Clinical and Applied Thrombosis/Hemostasis最新文献

Introduction: Persistent elevation of biomarkers associated with endothelial dysfunction in convalescent COVID-19 patients has been linked to an increased risk of long-term cardiovascular complications, including long COVID syndrome. Sulodexide, known for its vascular endothelial affinity, has demonstrated pleiotropic protective properties. This study aims to evaluate the impact of sulodexide on serum levels of endothelial dysfunction biomarkers in patients during the convalescent phase of COVID-19.

Methods: We conducted a double-blind, single-center, randomized, placebo-controlled trial in Mexico, comparing sulodexide (250 LRU orally, twice daily) with placebo over 8 weeks in adult patients during early COVID-19 convalescence. Differences in serum biomarkers between the groups were analyzed using repeated measures and post hoc tests, with Thrombomodulin (TM) as the primary endpoint.

Results: Among 206 analyzed patients (103 in each group), at week 8, the sulodexide group exhibited significantly lower mean levels of Thrombomodulin (TM) (25.2 ± 7.9 ng/mL vs 29.9 ± 14.7 ng/mL, P = .03), von Willebrand Factor (vWF) (232 ± 131 U/dL vs 266 ± 122 U/dL, P = .02) and Interleukin-6 (IL-6) (12.5 ± 13.2 pg/mL vs 16.2 ± 16.5 pg/mL, P = .03) compared to the placebo group. D-dimer and C reactive protein (CRP) in the sulodexide group were also lowered. No significant differences were observed for P-selectin, fibrinogen, VCAM-1, or ICAM-1 levels.

Conclusions: Patients in the convalescent phase of COVID-19 who received sulodexide for eight weeks showed a reduction in TM, vWF, D-dimer, CRP, and IL-6 serum levels compared to placebo. These findings suggest a potential protective effect of sulodexide against thromboinflammation and endothelial damage.

Introduction: Preoperative patients with knee osteoarthritis have a significantly increased risk of venous thromboembolism (VTE). While the Caprini risk assessment model offers some clinical guidance in predicting deep vein thrombosis (DVT), it has a relatively low predictive accuracy. Enhancing the model by integrating biomarkers, such as D-dimers, can potentially improve its accuracy. In this study, we explored the effectiveness of combining the Caprini risk model with D-dimer levels for individualized DVT risk assessment in patients with knee osteoarthritis.

Materials and methods: This retrospective cohort study included 1605 knee osteoarthritis patients scheduled for total knee arthroplasty from Peking Union Medical College Hospital, screened between January 2015 and December 2018. A revised Caprini risk stratification model was developed, and a predictive DVT model was developed based on this revised system. The sensitivity, specificity, and the area under the curve (AUC) were used to determine predictive effectiveness of the model.

Results: In the revised Caprini risk stratification, the incidence of DVT increased with higher risk levels: 2.52% in the low-risk group (scores 0-2), 2.88% in the moderate-risk group (score 3), 6.47% in the high-risk group (score 4), and 9.09% in the highest-risk group (score ≥ 5). The incidence of DVT was 3.869-fold higher in the highest-risk group and 2.676-fold higher in the high-risk group compared to the low-risk group (p = 0.013 and p = 0.014, respectively). Combining the revised Caprini risk stratification with D-dimer level demonstrated an improved AUC of 0.792, compared to D-dimer level alone (AUC 0.774) and the revised Caprini model alone (AUC 0.598). Furthermore, applying specific D-dimer thresholds across the four Caprini risk stratifications outperformed the combination of the revised Caprini model and D-dimer level in terms of AUC, specificity, and reduction in unnecessary ultrasonography. Using the Youden index, the AUC for the threshold-based method was slightly higher (0.775 vs 0.754, p = 0.310), with significantly better specificity (76.8% vs 63.6%, p < 0.001) and a greater reduction in ultrasound use (74.1% vs 61.4%). At a sensitivity of 85.5%, the differences were modest but still favored the threshold-based approach. At a sensitivity of 100%, the specificity (36.0% vs 24.7%, p < 0.001) and ultrasound reduction (34.8% vs 23.9%) were significantly better.

Conclusion: The revised Caprini risk stratification improves preoperative DVT prediction in patients with knee osteoarthritis. Incorporating specific D-dimer thresholds into the four-level Caprini risk model enhances specificity and reduces unnecessary ultrasonography, outperforming both the use of individual indicators and the combination of the revised Caprini model with D-dimer level.

Purpose: The purpose of this study was to investigate the clinical characteristics and risk factors for patients with lung cancer complicated by pulmonary embolism and to provide a reference for the early clinical identification of these patients.

Methods: Eighty patients with lung cancer complicated with pulmonary embolism who were treated at Bethune Hospital of Shanxi from October 2018 to October 2025 were compared with 80 patients with lung cancer without pulmonary embolism. The clinical data of the two groups of patients were collected and analysed.

