0.46 to 0.81, P = 0.0006). Early neurologic improvement favored tirofiban at 24-72 h (p = 0.001) but was neutral at 5-7 days (p = 0.25). Safety did not differ for any intracranial hemorrhage (ICH) (p = 0.26), asymptomatic ICH (p = 0.75), symptomatic ICH (p = 0.68), systemic bleeding (p = 0.75), or 90-day mortality (p = 0.84). Across randomized trials, adjunct tirofiban after IVT improved 90-day functional outcomes and early neurologic recovery. For safety, no statistically significant differences were observed in any ICH, asymptomatic ICH, systemic bleeding, or 90-day mortality; however, the estimate for sICH was very imprecise and does not exclude a clinically important increase. These results are exploratory and warrant confirmation in larger, multinational RCTs before informing practice.
The role of N6-methyladenosine associated genes in ischemic stroke risk: interplay with environmental factors.
Chiu YC, Yi L, Zhang Y … +7 more , Hu W, Bai J, Wu W, Wang T, Hao Y, Yu H, Wang X
J Thromb Thrombolysis · 2026 Apr · PMID 41466169 · Publisher ↗
Ischemic stroke is a leading cause of morbidity and mortality worldwide, resulting from a complex interplay between genetic predisposition and environmental exposures. Recent advances have highlighted the importance of e...
Ischemic stroke is a leading cause of morbidity and mortality worldwide, resulting from a complex interplay between genetic predisposition and environmental exposures. Recent advances have highlighted the importance of epitranscriptomic regulation, particularly N6-methyladenosine (mA) RNA modification, in the pathogenesis of cerebrovascular diseases. Key mA‑related genes, including the demethylases FTO and ALKBH5, the methyltransferase complex components METTL3 and METTL14, and mA readers of the YTH domain family (e.g., YTHDF1, YTHDF2, YTHDC1), have been implicated in processes such as vascular homeostasis, neuroinflammation, and neuronal survival. Emerging evidence suggests that specific genetic variants within these genes (for e.g., FTO rs9939609, FTO rs17817449, ALKBH5 rs12936694, METTL3 rs1139130, and YTHDF/ YTHDC locus polymorphisms) may modulate individual susceptibility to ischemic stroke. In a real-world contexts, lifestyle and environmental exposures such as diet, smoking, physical activity, and air pollution may interact with these genetic factors, potentially modifying overall stroke risk. This is the first review to systematically highlight m6A-related genes as key interfaces linking genetic susceptibility with environmental exposures in ischemic stroke, emphasizing their potential role as dynamic environmental sensors translating exposure signals into transcriptional and phenotypic outcomes. Elucidating these complex interactions could inform strategies for stroke prevention and the development of personalized therapeutic approaches.
Efficacy and safety of intravenous tirofiban pre-operatively as an adjunct to endovascular thrombectomy in ischemic stroke: a grade-assessed systematic review and Meta-Analysis.
Altaf A, Nazir T, Afridi A … +13 more , Farhan K, Sajjad F, Shahid I, Imran F, Gul A, Alam U, Iqbal A, Kazi N, Shaikh Z, Hoti RK, Afridi MU, Khattak F, Khan H
J Thromb Thrombolysis · 2026 Apr · PMID 41466168 · Publisher ↗
Acute ischemic stroke (AIS) due to large vessel occlusion (LVO) is a significant cause of disability and mortality. While endovascular thrombectomy (EVT) is the standard treatment, microvascular reperfusion remains a cha...
Acute ischemic stroke (AIS) due to large vessel occlusion (LVO) is a significant cause of disability and mortality. While endovascular thrombectomy (EVT) is the standard treatment, microvascular reperfusion remains a challenge. Although there is mixed information about the safety and effectiveness of tirofiban, a glycoprotein IIb/IIIa inhibitor, it may improve perfusion when administered before EVT. Its effects on risks and functional outcomes, including symptomatic intracranial hemorrhage (sICH), are investigated in this meta-analysis. We systematically searched PubMed, Embase, and Cochrane from inception to July 2025 for randomized controlled trials (RCTs) and Cohorts comparing pre-EVT tirofiban with EVT alone in LVO stroke. Primary outcomes were 90-day functional independence and the ordinal shift in mRS. Secondary outcomes included mortality and symptomatic intracerebral hemorrhage. Six Studies (1,664 patients) were included. Tirofiban did not significantly improve 90-day functional independence (RR: 1.09, 95% CI: 0.88-1.36; p = 0.44; I² = 62%) or ordinal mRS (MD: 0.06, 95% CI: -0.15 to 0.27; p = 0.58; I² = 0%). Mortality was similar between groups (RR: 0.75, 95% CI: 0.54-1.06; p = 0.11; I² = 0%). sICH risk was also comparable (RR: 0.83, 95% CI: 0.46-1.51; p = 0.55; I² = 28%). Pre-procedural tirofiban did not significantly raise the risk of sICH, improve functional outcomes, or lower death in LVO stroke patients having EVT. Although additional research may improve patient selection, these results point to limited value for routine tirofiban administration before EVT.Keypoints Pre-EVT tirofiban does not significantly improve 90-day functional outcomes in AIS due to LVO. No significant benefit was observed in ordinal modified Rankin Scale scores. Mortality and risk of symptomatic intracranial hemorrhage were similar between tirofiban and control groups. Heterogeneity was moderate to low, and findings were consistent across study types. Future studies should explore optimal patient selection, dosing strategies, and timing to identify potential subgroups that may benefit from pre-EVT tirofiban.
