Journal of Thrombosis and Haemostasis最新文献

英文中文

THROMBELASTOGRAPHY-ESTIMATED FUNCTIONAL FIBRINOGEN IN HEALTHY VOLUNTEERS, ESRD, AND TRAUMA: INACCURATE WHEN MOST NEEDED. 在健康志愿者、esrd和创伤中，血栓造影估计的功能性纤维蛋白原：在最需要的时候是不准确的。

IF 5 2区医学 Q1 HEMATOLOGY

Journal of Thrombosis and Haemostasis

Pub Date : 2026-02-02 DOI: 10.1016/j.jtha.2025.12.036

Dallas Vanderheyden, Ernest E Moore, Hunter B Moore, James Chandler, Anika Khakoo, Angela Sauaia

Background: Depletion of fibrinogen is an early event in trauma-induced coagulopathy (TIC), while hyperfibrinogenemia increases thrombotic risk in end stage renal disease (ESRD). Viscoelastic tests aim to provide rapid fibrinogen estimates, yet their accuracy to define abnormal fibrinogenemia remains debated.

Objectives: We assessed the accuracy of thrombelastography (TEG) -TEG® 5000, TEG® 6s-in measuring normal and abnormal fibrinogen levels across healthy volunteers, ESRD, and trauma patients at risk for TIC.

Patients/methods: We compared the von Clauss functional fibrinogen (gold standard) with TEG®5000 functional fibrinogen level(FLEV) in 118 healthy volunteers, 52 patients with ESRD undergoing arteriovenous fistula (AVF) surgery and 265 severely injured patients. We compared Clauss fibrinogen with TEG®6s citrated functional fibrinogen (CFF) in 140 trauma patients at high risk for TIC. Pearson correlation was used.

Results: Clauss fibrinogen correlated moderately with TEG®5000-FLEV in healthy volunteers (r=0.52, p<0.0001) and ESRD patients overall (r=0.62, p<0.0001). Correlation, however, deteriorated and became non-significant in ESRD patients with fibrinogen >500 mg/dl. Trauma patients showed moderate overall correlation (r=0.58, p<0.0001), but it decreased substantially with fibrinogen<150 mg/dl (r=0.20, p=0.29). TEG®6s-CFF had better overall correlation (r=0.66, p<0.0001), though decreased at fibrinogen<200mg/dl (r=0.39, p=0.04).

Conclusions: Both TEG®5000-FLEV and TEG®6s-CFF correlated moderately with Clauss fibrinogen but decreased in correlation in both hyperfibrinogenemia and hypofibrinogenemia. Thus, we caution relying on TEG®5000 or TEG®6s to be the only laboratory measurement to guide fibrinogen replacement when resuscitating trauma patients at risk for TIC and TEG®5000-FLEV for assessing fibrinogen in patients with ESRD at risk for thrombotic events.

背景：纤维蛋白原消耗是创伤性凝血病（TIC）的早期事件，而高纤维蛋白原血症增加终末期肾病（ESRD）的血栓形成风险。粘弹性试验旨在提供快速纤维蛋白原估计，但其准确性定义异常纤维蛋白原血症仍有争议。目的：我们评估血栓造影(TEG) -TEG®5000，TEG®6s-在健康志愿者，ESRD和有TIC风险的创伤患者中测量正常和异常纤维蛋白原水平的准确性。患者/方法：我们比较了118名健康志愿者、52名接受动静脉瘘（AVF）手术的ESRD患者和265名严重损伤患者的von Clauss功能性纤维蛋白原（金标准）和TEG®5000功能性纤维蛋白原水平（FLEV）。我们比较了140例TIC高危外伤患者的Clauss纤维蛋白原和TEG®6s柠檬酸功能性纤维蛋白原（CFF）。采用Pearson相关分析。结果：健康志愿者的Clauss纤维蛋白原与TEG®5000-FLEV中度相关（r=0.52, p500 mg/dl）。结论：TEG®5000-FLEV和TEG®6s-CFF与Clauss纤维蛋白原有中度相关性，但在高纤维蛋白原血症和低纤维蛋白原血症中相关性降低。因此，我们提醒，在有TIC风险的创伤患者复苏时，依赖TEG®5000或TEG®6s作为唯一的实验室测量来指导纤维蛋白原替代，而在有血栓事件风险的ESRD患者中，依赖TEG®5000- flev来评估纤维蛋白原。

