Thrombosis Journal最新文献

Background: Deep vein thrombosis (DVT) is a prevalent complication associated with malignancy. Clinical use of thromboprophylaxis is recommended, however its usage is limited due to bleeding complications, more cost associated, and reluctance to receive anticoagulant injections. Rivaroxaban a relatively easy to administer anticoagulant but it has a risk of bleeding and is expensive. Inflammation is the important factor in pathogenesis of cancer-associated thrombosis. Statins have the anti-inflammatory property that could decrease proinflammatory cytokines. Consequently, statins may be used as thromboprophylaxis for cancer patients receiving chemotherapy.

Objective: To provide comparison between atorvastatin and rivaroxaban on affecting inflammatory biomarkers (interleukin 6 [IL-6], C reactive protein [CRP]) and coagulation activation biomarkers (Tissue Factor [TF], prothrombin fragment 1 + 2 [F1 + 2], D-Dimer) in cancer patients at high risk of thrombosis receiving chemotherapy.

Methods: A randomized controlled study that was double-blinded and involved high-risk cancer patients undergoing chemotherapy. For up to ninety days, participants were randomized to receiver either atorvastatin 20 mg or rivaroxaban 10 mg daily. The level of plasma of IL-6, CRP, TF, F1 + 2, and D-dimer were assessed 24 h before chemotherapy, 30, 60, and 90 day after chemotherapy. The latest observation carried forward (LOCF) approach was used to examine the data. The laboratory results were evaluated using an independent T test or Mann-Whitney U test prior to and after chemotherapy.

Results: Eighty-six randomized patients were enrolled, although both groups showed a decreasing trend in plasma level of IL-6, CRP, TF, F1 + 2, and D-dimer, there were no significant differences between the two groups (p > 0.05). In the atorvastatin group, there was a significant correlation between delta level of IL-6 and F1 + 2 (r = 0.313, p = 0.043) and delta level of CRP and F1 + 2 (r = 0.398, p = 0.009), whereas in the rivaroxaban group there was a significant correlation between delta CRP and D-dimer level (r = 0.387, p = 0.009).

Conclusion: Atorvastatin decreases IL-6 and CRP level, which also decreases F1 + 2 level. Atorvastatin did not substantially differ from rivaroxaban in decreasing plasma levels of inflammatory biomarkers IL-6, CRP, and coagulation activation biomarkers TF, F1 + 2, D-dimer in high-risk cancer patients undergoing chemotherapy.

Trial registration: ISRCTN71891829, Registration Date: 17/12/2020.

Background: Arterial thrombotic events are the leading causes of death worldwide, and the therapeutic effects of current antiplatelet drugs are not fully satisfactory. Oroxylin A (OroA), a flavone compound extracted from Scutellaria radix, possesses cardioprotective and many other pharmacological effects. While platelets play a crucial role in the development of myocardial infarction, the direct effects of OroA on platelet activation and thrombosis have yet to be investigated.

Methods: FeCl₃-induced arteriole thrombosis and whole-blood perfusion were used to assess the inhibitory effect of OroA on thrombus formation. A myocardial ischemia model was employed to evaluate the protective effect of OroA on myocardial injury. Multiple platelet function studies including platelet aggregation, platelet spreading, clot retraction were performed. Network pharmacology, flow cytometry, enzyme-linked immunosorbent assay, co-immunoprecipitation and western blot were utilized to explore the mechanism of OroA on platelet activation.

Results: OroA inhibited thrombus formation with less bleeding risk compared with aspirin. OroA protected against myocardial injury by suppressing microvascular thrombosis and platelet infiltration. OroA suppressed different agonist-induced platelet activation in a concentration-dependent manner, showing greater antiplatelet activity against collagen-induced platelet aggregation compared to ADP or thrombin-induced aggregation. OroA decreased granule release, integrin αIIbβ3 activation, platelet spreading and clot retraction. As a flavone, OroA boosted superoxide dismutase (SOD) and glutathione (GSH) activities and decreased malondialdehyde (MDA), oxidized glutathione (GSSG) and ROS levels in platelets during oxidative stress. OroA binds to SHP-2 and prevents its oxidative inactivation, leading to the tyrosine dephosphorylation of Src, Syk and PLCγ2, as well as the reduction of Ca²⁺ influx and PKC phosphorylation in GPVI signaling.

Conclusions: OroA inhibits platelet activation, thrombus formation and myocardial injury via reversing SHP-2 oxidative inactivation thereby attenuating collagen-induced GPVI signaling. With minor bleeding risk and no obvious pharmacological toxicity, OroA holds promising therapeutic potential as an antithrombotic drug.

