Thrombosis Journal最新文献

Background: Pancreatic ductal adenocarcinoma (PDAC) carries a high risk of venous thromboembolism (VTE), which significantly contributes to mortality. However, national trends in VTE-related deaths among this population remain poorly defined.

Methods: We conducted a cross-sectional analysis of U.S. mortality data from 1999 to 2020 using the CDC WONDER platform. Deaths were included if VTE was the underlying cause and pancreatic cancer a contributing cause. Age-adjusted mortality rates (AAMRs) were calculated, and Joinpoint regression was used to assess temporal trends, with subgroup analyses by sex, race/ethnicity, age, region, urbanization level, and place of death.

Results: A total of 20,373 VTE-related deaths occurred in pancreatic cancer patients. The overall AAMR was 0.36 per 100,000 population. A significant increase in mortality was observed, particularly from 2016 to 2020 (APC: 8.71%; p = 0.0039). Males had a higher AAMR than females (0.46 vs. 0.35). Black individuals experienced the highest mortality rate (0.62), followed by White (0.40) and Hispanic (0.36) populations. The burden increased sharply with age, peaking in the 75-84 age group (1.67). Geographic variation was notable, with the Midwest and West showing the highest AAMRs. Urban-rural differences were minimal, though trends rose in both settings. One-third (31.4%) of deaths occurred at home, highlighting potential gaps in outpatient management and end-of-life care.

Conclusion: VTE-related mortality in pancreatic cancer is rising, with disproportionate effects on older adults, males, and Black individuals. These findings highlight the need for tailored prevention strategies, equitable care access, and better integration of palliative services.

Background: Recent studies have shown a relation between red blood cell distribution width (RDW) / albumin (RAR) levels and worse outcomes in cases of pulmonary embolism (PE). Simplified pulmonary embolism severity index (sPESI) has been developed from more complex PESI score, predicting the risk of death in patients with acute PE (APE). This study aims to investigate whether RDW-Standard Deviation/Albumin (RDW-SD/Alb) can serve as a useful prognostic marker for APE and enhance the predictive capability of the sPESI.

Methods: This research is a single-center, retrospective analysis involving patients over 18 years. We enrolled 235 consecutive hospitalized patients with confirmed APE diagnoses. To evaluate the sensitivity and specificity of RDW-SD/Alb, sPESI, and the combined sPESI plus RDW-SD/Alb in predicting 6-month all-cause death, we used Receiver Operating Characteristic (ROC) curves. Additionally, we conducted Kaplan-Meier analysis to assess the impact of elevated RDW-SD/Alb levels (> 13.6) on patient survival time. We utilized multivariate Cox regression analysis to identify independent prognostic factors affecting patients survival.

Results: The mortality rate for RDW-SD/Alb > 13.6 group was significantly higher than that for the RDW-SD/Alb ≤ 13.6 group. Area under ROC (AUROC) of sPESI plus RDW-SD/Alb was statistically larger than AUROC of sPESI (p = 0.025). In the fully adjusted model, increased RDW-SD/Alb levels were consistently linked to all-cause mortality within six months of admission.

Conclusions: The predictive value of the sPESI for 6-month all-cause death improved when the RDW-SD/Alb > 13.6 parameter was included. RDW-SD/Alb, a novel inflammatory marker, was an independent prognostic factor for predicting 6-month all-cause mortality in patients with APE.

Background: The mechanism of thrombotic complications in patients with aortic stenosis (AS) is unclear so far. Our aim was to evaluate the levels of phosphatidylserine (PS) exposed on blood cells, endothelial cells (ECs), and extracellular vesicles (EVs) and its procoagulant activity (PCA) in mild to severe AS patients.

Methods: Exposed PS on blood cells, ECs and EVs were analyzed by flow cytometry. PCA was evaluated by clotting time (CT), intrinsic factor Xa (FXa), extrinsic FXa, thrombin and fibrin formation assays. We also evaluated the inhibitory effects of lactadherin (Lact) on PCA in AS patients.

Results: Our results demonstrated that patients with AS had significantly higher percentages of positive phosphatidylserine (PS⁺) red blood cells (RBCs), platelets (PLTs), white blood cells (WBCs) and ECs compared to controls. Total EVs with PS⁺, platelet EVs (PEVs), endothelial-derived EVs (EEVs) and positive tissue factor EVs (TF⁺EVs) levels were significantly higher in mild to severe AS. In addition, we further confirmed that PS⁺ blood cells, ECs and EVs significantly contributed to shortened CT and dramatically increased FXa, thrombin and final fibrin generation in mild to severe AS compared to controls. Furthermore, lactadherin significantly inhibited the PCA of PS exposure on blood cells, ECs and EVs in AS patients, whereas anti-TF had no this effect.

Conclusion: Our study revealed a previously unrecognized association between exposed PS levels on blood cells, ECs and EVs and PCA in AS. Lactadherin promises to be a new therapy by blocking PS to prevent thrombosis in AS patients.

