Pub Date : 2026-01-01DOI: 10.1016/j.rpth.2025.103281
Fanny Collange , Ingrid M. Bistervels , Andrea Buchmuller , Hanke M.G. Wiegers , Fionnuala Ní Áinle , Peter Verhamme , Anne F. Jacobsen , Anette T. Hansen , Marc A. Rodger , Maria T. DeSancho , Roman G. Shmakov , Luuk J.J. Scheres , Celine Chauleur , Saskia Middeldorp , Bernard Tardy
Background
The value of pretest clinical probability scores in the diagnosis of pulmonary embolism (PE) during pregnancy and postpartum is unknown in women with a history of venous thromboembolism (VTE).
Objectives
We evaluate the modified Wells, revised Geneva, and pregnancy-adapted Geneva (PAG) scores for the diagnosis of PE during pregnancy and the postpartum period in women with a history of VTE.
Methods
Data from a multicenter randomized trial (Highlow) including 1110 pregnant women with a history of VTE and treated with either weight-adjusted intermediate-dose or fixed low-dose low-molecular-weight heparin subcutaneously once daily until 6 weeks postpartum were used. The modified Wells, revised Geneva, and PAG scores were calculated retrospectively in all women with a clinical suspicion of PE, and their discriminative capacity was assessed. Receiver operating characteristic (ROC) curve analysis was performed for quantitative variables and the optimal threshold defined.
Results
There were 102 suspected cases of PE, of which 12 were confirmed events. During pregnancy, the ROC curves showed an area under the curve of 0.68, 0.33, and 0.36 for the Wells, Geneva, and PAG scores, respectively. During postpartum, the ROC curves showed an area under the curve of 0.75, 0.55, and 0.52 for the Wells, Geneva, and PAG scores, respectively.
Conclusion
The 3 pretest clinical scores have modest discriminatory power, during both the antepartum and the postpartum period, to classify patients into 3 categories of pretest clinical probability. Further work is required to develop clinical-decision tools to exclude imaging in pregnant women with prior VTE with suspected PE in pregnancy.
{"title":"Assessment of clinical probability scores for pulmonary embolism diagnosis during pregnancy and postpartum in women with a history of venous thromboembolism: a Highlow ancillary study","authors":"Fanny Collange , Ingrid M. Bistervels , Andrea Buchmuller , Hanke M.G. Wiegers , Fionnuala Ní Áinle , Peter Verhamme , Anne F. Jacobsen , Anette T. Hansen , Marc A. Rodger , Maria T. DeSancho , Roman G. Shmakov , Luuk J.J. Scheres , Celine Chauleur , Saskia Middeldorp , Bernard Tardy","doi":"10.1016/j.rpth.2025.103281","DOIUrl":"10.1016/j.rpth.2025.103281","url":null,"abstract":"<div><h3>Background</h3><div>The value of pretest clinical probability scores in the diagnosis of pulmonary embolism (PE) during pregnancy and postpartum is unknown in women with a history of venous thromboembolism (VTE).</div></div><div><h3>Objectives</h3><div>We evaluate the modified Wells, revised Geneva, and pregnancy-adapted Geneva (PAG) scores for the diagnosis of PE during pregnancy and the postpartum period in women with a history of VTE.</div></div><div><h3>Methods</h3><div>Data from a multicenter randomized trial (Highlow) including 1110 pregnant women with a history of VTE and treated with either weight-adjusted intermediate-dose or fixed low-dose low-molecular-weight heparin subcutaneously once daily until 6 weeks postpartum were used. The modified Wells, revised Geneva, and PAG scores were calculated retrospectively in all women with a clinical suspicion of PE, and their discriminative capacity was assessed. Receiver operating characteristic (ROC) curve analysis was performed for quantitative variables and the optimal threshold defined.</div></div><div><h3>Results</h3><div>There were 102 suspected cases of PE, of which 12 were confirmed events. During pregnancy, the ROC curves showed an area under the curve of 0.68, 0.33, and 0.36 for the Wells, Geneva, and PAG scores, respectively. During postpartum, the ROC curves showed an area under the curve of 0.75, 0.55, and 0.52 for the Wells, Geneva, and PAG scores, respectively.</div></div><div><h3>Conclusion</h3><div>The 3 pretest clinical scores have modest discriminatory power, during both the antepartum and the postpartum period, to classify patients into 3 categories of pretest clinical probability. Further work is required to develop clinical-decision tools to exclude imaging in pregnant women with prior VTE with suspected PE in pregnancy.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"10 1","pages":"Article 103281"},"PeriodicalIF":3.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.rpth.2025.103328
Gabrielle Sarlon-Bartoli , Barbara Leclercq , Nathalie Trillot , Isabelle Mahé , Marie Daoud-Elias , Andrea Buchmuller , Geraldine Poenou , Antoine Elias , Jean Noel Poggi , Francis Couturaud , Noemie Resseguier , Martin Postzich , Lylia Hammoudi , Yasmine Benredouane , Florence Bretelle , Louisa Goumidi , Pierre Suchon , Sarah Jidal , Antonia Perez-Martin , Clementine Rousselin , Pierre Emmanuel Morange
Background
Anticoagulants cause abnormal uterine bleeding (AUB) in women of reproductive age with venous thromboembolism, but the safety profiles of oral anticoagulants (OACs) in this setting are unclear.
Objectives
To analyze and compare the prevalence of AUB and quality of life (QoL) in 4 groups (rivaroxaban, apixaban, vitamin K antagonists [VKAs], and controls).
Methods
The GENital Bleeding Oral AntiCoagulant (GENB-OAC) study was a national, multicenter, observational, cross-sectional study conducted in 10 French hospitals from 2018 to 2022. The primary outcome was the proportion of women with major genital bleeding and/or clinically relevant non-major genital bleeding and/or pictorial blood loss assessment chart score >100.
