Pub Date : 2026-03-01Epub Date: 2026-02-10DOI: 10.1016/j.thromres.2026.109609
Xiaolei Yi , Qiong Wu , Yilun Liu , Xuqian Wei , Jian Zhang
{"title":"Hereditary antithrombin deficiency with recurrent thrombosis caused by a novel SERPINC1 mutation","authors":"Xiaolei Yi , Qiong Wu , Yilun Liu , Xuqian Wei , Jian Zhang","doi":"10.1016/j.thromres.2026.109609","DOIUrl":"10.1016/j.thromres.2026.109609","url":null,"abstract":"","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"259 ","pages":"Article 109609"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146228392","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 : 2026-03-01Epub Date: 2026-02-18DOI: 10.1016/j.thromres.2026.109624
Luca Spiezia , Simone Guglielmo , Maria Pia Pennino , Chiara Ceolin , Margherita Vergadoro , Angela Napolitano , Chiara Simion , Elena Campello , Giuseppe Sergi , Paolo Simioni
Purpose
To study COVID-19-associated coagulopathy and the clinical outcomes across different COVID-19 pandemic waves.
Methods
We retrospectively analyzed n 344 patients hospitalized for acute COVID-19 to Padova University Hospital between March 2020–March 2023, grouped by variants: Wild-type (G1, n 155; March 2020–January 2021), Alpha (G2, n 79; February–May 2021), Delta (G3, n 50; May–December 2021), and Omicron (G4, n 60; December 2021–March 2023). We compared traditional coagulation tests, thromboelastometry and impedance aggregometry. Clinical outcomes were also considered.
Results
Factor VIII decreased progressively from G1 (195%, IQR 149–227) to G4 (156%, IQR 128–197; p < 0.05), as did von Willebrand factor (343%, IQR 244–407 to 235%, IQR 216–247; p < 0.05). Thromboelastometry showed a significantly and progressively: i) prolonged INTEM and EXTEM clot formation time (p < 0.05 in all comparisons); ii) reduced INTEM, EXTEM and FIBTEM maximum clot firmness (p < 0.05 in all comparisons). Platelet aggregation significantly decreased from G1 to G4 (p < 0.05 in all comparisons). VTE occurred in 18.1% of G1 and 19.0% of G2 patients vs. 6.0% and 6.7% in G3 and G4, respectively (p < 0.05 in all comparisons). The 28-day mortality was 15.5% in G1 and 15.2% in G2 vs. 4.0% and 1.7% in G3 and G4, respectively (p < 0.05 in all comparisons).
Conclusions
We observed a significant and progressive decrease in hypercoagulability across the four COVID-19 variants. A parallel decline in VTE incidence and 28-day mortality was also observed. Larger studies are needed to ascertain the pathophysiological mechanisms underlying the changes in coagulative profiles and their clinical implications.
