Thrombosis Journal最新文献

Vascular thiol isomerases (VTIs) encompass proteins such as protein disulfide isomerase (PDI), endoplasmic reticulum protein 5 (ERp5), ERp46, ERp57, ERp72, thioredoxin-related transmembrane protein 1 (TMX1), and TMX4, and play pivotal functions in platelet aggregation and formation of thrombosis. Investigating vascular thiol isomerases, their substrates implicated in thrombosis, the underlying regulatory mechanisms, and the development of inhibitors targeting these enzymes represents a rapidly advancing frontier within vascular biology. In this review, we summarize the structural characteristics and functional attributes of VTIs, describe the associations between these enzymes and thrombosis, and outline the progress in developing inhibitors of VTIs for potential antithrombotic therapeutic applications.

Cerebral sinus thrombosis, which constitutes a small percentage of all strokes, usually affects young individuals and can lead to venous stroke. Ischemic and hemorrhagic Stroke are associated with Spreading Depolarization (SD) waves in brain tissue, which propagate through the affected areas and cause a transient disruption of ionic homeostasis and neuronal function. This interaction highlights the complexity of the neurological consequences associated with SD. In this study, we investigated the occurrence of SDs following the occlusion of the superior sagittal sinus (SSS) in a gyrencephalic model, specifically swine. To instigate an occlusion, we surgically clipped the middle third of the SSS. The animals were grouped and monitored using one of three methods: electrocorticography (ECoG) alone, ECoG with intrinsic optical signal (IOS) imaging, or ECoG in conjunction with laser speckle contrast and oxygen imaging (LSCI). Post-mortem, the brains were analyzed using 2,3,5-triphenyl tetrazolium chloride (TTC) staining to check for venous infarction. Our results confirmed the spontaneous occurrence of SDs in the gyrencephalic swine brain after SSS occlusion, which was detectable via all monitoring methodologies. SD activity was most frequent in the first hour post-occlusion, subsequently diminishing. IOS imaging identified four unique hemodynamic responses, while TTC staining indicated no infarction. This research is the first to document SDs in the gyrencephalic swine brain following SSS occlusion, laying the groundwork for future investigations in both animal models and human clinical studies.

Background: Venous thromboembolism (VTE) is a major, frequent, and potentially fatal health issue worldwide. Community-acquired pneumonia (CAP) is one of the leading causes of hospitalization and parapneumonic pleural effusion (PPE) is a relatively common complication of pneumonia. Whether PPE is a risk factor for VTE in hospitalized patients with CAP has not been studied before.

Methods: We retrospectively reviewed all patients diagnosed with CAP admitted to our center from 1 January to 31 August in 2019. The clinical and laboratory data were collected from medical records. Univariate and multivariable logistic regression analysis were used to assess the VTE related risk factors. Subgroup analysis was conducted to investigate the potential correlation between PPE and VTE among distinct subsets of hospitalized patients diagnosed with CAP.

Results: This retrospective cohort study included 703 inpatients and 73 patients were confirmed VTE. In multivariable logistic regression analysis, PPE, age, sex, gender, D-dimer, and pneumonia severity index score, were significantly correlated with VTE. Several laboratory parameters within the PPE group demonstrated significant elevated levels compared to the non-PPE cohort, encompassing inflammatory markers such as neutrophils, C reaction protein, D-dimer, as well as some coagulation indicators including platelets, and prothrombin time.

Conclusion: PPE is an independent risk factor for hospitalized CAP patients. The patients with PPE have a higher level of inflammation response. Medical clinicians should pay more attention to VTE and improve its prevention and therapeutic strategies among hospitalized CAP patients.

Objectives: Total hip arthroplasty (THA) is classified as a high-risk surgery for venous thromboembolism (VTE) events, especially in elderly individuals and in cases of anemia. This study aims to uncover independent risk factors for predicting preoperative DVT in elderly anemic patients undergoing THA. Furthermore, it seeks to validate these factors' predictive efficacy in diagnosing DVT, with the goal of facilitating prompt identification and treatment to mitigate associated risks.

