Journal of Thrombosis and Haemostasis最新文献

{"title":"Prophylactic von Willebrand factor replacement in durable left ventricular assist device patients: a sticky subject","authors":"Michael Mazzeffi , Jerrold H. Levy , Kenichi Tanaka","doi":"10.1016/j.jtha.2025.10.023","DOIUrl":"10.1016/j.jtha.2025.10.023","url":null,"abstract":"","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"24 2","pages":"Pages 378-380"},"PeriodicalIF":5.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146102416","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}

{"title":"Unraveling the molecular mechanism of in situ surface-initiated thrombogenesis","authors":"Adam Hansen ,&nbsp;Georgios Kementzidis ,&nbsp;Bernard Essuman ,&nbsp;Ziyuan Niu ,&nbsp;Jawaad Sheriff ,&nbsp;Volodymyr Chernyshenko ,&nbsp;Yuefan Deng ,&nbsp;Miriam Rafailovich ,&nbsp;Dennis K. Galanakis","doi":"10.1016/j.jtha.2025.09.042","DOIUrl":"10.1016/j.jtha.2025.09.042","url":null,"abstract":"<div><h3>Background</h3><div>Thrombosis caused by contact of blood with surfaces is a serious complication in the incorporation of biomedical devices. Adsorption of fibrinogen to these commonly hydrophobic surfaces can lead to conformational changes in the molecule, which eventually leads to thrombogenesis. The origin of these thrombi and the underlying mechanism through which the surfaces contribute to the outcome remains undefined.</div></div><div><h3>Objectives</h3><div>This study aimed to investigate and understand the interactions of fibrinogen with surfaces at the molecular level.</div></div><div><h3>Methods</h3><div>Visualization of fibrinogen interactions following adsorption to polystyrene surfaces was performed using atomic force microscopy, transmission electron microscopy, and fluorescence microscopy and further evaluated using various antibodies and platelet flow assays.</div></div><div><h3>Results</h3><div>Surface adsorption led to a misfolding of fibrinogen molecules, namely untethering of αC-domains. Conformational changes resulted in the onset of intermolecular interactions and random linkages of neighboring molecules, mediated by the N-terminal subdomain of the αC-domain (Aα406-483). When concentration of fibrinogen solutions was increased to 20 to 500 μg/mL, structured monolayers that grew continuously into multilayers were observed but were self-limited due to the decrease in untethered αC-domains in subsequent fibrinogen bilayers. Soluble fibrin structure was determined to be a clustered complex of fibrinogen and fibrin with a protofibril core. These complexes adsorbed and aggregated onto multilayers through exposed αC-domains on both surfaces, leading to large fiber formations. Surface fibers promoted platelet adhesion and activation, implying exposure of binding domain γ400-411.</div></div><div><h3>Conclusion</h3><div>This comprehensive study models the precise molecular mechanism of surface-initiated thrombogenesis and may provide the foundation necessary to design effective inhibition techniques.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"24 2","pages":"Pages 530-544"},"PeriodicalIF":5.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145431525","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}