{"title":"Traditional and whole blood coagulative profiles across different variants of COVID-19 acute pneumonia admitted to the Internal Medicine Ward","authors":"Luca Spiezia , Simone Guglielmo , Maria Pia Pennino , Chiara Ceolin , Margherita Vergadoro , Angela Napolitano , Chiara Simion , Elena Campello , Giuseppe Sergi , Paolo Simioni","doi":"10.1016/j.thromres.2026.109624","DOIUrl":"10.1016/j.thromres.2026.109624","url":null,"abstract":"<div><h3>Purpose</h3><div>To study COVID-19-associated coagulopathy and the clinical outcomes across different COVID-19 pandemic waves.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed n 344 patients hospitalized for acute COVID-19 to Padova University Hospital between March 2020–March 2023, grouped by variants: Wild-type (G1, n 155; March 2020–January 2021), Alpha (G2, n 79; February–May 2021), Delta (G3, n 50; May–December 2021), and Omicron (G4, n 60; December 2021–March 2023). We compared traditional coagulation tests, thromboelastometry and impedance aggregometry. Clinical outcomes were also considered.</div></div><div><h3>Results</h3><div>Factor VIII decreased progressively from G1 (195%, IQR 149–227) to G4 (156%, IQR 128–197; <em>p</em> < 0.05), as did von Willebrand factor (343%, IQR 244–407 to 235%, IQR 216–247; p < 0.05). Thromboelastometry showed a significantly and progressively: <em>i)</em> prolonged INTEM and EXTEM clot formation time (<em>p</em> < 0.05 in all comparisons); <em>ii)</em> reduced INTEM, EXTEM and FIBTEM maximum clot firmness (<em>p</em> < 0.05 in all comparisons). Platelet aggregation significantly decreased from G1 to G4 (p < 0.05 in all comparisons). VTE occurred in 18.1% of G1 and 19.0% of G2 patients vs. 6.0% and 6.7% in G3 and G4, respectively (<em>p</em> < 0.05 in all comparisons). The 28-day mortality was 15.5% in G1 and 15.2% in G2 vs. 4.0% and 1.7% in G3 and G4, respectively (<em>p</em> < 0.05 in all comparisons).</div></div><div><h3>Conclusions</h3><div>We observed a significant and progressive decrease in hypercoagulability across the four COVID-19 variants. A parallel decline in VTE incidence and 28-day mortality was also observed. Larger studies are needed to ascertain the pathophysiological mechanisms underlying the changes in coagulative profiles and their clinical implications.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"259 ","pages":"Article 109624"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146776742","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 : 2026-03-01Epub Date: 2026-02-12DOI: 10.1016/j.thromres.2026.109621
Marco Zuin , Roman Chopard , Cecilia Becattini , Douglas E. Drachman , Gregory Piazza
Intermediate-high-risk pulmonary embolism (PE) is characterized by broad clinical, physiologic, and hemodynamic parameters, but its prognostic trajectory is poorly described by current risk stratification tools. New clinical scoring systems and echocardiographic indices have gained attention for their improved capacity to anticipate disease progression and predict clinical decompensation, particularly within the first 72 h or up to 7 days of diagnosis despite systemic anticoagulation. This growing evidence-base underscores the importance of clinical phenotype to determine the management approach, as well as early referral to specialized centers with access to pulmonary embolism response teams (PERTs) and the capacity to provide advanced reperfusion strategies, including systemic thrombolysis, catheter-directed therapy, surgical embolectomy, and mechanical circulatory support when indicated. This review provides a critical appraisal of the literature regarding the management of intermediate-high-risk PE, highlighting prognostic factors, phenotype-driven therapeutic approaches, emerging biomarkers, and existing gaps in evidence, to gain perspective on the spectrum of clinical trajectories for such patients.
{"title":"Identifying the spectrum of clinical trajectories in intermediate-high risk pulmonary embolism: A clinical and research imperative","authors":"Marco Zuin , Roman Chopard , Cecilia Becattini , Douglas E. Drachman , Gregory Piazza","doi":"10.1016/j.thromres.2026.109621","DOIUrl":"10.1016/j.thromres.2026.109621","url":null,"abstract":"<div><div>Intermediate-high-risk pulmonary embolism (PE) is characterized by broad clinical, physiologic, and hemodynamic parameters, but its prognostic trajectory is poorly described by current risk stratification tools. New clinical scoring systems and echocardiographic indices have gained attention for their improved capacity to anticipate disease progression and predict clinical decompensation, particularly within the first 72 h or up to 7 days of diagnosis despite systemic anticoagulation. This growing evidence-base underscores the importance of clinical phenotype to determine the management approach, as well as early referral to specialized centers with access to pulmonary embolism response teams (PERTs) and the capacity to provide advanced reperfusion strategies, including systemic thrombolysis, catheter-directed therapy, surgical embolectomy, and mechanical circulatory support when indicated. This review provides a critical appraisal of the literature regarding the management of intermediate-high-risk PE, highlighting prognostic factors, phenotype-driven therapeutic approaches, emerging biomarkers, and existing gaps in evidence, to gain perspective on the spectrum of clinical trajectories for such patients.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"259 ","pages":"Article 109621"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147272017","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}
Data on patients' adherence and satisfaction with prophylactic low molecular weight heparin (LMWH) after orthopaedic trauma surgery are lacking.
