Thrombosis research最新文献_第4页

Bluetooth enabled point-of-care INR device validation for warfarin management 蓝牙启用点护理INR设备验证华法林管理。

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

Pub Date : 2025-12-22 DOI: 10.1016/j.thromres.2025.109570

Robert D. McBane II , Jennifer Lutz , Carlee O'Connor , Anna Kramer , Michael Luker , David Hodge , Colleen S. Thomas , Harold J. Hellweg

Objective

Systems employing point-of-care (POC) INR monitoring with patient self-testing require test accuracy, data integrity, patient compliance, and prompt two-way communication for high quality warfarin management. With a goal of validating a POC Bluetooth capable device for prompt INR transfer to electronic medical record, two POC INR devices were compared against an internal plasma INR reference.

Methods

A multicenter study (February 14, 2023 – August 29, 2023) comparing concordance of two commercially available POC devices, Vantus and CoaguChek XS (Pro and Plus), against a plasma INR reference, was pursued among warfarin treated patients. Appropriateness of dosing decisions were assessed for each device.

Results

Across three Mayo Clinic sites, 151 warfarin treated patients agreed to participate. Atrial fibrillation (41.7 %), venous thromboembolism (33.1 %) and heart valve prosthesis (19.9 %) were common indications with target INR range 2.0–3.0 in 89 %. For the CoaguChek devices, 86.1 % of values fell within 0.4 INR units compared with plasma INR referent (CoaguChek - plasma INR correlation R² = 0.95). For the Vantus device, 88.7 % of values fell within 0.4 INR units of plasma INR values (Vantus – plasma INR correlation R² = 0.96). Mean (± standard deviation) deviation from plasma INR was 0.2 ± 0.3 for CoaguChek compared to 0.1 ± 0.2 for Vantus (p < 0.001). Using the plasma INR as the gold standard for dosing recommendations, appropriate dosing recommendations were similar between devices: CoaguChek 83.4 % vs Vantus 82.7 %.

Conclusions

Compared to a plasma referent, INR values obtained from the CoaguChek and Vantus devices exhibited strong correlation with plasma INR values without systemic bias.

目的：采用患者自检的护理点（POC） INR监测系统要求检测准确性、数据完整性、患者依从性和及时的双向沟通，以实现高质量的华法林管理。为了验证具有POC蓝牙功能的设备是否能够及时将INR传输到电子医疗记录，我们将两个POC INR设备与内部等离子体INR参考进行了比较。方法：一项多中心研究（2023年2月14日- 2023年8月29日）在华法林治疗的患者中比较了两种市售POC装置Vantus和CoaguChek XS （Pro和Plus）与血浆INR参考的一致性。评估每个装置的给药决定的适当性。结果：在梅奥诊所的三个地点，151名接受华法林治疗的患者同意参与。房颤（41.7%）、静脉血栓栓塞（33.1%）和心脏瓣膜置换术（19.9%）是常见的适应症，89%的患者目标INR在2.0-3.0之间。对于CoaguChek装置，与血浆INR参考值相比，86.1%的值下降在0.4 INR单位以内（CoaguChek -血浆INR相关R2 = 0.95）。对于Vantus装置，88.7%的数值落在血浆INR值的0.4 INR单位内（Vantus -血浆INR相关R2 = 0.96）。CoaguChek与血浆INR的平均（±标准差）偏差为0.2±0.3，而Vantus为0.1±0.2 (p)。结论：与血浆参考物相比，CoaguChek和Vantus装置获得的INR值与血浆INR值具有很强的相关性，无系统偏倚。

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引用次数: 0

Qualitative comparison of perioperative anticoagulation management guidelines across US institutions 美国各机构围手术期抗凝管理指南的定性比较。

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

Pub Date : 2025-12-20 DOI: 10.1016/j.thromres.2025.109569

Ishan J. Tatake , Rishabh Singh , Caroline Cromwell , Brianna Bakow , Jacob Cogan , Manila Gaddh , Radhika Gangaraju , Ming Y. Lim , Colleen T. Morton , Andrew M. Peseski , Rachel P. Rosovsky , Kimberley Youkhana , Lisa Baumann Kreuziger

Background

The indications for anticoagulation and the number of patients on anticoagulation is rising. Accordingly, adverse drug events related to anticoagulation use are on the rise and represents an opportunity for improvement in patient safety. About 15–20 % of patients on anticoagulation undergo invasive procedures. Perioperative management of anticoagulation requires balancing competing risks of thrombosis and bleeding. Clear, concise and evidence-based institutional guidelines are essential for providers to make individualized treatment decisions and to improve patient safety.

