Journal Of Thrombosis And Thrombolysis[JOURNAL]
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200 papers
RNA sequence analysis of differentially expressed genes in left atrial appendage thrombus.
Maeda J, Furutani M, Miyauchi S … +14 more , Nakashima M, Ishibashi N, Sakai T, Oguri N, Miyamoto S, Okamura S, Okubo Y, Tokuyama T, Oda N, Takasaki T, Takahashi S, Aizawa H, Shigemizu D, Nakano Y
J Thromb Thrombolysis · 2026 Feb · PMID 41047445 · Full text
Cardioembolic stroke is a major complication of atrial fibrillation (AF). We investigated differentially expressed genes (DEGs) in the left atrial appendage (LAA) with and without LAA thrombus (LAAT) using RNA sequencing...
Cardioembolic stroke is a major complication of atrial fibrillation (AF). We investigated differentially expressed genes (DEGs) in the left atrial appendage (LAA) with and without LAA thrombus (LAAT) using RNA sequencing (RNA-seq). LAA tissue samples were obtained during cardiac surgery. We analyzed samples with LAAT (n = 6) and without LAAT (n = 5). Differential gene expression analysis was conducted to identify significantly altered genes. RNA-seq identified 27 differentially expressed genes (false discovery rate < 0.05,|log(fold change)| >2). Among these, four DEGs-DIRAS3, CYP26B1, PRG4, and ITLN1-exhibited particularly large fold changes. Protein-protein interaction network analysis revealed two hub genes, FKBP5 and TUBA3D, based on degree (≥ 30) and betweenness centrality (≥ 3000). Quantitative PCR confirmed consistent expression patterns for these genes. Furthermore, consistent results were obtained in another independent set (10 cases with LAAT and 10 cases without LAAT). Linear regression analysis, adjusted for age and gender, showed that DIRAS3 expression was significantly associated with both the fibrosis ratio (β = 2.99, 95% confidence interval [CI] 0.22-5.75, p = 0.034) and NT-proBNP levels (β = 373, 95% CI 238-507, p= 5.71E-08). Additionally, CYP26B1 and TUBA3D expression levels were significantly associated with NT-proBNP (β = 349, 95% CI 23.8-674, p= 0.036; β = -140, 95% CI -272 to -8.81, p = 0.038, respectively). We identified candidate genes potentially involved in LAAT in AF patients through RNA-seq analysis. These findings may elucidate the molecular mechanisms underlying LAAT pathogenesis.
Protein carbonylation as a modulator of fibrin clot properties in thyroid disorders: impact of therapy.
Undas KW, Dąbrowa J, Natorska J … +3 more , Mazur P, Hubalewska-Dydejczyk A, Undas A
J Thromb Thrombolysis · 2026 Feb · PMID 41006730 · Full text
Protein carbonylation (PC), a marker of oxidative stress, was shown to be elevated in both hyperthyroid and hypothyroid disorders. These conditions are associated with unfavorable fibrin clot properties. We sought to inv...
Protein carbonylation (PC), a marker of oxidative stress, was shown to be elevated in both hyperthyroid and hypothyroid disorders. These conditions are associated with unfavorable fibrin clot properties. We sought to investigate whether elevated PC is associated with prothrombotic markers in hyperthyroid and hypothyroid individuals before and following effective therapy. We studied 31 hyperthyroid, 29 hypothyroid patients, and 29 sex- and age-matched controls. Along with plasma total PC content, we measured fibrin clot properties (fibrin clot permeability, K; clot lysis time, CLT), fibrinolysis proteins, and thrombin generation before and after 3-month successful therapy. Hyperthyroid patients had a tendency to higher PC (+ 9.1%; p = 0.05), while hypothyroid individuals had 17.2% higher PC (p = 0.01) compared with controls, without any difference between the patient groups. Pre-treatment PC inversely correlated with K in both hyper- (R=-0.425, p = 0.017) and hypothyroid (R=-0.510, p = 0.005) individuals, while solely in hyperthyroid patients PC was associated with CLT (R = 0.556, p = 0.001), but not with fibrinolysis inhibitors, or other hemostatic markers. On-treatment PC, which decreased by 19.6% (p < 0.001) in hyperthyroid and by 23.4% (p < 0.001) in hypothyroid patients reaching the control levels, was associated with K (R=-0.401, p = 0.031) and CLT (R = 0.537, p = 0.003) only in the hypothyroid group. In hyper- and hypothyroid patients elevated PC may contribute to formation of more compact fibrin clot networks with impaired fibrinolysis in the former group. Reduced PC following thyroid hormone normalization maintained its impact on fibrin clot properties solely in hypothyroid patients, which indicates complex effects of oxidative stress on blood coagulation.
Long term anticoagulation for Catheter-Related deep vein thrombosis of the upper extremities in women with cancer: retrospective analysis of effectiveness and safety outcomes.