Results
Overall, 445 women were included: 122 on apixaban, 123 on rivaroxaban, 81 taking VKAs, and 119 healthy controls. The primary genital bleeding endpoint was significantly higher in OAC vs control group (94.8% vs 82.4%; P < .001) and the rivaroxaban or VKA vs apixaban group (96.7% or 97.5% vs 90.1%; P = .04 and P = .047). Major genital bleeding was similar in the apixaban and rivaroxaban groups, but menstruation ≥8 days, clinically relevant non-major bleeding, and pictorial blood loss assessment chart score >100 were significantly higher in the rivaroxaban vs apixaban group. QoL was significantly lower in the OAC than in the control group but was similar in the 3 OAC groups.
Conclusion
AUB is frequent in women of reproductive age. OACs increase AUB and impact women’s QoL. Apixaban is associated with less AUB than rivaroxaban or VKAs with no difference in QoL. An international consensus is necessary to help clinicians detect and treat AUB in OAC users.
背景：抗凝剂可引起育龄妇女静脉血栓栓塞性子宫异常出血（AUB），但口服抗凝剂（OACs）在这种情况下的安全性尚不清楚。目的分析比较4组（利伐沙班、阿哌沙班、维生素K拮抗剂[VKAs]和对照组）患者AUB患病率和生活质量（QoL）。方法生殖器出血口服抗凝剂（GENB-OAC）研究是一项全国性、多中心、观察性、横断面研究，于2018年至2022年在法国10家医院进行。主要终点是女性生殖器大出血和/或临床相关的非生殖器大出血和/或图像失血评估图表得分为100分的比例。结果共纳入445例妇女：阿哌沙班122例，利伐沙班123例，vka 81例，健康对照119例。OAC组原发性生殖器出血终点明显高于对照组（94.8% vs 82.4%; P < 0.001），利伐沙班组或VKA组明显高于阿哌沙班组（96.7%或97.5% vs 90.1%; P = 0.04和P = 0.047）。阿哌沙班组和利伐沙班组生殖器大出血相似，但月经≥8天、临床相关非大出血、图像失血量评估表评分>；100在利伐沙班组明显高于阿哌沙班组。OAC组的生活质量明显低于对照组，但3个OAC组的生活质量相似。结论aub常见于育龄妇女。oac增加AUB，影响女性生活质量。阿哌沙班的AUB低于利伐沙班或vka，但生活质量无差异。有必要达成国际共识，以帮助临床医生发现和治疗OAC使用者的AUB。
{"title":"Prevalence of abnormal uterine bleeding and quality of life after venous thromboembolism by oral anticoagulant use: the GENB-OAC Study","authors":"Gabrielle Sarlon-Bartoli , Barbara Leclercq , Nathalie Trillot , Isabelle Mahé , Marie Daoud-Elias , Andrea Buchmuller , Geraldine Poenou , Antoine Elias , Jean Noel Poggi , Francis Couturaud , Noemie Resseguier , Martin Postzich , Lylia Hammoudi , Yasmine Benredouane , Florence Bretelle , Louisa Goumidi , Pierre Suchon , Sarah Jidal , Antonia Perez-Martin , Clementine Rousselin , Pierre Emmanuel Morange","doi":"10.1016/j.rpth.2025.103328","DOIUrl":"10.1016/j.rpth.2025.103328","url":null,"abstract":"<div><h3>Background</h3><div>Anticoagulants cause abnormal uterine bleeding (AUB) in women of reproductive age with venous thromboembolism, but the safety profiles of oral anticoagulants (OACs) in this setting are unclear.</div></div><div><h3>Objectives</h3><div>To analyze and compare the prevalence of AUB and quality of life (QoL) in 4 groups (rivaroxaban, apixaban, vitamin K antagonists [VKAs], and controls).</div></div><div><h3>Methods</h3><div>The GENital Bleeding Oral AntiCoagulant (GENB-OAC) study was a national, multicenter, observational, cross-sectional study conducted in 10 French hospitals from 2018 to 2022. The primary outcome was the proportion of women with major genital bleeding and/or clinically relevant non-major genital bleeding and/or pictorial blood loss assessment chart score >100.</div></div><div><h3>Results</h3><div>Overall, 445 women were included: 122 on apixaban, 123 on rivaroxaban, 81 taking VKAs, and 119 healthy controls. The primary genital bleeding endpoint was significantly higher in OAC vs control group (94.8% vs 82.4%; <em>P</em> < .001) and the rivaroxaban or VKA vs apixaban group (96.7% or 97.5% vs 90.1%; <em>P</em> = .04 and <em>P</em> = .047). Major genital bleeding was similar in the apixaban and rivaroxaban groups, but menstruation ≥8 days, clinically relevant non-major bleeding, and pictorial blood loss assessment chart score >100 were significantly higher in the rivaroxaban vs apixaban group. QoL was significantly lower in the OAC than in the control group but was similar in the 3 OAC groups.</div></div><div><h3>Conclusion</h3><div>AUB is frequent in women of reproductive age. OACs increase AUB and impact women’s QoL. Apixaban is associated with less AUB than rivaroxaban or VKAs with no difference in QoL. An international consensus is necessary to help clinicians detect and treat AUB in OAC users.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"10 1","pages":"Article 103328"},"PeriodicalIF":3.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.rpth.2025.103317
Lisbeth Eischer , Paul A. Kyrle , Alexandra Kaider , Anton Schmidt , Brigitte Wildner , Anja Boc , Charlotte Bradbury , Anetta Undas , Francis Couturaud , Matteo Nicola Dario Di Minno , Geert-Jan Geersing , David Jimenez , Sameer Parpia , Gualtiero Palareti , Daniela Poli , Daniel P. Potaczek , Paolo Prandoni , Sam Schulman , Astrid van Hylckama Vlieg , Michal Zabczyk , Sabine Eichinger
Background
Patients with venous thromboembolism (VTE) receive anticoagulation for at least 3 months. To evaluate recurrence risk thereafter, some strategies include D-dimer testing after discontinuing anticoagulation, which raises concern about early recurrence.