Background: Patients with solid organ cancers are at increased risk of developing cancer-associated thrombosis (CAT), a complication driven by a complex interplay of patient-specific factors, cancer characteristics, and treatment modalities. Data on CAT and its associated risk factors within diverse ethnic groups, such as the Malaysian population, remains limited. This observational, cohort study aimed to address this gap by determining the incidence of CAT and identifying associated risk factors among multi-ethnic Malaysian patients with solid organ cancers.

Methods: This study included solid organ cancer patients aged ≥ 18 who attended HCTM and HKL from May 2022 to August 2023. The baseline demographics, and clinical characteristics, were acquired at the cancer diagnosis. Data on cancer treatment, thrombotic events and anticoagulation therapy during the study and its treatment were documented. Multivariable logistic regression analysis was performed to determine the independent factors associated with CAT in solid organ cancer.

Results: A total of 250 solid organ cancer patients were included, with a mean age of 57.7 (13.7) years. This multi-ethnic cohort consisted of mostly Malay patients (55.2%), followed by Chinese (33.2%) and Indian & others (11.6%). The prevalence of CAT at baseline was 4.8%, while the incidence of CAT during follow-up was 12%. Poor performance status and obesity were associated with CAT at baseline. Univariable logistic regression showed platelets ≥ 450 × 10⁹/L and Khorana score ≥ 3 had significantly higher risks of CAT at baseline. Stage IV disease, radiotherapy and chemotherapy, namely platinum-based chemotherapy and antimetabolites were associated with CAT during follow-up. The ROC analysis showed that the KRS significantly predicted CAT (area under the curve, 0.701 (95%CI: 0.594-0.808, p = 0.001).

Conclusions: This study highlights the prevalence of CAT at baseline and the incidence of CAT during follow-up, similar to other studies. Patients' clinical characteristics were associated with CAT at baseline while disease and treatment factors were associated with CAT at follow-up. These findings emphasise the need for targeted thromboprophylaxis in high-risk populations and highlight the importance of risk stratification tools such as the Khorana score for optimal patient management. Future studies involving larger patient cohorts and longer study duration would be beneficial. These findings provide valuable insights to inform clinical decision-making, optimise patient outcomes, and minimise potential risks.

Coronary sinus thrombosis (CST) is a rare and severe disease that remains underrecognized in clinical practice. Most documented cases fall within the acute category, with non-specific symptoms, rapid progression, and a high mortality rate. In contrast, some cases follow an insidious course, leading to the formation of partial or incomplete thrombi that may not cause immediate death but can progress to severe complications over time. This review study the pathophysiology, clinical presentations, diagnostic challenges, and the association with persistent left superior vena cava (PLSVC), emphasizing the utility of imaging modalities such as Echocardiography, Computed Tomography, Magnetic Resonance Imaging and Venography. For management, anticoagulation remains the cornerstone of treatment for CST, with surgical thrombectomy reserved for severe or refractory cases. Post-treatment follow-up is highlighted as essential for monitoring recurrence and managing complications. In brief, the aim of this review is to enhance the understanding of CST and improve clinical outcomes through early recognition, tailored interventions, and multidisciplinary care.

Background: The location of thrombus in acute pulmonary embolism (PE) is a debatable prognostic factor. We compared the characteristics and outcomes of hospitalized patients with central versus peripheral PE.

Methods: This retrospective study evaluated patients with acute PE diagnosed by CT pulmonary angiography who were hospitalized between 01/01/2016 and 31/12/2022. We compared patients with central (pulmonary trunk/main pulmonary artery) and peripheral (lobar/segmental/subsegmental) PE.

Results: We studied 438 patients (median age: 63 years; PE diagnosis in the Emergency Department: 64.8%; PE peripheral in 305 patients [69.6%] and central in 133 [30.4%]). Patients with central PE had higher levels of troponin I and brain natriuretic peptide and more frequent right ventricular strain by CT pulmonary angiography/ echocardiography (72.1% versus 33.3%, p < 0.0001). PE mortality risk could be classified in 355 patients; 24.4% of the 238 patients with peripheral PE were intermediate-high/ high-risk compared with 63.3% of the 117 patients with central PE. Patients with central PE had more systemic thrombolysis (13/133 [9.8%] versus 6/305 [2.0%], p < 0.0001) and more advanced endovascular therapy (15/133 [11.3%] versus 2/305 [0.7%], p < 0.0001). All-cause hospital mortality rate was similar in patients with central and peripheral PE (5.3% and 6.6%, respectively; p = 0.61). On multivariable logistic regression analysis, central versus peripheral PE was not associated with hospital mortality (odds ratio 0.392, 95% confidence interval 0.128, 1.199).