Cavallaro C, Santini P, Leoni L … +9 more , Mosoni C, D'Ambrosio S, Mancinetti F, Coletta N, Iorio M, Porfidia A, D'Errico A, Talerico R, Pola R
J Thromb Thrombolysis · 2025 Dec · PMID 41006729 · Full text
Catheter-related upper extremity deep vein thrombosis (CRT-UEDVT) is a possible complication in patients with cancer carrying a central venous catheter. Anticoagulation is the primary treatment, but optimal duration is u...
Catheter-related upper extremity deep vein thrombosis (CRT-UEDVT) is a possible complication in patients with cancer carrying a central venous catheter. Anticoagulation is the primary treatment, but optimal duration is unclear. This study evaluated effectiveness and safety of different lengths of anticoagulation in women with cancer and CRT-UEDVT. We conducted a retrospective analysis on women ≥ 18 years-old, who had active cancer and had received anticoagulant treatment for CRT-UEDVT. Effectiveness was assessed in terms of VTE recurrence and thrombosis recanalization. Safety was determined by assessing major bleedings (MB) and clinically relevant non-major bleedings (CRNMB) during treatment. A total of 113 women where included. All of them had completed at least 3 months of anticoagulant therapy, while 106 and 97 had completed 6 and 12 months of anticoagulant therapy, respectively. The median follow-up was 568.5 days (IQR 300-910). Patients primarily presented with ovarian, breast, and endometrial cancers. Anticoagulant therapy was mainly parenteral during the initial 3 months and between 3 and 6 months, shifting predominantly to direct oral anticoagulants during months 6-12. The annual VTE recurrence rate was 0.5%. The annual rate of MB and CRNMB was 1.9%. Complete thrombosis recanalization was achieved in 52.0%, 69.1%, and 87.3% of patients at 3, 6, and 12 months, respectively. Our study provides interesting insights into the management and clinical outcomes of women with cancer and CRT-UEDVT. Prospective studies are needed to fully understand advantages and disadvantages of different lengths of anticoagulation in this set of patients.
Correction to: Apixaban versus warfarin for treatment of venous thromboembolism in patients with severe renal impairment: a multicenter study.
Hanke P, Domingo ME, Salanio G … +20 more , Ahmed K, Hu J, Hendricks K, Howard J, Hashimura T, Guiliano C, Haan BJ, Ng TH, Kelley D, Knight T, Koopman K, Obstoj M, Breeden T, Sirbu D, Romano M, Harpenau A, Konneker R, Acevedo J, Pan N, Edwin SB
J Thromb Thrombolysis · 2026 Mar · PMID 40963002 · Publisher ↗
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Circulating cfdna: A novel biomarker for preventing early recurrence in ischemic stroke.
Li X, Yuan Y, Jing W … +7 more , Liu C, Wei M, Liu Q, Li X, Wei L, Du X, Wang J
J Thromb Thrombolysis · 2026 Feb · PMID 40956471 · Full text
Stroke is the second-leading cause of mortality and the principal contributor to long-term disability worldwide. Despite the widespread clinical implementation of secondary prevention protocols, the 90-day stroke recurre...
Stroke is the second-leading cause of mortality and the principal contributor to long-term disability worldwide. Despite the widespread clinical implementation of secondary prevention protocols, the 90-day stroke recurrence rate remains a significant concern, particularly among patients with atherosclerosis. Mounting evidence implicates inflammatory pathways as central mediators in both atherogenesis and plaque destabilization. It is known that ischemic stroke triggers a substantial release of cell-free DNA (cfDNA) into the systemic circulation. These nucleic acid fragments can subsequently activate endothelial cells, thereby promoting atherosclerosis, and can also activate nucleotide-sensing inflammasomes within vulnerable plaques, thus triggering thrombotic cascades and early recurrent cerebrovascular events. In this review, we comprehensively examine the pathophysiological origins of cfDNA, delineate its mechanistic involvement in stroke recidivism, and evaluate current therapeutic strategies targeting cfDNA catabolism in the management of ischemic stroke, aiming to provide insights for future research in this field.
Treatment failure in patients with obesity with venous thromboembolism receiving truncated vs. recommended lead-in times with apixaban at an academic medical center.
Murchison A, Ball N, Rockhold M … +1 more , Bredhold B
J Thromb Thrombolysis · 2026 Feb · PMID 40952588 · Publisher ↗
Optimal lead-in duration of apixaban following a period of therapeutic parenteral anticoagulation for venous thromboembolism (VTE) has become controversial, and truncated lead-in periods accounting for parenteral therapy...
