Thrombosis research最新文献_第5页

The maternal hemostatic shift: Understanding VTE risk in pregnancy and postpartum 产妇止血转移：了解妊娠期和产后静脉血栓栓塞的风险

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

Pub Date : 2025-12-03 DOI: 10.1016/j.thromres.2025.109561

Marie Didembourg , Laure Morimont , Emilie De Gottal , Jonathan Douxfils

Venous thromboembolism (VTE) remains a leading cause of maternal morbidity and mortality, with pregnancy increasing the risk of VTE four- to five-fold compared with the non-pregnant state and up to 60-fold in the postpartum period. The incidence of pregnancy-related VTE ranges from 0.5 to 2.0 per 1000 pregnancies, with deep vein thrombosis (DVT) and pulmonary embolism (PE) accounting for most cases. The heightened thrombotic risk during pregnancy and postpartum stems from physiological adaptations in hemostasis, creating a hypercoagulable state to mitigate hemorrhage risk at delivery. These changes involve increased coagulation activation, reduced fibrinolysis, and venous stasis, fulfilling Virchow's triad. The risk rises as pregnancy progresses, peaking in the third trimester and postpartum period, with both hormonal fluctuations and mechanical factors playing key roles. Estrogen and progesterone contribute to early pregnancy risk by enhancing clotting factor synthesis, while later stages involve uterine compression of venous structures, impairing venous return. The postpartum period presents the highest risk, driven by endothelial injury during delivery, inflammatory responses, and hemodynamic shifts. Evolving obstetric practices, such as early ambulation and compression therapy, may have influenced the temporal distribution of VTE events. This review aims to clarify how pregnancy-specific hemostatic adaptations influence thrombotic risk and to identify strategies for improved, individualized prevention. Despite updated international guidelines, major discrepancies persist in risk scoring and prophylaxis thresholds, underscoring the limitations of current empirical approaches. Functional biomarkers such as thrombin generation and the Endogenous thrombin potential (ETP)-based activated protein C (APC) resistance assay, could represent promising tools to bridge the gap between mechanistic understanding and clinical application.

静脉血栓栓塞（VTE）仍然是孕产妇发病和死亡的主要原因，与未怀孕状态相比，怀孕使VTE的风险增加4到5倍，在产后期间增加60倍。妊娠相关静脉血栓栓塞的发生率为每1000例妊娠0.5至2.0例，其中深静脉血栓形成（DVT）和肺栓塞（PE）占大多数病例。妊娠期和产后血栓形成风险的增加源于止血的生理适应，产生高凝状态以减轻分娩时出血风险。这些变化包括凝血激活增加，纤维蛋白溶解减少和静脉停滞，符合Virchow的三要素。随着怀孕的进展，风险会增加，在妊娠晚期和产后达到顶峰，激素波动和机械因素都起着关键作用。雌激素和黄体酮通过增强凝血因子合成而增加妊娠早期风险，而后期则涉及子宫压迫静脉结构，损害静脉回流。由于分娩过程中内皮损伤、炎症反应和血流动力学变化，产后是风险最高的时期。不断发展的产科实践，如早期下床和压迫治疗，可能影响静脉血栓栓塞事件的时间分布。本综述旨在阐明妊娠特异性止血适应如何影响血栓形成风险，并确定改进的个体化预防策略。尽管更新了国际指南，但在风险评分和预防阈值方面仍然存在重大差异，强调了当前经验方法的局限性。功能生物标志物，如凝血酶生成和基于内源性凝血酶电位（ETP）的活化蛋白C （APC）抗性测定，可能是弥合机制理解和临床应用之间差距的有前途的工具。

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引用次数: 0

Suboptimal management of cancer-associated thrombotic microangiopathies in newly diagnosed and known cancers: A 15-year provincial retrospective cohort study 新诊断和已知癌症中癌症相关血栓性微血管病变的次优管理：一项15年省级回顾性队列研究。

