Journal of Thrombosis and Thrombolysis最新文献

Because patients with atrial fibrillation (AF) often exhibit heterogeneous risks that are not fully captured by traditional clinical factors, identifying a more accurate measure of physiological ageing could improve risk stratification and clinical management compared to chronological aging.This study aimed to determine the clinical outcome in relation to biological ageing in patients with AF. We used the data from the COOL-AF registry which is a multicentre nationwide registry of AF patients. The enrolment period was 2014-2017. Patients were followed-up for 3 years. Biological ageing was calculated from the Klemera-Doubal method (KDM) is a based on chronological age and blood chemistry and body function factors. The main outcome of this study was the composite of all-cause death, major bleeding, ischemic stroke/systemic embolism (SSE), and heart failure. We included total of 3405 patients, with a mean chronological age of 67.8 ± 11.3 years, and 1424 (41.8%) were female. During the median follow-up duration of 35.9 (IQR 34.8, 36.0) months, the composite outcomes, death, major bleeding, SSE, and heart failure developed in 726 (21.3%), 380 (11.2%), 199 (5.8%), 134 (3.9%), and 247 (7.3%) patients, respectively. Restricted cubic spline analysis showed that KDM bioage had higher hazard ratios compared to chronological age, with the adjusted Hazard ratios and 95% confidence interval (CI) of Quartile 4 (Q4) KDM for the composite outcomes, death, major bleeding, SSE, and heart failure were 2.11 (1.82-2.45), 2.53 (2.06-3.11), 2.12 (1.60-2.83), 1.96 (1.37-2.78), and 1.83 (1.42-2.38), respectively (all p < 0.001). In conclusion, KDM bioage is an independent predictor for clinical outcome and performs better than chronological age. These findings highlight the clinical value of incorporating biological ageing metrics into AF risk assessment models and suggest that KDM bioage may enhance personalized prognostication beyond conventional age-based evaluation.

Factor Xa inhibitor (FXaI)-associated major bleeding presents a critical management challenge. Although andexanet alfa is the targeted reversal agent, its limited availability and high cost has sustained the use of prothrombin complex concentrates (PCCs). Activated PCC (aPCC) may provide effective reversal at lower doses due to its inclusion of activated factor VII. This study compared the effectiveness and safety of aPCC versus 4-factor PCC (4 F-PCC) for reversal of apixaban- and rivaroxaban-associated major bleeding. A retrospective cohort study was conducted at Huntsville Hospital. Adult patients who received aPCC or 4 F-PCC for major bleeding while on apixaban or rivaroxaban were included. Major bleeding and clinical hemostasis were defined using International Society on Thrombosis and Haemostasis (ISTH) criteria. The primary outcome was hemostatic effectiveness; the secondary outcome was in-hospital thromboembolic complications. Among 293 patients (252 aPCC, 41 4 F-PCC), baseline characteristics were similar except for more intracranial hemorrhage in the 4 F-PCC group (75.6% vs. 46.8%, p < 0.001). Hemostasis was achieved in 77.0% of aPCC-treated and 70.7% of 4 F-PCC-treated patients (p = 0.376). Thromboembolic events were infrequent (1.6% vs. 4.9%, p = 0.156), with no significant difference between groups. In FXaI-associated major bleeding, aPCC and 4 F-PCC achieved comparable hemostatic outcomes with low thromboembolic event rates. These results support either agent as a reasonable reversal option when andexanet alfa is unavailable, with aPCC potentially effective at lower doses.

