Clinical and Applied Thrombosis/Hemostasis最新文献

BackgroundIntravenous thrombolytics are essential for achieving timely reperfusion in acute ischemic stroke (AIS), with alteplase historically serving as the standard of care. Emerging alternatives like recombinant human prourokinase (rhPro-UK), reteplase, and tenecteplase offer potential improvements in efficacy, safety, and convenience, necessitating a comparative analysis.MethodsElectronic databases, including PubMed, ScienceDirect, and Cochrane Central, were comprehensively searched from inception till December 2024 for relevant studies. A frequentist network meta-analysis was performed using R software version 4.2.3, and the "netmeta" package was employed. Alteplase 0.9 mg served as the reference group, with P-scores employed to determine the relative rankings of various interventions. The risk of publication bias was evaluated through funnel plots and Egger's regression test.ResultsEighteen trials with 12,950 participants were included in the final analysis. Compared to alteplase 0.9 mg, excellent functional outcome (mRS 0-1) was significantly improved by Reteplase 18 + 18 mg (RR = 1.13, p < 0.01) and Tenecteplase (TNK) 0.25 mg (RR = 1.05, p < 0.01). For a good functional outcome (mRS 0-2), Reteplase 18 + 18 mg (RR = 1.06, p < 0.01) and TNK 0.32 mg (RR = 1.30, p < 0.01) were significantly more effective than alteplase. Safety outcomes, symptomatic intracranial hemorrhage (sICH), and mortality were not significantly different between alteplase and other thrombolytics. According to P-scores, Reteplase 18 + 18 mg ranked the best for excellent functional outcome (P-score = 0.89) and TNK 0.32 mg for good functional outcome (P-score = 0.99), while rhPro-UK 35 mg ranked the best for sICH (P-score = 0.89).ConclusionReteplase 18 + 18 mg and TNK 0.32 mg demonstrated superior functional outcomes compared to alteplase, while rhPro-UK 35 mg showed the best safety profile with the lowest sICH risk.

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.

BackgroundTo investigate the relationship between heart failure (HF) and the non-resolution of atrial thrombus detected in anticoagulated patients with non-valvular atrial fibrillation (NVAF).MethodsThis was a single-center, observational, retrospective, and prospective study. Anticoagulated patients with NVAF and atrial thrombus identified by transesophageal echocardiography or cardiac computed tomography angiography were consecutively enrolled. All patients received follow-up imaging within 6 months to assess the resolution of atrial thrombus. The primary endpoint was the resolution of atrial thrombus and the secondary endpoint was the occurrence of ischemic stroke, major bleeding, and all-cause death during the follow-up period.ResultsAmong 8987 patients with NVAF scheduled for catheter ablation or cardioversion, 70 anticoagulated patients with atrial thrombus were final analyzed. The average age was 61.8±10.6 years, 62.9% of them were men, and 32 (45.7%) patients presented with HF. Within the 6-month follow-up period, atrial thrombus resolution was observed in 47 (67.1%) patients. The rate of atrial thrombus resolution was lower in patients with baseline HF (50.0% vs 81.6%). In the adjusted logistic regression analysis model, HF was independently associated with the non-resolution of atrial thrombus (adjusted OR: 5.38, 95% CI: 1.19-24.27). During the median follow-up period of 4.5 years, four ischemic stroke events occurred in four patients. None of the patients in this study experienced major bleeding events or death during follow-up.ConclusionsHF was associated with the non-resolution of atrial thrombus detected in anticoagulated patients with NVAF. Further research is needed to identify optimal therapeutic approaches for this high-risk population.