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

Pub Date : 2025-12-02 DOI: 10.1016/j.thromres.2025.109556

Jessica Krahn , Haowei Sun Linda

Cancer-associated thrombotic microangiopathy (CA-TMA) is a rare condition with high mortality. The mainstay treatment is anti-cancer treatment. We conducted a retrospective cohort study of all adults hospitalized with CA-TMA in a Canadian province between 2008 and 2023 to examine treatment patterns, quality of care, and outcomes. Eighteen patients were included, with a median age of 57.4 years. At presentation, nine (50 %) patients were newly diagnosed with malignancy, seven (39 %) had progressive or relapsed disease, and two (11 %) had stable disease. CA-TMA treatment included therapeutic plasma exchange (TPE, 13; 72 %), anti-cancer therapy (6; 33 %), and supportive transfusions (4; 22 %). Fifteen (83 %) patients died within three months. Anti-cancer therapy, but not TPE, was associated with higher TMA response (67 % vs 8 %) and longer survival (median 85 vs 9 days), although findings are limited by small sample size and generalizability. We identified suboptimal management including prolonged exposure to TPE, low rates of oncology consultation within 30 days of discharge, and low rates of initiation of cancer-directed therapies, especially in newly diagnosed cancers. Earlier recognition of CA-TMA is crucial, as prompt oncology consultation and initiation of cancer-directed therapy may improve outcomes.

癌症相关血栓性微血管病（CA-TMA）是一种死亡率很高的罕见疾病。主要的治疗是抗癌治疗。我们对2008年至2023年在加拿大一个省因CA-TMA住院的所有成人进行了回顾性队列研究，以检查治疗模式、护理质量和结果。纳入18例患者，中位年龄57.4岁。在就诊时，9名（50%）患者为新诊断的恶性肿瘤，7名（39%）患者为进展性或复发性疾病，2名（11%）患者病情稳定。CA-TMA治疗包括治疗性血浆置换（TPE, 13; 72%）、抗癌治疗（6;33%）和支持性输血（4;22%）。15例（83%）患者在3个月内死亡。抗癌治疗，而不是TPE，与更高的TMA反应（67% vs 8%）和更长的生存期（中位85 vs 9天）相关，尽管研究结果受到小样本量和普遍性的限制。我们确定了次优管理，包括长时间暴露于TPE，出院后30天内肿瘤咨询率低，癌症定向治疗的起始率低，特别是在新诊断的癌症中。早期识别CA-TMA是至关重要的，因为及时的肿瘤学咨询和开始癌症定向治疗可能会改善结果。

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引用次数: 0

Thrombin generation reference values using the ST Genesia and STG-Thromboscreen assay in pregnant women 使用ST genia和stg -血栓筛查法测定孕妇凝血酶生成参考值。

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

Pub Date : 2025-11-29 DOI: 10.1016/j.thromres.2025.109558

Mathieu Fortier , Marie Portes , Christophe Demattei , Eva Nouvellon , Eric Mercier , Chloé Bourguignon , Mathias Chea , Jean-Christophe Gris , Vincent Letouzey , Sylvie Bouvier

引用次数: 0

Platelets display immunophenotypic alterations and dysregulated transcriptomic signature in Philadelphia-negative myeloproliferative neoplasms 在费城阴性骨髓增殖性肿瘤中，血小板显示免疫表型改变和转录组特征失调。

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

Pub Date : 2025-11-29 DOI: 10.1016/j.thromres.2025.109559

Vitor Leonardo Bassan , Poliana Carina Paolini , Lilian Maria Garcia Ramos , Fabiana Rossetto de Morais , Luciana Ambrosio , Luiz Fernando Princi Chaim , Patrícia Vianna Bonini Palma , Camila Menezes Bonaldo , Rafaela de Freitas Martins Felício , Lorena Lobo de Figueiredo-Pontes , Fabíola Attié de Castro

Introduction & objectives

Polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (MF) are Philadelphia-negative myeloproliferative neoplasms (MPN) associated with gain-of-function mutations in JAK2, CALR, and MPL genes. Chronic inflammation is a central hallmark of MPN, significantly contributing to disease pathogenesis and progression and severe complications such as thrombosis. Alterations in platelet immunophenotype and gene expression may influence the thromboinflammatory state observed in MPN patients. We aimed to characterize platelet immunophenotype, ex vivo activation, and transcriptomic signatures in MPN patients compared to healthy controls.

Methods

Inflammatory indices, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII), were assessed to determine the thromboinflammatory status. Platelet immunophenotyping was performed at baseline and following stimulation with calcium ionophore A23187 or thrombin. Control platelets were exposed to MPN plasma to evaluate inflammatory activation. Transcriptomic data were analyzed in silico to identify dysregulated platelet-related pathways.

