Pub Date : 2026-02-01Epub Date: 2026-01-23DOI: 10.1016/j.thromres.2026.109596
Danica Michaličková , Karolína Hronová
{"title":"Letter in reference to the recent article: “Absorption and anticoagulant management of rivaroxaban in patients with short bowel syndrome” by Lunau et al.","authors":"Danica Michaličková , Karolína Hronová","doi":"10.1016/j.thromres.2026.109596","DOIUrl":"10.1016/j.thromres.2026.109596","url":null,"abstract":"","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"258 ","pages":"Article 109596"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038320","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: 2026-01-19DOI: 10.1016/j.thromres.2026.109592
M. von der Forst , S. Hoewelhaus , L. Gilles , D.D. Uzun , S. Katzenschlager , C. Heim , M. Dietrich , D. Gruneberg , M.A. Weigand , H. Schöchl , F.C.F. Schmitt
Purpose
Acquired Factor XIII (FXIII) deficiency is prevalent in hospitalized or surgical patients, with FXIII activity <70% in over 20% of cases. A decrease in FXIII has been linked with postoperative bleeding, anastomotic insufficiency, and a greater likelihood of requiring reoperation. This study aims to identify patients at increased risk for postoperative complications by comparing open versus minimally invasive pancreatic and esophageal surgery.
Methods
This prospective, monocentric observational study was conducted at Heidelberg University Hospital (Germany). Inclusion criteria consisted of age ≥ 18 years, the ability to provide informed consent, and scheduled esophageal or pancreatic surgery. A coagulation panel was performed preoperatively, directly after surgery and on postoperative day (POD) 1, 2, 3, 4, 7, 10, and 13, along with repeated thromboelastography (ClotPro®) Tests.
Results
Finally, 112 patients were enrolled (n = 77 open and n = 35 minimally invasive). FXIII activity showed a more pronounced decrease in the open surgery group until day 7; in both groups, the lowest FXIII activity occurred between days 4 and 7. There were no significant group differences in readmissions, reoperations, or severe perioperative complications according to the Clavien-Dindo classification.
Conclusion
Open surgery was associated with a significant decline in FXIII activity, with a nadir estimated to occur between POD 4 and 7. FXIII activity also remained significantly reduced until day 7 after surgery. Viscoelastic testing was not able to detect mild acquired FXIII deficiencies. The extent to which routine testing of FXIII activity should be performed prior to reoperation must be evaluated in further studies. German Clinical Trials Register (DRKS00028547, registration date: April 14, 2022).
{"title":"Perioperative factor XIII and viscoelastic measurements of open compared to minimal invasive major upper gastrointestinal surgery– A prospective observational study","authors":"M. von der Forst , S. Hoewelhaus , L. Gilles , D.D. Uzun , S. Katzenschlager , C. Heim , M. Dietrich , D. Gruneberg , M.A. Weigand , H. Schöchl , F.C.F. Schmitt","doi":"10.1016/j.thromres.2026.109592","DOIUrl":"10.1016/j.thromres.2026.109592","url":null,"abstract":"<div><h3>Purpose</h3><div>Acquired Factor XIII (FXIII) deficiency is prevalent in hospitalized or surgical patients, with FXIII activity <70% in over 20% of cases. A decrease in FXIII has been linked with postoperative bleeding, anastomotic insufficiency, and a greater likelihood of requiring reoperation. This study aims to identify patients at increased risk for postoperative complications by comparing open versus minimally invasive pancreatic and esophageal surgery.</div></div><div><h3>Methods</h3><div>This prospective, monocentric observational study was conducted at Heidelberg University Hospital (Germany). Inclusion criteria consisted of age ≥ 18 years, the ability to provide informed consent, and scheduled esophageal or pancreatic surgery. A coagulation panel was performed preoperatively, directly after surgery and on postoperative day (POD) 1, 2, 3, 4, 7, 10, and 13, along with repeated thromboelastography (ClotPro®) Tests.</div></div><div><h3>Results</h3><div>Finally, 112 patients were enrolled (<em>n</em> = 77 open and <em>n</em> = 35 minimally invasive). FXIII activity showed a more pronounced decrease in the open surgery group until day 7; in both groups, the lowest FXIII activity occurred between days 4 and 7. There were no significant group differences in readmissions, reoperations, or severe perioperative complications according to the Clavien-Dindo classification.</div></div><div><h3>Conclusion</h3><div>Open surgery was associated with a significant decline in FXIII activity, with a nadir estimated to occur between POD 4 and 7. FXIII activity also remained significantly reduced until day 7 after surgery. Viscoelastic testing was not able to detect mild acquired FXIII deficiencies. The extent to which routine testing of FXIII activity should be performed prior to reoperation must be evaluated in further studies. German Clinical Trials Register (DRKS00028547, registration date: April 14, 2022).</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"258 ","pages":"Article 109592"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038319","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: 2025-12-19DOI: 10.1016/j.thromres.2025.109566