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引用次数: 0

Prevention of hemorrhage after implantation of mechanical circulatory support with a purified von Willebrand factor concentrate: results of the early terminated randomized controlled trial 用纯化血管性血液病因子浓缩物预防机械循环支架植入后出血：早期终止的随机对照PHAM试验的结果。

IF 5 2区医学 Q1 HEMATOLOGY

Journal of Thrombosis and Haemostasis

Pub Date : 2026-02-01 DOI: 10.1016/j.jtha.2025.09.011

Antoine Rauch , Guillaume Lebreton , Mouhamed D. Moussa , André Vincentelli , Erwan Flecher , Olivier Bouchot , Camille Dambrin , Laurent Barandon , Bertrand Rozec , Emmanuelle Jeanpierre , Nadine Ajzenberg , Yohann Repessé , Emmanuel De Maistre , Elodie Boissier , David M. Smadja , Mathieu Fiore , Fabienne Nedelec , Sophie Voisin , Peter J. Lenting , Silvy Laporte , Sophie Susen

Background

Bleeding complications are frequent under left ventricular assist device (LVAD) support. LVAD-associated high shear stress induces increased proteolysis of circulating von Willebrand factor (VWF), which may contribute to this high bleeding rate.

Objectives

To assess if a prophylactic administration of a VWF concentrate could reduce bleeding rate in LVAD patients

Methods

In this multicenter open-label randomized controlled study, we investigated the efficacy, safety, and pharmacokinetic of a plasma-derived VWF concentrate (WILFACTIN, LFB), administered prophylactically twice-weekly at 50 IU.kg^-1 for 3 months after LVAD implantation, compared with standard of care. The efficacy end points were the difference in the incidence rate of any, clinically significant or major bleeding postrandomization. Bleeding and thrombotic events were reviewed at weeks 1 and 2 and then every 2 weeks. The study ended prematurely due to deficient recruitment and drug supply constraints, leading to prioritization of prescriptions for von Willebrand disease patients. We present the available data.

Results

Twenty-nine adult patients (166 planned) were randomized and analyzed. VWF prophylaxis resulted in a nonsignificant 55% reduction in bleeding incidence rate compared with standard of care (risk ratio, 0.45; 95% CI, 0.18-1.04; P = .06). Accordingly, there was a similar reduction of clinically relevant and major bleeding in VWF arm. Severe adverse events were similar postrandomization between VWF arm and control arm including deaths (2 and 4, respectively) and thrombotic events (2 in each arm). In pharmacokinetic analysis, a rapid degradation of WILFACTIN occurred within 24 hours.

Conclusion

The lack of observed therapeutic efficacy of VWF prophylaxis in LVAD setting is likely due to a short-lived prohemostatic effect due to rapid degradation of VWF concentrate.

背景：在左心室辅助装置（LVAD）的支持下，出血并发症是常见的。lvad相关的高剪切应力诱导循环血管性血友病因子（VWF）蛋白水解增加，这可能导致高出血率。方法：在这项多中心开放标签随机对照研究中，我们研究了一种血浆源性vwf浓缩物（WILFACTIN®，LFB，法国）的疗效、安全性和药代动力学，预防性每周给予两次，每次50iu。与标准护理（SOC）相比，lvad植入后3个月的kg-1。疗效终点是随机化后任何临床显著或重大出血发生率的差异。在第1周、第2周及以后每2周复查一次出血和血栓事件。由于招募不足和药物供应限制，该研究过早结束，导致优先考虑vwd患者的处方。我们提供可用的数据。结果：29例成人患者（计划166例）随机分析。与SOC相比，vwf预防导致出血发生率降低55%（风险比0.45;95%CI: 0.18至1.04;p=0.06）。因此，vwf组的临床相关出血和大出血也有类似的减少。随机化后，VWF组和对照组的严重不良事件相似，包括死亡（分别为2例和4例）和血栓形成事件（每组2例）。在药代动力学分析中，WILFACTIN®在24小时内发生快速降解。结论：在lvad环境下，vwf预防缺乏观察到的治疗效果可能是由于vwf浓缩物快速降解导致的短暂的止血作用。

