Pub Date : 2024-10-10DOI: 10.1016/j.jtha.2024.09.021
Pier Luigi Meroni, Maria Orietta Borghi, Olga Amengual, Tatsuyaa Atsumi, Maria Laura Bertolaccini, Hannah Cohen, Claudia Grossi, Robert Roubey, Savino Sciascia, Anne Tebo, Rohan Willis, Doruk Erkan, Katrien M J Devreese
{"title":"2023 American College of Rheumatology/European League Against Rheumatism antiphospholipid syndrome classification criteria solid phase-based antiphospholipid antibody domain-collaborative efforts of Antiphospholipid Syndrome Alliance for Clinical Trials and International Networking and ISTH SSC to harmonize enzyme-linked immunosorbent assay and non-enzyme-linked immunosorbent assay antiphospholipid antibody tests: communication from the ISTH SSC Subcommittee on Lupus Anticoagulant/Antiphospholipid Antibodies.","authors":"Pier Luigi Meroni, Maria Orietta Borghi, Olga Amengual, Tatsuyaa Atsumi, Maria Laura Bertolaccini, Hannah Cohen, Claudia Grossi, Robert Roubey, Savino Sciascia, Anne Tebo, Rohan Willis, Doruk Erkan, Katrien M J Devreese","doi":"10.1016/j.jtha.2024.09.021","DOIUrl":"10.1016/j.jtha.2024.09.021","url":null,"abstract":"","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468669","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}
Pub Date : 2024-10-10DOI: 10.1016/j.jtha.2024.09.026
David L Bark, Eudorah F Vital, Cécile Oury, Wilbur A Lam, Elizabeth E Gardiner
Blood flow is vital to life, yet disturbed flow has been linked to atherosclerosis, thrombosis, and endothelial dysfunction. The commonly used hemodynamic descriptor "disturbed flow" found in disease and medical devices is not clearly defined in many studies. However, the specific flow regime-laminar, transitional, or turbulent-can have very different effects on hemostasis, thrombosis, and vascular health. Therefore, it remains important to clinically identify turbulence in cardiovascular flow and to have available assays that can be used to study effects of turbulence. The objective of the current communication was to 1) provide clarity and guidance for how to clinically identify turbulence, 2) define standard measures of turbulence that can allow the recreation of flow conditions in a benchtop assay, and 3) review how cells and proteins in the blood can be impacted by turbulence based on current literature.
{"title":"Recommendations for defining disturbed flow as laminar, transitional, or turbulent in assays of hemostasis and thrombosis: communication from the ISTH SSC Subcommittee on Biorheology.","authors":"David L Bark, Eudorah F Vital, Cécile Oury, Wilbur A Lam, Elizabeth E Gardiner","doi":"10.1016/j.jtha.2024.09.026","DOIUrl":"10.1016/j.jtha.2024.09.026","url":null,"abstract":"<p><p>Blood flow is vital to life, yet disturbed flow has been linked to atherosclerosis, thrombosis, and endothelial dysfunction. The commonly used hemodynamic descriptor \"disturbed flow\" found in disease and medical devices is not clearly defined in many studies. However, the specific flow regime-laminar, transitional, or turbulent-can have very different effects on hemostasis, thrombosis, and vascular health. Therefore, it remains important to clinically identify turbulence in cardiovascular flow and to have available assays that can be used to study effects of turbulence. The objective of the current communication was to 1) provide clarity and guidance for how to clinically identify turbulence, 2) define standard measures of turbulence that can allow the recreation of flow conditions in a benchtop assay, and 3) review how cells and proteins in the blood can be impacted by turbulence based on current literature.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468677","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}
Pub Date : 2024-10-10DOI: 10.1016/j.jtha.2024.09.022
James Curtis, Daniel P Henderson, Mehrdad Zarghami, Sina Rashedi, Behnood Bikdeli
A growing number of patients receiving antithrombotic therapy require dental procedures. Dental interventions in these patients can be challenging, as the risk of bleeding from the continuation of antithrombotic therapy needs to be weighed against the thromboembolic risk associated with drug interruption or de-escalation. Most minor dental procedures, including simple dental cleaning and filling, pose minimal bleeding risk, and antiplatelet or anticoagulation therapy can be continued without interruption. Local hemostatic measures, such as tranexamic mouthwash, can be used, as needed, to reduce bleeding events following these interventions. Managing antithrombotic therapy during more invasive dental interventions and oral surgeries with a higher risk of perioperative bleeding necessitates the consideration of specific factors influencing the bleeding risk and thromboembolism. In patients receiving antithrombotic therapy for primary prevention, temporary interruption is reasonable. In others, the decisions may be more complex and more nuanced. In this article, we review the current evidence for managing patients receiving oral antiplatelet or anticoagulant drugs scheduled for various dental procedures and present a practical approach for the periprocedural management of antithrombotic treatments.