Okan Yılmaz , Beyza Nur Yılmaz , Neslihan Betül Kandilcik , Zeynep Sebla Yiğit , Mediha Esra Altuntop Yayla
Hemostasis is a complex physiological process that prevents blood loss following vascular injury via the blood coagulation cascade. The coagulation cascade is a highly controlled stepwise process that establishes clotting only at the site of bleeding, when needed. Recently, aptamers have been employed not only in the fields of biosensors and diagnostics, but also in molecular imaging, therapeutics, and drug delivery systems. The present article highlights recent developments in aptamer-based biomedical systems for the diagnosis and treatment of blood coagulation cascade disorders. Specifically, aptasensors for thrombin detection and aptamer-based medical imaging of thrombi were addressed as diagnostic tools for coagulation cascade disorders. Additionally, the use of aptamers as pharmaceutical agents and aptamer-targeted drug delivery systems were highlighted as part of the treatment. In summary, this is a valuable compilation in this emerging field that focuses on aptamer-based applications for monitoring and treatment of blood coagulation cascade disorders.
{"title":"Aptamer-based monitorization and therapeutic applications of blood coagulation cascade disorders: A systematic review","authors":"Okan Yılmaz , Beyza Nur Yılmaz , Neslihan Betül Kandilcik , Zeynep Sebla Yiğit , Mediha Esra Altuntop Yayla","doi":"10.1016/j.thromres.2025.109566","DOIUrl":"10.1016/j.thromres.2025.109566","url":null,"abstract":"<div><div>Hemostasis is a complex physiological process that prevents blood loss following vascular injury <em>via</em> the blood coagulation cascade. The coagulation cascade is a highly controlled stepwise process that establishes clotting only at the site of bleeding, when needed. Recently, aptamers have been employed not only in the fields of biosensors and diagnostics, but also in molecular imaging, therapeutics, and drug delivery systems. The present article highlights recent developments in aptamer-based biomedical systems for the diagnosis and treatment of blood coagulation cascade disorders. Specifically, aptasensors for thrombin detection and aptamer-based medical imaging of thrombi were addressed as diagnostic tools for coagulation cascade disorders. Additionally, the use of aptamers as pharmaceutical agents and aptamer-targeted drug delivery systems were highlighted as part of the treatment. In summary, this is a valuable compilation in this emerging field that focuses on aptamer-based applications for monitoring and treatment of blood coagulation cascade disorders.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"258 ","pages":"Article 109566"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145864797","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: 2026-01-07DOI: 10.1016/j.thromres.2025.109571
An Zhang , Guiyuan Li , Xiujian Wu
Venous thromboembolism is a major preventable complication among orthopedic inpatients, yet existing risk scores and correlation-driven models often miss complex physiological interactions and provide limited interpretability. We propose Causal-Aware Risk Embedding Network (CARE-Net), a causal representation learning framework for VTE prediction on structured clinical data. CARE-Net first infers a directed causal graph among laboratory, demographic, and therapeutic variables, then performs message passing strictly along causal directions to construct mechanism-aligned patient embeddings. A causal contrastive objective further aligns patients with similar causal signatures, enhancing robustness and suppressing spurious associations. Extensive comparisons with statistical, ensemble, deep tabular, transformer-based, and graph-based baselines show that CARE-Net delivers consistently superior discrimination and a more balanced sensitivity-specificity profile. Ablation and feature-importance analyses confirm that each causal component contributes meaningfully and that learned risk factors align with established clinical pathways. These findings suggest that embedding causal structure into representation learning offers a principled route to reliable VTE decision support in orthopedic care.