Methods: Clinical information and relevant laboratory test data of preoperative deep vein thrombosis (DVT) in 459 elderly patients with anemia who underwent total hip replacement surgery from January 2018 to June 2024 were retrospectively evaluated. Logistic regression analysis and backward stepwise method were used to detect independent predictors of preoperative DVT diagnosis in elderly patients with anemia who underwent total hip replacement surgery. A nomogram prediction model was established through multivariate logistic regression and subsequently utilized the testing group to validate.

Results: A multivariate logistic regression model was used to analyze the data, Hematocrit (HCT) (Odds ratio (OR) = 0.14, 95% confidence intervals (CI):[0.04,0.52]; P = 0.003), Albumin (ALB) (OR = 0.1, 95% CI:[0.03,0.37]; P = 0.001), Prothrombin Time (PT) (OR = 0.29, 95% CI:[0.1,0.83]; P = 0.02), Fibrin Degradation Products (FDP) (OR = 0.15, 95% CI:[0.05,0.49]; P = 0.002) and lymphocyte/Monocyte ratio (LMR) (OR = 0.28, 95% CI:[0.09,0.87], P = 0.028) were independent predictors for DVT before THA in elderly patients with anemia. The area under the curve (AUC) scores were 0.929 for the training group and 0.896 for the testing group, with calibration curve mean errors of 0.017 and 0.023, respectively. The decision curve analysis (DCA) graph indicates that the developed nomogram was highly practical and advantageous for clinical application.

Conclusion: The independent predictors of preoperative DVT in elderly anemic patients undergoing total hip replacement primarily include HCT, ALB, PT, FDP, and LMR at admission, which are easy to obtain and can quickly yield results. Moreover, the nomogram based on HCT, ALB, PT, FDP, and LMR can help clinical doctors evaluate the possibility of DVT formation, thereby accurately and quickly assisting clinical doctors in making better clinical judgments.

Background: Patient self-management (PSM) of anticoagulant treatment with vitamin K antagonist (VKA) has emerged as an effective approach for maintaining the international normalized ratio (INR) within the therapeutic range. The objective of this quality assurance project, conducted in clinical practice, was to evaluate the long-term effectiveness and safety of anticoagulant treatment with warfarin during PSM compared to conventional treatment administered by general practitioners (GPs).

Methods: This cohort study, using a retrospective and prospective design, included 400 patients who underwent PSM training for a 21-week period between 2011 and 2020. Clinical data extracted from the patient journal systems included hospitalization due to severe clinical complications. The primary outcome was any difference in the yearly risk of hospitalization between the conventional and PSM periods. Secondary outcomes included variations in time within the therapeutic range (TTR), INR fluctuations, and incidence of extreme INR values.

Results: The median treatment duration was 2.45 years (25th-75th percentile 0.80, 7.35) for the conventional period and 4.99 years (25th-75th percentile 2.41, 7.43) for the PSM period. The annual risk for hospitalization due to severe bleeding was 1.25% during PSM compared to 1.69% during conventional treatment (p = 0.885). The yearly risk for hospitalization due to thrombosis was 0.67% during PSM versus 1.48% during conventional treatment (p = 0.256), and the annual risk for hospitalization due to spontaneous bleeding, thrombosis, or thromboemboli was 1.12% versus 2.76% (p = 0.112). Median TTR (25th-75th percentile) increased from 71.6% (60.0, 82.7) to 78.6% (67.9, 91.7) (p < 0.001), while INR variance decreased from 21.0% to 16.5% (p < 0.001). The proportion of extreme subtherapeutic INR values (≤ 2.0 (≤ 1.5 for patients with mechanical ON-X aortic valve prostheses)) decreased from 14.0% to 5.0% (p < 0.001) during PSM, whereas the proportion of high-level INR (≥ 5.0) remained unchanged (0.6%).

Conclusions: The long-term evaluation of PSM of warfarin treatment in clinical practice suggests that PSM for suitable patients selected by GPs is as safe as conventional GP treatment.