Objectives
This observational prospective cohort study aimed to investigate adherence and satisfaction with subcutaneous self-administration of LMWH as postoperative thromboprophylaxis in orthopaedic trauma patients.
Patients/methods
One hundred adult patients who were prescribed ≥4 weeks of prophylactic LMWH after unplanned fracture surgery were included. After completing four weeks of LMWH, all patients received a questionnaire on administration adherence (Morisky Medication Adherence Scale 4-item; MMAS-4) and satisfaction (Anti-Clot Treatment Scale; ACTS) with LMWH, pain medication use and adverse effects of subcutaneous self-administration of LMWH at the injection site.
Results
Fifty-four patients reported high adherence with the administration of the prescribed LMWH (MMAS-4 score of 4), 29 patients reported moderate adherence (MMAS-4 score of 2–3) and 17 reported low adherence (MMAS-4 score of 0–1). The 46 patients with moderate/low adherence had a higher risk of adverse events at the injection site than the 54 patients with high adherence (bruising: OR2.81, 95% CI: 0.99–7.93); pain: OR8.27, 95% CI: 3.36–20.39); swelling: OR 3.58, 95% CI:1.32–9.73); minor bleeding: OR 4.27, 95% CI:1.50–12.11) and were less satisfied with their treatment (mean difference ACTS Benefits scale score: 2.0, 95% CI: 0.9–3.2; p < 0.001; mean difference ACTS Burdens scale score: 7.9, 95% CI: 5.3–10.5; p < 0.001).
Conclusion
Nearly half of the patients reported moderate or low adherence with prophylactic LMWH after orthopaedic trauma surgery. As adherence may influence prophylactic effectiveness and increase postoperative venous thromboembolism risk, further investigations into more user-friendly alternatives are an unmet need.
{"title":"Patient adherence and satisfaction with self-administration of prophylactic Low Molecular Weight Heparin (LMWH) after orthopaedic trauma surgery: a prospective observational cohort study","authors":"Ebru Horzum , Pieta Krijnen , Jochem Maarten Hoogendoorn , Frederikus A. Klok , Inger Birgitta Schipper","doi":"10.1016/j.thromres.2026.109611","DOIUrl":"10.1016/j.thromres.2026.109611","url":null,"abstract":"<div><h3>Background</h3><div>Data on patients' adherence and satisfaction with prophylactic low molecular weight heparin (LMWH) after orthopaedic trauma surgery are lacking.</div></div><div><h3>Objectives</h3><div>This observational prospective cohort study aimed to investigate adherence and satisfaction with subcutaneous self-administration of LMWH as postoperative thromboprophylaxis in orthopaedic trauma patients.</div></div><div><h3>Patients/methods</h3><div>One hundred adult patients who were prescribed ≥4 weeks of prophylactic LMWH after unplanned fracture surgery were included. After completing four weeks of LMWH, all patients received a questionnaire on administration adherence (Morisky Medication Adherence Scale 4-item; MMAS-4) and satisfaction (Anti-Clot Treatment Scale; ACTS) with LMWH, pain medication use and adverse effects of subcutaneous self-administration of LMWH at the injection site.</div></div><div><h3>Results</h3><div>Fifty-four patients reported high adherence with the administration of the prescribed LMWH (MMAS-4 score of 4), 29 patients reported moderate adherence (MMAS-4 score of 2–3) and 17 reported low adherence (MMAS-4 score of 0–1). The 46 patients with moderate/low adherence had a higher risk of adverse events at the injection site than the 54 patients with high adherence (bruising: OR2.81, 95% CI: 0.99–7.93); pain: OR8.27, 95% CI: 3.36–20.39); swelling: OR 3.58, 95% CI:1.32–9.73); minor bleeding: OR 4.27, 95% CI:1.50–12.11) and were less satisfied with their treatment (mean difference ACTS Benefits scale score: 2.0, 95% CI: 0.9–3.2; <em>p</em> < 0.001; mean difference ACTS Burdens scale score: 7.9, 95% CI: 5.3–10.5; p < 0.001).