{"title":"CARE-Net: Causal-aware risk embedding for venous thromboembolism prediction in orthopedic inpatients","authors":"An Zhang , Guiyuan Li , Xiujian Wu","doi":"10.1016/j.thromres.2025.109571","DOIUrl":"10.1016/j.thromres.2025.109571","url":null,"abstract":"<div><div>Venous thromboembolism is a major preventable complication among orthopedic inpatients, yet existing risk scores and correlation-driven models often miss complex physiological interactions and provide limited interpretability. We propose Causal-Aware Risk Embedding Network (CARE-Net), a causal representation learning framework for VTE prediction on structured clinical data. CARE-Net first infers a directed causal graph among laboratory, demographic, and therapeutic variables, then performs message passing strictly along causal directions to construct mechanism-aligned patient embeddings. A causal contrastive objective further aligns patients with similar causal signatures, enhancing robustness and suppressing spurious associations. Extensive comparisons with statistical, ensemble, deep tabular, transformer-based, and graph-based baselines show that CARE-Net delivers consistently superior discrimination and a more balanced sensitivity-specificity profile. Ablation and feature-importance analyses confirm that each causal component contributes meaningfully and that learned risk factors align with established clinical pathways. These findings suggest that embedding causal structure into representation learning offers a principled route to reliable VTE decision support in orthopedic care.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"258 ","pages":"Article 109571"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927657","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.2026.109590
Thaís D.R. Nóbrega , Tiago Boechat , Denys E. Fujimoto , Sibia S. Marcondes , Silvia Bueno , Suzanna A. Tavares , Alessandra Prezotti , Juliana S.M. Duarte , Fabiana C.C. Piassi , Lucas Cesped , Erica Okazaki , Bianca Stefanello , Carolina Costa-Lima , Paula R. Villaça , Fernanda A. Orsi
Most data supporting current knowledge about thrombotic thrombocytopenic purpura (TTP) come from high-income regions, while little is known about treatment access and prognosis in low- and middle-income countries. To address this gap, we conducted a multicenter prospective study that included 85 TTP patients in Brazil between 2018 and 2024, with a 12-month follow-up. The median age was 37 years (IQR 27–45) and 76% were female. The median PLASMIC score was six (IQR 6.0–7.0), and ADAMTS13 activity was tested in 62.4% of patients (all <10%). The median time from symptom onset to hospital admission was 8 days. Neurological manifestations were the most frequent (75.3%), followed by bleeding symptoms (58.8%) and abdominal pain (32.9%). Seventy-four patients (87.1%) underwent therapeutic plasma exchange (TPE), which was initiated within one day of admission (IQR 1–2). Corticosteroids were administered in 95.3% and rituximab in 56.5% of patients. Twenty-three patients (27.1%) required advanced life support and 13 (15.3%) died during hospitalization. In-hospital mortality was associated with older age and hemodynamic instability upon admission. Among survivors, 26% experienced exacerbation or relapse, and 22.4% developed chronic sequelae, mostly neurological and psychiatric symptoms. Rituximab use was protective against TTP relapses. In conclusion, TTP mortality in Brazil is higher than that observed in recent cohorts. TTP diagnosis and treatment in the country are delayed and outdated, negatively affecting disease prognosis. Ensuring rapid diagnosis and the availability of TPE and rituximab, a cost-effective treatment strategy, is essential for improving outcomes and reducing morbidity, including in low- and middle-income countries.