Results: Compared with that in patients in the LC group, the proportion of patients with pulmonary interstitial fibrosis in the LP group was significantly greater (p < 0.05). The incidence of dyspnoea in the LP group was significantly greater than that in the LC group (p < 0.05). Compared with that in the LC group, the proportion of pulmonary artery compression in the LP group was significantly greater, and the difference was statistically significant (p < 0.05). In terms of pathological type, the proportion of adenocarcinoma patients in the LP group was significantly greater than that in the LC group (p < 0.05). In terms of tumor stage, the proportion of patients with stage III/IV disease in the LP group was significantly greater than that in the LC group, while the proportion of patients with stage I/II disease was significantly lower than that in the LC group, and the difference was statistically significant (p < 0.05). The neutrophil [NEUT (%)], prothrombin time (PT), white blood cell (WBC), carcinoma embryonic antigen (CEA) and D-dimer (DD) levels were significantly greater in the LP group than in the LC group (p < 0.05). In terms of treatment, the proportion of patients receiving systemic chemotherapy in the LP group was significantly greater than that in the LC group (p < 0.05). Logistic regression analysis revealed that adenocarcinoma, systemic chemotherapy and tumor stage III-IV were independent risk factors for lung cancer complicated with pulmonary embolism.

Conclusion: (1) Tumor stage (III/IV), systemic chemotherapy, and adenocarcinoma were independent risk factors for pulmonary thromboembolism in patients with lung cancer. (2) In addition, patients with LP were more likely to have pulmonary interstitial fibrosis, dyspnoea, compression of the pulmonary artery by the tumor location, biological targeted therapy, and abnormal increases in D-dimer, WBC, NEUT (%), CEA and PT levels as laboratory indicators. (3) Pulmonary thromboembolism should be considered in lung cancer patients with a combination of the factors described above.

Background: Carotid artery stenosis (CAS) may cause many cerebrovascular diseases, and a biomarker for screening and monitoring is needed. This study focused on the clinical significance of long-chain non-coding RNA (lncRNA) non-coding RNA activated by DNA damage (NORAD) in patients with CAS and aimed to search for potential biomarkers of CAS.

Methods: Eighty-six asymptomatic patients with CAS and 60 healthy individuals were enrolled, with corresponding clinical data and serum samples collected. The expression of NORAD was detected by reverse transcription-quantitive PCR (RT-qPCR). All patients were followed up for 2 years to collected the occurrence data of cerebrovascular events, and Kaplan-Meier and Cox regression were used for data analysis. Receiver operator characteristic curve was used to analyze the diagnostic value of NORAD in distinguishing CAS patients from healthy people, and to evaluate the prediction accuracy of NORAD.

Results: NORAD is overexpressed in the serum of CAS patients, and associated with patients' hypertension, TC, LDL-C levels and stenosis degree. NORAD has high sensitivity (88.37%) and specificity (80.00%) in the identification of CAS patients (AUC = 0.917). NORAD was independently related to the occurrence of cerebrovascular events (HR = 2.435, P = .003). a logistic regression risk model for predicting cerebrovascular events was constructed with the parameters including NORAD, TC and LDL.

Conclusion: NORAD can be used as a diagnostic and prognostic biomarker for CAS, and NORAD, total cholesterol (TC), and low density lipoprotein cholesterol (LDL-C) can be independently correlated to predict cerebrovascular events.

Objectives: To explore the risk factors for thrombi occurring in patients with immune thrombocytopenia (ITP) and establish a risk prediction model to better predict the risk of thrombosis in patients with ITP.

Methods: We retrospectively analyzed 350 ITP patients who had been hospitalized in the First People's Hospital of Yunnan Province between January 2024 and June 2024. For all patients, we recorded demographic characteristics and clinical data, analyzed the risk factors for thrombosis in ITP patients and then developed a risk prediction model.

Results: Stepwise logistic regression analysis indicated that a high D-dimer level, a low PC (platelet count) and a high Padua score were independent risk factors for thrombosis in ITP patients. According to multivariate analysis, a predictive model for thrombus risk showed that the area; the area under the ROC curve (AUC) was 0.673 (95% CI: 0.615-0.730) and the maximum Youden index, sensitivity and specificity were 0.272, 47.0% and 80.2%, respectively.

Conclusion: A high D-dimer level, low PC, and high Padua score were shown to be independent risk factors for thrombosis in ITP patients. Also, the study showed that these three risk factors might be used as a risk predictors for thrombosis in ITP patients to some extent.