</div></div><div><h3>Conclusion</h3><div>Nearly half of the patients reported moderate or low adherence with prophylactic LMWH after orthopaedic trauma surgery. As adherence may influence prophylactic effectiveness and increase postoperative venous thromboembolism risk, further investigations into more user-friendly alternatives are an unmet need.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"259 ","pages":"Article 109611"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146166834","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 : 2026-03-01Epub Date: 2026-02-14DOI: 10.1016/j.thromres.2026.109620
Jameel Abdulrehman , Joseph R. Shaw , Steffan Frosi Stella , Sebastian Mafeld , Jim Douketis , Rita Selby , Peter Gross , Marc Carrier
Anticoagulation use is common in persons with cancer (PWC) due to a high prevalence of venous thromboembolism (VTE) and atrial fibrillation (AF). These PWC often require central venous catheters (CVC) for administration of chemotherapy, intravenous fluids, and blood products however the ideal peri-procedural anticoagulation management strategy for tunneled and port CVC insertion is unknown. Peri-procedural anticoagulation interruption is the de facto standard of care strategy for general procedures in the general population, however may not apply to tunneled and port CVC insertion in PWC as these are specialized low risk radiologically guided procedures but conducted in a high risk population. Alternatively, peri-procedural anticoagulation continuation, as conducted in the procedurally similar cardiac device insertion may be the strategy of choice given its simplicity and potentially equal or lower risk of complications. Improper peri-procedural anticoagulation management may expose PWC to bleeding and thrombotic risks, with the risks higher in those on anticoagulation for VTE compared to those on anticoagulation for AF. Despite the limited data available, guidelines regarding non-tunneled CVC insertion are consistent, endorsing peri-procedural anticoagulation continuation. Guidelines regarding peri-procedural anticoagulation for tunneled and port CVC insertion however are conflicting, with some endorsing interruption, and others continuation. With the incidence of cancer, thrombosis, and CVC use increasing, peri-procedural anticoagulation management for CVC insertion is expected to continue to become more frequent over time. High-quality data regarding peri-procedural anticoagulation management for tunneled and port CVC insertion in PWC are needed to standardize practice, streamline care, and mitigate complications in this high-risk population.
{"title":"Peri-procedural anticoagulation management for central venous catheter insertion in persons with cancer","authors":"Jameel Abdulrehman , Joseph R. Shaw , Steffan Frosi Stella , Sebastian Mafeld , Jim Douketis , Rita Selby , Peter Gross , Marc Carrier","doi":"10.1016/j.thromres.2026.109620","DOIUrl":"10.1016/j.thromres.2026.109620","url":null,"abstract":"<div><div>Anticoagulation use is common in persons with cancer (PWC) due to a high prevalence of venous thromboembolism (VTE) and atrial fibrillation (AF). These PWC often require central venous catheters (CVC) for administration of chemotherapy, intravenous fluids, and blood products however the ideal peri-procedural anticoagulation management strategy for tunneled and port CVC insertion is unknown. Peri-procedural anticoagulation interruption is the de facto standard of care strategy for general procedures in the general