{"title":"Management of antithrombotic therapy in patients undergoing dental procedures.","authors":"James Curtis, Daniel P Henderson, Mehrdad Zarghami, Sina Rashedi, Behnood Bikdeli","doi":"10.1016/j.jtha.2024.09.022","DOIUrl":"10.1016/j.jtha.2024.09.022","url":null,"abstract":"<p><p>A growing number of patients receiving antithrombotic therapy require dental procedures. Dental interventions in these patients can be challenging, as the risk of bleeding from the continuation of antithrombotic therapy needs to be weighed against the thromboembolic risk associated with drug interruption or de-escalation. Most minor dental procedures, including simple dental cleaning and filling, pose minimal bleeding risk, and antiplatelet or anticoagulation therapy can be continued without interruption. Local hemostatic measures, such as tranexamic mouthwash, can be used, as needed, to reduce bleeding events following these interventions. Managing antithrombotic therapy during more invasive dental interventions and oral surgeries with a higher risk of perioperative bleeding necessitates the consideration of specific factors influencing the bleeding risk and thromboembolism. In patients receiving antithrombotic therapy for primary prevention, temporary interruption is reasonable. In others, the decisions may be more complex and more nuanced. In this article, we review the current evidence for managing patients receiving oral antiplatelet or anticoagulant drugs scheduled for various dental procedures and present a practical approach for the periprocedural management of antithrombotic treatments.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468673","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}
Pub Date : 2024-10-10DOI: 10.1016/j.jtha.2024.09.023
Mette Søgaard, Marie Ørskov, Martin Jensen, Jamilla Goedegebuur, Eva K Kempers, Chantal Visser, Eric C T Geijteman, Denise Abbel, Simon P Mooijaart, Geert-Jan Geersing, Johanneke Portielje, Adrian Edwards, Sarah J Aldridge, Ashley Akbari, Anette A Højen, Frederikus A Klok, Simon Noble, Suzanne Cannegieter, Anne Gulbech Ording
Background: Despite uncertain benefit-risk profile near the end of life, antithrombotic therapy (ATT) is prevalent in patients with terminal cancer.
Objectives: To examine adherence and persistence with ATT in terminally ill cancer patients and investigate risks of major and clinically relevant bleeding, venous thromboembolism (VTE), and arterial thromboembolism (ATE) by ATT exposure.
Methods: Using a Danish nationwide cohort of terminal cancer patients, ATT adherence in the year following terminal illness declaration was measured by the proportion of days covered (PDC) by prescription. Discontinuation was defined as a treatment gap of ≥30 days between prescription renewals. One-year cumulative incidences of bleeding complications, VTE, and ATE were calculated, considering the competing risk of death.
Results: During 2013-2022, 86 732 terminally ill cancer patients were identified (median age, 75 years; 47% female; median survival, 57 days). At terminal illness declaration, 37.5% were receiving ATT (66.6% platelet inhibitors, 23.0% direct oral anticoagulants, and 10.4% vitamin K antagonists [VKAs]). The mean PDC with ATT was 88% (SD, 30%), highest among platelet inhibitor users (mean PDC, 89%) and lowest among VKA users (73%). One-year ATT discontinuation incidence was 7.9% (95% CI, 7.7%-8.1%). Most patients continued ATT until death (74.8% platelet inhibitors, 58.8% direct oral anticoagulants, and 61.6% VKAs). Patients receiving ATT had a lower 1-year VTE risk but higher risks of ATE and major bleeding.
Conclusion: Despite uncertain benefit-risk profile, most terminally ill cancer patients continue ATT until the end of life. These findings provide insights into current ATT utilization and discontinuation dynamics in the challenging context of terminal illness.