Cardiomyopathies are commonly believed to have genetic origins; however, the connection between cardiomyopathies and cardiovascular diseases remains uncertain. Thus, we employed a Mendelian randomization (MR) approach to investigate the potential causal effects of specific cardiovascular disease subtypes on dilated and hypertrophic cardiomyopathies, focusing primarily on a European population. Summary-level data for cardiomyopathies and other cardiovascular diseases were obtained from public genome-wide association studies. Random-effects inverse-variance weighting was used as the primary analysis, whereas sensitivity analyses, including weighted median, MR-Egger, and multivariable MR methods, were also conducted. A genetic predisposition to atrial fibrillation [odds ratio (OR): 1.33; 95% confidence interval (CI): 1.18-1.50; P < 0.001], heart failure (OR: 3.22; 95% CI: 1.92-5.41; P < 0.001), and hypertension (OR: 1.50; 95% CI: 1.25-1.81; P < 0.001) were causally linked to an increased risk of developing dilated cardiomyopathy. However, there was no direct causal connection between genetically predicted coronary heart disease, pulmonary embolism, or ischemic stroke and the risk of developing dilated cardiomyopathy. In contrast, no significant associations were found between genetically predicted CVD subtypes and the risk of developing hypertrophic cardiomyopathy. Genetically predicted heart failure is significantly associated with the risk of developing dilated cardiomyopathy, underscoring the importance of effective heart failure management for risk prevention. Moreover, individuals with hypertension and atrial fibrillation might have an increased predisposition to dilated cardiomyopathy, highlighting crucial implications for management.

Clot waveform analysis (CWA) involves an analysis of the activated partial thromboplastin time (CWA-APTT), diluted prothrombin time (CWA-dPT), and small amount of thrombin time (CWA-sTT), and clot fibrinolysis waveform analysis (CFWA). CWA was evaluated in order to propose its clinical application. CWA exhibits an abnormal waveform, as well as peak times and heights in its derivative curves. Although the CWA-APTT is frequently examined and is useful for diagnosing clotting deficiency, it has several limitations. Therefore, modified CWAs have been proposed for clinical application. CWA-dPT (small amount of tissue factor-induced FIX activation; sTF/FIXa) can detect hypercoagulability. CWA-sTT reflects thrombin burst and evaluates hemostatic abnormalities in patients treated with emicizumab. CFWA is a variant of CWA-APTT that includes a small amount of tissue-type plasminogen activator, indicating both clotting and fibrinolysis. The CWA-APTT and modified CWA should be further investigated in various diseases for many applications in the clinical setting, including the monitoring of hemophilia patients and patients receiving anticoagulant therapy, and the differential diagnosis of diseases.

BackgroundAtrial fibrillation (AF) is a leading cause of stroke, necessitating effective anticoagulation. While direct oral anticoagulants (DOACs) have improved stroke prevention, bleeding risks remain a concern. Factor XI/XIa inhibitors, targeting the intrinsic coagulation pathway, offer potential for reduced bleeding, although questions remain regarding their efficacy. This systematic review evaluates the efficacy and safety of Factor XI/XIa inhibitors compared to DOACs in AF patients.MethodsWe conducted a systematic review of randomized controlled trials (RCTs) comparing Factor XI/XIa inhibitors with DOACs in AF patients, identified through PubMed and Embase up to January 2025. Data were synthesized narratively due to heterogeneity in study designs and outcomes.ResultsThree RCTs (AZALEA-TIMI 71, OCEANIC-AF, PACIFIC-AF) involving 16 852 patients were included. Factor XI/XIa inhibitors (abelacimab and asundexian) demonstrated significant reductions in bleeding compared to DOACs. In AZALEA-TIMI 71, abelacimab reduced major or clinically relevant non-major bleeding by 62%-69% versus rivaroxaban. In PACIFIC-AF, asundexian reduced bleeding by 50%-84% compared to apixaban. However, OCEANIC-AF showed asundexian was inferior in stroke prevention, with a 3.8-fold higher risk of stroke or systemic embolism compared to apixaban, leading to early trial termination. Abelacimab showed a trend toward higher ischemic stroke rates abelacimab (150 mg: 1.21 vs 0.59 events/100 person-years; and 90 mg: 1.24 vs 0.59 events/100 person-years), though not statistically significant.ConclusionFactor XI/XIa inhibitors significantly reduce bleeding risk in AF patients compared to DOACs, but their thrombotic efficacy remains uncertain. While promising, further research is needed to optimize their use.

