Pub Date : 2025-01-23DOI: 10.1016/j.thromres.2025.109259
Muhammad Saad , Ruqiat Masooma Batool , Saad Ahmed Waqas , Muhammad Umer Sohail , Anmol Mohan , Vikash Kumar , Ishaque Hameed , Raheel Ahmed , M. Chadi Alraies
Background
While cancer mortality rates in the United States (U.S.) have decreased due to advances in chemotherapy, older adults with cancer face an elevated risk of venous thromboembolism (VTE). This study analyzes trends in cancer-associated VTE mortality among older adults in the U.S. population.
Methods
Using the CDC WONDER multiple cause of death (MCD) database, we reviewed death certificates from 1999 to 2020 to assess cancer-associated VTE mortalities among older adults (≥65 years old). We report age-adjusted mortality rates (AAMRs) per 100,000 persons, along with the average annual percent change (AAPC) using Joinpoint regression.
Results
Over the study period, 175,811 cancer-associated VTE deaths were recorded. The AAMR rose from 16.8 in 1999 to 22.8 in 2020, with an AAPC of +1.4 % (95 % CI: 1.2–1.6; p < 0.001). Males had a higher AAMR (22.2) than females (17.0). Non-Hispanic (NH) Black individuals had the highest AAMR (28.3), followed by NH Whites (19.3), Hispanics (12.0), and NH Asians (7.9). AAMRs were higher in nonmetropolitan areas (19.4) than urban counterparts (19.1). Regionally, the Midwest recorded the highest AAMR at 20.9. States in the top 90th percentile reported double the AAMRs compared to those in the bottom 10th percentile.
Conclusion
Cancer-associated VTE mortality rates are rising among older adults in the U.S., highlighting the need for enhanced screening, aggressive management, and consistent surveillance for VTE in cancer patients at risk.
{"title":"Unveiling the trends: Growing cancer and venous thromboembolism mortality in older adults in the United States, 1999–2020","authors":"Muhammad Saad , Ruqiat Masooma Batool , Saad Ahmed Waqas , Muhammad Umer Sohail , Anmol Mohan , Vikash Kumar , Ishaque Hameed , Raheel Ahmed , M. Chadi Alraies","doi":"10.1016/j.thromres.2025.109259","DOIUrl":"10.1016/j.thromres.2025.109259","url":null,"abstract":"<div><h3>Background</h3><div>While cancer mortality rates in the United States (U.S.) have decreased due to advances in chemotherapy, older adults with cancer face an elevated risk of venous thromboembolism (VTE). This study analyzes trends in cancer-associated VTE mortality among older adults in the U.S. population.</div></div><div><h3>Methods</h3><div>Using the CDC WONDER multiple cause of death (MCD) database, we reviewed death certificates from 1999 to 2020 to assess cancer-associated VTE mortalities among older adults (≥65 years old). We report age-adjusted mortality rates (AAMRs) per 100,000 persons, along with the average annual percent change (AAPC) using Joinpoint regression.</div></div><div><h3>Results</h3><div>Over the study period, 175,811 cancer-associated VTE deaths were recorded. The AAMR rose from 16.8 in 1999 to 22.8 in 2020, with an AAPC of +1.4 % (95 % CI: 1.2–1.6; <em>p</em> < 0.001). Males had a higher AAMR (22.2) than females (17.0). Non-Hispanic (NH) Black individuals had the highest AAMR (28.3), followed by NH Whites (19.3), Hispanics (12.0), and NH Asians (7.9). AAMRs were higher in nonmetropolitan areas (19.4) than urban counterparts (19.1). Regionally, the Midwest recorded the highest AAMR at 20.9. States in the top 90th percentile reported double the AAMRs compared to those in the bottom 10th percentile.</div></div><div><h3>Conclusion</h3><div>Cancer-associated VTE mortality rates are rising among older adults in the U.S., highlighting the need for enhanced screening, aggressive management, and consistent surveillance for VTE in cancer patients at risk.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"247 ","pages":"Article 109259"},"PeriodicalIF":3.7,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-22DOI: 10.1016/j.thromres.2025.109274
Emilie Sonne-Holm , Jesper Kjærgaard , Lia E. Bang , Lars Køber , Emil Fosbøl , Christian Hassager , Rasmus Paulin Beske , Jørn Carlsen , Matilde Winther-Jensen
Background
In patients with pulmonary embolism (PE), the impact of repeated troponin I or T (TnI/TnT) measurements remains unclear.