Background: Real-world data are needed to inform clinical practice with regards to anticoagulation treatment for persons with venous thromboembolism (VTE).

Objectives: To identify the type and duration of antithrombotic treatment in persons with VTE. Anticoagulation dosage and persistence/adherence were among the secondary objectives.

Methods: A multicenter, observational, prospective study conducted in Greek adults with VTE with two on-site visits -baseline and at three months- and a telephone follow-up at 6 months.

Results: A total of 600 eligible persons were enrolled. The index event was 'PE only' in 50%, 'DVT only' in 40%, and 'DVT+PE' in 10%. Risk factors were categorized as temporary major (21%), temporary minor (37%), and persistent (43%), with active cancer present in 18% of patients. All VTE patients received anticoagulants: 73% received oral anticoagulants (72% DOACs, 1% VKAs) and 70% received parenteral anticoagulants. Treatment was oral only in 30%, parenteral only in 27%, and both in 43%. The most common DOAC was apixaban (47%). Extended anticoagulation (>6 months) was administered to 41% with only 9% (18/198) of those on DOACs receiving a reduced dose. Persistent risk factors predicted extended anticoagulation, while diabetes, COVID-19, and temporary minor risk factors did not. Adherence/persistence rates were similar between DOAC and non-DOAC-treated patients.

Conclusion: VTE was mainly treated with a combination of parenteral and oral anticoagulants. DOACs, primarily apixaban, were the most common oral treatments. Forty percent of patients received extended anticoagulation, mostly at standard dosages. Adherence and persistence rates were high for both DOAC and non-DOAC treatments.

Introduction: Deep Vein Thrombosis is a significant public health concern associated with high morbidity and mortality, mainly when left undiagnosed or untreated. In Ethiopia, fragmented data from various studies have reported varying prevalence and risk factors, necessitating a comprehensive synthesis. This systematic review aimed to identify and summarize the key factors contributing to deep vein thrombosis among patients in Ethiopia.

Methods: The study used a systematic review and meta-analysis design, sourcing evidence from various electronic databases until April 04, 2025. Data was extracted from March 10-15 and analyzed from March 15-25, with the report generation until April 04, 2025. The mortality rate was assessed using the pooled odds ratio and the pooled proportion. A meta-analysis was conducted using R software, with forest plots for visual representation. Heterogeneity was evaluated using the I² statistic. The quality of the studies was assessed using validated tools.

Results: The review showed the pooled prevalence of deep vein thrombosis from eight articles was 5.6%( CI: 2.9, 8.5), with a 5% mortality rate (CI: 3, 8), and a 7.15%( CI: 2, 12) recurrence rate. Advanced age, being male, pregnancy, hypertension, diabetes, comorbid conditions, and a history of Deep Vein Thrombosis, high cholesterol level, orthopedic trauma, Alcohol consumption, and obesity, Patients with bilateral Deep Vein Thrombosis prolonged hospitalization, ward admission, and patient transfer from other hospitals, and use of central venous catheters were associate with increased the risk of Deep Vein Thrombosis development.

Conclusion and recommendation: The review showed that Deep Vein Thrombosis is a significant health concern in Ethiopia, with a prevalence of 5.6%, a mortality rate of 5%, and a recurrence rate of 7.15%. Factors such as advanced age, pregnancy, prior deep-vein thrombosis, comorbidities, intensive care unit admission, surgery, prolonged hospitalization, and central venous catheter use increase risk. To reduce DVT-related complications, routine risk assessments, early intervention strategies, and strengthened hospital protocols are essential.

Registration number: CRD420251024491 was registered with PROSPERO on 06 April 2025.

Background: Effective thromboprophylaxis is critical to reducing mortality and improving clinical outcomes in COVID-19 patients. Despite guidelines recommending prophylactic anticoagulation, particularly for those in intensive care, real-world adherence and optimal venous thromboembolism (VTE) prevention strategies remain challenging, particularly in populations with complex comorbidities.

Methods: A prospective study was conducted on patients hospitalized with moderate, severe, and critical COVID-19 in six Chinese hospitals during the Omicron pandemic (December 2022-January 2023). The dose and duration of low-molecular-weight heparin (LMWH) were recorded. VTE, all-cause mortality and major bleeding events during hospitalization and 90-days follow-up were analyzed as endpoints.

Results: Among 4,236 COVID-19 patients, 1575 (37.09%) received LMWH prophylaxis, with 592 (37.6%) receiving reduced dosage (< 4000IU/24 h). The multivariable logistic regression model revealed that age ≥ 65, elevated D-dimer levels, severely ill at admission and concomitant use of antiviral drugs or corticosteroids were the main factors influencing the initiation of LMWH thromboprophylaxis in hospitalized COVID-19 patients. Patients who were critically ill at admission were more likely to receive reduced doses of LMWH. The duration of thromboprophylaxis over 7 days was associated with reduced estimated glomerular filtration rate (eGFR) and concomitant use of antiviral drugs or corticosteroid, whereas shorter durations were observed in patients with platelet less than 100*10⁹/L and anemia.