Study design and methods

We qualitatively compared perioperative anticoagulation management guidelines from 11 US academic institutions. We also conducted a survey to evaluate how healthcare providers interpret perioperative anticoagulation management when different wording is used to convey recommendations.

Results

Institution-specific guidelines of the 11 US academic institutions varied in the management of perioperative anticoagulation and used different language to convey recommendations. In the survey, there was >90 % consensus amongst healthcare providers on the appropriate management of perioperative rivaroxaban and apixaban when the guidelines used the wording of “no dose day -X” which is used in the American College of Chest Physicians (CHEST) 2022 guidelines. Additionally, institution-specific guidelines were not available in 24.2 % of survey respondents.

Conclusions

This study demonstrates that institutions do not always have perioperative guidelines for anticoagulation management and when they do, there is variation in recommendations despite published international guidelines for perioperative management of anticoagulation. The language used to convey recommendations is important to standardizing perioperative anticoagulation management. These represent areas for further quality improvement and patient safety through anticoagulation stewardship.

背景：抗凝的适应症和抗凝患者的数量正在上升。因此，与抗凝使用相关的药物不良事件呈上升趋势，这为改善患者安全提供了机会。约15- 20%接受抗凝治疗的患者接受有创手术。围手术期抗凝治疗需要平衡血栓和出血的竞争风险。清晰、简明和基于证据的机构指南对于提供者做出个性化治疗决策和改善患者安全至关重要。研究设计和方法：我们对美国11家学术机构的围手术期抗凝治疗指南进行定性比较。我们还进行了一项调查，以评估当使用不同的措辞来传达建议时，医疗保健提供者如何解释围手术期抗凝管理。结果：美国11家学术机构的机构指南在围手术期抗凝治疗管理方面存在差异，并且使用了不同的语言来传达建议。在调查中，当指南使用美国胸科医师学会（Chest） 2022指南中使用的“无剂量日-X”措辞时，医疗保健提供者对利伐沙班和阿哌沙班围手术期的适当管理达成了约90%的共识。此外，24.2%的调查对象没有特定机构的指导方针。结论：本研究表明，各机构并不总是有围手术期抗凝管理指南，即使有，尽管已公布的国际抗凝围手术期管理指南，建议也存在差异。表达建议的语言对规范围手术期抗凝管理很重要。这些都代表了通过抗凝管理进一步提高质量和患者安全的领域。

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引用次数: 0

Aptamer-based monitorization and therapeutic applications of blood coagulation cascade disorders: A systematic review 基于适配体的凝血级联障碍监测和治疗应用：系统综述。

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

Pub Date : 2025-12-19 DOI: 10.1016/j.thromres.2025.109566

Okan Yılmaz , Beyza Nur Yılmaz , Neslihan Betül Kandilcik , Zeynep Sebla Yiğit , Mediha Esra Altuntop Yayla

Hemostasis is a complex physiological process that prevents blood loss following vascular injury via the blood coagulation cascade. The coagulation cascade is a highly controlled stepwise process that establishes clotting only at the site of bleeding, when needed. Recently, aptamers have been employed not only in the fields of biosensors and diagnostics, but also in molecular imaging, therapeutics, and drug delivery systems. The present article highlights recent developments in aptamer-based biomedical systems for the diagnosis and treatment of blood coagulation cascade disorders. Specifically, aptasensors for thrombin detection and aptamer-based medical imaging of thrombi were addressed as diagnostic tools for coagulation cascade disorders. Additionally, the use of aptamers as pharmaceutical agents and aptamer-targeted drug delivery systems were highlighted as part of the treatment. In summary, this is a valuable compilation in this emerging field that focuses on aptamer-based applications for monitoring and treatment of blood coagulation cascade disorders.