Methods
Using Danish national registries, we identified PE patients (≥18 years) hospitalized between 2013 and 2018 with initial TnI or TnT measurement within −1/+1 day from admission and >1 repeated measurement within three days. Trajectories of TnI and TnT were identified using latent class trajectory modeling. Hazard ratios for 30-day mortality were compared across trajectories via multivariable Cox regression.
Results
Among 1539 patients with TnI measurements and 1323 with TnT measurements, three distinct trajectories were identified. Trajectory I (nTnI = 286, nTnT = 472) exhibited consistently low TnI/TnT concentrations, trajectory II (nTnI = 1076, nTnT = 724) demonstrated initial elevated TnI/TnT decreasing within 24 h, and trajectory III (nTnI = 177, nTnT = 127) was characterized by elevated index TnI/TnT increasing within 10 h. 30-day mortality rates were higher in trajectory II and III compared to I in both the TnI (3 %, 7 % and 18 % across trajectory I to III) and the TnT (1 %, 9 % and 20 % across trajectory I to III) cohort. After adjustment hazard ratio of 30-day mortality for trajectory II vs. I was 7.42 (95 % CI 1.00–54.84, p = 0.04, TnI) and 2.93 (95 % CI 1.17–7.33, p = 0.02 TnT); and for trajectory III vs. I, 16.42 (95 % CI 2.42–127.29, p = 0.007, TnI) and 8.21 (95 % CI 2.78–24.19, p < 0.001, TnT).
Conclusion
A steep increase in TnI or TnT concentration within 10 h of PE diagnosis significantly escalates 30-day mortality risk indicating that early serial sampling may enhance risk stratification of PE patients.
{"title":"Dynamics of troponins and 30-day mortality in hospitalized patients with pulmonary embolism","authors":"Emilie Sonne-Holm , Jesper Kjærgaard , Lia E. Bang , Lars Køber , Emil Fosbøl , Christian Hassager , Rasmus Paulin Beske , Jørn Carlsen , Matilde Winther-Jensen","doi":"10.1016/j.thromres.2025.109274","DOIUrl":"10.1016/j.thromres.2025.109274","url":null,"abstract":"<div><h3>Background</h3><div>In patients with pulmonary embolism (PE), the impact of repeated troponin I or T (TnI/TnT) measurements remains unclear.</div></div><div><h3>Methods</h3><div>Using Danish national registries, we identified PE patients (≥18 years) hospitalized between 2013 and 2018 with initial TnI or TnT measurement within −1/+1 day from admission and >1 repeated measurement within three days. Trajectories of TnI and TnT were identified using latent class trajectory modeling. Hazard ratios for 30-day mortality were compared across trajectories via multivariable Cox regression.</div></div><div><h3>Results</h3><div>Among 1539 patients with TnI measurements and 1323 with TnT measurements, three distinct trajectories were identified. Trajectory I (n<sub>TnI</sub> = 286, n<sub>TnT</sub> = 472) exhibited consistently low TnI/TnT concentrations, trajectory II (n<sub>TnI</sub> = 1076, n<sub>TnT</sub> = 724) demonstrated initial elevated TnI/TnT decreasing within 24 h, and trajectory III (n<sub>TnI</sub> = 177, n<sub>TnT</sub> = 127) was characterized by elevated index TnI/TnT increasing within 10 h. 30-day mortality rates were higher in trajectory II and III compared to I in both the TnI (3 %, 7 % and 18 % across trajectory I to III) and the TnT (1 %, 9 % and 20 % across trajectory I to III) cohort. After adjustment hazard ratio of 30-day mortality for trajectory II vs. I was 7.42 (95 % CI 1.00–54.84, <em>p</em> = 0.04, TnI) and 2.93 (95 % CI 1.17–7.33, <em>p</em> = 0.02 TnT); and for trajectory III vs. I, 16.42 (95 % CI 2.42–127.29, <em>p</em> = 0.007, TnI) and 8.21 (95 % CI 2.78–24.19, <em>p</em> < 0.001, TnT).</div></div><div><h3>Conclusion</h3><div>A steep increase in TnI or TnT concentration within 10 h of PE diagnosis significantly escalates 30-day mortality risk indicating that early serial sampling may enhance risk stratification of PE patients.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"247 ","pages":"Article 109274"},"PeriodicalIF":3.7,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042053","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 : 2025-01-20DOI: 10.1016/j.thromres.2025.109271