{"title":"Outcomes of anticoagulation treatment for renal cell carcinoma tumor thrombi: a systematic review","authors":"Bram Akerboom ,&nbsp;Emily S.L. Martens ,&nbsp;Fleur H.J. Kaptein ,&nbsp;Tsunenori Kondo ,&nbsp;Tom van der Hulle ,&nbsp;Erik J. van Gennep ,&nbsp;Henri H. Versteeg ,&nbsp;Thijs E. van Mens ,&nbsp;Frederikus A. .Klok","doi":"10.1016/j.jtha.2025.10.020","DOIUrl":"10.1016/j.jtha.2025.10.020","url":null,"abstract":"<div><h3>Background</h3><div>Patients with renal cell carcinoma (RCC) and tumor thrombus (TT) are at significant risk of venous thromboembolism (VTE).</div></div><div><h3>Objectives</h3><div>This systematic review aimed to assess the role of anticoagulation in ambulatory patients with RCC and TT.</div></div><div><h3>Methods</h3><div>Inclusion criteria were diagnosis of RCC with TT, reporting of VTE, major bleeding and/or arterial thromboembolism, as well as exposure to anticoagulation. Studies with &lt;30 patients were excluded. Studies were also excluded if anticoagulation status was not reported per outcome stratum. A comprehensive search was conducted in PubMed and other databases. Risk of bias was assessed in accordance with the Scottish Intercollegiate Guidelines Network bias quality assessment tool.</div></div><div><h3>Results</h3><div>Six observational studies containing 659 patients were included. All studies had considerable risk of bias. Anticoagulation use ranged from 3.9% to 50%. Two studies reported a lower VTE incidence in anticoagulated patients than in non–anticoagulated patients: 7.3% (1.2–21) vs 20% (6.9–37) after 1 year, and 18% (1.5–49) vs 24% (14–36) after 2 years. In anticoagulated patients, major bleeding incidence was 12% (2.8–27) after 1 year and 33% (8.2–60) after 2 years. For non–anticoagulated patients the incidence was 19% (6.6–36) after 1 year and 12% (5.1–22) after 2 years. Importantly, none of the studies were management studies, and confidence intervals of our outcomes were wide.</div></div><div><h3>Conclusion</h3><div>Anticoagulation in patients with RCC with TT may lower VTE risk. Bleeding risk is high in both anticoagulated as well as non–anticoagulated patients. Current evidence remains inconclusive due to study heterogeneity and risk of bias.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"24 2","pages":"Pages 654-661"},"PeriodicalIF":5.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145459089","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}

{"title":"Thiol isomerase ERp46 catalyzes the disulfide formation of coagulation factor XII enhancing its activity","authors":"Aizhen Yang ,&nbsp;Yaqiong Zhang ,&nbsp;Yaowei Sun ,&nbsp;Miao Jiang ,&nbsp;Yi Lu ,&nbsp;Yue Han ,&nbsp;Depei Wu ,&nbsp;Zhipu Luo ,&nbsp;Yi Wu","doi":"10.1016/j.jtha.2025.10.016","DOIUrl":"10.1016/j.jtha.2025.10.016","url":null,"abstract":"<div><h3>Background</h3><div>Protein disulfide isomerases (PDIs) are a family of thiol oxidoreductases that catalyze the oxidation, reduction, and isomerization of disulfide bonds. While some PDIs enhance arterial thrombosis, their roles in coagulation system remain largely unknown.</div></div><div><h3>Methods</h3><div>The effect of a thiol blocker N-ethylmaleimide and a reducing agent dithiothreitol on factor XII activity was measured by chromogenic assay, activated partial thromboplastin time and thrombin generation assay. Redox states of FXII disulfides were determined by thiol labeling and mass spectrometry. Functional disulfides were evaluated through cysteine mutagenesis of FXII and predicting structural function via molecular dynamics simulations. Thiol modification and kinetic trapping were used to identify ERp46 substrates. The inferior vena cava stenosis model assessed the roles of ERp46 and FXII in venous thrombosis.</div></div><div><h3>Results</h3><div>N-ethylmaleimide significantly prolonged activated partial thromboplastin time and inhibited FXIIa chromogenic activity, while dithiothreitol inhibited clotting, thrombin generation, and substrate HK cleavage. Of the PDIs tested, only oxidized ERp46 enhanced FXII activity. Screening identified Cys513-Cys529 and Cys540-Cys571 as crucial disulfides for FXII function. Notably, half of Cys540-Cys571 were in partially disulfide-bonded form. ERp46 oxidized Cys540-Cys571 and increased FXII activity. <em>In vivo</em>, ERp46 deficiency reduced venous thrombus growth, with no additive effect observed in mice with combined ERp46 and FXII deficiency. Only wild-type FXII protein, not FXII/C540S-C571S mutant, restored venous thrombus growth in FXII-deficient mice.</div></div><div><h3>Conclusion</h3><div>These findings reveal a novel redox-regulatory mechanism for FXII activity and identify the critical role of ERp46 in oxidization of Cys540-Cys571 disulfide, facilitating the activation of FXII and intrinsic coagulation pathway.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"24 2","pages":"Pages 558-572"},"PeriodicalIF":5.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145459112","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}