{"title":"Brazilian Registry of Thrombotic Thrombocytopenic Purpura: A prospective cohort study of diagnosis, management and outcomes in Brazil","authors":"Thaís D.R. Nóbrega , Tiago Boechat , Denys E. Fujimoto , Sibia S. Marcondes , Silvia Bueno , Suzanna A. Tavares , Alessandra Prezotti , Juliana S.M. Duarte , Fabiana C.C. Piassi , Lucas Cesped , Erica Okazaki , Bianca Stefanello , Carolina Costa-Lima , Paula R. Villaça , Fernanda A. Orsi","doi":"10.1016/j.thromres.2026.109590","DOIUrl":"10.1016/j.thromres.2026.109590","url":null,"abstract":"<div><div>Most data supporting current knowledge about thrombotic thrombocytopenic purpura (TTP) come from high-income regions, while little is known about treatment access and prognosis in low- and middle-income countries. To address this gap, we conducted a multicenter prospective study that included 85 TTP patients in Brazil between 2018 and 2024, with a 12-month follow-up. The median age was 37 years (IQR 27–45) and 76% were female. The median PLASMIC score was six (IQR 6.0–7.0), and ADAMTS13 activity was tested in 62.4% of patients (all <10%). The median time from symptom onset to hospital admission was 8 days. Neurological manifestations were the most frequent (75.3%), followed by bleeding symptoms (58.8%) and abdominal pain (32.9%). Seventy-four patients (87.1%) underwent therapeutic plasma exchange (TPE), which was initiated within one day of admission (IQR 1–2). Corticosteroids were administered in 95.3% and rituximab in 56.5% of patients. Twenty-three patients (27.1%) required advanced life support and 13 (15.3%) died during hospitalization. In-hospital mortality was associated with older age and hemodynamic instability upon admission. Among survivors, 26% experienced exacerbation or relapse, and 22.4% developed chronic sequelae, mostly neurological and psychiatric symptoms. Rituximab use was protective against TTP relapses. In conclusion, TTP mortality in Brazil is higher than that observed in recent cohorts. TTP diagnosis and treatment in the country are delayed and outdated, negatively affecting disease prognosis. Ensuring rapid diagnosis and the availability of TPE and rituximab, a cost-effective treatment strategy, is essential for improving outcomes and reducing morbidity, including in low- and middle-income countries.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"258 ","pages":"Article 109590"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977993","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: 2025-12-29DOI: 10.1016/j.thromres.2025.109572
Xiaoling Shui , Yuqiong Cao , Yuhong He , Shan Zeng , Na Ye , Mao Ma
Background
Thrombosis, encompassing both venous thromboembolism (VTE) and arterial thrombotic events, represents a leading cause of mortality in patients with Systemic Lupus Erythematosus (SLE). A comprehensive evaluation of risk factors specific to each thrombotic type remains lacking.
Objective
To systematically identify and compare risk factors for venous and arterial thrombosis in SLE patients through a meta-analysis.
Methods
We systematically searched PubMed, Web of Science, Embase, Cochrane Library, CNKI, and Wanfang Data from inception to August 2025. Cohort studies (prospective or retrospective) and case-control studies reporting multivariable-adjusted associations between risk factors and thrombotic events in SLE were included. Two researchers independently performed study selection, data extraction, and quality assessment using the Newcastle-Ottawa Scale. Pooled odds ratios (ORs) with 95 % confidence intervals (CIs) were calculated using random-effects models.
Results
Analysis of 25 studies (13,290 patients) identified distinct risk factor profiles. For venous thrombosis, lupus anticoagulant showed the strongest association (OR 6.17, 95 % CI 2.77–13.76), followed by anti-β2-glycoprotein I IgA (OR 4.77, 95 % CI 3.08–7.39). Antiphospholipid syndrome demonstrated an exceptionally high risk (OR 44.72, 95 % CI 9.93–201.34). Elevated D-dimer was a specific venous thrombosis predictor (OR 1.35, 95 % CI 1.22–1.49). For arterial thrombosis, traditional cardiovascular risk factors predominated, including hypertension (OR 3.39, 95 % CI 2.38–4.83) and obesity (OR 3.17, 95 % CI 1.50–6.66). Disease-related factors such as high SLEDAI scores (OR 1.11, 95 % CI 1.05–1.16) and renal insufficiency (OR 2.38, 95 % CI 1.42–4.00) were associated with increased thrombotic risk.
Conclusion
Thrombosis in SLE exhibits distinct risk factor patterns between venous and arterial events. Venous thrombosis is strongly driven by antiphospholipid antibodies, while arterial events are predominantly associated with traditional cardiovascular risk factors. This review identifies and distinguishes key risk factors for venous and arterial thrombosis in SLE. These findings highlight the necessity for thrombotic type-specific risk assessment and provide an evidence base to inform the future development of targeted preventive strategies.