Sina Rashedi , Antoine Bejjani , Andetta R. Hunsaker , Ayaz Aghayev , Candrika D. Khairani , Bridget McGonagle , Ying-Chih Lo , Shiwani Mahajan , César Caraballo , Jose Victor Jimenez , Darsiya Krishnathasan , Mehrdad Zarghami , Manuel Monreal , Stefano Barco , Eric A. Secemsky , Frederikus A. Klok , Alfonso Muriel , Mohamad A. Hussain , Abena Appah-Sampong , Farbod N. Rahaghi , Behnood Bikdeli
Background
Isolated subsegmental pulmonary embolism (issPE) is a commonly encountered diagnosis. Although the International Classification of Diseases (ICD)-10 codes are used for research, their validity for identifying issPE is unknown. Moreover, issPE diagnosis is challenging, and the findings from radiology reports may conflict with those from expert radiologists.
Methods
Based on prespecified criteria, 1734 medical records of adult patients hospitalized within the Mass General Brigham health system (2016–2021) were selected in three equal groups: (1) patients with principal discharge diagnosis codes for PE, (2) patients with secondary discharge diagnosis codes for PE, and (3) patients with no PE codes. The accuracy of ICD-10 codes for issPE was verified by two independent physicians and weighted by total hospitalizations. In a randomly selected sample of 70 patients, the accuracy of initial radiology reports was determined through a blinded re-evaluation by two expert radiologists.
Results
In weighted estimates, ICD-10 codes in primary or secondary discharge positions, compared with chart reviews, showed a low sensitivity (7.0 %) and positive predictive value (25.2 %). Evaluation by two expert radiologists noted that initial radiology reports were sensitive (97.1 %) for issPE but had a low specificity (40.0 %). Two (3.6 %) out of 55 patients with initial issPE reports did not have PE, while 19 (34.5 %) had more proximal PE.
Conclusions
ICD-10 codes for issPE have poor sensitivity and positive predictive value and should not be used for research or quality improvement. Radiology reports for issPE may be inaccurate regarding the location or, less often, the presence of PE.
{"title":"Isolated subsegmental pulmonary embolism identification based on international classification of diseases (ICD)-10 codes and imaging reports","authors":"Sina Rashedi , Antoine Bejjani , Andetta R. Hunsaker , Ayaz Aghayev , Candrika D. Khairani , Bridget McGonagle , Ying-Chih Lo , Shiwani Mahajan , César Caraballo , Jose Victor Jimenez , Darsiya Krishnathasan , Mehrdad Zarghami , Manuel Monreal , Stefano Barco , Eric A. Secemsky , Frederikus A. Klok , Alfonso Muriel , Mohamad A. Hussain , Abena Appah-Sampong , Farbod N. Rahaghi , Behnood Bikdeli","doi":"10.1016/j.thromres.2025.109271","DOIUrl":"10.1016/j.thromres.2025.109271","url":null,"abstract":"<div><h3>Background</h3><div>Isolated subsegmental pulmonary embolism (issPE) is a commonly encountered diagnosis. Although the International Classification of Diseases (ICD)-10 codes are used for research, their validity for identifying issPE is unknown. Moreover, issPE diagnosis is challenging, and the findings from radiology reports may conflict with those from expert radiologists.