Objective: To evaluate the comparative effectiveness of two distinct balloon pressure band compression regimens on the treatment outcomes for deep vein thrombosis (DVT) and venous blood flow velocity in the lower limbs of patients undergoing anterograde thrombolysis through the superficial dorsalis pedis vein.

Methods: A total of 42 patients diagnosed with DVT were enrolled in the randomized controlled trial. Patients in the control group received balloon pressure band compression positioned 15 cm above the bony landmark of the medial malleolus of the affected limb, with continuous inflation and deflation. On the basis of the control group, a balloon pressure band was also used 15 cm above the bony landmark of the medial malleolus and 10 cm below the midpoint of the patella in the affected limb in experimental group, with rotational inflation at these two sites. The thrombolysis effects and venous blood flow velocity of the lower extremities were compared between the two groups.

Results: The differences in limb circumference and Marder scores of patients in the experimental group were significantly lower than those in the control group, while the detumescence rate and venous patency rate of the affected limbs in the experimental group were significantly higher than those in the control group (P < 0.05). After 30 and 60 min of thrombolysis, femoral and popliteal vein blood flow velocities in the experimental group were significantly higher than those in the control group (P < 0.05). After 45 min post-thrombolysis, the femoral vein blood flow velocity in the experimental group remained significantly higher than that in the control group (P < 0.05), though no significant difference was observed in the popliteal vein blood flow velocity (P > 0.05).

Conclusion: In this study, alternating balloon pressure band compression applied at 15 cm above the bony marker of the medial malleolus and 10 cm below the patellar midpoint to block superficial venous blood flow was found to enhance thrombolysis efficacy and significantly improve venous blood flow velocity in the lower extremities among patients with DVT.

Background and purpose: Although Ginkgo biloba extract (GBE) has been shown to be effective in treating acute ischemic stroke (AIS) in several clinical trials, concerns regarding adverse events, such as bleeding, have been raised. This study aimed to investigate the mechanisms by which GBE improves AIS prognosis, particularly its impact on platelet activity, coagulation function, and the potential risk of bleeding.

Methods: This real-world study consecutively enrolled 99 patients: 49 with internal jugular venous stenosis (IJVS) treated with GBE; 33 with AIS treated with GBE and low-dose aspirin; and 17 with AIS treated with low-dose aspirin alone. Plasma platelet aggregation and coagulation status were assessed before and after treatment. Major and minor bleeding events were recorded in the AIS group.

Results: In the IJVS group, GBE specifically inhibited arachidonic acid (AA)-induced, but not ADP-induced, platelet aggregation, along with prolonged thrombin time (PT) and activated partial thromboplastin time (APTT). In the AIS group, the combined use of low-dose aspirin and GBE further reduced AA-induced platelet aggregation, mildly prolonged APTT, and was associated with an increased risk of minor bleeding events.

Conclusions: The therapeutic effect of GBE in AIS may, in part, be attributed to its ability to enhance the antiplatelet action of aspirin, particularly in inhibiting AA-induced platelet aggregation. However, the potential for increased bleeding risk warrants further investigation.

Background: Nephrotic syndrome (NS) is associated with an increased risk of venous thromboembolism (VTE). Anticoagulants are widely used in the prevention of VTE in NS patients. The use of direct oral anticoagulants (DOACs) has not been studied intensively in NS patients. The aim of this study is to determine the efficacy and safety of DOACs compared to warfarin for prophylactic anticoagulation in patients with nephrotic syndrome.

Methods: Retrospective analysis conducted in a tertiary hospital-based ambulatory anticoagulation clinic between 01/07/2016 and 29/11/2021. We aimed to evaluate the incidence of VTE, major bleeding, and non-major bleeding in both the DOACs and warfarin groups.

Results: Fifty-seven patients were recruited, 31 patients were prescribed warfarin (54.4%), and 26 were on DOAC (45.6%). Two patients in the DOAC group developed VTE, while no subjects in the warfarin group developed VTE, however, the difference was not statistically significance (p = 0.2). Nine out of 31 patients in the warfarin group developed non-major bleeding compared to three patients in the DOAC group (p = 0.02). One patient developed major bleeding in each group DOAC group 1 (15.4%), warfarin 1 (12.9%) (p = 1.00). There was no statistically significant difference in major bleeding between DOAC and warfarin groups (p = 1.00).