The association between Factor V Leiden (FVL) and ischemic stroke in young adults remains uncertain. We compared the prevalence of FVL coding in ischemic stroke versus non-stroke hospitalizations and examined in-hospital outcomes among young adults with ischemic stroke in the United States.Using the 2016-2022 National Inpatient Sample, we identified hospitalizations for patients aged 18-49 years with a primary diagnosis of ischemic stroke and a secondary diagnosis of FVL. We compared survey-weighted FVL prevalence between stroke and non-stroke hospitalizations. Among stroke hospitalizations, we evaluated discharge disposition, length of stay, and inflation-adjusted costs with survey-weighted regression models adjusted for demographics and comorbidities. Among 67.8 million hospitalizations of adults aged 18-49 years, 297,905 (0.44%) were for ischemic stroke. FVL coding was more frequent in stroke than non-stroke hospitalizations (0.85% vs. 0.25%, p < .001). Among stroke admissions, FVL prevalence increased from 0.81% in 2016 to 0.95% in 2022 (relative increase 18.3%; p for trend = 0.14), while also rising among non-stroke hospitalizations. Stroke hospitalizations with FVL coding involved patients who were younger, more often female and White, and had fewer recorded traditional vascular risk factors. After adjustment, FVL coding was associated with longer length of stay (9.5% increase) and higher hospital costs (11.2% increase); discharge disposition did not differ meaningfully by FVL status. In this large, cross-sectional inpatient sample, FVL was more frequently coded among young adults hospitalized with ischemic stroke than among other hospitalizations and was associated with greater resource use. However, the design, reliance on ICD-10 codes, and likely differential thrombophilia testing limit causal inference and may partially explain the higher FVL prevalence in stroke admissions. These findings highlight the need for prospective, mechanistically focused studies with standardized thrombophilia testing and detailed stroke phenotyping to clarify the contribution of FVL to arterial ischemic stroke and to identify which patients, if any, might benefit from targeted FVL evaluation and tailored prevention strategies.

Care of patients with thrombosis requires application of rapidly advancing science, complex decisions balancing risks and benefits, interpretation of multiple data sources, and coordination across fields. To meet these challenges, we describe our collaborative meeting for discussion and coordination of complex thrombosis cases, the Clot Cases Conference. Based loosely on the tumor board model from oncology, we describe the multidisciplinary nature, with attendees from multiple disciplines and institutions, and hybrid format, including both case- and topic-based sessions. We present survey data on how conference participants perceive their attendance affected learning, patient care, and professional satisfaction. Finally, we discuss opportunities for improvement and expansion of the Clot Cases Conference model to meet the complexity of modern thrombosis care.

In intermediate high-risk pulmonary embolism (PE), the role of thrombolysis remains debated with a disagreement between European and American guidelines. Expected benefits are counterbalanced by increased hemorrhagic events with full-dose fibrinolysis. In these patients, half-dose thrombolysis may have similar effects with less complications. We have hypothesized that half-dose thrombolysis compared to anticoagulation alone may reduce hypoxemia duration and hospital length of stay. We have performed a 6 years' retrospective study in 2 Emergency Departments of French hospitals. One practiced fibrinolysis in intermediate risk PE (tPA 50 mg/2 h) and the other did not. We used logistic regression and propensity score matching to assess the effect of a thrombolysis strategy. 473 patients had a diagnosis of acute PE during the study period. 110 (23%) patients with intermediate risk PE met the inclusion criteria. After propensity score matching, 30 patients with thrombolysis therapy were compared to 30 control patients. The duration of oxygen therapy was shorter in the thrombolysis group (3 days, interquartile range 2 to 4) than in the control group (8 days, interquartile range 3 to 11; p = 0.0003). There was no significant difference between groups regarding pulmonary, cardiac, and hemorrhagic complications. The rates of treatment failure, defined by death or persistent hypotension requiring vasopressors, were not significantly different between the 2 groups (2% vs. 6%). Compared to anticoagulation alone, half-dose thrombolysis in intermediate risk PE is associated with a significantly shorter duration of hypoxemia.

Introduction: In a subset of acute ischemic stroke (AIS) patients, particularly those with large-artery atherosclerosis (LAA) and atrial cardiopathy, multiple embolic sources may coexist. Histological analysis of thrombi presents an opportunity for discerning insights into both etiology and prognosis.