止血是一个复杂的生理过程，通过血凝级联防止血管损伤后的失血。凝血级联是一个高度控制的逐步过程，在需要时仅在出血部位建立凝血。近年来，适体不仅应用于生物传感器和诊断领域，还应用于分子成像、治疗和药物输送系统。本文重点介绍了用于诊断和治疗凝血级联疾病的适配体生物医学系统的最新进展。具体来说，用于凝血酶检测的适配体传感器和基于适配体的血栓医学成像被认为是凝血级联疾病的诊断工具。此外，适体作为药物制剂和适体靶向药物递送系统的使用被强调为治疗的一部分。总之，这是一个有价值的汇编在这个新兴领域，重点是基于适配体的应用监测和治疗凝血级联障碍。

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引用次数: 0

Letter to “Erythrocyte rheology is altered in haemophilia patients with advanced arthropathy. A case-control study” 致“血友病合并晚期关节病患者红细胞流变学改变”的信。病例对照研究”。

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

Pub Date : 2025-12-18 DOI: 10.1016/j.thromres.2025.109568

XiaoMei Wang , SongQian Yang

引用次数: 0

Impact of ABO blood group on global coagulation assays ABO血型对整体凝血试验的影响

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

Pub Date : 2025-12-17 DOI: 10.1016/j.thromres.2025.109567

Tengyi Cai , Vincent Lu , Julie Wang , Mani Suleiman , Prahlad Ho , Hui Yin Lim

引用次数: 0

The in vitro anticoagulant effect of milvexian in healthy neonates and children 米尔维昔安在健康新生儿和儿童中的体外抗凝作用。

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

Pub Date : 2025-12-13 DOI: 10.1016/j.thromres.2025.109564

Natasha Letunica , Vasiliki Karlaftis , Paul Monagle , Hernando Patino , Madhu Chintala , Chantal Attard

Background

Effective anticoagulant therapies are crucial for managing thrombotic disorders, especially in children. While currently available direct oral anticoagulants offer many advantages over current standard of care anticoagulants, including predictable pharmacokinetics and reduced need for monitoring, they still have significant bleeding risks. Milvexian, a direct factor XIa inhibitor, has demonstrated potential in reducing bleeding risks compared to traditional anticoagulants and warrants further investigation in neonates and children.

Objectives

This study aimed to investigate the age-related anticoagulant effect of milvexian in vitro.

Patients/methods

Plasma samples from healthy participants from the following age groups: neonates, 28 days–23 months, 2–6 years, 7–11 years, 12–18 years, and adults were spiked with increasing concentrations of milvexian (0.1, 1.0, 3.0 and 10 μM). Clotting time was measured using an activated partial thromboplastin time (aPTT) assay, and thrombin generation parameters were assessed.

Results

A dose-dependent increase in clotting time was observed across all age groups. Thrombin generation parameters, including Lag time and time to peak (ttPeak), showed a linear dose-dependent increase, while endogenous thrombin potential (ETP), Peak, and Velocity index decreased dose-dependently. Significant age-specific differences were noted primarily in neonates and children less than two years of age compared to adults.

Conclusion

In vitro findings indicate a predictable, linear dose-response to milvexian, with significant in vitro anticoagulant effect differences in neonates and children under two years of age. Further in vivo studies are required to confirm these findings, determine dosing strategies, and assess clinical implications in the paediatric population.

背景：有效的抗凝治疗对于治疗血栓性疾病至关重要，特别是在儿童中。虽然目前可获得的直接口服抗凝剂比目前的标准护理抗凝剂有许多优点，包括可预测的药代动力学和减少监测的需要，但它们仍然存在显著的出血风险。Milvexian是一种直接因子XIa抑制剂，与传统抗凝剂相比，已被证明具有降低出血风险的潜力，值得在新生儿和儿童中进一步研究。目的：研究密乐维安的年龄相关性体外抗凝作用。患者/方法：从以下年龄组的健康参与者的血浆样本中：新生儿、28天-23个月、2-6岁、7-11岁、12-18岁和成人中加入浓度升高的米尔维克斯胺（0.1、1.0、3.0和10 μM）。使用活化部分凝血活酶时间（aPTT）测定凝血时间，并评估凝血酶生成参数。结果：在所有年龄组中观察到凝血时间的剂量依赖性增加。凝血酶生成参数，包括滞后时间和峰值时间（ttPeak），呈剂量依赖性线性增加，而内源性凝血酶电位（ETP）、峰值和速度指数呈剂量依赖性下降。与成年人相比，主要在新生儿和两岁以下儿童中发现了显著的年龄特异性差异。结论：体外研究结果表明，米尔维昔安具有可预测的线性剂量反应，在新生儿和两岁以下儿童中具有显著的体外抗凝效果差异。需要进一步的体内研究来证实这些发现，确定给药策略，并评估在儿科人群中的临床意义。

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引用次数: 0

Combined exome and RNA-seq analysis in patients with rare non-syndromic inherited brain arteriovenous malformation suggests a novel function for PTPN13 in arterial specification 对罕见的非综合征遗传性脑动静脉畸形患者的外显子组和RNA-seq分析表明，PTPN13在动脉规范中具有新的功能

