Journal of Thrombosis and Thrombolysis最新文献

Despite thromboprophylaxis, neurosurgical patients remain at high post-operative thromboembolic risk, but early diagnosis of deep vein thrombosis (DVT) is challenging. To investigate whether elevated D-dimer levels may assist to diagnose post-surgery DVT in neurosurgical patients. A retrospective observational study was performed involving all patients who received venous ultrasound assessment (US) for suspected DVT, prompted by elevated D-dimer levels observed after neurosurgery. We compared clinical characteristics and D-dimer levels in patients with and without venous thrombosis. Logistic regression analysis was used to ascertain any association between elevated D-dimer levels and the risk of developing DVT in patients investigated between the 3rd and 15th day after surgery. The ROC curve was used to identify the cut-offs values for suspected DVT. Among 556 consecutive neurosurgical patients, 73 underwent post-surgery venous US for increased D-dimer levels and 35 had venous thrombosis; among these, DVT occurred in 20 out of 43 (46.5%) patients investigated between the 3rd and 15th post-operative day. Among variables considered, only D-dimer levels were significantly higher in patients with DVT. Logistic regression analysis revealed an odds ratio (OR) of 1.98 (CI 1.04-3.78, p = 0.03) for each 1000 µg/L D-dimer increase. The ROC curve identified an optimal D-dimer cut-off value of 1334 µg/L (sensitivity 0.90, specificity 0.52, negative likelihood ratio 0.2) (OR 9.8, CI 1.8-5.7, p = 0.007). D-dimer threshold of 2200 µg/L was associated with the best positive predictive value (77%; specificity 0.87, positive likelihood ratio 3.8). Elevated D-dimer levels were associated with increased risk of DVT after neurosurgery.

Pancreatic cancer is one of the most thrombogenic malignancies. Venous thromboembolism (VTE) is a frequent and very severe complication. The risk of thrombosis and postoperative hemorrhage, especially post-pancreatectomy, makes thromboprophylaxis difficult to implement in clinical practice depending on what component dominates. A review was conducted using PubMed, Scopus, Web of Science, Elsevier, and Google Scholar databases. Studies published in English focusing on VTE pathophysiology, prevention, and treatment in pancreatic cancer were included. The evidence was summarized descriptively. Two randomized trials (FRAGEM and CONKO-004) have shown that intensified, weight-adjusted low-molecular-weight heparin (LMWH) significantly decreases the incidence of VTE in advanced pancreatic cancer (PC) without significantly increasing major bleeding or enhancing survival rates. Direct oral anticoagulants (DOACs) such as rivaroxaban and apixaban present potential as oral alternatives; however, they are associated with a greater risk of gastrointestinal bleeding. Following pancreatectomy, VTE occurs in 20-25% of patients-frequently after discharge-highlighting the necessity for extended prophylaxis lasting at least 28 days. Minimally invasive surgical techniques are linked to a marginally elevated risk of VTE when compared to open surgery. Nevertheless, the available data concerning dosing, timing, and the resumption of anticoagulation after post-pancreatectomy hemorrhage (PPH) is still inadequate. Current evidence supports the use of LMWH-based anticoagulation strategies for VTE prevention in pancreatic cancer; however, direct evidence for standard prophylactic dosing is lacking, as available randomized trials evaluated intensified regimens. DOACs may be used selectively, considering bleeding risk. The lack of pancreatic-cancer-specific dosing protocols and perioperative guidelines highlights the need for dedicated trials defining optimal anticoagulation strategies and safe timing of therapy after PPH.

Introduction: Coronary artery bypass grafting (CABG) is a common surgical treatment for coronary artery disease; however, long-term success is limited by saphenous vein graft (SVG) occlusion. Aspirin remains the standard lifelong antiplatelet therapy; however, graft failure and adverse events persist after its use. More potent agents, such as ticagrelor, have been proposed, although the evidence is inconsistent, and concerns about bleeding risk remain. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing ticagrelor-based therapy with aspirin monotherapy in patients who underwent CABG. A comprehensive literature search of major databases was performed until August 2025. The primary endpoints were major bleeding, MACE, and all-cause mortality. The secondary outcomes included saphenous vein graft failure, stroke, myocardial infarction, and repeat revascularization. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model. Five randomized controlled trials comprising 4,208 patients (ticagrelor-based therapy ≈ 2,108; aspirin monotherapy ≈ 2,100) were included. Across the primary clinical endpoints, ticagrelor-based therapy showed no significant advantage over aspirin, with comparable rates of MACE (RR 1.05, 95% CI 0.78-1.41; p = 0.75; I² = 20%), all-cause mortality (RR 1.02, 95% CI 0.74-1.40; p = 0.93; I² = 0%), and major bleeding (RR 1.09, 95% CI 0.68-1.74; p = 0.73; I² = 51%). Similarly, no significant differences were observed for stroke (RR 1.10, 95% CI 0.70-1.75; p = 0.67; I² = 0%), myocardial infarction (RR 1.52, 95% CI 0.94-2.46; p = 0.09; I² = 27%), or repeat revascularization (RR 1.02, 95% CI 0.71-1.45; p = 0.93; I² = 7%). In contrast to the neutral clinical outcomes, ticagrelor-based therapy was associated with a significant reduction in saphenous vein graft (SVG) failure compared with aspirin monotherapy (RR 0.62, 95% CI 0.50-0.78; p < 0.0001; I² = 0%). Subgroup analysis revealed no meaningful differences between ticagrelor monotherapy and ticagrelor plus aspirin for major clinical events. Ticagrelor-based therapy did not reduce major clinical outcomes (MACE, mortality, MI, stroke, revascularization, or major bleeding) compared with aspirin after CABG, although it was associated with improved SVG patency. Routine use cannot be recommended; ticagrelor may be considered in selected high-risk patients. Further large, long-term trials are needed to determine whether patency benefits translate into improved clinical outcomes.