Methods: In our investigation, we meticulously examined 97 retrieved thrombi through histological staining and immunohistological techniques.

Results: Thrombi originating from patients diagnosed with atrial fibrillation (AF) (n = 43) presented notably elevated levels of fibrin (54.16 ± 18.57% vs. 36.07 ± 18.23%, P < 0.001) and neutrophil extracellular traps (NETs) [13.21 (9.42, 15.36)% vs. 7.96 (4.98, 15.13)%, P = 0.01], alongside reduced red blood cell content (35.09 ± 16.74% vs. 51.58 ± 19.67%, P < 0.001). Within the subgroup of AIS patients with LAA, those presenting with atrial cardiopathy (n = 29) presented higher platelet levels within the thrombus (12.44 (7.59, 19.25)% vs. 8.90 (0.60, 12.37)%, P = 0.04), with the association remaining significant after generalized linear model (GLM) adjustments (P = 0.004). Notably, NETs identified within the thrombus emerged as an independent prognostic indicator for poor outcomes, defined as the modified Rankin scale (mRS) score > 2 at 90 days (OR: 1.12, 95% CI: 1.02-1.25; P = 0.02).

Conclusions: These observations provide histopathological evidence supporting the presence of overlapping mechanisms contributing to thromboembolism that are potentially associated with underlying atrial cardiopathy. Consequently, histopathological evaluation of thrombi holds promise as a valuable tool for distinguishing between various etiologies and predicting clinical outcomes in AIS patients.

Venous thromboembolism in cancer patients constitutes a complex and clinically significant disease due to its pathophysiology, morbidity and mortality. Pulmonary embolism is a potentially life-threatening disease, and therefore it represents the second leading cause of death among cancer patients, surpassed only by cancer itself. In recent years, direct-acting oral anticoagulants have emerged as the preferred option for the treatment of cancer-related venous thromboembolism, although low-molecular weight heparins are still specifically recommended for patients with high bleeding risk. The management of anticoagulant therapy beyond the first 6 months following pulmonary embolism remains a challenging scenario, requiring careful evaluation of the balance between benefits and risks. Anti-thrombotic prophylaxis is not routinely recommended in the outpatient setting, although emerging data suggest validated risk tools could help identify high-risk populations who might benefit. This review summarizes available clinical trial data, meta-analyses, real-world studies, both national and international guidelines providing a practical approach to the management of pulmonary embolism in patients with cancer.

Although several studies have examined the relationship between factor VIII levels and recurrent venous thromboembolism (VTE), findings remain inconsistent. This systematic review and meta-analysis aimed to assess the association between elevated plasma factor VIII levels and VTE recurrence. A comprehensive search was conducted in PubMed, Web of Science, Scopus, and Embase databases, and Google Scholar up to May 2025 to identify observational studies evaluating the association between elevated factor VIII levels and recurrent VTE. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated using random-effects model. Eighteen studies (12 cohort and 6 case-control studies) involving 9835 participants and 1554 recurrent events were included. Plasma factor VIII levels > 200 IU/dL were associated with an increased risk of VTE recurrence (RR = 1.70; 95% CI: 1.32-2.19; I² = 85.0%, P < 0.001). Subgroup analyses based on the type of effect measures indicated increased risk of VTE recurrence across studies reporting hazard ratios (HRs), odds ratios (Ors), and RRs. Similarly, the association remained significant in both cohort and case-control studies. Elevated factor VIII levels were associated with recurrence only in patients not receiving anticoagulation (RR = 1.64; 95% CI: 1.28-2.10), whereas no significant association was observed among those receiving anticoagulation (RR = 1.89; 95% CI: 0.36-9.87). This meta-analysis demonstrates a possible relationship between elevated factor VIII levels and VTE recurrence. These findings highlight the potential of factor VIII as a prognostic marker. Further prospective studies are needed to confirm this association and support clinical decision-making.