BackgroundTranexamic acid (TA), a synthetic lysine derivative, is known for its antifibrinolytic effect and potential to reduce bleeding in surgeries like arthroplasty, cardio-aortic procedures, and liver transplantation. This meta-analysis seeks to provide robust clinical evidence on TA's effectiveness in reducing blood loss and transfusion needs during orthotopic liver transplantation.MethodsThe systematic review and meta-analysis included the relevant randomized controlled trials (RCTs) retrieved from PubMed, EMBASE, Web of Science, Cochrane, and SCOPUS databases until August 2024. The meta-analysis was done using (RevMan 5.4.1). PROSPERO ID: CRD42024589151.ResultsOur meta-analysis of seven RCTs with 1875 patients found no significant differences between TA and control groups in total red blood cell units transfused (MD: -3.74 units; 95% CI [-8.49, 1.01]; P = .12), perioperative transfusions (MD: -0.42 units; 95% CI [-3.17, 2.32]; P = .76), or overall blood loss (MD: -167.81 mL; 95% CI [-415.29, 79.67]; P = .18).For safety outcomes, TA was associated with a higher rate of venous thromboembolism events (RR: 1.71; 95% CI [1.01, 2.87]; P = .05; event rate: 4.89% vs 2.91%), while no significant differences were found in other surgical complications (RR: 1.12; 95% CI [0.92, 1.37]; P = .26).ConclusionTA does not reduce blood loss or the need for postoperative transfusions in orthotopic liver transplantation and may raise thrombotic risk. Caution is required to interpret these results due to variations in the study/hospital-specific transfusion protocol details. Larger studies are needed to confirm these findings, and future research should explore the effects of multiple dosing regimens on blood loss and transfusion requirements.

BackgroundOesophagectomy is a major oncological surgical procedure. Previous studies have shown a wide range of bleeding during and after surgery, and it is unknown if perioperative bleeding associated with oesophagectomy is purely surgical in nature, or if it is exacerbated by impaired haemostasis. We aimed to perform a detailed investigation of the perioperative coagulation in patients undergoing oesophagectomy due to cancer.MethodsThe study was a prospective study including adult patients with adeno- or squamous cell carcinoma referred for intended curative oesophagectomy. Operative bleeding volume and blood transfusions were recorded. Blood samples were collected at three timepoints: before, at the end of surgery, and on postoperative day one. Dynamic global haemostasis was investigated employing thromboelastometry (ROTEM^®). Platelet aggregation was analysed with a Multiplate Analyzer^®, and routine coagulation parameters were analysed.ResultsWe included 87 patients. Patients bled a median of 300 mL during surgery. One patient bled 1830 mL, while the remaining patients bled ≤1000 mL. Blood transfusions were administered to 14 (16%) patients. Median platelet aggregation was within the reference ranges at all time points. Platelet aggregation increased during surgery and normalised within 24 h. ROTEM^® analyses showed no perioperative significantly decrease of clot formation or clot strength. Routine coagulation parameters were overall normal.ConclusionsSevere perioperative bleeding was rare, and transfusions of blood products were used sparingly. Patients undergoing oesophagectomy due to cancer had an intact haemostasis with no sign of impaired haemostasis.Clinical trial registrationThe trial was registered prior to initiation at www.clinicaltrials.gov (identification number NCT05067153).

Recurrent spontaneous abortion (RSA) is a multifactorial condition influenced by genetic, hormonal, immunological, and anatomical factors. Thrombophilia, characterized by a heightened propensity for blood clotting, is a significant contributor to RSA. This review examines the mechanisms connecting thrombosis and RSA, focusing on hypercoagulable states, placental thrombosis, inflammation, and endothelial dysfunction. Genetic and acquired thrombophilic factors, such as factor V Leiden mutation, prothrombin gene mutation, protein C and S deficiencies, antithrombin III deficiency, antiphospholipid syndrome, and hyperhomocysteinemia, are discussed in detail. The diagnosis of thrombophilia in RSA entails a comprehensive clinical evaluation, including the assessment of physical examination, medical history and laboratory investigations, although there is still debate over the need for universal screening. Therapeutic strategies, including anticoagulant and antiplatelet therapies, as well as lifestyle modifications, are tailored to individual risk factors and disease severity. Although anticoagulant therapy demonstrates potential in lowering the risk of miscarriage, additional research is necessary to refine treatment protocols and assess long-term outcomes. This review highlights the need for a nuanced approach to managing thrombophilia-associated RSA, balancing diagnostic precision with therapeutic efficacy to improve reproductive outcomes.