{"title":"Mechanisms and treatment of venous thromboembolism in patients with brain cancer: a narrative review","authors":"Timothy Hoberstorfer,&nbsp;Cihan Ay,&nbsp;Julia Riedl","doi":"10.1016/j.jtha.2025.10.022","DOIUrl":"10.1016/j.jtha.2025.10.022","url":null,"abstract":"<div><div>Malignant brain tumors, including both primary brain cancer and metastatic brain cancer, are associated with a markedly increased risk of venous thromboembolism (VTE). Anticoagulation is challenging in this population, as these patients are not only at risk of thrombotic complications but also at high risk of bleeding. In this review, we examine current knowledge on the incidence, risk factors, pathophysiology, and management of brain cancer–associated VTE. In primary brain cancer, particularly in glioblastoma, expression of the procoagulant proteins podoplanin and tissue factor by tumor cells was found to be an important pathophysiological driver of hypercoagulability. Expression of these prothrombotic factors was found to be dependent on the genetic profile of the brain tumor. Clinical data on the treatment of VTE in brain cancer are limited and mostly based on observational studies. The risk of intracranial hemorrhage during anticoagulation remains a key concern. Data from retrospective studies suggest that direct oral anticoagulants may be associated with a lower bleeding risk than low-molecular-weight heparins. Pharmacological thromboprophylaxis in the ambulatory setting is not routinely recommended, largely due to the lack of trial data in this population. Future studies are needed to improve risk prediction, to clarify the underlying mechanisms of brain cancer–associated VTE, and to define safe and effective treatment strategies.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"24 2","pages":"Pages 343-353"},"PeriodicalIF":5.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145445205","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}

{"title":"Anticoagulation stewardship from menstruation to menopause: a toolkit for clinical management","authors":"Divyaswathi Citla-Sridhar ,&nbsp;Shruti Karanth ,&nbsp;Andrea Van Beek ,&nbsp;Tara Lech ,&nbsp;Bethany Samuelson Bannow","doi":"10.1016/j.jtha.2025.11.008","DOIUrl":"10.1016/j.jtha.2025.11.008","url":null,"abstract":"<div><div>The care of menstruating individuals on anticoagulation is complex and often overlooked in current clinical guidelines. Although existing recommendations address anticoagulant use broadly, they provide little guidance on managing menstrual bleeding, contraception, or reproductive transitions in this population. To address these gaps, we developed a practical clinical toolkit focused on anticoagulation stewardship for individuals who menstruate—from adolescence through menopause. This expert-driven resource outlines the best practices for identifying and managing heavy menstrual bleeding, optimizing contraceptive counseling, and coordinating care during high-risk periods such as pregnancy, surgery, and perimenopause. It also offers guidance for special populations, including adolescents, transgender and gender-diverse individuals, and those with limited access to care. Key topics include medication selection, dose adjustment, screening for anemia, and referral to gynecology when appropriate. The toolkit emphasizes the role of multidisciplinary teams—including hematology, gynecology, primary care, and anticoagulation services—in delivering patient-centered, equitable care. It also highlights practical strategies for integrating menstrual health into routine anticoagulation management, promoting shared decision making, and improving quality of life for affected individuals.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"24 2","pages":"Pages 387-398"},"PeriodicalIF":5.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145723875","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}