Optimal lead-in duration of apixaban following a period of therapeutic parenteral anticoagulation for venous thromboembolism (VTE) has become controversial, and truncated lead-in periods accounting for parenteral therapy have been proposed in recent studies. Results from previous studies cannot be generalized to many subpopulations of interest, including patients with obesity. This study characterized recurrent VTE in patients with obesity within 6 months of apixaban initiation based on full versus truncated lead-in times following parenteral anticoagulation. This single-center, multi-site, retrospective cohort study within the West Virginia University Medicine enterprise among adult patients with obesity, defined as body mass index (BMI) of 30 kg/m or greater, diagnosed with VTE who received apixaban following at least 48 h of parenteral anticoagulation. Truncated lead-ins were uncommon (10%). There were no significant differences in recurrent thrombosis between full and truncated lead-in cohorts [10 (4.5%) vs. 2 (8.0%); p = 0.771]. The truncated lead-in cohort was associated with longer length of stay and extended duration of parenteral anticoagulation. A truncated lead-in strategy may be reasonable for patients with obesity. Larger studies should be conducted to identify patient factors that support the use of a truncated lead-in strategy. 1) Previous studies investigating truncated lead-in times cannot be generalized to subpopulations of interest such as patients with obesity 2)Safety and efficacy outcomes are variable among the general population within previous studies 3) In clinical practice, truncated lead-in regimens are chosen for patients with longer durations of parenteral anticoagulation 4)Recurrent thrombosis rates within subpopulations who are at higher of thrombosis requires further evaluation regarding the truncated lead-in.
Tyrosine kinase inhibitors - balancing the haemostatic scales: a review of associated thrombosis and bleeding.
Butel-Simoes LE, Albayati A, Yu J … +6 more , Quirk T, Sritharan S, French M, Bennetts JD, Ngo DTM, Sverdlov AL
J Thromb Thrombolysis · 2026 Feb · PMID 40952587 · Full text
Tyrosine kinase inhibitors (TKIs) have revolutionised cancer therapy, significantly impacting survival and outcomes by targeting specific signalling pathways that are necessary for tumour survival. Despite their clinical...
Tyrosine kinase inhibitors (TKIs) have revolutionised cancer therapy, significantly impacting survival and outcomes by targeting specific signalling pathways that are necessary for tumour survival. Despite their clinical efficacy, TKIs exhibit a complex toxicity profile. Many of the signalling pathways that are targeted by TKIs are shared with normal homeostatic processes, including those responsible for modulating thrombosis and bleeding. The risk profile of thrombosis and bleeding associated with TKIs varies considerably across agents. Multi-kinase inhibitors, particularly those targeting the breakpoint cluster regio-abelson murine leukaemia 1 gene mutation (BCR-ABL) (i.e., nilotinib and ponatinib), significantly elevate arterial thrombotic events. This thrombosis risk is driven by endothelial dysfunction, accelerated atherosclerosis, platelet hyper-reactivity, and impaired fibrinolysis. Similarly, vascular endothelial growth factor (VEGF) pathway inhibition contributes markedly to thrombotic vascular complications by reducing vasodilators like nitric oxide and promoting pro-thrombotic endothelial environments. TKIs targeting the VEGF receptor (VEGFR-TKIs) (i.e., sunitinib and regorafenib) and brutons tyrosine kinase (BTK) inhibitors (i.e., ibrutinib), increase bleeding risk through platelet dysfunction, thrombocytopenia, and interactions affecting coagulation pathways. Optimal management of these medications encompasses careful baseline cardiovascular and bleeding risk assessments, proactive modification of modifiable risk factors, and vigilant patient monitoring. Prophylactic antithrombotic therapy necessitates cautious individualised evaluation and comprehensive patient monitoring strategies. TKIs exemplify the advancements in precision oncology but necessitate nuanced management of their complex vascular toxicities. A multidisciplinary cardio-oncology approach involving detailed patient education, robust risk stratification, and collaborative clinical management is essential. Future research should aim to clarify TKI-specific haemostatic mechanisms and develop predictive biomarkers, enabling tailored therapeutic strategies to optimise clinical outcomes and reduce adverse events..
Use of viscoelastic testing in the transfusion management of burn patients: a scoping review.
Álvarez MG, Rojas GR, Triana Sutachan MA … +1 more , Hernández Rincón EH
J Thromb Thrombolysis · 2026 Feb · PMID 40932631 · Full text
Severe burns cause complex hemostatic alterations that complicate transfusion management. Conventional coagulation tests (CCTs) have limitations in timely and accurately assessing these disorders. Viscoelastic tests (VET...
Severe burns cause complex hemostatic alterations that complicate transfusion management. Conventional coagulation tests (CCTs) have limitations in timely and accurately assessing these disorders. Viscoelastic tests (VETs), such as thromboelastography (TEG) and rotational thromboelastometry (ROTEM), allow for a dynamic and real-time evaluation of coagulation. A scoping review was conducted following the Arksey and O'Malley methodology and PRISMA-ScR guidelines. Studies from 2010 to 2025 in English or Spanish that evaluated the use of VETs in burn patients were included. Databases such as PubMed, Scopus, and ScienceDirect were analyzed. Eighteen studies were included, mostly narrative reviews and observational studies. ROTEM was the most reported test. VETs were mainly used at admission and intraoperatively. Evidence indicates that TEG and ROTEM outperform CCTs in sensitivity, specificity, and speed, allowing for reduced transfusions and detection of both hypocoagulability and hypercoagulability. VETs are promising tools for transfusion management in burn patients. Although their use is not yet standardized, they offer significant advantages over CCTs and promote more accurate clinical decisions. More studies are needed to support their systematic implementation.