Results

MPN patients exhibited elevated NLR, PLR, and SII, consistent with systemic inflammation. Their platelets showed a pre-activated phenotype, with increased baseline expression of CD62P, CD36, CD63, and CD154. Compared to controls, MPN platelets were less responsive to thrombin stimulation, whereas control platelets exposed to MPN plasma acquired an activated phenotype. Transcriptomic profiling revealed downregulation of genes associated with cytoskeleton organization, integrin signaling, adhesion, metabolism, and trafficking.

Conclusion

MPN platelets are intrinsically activated and transcriptionally dysregulated, even in treated patients. These findings underscore the critical role of platelets in MPN-associated thromboinflammation, highlighting platelet contribution to hemostatic and thrombotic complications.

真性红细胞增多症（PV）、原发性血小板增多症（ET）和原发性骨髓纤维化（MF）是费城阴性骨髓增生性肿瘤（MPN），与JAK2、CALR和MPL基因的功能获得性突变相关。慢性炎症是MPN的中心标志，对疾病的发病和进展以及血栓形成等严重并发症有重要影响。血小板免疫表型和基因表达的改变可能影响MPN患者观察到的血栓炎症状态。我们旨在与健康对照者比较MPN患者的血小板免疫表型、体外激活和转录组特征。方法：评估炎症指标，包括中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）和全身免疫炎症指数（SII），以确定血栓炎症状态。在基线和用钙离子载体A23187或凝血酶刺激后进行血小板免疫分型。对照血小板暴露于MPN血浆中以评估炎症激活。转录组学数据进行了计算机分析，以确定血小板相关通路失调。结果：MPN患者表现出NLR、PLR和SII升高，与全身性炎症一致。他们的血小板表现出预先激活的表型，CD62P、CD36、CD63和CD154的基线表达增加。与对照组相比，MPN血小板对凝血酶刺激的反应较弱，而暴露于MPN血浆的对照组血小板获得了活化表型。转录组学分析显示与细胞骨架组织、整合素信号、粘附、代谢和运输相关的基因下调。结论：即使在接受治疗的患者中，MPN血小板也存在内在激活和转录失调。这些发现强调了血小板在mpn相关的血栓炎症中的关键作用，强调了血小板在止血和血栓并发症中的作用。

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引用次数: 0

Clinical features, management, and outcomes of right heart thrombi: a retrospective cohort study 右心血栓的临床特征、处理和结局：一项回顾性队列研究。

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

Pub Date : 2025-11-26 DOI: 10.1016/j.thromres.2025.109557

Emily Fritzmann , Alexander D. Yuen , Stephanie Chang , Maidah Yaqoob , April Kinninger , Jina Chung , Janine R.E. Vintch , Yuri Matusov

Right heart thrombi (RHT) are a rare entity with high morbidity and mortality. There are no societal guidelines on the management of intracardiac thrombi. In an effort to understand the clinical elements associated with treatment decisions for RHT, this retrospective multi-center cohort study evaluated a real-world diverse patient population treated at two academic medical centers with PE response team (PERT) programs who presented with RHT, with and without PE, and evaluated the associated treatment strategies and outcomes. This study examined the clinical features and outcomes among patients presenting with RHT who were treated with anticoagulation monotherapy, systemic thrombolysis, and advanced intervention. Outcomes of interest included 30-day mortality, duration of hospitalization, need for ICU admission, bleeding complications, and in-hospital mortality. A total of 48 adult patients with RHT identified by transthoracic echocardiography (TTE) between January 2010 and December 2022 were included. Most patients with RHT presented with intermediate-high or high risk PE with right heart dysfunction. Mortality at 30 days was higher in the anticoagulation monotherapy group when compared to the systemic thrombolysis and advanced intervention groups, though not reaching statistical significance (25 % vs 11 % and 5.6 %, respectively). Other outcomes were not significantly different between groups. Although it is not clear that advanced therapy offers a benefit in this population overall, there are likely patients who will benefit; identifying that subpopulation remains a key question.