VEGF as a predictor of major adverse events in patients with peripheral arterial disease - an exploratory study.
Khan H, Frljuckic S, Zamzam A … +4 more , Ashour R, Saposnik G, Mamdani M, Qadura M
J Thromb Thrombolysis · 2026 Apr · PMID 41466167 · Full text
Peripheral arterial disease (PAD) is an atherosclerotic disease caused by the narrowing of peripheral arteries due to atheromatous plaque build-up. Angiogenesis can be beneficial in patients with PAD however it may contr...
Peripheral arterial disease (PAD) is an atherosclerotic disease caused by the narrowing of peripheral arteries due to atheromatous plaque build-up. Angiogenesis can be beneficial in patients with PAD however it may contribute to negative long-term cardiovascular outcomes. Vascular endothelial growth factor-A (VEGF/VEGF-A) has been associated with PAD. This study investigated the association between VEGF and major adverse cardiovascular events (MACE), and major adverse limb events (MALE) in patient with PAD. Plasma levels of VEGF were quantified in 300 patients with PAD (ABI < 0.9). Patients were monitored for MACE, defined as the composite of myocardial infarction, stroke, and cardiovascular-related death and MALE, defined as composite of progression to chronic limb threatening ischemia, need for surgical intervention, graft/stent re-occlusion, and need for minor or major limb amputation. Multivariable Cox proportional hazards regression was used to assess associations between VEGF levels and the risk of MACE and MALE, reported as hazard ratios with 95% confidence intervals. A Bonferroni correction was applied to address multiple hypothesis testing with p < 0.025 considered as significant. VEGF was independently associated with an increased risk of MACE (HR 1.26, 95% CI: 1.14-1.40, p < 0.001) and MALE (HR 1.176, 95% CI: 1.066-1.297, p = 0.001) after adjusting for cardiovascular risk factors. VEGF demonstrated a strong association with MACE and MALE events with each unit increase in VEGF being associated with a 26.0% increase in the risk of MACE and 17.6% increase in the risk of MALE, supporting its potential utility in risk stratification in patients with PAD.
Implementing anticoagulation stewardship: the use of a dedicated mobile phone 'app' in the experience of the Italian Federation of Anticoagulation linics (FCSA).
Poli D, Bucciarelli P, Cappugi C … +7 more , Donadini MP, Pengo V, Rescigno G, Sarti L, Testa S, Toschi V, Squizzato A
J Thromb Thrombolysis · 2026 Apr · PMID 41466166 · Publisher ↗
Anticoagulants are life-saving drugs used to prevent and treat thrombosis, and a wide use of these drugs is increasing overtime. However, anticoagulants are one of the most common causes of drug-related adverse events in...
Anticoagulants are life-saving drugs used to prevent and treat thrombosis, and a wide use of these drugs is increasing overtime. However, anticoagulants are one of the most common causes of drug-related adverse events in- and out-of-hospital. The need for empowering clinicians and patients, enhancing compliance and favoring multidisciplinary collaboration, has been widely outlined. Programs of Anticoagulation Stewardship (ACS) have been implemented worldwide. It has been widely demonstrated that ACS is associated with reduction of hospital-acquired blood clots, drug-drug interactions, bleeding events, hospital readmissions, length of hospital stay and other healthcare costs. Although ACS is widely discussed, no ACS model has been extensively and officially realized in the Italian healthcare system. Since its constitution, the Italian Federation of Centers for the Diagnosis of Thrombotic Disorders and the Surveillance of the Antithrombotic Therapies (i.e. FCSA) supported healthcare professionals providing educational programs, aimed to improve anticoagulation quality and to decrease associated risks and costs. In 2021, FCSA developed an app for mobile phones named FCSApp, which was distributed to affiliated physicians. Aim of this study is to describe this experience. FCSApp was actively used for three years by 100 of 232 registered users, with approximately 3200 messages. The channels of main interest were the so-called 'Clinical Cases' with 1671 messages [52.3%]), and 'Laboratory' (with 586 messages [18.3%]). This experience should be considered in the organization of more comprehensive ACS programs for each national or regional healthcare system.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe