Journal of Thrombosis and Thrombolysis最新文献

Atrial fibrillation (AF) and malignancy share a complex relationship, significantly complicating patient management. Patients with cancer, particularly those with lung, gastrointestinal, genitourinary, and hematologic malignancies, are at increased risk of AF due to cancer-related hypercoagulability, proinflammatory cytokines, and treatment-related factors. This population faces unique thrombotic and bleeding risks, challenging standard management approaches. Anticoagulation is often complicated by drug-drug interactions with cancer therapies and heightened bleeding risks, including thrombocytopenia and coagulopathy. Left atrial appendage occlusion (LAAO) offers an alternative stroke prevention strategy for patients unable to tolerate long-term anticoagulation. By isolating the left atrial appendage, LAAO reduces thromboembolic risk while minimizing bleeding complications. Indications include patients with elevated stroke risk with contraindications to anticoagulation due to nonreversible causes, such as recurrent bleeding or significant drug interactions. Surgical LAAO may also be considered during cardiac surgery in patients with AF and high thromboembolic risk, with previous studies showing reduced risk of thromboembolic complications. Outcomes of LAAO in cancer patients are generally favorable, with studies showing comparable stroke rates, bleeding risks, and mortality to non-cancer populations. However, malignancy-specific complications, such as device-related thrombus, require further investigation. LAAO provides a promising option for stroke prevention in this complex population, but further research is needed to refine patient selection and optimize outcomes.

To explore the possible causal link between stable angina pectoris (SAP) and gastric cancer (GC) through Mendelian randomization analysis. We used data from genome-wide association studies (GWAS) statistical datasets, with SAP and GC screened as relevant instrumental variables for exposure factors, respectively. To evaluate the causal link between SAP and GC, a two-sample bidirectional Mendelian randomization analysis was conducted, leveraging genetic variants as instrumental variables. In addition, effects of horizontal pleiotropy were evaluated using MR-PRESSO and MR-Egger intercept analysis. Sensitivity analysis was performed using Cochran Q test and "leave one out" method. The study showed a significant causal relationship between SAP and GC in the analysis with SAP as the exposure variable (odds ratio [OR] = 0.78, 95% confidence interval [CI] = 0.69-0.87, p = 0.000027 using inverse variance weighting [IVW]). Sensitivity analysis confirmed the robustness of Mendelian randomization results. In the analysis of GC as an exposure variable, gastric cancer and SAP also showed a significant causal association (OR = 0.87, 95%CI = 0.77-0.98, p = 0.024 using IVW), but sensitivity analysis suggested a significant pleiotropy between instrumental variables (p = 0.0093 using MR-Egger intercept analysis), which cast doubt on the reliability of the study and requires careful interpretation of the results. Existing studies suggest that individuals with SAP may have a lower risk of developing GC. However, the precise causal relationship, particularly regarding whether GC contributes to an increased risk of SAP, remains unclear and warrants further investigation. GC and ischemic heart disease which represented by SAP are both associated with oxidative stress in their pathogenesis. Local tissue-induced mitochondrial autophagy or cellular ferroptosis triggers a systemic response, potentially underlying the negative correlation between GC and SAP. Thus, therapeutic strategies that target the interplay between local tissue and systemic responses in oxidative stress may hold promise for the benefits to patients.

Venous thromboembolism (VTE) remains a major contributor to postoperative morbidity and mortality in patients undergoing lung cancer surgery. This study aims to identify perioperative risk factors associated with VTE development following such procedures. We performed an exhaustive search of PUBMED and EMBASE from inception to November 1, 2023, using terms related to VTE following lung cancer surgery. A random-effects meta-analysis was performed to calculate the pooled incidence and odds ratios (ORs) for risk factors. Of 3,576 screened studies, 13 met eligibility criteria for qualitative synthesis, and 11 studies (53,382 patients) were included in the meta-analysis. The pooled incidence of postoperative VTE was 1.82% (971 cases). Significant risk factors included advanced age (standardized mean difference [SMD] 0.43, 95% CI 0.22-0.63; I² = 59.9%), prolonged surgical duration (SMD 0.58, 95% CI 0.24-0.92; I² = 81.2%), open thoracotomy (OR 1.77, 95% CI 1.50-2.09; I² = 19.9%), TNM stage > 1 (OR = 1.81, 95% CI 1.53-2.13; I² = 39.8%), adenocarcinoma histology (OR = 1.29, 95% CI 1.08-1.53; I² = 1.2%), and major lung resection (OR = 1.51, 95% CI 1.24-1.83; I2 = 0.0%). This study highlights key modifiable and non-modifiable risk factors for postoperative VTE in lung cancer surgery patients. These findings support individualized risk stratification and targeted thromboprophylaxis strategies to improve clinical outcomes.