背景:血栓形成,包括静脉血栓栓塞(VTE)和动脉血栓事件,是系统性红斑狼疮(SLE)患者死亡的主要原因。对每种血栓形成类型的危险因素的综合评估仍然缺乏。目的:通过荟萃分析系统地识别和比较SLE患者静脉和动脉血栓形成的危险因素。方法:系统检索PubMed、Web of Science、Embase、Cochrane Library、CNKI、万方数据,检索时间为建站至2025年8月。队列研究(前瞻性或回顾性)和病例对照研究报告了SLE中危险因素与血栓形成事件之间的多变量调整相关性。两名研究人员使用纽卡斯尔-渥太华量表独立进行研究选择、数据提取和质量评估。采用随机效应模型计算95%置信区间(ci)的合并优势比(ORs)。结果:对25项研究(13290例患者)的分析确定了不同的风险因素。对于静脉血栓形成,狼疮抗凝剂的相关性最强(OR 6.17, 95% CI 2.77 ~ 13.76),其次是抗β2-糖蛋白I IgA (OR 4.77, 95% CI 3.08 ~ 7.39)。抗磷脂综合征表现出异常高的风险(OR 44.72, 95% CI 9.93-201.34)。升高的d -二聚体是特定的静脉血栓形成预测因子(OR 1.35, 95% CI 1.22-1.49)。对于动脉血栓,传统的心血管危险因素占主导地位,包括高血压(OR 3.39, 95% CI 2.38-4.83)和肥胖(OR 3.17, 95% CI 1.50-6.66)。疾病相关因素,如高SLEDAI评分(OR 1.11, 95% CI 1.05-1.16)和肾功能不全(OR 2.38, 95% CI 1.42-4.00)与血栓形成风险增加相关。结论:SLE血栓形成在静脉和动脉事件之间表现出不同的危险因素模式。静脉血栓形成是由抗磷脂抗体强烈驱动的,而动脉事件主要与传统的心血管危险因素相关。这篇综述确定并区分了SLE中静脉和动脉血栓形成的关键危险因素。这些发现强调了血栓形成特定类型风险评估的必要性,并为未来制定有针对性的预防策略提供了证据基础。
{"title":"Factors associated with venous and arterial thrombosis in patients with Systemic Lupus Erythematosus: A systematic review and meta-analysis","authors":"Xiaoling Shui , Yuqiong Cao , Yuhong He , Shan Zeng , Na Ye , Mao Ma","doi":"10.1016/j.thromres.2025.109572","DOIUrl":"10.1016/j.thromres.2025.109572","url":null,"abstract":"<div><h3>Background</h3><div>Thrombosis, encompassing both venous thromboembolism (VTE) and arterial thrombotic events, represents a leading cause of mortality in patients with Systemic Lupus Erythematosus (SLE). A comprehensive evaluation of risk factors specific to each thrombotic type remains lacking.</div></div><div><h3>Objective</h3><div>To systematically identify and compare risk factors for venous and arterial thrombosis in SLE patients through a meta-analysis.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, Web of Science, Embase, Cochrane Library, CNKI, and Wanfang Data from inception to August 2025. Cohort studies (prospective or retrospective) and case-control studies reporting multivariable-adjusted associations between risk factors and thrombotic events in SLE were included. Two researchers independently performed study selection, data extraction, and quality assessment using the Newcastle-Ottawa Scale. Pooled odds ratios (ORs) with 95 % confidence intervals (CIs) were calculated using random-effects models.</div></div><div><h3>Results</h3><div>Analysis of 25 studies (13,290 patients) identified distinct risk factor profiles. For venous thrombosis, lupus anticoagulant showed the strongest association (OR 6.17, 95 % CI 2.77–13.76), followed by anti-β2-glycoprotein I IgA (OR 4.77, 95 % CI 3.08–7.39). Antiphospholipid syndrome demonstrated an exceptionally high risk (OR 44.72, 95 % CI 9.93–201.34). Elevated D-dimer was a specific venous thrombosis predictor (OR 1.35, 95 % CI 1.22–1.49). For arterial thrombosis, traditional cardiovascular risk factors predominated, including hypertension (OR 3.39, 95 % CI 2.38–4.83) and obesity (OR 3.17, 95 % CI 1.50–6.66). Disease-related factors such as high SLEDAI scores (OR 1.11, 95 % CI 1.05–1.16) and renal insufficiency (OR 2.38, 95 % CI 1.42–4.00) were associated with increased thrombotic risk.</div></div><div><h3>Conclusion</h3><div>Thrombosis in SLE exhibits distinct risk factor patterns between venous and arterial events. Venous thrombosis is strongly driven by antiphospholipid antibodies, while arterial events are predominantly associated with traditional cardiovascular risk factors. This review identifies and distinguishes key risk factors for venous and arterial thrombosis in SLE. These findings highlight the necessity for thrombotic type-specific risk assessment and provide an evidence base to inform the future development of targeted preventive strategies.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"258 ","pages":"Article 109572"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145864789","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}
Cardiac surgery with cardiopulmonary bypass (CPB) requires precise hemostasis management to limit postoperative bleeding. Fibrinogen, platelet count, and pro-coagulant factors guide transfusion decisions, yet Clauss fibrinogen measurement during CPB is debated, and prothrombin time (PT) cannot be measured accurately due to interference from high-dose heparin. This study investigated whether intraoperative measurements of fibrinogen, prothrombin (FII), factor V (FV), and platelet obtained during CPB could reliably predict post-CPB values.