</div></div><div><h3>Methods</h3><div>Based on prespecified criteria, 1734 medical records of adult patients hospitalized within the Mass General Brigham health system (2016–2021) were selected in three equal groups: (1) patients with principal discharge diagnosis codes for PE, (2) patients with secondary discharge diagnosis codes for PE, and (3) patients with no PE codes. The accuracy of ICD-10 codes for issPE was verified by two independent physicians and weighted by total hospitalizations. In a randomly selected sample of 70 patients, the accuracy of initial radiology reports was determined through a blinded re-evaluation by two expert radiologists.</div></div><div><h3>Results</h3><div>In weighted estimates, ICD-10 codes in primary or secondary discharge positions, compared with chart reviews, showed a low sensitivity (7.0 %) and positive predictive value (25.2 %). Evaluation by two expert radiologists noted that initial radiology reports were sensitive (97.1 %) for issPE but had a low specificity (40.0 %). Two (3.6 %) out of 55 patients with initial issPE reports did not have PE, while 19 (34.5 %) had more proximal PE.</div></div><div><h3>Conclusions</h3><div>ICD-10 codes for issPE have poor sensitivity and positive predictive value and should not be used for research or quality improvement. Radiology reports for issPE may be inaccurate regarding the location or, less often, the presence of PE.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"247 ","pages":"Article 109271"},"PeriodicalIF":3.7,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042055","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 : 2025-01-14DOI: 10.1016/j.thromres.2025.109258
Eman Hassan , David Sutton , Richard J Buka , Gillian Lowe , Taran Nandra , Nkemdirim Jacob , Lucy Rose , Yasir Alhamdi , HaemSTAR Collaborators, Phillip L.R. Nicolson
Background
Heavy menstrual bleeding (HMB) is a significant clinical burden for premenopausal individuals treated with anticoagulation for acute venous thromboembolism (VTE). Despite its prevalence, HMB management remains poorly studied, with wide variation in clinical practice.
Objectives
The current study aimed to explore current UK practices in managing HMB in anticoagulated individuals and identify areas requiring clinical research to address disparities.
Methods
A national survey was conducted among haematology consultants and consultant clinical pharmacists managing anticoagulated patients. The survey focused on management strategies, including anticoagulant selection, use of tranexamic acid (TXA), contraceptive options, and anticoagulation interruption.
Results and conclusion
Responses were collected from 102 participants, across the UK. Apixaban was the preferred anticoagulant for patients with HMB, followed by LMWH then dabigatran. Timing of TXA initiation varied widely between respondents, with (35.3 %) prescribing it any time after anticoagulation initiation, (11.8 %) delaying TXA use for 3 months, and (7.8 %) would not give it at all. (47.1 %) of respondents advise to discontinue oestrogen containing contraceptives in patients with acute VTE. Almost all respondents never or rarely stop anticoagulation for a patient with HMB and recent VTE ≤4 weeks. (62.7 %) of respondents showed their willingness to participate in clinical studies to study TXA use in the setting of acute VTE ≤4 weeks in anticoagulated individuals.
This study highlights significant variations in HMB management during anticoagulation for acute VTE. Disparities raise concerns about health inequities and underscore the urgent need for prospective clinical trials to improve patient outcomes.