右心血栓（RHT）是一种发病率和死亡率都很高的罕见疾病。目前还没有关于心脏内血栓处理的社会指南。为了了解与RHT治疗决策相关的临床因素，这项回顾性多中心队列研究评估了在两个学术医疗中心接受PE反应小组（PERT）项目治疗的真实世界不同患者群体，这些患者接受RHT治疗，伴有和不伴有PE，并评估了相关的治疗策略和结果。本研究考察了接受抗凝单药治疗、全身溶栓和晚期干预治疗的RHT患者的临床特征和预后。关注的结局包括30天死亡率、住院时间、ICU入院需求、出血并发症和住院死亡率。本研究纳入2010年1月至2022年12月通过经胸超声心动图（TTE）确诊的48例成年RHT患者。大多数RHT患者表现为中高或高风险PE伴右心功能障碍。与全身性溶栓和高级干预组相比，抗凝单药组30天死亡率更高，但未达到统计学意义（分别为25% vs 11%和5.6%）。其他结果组间无显著差异。虽然尚不清楚先进的治疗是否对这一人群整体有益，但可能会有患者从中受益；确定这个亚群仍然是一个关键问题。

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引用次数: 0

Early outpatient use of low-molecular-weight heparin benefits COVID-19 outcome in association with hospitalization - Lessons learned 门诊早期使用低分子肝素有利于与住院相关的COVID-19结局-经验教训

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

Pub Date : 2025-11-26 DOI: 10.1016/j.thromres.2025.109555

Miika Koskinen , Eeva Ruotsalainen , Mia Wallin , Hilkka Kivelä , Kerstin Carlsson , Jari Petäjä , Eero Hirvensalo , Markku Mäkijärvi , Riitta Lassila

Background

Covid-19 and venous thromboembolism (VTE) share risk factors and thrombo-inflammatory pathophysiology. In-hospital low-molecular-weight heparin (LMWH) use improved outcomes. Before vaccinations or available treatments, the Helsinki university hospital in Finland, initiated LMWH thromboprophylaxis to Covid-19 outpatients with progressing illness and high-risk of VTE (LMWH+ group), aligning with the existing in-hospital guidance for thromboprophylaxis.

Methods

We observationally studied whether pre-admission LMWH thromboprophylaxis impacted outcomes: hospital and ICU stay, and respiratory support after Covid-19 hospitalization. We compared control group (LMWH-) by propensity score-matching comorbidities, medications and Covid-19 severity and VTE risk with the LMWH+ group with 30-day follow-up.

Results

Among 1189 hospitalized patients, 241 were stratified in the LMWH+ group and 482 were propensity-matched into the LMWH- group. The mean time (±SD) from Covid-19 diagnosis until outpatient thromboprophylaxis in the LMWH+ group was 1.9 (±3.0) days; ~80 % of patients received thromboprophylaxis ≤2 days after the diagnosis. Longer duration of pre-admission LMWH use was associated with shorter hospital stays and less days with respiratory support (p < 0.006–0.008). The incidences of bleeds and VTE (LMWH+ 4.6 %, LMWH- 5.4 %) were similar. Overall, 2.9-fold higher mortality (p = 0.014) occurred in the LMWH- (10.6 %) versus the LMWH+ group (3.7 %).

Conclusions

Outpatient LMWH given pre-admission for high-risk Covid-19 patients was associated with improved outcome following diagnosis: shorter respiratory support and hospital stay with reduced need for intensive care. Our findings support early initiation of LMWH in risk-stratified patients to manage thrombo-inflammation. While being Covid-19 aftermath, our study is relevant for any other severe viral outbursts associated with thrombogenicity.

背景：Covid-19和静脉血栓栓塞（VTE）具有共同的危险因素和血栓炎症病理生理。院内低分子肝素（LMWH）的使用改善了预后。在疫苗接种或可用治疗之前，芬兰赫尔辛基大学医院对病情进展和VTE高风险的Covid-19门诊患者（低分子肝素+组）启动了低分子肝素血栓预防，与现有的院内血栓预防指南保持一致。方法：观察性研究入院前低分子肝素血栓预防是否影响结果：住院和ICU住院时间，以及Covid-19住院后的呼吸支持。我们通过倾向评分匹配合并症、药物、Covid-19严重程度和静脉血栓栓塞风险，将对照组（低分子肝素-）与低分子肝素+组进行了30天的随访。结果：1189例住院患者中，241例被分层为低分子肝素+组，482例被倾向匹配为低分子肝素-组。低分子肝素+组从Covid-19诊断到门诊血栓预防的平均时间（±SD）为1.9（±3.0）天；~ 80%的患者在诊断后≤2天接受血栓预防治疗。入院前使用低分子肝素的时间越长，住院时间越短，呼吸支持天数越少(p)。结论：高危Covid-19患者入院前给予门诊低分子肝素与诊断后预后改善相关：呼吸支持时间缩短，住院时间缩短，重症监护需求减少。我们的研究结果支持在危险分层患者中早期开始低分子肝素来控制血栓炎症。虽然是Covid-19的后果，但我们的研究与任何其他与血栓形成性相关的严重病毒爆发相关。