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引用次数: 0

A comprehensive care pathway of gene therapy for hemophilia based on current guideline documents and summary of product characteristics: communication from the ISTH SSC working group on gene therapy 基于现行指南文件和产品特性综述的血友病基因治疗综合护理路径来自ISTH SSC基因治疗工作组的通讯。

IF 5 2区医学 Q1 HEMATOLOGY

Journal of Thrombosis and Haemostasis

Pub Date : 2026-02-01 DOI: 10.1016/j.jtha.2025.09.041

Caroline M.A. Mussert , Wolfgang Miesbach , Pratima Chowdary , David Lillicrap , Johnny Mahlangu , Flora Peyvandi , Steven W. Pipe , Alok Srivastava , Jan Voorberg , Glenn F. Pierce , Radoslaw Kaczmarek , Paul Batty , Ilaria Cutica , Amit Nathwani , Frank W.G. Leebeek

Background

Gene therapy for hemophilia has recently been implemented as standard clinical care, requiring organizational and multistakeholder preparedness and clear guidelines. In addition to pharmaceutical summaries of product characteristics (SMPCs), various (inter)national guidance documents have been published. However, no guidance document or SMPC covers the entire gene therapy care pathway.

Objectives

This study provides a complete and comprehensive overview of current guidance documents and SMPCs to develop a comprehensive care pathway for hemophilia gene therapy delivery.

Methods

Published gene therapy guidance documents and collected SMPCs were complemented by a selective search in online databases, including PubMed and scientific societies’ websites. Reference lists were checked for additional relevant articles.

Results

Four SMPCs and 11 (inter)national guidance documents and recommendations were collected. The documents were focused on either the intervention or the care pathway, and none were comprehensive covering all aspects of hemophilia gene therapy delivery. Considerable differences were found between the 2 approved gene therapy products and between the SMPCs issued by the 2 regulatory authorities, the Food and Drug Administration and the European Medicines Agency. (Inter)national guidance documents provided additional information and recommendations not covered in SMPCs.

Conclusion

Based on SMPCs and (inter)national guidance documents and recommendations a care pathway has been developed and visualized in a Metro Map. This provides a clear and comprehensive overview of all activities, contact moments, and responsibilities within the longitudinal gene therapy treatment process. This comprehensive care pathway may help navigate gene therapy implementation, providing guidance to clinicians, patients, and caregivers.

背景：血友病基因治疗最近已作为标准临床治疗实施，需要组织和多方利益相关者的准备和明确的指导方针。除了药品特性摘要（smpc）外，还发布了各种（国际）国家指导文件。然而，没有指导文件或SMPC涵盖整个基因治疗护理途径。研究目的：对现有的指导文件和smpc进行完整和全面的概述，以开发血友病基因治疗递送的综合护理途径。方法：对已发表的基因治疗指导文件和收集到的smpc进行选择性检索，包括Pubmed和科学学会网站。查阅参考文献列表以查找其他相关文章。结果：收集到4份smpc和11份（国际）国家指导文件和建议。这些文献要么集中在干预途径，要么集中在护理途径，没有一个文献全面覆盖血友病基因治疗传递的所有方面。在两种批准的基因治疗产品之间以及两个监管机构（食品和药物管理局（FDA）和欧洲药品管理局（EMA））颁发的smpc之间发现了很大的差异。（国际）国家指导文件提供了smpc未包括的额外信息和建议。结论：基于smpc和（国际）国家指导文件和建议，制定了一条护理路径，并在地铁地图上可视化。这为纵向基因治疗过程中的所有活动、接触时刻和责任提供了清晰而全面的概述。这种全面的护理途径可能有助于导航基因治疗的实施，为临床医生、患者和护理人员提供指导。

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引用次数: 0

Microthrombi growth in ADAMTS13 deficiency exacerbates inflammatory bowel disease via mucosal and endothelial dysfunction ADAMTS13缺乏的微血栓生长通过粘膜和内皮功能障碍加重炎症性肠病。

IF 5 2区医学 Q1 HEMATOLOGY

Journal of Thrombosis and Haemostasis

Pub Date : 2026-02-01 DOI: 10.1016/j.jtha.2025.09.027

Kyota Tatsuta , Naoki Honkura , Nanami Morooka , Mayu Sakata , Kiyotaka Kurachi , Ken Sugimoto , Koichi Kokame , Hiroya Takeuchi , Tetsumei Urano , Yuko Suzuki

Background

Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by mucosal inflammation and ulceration. While von Willebrand factor, typically cleaved by ADAMTS13 from ultralarge multimers into smaller fragments, has been found to accumulate in the inflamed lesions of the ADAMTS13-deficient colitis model, the association between aberrant thrombus formation in lesional microvessels and colitis exacerbation remains unclear.