population, however may not apply to tunneled and port CVC insertion in PWC as these are specialized low risk radiologically guided procedures but conducted in a high risk population. Alternatively, peri-procedural anticoagulation continuation, as conducted in the procedurally similar cardiac device insertion may be the strategy of choice given its simplicity and potentially equal or lower risk of complications. Improper peri-procedural anticoagulation management may expose PWC to bleeding and thrombotic risks, with the risks higher in those on anticoagulation for VTE compared to those on anticoagulation for AF. Despite the limited data available, guidelines regarding non-tunneled CVC insertion are consistent, endorsing peri-procedural anticoagulation continuation. Guidelines regarding peri-procedural anticoagulation for tunneled and port CVC insertion however are conflicting, with some endorsing interruption, and others continuation. With the incidence of cancer, thrombosis, and CVC use increasing, peri-procedural anticoagulation management for CVC insertion is expected to continue to become more frequent over time. High-quality data regarding peri-procedural anticoagulation management for tunneled and port CVC insertion in PWC are needed to standardize practice, streamline care, and mitigate complications in this high-risk population.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"259 ","pages":"Article 109620"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146776750","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 : 2026-03-01Epub Date: 2026-02-05DOI: 10.1016/j.thromres.2026.109607
Ildikó Beke Debreceni , Bálint Krajcsir , Ádám Attila Mátrai , Balázs Ujhelyi , Marianna Pócsi , György Jázon Balla , Béla Nagy Jr. , Ádám Deák , Norbert Németh , Béla Fülesdi , János Kappelmayer
Introduction
Inflammation and coagulation are closely interrelated process in the pathogenesis of sepsis. In this study, we investigated whether intravenous IgM-enriched immunoglobulin (IgM-IVIG) preparation could improve hemostatic abnormalities in a fulminant sepsis model.
Materials and methods
Live Escherichia coli (E.coli) bacteria were administered to pigs with simultaneously (E. coli + Ig) or delayed (E. coli post Ig) of IgM-IVIG while control pigs received only physiological saline. Prothrombin time, activated partial thromboplastin time (APTT) and fibrinogen were measured by coagulometry. Hematologic parameters and soluble P-selectin were also measured. Furthermore, thrombin generation assay was carried out by fluorimetry and results were evaluated by the Thrombinoscope software.
Results
In septic pigs continous increase of fibrinogen levels and significant prolongation of APTT were observed. However, IgM-IVIG treatment significantly decreased fibrinogen levels and shortened the APTT after E. coli administration. In addition, in thrombin generation assay (TGA), that was performed without any exogenous coagulation trigger a significant increase of endogenous thrombin potential (ETP) and peak thrombin were observed in the E. coli-administered group which were abolished by IgM-IVIG treatment. Furthermore, in another TGA using phospholipid and tissue factor triggers, a significant decrease of ETP and thrombin peak were detected in septic-group, however IgM-IVIG treatment prevented the effect of E. coli. Increased level of soluble P-selectin was measured in E. coli-administered group, but it was attenuted by simultaneously administered IgM-IVIG treatment.
Conclusions
We conclude that IgM-IVIG attenuates sepsis-induced hemostatic abnormalities, and the effect of simultaneously administered IgM-IVIG was more pronounced.