{"title":"Early outpatient use of low-molecular-weight heparin benefits COVID-19 outcome in association with hospitalization - Lessons learned","authors":"Miika Koskinen , Eeva Ruotsalainen , Mia Wallin , Hilkka Kivelä , Kerstin Carlsson , Jari Petäjä , Eero Hirvensalo , Markku Mäkijärvi , Riitta Lassila","doi":"10.1016/j.thromres.2025.109555","DOIUrl":"10.1016/j.thromres.2025.109555","url":null,"abstract":"<div><h3>Background</h3><div>Covid-19 and venous thromboembolism (VTE) share risk factors and thrombo-inflammatory pathophysiology. In-hospital low-molecular-weight heparin (LMWH) use improved outcomes. Before vaccinations or available treatments, the Helsinki university hospital in Finland, initiated LMWH thromboprophylaxis to Covid-19 <em>outpatients</em> with progressing illness and high-risk of VTE (LMWH+ group), aligning with the existing in-hospital guidance for thromboprophylaxis.</div></div><div><h3>Methods</h3><div>We observationally studied whether pre-admission LMWH thromboprophylaxis impacted outcomes: hospital and ICU stay, and respiratory support after Covid-19 hospitalization. We compared control group (LMWH-) by propensity score-matching comorbidities, medications and Covid-19 severity and VTE risk with the LMWH+ group with 30-day follow-up.</div></div><div><h3>Results</h3><div>Among 1189 hospitalized patients, 241 were stratified in the LMWH+ group and 482 were propensity-matched into the LMWH- group. The mean time (±SD) from Covid-19 diagnosis until outpatient thromboprophylaxis in the LMWH+ group was 1.9 (±3.0) days; ~80 % of patients received thromboprophylaxis ≤2 days after the diagnosis. Longer duration of pre-admission LMWH use was associated with shorter hospital stays and less days with respiratory support (<em>p</em> < 0.006–0.008). The incidences of bleeds and VTE (LMWH+ 4.6 %, LMWH- 5.4 %) were similar. Overall, 2.9-fold higher mortality (<em>p</em> = 0.014) occurred in the LMWH- (10.6 %) versus the LMWH+ group (3.7 %).</div></div><div><h3>Conclusions</h3><div>Outpatient LMWH given pre-admission for high-risk Covid-19 patients was associated with improved outcome following diagnosis: shorter respiratory support and hospital stay with reduced need for intensive care. Our findings support early initiation of LMWH in risk-stratified patients to manage thrombo-inflammation. While being Covid-19 aftermath, our study is relevant for any other severe viral outbursts associated with thrombogenicity.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"257 ","pages":"Article 109555"},"PeriodicalIF":3.4,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145783017","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}

引用次数: 0

Rivaroxaban versus warfarin in pediatric intracardiac thrombosis: A promising step forward amid methodological caveats 利伐沙班与华法林治疗小儿心内血栓：在方法学上的警告中向前迈出了有希望的一步。

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

Pub Date : 2025-11-25 DOI: 10.1016/j.thromres.2025.109538

Xiaoliang Ying , Ruihua Wang

引用次数: 0

Thrombosis, bleeding, and mortality in patients with sepsis-induced coagulopathy: Analysis of a prospective cohort 败血症诱导凝血病患者的血栓、出血和死亡率：一项前瞻性队列分析。

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

Pub Date : 2025-11-24 DOI: 10.1016/j.thromres.2025.109554

Gianni Turcato , Arian Zaboli , Lucia Filippi , Paolo Ferretto , Alice Bresolin , Fabrizio Lucente , Alessandro Cipriano , Lorenzo Ghiadoni , Walter Ageno , Christian J. Wiedermann

Background

Sepsis-induced coagulopathy (SIC) is an early phase of disseminated intravascular coagulation and a candidate marker for risk stratification. Although SIC is linked to higher mortality, its value for predicting thrombotic and hemorrhagic events remains uncertain. We assessed the prevalence of SIC and its association with hemostatic complications and mortality in sepsis.