Objectives
To assess the incidence of recurrent VTE within 30 days after stopping anticoagulation.
Methods
We conducted a systematic review of EMBASE, CENTRAL, and MEDLINE to identify controlled trials and cohort studies of adult noncancer patients with deep vein thrombosis of the leg and/or pulmonary embolism treated with anticoagulants for ≥3 months. The primary outcome was symptomatic VTE within 30 days. The risk of bias was assessed using a modified version of the Newcastle-Ottawa Scale. Pooled recurrence rates were calculated using fixed random-effects meta-analyses.
Results
Of 42 studies, 24 (57%) provided data, encompassing 11,407 patients. Early recurrence occurred in 115 patients (1.01%), with a pooled incidence of 1.04% (95% CI, 0.8%-1.4%). Men had a risk similar to that of women (risk ratio, 1.2; 95% CI, 0.6-2.3; P = .7). Unprovoked VTE was associated with a 2.6-fold increase in risk (95% CI, 1.4-4.6; P < .001) compared with provoked VTE. Patients with deep vein thrombosis at presentation had a similar risk of recurrence compared with those with an incident pulmonary embolism (risk ratio, 0.6; 95% CI: 0.3-1.2; P = .1). Findings regarding age were inconsistent. None of the recurrences was fatal. The overall risk of bias was low.
Conclusion
The incidence of early VTE recurrence after stopping anticoagulation is low. Temporarily discontinuing therapy to assess recurrence risk, therefore, appears safe and may aid in guiding treatment duration.
静脉血栓栓塞（VTE）患者接受抗凝治疗至少3个月。为了评估此后的复发风险，一些策略包括在停止抗凝后进行d -二聚体检测，这引起了对早期复发的关注。目的探讨静脉血栓栓塞停药后30天内复发的发生率。方法：我们对EMBASE、CENTRAL和MEDLINE进行了系统回顾，以确定接受抗凝治疗≥3个月的成年非癌症患者下肢深静脉血栓和/或肺栓塞的对照试验和队列研究。主要结局是30天内出现症状性静脉血栓栓塞。偏倚风险采用改良版的纽卡斯尔-渥太华量表进行评估。合并复发率采用固定随机效应荟萃分析计算。结果42项研究中，24项（57%）提供了数据，包括11,407例患者。115例患者（1.01%）出现早期复发，合并发病率为1.04% （95% CI, 0.8%-1.4%）。男性的风险与女性相似（风险比，1.2;95% CI, 0.6-2.3; P = 0.7）。与诱发性静脉血栓栓塞相比，非诱发性静脉血栓栓塞的风险增加2.6倍（95% CI, 1.4-4.6; P < 0.001）。与发生肺栓塞的患者相比，出现深静脉血栓的患者有相似的复发风险（风险比0.6;95% CI: 0.3-1.2; P = 0.1）。关于年龄的研究结果不一致。没有一例复发是致命的。总体偏倚风险较低。结论静脉血栓栓塞停凝后早期复发率低。因此，暂时停止治疗以评估复发风险似乎是安全的，并可能有助于指导治疗时间。
{"title":"The incidence of early recurrent venous thromboembolism: a systematic review and meta-analysis","authors":"Lisbeth Eischer , Paul A. Kyrle , Alexandra Kaider , Anton Schmidt , Brigitte Wildner , Anja Boc , Charlotte Bradbury , Anetta Undas , Francis Couturaud , Matteo Nicola Dario Di Minno , Geert-Jan Geersing , David Jimenez , Sameer Parpia , Gualtiero Palareti , Daniela Poli , Daniel P. Potaczek , Paolo Prandoni , Sam Schulman , Astrid van Hylckama Vlieg , Michal Zabczyk , Sabine Eichinger","doi":"10.1016/j.rpth.2025.103317","DOIUrl":"10.1016/j.rpth.2025.103317","url":null,"abstract":"<div><h3>Background</h3><div>Patients with venous thromboembolism (VTE) receive anticoagulation for at least 3 months. To evaluate recurrence risk thereafter, some strategies include D-dimer testing after discontinuing anticoagulation, which raises concern about early recurrence.</div></div><div><h3>Objectives</h3><div>To assess the incidence of recurrent VTE within 30 days after stopping anticoagulation.</div></div><div><h3>Methods</h3><div>We conducted a systematic review of EMBASE, CENTRAL, and MEDLINE to identify controlled trials and cohort studies of adult noncancer patients with deep vein thrombosis of the leg and/or pulmonary embolism treated with anticoagulants for ≥3 months. The primary outcome was symptomatic VTE within 30 days. The risk of bias was assessed using a modified version of the Newcastle-Ottawa Scale. Pooled recurrence rates were calculated using fixed random-effects meta-analyses.</div></div><div><h3>Results</h3><div>Of 42 studies, 24 (57%) provided data, encompassing 11,407 patients. Early recurrence occurred in 115 patients (1.01%), with a pooled incidence of 1.04% (95% CI, 0.8%-1.4%). Men had a risk similar to that of women (risk ratio, 1.2; 95% CI, 0.6-2.3; <em>P</em> = .7). Unprovoked VTE was associated with a 2.6-fold increase in risk (95% CI, 1.4-4.6; <em>P</em> < .001) compared with provoked VTE. Patients with deep vein thrombosis at presentation had a similar risk of recurrence compared with those with an incident pulmonary embolism (risk ratio, 0.6; 95% CI: 0.3-1.2; <em>P</em> = .1). Findings regarding age were inconsistent. None of the recurrences was fatal. The overall risk of bias was low.</div></div><div><h3>Conclusion</h3><div>The incidence of early VTE recurrence after stopping anticoagulation is low. Temporarily discontinuing therapy to assess recurrence risk, therefore, appears safe and may aid in guiding treatment duration.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"10 1","pages":"Article 103317"},"PeriodicalIF":3.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Persons with hemophilia A (HA) and inhibitors undergoing emicizumab prophylaxis require bypassing agents when breakthrough bleeding occurs. Recent studies have demonstrated that either factor (F)IX or FX supplementation can improve coagulation potential of emicizumab-treated persons with HA and inhibitors.