The inhibitory effect of antiplatelet drugs on spontaneous platelet aggregation on glass surfaces: an analysis based on microscopic three-dimensional topography.
Wu Y, Ding L, Shen Y … +4 more , Gao X, Chen D, Huang X, Li Y
J Thromb Thrombolysis · 2026 Feb · PMID 40924280 · Publisher ↗
In vitro assessment of the inhibitory effect of antiplatelet drugs on platelet aggregation is frequently employed to guide personalized antiplatelet therapy in clinical practice. However, existing methods for detecting p...
In vitro assessment of the inhibitory effect of antiplatelet drugs on platelet aggregation is frequently employed to guide personalized antiplatelet therapy in clinical practice. However, existing methods for detecting platelet aggregation rely heavily on high concentrations of exogenous agonists, which may obscure part of the inhibitory effect of antiplatelet drugs and lead to an underestimation of their effects. This study validates a novel analytical strategy for evaluating the effects of antiplatelet drugs by quantifying the microscopic three-dimensional morphological parameters of platelet aggregates formed through spontaneous aggregation on a glass surface. Heparin-anticoagulated platelet-rich plasma (PRP) was applied to a glass surface to induce spontaneous platelet aggregation. The microscopic three-dimensional morphology of platelet aggregates was characterized using a laser three-dimensional microscopic imaging system, and platelet aggregation function was assessed based on the volume parameter (Vol) and cross-sectional area parameter (CS-area) of the aggregates. The results demonstrated that platelets could spontaneously aggregate on the glass surface under the participation of plasma proteins and Ca. Aspirin (80 μM) significantly reduced Vol but had no significant effect on CS-area. Ticagrelor, eptifibatide, and tirofiban dose-dependently decreased both Vol and CS-area. High concentrations of eptifibatide (4 μM) and tirofiban (4 μM) completely inhibited platelet adhesion and aggregation. The combination of aspirin (20 μM) and ticagrelor (0.5 μM) synergistically suppressed platelet aggregation behavior. GPIb-IX-von Willebrand factor (vWF) inhibitors (4 μM) and indomethacin (4 μM) significantly reduced both Vol and CS-area, with a smaller reduction in CS-area compared to Vol. In patients, aspirin alone significantly reduced Vol, while clopidogrel, aspirin combined with clopidogrel, and Xuesaitong significantly decreased both Vol and CS-area. Our novel analytical strategy is capable of distinguishing the pharmacological effects of various antiplatelet agents without the need for exogenous agonists, suggesting that this system may aid in the determination of the appropriate type and dose of the antiplatelet agent in the clinical setting.
Efficacy of sonothrombolysis as an adjunct to primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: a systematic review and meta-analysis.
Abo Zeid M, Gadelmawla AF, Khalefa K … +1 more , Shaban AY
J Thromb Thrombolysis · 2026 Feb · PMID 40924279 · Full text
In this review, we aimed to evaluate Sonothrombolysis when combined with primary percutaneous coronary intervention (pPCI) in STEMI patients with regard to improving cardiac function and clinical outcomes. This study pri...
In this review, we aimed to evaluate Sonothrombolysis when combined with primary percutaneous coronary intervention (pPCI) in STEMI patients with regard to improving cardiac function and clinical outcomes. This study primarily assesses short-term efficacy outcomes, while long-term impacts, such as mortality, were not evaluated. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched four electronic databases (PubMed, Scopus, Cochrane Library, and Web of Science) to identify eligible studies reported up to November 2024. Four studies, with a total population of 252 participants, were included. The sonothrombolysis group demonstrated an overall greater improvement in left ventricular ejection fraction compared to the control group (MD = 3.07, 95% CI [1.20 to 4.94], p = 0.001), with no heterogeneity (p = 0.44, I = 0%). When subgrouped according to the follow-up period, there was no significant difference between the two groups (MD = 2.56, 95% CI [-0.35 to 5.46]) after 2 to 6 months. Infarction size, microvascular obstruction, left ventricular end-diastolic volume, and left ventricular end-systolic volume showed no statistically significant difference between the two groups. Sonothrombolysis following pPCI is associated with better left ventricular ejection fraction, emphasizing the potential role of sonothrombolysis as an adjunctive therapy to pPCI in the management of STEMI.
A 10-year review of iliofemoral deep vein thrombosis - are they more dangerous than their distal counterparts?