{"title":"Evaluation of the updated ABC-AF-bleeding score 2.0 in patients with atrial fibrillation treated with a direct oral anticoagulant or warfarin","authors":"Ziad Hijazi ,&nbsp;Johan Lindbäck ,&nbsp;Jonas Oldgren ,&nbsp;John H. Alexander ,&nbsp;Alexander P. Benz ,&nbsp;David D. Berg ,&nbsp;Anthony P. Carnicelli ,&nbsp;John W. Eikelboom ,&nbsp;Robert P. Giugliano ,&nbsp;Shinya Goto ,&nbsp;Christopher B. Granger ,&nbsp;Renato D. Lopes ,&nbsp;Christian T. Ruff ,&nbsp;Agneta Siegbahn ,&nbsp;David A. Morrow ,&nbsp;Lars Wallentin","doi":"10.1016/j.jtha.2025.09.032","DOIUrl":"10.1016/j.jtha.2025.09.032","url":null,"abstract":"<div><h3>Background</h3><div>Oral anticoagulation (OAC) reduces stroke in patients with atrial fibrillation (AF), but increases bleeding.</div></div><div><h3>Objectives</h3><div>This study aimed to evaluate an updated version of the Age, Biomarkers, and Clinical history of bleeding in AF (ABC-AF)-bleeding score (2.0) including consideration of OAC type (direct oral anticoagulant [DOAC] or warfarin) and compare its performance with other bleeding risk scores in 25 962 patients from the COMBINE AF cohort.</div></div><div><h3>Methods</h3><div>The COMBINE AF biomarker cohort contains individual participant data from patients with AF enrolled in 3 pivotal randomized trials comparing DOACs with warfarin. The biomarkers in the ABC-AF-bleeding score (growth differentiation factor 15, hemoglobin, and troponin-T) were analyzed in baseline samples. The biomarker-based ABC-AF-bleeding score was updated (version 2.0) by incorporating OAC type into the model (DOAC or warfarin). Discrimination was assessed by Harrell C-index and compared with clinically based bleeding scores; HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile INR, Elderly, Drugs/alcohol), DOAC, and ORBIT (Older age, Reduced haemoglobin/haematocrit or history of anaemia, Bleeding history, Insufficient renal function, Treatment with antiplatelet agents).</div></div><div><h3>Results</h3><div>During follow-up, 1321 patients (5.1%) had an International Society on Thrombosis and Haemostasis major bleeding event, including 480 gastrointestinal, and 248 intracranial hemorrhages. The ABC-AF-bleeding 2.0 risk score showed better discrimination and calibration than the original version and provided superior discrimination than clinical risk scores for all outcomes. The ABC-AF-bleeding score 2.0 C-indices for major bleeding were 0.69 (95% CI, 0.68-0.71); gastrointestinal bleeding, 0.72 (95% CI, 0.69-0.74); and intracranial bleeding, 0.66 (95% CI, 0.63-0.70). The ABC-AF-bleeding score 2.0 also provided consistent superior discrimination in clinically relevant subgroups.</div></div><div><h3>Conclusion</h3><div>The updated ABC-AF-bleeding score 2.0 provided better discrimination and calibration for the risk of major bleeding than clinical risk scores, which was consistent across multiple subgroups. These findings support the utility of the ABC-AF-bleeding score for advancing precision medicine in AF.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"24 2","pages":"Pages 399-407"},"PeriodicalIF":5.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146102578","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}

{"title":"Plasma levels measurement of the 4 direct oral anticoagulants in patients with atrial fibrillation at the time of acute thromboembolic and bleeding events: reply","authors":"Cosmo Godino ,&nbsp;Riccardo Mazza","doi":"10.1016/j.jtha.2025.11.012","DOIUrl":"10.1016/j.jtha.2025.11.012","url":null,"abstract":"","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"24 2","pages":"Page 784"},"PeriodicalIF":5.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146102420","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}

{"title":"Considerations of safety for women prescribed apixaban or rivaroxaban who breastfeed—a physiologically based pharmacokinetic analysis","authors":"Andrew S. Butler ,&nbsp;Susan Cole ,&nbsp;Roopen Arya ,&nbsp;Jignesh P. Patel","doi":"10.1016/j.jtha.2025.09.040","DOIUrl":"10.1016/j.jtha.2025.09.040","url":null,"abstract":"<div><h3>Background</h3><div>The risk of venous thromboembolism is significantly increased during the perinatal period. The safety of the direct oral anticoagulants, apixaban and rivaroxaban, has not been established in women who breastfeed. Physiologically based pharmacokinetic (PBPK) modeling provides a means to understand drug disposition and is increasingly being used to predict infant exposure to maternal medication via breastmilk.</div></div><div><h3>Objectives</h3><div>To utilize established PBPK models of apixaban and rivaroxaban to simulate infant exposure to maternal ingestion.</div></div><div><h3>Methods</h3><div>Existing PBPK models for apixaban and rivaroxaban were adapted to the lactation setting. These models were verified using published reports of apixaban and rivaroxaban from breastfeeding women. A virtual postpartum population was then generated to simulate maternal and infant exposure to rivaroxaban and apixaban at different doses and time points during the postpartum period. Work was conducted on Simcyp Simulator (v23).</div></div><div><h3>Results</h3><div>The adapted apixaban and rivaroxaban PBPK models captured the published breastfeeding clinical data well. Apixaban transferred into human breastmilk significantly more than rivaroxaban. Steady state infant plasma AUC_24-48 to a fully breastfed infant following maternal dose of rivaroxaban 20 mg daily was 242 (±107) ng/mL·h in the immediate postpartum period and for apixaban 5 mg twice a day AUC_24-48 was 2041 (±466) ng/mL. Maternal exposure to apixaban and rivaroxaban was lower immediately postdelivery and then normalized by 6 weeks postpartum.</div></div><div><h3>Conclusion</h3><div>Our work demonstrates that apixaban would not be a suitable agent for breastfeeding women during the postnatal period, while rivaroxaban shows significant promise due to low infant exposure and warrants further investigation.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"24 2","pages":"Pages 520-529"},"PeriodicalIF":5.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145401298","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}

