Journal of Thrombosis and Thrombolysis最新文献

Management of acute pulmonary embolism (PE) during pregnancy or post-partum is challenging especially in women at intermediate or high-risk of adverse outcomes. Catheter-directed therapies (CDTs) are increasingly used given their potential efficacy and relatively low complication rates. We systematically reviewed the evidence on CDTs use in pregnancy and post-partum PE. Literature search was conducted in bibliographic databases, reference lists, and review articles until 2 July 2025, without restrictions. Main efficacy and safety outcomes were maternal all-cause and PE-related mortality, fetal mortality, improved right ventricle dysfunction (RVD) and/or pulmonary artery (PA) pressures, improved lung perfusion/clot burden reduction, and maternal major bleeding (MB). We identified 65 case reports, 4 case series and 1 cohort study for a total of 76 patients. Maternal all-cause mortality within 7 days from CDT was 2.8% (2/72; 95% confidence interval [CI], 0.3-9.7%) with no PE-related deaths. In-hospital fetal mortality was 12.5% (5/40; 95% CI, 4.2-26.8%). Within 72 h from CDT were observed: an improvement of RVD and/or PA pressures in 96.2% (25/26; 95% CI, 80.4-99.9%), and in lung perfusion/reduction in clot burden in 94.4% of cases (34/36; 95% CI, 81.3-99.3%); maternal MB in 17.2% of cases (11/64; 95% CI, 8.9-28.7%), with 10 out of 11 events (90.9%) reported in the post-partum period. Current evidence is limited and of low quality. CDTs should be considered only after a multidisciplinary evaluation of selected cases, balancing potential benefits and bleeding risks, the latter being mainly observed in the post-partum.

Acute ischemic stroke is a leading cause of disability and death worldwide. This commentary highlights the role of thrombus composition in influencing treatment outcomes and therapeutic strategies. Rapid reperfusion through intravenous thrombolysis and mechanical thrombectomy is critical to salvage brain tissue. Distal medium vessel occlusions, accounting for approximately 30% of strokes, often result in persistent disability despite optimal therapy, emphasizing the need to understand factors affecting reperfusion success. Stroke thrombi exhibit marked heterogeneity, comprising red blood cells, fibrin, platelets, neutrophils, and von Willebrand factor. Distal occlusions tend to contain more platelet- and fibrin-rich thrombi and fewer red blood cells compared with proximal occlusions. Platelet- and fibrin-dense thrombi are more resistant to thrombolysis and are associated with longer, more complex thrombectomy procedures, while red blood cell-rich thrombi respond better. Anticoagulation may influence thrombus composition, and novel strategies, including fibrin-specific thrombolytics and combination approaches targeting multiple thrombus components, hold promise for improving reperfusion and functional outcomes.

This study evaluates the role of ultrasound-mediated thrombolysis (sonothrombolysis) as an adjunct to percutaneous coronary intervention (PCI) in patients with ST-elevated myocardial infarction (STEMI). A comprehensive literature search was conducted across five databases, identifying randomized controlled trials (RCTs) assessing sonothrombolysis in addition to PCI in STEMI patients. Data analysis employed a random effects model in R, focusing on outcomes like left ventricular ejection fraction (LVEF), end diastolic volume (LVEDV), systolic volume (LVESV), left ventricular global longitudinal strain (LV-GLS), and infarct size, evaluated at multiple time points. Six RCTs evaluated sonothrombolysis combined with PCI (241 patients) versus PCI alone (232 patients). LVEF was significantly higher in the sonothrombolysis group immediately post-PCI (MD: 4.00; 95% CI: 1.62, 6.38; P = 0.001) and at subsequent time points (MD: 4.06-4.39; P < 0.01). LVEDV and LVESV were significantly lower at 48-72 h and 6 months in the sonothrombolysis group. LV-GLS was consistently higher across all time points. Infarct size was notably smaller in the sonothrombolysis arm across all time points (MD: - 5.41, 95%CI: [- 8.82, - 2.00]; p = 0.0018). Sonothrombolysis significantly improves cardiac outcomes following PCI in STEMI patients, showcasing better LVEF, lower LVEDV and LVESV, and reduced infarct size. Further exploration of its standalone and adjunctive potential with PCI is warranted.

Cancer-associated thrombosis (CAT) with thrombocytopenia (TP) poses concurrent risks of bleeding and recurrence. Guidance is fragmented by nonuniform platelet thresholds, tumor-context effects on agent choice, and scarce prospective data for DOACs specifically in TP. We outline a platelet-count-adaptive framework: (i) standardized platelet bands linked to dose/agent actions; (ii) tumor-biology-aware selection; (iii) transfusion-sparing triggers; and (iv) a core outcome set that indexes events to time spent within platelet bands ("platelet-adjusted bleeding rate"). The schema is evidence-aligned, feasible in resource-constrained settings, and offers testable standards for pragmatic trials. Translating recent syntheses into implementable, equity-aware standards can reduce unwarranted variation and accelerate learning across diverse care settings.