Lui B, Wee B, Khattak Z … +5 more , Lai J, Kwok A, Donarelli C, Ho P, Lim HY
J Thromb Thrombolysis · 2026 Feb · PMID 40913667 · Full text
Iliofemoral deep vein thrombosis (IFDVT) is associated with potential for poor outcomes despite optimal anticoagulation therapy. To characterize the real-world management of IFDVT in an Australian population. Retrospecti...
Iliofemoral deep vein thrombosis (IFDVT) is associated with potential for poor outcomes despite optimal anticoagulation therapy. To characterize the real-world management of IFDVT in an Australian population. Retrospective evaluation of IFDVT cases managed at Northern Health, Australia from January 2011 to December 2020 was performed and compared to non-iliofemoral lower limb DVTs (non-IFDVT) (n = 1793). 375 IFDVT episodes (median age 69 years; 54.7% female (n = 205)) were diagnosed with median follow-up 56 months. 61.6% (n = 231) were provoked events, including 100 episodes (26.7%) of cancer-associated thrombosis. 24.8% (n = 93) of patients had concomitant pulmonary embolism. Eleven cases underwent endovascular intervention including all seven patients with May-Thurner syndrome. Non-cancer patients with IFDVT received longer duration of anticoagulation (8 vs. 6 months, p < 0.001) or indefinite anticoagulation (28.7% vs. 16.0%, p < 0.001) compared to those with non-IFDVTs. Venous thromboembolism (VTE) recurrence (2.3/100PY, HR 0.839, 95% CI 0.562-1.255, p = 0.390) and major bleeding (2.7/100PY, HR 1.679, 95% CI: 0.876-3.220, p = 0.119) were comparable but the 30-day all-cause mortality (5.1% vs. 1.2%, p < 0.001) including thrombosis-related deaths (1.8% vs. 0.4%, p = 0.004) was more common in the non-cancer IFDVTs. In cancer patients, VTE recurrence rate (4.3/100PY, p = 0.421) was similar but major bleeding (12.4/100PY, p = 0.043) and 30-day mortality (23.0%, p = 0.026) was higher compared to IFDVT patients without active cancer. While the VTE recurrence and major bleeding were comparable between patients with IFDVT and non-IFDVTs, 30-day mortality (including thrombosis-related death) was higher in patients with IFDVT, suggesting a higher risk cohort that warrants careful assessment particularly during the acute period post diagnosis.
Blood pressure in the first 6 hours for older adults with stroke after endovascular therapy: a pooled analysis of the DEVT and RESCUE BT randomized clinical trials.
Ma C, Li J, Zheng X … +11 more , Yang D, Zhang Q, Zhang C, Wang Y, Li X, Hu C, Tong G, Tao K, Hu J, Miao J, Wang W
J Thromb Thrombolysis · 2026 Feb · PMID 40908335 · Publisher ↗
Optimal systolic blood pressure (SBP) targets after endovascular therapy (EVT) for stroke in older adults (≥ 65 years) remain undefined. This study assessed age-stratified associations between early post-EVT SBP (first 6...
Optimal systolic blood pressure (SBP) targets after endovascular therapy (EVT) for stroke in older adults (≥ 65 years) remain undefined. This study assessed age-stratified associations between early post-EVT SBP (first 6 h) and outcomes. Post hoc analysis of two trials. Patients were stratified by age (18-64 vs. ≥ 65 years) and SBP (≤ 120, 120-140, > 140 mmHg). Primary outcome was 90-day functional status (modified Rankin Scale, mRS). Inverse probability treatment weighting (IPTW) and multivariable regression adjusted for confounders. Post-EVT SBP data were available for 267 young and 395 old patients. IPTW analysis revealed that sustained SBP below 120 mmHg during the first 6 h post-EVT significantly enhanced functional independence in elderly patients (common OR: 2.00; 95% CI: 1.18-3.39). Among young cohorts, maintenance of SBP ≤ 120 mmHg (cOR, 2.89; 95% CI, 1.45-5.82) and 120-140 mmHg (cOR, 3.18; 95% CI, 1.58-6.47) were associated with a better outcome. sICH incidence demonstrated no statistically significant association with systolic blood pressure (SBP) levels (P = 0.21; 95% CI: 0.93-1.35). During the initial 6-h window post-EVT, younger patients with SBP ≤ 140 mmHg and elderly patients with SBP ≤ 120 mmHg were associated with favorable outcome. These results suggest that stricter blood pressure control may be particularly beneficial for older adults in the early post-EVT phase.Trial Registration: The DEVT registration: URL: http://www.chictr.org.cn ; Chinese Clinical Trial Registry: ChiCTR-IOR-17013568, and the RESCUE BT registration: URL: http://www.chictr.org.cn ; ChiCTR-INR-17014167.
Effect of half-dose thrombolysis on hypoxemia duration in intermediate risk pulmonary embolism.