Objectives

We investigated potential linkages between microthrombus formation and colitis progression.

Methods

Plasma and inflamed colonic tissues from patients with UC were analyzed. We employed intravital multiphoton microscopy to reveal the real-time structural dynamics of the mucus layer and mucosal vasculature at single-cell spatial resolution in a dextran sulfate sodium-induced colitis model of wild-type and ADAMTS13–deficient green fluorescent protein-expressing mice.

Results

Patients with UC exhibited significantly reduced plasma ADAMTS13 activity and excessive von Willebrand factor deposition in inflamed colonic tissues. In dextran sulfate sodium-induced colitis mice, ADAMTS13 deficiency showed heightened disease activity and increased mucosal erosion in histochemical analysis compared with wild-type mice. A novel methodology appraised colonic mucus barrier integrity by visualizing fluorescent dextran penetration from the colonic lumen to crypts. ADAMTS13 deficiency accelerated mucus layer disruption, leukocyte recruitment, and microthrombus formation, particularly in periepithelium regions. Vessel-specific analyses demonstrated that obstructive microthrombi were most prominent in the mucosal layer, contributing to local ischemia and mucosal erosion. Recombinant human ADAMTS13 alleviated microthrombus formation, improved mucosal integrity, and mitigated colitis severity in both wild-type and ADAMTS13–deficient mice.

Conclusion

Advanced intravital imaging analysis revealed that obstructive thrombi formed in mucosal vessels due to impaired ADAMTS13 activity were essential for colitis severity.

背景：溃疡性结肠炎（UC）是一种以黏膜炎症和溃疡为特征的慢性炎症性肠病。虽然von Willebrand因子（VWF）通常被ADAMTS13从超大的多聚体切割成更小的片段，已被发现在ADAMTS13缺陷结肠炎模型的炎症病变中积累，但病变微血管异常血栓形成与结肠炎恶化之间的关系尚不清楚。目的：我们研究微血栓形成和结肠炎进展之间的潜在联系。方法：对UC患者的血浆和炎性结肠组织进行分析。我们利用活体多光子显微镜在单细胞空间分辨率下观察了dextran sulfate钠（DSS）诱导的野生型和adamts13缺陷型gfp表达小鼠结肠炎模型的黏液层和粘膜血管的实时结构动力学。结果：UC患者血浆ADAMTS13活性明显降低，炎症结肠组织中VWF沉积过多。在dss诱导的结肠炎小鼠中，组织化学分析显示，与野生型相比，ADAMTS13缺乏表现出更高的疾病活动性和更多的粘膜侵蚀。一种新的方法评估结肠粘液屏障的完整性通过可视化荧光葡聚糖渗透从结肠腔到隐窝。ADAMTS13缺乏加速了黏液层破坏、白细胞募集和微血栓形成，特别是在上皮周围区域。血管特异性分析表明，梗阻性微血栓在粘膜层最为突出，导致局部缺血和粘膜侵蚀。重组人ADAMTS13减轻了两种小鼠的微血栓形成，改善了粘膜完整性，减轻了结肠炎的严重程度。结论：先进的活体成像分析显示，由于ADAMTS13活性受损而在粘膜血管中形成的阻塞性血栓对结肠炎的严重程度至关重要。