Methods

In a prospective cohort of 389 adults with sepsis admitted to an intermediate care unit, SIC was defined by International Society of Thrombosis and Haemostasis criteria (score ≥ 4). Primary outcomes were 30-day venous thromboembolism, arterial thrombosis, and bleeding; all-cause 30-day mortality was secondary. Predictive performance of the SIC score was evaluated with receiver operating characteristic analysis, bootstrap resampling, and Monte Carlo simulation.

Results

SIC was present in 33.4 % of patients. Thirty-day mortality was 27.1 % in SIC-positive patients versus 13.1 % in SIC-negative patients (p = 0.001), and SIC remained independently associated with death (adjusted OR 1.43; 95 % CI 1.13–1.80; p = 0.003). SIC positivity was not associated with overall thrombotic events: 42.9 % (12/28) of patients with thrombosis and 32.7 % (118/361) without thrombosis had SIC (p = 0.301). Discrimination for thrombotic and hemorrhagic events was poor (AUROC 0.573 and 0.576, respectively), with further decline after resampling; simulation analyses confirmed limited predictive capacity for either complication.

Conclusions

In this cohort, SIC was associated with higher mortality but not with thrombotic or hemorrhagic events. This association likely reflects overall severity of illness rather than clinically overt vascular complications. These findings do not support using SIC alone to guide anticoagulation or transfusion decisions and support the development of outcome-specific risk models, potentially integrating dynamic clinical variables and serial laboratory trajectories.

背景：脓毒症诱导凝血病（SIC）是弥散性血管内凝血的早期阶段，也是危险分层的候选标志物。虽然SIC与较高的死亡率有关，但其预测血栓和出血事件的价值仍不确定。我们评估了SIC的患病率及其与脓毒症的止血并发症和死亡率的关系。方法：在一项包含389名入住中级护理病房的脓毒症成人的前瞻性队列研究中，根据国际血栓形成和止血学会的标准（评分≥4）定义SIC。主要结局是30天静脉血栓栓塞、动脉血栓形成和出血；全因30天死亡率是次要的。通过接收机工作特性分析、自举重采样和蒙特卡罗模拟来评估SIC评分的预测性能。结果：33.4%的患者存在SIC。SIC阳性患者的30天死亡率为27.1%，而SIC阴性患者的30天死亡率为13.1% (p = 0.001)，并且SIC仍然与死亡独立相关（校正OR为1.43；95% CI为1.13-1.80;p = 0.003）。SIC阳性与整体血栓事件无关：42.9%（12/28）的血栓患者和32.7%（118/361）的非血栓患者有SIC （p = 0.301）。对血栓和出血事件的辨别能力较差（AUROC分别为0.573和0.576），重新采样后进一步下降；仿真分析证实了两种并发症的预测能力有限。结论：在这个队列中，SIC与较高的死亡率相关，但与血栓或出血事件无关。这种关联可能反映了疾病的总体严重程度，而不是临床明显的血管并发症。这些发现不支持单独使用SIC来指导抗凝或输血决策，并支持发展结果特异性风险模型，潜在地整合动态临床变量和一系列实验室轨迹。

{"title":"Thrombosis, bleeding, and mortality in patients with sepsis-induced coagulopathy: Analysis of a prospective cohort","authors":"Gianni Turcato , Arian Zaboli , Lucia Filippi , Paolo Ferretto , Alice Bresolin , Fabrizio Lucente , Alessandro Cipriano , Lorenzo Ghiadoni , Walter Ageno , Christian J. Wiedermann","doi":"10.1016/j.thromres.2025.109554","DOIUrl":"10.1016/j.thromres.2025.109554","url":null,"abstract":"<div><h3>Background</h3><div>Sepsis-induced coagulopathy (SIC) is an early phase of disseminated intravascular coagulation and a candidate marker for risk stratification. Although SIC is linked to higher mortality, its value for predicting thrombotic and hemorrhagic events remains uncertain. We assessed the prevalence of SIC and its association with hemostatic complications and mortality in sepsis.</div></div><div><h3>Methods</h3><div>In a prospective cohort of 389 adults with sepsis admitted to an intermediate care unit, SIC was defined by International Society of Thrombosis and Haemostasis criteria (score ≥ 4). Primary outcomes were 30-day venous thromboembolism, arterial thrombosis, and bleeding; all-cause 30-day mortality was secondary. Predictive performance of the SIC score was evaluated with receiver operating characteristic analysis, bootstrap resampling, and Monte Carlo simulation.</div></div><div><h3>Results</h3><div>SIC was present in 33.4 % of patients. Thirty-day mortality was 27.1 % in SIC-positive patients versus 13.1 % in SIC-negative patients (<em>p</em> = 0.001), and SIC remained independently associated with death (adjusted OR 1.43; 95 % CI 1.13–1.80; <em>p</em> = 0.003). SIC positivity was not associated with overall thrombotic events: 42.9 % (12/28) of patients with thrombosis and 32.7 % (118/361) without thrombosis had SIC (<em>p</em> = 0.301). Discrimination for thrombotic and hemorrhagic events was poor (AUROC 0.573 and 0.576, respectively), with further decline after resampling; simulation analyses confirmed limited predictive capacity for either complication.</div></div><div><h3>Conclusions</h3><div>In this cohort, SIC was associated with higher mortality but not with thrombotic or hemorrhagic events. This association likely reflects overall severity of illness rather than clinically overt vascular complications. These findings do not support using SIC alone to guide anticoagulation or transfusion decisions and support the development of outcome-specific risk models, potentially integrating dynamic clinical variables and serial laboratory trajectories.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"257 ","pages":"Article 109554"},"PeriodicalIF":3.4,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145606239","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}