{"title":"Safety and efficiency of diagnostic strategies for ruling out pulmonary embolism in patients with chronic lung disease: an individual-patient data meta-analysis","authors":"Vicky Mai ,&nbsp;Toshihiko Takada ,&nbsp;Noemie Kraaijpoel ,&nbsp;Nick van Es ,&nbsp;Ranjeeta Mallick ,&nbsp;Milou A.M. Stals ,&nbsp;Harry R. Büller ,&nbsp;D. Mark Courtney ,&nbsp;Yonathan Freund ,&nbsp;Javier Galipienzo ,&nbsp;Waleed Ghanima ,&nbsp;Menno V. Huisman ,&nbsp;Jeffrey A. Kline ,&nbsp;Karel G.M. Moons ,&nbsp;Sameer Parpia ,&nbsp;Arnaud Perrier ,&nbsp;Marc Righini ,&nbsp;Helia Robert-Ebadi ,&nbsp;Pierre-Marie Roy ,&nbsp;Maarten van Smeden ,&nbsp;Grégoire Le Gal","doi":"10.1016/j.jtha.2025.10.004","DOIUrl":"10.1016/j.jtha.2025.10.004","url":null,"abstract":"<div><h3>Background</h3><div>The optimal diagnostic management of patients with chronic lung disease (CLD) and suspected pulmonary embolism (PE) is unclear.</div></div><div><h3>Objectives</h3><div>The aim of this study was to evaluate the performance of PE diagnostic strategies in patients with and without CLD.</div></div><div><h3>Methods</h3><div>This is a secondary analysis of an individual-patient data meta-analysis (PROSPERO CRD42018089366) of prospective or cross-sectional studies evaluating conventional (Wells or revised Geneva score with fixed or age-adjusted D-dimer) and newer (YEARS and the Pulmonary Embolism Graduated D-dimer Study algorithms) diagnostic strategies. Main outcomes were safety and efficiency. Safety was defined by the failure rate (proportion of patients diagnosed with venous thromboembolism during initial workup or follow-up among those in whom PE was considered ruled out at baseline without imaging). Efficiency was defined as the proportion of patients in whom PE was considered excluded without the need for imaging among all patients.</div></div><div><h3>Results</h3><div>Twelve studies, representing 16 990 patients (2201 patients with CLD) were included. The safety of each strategy was comparable in patients with and without CLD, whereas efficiency of the strategies was lower in patients with CLD. In patients with CLD, the predicted failure rate varied between 0.58% (95% CI, 0.10%-3.20%) and 1.06% (95% CI, 0.44%-2.53%), and between 2.54% (95% CI, 1.45%-4.39%) and 3.12% (95% CI, 2.04%-4.74%) for conventional and newer diagnostic strategies, respectively. The predicted efficiency was 19.0% to 33.2% and 35.8% to 43.9% for conventional and newer diagnostic strategies, respectively.</div></div><div><h3>Conclusion</h3><div>In patients with CLD, diagnostic failure rate seemed slightly lower with conventional diagnostic strategies, but more patients would need imaging to rule out PE, compared with newer diagnostic strategies.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"24 2","pages":"Pages 598-607"},"PeriodicalIF":5.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145401307","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}