背景:尽管临近生命终点时的获益-风险情况尚不确定,但抗血栓治疗(ATT)在癌症晚期患者中十分普遍:尽管临近生命终点时的获益-风险不确定,但抗血栓治疗(ATT)在癌症晚期患者中仍很普遍:研究癌症晚期患者对抗血栓治疗的依从性和持续性,并根据抗血栓治疗暴露情况调查大出血和临床相关出血、静脉血栓栓塞症(VTE)和动脉血栓栓塞症(ATE)的风险:利用丹麦全国范围内的癌症晚期患者队列,通过处方覆盖天数比例(PDC)来衡量晚期患者在宣布绝症后一年内的ATT依从性。处方更新间隔≥30天即为停药。考虑到死亡的竞争风险,计算出血并发症、VTE 和 ATE 的一年累计发病率:2013-2022年间,共发现86732名癌症晚期患者(中位年龄75岁,47%为女性,中位生存期57天)。在宣布临终时,37.5%的患者正在接受ATT治疗(66.6%为血小板抑制剂,23.0%为直接口服抗凝剂(DOAC),10.4%为维生素K拮抗剂(VKA))。平均 PDC 为 88%(SD 30%),其中血小板抑制剂使用者的平均 PDC 最高(89%),VKA 使用者最低(73%)。一年内 ATT 停药率为 7.9%(95% CI 7.7%-8.1%)。大多数患者持续服用 ATT 直到死亡(74.8% 的患者服用血小板抑制剂,58.8% 的患者服用 DOACs,61.6% 的患者服用 VKA)。接受 ATT 的患者一年内 VTE 风险较低,但 ATE 和大出血风险较高:尽管获益-风险不确定,但大多数晚期癌症患者仍在继续接受 ATT 直到生命终结。这些研究结果为我们提供了在临终疾病这一具有挑战性的背景下目前ATT使用和停药动态的见解。
{"title":"Use of antithrombotic therapy and the risk of cardiovascular outcomes and bleeding in cancer patients at the end of life: a Danish nationwide cohort study.","authors":"Mette Søgaard, Marie Ørskov, Martin Jensen, Jamilla Goedegebuur, Eva K Kempers, Chantal Visser, Eric C T Geijteman, Denise Abbel, Simon P Mooijaart, Geert-Jan Geersing, Johanneke Portielje, Adrian Edwards, Sarah J Aldridge, Ashley Akbari, Anette A Højen, Frederikus A Klok, Simon Noble, Suzanne Cannegieter, Anne Gulbech Ording","doi":"10.1016/j.jtha.2024.09.023","DOIUrl":"10.1016/j.jtha.2024.09.023","url":null,"abstract":"<p><strong>Background: </strong>Despite uncertain benefit-risk profile near the end of life, antithrombotic therapy (ATT) is prevalent in patients with terminal cancer.</p><p><strong>Objectives: </strong>To examine adherence and persistence with ATT in terminally ill cancer patients and investigate risks of major and clinically relevant bleeding, venous thromboembolism (VTE), and arterial thromboembolism (ATE) by ATT exposure.</p><p><strong>Methods: </strong>Using a Danish nationwide cohort of terminal cancer patients, ATT adherence in the year following terminal illness declaration was measured by the proportion of days covered (PDC) by prescription. Discontinuation was defined as a treatment gap of ≥30 days between prescription renewals. One-year cumulative incidences of bleeding complications, VTE, and ATE were calculated, considering the competing risk of death.</p><p><strong>Results: </strong>During 2013-2022, 86 732 terminally ill cancer patients were identified (median age, 75 years; 47% female; median survival, 57 days). At terminal illness declaration, 37.5% were receiving ATT (66.6% platelet inhibitors, 23.0% direct oral anticoagulants, and 10.4% vitamin K antagonists [VKAs]). The mean PDC with ATT was 88% (SD, 30%), highest among platelet inhibitor users (mean PDC, 89%) and lowest among VKA users (73%). One-year ATT discontinuation incidence was 7.9% (95% CI, 7.7%-8.1%). Most patients continued ATT until death (74.8% platelet inhibitors, 58.8% direct oral anticoagulants, and 61.6% VKAs). Patients receiving ATT had a lower 1-year VTE risk but higher risks of ATE and major bleeding.</p><p><strong>Conclusion: </strong>Despite uncertain benefit-risk profile, most terminally ill cancer patients continue ATT until the end of life. These findings provide insights into current ATT utilization and discontinuation dynamics in the challenging context of terminal illness.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406566","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}
Pub Date : 2024-10-10DOI: 10.1016/j.jtha.2024.09.024
Eleonora Friedberg, Philipp Wohlfarth, Ana Iris Schiefer, Cathrin Skrabs, Winfried Franz Pickl, Nina Worel, Philipp Staber, Ulrich Jäger, Cihan Ay
Antiphospholipid syndrome is an autoimmune disorder characterized by the development of spontaneous venous, arterial, or microvascular thrombosis and/or pregnancy-related complications (eg, miscarriages, fetal loss) in the presence of persistent antiphospholipid (aPL) antibodies. Current state-of-the-art treatment consists of indefinite anticoagulation with vitamin K antagonists to prevent recurrence of thrombotic events. This, however, represents only a symptom-control-oriented treatment approach. To date, no curative option eradicating aPL antibodies permanently or addressing the underlying pathomechanism has been established. Here, we report the case of a woman with systemic lupus erythematosus and antiphospholipid syndrome with triple aPL antibody-positivity who developed recurrent deep venous thrombosis. After receiving chimeric antigen receptor T-cell therapy for aggressive B-cell lymphoma, sustained eradication of all 3 aPL antibody subtypes was observed, suggesting a promising role of immunotherapies targeting anti-CD19 for the treatment of prothrombotic autoimmune disorders.