Conclusions: The majority of patients with central PE and a minority of those with peripheral PE were classified as intermediate-high/ high-risk, however, the central thrombus location was not associated with an increased risk of mortality.

Background: Even with adherence to thromboprophylaxis recommended by guidelines, the incidence of deep vein thrombosis (DVT) remains high among patients with severe community-acquired pneumonia (SCAP). There is an urgent need to identify the risk factors for DVT in these patients to optimize preventive strategies.

Study design and methods: We retrospectively enrolled 309 adults with SCAP admitted to Beijing Chao-Yang Hospital between 1 January 2015 and 30 June 2023. All patients received guideline-recommended thromboprophylaxis and lower extremity venous compression ultrasound scanning. Clinical characteristics, including demographic information, clinical history, vital signs, laboratory findings, treatments, complications, and outcomes, were analyzed for patients with and without DVT in these two cohorts.

Results: Of the 309 patients, 110 (35.6%) developed 1ower extremity DVT. There was no significant difference in the incidence of DVT among the different prophylactic measures (P = 0.393). Multivariate logistic regression analysis showed an association between a history of VTE (OR, 13.388, 95% CI: 2.179 ~ 82.257; P = 0.005), bedridden time > 3 days (OR, 17.672, 95% CI: 5.686 ~ 54.929; P < 0.001), D-dimer levels ≥ 1.0 µg/mL (OR, 2.109, 95% CI: 1.018 ~ 4.372; P = 0.045), LDH levels ≥ 400 U/L (OR, 2.548, 95% CI: 1.308 ~ 4.965; P = 0.006), IMV (OR, 2.479, 95% CI: 1.233 ~ 4.986; P = 0.011) and the occurrence of DVT. A new prediction model, including history of VTE, bedridden time, D-dimer levels, LDH levels and IMV, showed a better performance in predicting DVT (AUC = 0.856; 95% CI: 0.766 ~ 0.921; sensitivity: 80.6%; specificity: 81.4%) than Padua prediction score (AUC = 0.666) and Caprini prediction score (AUC = 0.688) for patients with SCAP. The 30-day mortality and in-hospital mortality in the DVT group were significantly higher than those in the non-DVT group.

Conclusions: Even received guideline-recommended thromboprophylaxis, the prevalence of DVT among patients with SCAP remains unexpectedly high which is also associated with a poor prognosis. It is necessary to identify people at high risk of DVT early and refine the preventive strategies accordingly to improve patient outcomes.

Background: Direct oral anticoagulants (DOACs) are widely used as first-line agents in various clinical settings. However, there is very little evidence regarding their use in critically ill patients in the intensive care unit (ICU), given the gap in the literature regarding their safety in this population and the concerns of bleeding and alterations in pharmacokinetics. Therefore, this study aimed to evaluate the prescribing pattern and safety of DOAC use in critically ill patients.

Methods: This was a single-centre retrospective chart review study involving critically ill patients with confirmed prehospital use of DOACs who either continued their use of DOACs or switched to a therapeutic parenteral anticoagulant agent (enoxaparin or heparin) during the admission to the medical ICU and/or coronary care unit (CCU). The primary outcome was the incidence of major bleeding (MB) events. The secondary outcomes included the incidence of new thrombosis and medical ICU/CCU mortality and hospital and medical ICU/CCU lengths of stay (LOS).

Results: A total of 675 patients were screened for inclusion. A total of 302 patients were included in the final analysis, with 167 patients in the DOAC group and 135 patients in the parenteral anticoagulant group. There were no differences between the groups in terms of the incidence of MB (11% vs. 9%, p = 0.61) or new thrombosis (1% vs. 3%, p = 0.50). The overall medical ICU/CCU mortality rate was lower in the DOAC group compared to the parenteral anticoagulant group (7% vs. 15%, p = 0.03). Additionally, the DOAC group had shorter medical ICU/CCU stays (6 days [4-11] vs. 11 days [5-24], p < 0.001) and shorter hospital stays (7 days [5-13] vs. 13 days [7-35], p < 0.001), respectively.

Conclusion: Compared with the use of parenteral anticoagulants, the use of DOACs in critically ill patients was associated with a similar incidence of MB and new thrombotic events. The observed differences in mortality and LOS between the groups may be attributed to variability in physician decision-making regarding anticoagulation strategies, potentially influenced by patient-specific factors and severity of illness. Further prospective studies to determine the optimal anticoagulation strategy in critically ill patients are warranted.

Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rt-PA) is the preferred treatment for acute ischemic stroke (AIS). Nevertheless, only approximately half of patients undergoing IVT experience positive outcomes. The objective of the study was to examine the clinical characteristics of patients with AIS and identify predictors for unfavorable clinical outcomes at 3 months after IVT. This retrospective cohort study comprised 3805 consecutive patients diagnosed with AIS who received IVT. Patients categorized as having a poor outcome were those with a modified Rankin scale score (mRS) of 3-6, while those categorized as having a good outcome had a score of 0-2. Clinical profiles and laboratory examinations were compared among patients with differing outcomes. A logistic regression model was utilized to investigate potential factors correlated with unfavorable outcomes. Of the 3805 patients included in the study, 3176 (83.5%) were found to have a good outcome, while 629 (16.5%) experienced an poor outcome following IVT. Advancing age (OR = 1.037, P < 0.001) and higher baseline National Institutes of Health Stroke Scale (NIHSS) scores (OR = 1.156, P < 0.001) were significant independent predictors of a poor outcome. The area under curve (AUC) values for age, NIHSS score, and the combined effect of age and NIHSS score in predicting a poor response were 0.644, 0.761, and 0.777, respectively. Our research indicates that advancing age and higher baseline NIHSS score may serve as prognostic indicators for predicting early unfavorable outcomes following IVT in patients with AIS.

This study aimed to explore the efficacy of Prognostic Nutritional Index (PNI), Controlling Nutritional Status (CONUT), and Nutritional Risk Index (NRI) in predicting postthrombotic syndrome (PTS) in patients with lower extremity deep vein thrombosis (DVT) based on peripheral blood samples. We reviewed and analyzed patients with lower extremity DVT in our hospital from June 2020 to December 2023. The receiver operating characteristic (ROC) curve identified the best nutritional scoring system for a logistic regression model. Restricted cubic spline (RCS) analysis examined the nonlinear link between the CONUT score and PTS risk, using knots at the 10th, 50th, and 90th percentiles of the CONUT score.The study investigated 246 cases of lower extremity DVT, PTS occurred in 59 patients (23.2%). Multifactorial analysis indicated that body mass index (BMI), prior varicose veins, recurrent venous thromboembolism (VTE), and CONUT score were independent risk factors for patients with DVT developing PTS (P < 0.05). In the multivariate analysis model, a CONUT score of > 4.5 was independently associated with PTS (P < 0.001). RCS analysis demonstrated a significant nonlinear relationship (P for nonlinearity = 0.028), with the risk of PTS increasing with CONUT scores up to an inflection point of 7, after which the risk plateaued. Our study suggest that an independent correlation was found between CONUT score and PTS in patients with lower extremity DVT.

Objective: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in diabetes mellitus (DM) patients. Oxidative stress and inflammation are important pathological mechanisms affecting the occurrence and development of ASCVD in DM patients. Dietary zinc acts a key role in anti-oxidation, anti-inflammation and blood glucose regulation. This study purposes to explore the relationship between dietary zinc intake and 10-year ASCVD in DM patients.

Methods: Based on the National Health and Nutrition Examination Survey (NHANES) 2007-2018, the 10-year risk of ASCVD was assessed using the 2018 ACC/AHA guidelines & pooled cohort equations model. The total dietary zinc intake was calculated through 24-h dietary recall. Weighted univariable, multivariate logistic regression and restricted cubic splines (RCS) were performed to evaluate the association between dietary zinc intake and 10-year risk of ASCVD among patients with DM. Stratified analysis based on the history of hypertension, dyslipidemia and hypoglycemic agent's treatment were further evaluated these associations.

Results: Finally, we included 3,053 DM patients, of which 1,245 (40.78%) had high risk of 10-year ASCVD. We found higher dietary zinc intake was related to lower 10-year ASCVD risk among patients with DM (OR = 0.77, 95%CI: 0.61-0.99, P = 0.044), especially in patients with hypertension (OR = 0.53, 95%CI: 0.36-0.80), dyslipidemia (OR = 0.74, 95%CI: 0.58-0.95, P = 0.019), and hypoglycemic agent's treatment (OR = 0.71, 95%CI: 0.54-0.93, P = 0.016).

Conclusion: Sufficient dietary zinc intake has potential benefits for cardiovascular health among patients with DM. Further large-scale and well-designed prospective study are needed to further explore these associations.