{"title":"Disparities in menstrual bleeding management during acute venous thromboembolism treatment: A review of UK practice and a call for clinical studies","authors":"Eman Hassan , David Sutton , Richard J Buka , Gillian Lowe , Taran Nandra , Nkemdirim Jacob , Lucy Rose , Yasir Alhamdi , HaemSTAR Collaborators, Phillip L.R. Nicolson","doi":"10.1016/j.thromres.2025.109258","DOIUrl":"10.1016/j.thromres.2025.109258","url":null,"abstract":"<div><h3>Background</h3><div>Heavy menstrual bleeding (HMB) is a significant clinical burden for premenopausal individuals treated with anticoagulation for acute venous thromboembolism (VTE). Despite its prevalence, HMB management remains poorly studied, with wide variation in clinical practice.</div></div><div><h3>Objectives</h3><div>The current study aimed to explore current UK practices in managing HMB in anticoagulated individuals and identify areas requiring clinical research to address disparities.</div></div><div><h3>Methods</h3><div>A national survey was conducted among haematology consultants and consultant clinical pharmacists managing anticoagulated patients. The survey focused on management strategies, including anticoagulant selection, use of tranexamic acid (TXA), contraceptive options, and anticoagulation interruption.</div></div><div><h3>Results and conclusion</h3><div>Responses were collected from 102 participants, across the UK. Apixaban was the preferred anticoagulant for patients with HMB, followed by LMWH then dabigatran. Timing of TXA initiation varied widely between respondents, with (35.3 %) prescribing it any time after anticoagulation initiation, (11.8 %) delaying TXA use for 3 months, and (7.8 %) would not give it at all. (47.1 %) of respondents advise to discontinue oestrogen containing contraceptives in patients with acute VTE. Almost all respondents never or rarely stop anticoagulation for a patient with HMB and recent VTE ≤4 weeks. (62.7 %) of respondents showed their willingness to participate in clinical studies to study TXA use in the setting of acute VTE ≤4 weeks in anticoagulated individuals.</div><div>This study highlights significant variations in HMB management during anticoagulation for acute VTE. Disparities raise concerns about health inequities and underscore the urgent need for prospective clinical trials to improve patient outcomes.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"247 ","pages":"Article 109258"},"PeriodicalIF":3.7,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-11DOI: 10.1016/j.thromres.2025.109255
Kristina Mott
{"title":"Is all collagen the same for platelet testing? Editorial on “Platelet collagen receptors and their role in modulating platelet adhesion patterns and activation on alternatively processed collagen substrates”","authors":"Kristina Mott","doi":"10.1016/j.thromres.2025.109255","DOIUrl":"10.1016/j.thromres.2025.109255","url":null,"abstract":"","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"247 ","pages":"Article 109255"},"PeriodicalIF":3.7,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143010918","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 : 2025-01-11DOI: 10.1016/j.thromres.2025.109257
Alex Predy , Ben Vandermeer , Theresa Eberhardt , Tammy J. Bungard
Background
Advances in alternative oral anticoagulants has reduced use and clinician comfort with warfarin. Our specialty anticoagulation clinic (AC) operates at maximum capacity and must transfer patients to accept new referrals.
Objectives
To compare time within therapeutic range (TTR) during 6 months of AC care versus following transfer to primary care for a minimum of 6 months and to a maximum of 24 months. Secondarily, to compare frequency of INR assessments, proportion of INRs ≤1.5 and > 5, and rates of bleeding and thromboembolic events post-transfer to primary care.
Methods
Mixed retrospective chart review and administrative audit with a before-after study design for patients managed by the University of Alberta's AC for at least 6 months that were transferred to primary care.
Results
177 (27.7 %) patients were included, managed by the AC for 3.4 years (1.3, 7.9). TTR declined during the first 6 months post-transfer with AC care achieving 69.2 % and primary care 64.5 % (p = 0.02) and when compared to the 24-month interval (69.2 % vs 63.4 %; respectively; p = 0.003). A shorter interval between INRs in AC care was observed (28.9 (24.4) vs 34.5 (31.7) days, respectively; p = 0.0004). Similar numbers of critical INRs occurred between groups, whereas more INRs ≤1.5 occurred in primary care (7.3 % vs 4.7 %, respectively; p = 0.0003). Bleeding and thromboembolic event rates were balanced following transfer to primary care with both occurring at 9.4 % per patient year.
Conclusion
A decline in anticoagulation control after transfer to primary care was observed, which appeared to be driven by a greater proportion of subtherapeutic INRs.