抗磷脂综合征是一种自身免疫性疾病,其特点是在持续存在抗磷脂抗体(aPL)的情况下发生自发性静脉、动脉或微血管血栓和/或与妊娠有关的并发症(如流产、胎儿死亡)。目前最先进的治疗方法是使用维生素 K 拮抗剂进行无限期抗凝,以防止血栓事件再次发生。然而,这只是一种以症状控制为导向的治疗方法。到目前为止,还没有一种能永久根除 aPL 或解决其根本病理机制的治疗方案。在此,我们报告了一例患有系统性红斑狼疮和抗磷脂综合征并伴有三重 aPL 阳性的女性患者,她出现了复发性深静脉血栓。在接受 CAR T 细胞疗法治疗侵袭性 B 细胞淋巴瘤后,观察到所有三种 aPL 亚型均被持续清除,这表明靶向抗 CD19 的免疫疗法在治疗促血栓形成的自身免疫性疾病方面大有可为。
{"title":"Disappearance of antiphospholipid antibodies after anti-CD19 chimeric antigen receptor T-cell therapy of B-cell lymphoma in a patient with systemic lupus erythematosus and antiphospholipid syndrome.","authors":"Eleonora Friedberg, Philipp Wohlfarth, Ana Iris Schiefer, Cathrin Skrabs, Winfried Franz Pickl, Nina Worel, Philipp Staber, Ulrich Jäger, Cihan Ay","doi":"10.1016/j.jtha.2024.09.024","DOIUrl":"10.1016/j.jtha.2024.09.024","url":null,"abstract":"<p><p>Antiphospholipid syndrome is an autoimmune disorder characterized by the development of spontaneous venous, arterial, or microvascular thrombosis and/or pregnancy-related complications (eg, miscarriages, fetal loss) in the presence of persistent antiphospholipid (aPL) antibodies. Current state-of-the-art treatment consists of indefinite anticoagulation with vitamin K antagonists to prevent recurrence of thrombotic events. This, however, represents only a symptom-control-oriented treatment approach. To date, no curative option eradicating aPL antibodies permanently or addressing the underlying pathomechanism has been established. Here, we report the case of a woman with systemic lupus erythematosus and antiphospholipid syndrome with triple aPL antibody-positivity who developed recurrent deep venous thrombosis. After receiving chimeric antigen receptor T-cell therapy for aggressive B-cell lymphoma, sustained eradication of all 3 aPL antibody subtypes was observed, suggesting a promising role of immunotherapies targeting anti-CD19 for the treatment of prothrombotic autoimmune disorders.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406564","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}
Pub Date : 2024-10-10DOI: 10.1016/j.jtha.2024.09.025
Gavin O'Toole, Dawn Swan, Jean M Connors, Jecko Thachil
Ischemic stroke is a common cause of morbidity and mortality worldwide. The majority of affected individuals are older, with clear cardiovascular or embolic risk factors; however, up to a fifth of cases may occur in patients under the age of 50 years. In this review, we discuss some common hematological causes of ischemic stroke in this age range, with a focus on antiphospholipid syndrome, myeloproliferative neoplasms, immune thrombocytopenic purpura, and sickle cell disease. We review the etiology of stroke associated with these conditions and explore important management considerations that may be unique to these settings. These include the choice of antithrombotic agents, cytoreduction in myeloproliferative neoplasms, management of thrombocytopenia in immune thrombocytopenic purpura, and treatment of sickle cell disease.
{"title":"Hematological causes of acute ischemic stroke in younger individuals.","authors":"Gavin O'Toole, Dawn Swan, Jean M Connors, Jecko Thachil","doi":"10.1016/j.jtha.2024.09.025","DOIUrl":"10.1016/j.jtha.2024.09.025","url":null,"abstract":"<p><p>Ischemic stroke is a common cause of morbidity and mortality worldwide. The majority of affected individuals are older, with clear cardiovascular or embolic risk factors; however, up to a fifth of cases may occur in patients under the age of 50 years. In this review, we discuss some common hematological causes of ischemic stroke in this age range, with a focus on antiphospholipid syndrome, myeloproliferative neoplasms, immune thrombocytopenic purpura, and sickle cell disease. We review the etiology of stroke associated with these conditions and explore important management considerations that may be unique to these settings. These include the choice of antithrombotic agents, cytoreduction in myeloproliferative neoplasms, management of thrombocytopenia in immune thrombocytopenic purpura, and treatment of sickle cell disease.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406565","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}
Pub Date : 2024-10-09DOI: 10.1016/j.jtha.2024.09.018
Irene Klaassen, Sahinde Sari, Heleen van Ommen, Eva Rettenbacher, Karin Fijnvandraat, Monique Suijker, Suzanne Cannegieter
Background: Postthrombotic syndrome (PTS) is a chronic condition following deep vein thrombosis (DVT) and is associated with pain, swelling, and restricted use of the affected limb. In pediatric age groups, its incidence and risk factors are not well-known.