{"title":"Microthrombi growth in ADAMTS13 deficiency exacerbates inflammatory bowel disease via mucosal and endothelial dysfunction","authors":"Kyota Tatsuta , Naoki Honkura , Nanami Morooka , Mayu Sakata , Kiyotaka Kurachi , Ken Sugimoto , Koichi Kokame , Hiroya Takeuchi , Tetsumei Urano , Yuko Suzuki","doi":"10.1016/j.jtha.2025.09.027","DOIUrl":"10.1016/j.jtha.2025.09.027","url":null,"abstract":"<div><h3>Background</h3><div>Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by mucosal inflammation and ulceration. While von Willebrand factor, typically cleaved by ADAMTS13 from ultralarge multimers into smaller fragments, has been found to accumulate in the inflamed lesions of the ADAMTS13-deficient colitis model, the association between aberrant thrombus formation in lesional microvessels and colitis exacerbation remains unclear.</div></div><div><h3>Objectives</h3><div>We investigated potential linkages between microthrombus formation and colitis progression.</div></div><div><h3>Methods</h3><div>Plasma and inflamed colonic tissues from patients with UC were analyzed. We employed intravital multiphoton microscopy to reveal the real-time structural dynamics of the mucus layer and mucosal vasculature at single-cell spatial resolution in a dextran sulfate sodium-induced colitis model of wild-type and ADAMTS13–deficient green fluorescent protein-expressing mice.</div></div><div><h3>Results</h3><div>Patients with UC exhibited significantly reduced plasma ADAMTS13 activity and excessive von Willebrand factor deposition in inflamed colonic tissues. In dextran sulfate sodium-induced colitis mice, ADAMTS13 deficiency showed heightened disease activity and increased mucosal erosion in histochemical analysis compared with wild-type mice. A novel methodology appraised colonic mucus barrier integrity by visualizing fluorescent dextran penetration from the colonic lumen to crypts. ADAMTS13 deficiency accelerated mucus layer disruption, leukocyte recruitment, and microthrombus formation, particularly in periepithelium regions. Vessel-specific analyses demonstrated that obstructive microthrombi were most prominent in the mucosal layer, contributing to local ischemia and mucosal erosion. Recombinant human ADAMTS13 alleviated microthrombus formation, improved mucosal integrity, and mitigated colitis severity in both wild-type and ADAMTS13–deficient mice.</div></div><div><h3>Conclusion</h3><div>Advanced intravital imaging analysis revealed that obstructive thrombi formed in mucosal vessels due to impaired ADAMTS13 activity were essential for colitis severity.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"24 2","pages":"Pages 583-597"},"PeriodicalIF":5.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145329493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Corrigendum to “Evaluation of a microfluidic flow assay to screen for von Willebrand disease and low von Willebrand factor levels” “评价筛选血管性血友病和低血管性血友病因子水平的微流体流动试验”的勘误表。

IF 5 2区医学 Q1 HEMATOLOGY

Journal of Thrombosis and Haemostasis

Pub Date : 2026-02-01 DOI: 10.1016/j.jtha.2025.12.012

Marcus Lehmann , Katrina Ashworth , Marilyn Manco-Johnson , Jorge Di Paola , Keith B. Neeves , Christopher J. Ng

引用次数: 0

Corrigendum to ‘Real-world use of protein C concentrate for the treatment of patients with protein C deficiency: an international registry’ “蛋白C浓缩物用于治疗蛋白C缺乏症患者的实际使用：国际注册”的更正：[Journal of Thrombosis and heemostasis 23(11)(2025) 3569-3577]。

IF 5 2区医学 Q1 HEMATOLOGY

Journal of Thrombosis and Haemostasis

Pub Date : 2026-02-01 DOI: 10.1016/j.jtha.2025.12.001

Marilyn Manco-Johnson , Paul Brons , Paul Knoebl , Michael Wang , Csaba Siffel , Peter L. Turecek , Hanna T. Gazda

引用次数: 0

Factor XII locking in (for contact activation through disulfide control) 因子十二锁定（通过二硫控制激活触点）

IF 5 2区医学 Q1 HEMATOLOGY

Journal of Thrombosis and Haemostasis

Pub Date : 2026-02-01 DOI: 10.1016/j.jtha.2025.11.002

Coen Maas , Philip J. Hogg

引用次数: 0

Racing toward a common biology of venous thromboembolism prophylaxis: the small interfering RNA fibrinogen knockdown strategy 冲向静脉血栓栓塞预防的共同生物学：小干扰RNA纤维蛋白原敲低策略