{"title":"Quality of warfarin management following transfer from an anticoagulation clinic to primary care","authors":"Alex Predy , Ben Vandermeer , Theresa Eberhardt , Tammy J. Bungard","doi":"10.1016/j.thromres.2025.109257","DOIUrl":"10.1016/j.thromres.2025.109257","url":null,"abstract":"<div><h3>Background</h3><div>Advances in alternative oral anticoagulants has reduced use and clinician comfort with warfarin. Our specialty anticoagulation clinic (AC) operates at maximum capacity and must transfer patients to accept new referrals.</div></div><div><h3>Objectives</h3><div>To compare time within therapeutic range (TTR) during 6 months of AC care versus following transfer to primary care for a minimum of 6 months and to a maximum of 24 months. Secondarily, to compare frequency of INR assessments, proportion of INRs ≤1.5 and > 5, and rates of bleeding and thromboembolic events post-transfer to primary care.</div></div><div><h3>Methods</h3><div>Mixed retrospective chart review and administrative audit with a before-after study design for patients managed by the University of Alberta's AC for at least 6 months that were transferred to primary care.</div></div><div><h3>Results</h3><div>177 (27.7 %) patients were included, managed by the AC for 3.4 years (1.3, 7.9). TTR declined during the first 6 months post-transfer with AC care achieving 69.2 % and primary care 64.5 % (p = 0.02) and when compared to the 24-month interval (69.2 % vs 63.4 %; respectively; p = 0.003). A shorter interval between INRs in AC care was observed (28.9 (24.4) vs 34.5 (31.7) days, respectively; p = 0.0004). Similar numbers of critical INRs occurred between groups, whereas more INRs ≤1.5 occurred in primary care (7.3 % vs 4.7 %, respectively; p = 0.0003). Bleeding and thromboembolic event rates were balanced following transfer to primary care with both occurring at 9.4 % per patient year.</div></div><div><h3>Conclusion</h3><div>A decline in anticoagulation control after transfer to primary care was observed, which appeared to be driven by a greater proportion of subtherapeutic INRs.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"247 ","pages":"Article 109257"},"PeriodicalIF":3.7,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143011297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-10DOI: 10.1016/j.thromres.2025.109256
S. Charles , T. Fatrara , T. Bouriche , A. Bonifay , T. Lecompte , F. Dignat-George , B. Tardy , C. Frere , R. Lacroix , E. Chalayer
Background
Candidate biomarkers to improve venous thromboembolism (VTE) risk prediction in patients with newly diagnosed multiple myeloma (MM) undergoing anti-myeloma therapy include tissue factor-bearing microvesicles (MV-TF), procoagulant phospholipids (procoag-PPL), and D-dimer.
Objective
We aimed to determine the levels of MV-TF, procoag-PPL, and D-dimer at baseline and during initial anti-myeloma therapy and their association with the risk of VTE.
Methods
This prospective, longitudinal, observational study included 71 patients with newly diagnosed MM who were eligible for anti-myeloma therapy. Circulating MV-TF levels were measured using a functional method adapted from the Chapel Hill TF-dependent Factor Xa generation assay, and PPL and D-dimer levels with commercially available assays. The three biomarkers were measured at baseline and throughout treatment.
Results
Baseline and on-treatment MV-TF levels were higher in patients who developed VTE compared to those who did not (4.25 versus 2.75 fM at baseline, p = 0.047 and 6.5 versus 1.5 fM during treatment, p = 0.001). Baseline and on-treatment Procoag-PPL clotting times did not differ between the groups. Baseline D-dimer levels tended to be higher in patients who developed VTE than in those who did not (1.38 versus 0.7 μg/mL, p = 0.08). During treatment, D-dimer levels were significantly higher in the VTE group than in the non-VTE group (1.08 versus 0.44 μg/mL, p = 0.008).
Conclusion
Our results suggest that MV-TF and D-dimer levels may help to refine VTE risk prediction in nMM patients undergoing anti-myeloma therapy. Adequately sized studies including patients receiving new MM therapies are needed to confirm this hypothesis.