引用次数: 0

Comparative outcomes of ultrasound-assisted catheter-directed thrombolysis between patients with acute and acute-on-chronic pulmonary embolism 超声辅助导管溶栓治疗急性和急性伴慢性肺栓塞的比较结果

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

Pub Date : 2025-11-21 DOI: 10.1016/j.thromres.2025.109552

Riccardo M. Fumagalli , Conrad von Stempel , William Pleming , Frederikus A. Klok , Stavros V. Konstantinides , Nils Kucher , Bhavin Rawal , Luca Valerio , Stefano Barco

Background

Radiologic signs of chronic thrombi are present in approximately 20 % of patients with acute pulmonary embolism (PE). We assessed the effectiveness of ultrasound-assisted catheter-directed thrombolysis (USAT) in patients with acute PE with or without signs of chronic PE and the accuracy of radiologic parameters predicting chronic thromboembolic pulmonary hypertension (CTEPH).

Methods

Index CT scans of patients who underwent USAT for acute PE with right ventricular strain were reviewed by three radiologists blinded to clinical and hemodynamic outcomes. At least 3 validated radiological criteria of chronic thromboembolism defined acute-on-chronic PE. Changes in mean pulmonary arterial pressure (mPAP) 20 h after USAT and presence of post-PE impairment (PPEI) or CTEPH at 3–6 months were compared between patients with and without acute-on-chronic PE.

Results

Among 180 consecutive patients (median age 65 years), 31 (17 %) had acute-on-chronic PE. Absolute mPAP reduction was 11 (Q1-Q3: 5–17) mmHg in acute vs. 10 (Q1-Q3: 5–17) mmHg in acute-on-chronic PE from similar baseline mPAP. PPEI or CTEPH were recorded in 2.0 % of patients in the acute group vs. 13 % in the acute-on-chronic group (odds ratio 7.0, 95 %C.I. 1.4–40). Of 3 (1.7 %) patients diagnosed with CTEPH, all presented with ≥3 radiological criteria suggesting pre-existing CTEPH at index CT scan.

Conclusions

CT signs of chronic thromboembolism at the time of acute PE did not appear to influence the immediate hemodynamic response to USAT in most patients but may raise the suspicion of pre-existing CTEPH if ≥3 validated radiological criteria are present.

背景：大约20%的急性肺栓塞（PE）患者存在慢性血栓的影像学征象。我们评估了超声辅助导管定向溶栓（USAT）在伴有或不伴有慢性PE症状的急性PE患者中的有效性，以及预测慢性血栓栓塞性肺动脉高压（CTEPH）的放射学参数的准确性。方法对三名不了解临床和血流动力学结果的放射科医师对急性PE合并右室劳损行USAT的患者的CT扫描进行回顾性分析。至少有3个经过验证的慢性血栓栓塞的放射学标准定义了急性对慢性PE。比较USAT后20小时平均肺动脉压（mPAP）的变化以及3-6个月PE后损伤（PPEI）或CTEPH的存在。结果在180例连续患者（中位年龄65岁）中，31例（17%）患有急性慢性肺栓塞。在相似的基线mPAP下，急性肺栓塞患者的绝对mPAP降低为11 (Q1-Q3: 5-17) mmHg，而急性慢性肺栓塞患者的绝对mPAP降低为10 (Q1-Q3: 5-17) mmHg。急性组中有2.0%的患者记录了PPEI或CTEPH，而急性慢性组中有13%（优势比为7.0,95% C.I.）-40 - 1.4)。在3例（1.7%）被诊断为CTEPH的患者中，所有患者在CT扫描中均表现出≥3个放射学标准，表明已有CTEPH。结论：急性PE时慢性血栓栓塞的sct体征似乎不会影响大多数患者对USAT的即时血流动力学反应，但如果存在≥3个有效的放射标准，则可能会引起对先前存在CTEPH的怀疑。