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

Pub Date : 2025-12-13 DOI: 10.1016/j.thromres.2025.109563

Simona Alibrandi , Domenico Mordà , Antonino Germanò , Alfredo Conti , Sergio Lucio Vinci , Rosalia D'Angelo , Luigi Donato , Antonina Sidoti , Concetta Scimone

Non-syndromic inherited brain arteriovenous malformation (bAVM) is a very rare condition whose molecular basis is still uncharacterized. In contrast, sporadic bAVM can arise following gain-of-function mutations in the KRAS and BRAF proto-oncogenes. The bAVM lesion is characterized by a direct arteriole-to-venule shunt and the absence of a normal capillary bed, due to impaired expression of endothelial differentiation markers and failed arterial specification. In this context, perturbation of EphrinB2-EphB4 reverse signaling plays a pivotal role. According to this knowledge, this study describes the possible role of the PTPN13 gene in non-syndromic inherited bAVM.

Whole-exome sequencing was performed on germline DNA purified from peripheral blood of two consanguineous relatives affected by bAVM. Common rare genetic variants were selected and affected genes were prioritized. RNA-sequencing was conducted on endothelial cells isolated from the bAVM lesion after surgical removal. Differentially expressed genes were functionally clustered. The resulting data were integrated to determine the possible common genetic cause of the phenotype in both relatives. PTPN13 was identified as a possible causative gene for non-syndromic inherited bAVM. By dephosphorylating EphrinB2 and SRC in particular, it contributes to the modulation of the EphrinB2- EphB4 reverse signaling, during arterial specification. Moreover, this phenotype does not depend on KRAS and BRAF gain-of-function, in contrast to the sporadic form. Given the exceptional nature of the non-syndromic inherited phenotype, this study represents the first evidence of a candidate gene for this rare form of the disease, further suggesting a novel field of investigation for the bAVM pathogenesis.

非综合征遗传性脑动静脉畸形（bAVM）是一种非常罕见的疾病，其分子基础尚未明确。相反，散发性bAVM可在KRAS和BRAF原癌基因的功能获得突变后出现。由于内皮分化标志物的表达受损和动脉规范失败，bAVM病变的特征是小动脉到小静脉的直接分流和没有正常的毛细血管床。在这种情况下，EphrinB2-EphB4反向信号的扰动起着关键作用。根据这一认识，本研究描述了PTPN13基因在非综合征遗传性bAVM中的可能作用。对两名受bAVM影响的近亲外周血中纯化的种系DNA进行了全外显子组测序。选择常见的罕见遗传变异，并对受影响的基因进行优先排序。对手术切除后从bAVM病变中分离的内皮细胞进行rna测序。差异表达基因功能聚类。结果数据被整合，以确定可能的共同遗传原因的表型在两个亲属。PTPN13被确定为非综合征遗传性bAVM的可能致病基因。通过去磷酸化EphrinB2和SRC，它有助于调节EphrinB2- EphB4的反向信号，在动脉规范。此外，与散发形式相反，这种表型不依赖于KRAS和BRAF功能获得。鉴于非综合征遗传表型的特殊性质，这项研究首次证明了这种罕见疾病的候选基因，进一步为bAVM的发病机制提供了一个新的研究领域。

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引用次数: 0

Rethinking thrombophilia testing in pediatric VTE: A decade of real-world evidence 重新思考儿科静脉血栓栓塞测试：十年的真实世界证据

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

Pub Date : 2025-12-13 DOI: 10.1016/j.thromres.2025.109565

Mahdi Asleh , Hadeel Musa , Shirly Ammar , Hagit Miskin

Background

The clinical utility of routine thrombophilia testing to guide management in pediatric venous thromboembolism (VTE) is debated. This study sought to evaluate the real-world impact of thrombophilia testing on anticoagulation duration and clinical outcomes.

Methods

We conducted a 10-year retrospective cohort study of 67 pediatric patients with VTE. We analyzed the association between thrombophilia status and anticoagulation duration, VTE recurrence, and thrombus resolution on follow-up imaging.

Results

The majority of VTE events (80.6 %) were provoked. A positive thrombophilia workup did not significantly alter the median anticoagulation duration compared to a negative workup (p = 0.582). A positive thrombophilia status was not a significant predictor of VTE recurrence in survival analysis (HR 2.22, p = 0.281). However, a positive workup was significantly associated with a higher rate of Residual Vein Obstruction (RVO) (73.3 % vs. 36.4 %, p = 0.045). This imaging finding did not, in turn, predict VTE recurrence (p = 0.388).