Methods
We conducted a single-center, prospective observational study involving 73 adult patients undergoing cardiac surgery with CPB. Blood samples were collected before aortic unclamping and five minutes after completion of protamine administration. Fibrinogen (Clauss method), FII, and FV activities were measured using HemosIL reagents on an ACL TOP analyzer.
Results
Using appropriate reagents, fibrinogen, FII, and FV were reliably measured during CPB, despite high-dose heparin. Strong correlations were observed between intra-CPB and post-CPB values for fibrinogen (r = 0.81), FII (r = 0.78), and FV (r = 0.73), supporting their reliability in anticipating post-bypass coagulation status. ROC curve analyses demonstrated good predictive performance for transfusion-relevant thresholds, with AUCs of 0.93 for platelet count <100 G/L, 0.86 for fibrinogen <1.5 g/L, and 0.84 for FII < 50% activity.
Conclusions
This study showed that fibrinogen and factor II (a surrogate for PT) levels remain consistent between the CPB period and after protamine administration in adult cardiac surgery patients, confirming the reliability of their intraoperative assessment.
{"title":"Standard coagulation assays during cardiopulmonary bypass predict post-bypass levels in cardiac surgery","authors":"Victor-Emmanuel Brett , Antoine Beurton , Alexandre Ouattara , Céline Delassasseigne , Christine Mouton","doi":"10.1016/j.thromres.2026.109593","DOIUrl":"10.1016/j.thromres.2026.109593","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac surgery with cardiopulmonary bypass (CPB) requires precise hemostasis management to limit postoperative bleeding. Fibrinogen, platelet count, and pro-coagulant factors guide transfusion decisions, yet Clauss fibrinogen measurement during CPB is debated, and prothrombin time (PT) cannot be measured accurately due to interference from high-dose heparin. This study investigated whether intraoperative measurements of fibrinogen, prothrombin (FII), factor V (FV), and platelet obtained during CPB could reliably predict post-CPB values.</div></div><div><h3>Methods</h3><div>We conducted a single-center, prospective observational study involving 73 adult patients undergoing cardiac surgery with CPB. Blood samples were collected before aortic unclamping and five minutes after completion of protamine administration. Fibrinogen (Clauss method), FII, and FV activities were measured using HemosIL reagents on an ACL TOP analyzer.</div></div><div><h3>Results</h3><div>Using appropriate reagents, fibrinogen, FII, and FV were reliably measured during CPB, despite high-dose heparin. Strong correlations were observed between intra-CPB and post-CPB values for fibrinogen (<em>r</em> = 0.81), FII (<em>r</em> = 0.78), and FV (<em>r</em> = 0.73), supporting their reliability in anticipating post-bypass coagulation status. ROC curve analyses demonstrated good predictive performance for transfusion-relevant thresholds, with AUCs of 0.93 for platelet count <100 G/L, 0.86 for fibrinogen <1.5 g/L, and 0.84 for FII < 50% activity.</div></div><div><h3>Conclusions</h3><div>This study showed that fibrinogen and factor II (a surrogate for PT) levels remain consistent between the CPB period and after protamine administration in adult cardiac surgery patients, confirming the reliability of their intraoperative assessment.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"258 ","pages":"Article 109593"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146030793","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: 2026-01-14DOI: 10.1016/j.thromres.2026.109583
Andrew R. Gosselin , Sameer Ahmad , Joseph S. Hanna , Julie Goswami , Valerie Tutwiler
Background
In severely injured patients, altered coagulation impairs stable clot formation and increases mortality. Traumatic brain injury (TBI) precipitates alterations in clot formation and breakdown. In this study, we aimed to characterize clotting kinetics, mechanics, fibrin networks, and circulating proteomic markers in TBI patients, and correlate these biomarkers to outcomes.