Objectives
This study assessed the effect of combined supplementation with FIX and FX on the coagulation potential in emicizumab-treated HA state.
Methods
FVIII-deficient plasmas were spiked with emicizumab (50 μg/mL), FX (100 IU/dL), and various FIX levels (100-1600 IU/dL). Plasmas from emicizumab-treated persons with HA and inhibitors were also added with FIX/FX (100 IU/dL each). Coagulation potential was assessed by maximum coagulation velocity (Ad|min1|) using tissue factor (TF)/ellagic acid–triggered clot waveform analysis and peak thrombin (PeakTh) using TF-triggered thrombin generation assay. For in vivo method, emicizumab (3 mg/kg) and human (h)FIX/hFX (100 IU/kg each) were intravenously administered to HA mice (emicizumab-HA mice). Coagulation potentials in these mice with or without additional hFIX/hFX (100 IU/dL each) were assessed by clotting time plus clot formation time (CT + CFT) and blood loss using rotational thromboelastometry and tail-clip assay.
Results
Ad|min1| and PeakTh in FVIII-deficient plasmas with emicizumab, FIX, and FX increased in FIX dose dependently. Addition of FIX and FX (100 IU/dL each) to emicizumab-supplemented FVIII-deficient plasma and plasma of emicizumab-treated persons with HA and inhibitor improved both parameters to normal levels. CT+CFT and blood loss in emicizumab-HA mice with additional hFIX/hFX (100 IU/dL each) administration were significantly shorter and decreased than those in emicizumab-HA mice. The thrombotic markers largely did not change.
Conclusion
Combined FIX and FX supplementation could enhance coagulation potential in emicizumab-treated persons with HA and inhibitors.
{"title":"Augmented emicizumab-driven coagulation potential in hemophilia A state by in vitro and in vivo supplementation of combined factors IX and X","authors":"Mitsumasa Osuna , Yuto Nakajima , Eisuke Takami , Hirotoshi Nakano , Keiji Nogami","doi":"10.1016/j.rpth.2025.103329","DOIUrl":"10.1016/j.rpth.2025.103329","url":null,"abstract":"<div><h3>Background</h3><div>Persons with hemophilia A (HA) and inhibitors undergoing emicizumab prophylaxis require bypassing agents when breakthrough bleeding occurs. Recent studies have demonstrated that either factor (F)IX or FX supplementation can improve coagulation potential of emicizumab-treated persons with HA and inhibitors.</div></div><div><h3>Objectives</h3><div>This study assessed the effect of combined supplementation with FIX and FX on the coagulation potential in emicizumab-treated HA state.</div></div><div><h3>Methods</h3><div>FVIII-deficient plasmas were spiked with emicizumab (50 μg/mL), FX (100 IU/dL), and various FIX levels (100-1600 IU/dL). Plasmas from emicizumab-treated persons with HA and inhibitors were also added with FIX/FX (100 IU/dL each). Coagulation potential was assessed by maximum coagulation velocity (Ad|min1|) using tissue factor (TF)/ellagic acid–triggered clot waveform analysis and peak thrombin (PeakTh) using TF-triggered thrombin generation assay. For <em>in vivo</em> method, emicizumab (3 mg/kg) and human (h)FIX/hFX (100 IU/kg each) were intravenously administered to HA mice (emicizumab-HA mice). Coagulation potentials in these mice with or without additional hFIX/hFX (100 IU/dL each) were assessed by clotting time plus clot formation time (CT + CFT) and blood loss using rotational thromboelastometry and tail-clip assay.</div></div><div><h3>Results</h3><div>Ad|min1| and PeakTh in FVIII-deficient plasmas with emicizumab, FIX, and FX increased in FIX dose dependently. Addition of FIX and FX (100 IU/dL each) to emicizumab-supplemented FVIII-deficient plasma and plasma of emicizumab-treated persons with HA and inhibitor improved both parameters to normal levels. CT+CFT and blood loss in emicizumab-HA mice with additional hFIX/hFX (100 IU/dL each) administration were significantly shorter and decreased than those in emicizumab-HA mice. The thrombotic markers largely did not change.</div></div><div><h3>Conclusion</h3><div>Combined FIX and FX supplementation could enhance coagulation potential in emicizumab-treated persons with HA and inhibitors.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"10 1","pages":"Article 103329"},"PeriodicalIF":3.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146022846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.rpth.2025.103330
Callie Berkowitz , Supreet K. Goraya , Angela M. Stover , Marcella H. Boynton , Alice Ma , Nigel S. Key
Background
The clinician-administered ISTH bleeding assessment tool (ISTH-BAT) and its self-report counterpart (self-BAT) were developed to standardize and quantify bleeding history. How BATs relate to overall clinical assessment and quality of life (QoL) is uncertain.
Methods
A cross-sectional analysis of the ISTH-BAT, self-BAT, and PROMIS-29 QoL instruments was performed in 101 adult patients referred for bleeding disorder evaluation. We assessed reliability/agreement (Krippendorf’s α) and diagnostic test characteristics of the ISTH-BAT and self-BAT. Linear regression models were used to evaluate the association between BATs and QoL domains, measured as standardized Z-scores.