Conclusion: Real-world thromboprophylaxis in hospitalized COVID-19 patients vary widely, with a significant proportion receiving lower-than-conventional doses of LMWH. There is a need for individualized thromboprophylaxis strategies that consider patient-specific factors such as disease severity, renal function, low platelet and anemia to optimize outcomes.

Acute renal artery embolism (ARAE) is a rare vascular event that precipitates renal infarction (RI) caused by abrupt disruption of renal artery blood flow. RI is frequently misdiagnosed or diagnosed late because of its rarity and frequently ambiguous clinical presentation, potentially leading to irreversible harm to the renal parenchyma or an increased risk of other embolic events affecting other organs. Risk factors for ARAEs include atrial fibrillation, valvular or ischemic heart disease, renal artery embolism/dissection, and coagulopathy, and complete unilateral renal artery embolism is rare. We present the case of one patient with unilateral ARAE caused by atrial fibrillation. We performed percutaneous endovascular therapy (PET) for the renal artery embolism, including catheter-directed thrombolysis (CDT) and aspiration thrombectomy with systemic anticoagulant therapy. At the one-year follow-up, severe atrophy of the affected kidney and compensatory enlargement of the contralateral kidney were observed. We found that procedurally successful revascularization does not necessarily translate to functional recovery of the renal parenchyma. To accurately assess long-term renal functional restoration, we propose incorporating post-thrombectomy anatomical evaluations (e.g., via renal artery angiography or CT angiography [CTA]) combined with functional renal scintigraphy into standardized clinical protocols. This multimodal approach would not only validate the angiographic outcomes but also provide critical insights into the viability of the parenchyma, thereby guiding the development of patient-specific therapeutic strategies. Recommendations for optimal treatment for renal artery embolism are needed. Therefore, we share this case with the aim of providing valuable information for the treatment of renal infarction.

Objective: Atherosclerotic plaque regression under lipid-lowering therapy shows considerable individual variation, and the factors influencing this variability remain incompletely understood. This study aimed to investigate the relationship between carotid plaque echogenicity and plaque regression in patients receiving lipid-lowering therapy, and to identify ultrasound characteristics that might predict plaque regression.

Methods: A total of 838 patients with carotid plaques receiving lipid-lowering therapy were enrolled between July 2020 and May 2024 and followed up for 12 months. Carotid ultrasound was performed at baseline and follow-up to evaluate plaque characteristics. Plaque regression was defined as meeting any of the following criteria: (1) reduction in plaque area ≥ 5%, (2) decrease in plaque thickness ≥ 0.4 mm, or (3) reduction in plaque number, as assessed by vascular ultrasound imaging. Plaque echogenicity was classified into three types: hypoechoic, hyperechoic, and mixed echogenicity. Cox proportional hazards regression analysis was performed to assess the association between plaque echogenicity and plaque regression, adjusting for potential confounding factors.

Results: Hypoechoic plaques showed higher rates of regression (72.8%) compared to hyperechoic (37.7%) and mixed echogenicity plaques (50.0%) (p < 0.001). After adjusting for confounding variables, hypoechoic plaques exhibited greater odds of regression compared to hyperechoic plaques (adjusted HR = 4.52, 95% CI: 3.18-6.43, p < 0.001). Additionally, the median percentage reduction in plaque size was more pronounced in hypoechoic plaques, (15.2%, IQR: 7.7-22.3%) compared with other echogenicities (p < 0.001).

Conclusion: Carotid plaque echogenicity is strongly associated with the likelihood plaque regression, with hypoechoic plaques exhibiting higher regression rates and greater reductions in plaque size. These findings may help guide personalized treatment strategies and improve risk assessment.

Background: A considerable number of patients with deep vein thrombosis of the lower extremities will develop post-thrombotic syndrome even after receiving standardized anticoagulation therapy. Damage to the femoral vein valves caused by post-thrombotic syndrome can lead to severe chronic lower limb venous insufficiency and currently there is a lack of effective treatment.

Case presentation: We present a patient with pigmentation and itching due to post-thrombotic syndrome, where the anterior leaflet of the first set of valves in the superficial femoral vein was completely destroyed, while the posterior leaflet, although structurally intact, was adhered to the vessel wall. By reconstructing the posterior leaflet of the femoral vein valve and simultaneously narrowing the lumen where the anterior leaflet was located through suture ligation, we restored the valve's function to prevent venous reflux. During a 12-month follow-up period, the patient's quality of life significantly improved.

Conclusions: Single-leaflet reconstruction surgery may serve as a potential treatment option for patients with post-thrombotic syndrome.