Pub Date : 2025-12-05DOI: 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。
{"title":"Diagnostic performance of ultrasound, computed tomography and magnetic resonance imaging in portal vein thrombosis: A systematic review with meta-analysis","authors":"Laura Girardi , Farah Zarka , Michelle Pradier , Sarah Visintini , Mattia Poletti , Grégoire Le Gal , Tzu-Fei Wang , Aurélien Delluc","doi":"10.1016/j.thromres.2025.109560","DOIUrl":"10.1016/j.thromres.2025.109560","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 %.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"257 ","pages":"Article 109560"},"PeriodicalIF":3.4,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145737195","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 : 2025-12-03DOI: 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.
{"title":"The maternal hemostatic shift: Understanding VTE risk in pregnancy and postpartum","authors":"Marie Didembourg , Laure Morimont , Emilie De Gottal , Jonathan Douxfils","doi":"10.1016/j.thromres.2025.109561","DOIUrl":"10.1016/j.thromres.2025.109561","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"257 ","pages":"Article 109561"},"PeriodicalIF":3.4,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681791","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 : 2025-12-02DOI: 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。
{"title":"Suboptimal management of cancer-associated thrombotic microangiopathies in newly diagnosed and known cancers: A 15-year provincial retrospective cohort study","authors":"Jessica Krahn , Haowei Sun Linda","doi":"10.1016/j.thromres.2025.109556","DOIUrl":"10.1016/j.thromres.2025.109556","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"257 ","pages":"Article 109556"},"PeriodicalIF":3.4,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145701910","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 : 2025-11-29DOI: 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.
{"title":"Platelets display immunophenotypic alterations and dysregulated transcriptomic signature in Philadelphia-negative myeloproliferative neoplasms","authors":"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","doi":"10.1016/j.thromres.2025.109559","DOIUrl":"10.1016/j.thromres.2025.109559","url":null,"abstract":"<div><h3>Introduction & objectives</h3><div>Polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (MF) are Philadelphia-negative myeloproliferative neoplasms (MPN) associated with gain-of-function mutations in <em>JAK2, CALR,</em> and <em>MPL</em> 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, <em>ex vivo</em> activation, and transcriptomic signatures in MPN patients compared to healthy controls.</div></div><div><h3>Methods</h3><div>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 <em>status.</em> 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 <em>in silico</em> to identify dysregulated platelet-related pathways.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"257 ","pages":"Article 109559"},"PeriodicalIF":3.4,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145678953","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 : 2025-11-26DOI: 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。
{"title":"Clinical features, management, and outcomes of right heart thrombi: a retrospective cohort study","authors":"Emily Fritzmann , Alexander D. Yuen , Stephanie Chang , Maidah Yaqoob , April Kinninger , Jina Chung , Janine R.E. Vintch , Yuri Matusov","doi":"10.1016/j.thromres.2025.109557","DOIUrl":"10.1016/j.thromres.2025.109557","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"257 ","pages":"Article 109557"},"PeriodicalIF":3.4,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145715858","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 : 2025-11-26DOI: 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.
{"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}
Pub Date : 2025-11-24DOI: 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.
{"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}
Pub Date : 2025-11-21DOI: 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.
{"title":"Comparative outcomes of ultrasound-assisted catheter-directed thrombolysis between patients with acute and acute-on-chronic pulmonary embolism","authors":"Riccardo M. Fumagalli , Conrad von Stempel , William Pleming , Frederikus A. Klok , Stavros V. Konstantinides , Nils Kucher , Bhavin Rawal , Luca Valerio , Stefano Barco","doi":"10.1016/j.thromres.2025.109552","DOIUrl":"10.1016/j.thromres.2025.109552","url":null,"abstract":"<div><h3>Background</h3><div>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).</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"257 ","pages":"Article 109552"},"PeriodicalIF":3.4,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145616915","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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