Methods: This observational cohort study of all consecutive children (≤18 years) with DVT treated at the Emma Children's Hospital Amsterdam between January 2001 and January 2021 was conducted to identify incidence and risk factors for PTS in neonates aged ≤2 months and children aged >2 months. PTS was diagnosed using the modified Villalta scale.
Results: In total, 315 patients were included. The 20-year incidence of PTS was 20.0% in neonates and 40.0% in children. In neonates, involvement of ≥3 vessels (odds ratio [OR], 6.6; 95% CI, 1.6-26.4) and incomplete thrombus resolution (OR, 3.0; 95% CI, 1.1-8.0) were risk factors for PTS. In children, involvement of ≥3 vessels (OR, 6.2; 95% CI, 2.2-17.8), recurrent DVT (OR, 3.7; 95% CI, 1.3-10.3), and incomplete thrombus resolution (OR, 5.2; 95% CI, 1.6-17.0) were associated with PTS. Exercise ≥3 times/wk (OR, 0.4; 95% CI, 0.2-0.9), central venous catheter-related DVT (OR, 0.2; 95% CI, 0.1-0.5), and provoked DVT (OR, 0.4; 95% CI, 0.1-0.97) were protective factors for PTS.
Conclusion: This study demonstrated a high incidence of pediatric PTS. Additionally, risk factors for PTS differed between neonates and children. These findings provide a basis for better prevention and management of PTS that may differ between neonates and children.
血栓后综合征(PTS)是深静脉血栓形成(DVT)后的一种慢性疾病,与疼痛、肿胀和患肢使用受限有关。在儿童年龄组中,其发病率和风险因素尚不为人所知。这项观察性队列研究对 2001 年 1 月至 2021 年 1 月期间在阿姆斯特丹艾玛儿童医院接受治疗的所有连续深静脉血栓患儿(18 岁以下)进行了研究,以确定 2 个月以下新生儿和 2 个月以上儿童的 PTS 发病率和风险因素。PTS 采用改良维拉尔塔量表进行诊断。共纳入 315 名患者。20 年来,新生儿 PTS 的发病率为 20.0%,儿童为 40.0%。在新生儿中,累及≥3条血管(OR 6.6;95% CI 1.6-26.4)和血栓未完全溶解(OR 3.0;95% CI 1.1-8.0)是PTS的危险因素。在儿童中,累及≥ 3 根血管(OR 6.2,95% CI 2.2-17.8)、复发性深静脉血栓(OR 3.7,95% CI 1.3-10.3)和血栓未完全溶解(OR 5.2,95% CI 1.6-17.0)与 PTS 相关。运动≥3次/周(OR 0.4;95% CI 0.2-0.9)、中心静脉导管相关深静脉血栓(OR 0.2,95% CI 0.1-0.5)和诱发深静脉血栓(OR 0.4,95% CI 0.1-0.97)是PTS的保护因素。这项研究表明,儿科 PTS 的发病率很高。此外,新生儿和儿童的 PTS 风险因素也有所不同。这些发现为更好地预防和管理新生儿和儿童之间可能存在差异的 PTS 提供了依据。
{"title":"Incidence and risk factors for postthrombotic syndrome in neonates and children in a single-center cohort study.","authors":"Irene Klaassen, Sahinde Sari, Heleen van Ommen, Eva Rettenbacher, Karin Fijnvandraat, Monique Suijker, Suzanne Cannegieter","doi":"10.1016/j.jtha.2024.09.018","DOIUrl":"10.1016/j.jtha.2024.09.018","url":null,"abstract":"<p><strong>Background: </strong>Postthrombotic syndrome (PTS) is a chronic condition following deep vein thrombosis (DVT) and is associated with pain, swelling, and restricted use of the affected limb. In pediatric age groups, its incidence and risk factors are not well-known.</p><p><strong>Methods: </strong>This observational cohort study of all consecutive children (≤18 years) with DVT treated at the Emma Children's Hospital Amsterdam between January 2001 and January 2021 was conducted to identify incidence and risk factors for PTS in neonates aged ≤2 months and children aged >2 months. PTS was diagnosed using the modified Villalta scale.