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引用次数: 0

Absolute time-dependent risk of hospital-acquired venous thromboembolism in children 儿童医院获得性静脉血栓栓塞的绝对时间依赖性风险。

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

Pub Date : 2025-11-21 DOI: 10.1016/j.thromres.2025.109553

Maya K. Raad, Stephanie Prozora, E. Vincent S. Faustino

Background

Absolute time-dependent risk of hospital-acquired venous thromboembolism (HA-VTE) is essential to evaluate the net clinical benefit of pharmacologic thromboprophylaxis. The multicenter Children's Hospital Acquired Thrombosis (CHAT) risk assessment model (RAM) identified risk factors for pediatric HA-VTE but was not designed to predict this risk. We aimed to predict the absolute time-dependent risk of HA-VTE in hospitalized children.

Methods

We conducted a single center case-cohort study of children ≤18 years old admitted from 2013 to 2022. Children with radiologically confirmed, symptomatic HA-VTE were considered cases. A 5 % random sample of eligible admissions formed the subcohort. Using Kaplan-Meier estimates and Cox regression with risk factors from the CHAT RAM and time to HA-VTE as outcome, we calculated the absolute time-dependent risk of HA-VTE of each child. Performance was assessed using area under the receiver operating characteristic curve (AUROC), calibration plot, and area under the precision-recall curve (AUPRC).

Results

We identified 81 children with HA-VTE from 23,287 admissions. Adolescent age, slightly limited mobility, and central venous catheter were associated with time to HA-VTE. Median absolute time-dependent risk of HA-VTE was 1.7 % (IQR: 1.0 %, 2.1 %) by day 12 of admission when the revised RAM performed best. AUROC by day 12 was 0.81 (95 % confidence interval, CI: 0.70, 0.93) with calibration slope of 1.13 (95 % CI: 0.38, 1.87), calibration intercept of 0.004 (95 % CI: −0.64, 0.65), and AUPRC of 0.04 (95 % CI: 0.004, 0.07).

Conclusions

We accurately predicted the absolute time-dependent risk of HA-VTE. Similar predictions should be developed for bleeding.

背景：医院获得性静脉血栓栓塞（HA-VTE）的绝对时间依赖风险是评估药物血栓预防的净临床效益的必要条件。多中心儿童医院获得性血栓形成（CHAT）风险评估模型（RAM）确定了儿童HA-VTE的危险因素，但并未设计用于预测这种风险。我们的目的是预测住院儿童HA-VTE的绝对时间依赖性风险。方法：对2013 - 2022年收治的≤18岁儿童进行单中心病例队列研究。放射学证实的有症状的HA-VTE患儿被认为是病例。随机抽取5%的符合条件的入学人员组成亚队列。使用Kaplan-Meier估计和Cox回归，以CHAT RAM和时间到HA-VTE的危险因素为结果，我们计算了每个儿童HA-VTE的绝对时间依赖性风险。使用受试者工作特征曲线下面积（AUROC）、校准图和精确召回率曲线下面积（AUPRC）来评估其性能。结果：我们从23,287例入院患者中确定了81例HA-VTE患儿。青少年年龄、活动能力轻微受限和中心静脉导管与HA-VTE发生时间相关。入院第12天，HA-VTE的绝对时间依赖风险中位数为1.7% (IQR: 1.0%, 2.1%)，此时修改后的RAM表现最佳。第12天的AUROC为0.81(95%可信区间，CI: 0.70, 0.93)，校准斜率为1.13 (95% CI: 0.38, 1.87)，校准截距为0.004 (95% CI: -0.64, 0.65)， AUPRC为0.04 （95% CI: 0.004, 0.07）。结论：我们准确地预测了HA-VTE的绝对时间依赖性风险。对于出血也应该有类似的预测。

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引用次数: 0