Conclusion: In patients with NS, preliminary evidence suggests that DOACs have comparable efficacy as compared to warfarin when used as prophylaxis. Additionally, DOACs result in lower incidences of non-major bleeding. However, further studies are indicated to confirm the superiority of DOACs over warfarin.

Anticoagulation therapy is a critical component of post-transcatheter aortic valve implantation (TAVI) management, aimed at reducing the risk of thromboembolic events and mortality. This review examines the efficacy of continuous versus interrupted anticoagulation strategies in TAVI patients, focusing on mortality, stroke rates, and composite events. A literature review was conducted, analyzing recent studies that evaluate the impact of different anticoagulation regimens on clinical outcomes in TAVI patients. Key outcomes assessed include all-cause mortality, thromboembolic events, and major cardiovascular complications within 30 days and up to one year post-procedure. The review identifies a trend favoring continuous anticoagulation, particularly with direct-acting oral anticoagulants (DOACs), which was associated with lower mortality rates and reduced stroke incidence in high-risk patients. However, findings were inconsistent across studies, with some reporting no significant differences in outcomes between continuous and interrupted strategies. Additionally, the review highlights the need to balance the benefits of thromboembolic prevention with the increased risk of bleeding and vascular complications associated with continuous therapy. The findings show the importance of individualized anticoagulation strategies tailored to patient risk profiles. Clinicians should weigh the potential benefits of continuous anticoagulation against the risks, particularly in high-risk populations. Ongoing research is essential to refine anticoagulation protocols in TAVI patients, enhancing both safety and efficacy in clinical practice.

Background: Venous thromboembolism (VTE) is a common vascular disease with a significant global burden, influenced by multiple factors, such as genetic, environmental, and immune components. Immune responses and shifts in immune cell profiles are closely linked to the development and progression of VTE, yet current studies are limited by confounding factors and reverse causation. To address these limitations, this study uses Mendelian randomization to explore the causal relationship between immune cell traits and VTE, aiming to provide insights into underlying mechanisms.

Methods: We utilized GWAS data on 731 immunological traits (n = 3757) from the IEU OpenGWAS project and VTE (21021 cases, 391160 controls) from Finngen public data. Five commonly used Mendelian randomization (MR) methods were employed, including inverse-variance weighted (IVW), MR-Egger regression, weighted median estimator (WME), and both weighted and simple models to analyze their associations. Sensitivity checks for the results included pleiotropy tests, heterogeneity tests, and leave-one-out analyses.

Results: From a strictly statistical perspective, no significant associations were observed after FDR correction. However, our exploratory analysis suggested potential trends between immune cell traits and VTE. When immune cells were considered as the exposure and VTE as the outcome, 44 immune cell traits were suggestively associated with VTE based on uncorrected p-values. Conversely, when VTE was considered as the exposure, it appeared to influence immune cell traits. Specifically, secreting CD4 regulatory T cells (OR = 0.9084; 95% CI: 0.8418-0.9804; P = 0.0135; FDR = 0.7339) and activated and resting CD4 regulatory T cells (OR = 0.9275; 95% CI: 0.8622-0.9977; P = 0.0433; FDR = 0.8048) suggested a potential protective trend against VTE. On the other hand, B cells expressing CD20 (OR = 1.0697; 95% CI: 1.0227-1.1188; P = 0.0033; FDR = 0.5767) and myeloid cells expressing CD33 (OR = 1.0199; 95% CI: 1.0021-1.0382; P = 0.0296; FDR = 0.7339) may be linked to an increased risk of VTE.

Conclusions: From a strict statistical perspective, no significant associations were identified after FDR correction. However, our analysis using MR method suggests a potential link between VTE and immune cell traits, suggesting the complex interplay between the immune system and thrombotic events. While this study is exploratory and needs validation, the findings of this study are hypothesis-generating with resect to the mechanisms underlying VTE and encourage further investigation into the role of immune activity in VTE pathology.