</p><p><strong>Results: </strong>In total, 315 patients were included. The 20-year incidence of PTS was 20.0% in neonates and 40.0% in children. In neonates, involvement of ≥3 vessels (odds ratio [OR], 6.6; 95% CI, 1.6-26.4) and incomplete thrombus resolution (OR, 3.0; 95% CI, 1.1-8.0) were risk factors for PTS. In children, involvement of ≥3 vessels (OR, 6.2; 95% CI, 2.2-17.8), recurrent DVT (OR, 3.7; 95% CI, 1.3-10.3), and incomplete thrombus resolution (OR, 5.2; 95% CI, 1.6-17.0) were associated with PTS. Exercise ≥3 times/wk (OR, 0.4; 95% CI, 0.2-0.9), central venous catheter-related DVT (OR, 0.2; 95% CI, 0.1-0.5), and provoked DVT (OR, 0.4; 95% CI, 0.1-0.97) were protective factors for PTS.</p><p><strong>Conclusion: </strong>This study demonstrated a high incidence of pediatric PTS. Additionally, risk factors for PTS differed between neonates and children. These findings provide a basis for better prevention and management of PTS that may differ between neonates and children.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400608","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}
Pub Date : 2024-10-09DOI: 10.1016/j.jtha.2024.09.016
Amelia K Haj, Justine Ryu, Sean J Jurgens, Sharjeel Chaudhry, Satoshi Koyama, Xin Wang, Seung Hoan Choi, Cody Hou, Simone Sanna-Cherchi, Christopher D Anderson, Patrick T Ellinor, Pavan K Bendapudi
Background: The vitamin K-dependent coagulation factor protein Z (PZ), encoded by the PROZ gene, is canonically considered to have anticoagulant effects through negative regulation of factor Xa. Paradoxically, higher circulating PZ concentrations have repeatedly been associated with an elevated risk of acute ischemic stroke.
Objectives: We performed a large-scale genetic association study to examine the relationship between germline genetic variants in PROZ and the risk of ischemic stroke.
Methods: Using whole-exome sequencing and clinical data for 416 711 participants in the UK Biobank (UKB), we identified individuals with rare (minor allele frequency ≤0.1%) putatively function-altering variants in PROZ. Using Firth's logistic regression and controlling for known stroke risk factors, we evaluated the association between variant carrier status and noncardioembolic ischemic stroke (NCEIS). Additionally, we evaluated differences in the plasma levels of 1472 proteins between PROZ variant carriers and noncarriers in a subset of 48 893 UKB participants.
Results: After accounting for missing data, qualifying variants in PROZ were identified in 414 UKB participants (99.0% heterozygous). Variant carriers had a significantly increased risk of NCEIS (odds ratio, 2.34; 95% CI, 1.15-4.13; P = .02) but not of venous thromboembolism, myocardial infarction, or peripheral artery disease. Plasma proteomics analysis revealed that PROZ variant carriers had significantly elevated levels of 2 proteins related to the response to cerebral ischemia, peroxiredoxins 1 and 6 (PRDX1: fold change, 1.83; P = 1.3 × 10-5; PRDX6: fold change, 1.78; P = 9.6 × 10-10).
Conclusion: Lifelong exposure to decreased PZ levels confers a significantly increased risk of NCEIS, consistent with the role of PZ as an anticoagulant factor.