Results
Surveyed patients received the following diagnoses: Bleeding disorder of unknown cause (n = 46, 45.5%), qualitative platelet defect (n = 11, 10.9%), von Willebrand disease (n = 9, 8.9%), hypodysfibrinogenemia (n = 1, 1.0%), other/unclassified (n = 13, 12.9%), and no bleeding disorder (n = 21, 20.8%). The mean ISTH-BAT score was 8.1 (SD = 4.8), compared with a mean self-BAT score of 9.1 (SD = 5.8). Reliability between the ISTH-BAT and self-BAT was moderate/high for postpartum hemorrhage (α = 0.79) and menstrual bleeding (α = 0.69) and lowest for hemarthrosis (α = 0.26). The self-BAT had a sensitivity of 79.7% and specificity of 53.1% for an abnormal ISTH-BAT. Adjusting for age and sex, a higher ISTH-BAT (and similarly self-BAT) was associated with impairments in fatigue (β = −0.07, [95% CI, −0.12 to −0.02]), social roles (β = −0.07, [95% CI, −0.11 to −0.03]), sleep (β = −0.04, [95% CI, −0.08 to −0.009]), pain interference (β = −0.06, [95% CI, −0.11 to −0.02]), and physical function (β = −0.07, (95% CI, −0.11 to −0.04]).
Conclusion
Regardless of diagnosis, higher ISTH-BAT and self-BAT scores are associated with QoL impairments. Self-BAT items may be meaningful surrogates for clinician assessment of heavy menstrual bleeding and postpartum hemorrhage, although domain-level reliability is variable.
{"title":"Relationships between bleeding assessment tools (ISTH-BAT, Self-BAT) and quality of life in patients with bleeding symptoms","authors":"Callie Berkowitz , Supreet K. Goraya , Angela M. Stover , Marcella H. Boynton , Alice Ma , Nigel S. Key","doi":"10.1016/j.rpth.2025.103330","DOIUrl":"10.1016/j.rpth.2025.103330","url":null,"abstract":"<div><h3>Background</h3><div>The clinician-administered ISTH bleeding assessment tool (ISTH-BAT) and its self-report counterpart (self-BAT) were developed to standardize and quantify bleeding history. How BATs relate to overall clinical assessment and quality of life (QoL) is uncertain.</div></div><div><h3>Methods</h3><div>A cross-sectional analysis of the ISTH-BAT, self-BAT, and PROMIS-29 QoL instruments was performed in 101 adult patients referred for bleeding disorder evaluation. We assessed reliability/agreement (Krippendorf’s α) and diagnostic test characteristics of the ISTH-BAT and self-BAT. Linear regression models were used to evaluate the association between BATs and QoL domains, measured as standardized Z-scores.</div></div><div><h3>Results</h3><div>Surveyed patients received the following diagnoses: Bleeding disorder of unknown cause (<em>n</em> = 46, 45.5%), qualitative platelet defect (<em>n</em> = 11, 10.9%), von Willebrand disease (<em>n</em> = 9, 8.9%), hypodysfibrinogenemia (<em>n</em> = 1, 1.0%), other/unclassified (<em>n</em> = 13, 12.9%), and no bleeding disorder (<em>n</em> = 21, 20.8%). The mean ISTH-BAT score was 8.1 (SD = 4.8), compared with a mean self-BAT score of 9.1 (SD = 5.8). Reliability between the ISTH-BAT and self-BAT was moderate/high for postpartum hemorrhage (α = 0.79) and menstrual bleeding (α = 0.69) and lowest for hemarthrosis (α = 0.26). The self-BAT had a sensitivity of 79.7% and specificity of 53.1% for an abnormal ISTH-BAT. Adjusting for age and sex, a higher ISTH-BAT (and similarly self-BAT) was associated with impairments in fatigue (β = −0.07, [95% CI, −0.12 to −0.02]), social roles (β = −0.07, [95% CI, −0.11 to −0.03]), sleep (β = −0.04, [95% CI, −0.08 to −0.009]), pain interference (β = −0.06, [95% CI, −0.11 to −0.02]), and physical function (β = −0.07, (95% CI, −0.11 to −0.04]).</div></div><div><h3>Conclusion</h3><div>Regardless of diagnosis, higher ISTH-BAT and self-BAT scores are associated with QoL impairments. Self-BAT items may be meaningful surrogates for clinician assessment of heavy menstrual bleeding and postpartum hemorrhage, although domain-level reliability is variable.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"10 1","pages":"Article 103330"},"PeriodicalIF":3.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.rpth.2025.103278
Céline Chapelle , Philippe Girard , Luis Jara-Palomares , Agnès Y.Y. Lee , Olivier Sanchez , Guy Meyer , Géraldine Poenou , Patrick Mismetti , Isabelle Mahé , Silvy Laporte
Background
Risk of venous thromboembolism (VTE) recurrence remains high in patients with cancer-associated thrombosis (CAT), despite therapeutic anticoagulation. Identifying patients at risk of treatment failure is still a challenge.
Objectives
We aimed to assess the performance of the Ottawa score in predicting VTE recurrence in a large homogeneous population of patients with CAT treated with the same anticoagulant, tinzaparin, for at least 3 months.
Methods
Individual patient data from 3 prospective cohort studies and 1 randomized controlled trial were pooled (PROSPERO: CRD42019119907). Clinical events of interest were adjudicated by independent central adjudication committees in all 4 studies.