背景：在接受抗骨髓瘤治疗的新诊断多发性骨髓瘤（MM）患者中，改善静脉血栓栓塞（VTE）风险预测的候选生物标志物包括组织因子承载微泡（MV-TF）、促凝磷脂（procoagulant磷脂- ppl）和d -二聚体。目的：我们旨在确定基线和初始抗骨髓瘤治疗期间MV-TF、促凝血ppl和d -二聚体的水平及其与静脉血栓栓塞风险的关系。方法：这项前瞻性、纵向、观察性研究纳入了71例符合抗骨髓瘤治疗条件的新诊断MM患者。循环MV-TF水平的测量采用了一种功能方法，该方法采用了Chapel Hill tf依赖因子Xa生成法，PPL和d -二聚体水平采用了市售法。在基线和整个治疗过程中测量这三种生物标志物。结果：发生VTE的患者的基线和治疗期间MV-TF水平高于未发生VTE的患者（基线时为4.25 fM对2.75 fM, p = 0.047；治疗期间为6.5 fM对1.5 fM, p = 0.001）。两组之间基线和治疗时的促凝剂- ppl凝血时间没有差异。静脉血栓栓塞患者的基线d -二聚体水平往往高于未发生静脉血栓栓塞的患者（1.38 vs 0.7 μg/mL, p = 0.08）。治疗期间，VTE组d -二聚体水平显著高于非VTE组（1.08 vs 0.44 μg/mL, p = 0.008）。结论：我们的研究结果表明MV-TF和d -二聚体水平可能有助于改进nMM患者接受抗骨髓瘤治疗的静脉血栓栓塞风险预测。需要足够规模的研究，包括接受新的MM治疗的患者来证实这一假设。
{"title":"Tissue factor-bearing extracellular vesicles, procoagulant phospholipids and D-dimer as potential biomarkers for venous thromboembolism in patients with newly diagnosed multiple myeloma: A comprehensive analysis","authors":"S. Charles , T. Fatrara , T. Bouriche , A. Bonifay , T. Lecompte , F. Dignat-George , B. Tardy , C. Frere , R. Lacroix , E. Chalayer","doi":"10.1016/j.thromres.2025.109256","DOIUrl":"10.1016/j.thromres.2025.109256","url":null,"abstract":"<div><h3>Background</h3><div>Candidate biomarkers to improve venous thromboembolism (VTE) risk prediction in patients with newly diagnosed multiple myeloma (MM) undergoing anti-myeloma therapy include tissue factor-bearing microvesicles (MV-TF), procoagulant phospholipids (procoag-PPL), and D-dimer.</div></div><div><h3>Objective</h3><div>We aimed to determine the levels of MV-TF, procoag-PPL, and D-dimer at baseline and during initial anti-myeloma therapy and their association with the risk of VTE.</div></div><div><h3>Methods</h3><div>This prospective, longitudinal, observational study included 71 patients with newly diagnosed MM who were eligible for anti-myeloma therapy. Circulating MV-TF levels were measured using a functional method adapted from the Chapel Hill TF-dependent Factor Xa generation assay, and PPL and D-dimer levels with commercially available assays. The three biomarkers were measured at baseline and throughout treatment.</div></div><div><h3>Results</h3><div>Baseline and on-treatment MV-TF levels were higher in patients who developed VTE compared to those who did not (4.25 <em>versus</em> 2.75 fM at baseline, <em>p</em> = 0.047 and 6.5 <em>versus</em> 1.5 fM during treatment, <em>p</em> = 0.001). Baseline and on-treatment Procoag-PPL clotting times did not differ between the groups. Baseline D-dimer levels tended to be higher in patients who developed VTE than in those who did not (1.38 <em>versus</em> 0.7 μg/mL, <em>p</em> = 0.08). During treatment, D-dimer levels were significantly higher in the VTE group than in the non-VTE group (1.08 <em>versus</em> 0.44 μg/mL, <em>p</em> = 0.008).</div></div><div><h3>Conclusion</h3><div>Our results suggest that MV-TF and D-dimer levels may help to refine VTE risk prediction in nMM patients undergoing anti-myeloma therapy. Adequately sized studies including patients receiving new MM therapies are needed to confirm this hypothesis.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"247 ","pages":"Article 109256"},"PeriodicalIF":3.7,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143011533","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 : 2025-01-01DOI: 10.1016/j.thromres.2024.109238
Maria Macoviciuc , Christina Furneri , Léa Callens , Bao Ling Wei , Helen Mantzanis , Nikki Kampouris , Maral Koolian , Vincent Dagenais-Beaulé , Ryan S. Kerzner
Background
Anticoagulants have consistently emerged as the leading cause of adverse drug events in both inpatient and outpatient settings. While literature on anticoagulation stewardship programs (ACSP) exists for hospital settings, there is a paucity of data in long-term care and rehabilitation settings.