{"title":"Loss of function in protein Z (PROZ) is associated with increased risk of ischemic stroke in the UK Biobank.","authors":"Amelia K Haj, Justine Ryu, Sean J Jurgens, Sharjeel Chaudhry, Satoshi Koyama, Xin Wang, Seung Hoan Choi, Cody Hou, Simone Sanna-Cherchi, Christopher D Anderson, Patrick T Ellinor, Pavan K Bendapudi","doi":"10.1016/j.jtha.2024.09.016","DOIUrl":"10.1016/j.jtha.2024.09.016","url":null,"abstract":"<p><strong>Background: </strong>The vitamin K-dependent coagulation factor protein Z (PZ), encoded by the PROZ gene, is canonically considered to have anticoagulant effects through negative regulation of factor Xa. Paradoxically, higher circulating PZ concentrations have repeatedly been associated with an elevated risk of acute ischemic stroke.</p><p><strong>Objectives: </strong>We performed a large-scale genetic association study to examine the relationship between germline genetic variants in PROZ and the risk of ischemic stroke.</p><p><strong>Methods: </strong>Using whole-exome sequencing and clinical data for 416 711 participants in the UK Biobank (UKB), we identified individuals with rare (minor allele frequency ≤0.1%) putatively function-altering variants in PROZ. Using Firth's logistic regression and controlling for known stroke risk factors, we evaluated the association between variant carrier status and noncardioembolic ischemic stroke (NCEIS). Additionally, we evaluated differences in the plasma levels of 1472 proteins between PROZ variant carriers and noncarriers in a subset of 48 893 UKB participants.</p><p><strong>Results: </strong>After accounting for missing data, qualifying variants in PROZ were identified in 414 UKB participants (99.0% heterozygous). Variant carriers had a significantly increased risk of NCEIS (odds ratio, 2.34; 95% CI, 1.15-4.13; P = .02) but not of venous thromboembolism, myocardial infarction, or peripheral artery disease. Plasma proteomics analysis revealed that PROZ variant carriers had significantly elevated levels of 2 proteins related to the response to cerebral ischemia, peroxiredoxins 1 and 6 (PRDX1: fold change, 1.83; P = 1.3 × 10<sup>-5</sup>; PRDX6: fold change, 1.78; P = 9.6 × 10<sup>-10</sup>).</p><p><strong>Conclusion: </strong>Lifelong exposure to decreased PZ levels confers a significantly increased risk of NCEIS, consistent with the role of PZ as an anticoagulant factor.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391506","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}
Pub Date : 2024-09-30DOI: 10.1016/j.jtha.2024.09.011
Yao An, Minghui Xu, Meishan Yan, Hongyu Zhang, Caixia Li, Lifeng Wang, Caixu Liu, Haoran Dong, Li Chen, Lixin Zhang, Yingli Chen, Xu Han, Yun Li, Dongsheng Wang, Chunyan Gao
Background: Whether primary or just as a complication from the progression of pulmonary arterial hypertension (PAH), thrombosis seems to be an important player in this condition. The crosstalk between red blood cells (RBCs) and pulmonary microvascular endothelial cells (PMVECs) and their role in PAH remain undefined.
Objectives: The goals of this study were to assess the role of RBC-PMVEC interaction in microvascular thrombosis and thrombotic vascular remodeling under hypoxic conditions.
Methods: We established an in vitro hypoxic coincubation model of RBC and PMVEC as well as a hypoxic mouse model. We investigated erythrophagocytosis (EP), ferroptosis, thrombosis tendency, and pulmonary hemodynamics in experimental PAH.
Results: Increased EP in PMVEC triggered ferroptosis, enhanced procoagulant activity, and exacerbated vessel remodeling under hypoxic conditions. In the PAH mouse model induced by chronic hypoxia, EP-induced ferroptosis followed by upregulated TMEM16F led to a high tendency of thrombus formation and thrombotic vascular remodeling. Inhibition of ferroptosis or silencing of TMEM16F could alleviate hypercoagulable phenotype, reverse right ventricular systolic pressure, right ventricular hypertrophy index, and remodeling of pulmonary vessels.
Conclusion: These results illustrate the pathogenic RBC-PMVEC interactions in PAH. Inhibition EP, ferroptosis, or TMEM16F could be a novel therapeutic target to prevent PAH development and thrombotic complications.
{"title":"Erythrophagocytosis-induced ferroptosis contributes to pulmonary microvascular thrombosis and thrombotic vascular remodeling in pulmonary arterial hypertension.","authors":"Yao An, Minghui Xu, Meishan Yan, Hongyu Zhang, Caixia Li, Lifeng Wang, Caixu Liu, Haoran Dong, Li Chen, Lixin Zhang, Yingli Chen, Xu Han, Yun Li, Dongsheng Wang, Chunyan Gao","doi":"10.1016/j.jtha.2024.09.011","DOIUrl":"10.1016/j.jtha.2024.09.011","url":null,"abstract":"<p><strong>Background: </strong>Whether primary or just as a complication from the progression of pulmonary arterial hypertension (PAH), thrombosis seems to be an important player in this condition. The crosstalk between red blood cells (RBCs) and pulmonary microvascular endothelial cells (PMVECs) and their role in PAH remain undefined.</p><p><strong>Objectives: </strong>The goals of this study were to assess the role of RBC-PMVEC interaction in microvascular thrombosis and thrombotic vascular remodeling under hypoxic conditions.</p><p><strong>Methods: </strong>We established an in vitro hypoxic coincubation model of RBC and PMVEC as well as a hypoxic mouse model. We investigated erythrophagocytosis (EP), ferroptosis, thrombosis tendency, and pulmonary hemodynamics in experimental PAH.</p><p><strong>Results: </strong>Increased EP in PMVEC triggered ferroptosis, enhanced procoagulant activity, and exacerbated vessel remodeling under hypoxic conditions. In the PAH mouse model induced by chronic hypoxia, EP-induced ferroptosis followed by upregulated TMEM16F led to a high tendency of thrombus formation and thrombotic vascular remodeling. Inhibition of ferroptosis or silencing of TMEM16F could alleviate hypercoagulable phenotype, reverse right ventricular systolic pressure, right ventricular hypertrophy index, and remodeling of pulmonary vessels.</p><p><strong>Conclusion: </strong>These results illustrate the pathogenic RBC-PMVEC interactions in PAH. Inhibition EP, ferroptosis, or TMEM16F could be a novel therapeutic target to prevent PAH development and thrombotic complications.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365705","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}
Background: Despite appropriate treatment, up to 50% of patients with proximal deep vein thrombosis will develop postthrombotic syndrome (PTS). Once PTS occurs, there is no specific treatment, and some patients constantly experience intolerable symptoms. Hence, prevention of PTS is important.