Percutaneous valve implantation or surgical replacement with mechanical or biological valves are standard therapies for severe valvular heart diseases. Prosthetic valve thrombosis, though rare, is a serious complication, particularly with mechanical prostheses. This study aimed to investigate the predictive value of platelet volume parameters, including mean platelet volume (MPV), platelet distribution width (PDW), and platelet-large cell ratio (P-LCR), for valvular thrombosis risk in patients undergoing valve replacement therapy. A retrospective cross-sectional study was conducted from May 2002 to May 2020, involving 108 patients with a history of mitral or aortic valve replacement and valvular thrombosis, and 216 controls with a history of valve surgery without valvular malfunction. PDW was significantly associated with an increased risk of thrombosis after adjusting for confounders, while MPV showed a clinical difference but did not reach statistical significance. P-LCR did not exhibit a significant association. These findings suggest PDW as a potential predictor of valvular thrombosis in such patients. The ease of measuring platelet volume parameters suggests their utility in routine hematological analysis for identifying patients at higher risk of valvular thrombosis post-replacement surgery. Further studies are warranted to validate these findings and explore additional laboratory markers, such inflammatory markers, for thrombotic risk assessment in this population.

Background: Venous thromboembolism (VTE) comprises deep vein thrombosis (DVT) and pulmonary embolism (PE). Chronic thromboembolic pulmonary hypertension (CTEPH) typically arises from acute pulmonary embolism. The pathogenesis of them involves multiple risk factors such as genetic predisposition. However, the findings from these studies are not entirely consistent. This study aims to investigate the association between FGA rs6050 polymorphism and susceptibility to thrombotic diseases.

Methods: We searched PubMed, OVID, Web of Science, Academic Search Ultimate, CNKI, and Wan Fang database. To assess the strength of associations, we calculated pooled odds ratios (ORs) and 95% confidence intervals (CIs) in different genetic models. Additionally, subgroup analyses, sensitivity analysis, and assessment of publication bias were also carried out.

Results: A total of 11 studies, including 9 reported results on VTE (3856 individuals [1545 cases]) and 3 on CTEPH (761 participants [350 cases]), revealed a significant association between the rs6050 polymorphism and susceptibility to both VTE and CTEPH. The A allele was consistently linked to an elevated risk of VTE across all genetic models (allele, homozygote, heterozygote, recessive, and dominant model), while it was also associated with an increased risk of CTEPH under all genetic models excluding the recessive model. Furthermore, subgroup analysis among ethnic groups revealed a significant association between rs6050 polymorphisms and VTE in both Caucasians and Asians under all genetic models. In Africans, the association with VTE was only observed for rs6050 polymorphisms in dominant and heterozygous models.

Conclusions: The FGA rs6050 polymorphism is positively associated with susceptibility to VTE and CTEPH.

Hematologic diseases are considered important contributors to cerebral venous sinus thrombosis (CVST) cases. This retrospective study aims to compare the difference of the clinical and radiological characters between CVST patients with and without hematologic diseases. Consecutive hospitalized CVST patients with hematologic disorders constituted the hematologic disorder group, while that without identifiable risk factors comprised the control group in this study. We systematically documented the various types of hematologic diseases associated with CVST, along with laboratory tests. Clinical manifestations, imaging findings, as well as treatment and prognosis, were recorded. A comparative analysis was conducted between the hematologic disorder group and the control group based on the aforementioned parameters. The final analysis included 97 CVST cases associated with hematologic diseases and 65 cases without any identified risk factors. The spectrum of hematologic diseases in our study ranged from iron-deficiency anemia to acute leukemia. Patients with hematologic disorder showed higher admission mRS, greater thrombotic burden, and higher incidence of stroke and cerebral hemorrhage (p < 0.05). The use of batroxobin significantly improved the prognosis of CVST caused by hematologic diseases, without causing major bleeding or death during the follow-up period. Patients with hematologic disorders who develop CVST tend to present with more severe conditions compared to those without identifiable risk factors. It is essential to conduct timely screening for CVST in patients with hematologic diseases who present with risk factors of thrombosis.

Background: Deep vein thrombosis (DVT) is a leading cause of death disability. DVT can be classified based on the location and extent of the clot into isolated distal DVT (iDDVT), isolated proximal DVT (iPDVT), or mixed DVT. The aim of this study is to explore the baseline characteristics and clinical outcomes of patients with different types of DVT. Methods: This was a retrospective study of patients who experienced their first DVT event and received an anticoagulant for management. The outcomes of this study include evaluating patients' characteristics for patients with DVT and assessing the incidence of recurrent DVT, major bleeding (MB), VTE-related rehospitalization, and DVT-related inpatient mortality across different types of DVT. Results: A total of 493 patients were included in the study. Of those, 273 (55.4%) had iPDVT, 25 (5.1%) had iDDVT, and 195 (39.6%) had mixed DVT. The VTE etiology was similar across the groups except for the leg injury, which was significantly higher in patients with iDDVT (24%) compared to iPDVT (6.2%) and mixed DVT (5.6%) (P = .002). At 12 months, a total of 49 patients (9.9%) had a recurrent DVT event; 25 (9.2%) in the iPDVT group, 3 (12.0%) in the iDDVT group, and 21 (10.8%) in the mixed DVT group (P = .797). Rates of MB, re-hospitalization, and death from DVT were similar between the groups. Conclusion: Baseline characteristics were not significantly linked to the risk of developing a specific type of lower extremity DVT. Long-term outcomes were similar across all DVT types.