Objective
Assess the feasibility of a pharmacist led ACSP in the ambulatory healthcare settings of long-term care facilities (LTC) and rehabilitation centers (RC).
Methods
We conducted a prospective pilot project in 3 rehabilitation centers and 7 long-term care facilities. Patients were selected over 5 months in 2023. Patient and anticoagulant prescription-related characteristics were collected. The primary feasibility outcome was the proportion of anticoagulant prescription reviews leading to a pharmacist intervention.
Results
A total of 411 patients were enrolled. Common indications for anticoagulants were atrial fibrillation (n = 255, 62.0 %), medical thromboprophylaxis (n = 52, 12.7 %) and venous thromboembolism (n = 53, 12.9 %). Direct oral anticoagulants (DOAC) were most frequently prescribed (n = 309, 75.2 %). Of 411 prescription reviews, 93 led to at least one intervention (22.6 %), for a total of 100 interventions. Interventions mainly concerned laboratory ordering (n = 29) and DOAC dose adjustment (n = 24). Baseline anticoagulant characteristics and outcomes varied by healthcare setting.
Conclusion
Expanding ACSP into outpatient LTC and RC settings is feasible. ACSP should include both therapeutic and thromboprophylactic anticoagulants. Additional research is warranted to evaluate the viability of ongoing ACSP monitoring, and more extensive prospective studies are required to assess clinical outcomes effectively.
{"title":"Anticoagulation stewardship in the ambulatory settings of long-term care and rehabilitation - A multi-centric descriptive pilot study","authors":"Maria Macoviciuc , Christina Furneri , Léa Callens , Bao Ling Wei , Helen Mantzanis , Nikki Kampouris , Maral Koolian , Vincent Dagenais-Beaulé , Ryan S. Kerzner","doi":"10.1016/j.thromres.2024.109238","DOIUrl":"10.1016/j.thromres.2024.109238","url":null,"abstract":"<div><h3>Background</h3><div>Anticoagulants have consistently emerged as the leading cause of adverse drug events in both inpatient and outpatient settings. While literature on anticoagulation stewardship programs (ACSP) exists for hospital settings, there is a paucity of data in long-term care and rehabilitation settings.</div></div><div><h3>Objective</h3><div>Assess the feasibility of a pharmacist led ACSP in the ambulatory healthcare settings of long-term care facilities (LTC) and rehabilitation centers (RC).</div></div><div><h3>Methods</h3><div>We conducted a prospective pilot project in 3 rehabilitation centers and 7 long-term care facilities. Patients were selected over 5 months in 2023. Patient and anticoagulant prescription-related characteristics were collected. The primary feasibility outcome was the proportion of anticoagulant prescription reviews leading to a pharmacist intervention.</div></div><div><h3>Results</h3><div>A total of 411 patients were enrolled. Common indications for anticoagulants were atrial fibrillation (<em>n</em> = 255, 62.0 %), medical thromboprophylaxis (<em>n</em> = 52, 12.7 %) and venous thromboembolism (<em>n</em> = 53, 12.9 %). Direct oral anticoagulants (DOAC) were most frequently prescribed (<em>n</em> = 309, 75.2 %). Of 411 prescription reviews, 93 led to at least one intervention (22.6 %), for a total of 100 interventions. Interventions mainly concerned laboratory ordering (<em>n</em> = 29) and DOAC dose adjustment (<em>n</em> = 24). Baseline anticoagulant characteristics and outcomes varied by healthcare setting.</div></div><div><h3>Conclusion</h3><div>Expanding ACSP into outpatient LTC and RC settings is feasible. ACSP should include both therapeutic and thromboprophylactic anticoagulants. Additional research is warranted to evaluate the viability of ongoing ACSP monitoring, and more extensive prospective studies are required to assess clinical outcomes effectively.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"245 ","pages":"Article 109238"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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