{"title":"IgM-enriched immunoglobulin treatment significantly improves coagulation dysbalance in an experimental animal model of fulminant sepsis","authors":"Ildikó Beke Debreceni , Bálint Krajcsir , Ádám Attila Mátrai , Balázs Ujhelyi , Marianna Pócsi , György Jázon Balla , Béla Nagy Jr. , Ádám Deák , Norbert Németh , Béla Fülesdi , János Kappelmayer","doi":"10.1016/j.thromres.2026.109607","DOIUrl":"10.1016/j.thromres.2026.109607","url":null,"abstract":"<div><h3>Introduction</h3><div>Inflammation and coagulation are closely interrelated process in the pathogenesis of sepsis. In this study, we investigated whether intravenous IgM-enriched immunoglobulin (IgM-IVIG) preparation could improve hemostatic abnormalities in a fulminant sepsis model.</div></div><div><h3>Materials and methods</h3><div>Live <em>Escherichia coli (E.coli)</em> bacteria were administered to pigs with simultaneously (<em>E. coli</em> + Ig) or delayed (<em>E. coli</em> post Ig) of IgM-IVIG while control pigs received only physiological saline. Prothrombin time, activated partial thromboplastin time (APTT) and fibrinogen were measured by coagulometry. Hematologic parameters and soluble P-selectin were also measured. Furthermore, thrombin generation assay was carried out by fluorimetry and results were evaluated by the Thrombinoscope software.</div></div><div><h3>Results</h3><div>In septic pigs continous increase of fibrinogen levels and significant prolongation of APTT were observed. However, IgM-IVIG treatment significantly decreased fibrinogen levels and shortened the APTT after <em>E. coli</em> administration. In addition, in thrombin generation assay (TGA), that was performed without any exogenous coagulation trigger a significant increase of endogenous thrombin potential (ETP) and peak thrombin were observed in the <em>E. coli</em>-administered group which were abolished by IgM-IVIG treatment. Furthermore, in another TGA using phospholipid and tissue factor triggers, a significant decrease of ETP and thrombin peak were detected in septic-group, however IgM-IVIG treatment prevented the effect of <em>E. coli</em>. Increased level of soluble P-selectin was measured in <em>E. coli</em>-administered group, but it was attenuted by simultaneously administered IgM-IVIG treatment.</div></div><div><h3>Conclusions</h3><div>We conclude that IgM-IVIG attenuates sepsis-induced hemostatic abnormalities, and the effect of simultaneously administered IgM-IVIG was more pronounced.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"259 ","pages":"Article 109607"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137902","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 : 2026-02-09DOI: 10.1016/j.thromres.2026.109615
Jack Hirsh
{"title":"In memory of Dr. Jeffrey Ginsberg.","authors":"Jack Hirsh","doi":"10.1016/j.thromres.2026.109615","DOIUrl":"https://doi.org/10.1016/j.thromres.2026.109615","url":null,"abstract":"","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":" ","pages":"109615"},"PeriodicalIF":3.4,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146158512","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 : 2026-02-01Epub Date: 2026-01-02DOI: 10.1016/j.thromres.2025.109581
Alexander Schmidt , Joschua Wiese , Fabian Tomschi , Barabara Boddenberg-Pätzold , Andreas Christian Strauss , Thomas Hilberg
Purpose
This systematic-review and meta-analysis investigated the effectiveness of radiosynoviorthesis (RSO) on clinical outcomes in male persons with haemophilia (PwH) and evaluated the quality of existing evidence.
Methods
Literature searches in PubMed and Web of Science identified 31 studies, with 17 included in the meta-analysis. Random-effects models were computed to analyse RSO-related changes in bleeding frequency, pain, synovial hypertrophy, and orthopaedic joint score. Due to insufficient data, Range of Motion (RoM) changes could not be meta-analytically calculated. Mean differences (MD) for bleeding frequency and standardized mean differences (SMD) for the remaining outcomes were computed.
Results
Results showed significant reductions in bleeding frequency at six months (MD = −5.93 [95 %-CI: −7.80, −4.06], p < 0.001, k = 10) and twelve months (MD = −7.83 [95 %-CI: −12.11, −3.55], p < 0.001, k = 6). Six months post treatment, pain (SMD = −1.31 [95 %-CI: −2.25, −0.38], p = 0.006, k = 5), synovial hypertrophy (SMD = −0.50 [95 %-CI: −0.65, −0.36], p < 0.001, k = 4), and orthopaedic joint score (SMD = −0.61 [95 %-CI: −0.92, −0.30], p < 0.001, k = 4) showed moderate to large improvements. Average RoM changes were minimal (2.6 % improvement). The overall complication rate was 12 per 1000 treated joints.
Conclusion
Despite promising results, the overall quality of evidence was moderate to low due to high methodological heterogeneity and lack of control groups. These findings suggest RSO is a safe and effective treatment for key clinical outcomes in PwH, but further well-designed controlled trials are needed to confirm these results.