The concomitant occurrence of pulmonary embolism (PE) and lung cancer (LC) poses a significant mortality risk in the United States. Though both diseases are well studied across the literature individually, their combined burden remains unexplored. To evaluate the temporal trends in PE-related mortality among US adults ≥ 65 years with lung cancer from 1999 to 2020, stratified by demographic and geographic variables, by analyzing death certificates related to PE and lung cancer from the CDC WONDER database. We queried the CDC WONDER database for mortality trend analysis with multiple causes of death, having PE and LC, both as either contributing or underlying causes of death, from 1999 to 2020. AAMRs were calculated per 1,000,000 people, stratified by sex, race, geography, and metropolitan status. AAPCs and APCs with 95% CI were evaluated through Joinpoint regression. Between 1999 and 2020, there were 32,409 deaths among adults (aged ≥ 65) with PE and LC, with the majority of fatalities manifesting in medical facilities (60.52%). The overall AAMR increased significantly from 26 (95% CI: 24.3 to 27.7) in 1999 to 41.2 (95% CI: 39.4 to 42.9) in 2020, with an AAPC of 1.92 (95% CI: 1.10 to 2.76, p < 0.001). Men had higher mortality rates with an AAMR of 44.4 (95% CI: 43.8 to 45.1) than 28.4 (95% CI: 27.9 to 28.8) in females. In race/ethnicity, NH-Blacks possessed the highest AAMRs of 44.4 (95% CI: 42.9 to 45.8) among other races. In regional stratification, the Midwest region showed the highest AAMRs of 39.3 (95% CI: 38.4 to 40.1), with the highest AAMRs of 58 (95% CI: 47.5 to 68.4) in Vermont, and non-metropolitan areas had higher AAMRs of 36.06 (95% CI: 35.1 to 37) (Graphical abstract). This study highlights the potential demographic disparities in PE and LC-related mortalities among older adults, underscoring the necessity for improved interventions, early screening, public health awareness programs, and equity in healthcare access.Clinical trial registration: Not applicable, as this is a retrospective observational study that relies on publicly available data.

Thrombocytopenia, a common side effect of chronic liver disease (CLD), increases bleeding risk during invasive procedures. Thrombopoietin receptor agonists (TPO-RAs) offer an effective alternative to platelet transfusions. A systematic review and meta-analysis assessed the efficacy and safety of TPO-RAs in thrombocytopenia patients undergoing elective procedures. A systematic search (PubMed, Google Scholar, Cochrane Library, up to August 2024) evaluated perioperative thrombopoietin receptor agonists in patients with thrombocytopenia undergoing elective procedures. Primary and secondary outcomes included platelet count ≥50 x 10^9/L, bleeding/thrombotic events, platelet transfusions, adverse effects, rescue treatment, discontinuation, death, and serious adverse effects, analyzed via random-effects model. This meta-analysis synthesized evidence from nine trials and 1,409 patients (819 TPO-RAs vs 590 placebo; mean age ~59 years). TPO-RAs significantly increased the likelihood of achieving platelet counts ≥50×10⁹/L compared with placebo (RR 3.93, 95% CI 2.24-6.90; p<0.00001). They also reduced the need for preoperative platelet transfusions (RR 0.34, 95% CI 0.27-0.44; p<0.00001) and lowered the risk of surgical bleeding (RR 0.64, 95% CI 0.49-0.85; p=0.002). In contrast, no statistically significant differences were observed for thrombotic events (RR 1.24, 95% CI 0.57-2.67; p=0.59), treatment-emergent adverse events (RR 0.99, 95% CI 0.89-1.09; p=0.83), study drug discontinuation (RR 0.74, 95% CI 0.32-1.70; p=0.47), rescue treatment use (RR 0.82, 95% CI 0.34-2.03; p=0.67), all-cause mortality (RR 1.23, 95% CI 0.35-4.35; p=0.75), or serious adverse events (RR 1.13, 95% CI 0.70-1.84; p=0.62). TPO-RAs raise platelet counts and reduce transfusions in CLD patients undergoing invasive procedures. However, close monitoring for thrombotic risks is necessary, and further research is needed to optimize dosing.

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.