IF 5 2区医学 Q1 HEMATOLOGY

Journal of Thrombosis and Haemostasis

Pub Date : 2026-02-01 DOI: 10.1016/j.jtha.2025.09.045

Annie M. Apffel, Emily Mosher, Matthew D. Neal

引用次数: 0

Bleeding risk prediction models in varied clinical scenarios 不同临床情况下出血风险预测模型

IF 5 2区医学 Q1 HEMATOLOGY

Journal of Thrombosis and Haemostasis

Pub Date : 2026-02-01 DOI: 10.1016/j.jtha.2025.10.010

Mark Goldin , Ermioni Oikonomou , Alex C. Spyropoulos

引用次数: 0

Reduced vs full-dose direct oral anticoagulants for extended treatment of cancer-associated venous thromboembolism: a systematic review and meta-analysis of randomized trials 减少与全剂量直接口服抗凝剂用于癌症相关静脉血栓栓塞的延长治疗：随机试验的系统回顾和荟萃分析

IF 5 2区医学 Q1 HEMATOLOGY

Journal of Thrombosis and Haemostasis

Pub Date : 2026-02-01 DOI: 10.1016/j.jtha.2025.09.026

Larissa A. de Lucena , Amanda G. Duarte , Larissa C. Hespanhol , Juliana Muniz , Nicole Félix , Kleyton Medeiros , C. Michael Gibson

Background

Patients with cancer-associated venous thromboembolism (VTE) are at high risk of recurrent thrombosis and bleeding during prolonged anticoagulation. While full-dose direct oral anticoagulants (DOACs) are widely used, the safety and efficacy of reduced-dose regimens for extended treatment remain uncertain.

Objectives

This study compared the safety and efficacy of reduced-dose vs full-dose DOACs in the extended treatment of cancer-associated VTE.

Methods

We conducted a systematic review and meta-analysis of randomized controlled trials comparing reduced- and full-dose DOACs in adults with active cancer and VTE. Searches were performed in PubMed, Embase, and the Cochrane Library. The primary outcomes were a composite of VTE recurrence, major bleeding, or clinically relevant nonmajor bleeding, and the combined risk of major or clinically relevant nonmajor bleeding.

Results

Three randomized controlled trials comprising 2361 patients were included. Two trials evaluated apixaban 2.5 mg vs 5 mg twice daily, and 1 evaluated rivaroxaban 10 mg vs 20 mg once daily. Reduced-dose DOACs were associated with a lower risk of the composite outcome (relative risk, 0.77; 95% CI, 0.64-0.93; P = .006) and reduced bleeding (relative risk, 0.76; 95% CI, 0.62-0.93; P = .008) than full-dose DOACs. No significant differences were observed in major bleeding, clinically relevant nonmajor bleeding, VTE recurrence, or all-cause mortality when analyzed individually.

Conclusions

Reduced-dose DOACs appear as effective as full-dose regimens for extended treatment of cancer-associated VTE, with a lower risk of bleeding. These findings support their use as a safer long-term anticoagulation strategy in selected patients.

导论：癌症相关性静脉血栓栓塞（VTE）患者在长期抗凝治疗期间血栓复发和出血的风险很高。虽然全剂量直接口服抗凝剂（DOACs）被广泛使用，但减少剂量方案用于长期治疗的安全性和有效性仍不确定。目的：比较减少剂量与全剂量DOACs在癌症相关性静脉血栓栓塞延长治疗中的安全性和有效性。方法：我们对随机对照试验（rct）进行了系统回顾和荟萃分析，比较了活动性癌症和静脉血栓栓塞的成人减少剂量和全剂量DOACs。检索在PubMed、Embase和Cochrane图书馆进行。主要结局是静脉血栓栓塞复发、大出血或临床相关的非大出血，以及大出血或临床相关的非大出血的综合风险。结果：纳入3项随机对照试验，共2361例患者。两项试验评估阿哌沙班2.5 mg与5 mg每日两次，一项试验评估利伐沙班10 mg与20 mg每日一次。与全剂量DOACs相比，减少剂量DOACs与较低的复合结局风险（RR 0.77; 95% CI 0.64-0.93; p=0.006）和减少出血（RR 0.76; 95% CI 0.62-0.93; p=0.008）相关。单独分析时，在大出血、临床相关的非大出血、静脉血栓栓塞复发或全因死亡率方面没有观察到显著差异。结论：对于癌症相关性静脉血栓栓塞的延长治疗，减少剂量的doac与全剂量方案一样有效，且出血风险更低。这些发现支持它们作为一种更安全的长期抗凝策略在特定患者中使用。

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引用次数: 0

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