Results
Among the 1413 patients included, the Ottawa score could be calculated for 1088 of whom 646 (59.4%) were classified at high risk of recurrence (Ottawa score ≥ 1). The 6-month cumulative incidence of recurrent VTE was 5.0% (95% CI, 3.2-7.8) in the Ottawa low-risk group and 8.5% (95% CI, 6.6-10.8) in the high-risk group. The area under the receiver operating characteristic curve was 0.56 (95% CI, 0.51-0.62). The sensitivity of the dichotomized Ottawa score (score ≥ 1) was 72.8% (95% CI, 62.6%-83.0%), the specificity was 41.9% (95% CI, 37.8%-45.9%), the positive predictive value was 8.6% (95% CI, 6.4%-10.8%), and the negative predictive value was 95.3% (95% CI, 93.3%-97.4%). Introducing additional predictive factors failed to significantly improve the score’s performance.
Conclusions
Despite the large number of patients and anticoagulant treatment standardization, the Ottawa score failed to accurately predict recurrent VTE in patients with CAT treated with tinzaparin.
{"title":"The Ottawa score for prediction of recurrent venous thromboembolism in cancer patients treated with tinzaparin: an individual patient data meta-analysis","authors":"Céline Chapelle , Philippe Girard , Luis Jara-Palomares , Agnès Y.Y. Lee , Olivier Sanchez , Guy Meyer , Géraldine Poenou , Patrick Mismetti , Isabelle Mahé , Silvy Laporte","doi":"10.1016/j.rpth.2025.103278","DOIUrl":"10.1016/j.rpth.2025.103278","url":null,"abstract":"<div><h3>Background</h3><div>Risk of venous thromboembolism (VTE) recurrence remains high in patients with cancer-associated thrombosis (CAT), despite therapeutic anticoagulation. Identifying patients at risk of treatment failure is still a challenge.</div></div><div><h3>Objectives</h3><div>We aimed to assess the performance of the Ottawa score in predicting VTE recurrence in a large homogeneous population of patients with CAT treated with the same anticoagulant, tinzaparin, for at least 3 months.</div></div><div><h3>Methods</h3><div>Individual patient data from 3 prospective cohort studies and 1 randomized controlled trial were pooled (PROSPERO: CRD42019119907). Clinical events of interest were adjudicated by independent central adjudication committees in all 4 studies.</div></div><div><h3>Results</h3><div>Among the 1413 patients included, the Ottawa score could be calculated for 1088 of whom 646 (59.4%) were classified at high risk of recurrence (Ottawa score ≥ 1). The 6-month cumulative incidence of recurrent VTE was 5.0% (95% CI, 3.2-7.8) in the Ottawa low-risk group and 8.5% (95% CI, 6.6-10.8) in the high-risk group. The area under the receiver operating characteristic curve was 0.56 (95% CI, 0.51-0.62). The sensitivity of the dichotomized Ottawa score (score ≥ 1) was 72.8% (95% CI, 62.6%-83.0%), the specificity was 41.9% (95% CI, 37.8%-45.9%), the positive predictive value was 8.6% (95% CI, 6.4%-10.8%), and the negative predictive value was 95.3% (95% CI, 93.3%-97.4%). Introducing additional predictive factors failed to significantly improve the score’s performance.</div></div><div><h3>Conclusions</h3><div>Despite the large number of patients and anticoagulant treatment standardization, the Ottawa score failed to accurately predict recurrent VTE in patients with CAT treated with tinzaparin.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"10 1","pages":"Article 103278"},"PeriodicalIF":3.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.rpth.2025.103295
Inga A. Røstvold , Ben Brumpton , Kristian Hveem , Bjørn Olav Åsvold , Guro F. Giskeødegård , George Davey Smith , Nicholas J. Timpson , Kaitlin H. Wade , John-Bjarne Hansen , Sigrid K. Brækkan
Background
Previous studies on high-density lipoprotein (HDL) cholesterol levels and the risk of venous thromboembolism (VTE) have shown conflicting results, and it has been suggested that specific HDL subfractions and lipid composition may be more informative with regards to VTE risk.
Objectives
We aimed to investigate the association between HDL subfractions (including particle size, concentration, and lipid composition) and risk of VTE in a population-based cohort.
Methods
The study included 17,032 participants from the Trøndelag Health Study (HUNT3) cohort conducted in 2006-2008 who were followed up until December 31, 2019. HDL subfractions were analyzed in serum using nuclear magnetic resonance spectroscopy. All incident VTEs during follow-up were validated and recorded. Cox proportional hazards regression models estimated hazard ratios (HRs) for the association between HDL metrics and incident VTE, adjusting for age, sex, and body mass index.
Results
During a median follow-up of 12.0 years, 342 incident VTE cases were confirmed. No associations were found among HDL particle size, HDL concentration, HDL lipid composition, apolipoprotein (Apo)A1 levels, and VTE risk. All HRs per 1-SD increase in HDL metrics were within the range of 0.83 to 1.16 and had 95% CIs that included 1. Furthermore, quartile analyses of HDL particles (Q4 vs Q1—HR, 0.89; 95% CI, 0.65-1.21) and ApoA1 (Q4 vs Q1—HR, 0.94; 95% CI, 0.68-1.29) showed no associations with VTE risk.
Conclusion
HDL subfractions, including particle size, concentration, lipid composition, and ApoA1, were not associated with the risk of a first-lifetime VTE event.