Moini C, Monchi M, Ramamourthy U … +4 more , Awede R, Cabot B, Hraiech K, Jochmans S
J Thromb Thrombolysis · 2026 Jan · PMID 40905994 · Publisher ↗
In intermediate high-risk pulmonary embolism (PE), the role of thrombolysis remains debated with a disagreement between European and American guidelines. Expected benefits are counterbalanced by increased hemorrhagic eve...
In intermediate high-risk pulmonary embolism (PE), the role of thrombolysis remains debated with a disagreement between European and American guidelines. Expected benefits are counterbalanced by increased hemorrhagic events with full-dose fibrinolysis. In these patients, half-dose thrombolysis may have similar effects with less complications. We have hypothesized that half-dose thrombolysis compared to anticoagulation alone may reduce hypoxemia duration and hospital length of stay. We have performed a 6 years' retrospective study in 2 Emergency Departments of French hospitals. One practiced fibrinolysis in intermediate risk PE (tPA 50 mg/2 h) and the other did not. We used logistic regression and propensity score matching to assess the effect of a thrombolysis strategy. 473 patients had a diagnosis of acute PE during the study period. 110 (23%) patients with intermediate risk PE met the inclusion criteria. After propensity score matching, 30 patients with thrombolysis therapy were compared to 30 control patients. The duration of oxygen therapy was shorter in the thrombolysis group (3 days, interquartile range 2 to 4) than in the control group (8 days, interquartile range 3 to 11; p = 0.0003). There was no significant difference between groups regarding pulmonary, cardiac, and hemorrhagic complications. The rates of treatment failure, defined by death or persistent hypotension requiring vasopressors, were not significantly different between the 2 groups (2% vs. 6%). Compared to anticoagulation alone, half-dose thrombolysis in intermediate risk PE is associated with a significantly shorter duration of hypoxemia.
Atopic dermatitis, venous thromboembolism and cancer: a cohort analysis.
Sørensen SBT, Fuglsang CH, Horváth-Puhó E
J Thromb Thrombolysis · 2025 Dec · PMID 40905993 · Full text
Atopic dermatitis is a risk factor for venous thromboembolism which may be the first manifestation of occult cancer. We examined whether a venous thromboembolism in patients with atopic dermatitis is a marker of occult c...
Atopic dermatitis is a risk factor for venous thromboembolism which may be the first manifestation of occult cancer. We examined whether a venous thromboembolism in patients with atopic dermatitis is a marker of occult cancer. We used Danish health registries to conduct this population-based cohort study. Patients with a first-time diagnosis of venous thromboembolism and a history of atopic dermatitis were identified from the Danish National Patients Registry from 1980 through 2022. We calculated the absolute risk of cancer treating death as a competing event. As a measure of relative risk, we calculated standardized incidence ratios (SIRs) for cancer among patients with venous thromboembolism and atopic dermatitis and compared the observed cancer incidence to that of the general Danish population. We identified 582 patients with a first venous thromboembolism diagnosis and a history of atopic dermatitis. During the first year of follow-up, the absolute risk of overall cancer was 1.7%, corresponding to an SIR of 2.90 (95% confidence interval [CI] 1.39-5.34). The overall SIR decreased to 1.12 (95% CI 0.74-1.62) during the subsequent years of follow-up. Although the risk estimates were imprecise, an elevated cancer risk following venous thromboembolism in patients with atopic dermatitis cannot be ruled out, particularly within the first year after venous thromboembolism, when compared to the cancer risk in the general population.
Physical activity before venous thromboembolism and risk of recurrence in a population-based inception cohort.
Frauenheim AC, Wiggins KL, Lemaitre RN … +2 more , Smith NL, Harrington LB
J Thromb Thrombolysis · 2026 Jan · PMID 40905992 · Full text
INTRODUCTION: The association between moderate-to-vigorous physical activity (MVPA) and recurrent venous thromboembolism (VTE) is unclear, but an improved understanding could inform behavioral health recommendations. MET...
INTRODUCTION: The association between moderate-to-vigorous physical activity (MVPA) and recurrent venous thromboembolism (VTE) is unclear, but an improved understanding could inform behavioral health recommendations. METHODS: The Heart and Vascular Health study, set in a large integrated healthcare system, identified adults with a validated incident VTE between January 2002 and December 2010. An inception cohort was formed from these cases and followed for a first recurrent VTE through December 2014. Usual MVPA pre-incident VTE was self-reported by 1381 adults via telephone interview, and MVPA amount was calculated in metabolic equivalent of task (MET) hours (h) per week. Multivariable-adjusted Cox proportional hazards models estimated adjusted hazard ratios (HR) for any MVPA versus none and MVPA amount, continuously and in quartiles, in MET-h/week among participants reporting any MVPA. Secondary analyses separately evaluated MET-h/week, by intensity. RESULTS: During follow-up (median = 5.23 years), 288 (20.9%) individuals developed a recurrent VTE. There was no evidence of an association between any MVPA versus none and VTE recurrence (HR=1.24, [95% confidence interval [CI]: 0.80, 1.91]). Among participants with any MVPA, there was no evidence of an association between MVPA in MET-h/week (HR per 7.5 MET-h/week = 1.00, [95% CI: 0.98, 1.03]), nor quartiles of MVPA (p-trend = 0.62) with VTE recurrence risk. In secondary analyses there was no evidence of an association of MET-h/week of moderate or vigorous physical activity (PA) with VTE recurrence. CONCLUSIONS: In this cohort of adults who experienced incident VTE, there was no evidence of an association between self-reported MVPA pre-incident VTE and VTE recurrence risk.