目的：本系统综述和荟萃分析探讨了放射滑膜术（RSO）对男性血友病（PwH）患者临床结果的有效性，并评估了现有证据的质量。方法在PubMed和Web of Science中检索了31项研究，其中17项纳入了meta分析。计算随机效应模型来分析与rso相关的出血频率、疼痛、滑膜肥厚和骨科关节评分的变化。由于数据不足，活动度（RoM）的变化不能进行meta分析计算。计算出血频率的平均差异（MD）和其余结果的标准化平均差异（SMD）。结果6个月时（MD = - 5.93 [95% -CI: - 7.80, - 4.06], p < 0.001, k = 10）和12个月时（MD = - 7.83 [95% -CI: - 12.11, - 3.55], p < 0.001, k = 6）出血频率显著降低。治疗6个月后，疼痛（SMD = - 1.31 [95% -CI: - 2.25, - 0.38], p = 0.006, k = 5）、滑膜肥厚（SMD = - 0.50 [95% -CI: - 0.65, - 0.36], p < 0.001, k = 4）和矫形关节评分（SMD = - 0.61 [95% -CI: - 0.92, - 0.30], p < 0.001, k = 4）均有中度至重度改善。平均RoM变化最小（改善2.6%）。总并发症发生率为12 / 1000。结论尽管结果令人鼓舞，但由于方法学的高度异质性和缺乏对照组，证据的总体质量为中到低。这些发现表明，对于PwH的关键临床结果，RSO是一种安全有效的治疗方法，但需要进一步精心设计的对照试验来证实这些结果。
{"title":"Efficacy of radiosynoviorthesis on clinical outcomes in persons with haemophilia. A systematic review and meta-analysis","authors":"Alexander Schmidt , Joschua Wiese , Fabian Tomschi , Barabara Boddenberg-Pätzold , Andreas Christian Strauss , Thomas Hilberg","doi":"10.1016/j.thromres.2025.109581","DOIUrl":"10.1016/j.thromres.2025.109581","url":null,"abstract":"<div><h3>Purpose</h3><div>This systematic-review and meta-analysis investigated the effectiveness of radiosynoviorthesis (RSO) on clinical outcomes in male persons with haemophilia (PwH) and evaluated the quality of existing evidence.</div></div><div><h3>Methods</h3><div>Literature searches in PubMed and Web of Science identified 31 studies, with 17 included in the meta-analysis. Random-effects models were computed to analyse RSO-related changes in bleeding frequency, pain, synovial hypertrophy, and orthopaedic joint score. Due to insufficient data, Range of Motion (RoM) changes could not be meta-analytically calculated. Mean differences (MD) for bleeding frequency and standardized mean differences (SMD) for the remaining outcomes were computed.</div></div><div><h3>Results</h3><div>Results showed significant reductions in bleeding frequency at six months (MD = −5.93 [95 %-CI: −7.80, −4.06], <em>p</em> < 0.001, k = 10) and twelve months (MD = −7.83 [95 %-CI: −12.11, −3.55], p < 0.001, k = 6). Six months post treatment, pain (SMD = −1.31 [95 %-CI: −2.25, −0.38], <em>p</em> = 0.006, k = 5), synovial hypertrophy (SMD = −0.50 [95 %-CI: −0.65, −0.36], <em>p</em> < 0.001, k = 4), and orthopaedic joint score (SMD = −0.61 [95 %-CI: −0.92, −0.30], p < 0.001, k = 4) showed moderate to large improvements. Average RoM changes were minimal (2.6 % improvement). The overall complication rate was 12 per 1000 treated joints.</div></div><div><h3>Conclusion</h3><div>Despite promising results, the overall quality of evidence was moderate to low due to high methodological heterogeneity and lack of control groups. These findings suggest RSO is a safe and effective treatment for key clinical outcomes in PwH, but further well-designed controlled trials are needed to confirm these results.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"258 ","pages":"Article 109581"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927718","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 : 2026-02-01Epub Date: 2026-01-15DOI: 10.1016/j.thromres.2026.109589
Elisa Frenzel , Maren Keller , Maria Weise , Tristan Klöter , Martin Federbusch , Mitja Heinemann , Michael Metze , Sirak Petros , Christian Pfrepper
Introduction
Pregnancy is a hypercoagulable state that raises the risk of venous thromboembolism VTE), particularly in women with thrombophilia. D-Dimer levels increase during the activation of the coagulation cascade and are used to exclude VTE in non-pregnant women. This study aimed to analyze the influence of thrombophilia and the use of low molecular weight heparin (LMWH) on D-dimer levels in pregnant women.