背景：先前关于高密度脂蛋白（HDL）胆固醇水平和静脉血栓栓塞（VTE）风险的研究显示出相互矛盾的结果，并且已经表明特定的HDL亚组分和脂质组成可能在VTE风险方面提供更多信息。目的：在以人群为基础的队列中，研究HDL亚组分（包括颗粒大小、浓度和脂质组成）与静脉血栓栓塞风险之间的关系。方法本研究纳入了2006-2008年开展的Trøndelag健康研究（HUNT3）队列中的17032名参与者，随访至2019年12月31日。采用核磁共振波谱法分析血清中HDL亚组分。随访期间的所有事件静脉血栓栓塞均被验证和记录。Cox比例风险回归模型在调整年龄、性别和体重指数后，估计了HDL指标与VTE事件之间的风险比（hr）。结果在中位随访12.0年期间，确认了342例静脉血栓栓塞病例。HDL颗粒大小、HDL浓度、HDL脂质组成、载脂蛋白（Apo）A1水平和静脉血栓栓塞（VTE）风险之间没有相关性。所有HDL指标每增加1- sd的hr范围在0.83 ~ 1.16之间，95% ci包括1。此外，HDL颗粒（Q4 vs Q1-HR, 0.89; 95% CI, 0.65-1.21）和ApoA1 （Q4 vs Q1-HR, 0.94; 95% CI, 0.68-1.29）的四分位数分析显示与静脉血栓栓塞风险无关联。结论hdl亚组分，包括颗粒大小、浓度、脂质组成和ApoA1，与首生命期静脉血栓栓塞事件的风险无关。
{"title":"High-density lipoprotein subfractions and risk of future venous thromboembolism—the HUNT study","authors":"Inga A. Røstvold , Ben Brumpton , Kristian Hveem , Bjørn Olav Åsvold , Guro F. Giskeødegård , George Davey Smith , Nicholas J. Timpson , Kaitlin H. Wade , John-Bjarne Hansen , Sigrid K. Brækkan","doi":"10.1016/j.rpth.2025.103295","DOIUrl":"10.1016/j.rpth.2025.103295","url":null,"abstract":"<div><h3>Background</h3><div>Previous studies on high-density lipoprotein (HDL) cholesterol levels and the risk of venous thromboembolism (VTE) have shown conflicting results, and it has been suggested that specific HDL subfractions and lipid composition may be more informative with regards to VTE risk.</div></div><div><h3>Objectives</h3><div>We aimed to investigate the association between HDL subfractions (including particle size, concentration, and lipid composition) and risk of VTE in a population-based cohort.</div></div><div><h3>Methods</h3><div>The study included 17,032 participants from the Trøndelag Health Study (HUNT3) cohort conducted in 2006-2008 who were followed up until December 31, 2019. HDL subfractions were analyzed in serum using nuclear magnetic resonance spectroscopy. All incident VTEs during follow-up were validated and recorded. Cox proportional hazards regression models estimated hazard ratios (HRs) for the association between HDL metrics and incident VTE, adjusting for age, sex, and body mass index.</div></div><div><h3>Results</h3><div>During a median follow-up of 12.0 years, 342 incident VTE cases were confirmed. No associations were found among HDL particle size, HDL concentration, HDL lipid composition, apolipoprotein (Apo)A1 levels, and VTE risk. All HRs per 1-SD increase in HDL metrics were within the range of 0.83 to 1.16 and had 95% CIs that included 1. Furthermore, quartile analyses of HDL particles (Q4 vs Q1—HR, 0.89; 95% CI, 0.65-1.21) and ApoA1 (Q4 vs Q1—HR, 0.94; 95% CI, 0.68-1.29) showed no associations with VTE risk.</div></div><div><h3>Conclusion</h3><div>HDL subfractions, including particle size, concentration, lipid composition, and ApoA1, were not associated with the risk of a first-lifetime VTE event.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"10 1","pages":"Article 103295"},"PeriodicalIF":3.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.rpth.2025.103296
Daniel Tham , Wenhui Yu , Lucy Zhao , Roger Kou , Jayhan Kherani , Pei Yi Li , Shreyas Sreeraman , Ali Eshaghpour , Allen Li , Mark A. Crowther
Background
Direct oral anticoagulants (DOACs) are the standard of care for treatment of venous thromboembolism and stroke prophylaxis in atrial fibrillation. Since patients with Child-Pugh (CP) B or C liver cirrhosis are underrepresented in trials, the safety of DOACs in this population is unclear.
Objectives
This study synthesized primary evidence on the safety profile of DOACs in patients with advanced liver cirrhosis.
Methods
A literature search of MEDLINE and Embase from inception to October 2025 identified randomized and nonrandomized cohort studies comparing DOAC with vitamin K antagonists or low-molecular-weight heparin in patients with liver cirrhosis. Screening and data collection were conducted in duplicate. The primary outcome was major bleeding defined by International Society on Thrombosis and Haemostasis criteria, stratified by CP class. Data were meta-analyzed using a random-effects model, presented as odds ratios (OR) with corresponding 95% CIs.
Results
Of 797 articles captured in the literature search, 15 nonrandomized (n = 17,387) and 1 randomized (n = 70) study were included. DOACs reduced major bleeding in both CP class B and C exclusive subgroup and a subgroup with unspecified CP stages of liver cirrhosis (CP B and C: OR, 0.53; 95% CI, 0.36-0.80; CP unspecified: OR, 0.66; 95% CI, 0.46-0.98).
Conclusion
Based on the findings of this meta-analysis, DOACs may be associated with a reduced risk of major bleeding compared with vitamin K antagonists or low-molecular-weight heparin in patients with liver cirrhosis, including those with CP class B and C cirrhosis. The results of this meta-analysis should be interpreted in the context of methodological limitations. Future analysis should evaluate the impact of specific DOACs and dosage on safety outcomes in this patient population.