Missense and nonsense mutations and inhibitor development in patients with hemophilia A and B.
Karimi F, Saki N, Khademi R … +2 more , Kaydani GA, Keikhaei B
J Thromb Thrombolysis · 2026 Jan · PMID 40879869 · Publisher ↗
Hemophilia A and B are X-linked bleeding disorders caused by mutations in the F8 and F9 genes, resulting in deficiencies of coagulation factors VIII (FVIII) and IX (FIX), respectively. A major complication of replacement...
Hemophilia A and B are X-linked bleeding disorders caused by mutations in the F8 and F9 genes, resulting in deficiencies of coagulation factors VIII (FVIII) and IX (FIX), respectively. A major complication of replacement therapy is the development of neutralizing antibodies (inhibitors), which occur in approximately 30% of patients with severe hemophilia A and about 3% of those with hemophilia B. The role of missense and nonsense mutations in inhibitor formation has been increasingly recognized. In hemophilia A, missense mutations within immunogenic domains may alter FVIII structure, eliciting immune responses. Nonsense mutations especially those located in the light chain are associated with higher inhibitor risk due to the production of truncated, non-functional proteins. In hemophilia B, missense mutations rarely result in inhibitor development, whereas nonsense mutations and large deletions carry a significantly higher risk. Molecular genotyping contributes to predicting inhibitor formation and supports individualized treatment planning.
Association of left atrial strain and fibrin clot properties in patients with heart failure and severe mitral regurgitation undergoing transcatheter edge-to-edge repair.
Woźniak A, Gackowski A, Golińska-Grzybała K … +5 more , Szlósarczyk B, Trębacz J, Nessler J, Gajos G, Siniarski A
J Thromb Thrombolysis · 2026 Feb · PMID 40879868 · Full text
The link between heart failure (HF) and increased prothrombotic risk has gathered attention, with several studies exploring this association. Patients with HF and severe mitral regurgitation (MR) undergoing transcatheter...
The link between heart failure (HF) and increased prothrombotic risk has gathered attention, with several studies exploring this association. Patients with HF and severe mitral regurgitation (MR) undergoing transcatheter edge-to-edge repair (TEER) may present enhanced left atrial (LA) function and improve thrombosis-related factors due to the procedure. This study investigates the role of left atrial strain (LAS), assessed via speckle-tracking echocardiography, in detecting subtle LA abnormalities and its potential link to thrombotic risk in severe MR patients. 31 consecutive patients with severe MR who underwent TEER were enrolled. Six patients were lost to follow-up, and 25 completed both visits (V1 and V2). Coagulation parameters (thrombin generation, clot permeation [Ks], clot lysis time [CLT]) and echocardiographic assessments were performed at each visit. Subgroup analysis was also done for patients with sinus rhythm and atrial fibrillation. A significant correlation was found between LAS-r and changes in CLT (p = 0.03; R = -0.43) before and after TEER. LAS-cd decreased, and LAS-ct increased. No significant differences were noted in coagulation parameters. Patients with sinus rhythm also showed a significant correlation with CLT changes. This study demonstrates significant changes in LAS after TEER, with reduced LAS-cd and increased LAS-ct, which highlights a potential link between cardiac mechanics and clotting properties, with distinct differences between patients with sinus rhythm and atrial fibrillation. These findings provide insights into cardiac and thrombotic changes post-TEER, requiring further investigation.
Efficacy and safety of reduced-dose versus full-dose DOACs in extended treatment of VTE: A systematic review and meta-analysis.
Bilal AR, Umar SA, Arfin SMW … +6 more , Bilal AR, Sajid M, Gaba H, Qureshi S, Inam MH, Waqas SA
J Thromb Thrombolysis · 2026 Jan · PMID 40879867 · Publisher ↗
Extended anticoagulation is recommended for venous thromboembolism (VTE) patients at high recurrence risk. However, the optimal long-term dosing strategy for direct oral anticoagulants (DOACs) remains uncertain. This met...