Methods
Plasma samples were collected from 63 injured patients upon presentation. Clotting kinetics, structure, fibrinolytic markers, thrombin generation, and proteomic profiles were analyzed. Clinical chart review was performed using our institution's trauma registry and medical records.
Results
We analyzed coagulation and clinical factors of 34 No-TBI, 29 TBI patients and 7 healthy donors. Demographics were comparable between patient groups. TBI patients had increased mortality and larger perturbations in coagulation mainly in intrinsic coagulation and fibrinolytic function. Upon admission, TBI patients had higher D-dimer, lower factor VIII, and lower von Willebrand factor than No-TBI patients. TBI patients had reduced coagulation factor XIII alpha chain than healthy donors. Subgroup analyses included isolated TBI, polytrauma with TBI, and varying TBI severities. We identified distinct contributions of intracranial and extracranial injury on coagulopathy, thrombin generation and coagulation factor concentrations. Along with this, Severe TBI was associated with increased prehospital fibrinolysis, without an increase in tissue plasminogen activator concentration or fibrinolysis at blood draw.
Conclusion
TBI patients demonstrated patterns consistent with prehospital fibrinogen consumption and fibrinolysis. Unique differences were observed between the phenotypes of TBI, with severe isolated TBI patients exhibiting lower levels of vWF, Coagulation Factor VIII, Coagulation Factor XIII alpha chain, and PAI-1. These findings highlight the temporal and injury-phenotype contributions to TBI-induced coagulopathy.
{"title":"Characterizing the impact of traumatic brain injury phenotype on coagulation dynamics in severely injured patients","authors":"Andrew R. Gosselin , Sameer Ahmad , Joseph S. Hanna , Julie Goswami , Valerie Tutwiler","doi":"10.1016/j.thromres.2026.109583","DOIUrl":"10.1016/j.thromres.2026.109583","url":null,"abstract":"<div><h3>Background</h3><div>In severely injured patients, altered coagulation impairs stable clot formation and increases mortality. Traumatic brain injury (TBI) precipitates alterations in clot formation and breakdown. In this study, we aimed to characterize clotting kinetics, mechanics, fibrin networks, and circulating proteomic markers in TBI patients, and correlate these biomarkers to outcomes.</div></div><div><h3>Methods</h3><div>Plasma samples were collected from 63 injured patients upon presentation. Clotting kinetics, structure, fibrinolytic markers, thrombin generation, and proteomic profiles were analyzed. Clinical chart review was performed using our institution's trauma registry and medical records.</div></div><div><h3>Results</h3><div>We analyzed coagulation and clinical factors of 34 No-TBI, 29 TBI patients and 7 healthy donors. Demographics were comparable between patient groups. TBI patients had increased mortality and larger perturbations in coagulation mainly in intrinsic coagulation and fibrinolytic function. Upon admission, TBI patients had higher D-dimer, lower factor VIII, and lower von Willebrand factor than No-TBI patients. TBI patients had reduced coagulation factor XIII alpha chain than healthy donors. Subgroup analyses included isolated TBI, polytrauma with TBI, and varying TBI severities. We identified distinct contributions of intracranial and extracranial injury on coagulopathy, thrombin generation and coagulation factor concentrations. Along with this, Severe TBI was associated with increased prehospital fibrinolysis, without an increase in tissue plasminogen activator concentration or fibrinolysis at blood draw.</div></div><div><h3>Conclusion</h3><div>TBI patients demonstrated patterns consistent with prehospital fibrinogen consumption and fibrinolysis. Unique differences were observed between the phenotypes of TBI, with severe isolated TBI patients exhibiting lower levels of vWF, Coagulation Factor VIII, Coagulation Factor XIII alpha chain, and PAI-1. These findings highlight the temporal and injury-phenotype contributions to TBI-induced coagulopathy.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"258 ","pages":"Article 109583"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038336","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.2025.109573
For the DELPHI Serenity Group, Isabelle Mahé , Skerdi Haviari , Nassima Si Mohammed , Anette Arbjerg Højen , Carme Font , Stavros Konstantinides , Marieke J.H.A. Kruip , Luigi Maiorana , Sebastian Szmit , Denise Abbel , Laurent Bertoletti , Adrian Edwards , Michelle Edwards , Alessandra Gava , Jacobijn Gussekloo , Miriam J. Johnson , Rashmi Kumar , Johan Langendoen , Kate J. Lifford , Camille Couffignal
Introduction
To develop a European shared decision-support tool (SDST), a two-round Delphi process was used to achieve consensus on aspects relating to the antithrombotic therapy (ATT) deprescribing discussions and process in end-of-life cancer patients.