Methods
We retrospectively analyzed data from pregnant women presenting at the hemostaseology outpatient clinic of the University Hospital of Leipzig between July 2016 and June 2023. The women were seen at intervals of four to six weeks and D-dimer concentrations were measured at every visit.
Results
A total of 301 women were included in the study, of whom 121 were diagnosed with thrombophilia. The concentration of D-dimer increased continuously throughout pregnancy both in women with and without LMWH. Patients diagnosed with thrombophilia had similar D-Dimer levels compared to women without thrombophilia, irrespective of LMWH administration. Women with heterozygous Factor-V-Leiden mutation who did not receive thromboprophylaxis had higher D-Dimer levels during most of their pregnancy than those without thrombophilia. The initiation of LMWH led to a significant reduction of D-dimers in early pregnancy, and patients started on LMWH prophylaxis early in pregnancy had lower D-dimers later in pregnancy.
Conclusion
This is one of the largest studies evaluating D-dimer concentrations in women with high-risk pregnancies. Further studies with clinical endpoints are required to evaluate the role of D-dimers in deciding whether to initiate LMWH prophylaxis.
{"title":"The influence of thrombophilia and low molecular weight heparin on D-Dimer levels in women with high-risk pregnancy","authors":"Elisa Frenzel , Maren Keller , Maria Weise , Tristan Klöter , Martin Federbusch , Mitja Heinemann , Michael Metze , Sirak Petros , Christian Pfrepper","doi":"10.1016/j.thromres.2026.109589","DOIUrl":"10.1016/j.thromres.2026.109589","url":null,"abstract":"<div><h3>Introduction</h3><div>Pregnancy is a hypercoagulable state that raises the risk of venous thromboembolism VTE), particularly in women with thrombophilia. D-Dimer levels increase during the activation of the coagulation cascade and are used to exclude VTE in non-pregnant women. This study aimed to analyze the influence of thrombophilia and the use of low molecular weight heparin (LMWH) on D-dimer levels in pregnant women.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed data from pregnant women presenting at the hemostaseology outpatient clinic of the University Hospital of Leipzig between July 2016 and June 2023. The women were seen at intervals of four to six weeks and D-dimer concentrations were measured at every visit.</div></div><div><h3>Results</h3><div>A total of 301 women were included in the study, of whom 121 were diagnosed with thrombophilia. The concentration of D-dimer increased continuously throughout pregnancy both in women with and without LMWH. Patients diagnosed with thrombophilia had similar D-Dimer levels compared to women without thrombophilia, irrespective of LMWH administration. Women with heterozygous Factor-V-Leiden mutation who did not receive thromboprophylaxis had higher D-Dimer levels during most of their pregnancy than those without thrombophilia. The initiation of LMWH led to a significant reduction of D-dimers in early pregnancy, and patients started on LMWH prophylaxis early in pregnancy had lower D-dimers later in pregnancy.</div></div><div><h3>Conclusion</h3><div>This is one of the largest studies evaluating D-dimer concentrations in women with high-risk pregnancies. Further studies with clinical endpoints are required to evaluate the role of D-dimers in deciding whether to initiate LMWH prophylaxis.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"258 ","pages":"Article 109589"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146012409","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}
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