Extended anticoagulation is recommended for venous thromboembolism (VTE) patients at high recurrence risk. However, the optimal long-term dosing strategy for direct oral anticoagulants (DOACs) remains uncertain. This meta-analysis compares the efficacy and safety of reduced-dose versus full-dose DOACs during extended-phase VTE treatment. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing reduced-dose (apixaban 2.5 mg BID or rivaroxaban 10 mg QD) and full-dose (apixaban 5 mg BID or rivaroxaban 20 mg QD) DOACs. Searches were performed in PubMed, Cochrane CENTRAL, Embase and Scopus till June 10, 2025. Outcomes included recurrent VTE, major bleeding, clinically relevant non-major bleeding (CRNMB), and all-cause mortality. Risk ratios (RRs) were pooled using random-effects models. Five RCTs comprising 8,781 patients were analyzed. Reduced-dose DOACs significantly lowered major bleeding risk (RR: 0.62; 95% CI: 0.42-0.92; p = 0.02; I² = 12%) and CRNMB (RR: 0.75; 95% CI: 0.63-0.88; p = 0.0006; I² = 0%) compared to full-dose DOACs. No significant differences were observed between the groups in recurrent VTE (RR: 0.94; 95% CI: 0.68-1.29; p = 0.70; I² = 0%) or all-cause mortality (RR: 0.86; 95% CI: 0.63-1.17; p = 0.35; I² = 42%). No significant differences across outcomes were observed between cancer-associated and general VTE populations. Reduced-dose DOACs significantly lower bleeding risk without compromising efficacy in preventing recurrent VTE. These findings support the preferential use of reduced-dose DOACs as a safer and effective option for extended anticoagulation, especially in patients at elevated bleeding risk.
Practical considerations about management of pulmonary embolism in patients with cancer.
Bianchi L, Ghigliotti G, Sarocchi M … +4 more , Canale C, Toma M, Porto I, Spallarossa P
J Thromb Thrombolysis · 2026 Jan · PMID 40879866 · Publisher ↗
Venous thromboembolism in cancer patients constitutes a complex and clinically significant disease due to its pathophysiology, morbidity and mortality. Pulmonary embolism is a potentially life-threatening disease, and th...
Venous thromboembolism in cancer patients constitutes a complex and clinically significant disease due to its pathophysiology, morbidity and mortality. Pulmonary embolism is a potentially life-threatening disease, and therefore it represents the second leading cause of death among cancer patients, surpassed only by cancer itself. In recent years, direct-acting oral anticoagulants have emerged as the preferred option for the treatment of cancer-related venous thromboembolism, although low-molecular weight heparins are still specifically recommended for patients with high bleeding risk. The management of anticoagulant therapy beyond the first 6 months following pulmonary embolism remains a challenging scenario, requiring careful evaluation of the balance between benefits and risks. Anti-thrombotic prophylaxis is not routinely recommended in the outpatient setting, although emerging data suggest validated risk tools could help identify high-risk populations who might benefit. This review summarizes available clinical trial data, meta-analyses, real-world studies, both national and international guidelines providing a practical approach to the management of pulmonary embolism in patients with cancer.
Genetic mutations associated with congenital fibrinogen disorders: global distribution and clinical outcomes.
Nóbrega T, Villaça P, Okazaki E … +5 more , Rothschild C, Stefanello B, Rocha T, Rocha V, A Orsi F
J Thromb Thrombolysis · 2026 Jan · PMID 40879865 · Publisher ↗
Congenital fibrinogen disorders (CFD) are characterized by heterogeneous manifestations, from asymptomatic to severe bleeding or thrombosis, associated with genetic mutations in FGA, FGB, or FGG genes. As a result, diagn...
Congenital fibrinogen disorders (CFD) are characterized by heterogeneous manifestations, from asymptomatic to severe bleeding or thrombosis, associated with genetic mutations in FGA, FGB, or FGG genes. As a result, diagnosis is challenging, particularly in low- and middle-income countries, where evidence is scarce. The aim of this review is to describe the distribution of CFD-associated genetic mutations across different regions of the world and their corresponding phenotypes. Data from MEDLINE and the French Group for the Study of Hemostasis and Thrombosis databases were qualitatively organized based on the United Nations regional classification. A total of 132 studies on CFD were selected from MEDLINE and GFHT fibrinogen database, comprising over 1000 mutations descriptions and approximately 340 unique mutations. FGA mutations are most associated with dys- or afibrinogenemia, while FGB mutations are associated with hypo- or afibrinogenemia and FGG with dys- or hypofibrinogenemia Across countries, the most common mutations in afibrinogenemia and hypofibrinogenemia were intronic variant sequence in FGA, p. Arg47stop in FGB, and mutations in exon 8 of FGG. Dysfibrinogenemia was associated with mutations in exon 2 of FGA, typically resulting in asymptomatic individuals and with mutations in exon 8 of FGG, which are associated with thrombosis. The majority of mutations related to CFD and their associated phenotypes have been reported in Western Europe, North America and East Asia. Evidence from Latin America, Southeast Asia, and Africa remains limited, with Brazil having only one study that evaluated CFD mutations. Data on CFD phenotypes and associated genetic mutations from low and middle income countries are necessary to ensure equity in the management of these rare diseases.t.
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