Conclusion

Thrombophilia testing did not influence treatment duration or predict recurrence. Our findings provide real-world evidence supporting current guidelines that advocate for a selective, clinically driven approach to testing rather than its routine use after a first pediatric VTE.

背景常规血栓检测在指导小儿静脉血栓栓塞（VTE）治疗中的临床应用一直存在争议。本研究旨在评估血栓形成试验对抗凝时间和临床结果的实际影响。方法对67例静脉血栓栓塞患儿进行10年回顾性队列研究。我们分析了血栓形成状态与抗凝时间、静脉血栓栓塞复发和随访影像中血栓溶解的关系。结果静脉血栓栓塞（VTE）以诱发性为主（80.6%）。与阴性检查相比，阳性血栓形成检查没有显著改变中位抗凝时间（p = 0.582）。在生存分析中，血栓倾向阳性状态不是静脉血栓栓塞复发的显著预测因子（HR 2.22, p = 0.281）。然而，阳性检查与较高的残余静脉阻塞（RVO）率显著相关（73.3%对36.4%,p = 0.045）。这一影像学发现并不能预测静脉血栓栓塞复发（p = 0.388）。结论血栓检测不影响治疗时间或预测复发。我们的研究结果提供了现实世界的证据，支持当前的指导方针，即提倡选择性的、临床驱动的检测方法，而不是在首次小儿静脉血栓栓塞后常规使用。

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引用次数: 0

The risks and benefits of disseminated intravascular coagulation-targeted anticoagulant therapy in abdominal sepsis 弥散性血管内靶向凝血抗凝治疗腹部败血症的风险和益处。

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

Pub Date : 2025-12-11 DOI: 10.1016/j.thromres.2025.109562

Tadashi Matsuoka , Kazuma Yamakawa , Noritaka Ushio , Ryo Hisamune , Koichiro Homma , Junichi Sasaki

Background

Abdominal sepsis frequently leads to disseminated intravascular coagulation (DIC), exacerbating organ dysfunction and bleeding complications. Although anticoagulant therapy is a potential treatment for DIC, its use in this context raises concerns about bleeding risks.

Objectives

The purpose of this study is to investigate the risks and benefits of DIC-targeted anticoagulant therapy in patients with abdominal sepsis.

Methods

Data were analyzed from a dataset from a multicenter nationwide retrospective cohort study (J-Septic DIC registry) in Japan between 2011 and 2013. The study included 987 patients with abdominal sepsis-induced DIC, diagnosed within three days of ICU admission. Patients were divided into DIC-targeted anticoagulant therapy (recombinant thrombomodulin or antithrombin) and non-use groups. Propensity score matching was used to adjust for confounding factors. The primary outcome was all-cause 90-day mortality, with bleeding complications requiring blood transfusion as the primary safety outcome.

Results

The results indicated that anticoagulant therapy was associated with improved survival (hazard ratio: 0.662, 95 % confidential interval: 0.472–0.929), but a higher risk of bleeding complications (OR: 2.451, 95 % confidential interval:1.372–4.379). Dual combination of anticoagulant therapy did not provide additional survival benefits and increased bleeding risks. The efficacy of DIC-targeted anticoagulant therapy correlated with disease severity, while bleeding risk was inversely correlated with severity.

Conclusion

DIC-targeted anticoagulant therapy in patients with abdominal sepsis was related with improved prognosis but increased bleeding risks. The risk-benefit profile varies with disease severity, suggesting a need for cautious and personalized treatment strategies.

背景：腹部败血症经常导致弥散性血管内凝血（DIC），加重器官功能障碍和出血并发症。虽然抗凝治疗是DIC的一种潜在治疗方法，但在这种情况下使用抗凝治疗会引起出血风险的担忧。目的：本研究的目的是探讨dic靶向抗凝治疗腹部脓毒症患者的风险和获益。方法：数据分析来自日本2011 - 2013年多中心全国回顾性队列研究（j -脓毒性DIC登记）的数据集。该研究纳入987例腹部败血症性DIC患者，这些患者在ICU入院3天内被诊断为DIC。将患者分为针对dic的抗凝治疗组（重组凝血调节素或抗凝血酶）和不使用组。倾向评分匹配用于调整混杂因素。主要结局是全因90天死亡率，出血并发症需要输血作为主要安全结局。结果：抗凝治疗与生存率提高相关（风险比：0.662,95%保密区间：0.472 ~ 0.929），但出血并发症风险较高（OR: 2.451, 95%保密区间：1.372 ~ 4.379）。双重联合抗凝治疗没有提供额外的生存益处和增加出血风险。针对dic的抗凝治疗效果与疾病严重程度相关，而出血风险与严重程度呈负相关。结论：腹部脓毒症患者的dic靶向抗凝治疗与预后改善有关，但出血风险增加。风险-收益情况因疾病严重程度而异，提示需要谨慎和个性化的治疗策略。