Background: Cancer is common in patients with ischemic stroke. The aim was to reveal the differences in acute management and outcomes of patients with in-hospital acute ischemic stroke (IHS) with and without active cancer.

Methods: Two hundred IHS patients (58% male, median age 78 years, median NIHSS score 9) from August 2016 to July 2023 at our institution were divided into two groups: 70 with active cancer (IHS-AC 35%) and 130 without AC (IHS-nonAC 65%). Patients' characteristics, time intervals, and clinical outcomes were compared between the groups. A good clinical outcome was defined as modified Rankin Scale score 0-3.

Results: IHS was identified most frequently by a nurse (IHS-AC group 67%, IHS-nonAC group 71%). Time from recognition to stroke physician assessment (37 vs. 90 min, p = 0.008) was shorter in the IHS-AC group. Good clinical outcomes at discharge (31% in each group, p = 1.000) and in-hospital mortality (IHS-AC group 29%, IHS-nonAC group 21%, p = 0.225) were similar in the groups. The rates of reperfusion therapy (intravenous rt-PA and/or mechanical thrombectomy) were 16% in the IHS-AC group and 15% in the IHS-nonAC group (p = 1.000). The rates of good clinical outcomes and mortality at discharge in patients with reperfusion therapy were each 36%.

Discussion and conclusion: One-third of IHS patients had comorbid active cancer. The rates of reperfusion therapy and good clinical outcomes were similar in groups with and without active cancer. Acute stroke management should not be withheld solely based on cancer.

Atopic dermatitis is a risk factor for venous thromboembolism which may be the first manifestation of occult cancer. We examined whether a venous thromboembolism in patients with atopic dermatitis is a marker of occult cancer. We used Danish health registries to conduct this population-based cohort study. Patients with a first-time diagnosis of venous thromboembolism and a history of atopic dermatitis were identified from the Danish National Patients Registry from 1980 through 2022. We calculated the absolute risk of cancer treating death as a competing event. As a measure of relative risk, we calculated standardized incidence ratios (SIRs) for cancer among patients with venous thromboembolism and atopic dermatitis and compared the observed cancer incidence to that of the general Danish population. We identified 582 patients with a first venous thromboembolism diagnosis and a history of atopic dermatitis. During the first year of follow-up, the absolute risk of overall cancer was 1.7%, corresponding to an SIR of 2.90 (95% confidence interval [CI] 1.39-5.34). The overall SIR decreased to 1.12 (95% CI 0.74-1.62) during the subsequent years of follow-up. Although the risk estimates were imprecise, an elevated cancer risk following venous thromboembolism in patients with atopic dermatitis cannot be ruled out, particularly within the first year after venous thromboembolism, when compared to the cancer risk in the general population.

Catheter-related upper extremity deep vein thrombosis (CRT-UEDVT) is a possible complication in patients with cancer carrying a central venous catheter. Anticoagulation is the primary treatment, but optimal duration is unclear. This study evaluated effectiveness and safety of different lengths of anticoagulation in women with cancer and CRT-UEDVT. We conducted a retrospective analysis on women ≥ 18 years-old, who had active cancer and had received anticoagulant treatment for CRT-UEDVT. Effectiveness was assessed in terms of VTE recurrence and thrombosis recanalization. Safety was determined by assessing major bleedings (MB) and clinically relevant non-major bleedings (CRNMB) during treatment. A total of 113 women where included. All of them had completed at least 3 months of anticoagulant therapy, while 106 and 97 had completed 6 and 12 months of anticoagulant therapy, respectively. The median follow-up was 568.5 days (IQR 300-910). Patients primarily presented with ovarian, breast, and endometrial cancers. Anticoagulant therapy was mainly parenteral during the initial 3 months and between 3 and 6 months, shifting predominantly to direct oral anticoagulants during months 6-12. The annual VTE recurrence rate was 0.5%. The annual rate of MB and CRNMB was 1.9%. Complete thrombosis recanalization was achieved in 52.0%, 69.1%, and 87.3% of patients at 3, 6, and 12 months, respectively. Our study provides interesting insights into the management and clinical outcomes of women with cancer and CRT-UEDVT. Prospective studies are needed to fully understand advantages and disadvantages of different lengths of anticoagulation in this set of patients.