Objectives: To characterize vein wall remodeling after thrombus and investigate the effects of antiproliferative agent on postthrombotic vein wall remodeling in murine and human subjects.
Methods: Features of postthrombotic vein wall remodeling in murine and human subjects were characterized using imaging and histologic examinations. Paclitaxel-loaded hydrogels were used to assess the effects of antiproliferative agent on the remodeling in murine model. Based on the abovementioned results, a pilot study was conducted to assess the effects of paclitaxel-coated balloon dilation in patients with severe PTS experiencing intolerable symptoms. The control cohort was obtained by 1:1 propensity score matching from a prospective database.
Results: Structural and functional alterations in postthrombotic vein wall were verified by imaging and histologic examinations, and predominant active α-smooth muscle actin-positive cells and fibroblast-specific protein 1-positive cells proliferation was observed. In the murine model, the application of paclitaxel-loaded hydrogels inhibited the remodeling. In the pilot clinical study, patients receiving drug-coated balloon demonstrated benefits in Villalta scores and venous clinical severity scores compared with those not receiving drug-coated balloon, and no severe adverse events were reported except for thrombosis recurrence.
Conclusion: Cell proliferation plays an important role in postthrombotic vein wall remodeling. Inhibition of cell proliferation inhibits the remodeling in murine model and may reduce signs and symptoms in patients with severe PTS.
{"title":"Antiproliferative agent attenuates postthrombotic vein wall remodeling in murine and human subjects.","authors":"Hongji Pu, Jiahao Lei, Guodong Du, Qun Huang, Peng Qiu, Junchao Liu, Chenshu Li, Xiaoliang Ying, Kailang Liu, Zhijue Xu, Xinwu Lu, Ruihua Wang","doi":"10.1016/j.jtha.2024.09.012","DOIUrl":"10.1016/j.jtha.2024.09.012","url":null,"abstract":"<p><strong>Background: </strong>Despite appropriate treatment, up to 50% of patients with proximal deep vein thrombosis will develop postthrombotic syndrome (PTS). Once PTS occurs, there is no specific treatment, and some patients constantly experience intolerable symptoms. Hence, prevention of PTS is important.</p><p><strong>Objectives: </strong>To characterize vein wall remodeling after thrombus and investigate the effects of antiproliferative agent on postthrombotic vein wall remodeling in murine and human subjects.</p><p><strong>Methods: </strong>Features of postthrombotic vein wall remodeling in murine and human subjects were characterized using imaging and histologic examinations. Paclitaxel-loaded hydrogels were used to assess the effects of antiproliferative agent on the remodeling in murine model. Based on the abovementioned results, a pilot study was conducted to assess the effects of paclitaxel-coated balloon dilation in patients with severe PTS experiencing intolerable symptoms. The control cohort was obtained by 1:1 propensity score matching from a prospective database.</p><p><strong>Results: </strong>Structural and functional alterations in postthrombotic vein wall were verified by imaging and histologic examinations, and predominant active α-smooth muscle actin-positive cells and fibroblast-specific protein 1-positive cells proliferation was observed. In the murine model, the application of paclitaxel-loaded hydrogels inhibited the remodeling. In the pilot clinical study, patients receiving drug-coated balloon demonstrated benefits in Villalta scores and venous clinical severity scores compared with those not receiving drug-coated balloon, and no severe adverse events were reported except for thrombosis recurrence.</p><p><strong>Conclusion: </strong>Cell proliferation plays an important role in postthrombotic vein wall remodeling. Inhibition of cell proliferation inhibits the remodeling in murine model and may reduce signs and symptoms in patients with severe PTS.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365704","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}