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引用次数: 0

Diagnostic performance of ultrasound, computed tomography and magnetic resonance imaging in portal vein thrombosis: A systematic review with meta-analysis 超声、计算机断层扫描和磁共振成像在门静脉血栓中的诊断性能：一项系统回顾和荟萃分析

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

Pub Date : 2025-12-05 DOI: 10.1016/j.thromres.2025.109560

Laura Girardi , Farah Zarka , Michelle Pradier , Sarah Visintini , Mattia Poletti , Grégoire Le Gal , Tzu-Fei Wang , Aurélien Delluc

Background

Ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) are commonly used for the diagnosis of portal vein thrombosis (PVT), however, their accuracy compared to invasive tests is not clearly known.

Methods

We systematically searched MEDLINE, Embase, Cochrane Central, and Scopus databases for studies assessing the sensitivity and specificity of US, CT, and MRI for PVT diagnosis. Inclusion criteria required at least 10 participants and comparison with invasive gold standards (angiography or surgery/pathology). The quality assessment was performed using the QUADAS-2 tool. Pooled estimates of sensitivity and specificity were calculated through mixed-effects logistic regression model and reported with 95 % confidence intervals (CI). Based on the obtained results, we computed Bayesian models simulating the work-up of PVT in case of different clinical pre-test probabilities of PVT.

Results

Out of 8526 identified citations, 26 studies with 1499 patients were included in the meta-analysis. The risk of bias was low in 3 studies. Pooled sensitivities and specificities were 0.84 (95 %CI 0.69–0.92) and 0.96 (95 %CI 0.92–0.98) for US, 0.81 (95 %CI 0.66–0.90) and 0.96 (95 %CI 0.88–0.99) for CT, and 0.81 (95 %CI 0.65–0.90) and 0.98 (95 %CI 0.96–0.99) for MRI. In patients with a pre-test probability of PVT of 30 %, a positive US yields a post-test probability of PVT of 90 % and a second positive imaging result leads to a post-test probability of 99 %.

Conclusions

US, CT, and MRI demonstrate comparable accuracy for PVT diagnosis, with a high specificity across modalities. A stepwise diagnostic approach integrating clinical probability and imaging results could optimize diagnostic confidence.

超声（US）、计算机断层扫描（CT）和磁共振成像（MRI）常用于门静脉血栓形成（PVT）的诊断，然而，与有创检查相比，它们的准确性尚不清楚。方法系统检索MEDLINE、Embase、Cochrane Central和Scopus数据库，以评估US、CT和MRI对PVT诊断的敏感性和特异性。纳入标准要求至少10名参与者，并与侵入性金标准（血管造影或手术/病理）进行比较。使用QUADAS-2工具进行质量评估。通过混合效应logistic回归模型计算敏感性和特异性的汇总估计，并以95%的置信区间（CI）报告。根据获得的结果，我们计算了模拟PVT在不同临床预测概率下的工作的贝叶斯模型。结果在8526篇被识别的引文中，有26篇研究，1499例患者被纳入meta分析。有3项研究的偏倚风险较低。US的敏感性和特异性分别为0.84 （95% CI 0.69-0.92）和0.96 (95% CI 0.92-0.98)， CT的敏感性和特异性分别为0.81 （95% CI 0.66-0.90）和0.96 (95% CI 0.88-0.99)， MRI的敏感性和特异性分别为0.81 （95% CI 0.65-0.90）和0.98 （95% CI 0.96 - 0.99）。在检测前PVT概率为30%的患者中，US阳性导致检测后PVT概率为90%，第二次成像阳性导致检测后PVT概率为99%。结论：超声、CT和MRI对PVT的诊断具有相当的准确性，具有高特异性。结合临床概率和影像学结果的逐步诊断方法可优化诊断置信度。

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引用次数: 0