{"title":"Safety and efficacy of direct oral anticoagulants in patients with liver cirrhosis: a meta-analysis","authors":"Daniel Tham , Wenhui Yu , Lucy Zhao , Roger Kou , Jayhan Kherani , Pei Yi Li , Shreyas Sreeraman , Ali Eshaghpour , Allen Li , Mark A. Crowther","doi":"10.1016/j.rpth.2025.103296","DOIUrl":"10.1016/j.rpth.2025.103296","url":null,"abstract":"<div><h3>Background</h3><div>Direct oral anticoagulants (DOACs) are the standard of care for treatment of venous thromboembolism and stroke prophylaxis in atrial fibrillation. Since patients with Child-Pugh (CP) B or C liver cirrhosis are underrepresented in trials, the safety of DOACs in this population is unclear.</div></div><div><h3>Objectives</h3><div>This study synthesized primary evidence on the safety profile of DOACs in patients with advanced liver cirrhosis.</div></div><div><h3>Methods</h3><div>A literature search of MEDLINE and Embase from inception to October 2025 identified randomized and nonrandomized cohort studies comparing DOAC with vitamin K antagonists or low-molecular-weight heparin in patients with liver cirrhosis. Screening and data collection were conducted in duplicate. The primary outcome was major bleeding defined by International Society on Thrombosis and Haemostasis criteria, stratified by CP class. Data were meta-analyzed using a random-effects model, presented as odds ratios (OR) with corresponding 95% CIs.</div></div><div><h3>Results</h3><div>Of 797 articles captured in the literature search, 15 nonrandomized (<em>n</em> = 17,387) and 1 randomized (<em>n</em> = 70) study were included. DOACs reduced major bleeding in both CP class B and C exclusive subgroup and a subgroup with unspecified CP stages of liver cirrhosis (CP B and C: OR, 0.53; 95% CI, 0.36-0.80; CP unspecified: OR, 0.66; 95% CI, 0.46-0.98).</div></div><div><h3>Conclusion</h3><div>Based on the findings of this meta-analysis, DOACs may be associated with a reduced risk of major bleeding compared with vitamin K antagonists or low-molecular-weight heparin in patients with liver cirrhosis, including those with CP class B and C cirrhosis. The results of this meta-analysis should be interpreted in the context of methodological limitations. Future analysis should evaluate the impact of specific DOACs and dosage on safety outcomes in this patient population.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"10 1","pages":"Article 103296"},"PeriodicalIF":3.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A cecal slurry mouse model of polymicrobial abdominal sepsis to evaluate the effects of antiplatelet agents","authors":"Alexandre Mansour , Isabelle Gouin-Thibault , Elisa Rossi , Aurore Marchelli , Tiphaine Belleville-Rolland , Nicolas Nesseler , Pascale Gaussem , Christilla Bachelot-Loza","doi":"10.1016/j.rpth.2025.103292","DOIUrl":"10.1016/j.rpth.2025.103292","url":null,"abstract":"","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"10 1","pages":"Article 103292"},"PeriodicalIF":3.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.rpth.2025.103298
Nikolaj Julian Skrøder Nytofte, Emil List Larsen
Background
The international normalized ratio (INR) is designed to monitor vitamin K antagonist (VKA) treatment. Before patients start a self-managing VKA program, parallel measurements are conducted to compare point-of-care testing (POCT) INR with venous INR samples. Previously, genetic variants in F7 have shown discrepancies in INR measurements when thromboplastins from different species were used. It is unknown whether genetic variants in F10 affect INR measured with thromboplastins from different species.
Key Clinical Question
Does F10:p.Gly244Arg heterozygosity affects the INR when measured using rabbit compared with human thromboplastin?
Clinical Approach
A patient self-managing warfarin treatment had a recurrent venous thromboembolism during VKA treatment. The POCT therapeutic range was low (ie, 1.6-2.4) based on parallel measurements of POCT INR (human thromboplastin) and venous INR (rabbit thromboplastin). Subsequently, it was noted that the patient had a spontaneous increase in INR (1.3), and the patient was found to be a heterozygous carrier of F10:p.Gly244Arg.
Conclusion
Genetic variants in F10 may also interfere with INR or prothrombin time measurements when different thromboplastins are used. This case illustrates that discrepancies in INR measurements with different thromboplastins should prompt consideration of genetic variants in F10 and F7 to ensure sufficient anticoagulant VKA treatment.
{"title":"Discrepancy between international normalized ratio measurements in a heterozygous carrier of F10:p.Gly244Arg with recurrent venous thromboembolism: a case report","authors":"Nikolaj Julian Skrøder Nytofte, Emil List Larsen","doi":"10.1016/j.rpth.2025.103298","DOIUrl":"10.1016/j.rpth.2025.103298","url":null,"abstract":"<div><h3>Background</h3><div>The international normalized ratio (INR) is designed to monitor vitamin K antagonist (VKA) treatment. Before patients start a self-managing VKA program, parallel measurements are conducted to compare point-of-care testing (POCT) INR with venous INR samples. Previously, genetic variants in <em>F7</em> have shown discrepancies in INR measurements when thromboplastins from different species were used. It is unknown whether genetic variants in <em>F10</em> affect INR measured with thromboplastins from different species.</div></div><div><h3>Key Clinical Question</h3><div>Does <em>F10</em>:p.Gly244Arg heterozygosity affects the INR when measured using rabbit compared with human thromboplastin?</div></div><div><h3>Clinical Approach</h3><div>A patient self-managing warfarin treatment had a recurrent venous thromboembolism during VKA treatment. The POCT therapeutic range was low (ie, 1.6-2.4) based on parallel measurements of POCT INR (human thromboplastin) and venous INR (rabbit thromboplastin). Subsequently, it was noted that the patient had a spontaneous increase in INR (1.3), and the patient was found to be a heterozygous carrier of <em>F10</em>:p.Gly244Arg.</div></div><div><h3>Conclusion</h3><div>Genetic variants in <em>F10</em> may also interfere with INR or prothrombin time measurements when different thromboplastins are used. This case illustrates that discrepancies in INR measurements with different thromboplastins should prompt consideration of genetic variants in <em>F10</em> and <em>F7</em> to ensure sufficient anticoagulant VKA treatment.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"10 1","pages":"Article 103298"},"PeriodicalIF":3.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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