Methods
Conducted between September 2024 and March 2025, the Delphi survey was developed by a multidisciplinary 24-member steering committee (SC), including medical specialists in oncology, hematology, palliative care, primary care, geriatrics, and vascular medicine. The survey involved 188 experts from these specialties across eight European countries. Consensus was defined with pooled items as ≥70 % agreement with a final decision by the SC. Themes covered deprescribing timing, stakeholders, reassessment and clinical drivers of patients with ATT, SDST, and choice of outcomes for a randomized controlled trial (RCT) to evaluate the SDST.
Results
Round 1 reached consensus for seven pooled questions (37 %), especially the reassessment of ATT deprescribing. Considering these results, the SC reformulated round 2 to reduce ambiguity and move toward consensus. The SC made the final decision. Three medical specialties should be involved in ATT deprescribing: palliative care specialists, oncologists, and general practitioners after a triggering circumstance such as clinical triggers or at 3-month prognosis. For the SDST design, the findings confirmed that this tool would be meaningful to clinicians. Eleven predefined outcomes were selected for a future RCT.
Conclusion
These results succeeded in shaping the content of the future SDST and mapping its useability in palliative care clinical pathways across Europe, with the perspective to support informed decision-making, reduce complications, and improve quality of life in this population.
{"title":"Developing a decision support tool for the continuation or deprescribing of antithrombotic therapy in patients receiving end-of-life care: Results of a European Delphi study","authors":"For the DELPHI Serenity Group, Isabelle Mahé , Skerdi Haviari , Nassima Si Mohammed , Anette Arbjerg Højen , Carme Font , Stavros Konstantinides , Marieke J.H.A. Kruip , Luigi Maiorana , Sebastian Szmit , Denise Abbel , Laurent Bertoletti , Adrian Edwards , Michelle Edwards , Alessandra Gava , Jacobijn Gussekloo , Miriam J. Johnson , Rashmi Kumar , Johan Langendoen , Kate J. Lifford , Camille Couffignal","doi":"10.1016/j.thromres.2025.109573","DOIUrl":"10.1016/j.thromres.2025.109573","url":null,"abstract":"<div><h3>Introduction</h3><div>To develop a European shared decision-support tool (SDST), a two-round Delphi process was used to achieve consensus on aspects relating to the antithrombotic therapy (ATT) deprescribing discussions and process in end-of-life cancer patients.</div></div><div><h3>Methods</h3><div>Conducted between September 2024 and March 2025, the Delphi survey was developed by a multidisciplinary 24-member steering committee (SC), including medical specialists in oncology, hematology, palliative care, primary care, geriatrics, and vascular medicine. The survey involved 188 experts from these specialties across eight European countries. Consensus was defined with pooled items as ≥70 % agreement with a final decision by the SC. Themes covered deprescribing timing, stakeholders, reassessment and clinical drivers of patients with ATT, SDST, and choice of outcomes for a randomized controlled trial (RCT) to evaluate the SDST.</div></div><div><h3>Results</h3><div>Round 1 reached consensus for seven pooled questions (37 %), especially the reassessment of ATT deprescribing. Considering these results, the SC reformulated round 2 to reduce ambiguity and move toward consensus. The SC made the final decision. Three medical specialties should be involved in ATT deprescribing: palliative care specialists, oncologists, and general practitioners after a triggering circumstance such as clinical triggers or at 3-month prognosis. For the SDST design, the findings confirmed that this tool would be meaningful to clinicians. Eleven predefined outcomes were selected for a future RCT.</div></div><div><h3>Conclusion</h3><div>These results succeeded in shaping the content of the future SDST and mapping its useability in palliative care clinical pathways across Europe, with the perspective to support informed decision-making, reduce complications, and improve quality of life in this population.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"258 ","pages":"Article 109573"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977994","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}