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Letter in reference to the recent article: “Absorption and anticoagulant management of rivaroxaban in patients with short bowel syndrome” by Lunau et al. 参考Lunau等人最近发表的文章:“利伐沙班在短肠综合征患者中的吸收和抗凝管理”。
IF 3.4 3区 医学 Q1 HEMATOLOGY Pub Date : 2026-02-01 Epub Date: 2026-01-23 DOI: 10.1016/j.thromres.2026.109596
Danica Michaličková , Karolína Hronová
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引用次数: 0
Perioperative factor XIII and viscoelastic measurements of open compared to minimal invasive major upper gastrointestinal surgery– A prospective observational study 一项前瞻性观察研究:与微创上消化道大手术相比,开放手术围手术期因子XIII和粘弹性测量
IF 3.4 3区 医学 Q1 HEMATOLOGY Pub Date : 2026-02-01 Epub Date: 2026-01-19 DOI: 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).
目的获得性因子XIII (FXIII)缺乏在住院或手术患者中很普遍,超过20%的病例中FXIII活性为70%。FXIII的减少与术后出血、吻合口不全和需要再次手术的可能性增加有关。本研究旨在通过比较开放与微创胰腺和食管手术来确定术后并发症风险增加的患者。方法本前瞻性、单中心观察性研究在德国海德堡大学医院进行。纳入标准包括年龄≥18岁,有能力提供知情同意,并计划进行食管或胰腺手术。术前、术后直接和术后第1、2、3、4、7、10和13天进行凝血检查,同时进行重复血栓弹性成像(ClotPro®)试验。结果最终纳入112例患者,其中开放手术77例,微创手术35例。开放手术组FXIII活性下降更明显,直至第7天;在两组中,FXIII活性最低发生在第4天和第7天。根据Clavien-Dindo分类,两组在再入院、再手术或严重围手术期并发症方面无显著差异。结论开放手术与FXIII活性显著下降相关,最低点估计发生在POD 4和7之间。FXIII活性直到术后第7天仍显著降低。粘弹性试验不能检测到轻度获得性FXIII缺陷。必须在进一步的研究中评估在再手术前应在多大程度上进行FXIII活性常规检测。德国临床试验注册(DRKS00028547,注册日期:2022年4月14日)。
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引用次数: 0
Aptamer-based monitorization and therapeutic applications of blood coagulation cascade disorders: A systematic review 基于适配体的凝血级联障碍监测和治疗应用:系统综述。
IF 3.4 3区 医学 Q1 HEMATOLOGY Pub Date : 2026-02-01 Epub Date: 2025-12-19 DOI: 10.1016/j.thromres.2025.109566
Okan Yılmaz , Beyza Nur Yılmaz , Neslihan Betül Kandilcik , Zeynep Sebla Yiğit , Mediha Esra Altuntop Yayla
Hemostasis is a complex physiological process that prevents blood loss following vascular injury via the blood coagulation cascade. The coagulation cascade is a highly controlled stepwise process that establishes clotting only at the site of bleeding, when needed. Recently, aptamers have been employed not only in the fields of biosensors and diagnostics, but also in molecular imaging, therapeutics, and drug delivery systems. The present article highlights recent developments in aptamer-based biomedical systems for the diagnosis and treatment of blood coagulation cascade disorders. Specifically, aptasensors for thrombin detection and aptamer-based medical imaging of thrombi were addressed as diagnostic tools for coagulation cascade disorders. Additionally, the use of aptamers as pharmaceutical agents and aptamer-targeted drug delivery systems were highlighted as part of the treatment. In summary, this is a valuable compilation in this emerging field that focuses on aptamer-based applications for monitoring and treatment of blood coagulation cascade disorders.
止血是一个复杂的生理过程,通过血凝级联防止血管损伤后的失血。凝血级联是一个高度控制的逐步过程,在需要时仅在出血部位建立凝血。近年来,适体不仅应用于生物传感器和诊断领域,还应用于分子成像、治疗和药物输送系统。本文重点介绍了用于诊断和治疗凝血级联疾病的适配体生物医学系统的最新进展。具体来说,用于凝血酶检测的适配体传感器和基于适配体的血栓医学成像被认为是凝血级联疾病的诊断工具。此外,适体作为药物制剂和适体靶向药物递送系统的使用被强调为治疗的一部分。总之,这是一个有价值的汇编在这个新兴领域,重点是基于适配体的应用监测和治疗凝血级联障碍。
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引用次数: 0
CARE-Net: Causal-aware risk embedding for venous thromboembolism prediction in orthopedic inpatients CARE-Net:骨科住院患者静脉血栓栓塞预测的因果意识风险嵌入
IF 3.4 3区 医学 Q1 HEMATOLOGY Pub Date : 2026-02-01 Epub Date: 2026-01-07 DOI: 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.
静脉血栓栓塞是骨科住院患者可预防的主要并发症,但现有的风险评分和相关驱动模型往往忽略了复杂的生理相互作用,可解释性有限。我们提出了因果感知风险嵌入网络(CARE-Net),这是一个用于结构化临床数据VTE预测的因果表示学习框架。CARE-Net首先推断出实验室、人口统计和治疗变量之间的有向因果图,然后严格按照因果方向进行信息传递,以构建与机制一致的患者嵌入。因果对比目标进一步使患者具有相似的因果特征,增强鲁棒性并抑制虚假关联。与统计基线、整体基线、深度表格基线、基于变压器基线和基于图表基线的广泛比较表明,CARE-Net始终提供优越的判别和更平衡的敏感性-特异性特征。消融和特征重要性分析证实,每个因果成分都有意义,并且已知的危险因素与已建立的临床途径一致。这些发现表明,将因果结构嵌入表征学习为骨科护理中可靠的VTE决策支持提供了一条原则性的途径。
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引用次数: 0
Brazilian Registry of Thrombotic Thrombocytopenic Purpura: A prospective cohort study of diagnosis, management and outcomes in Brazil 巴西血栓性血小板减少性紫癜登记:巴西诊断、管理和结果的前瞻性队列研究
IF 3.4 3区 医学 Q1 HEMATOLOGY Pub Date : 2026-02-01 Epub Date: 2026-01-15 DOI: 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.
支持目前关于血栓性血小板减少性紫癜(TTP)知识的大多数数据来自高收入地区,而对低收入和中等收入国家的治疗可及性和预后知之甚少。为了解决这一差距,我们进行了一项多中心前瞻性研究,包括2018年至2024年间巴西的85名TTP患者,随访12个月。中位年龄为37岁(IQR 27-45), 76%为女性。血浆评分中位数为6分(IQR 6.0-7.0), 62.4%的患者(均为10%)检测了ADAMTS13活性。从症状出现到住院的中位时间为8天。以神经系统症状最为常见(75.3%),其次为出血症状(58.8%)和腹痛(32.9%)。74例患者(87.1%)接受了治疗性血浆置换(TPE),并在入院1天内开始(IQR 1-2)。95.3%的患者使用皮质类固醇,56.5%的患者使用利妥昔单抗。23例(27.1%)患者需要高级生命支持,13例(15.3%)患者在住院期间死亡。住院死亡率与年龄和入院时血流动力学不稳定有关。在幸存者中,26%的人病情加重或复发,22.4%的人出现慢性后遗症,主要是神经和精神症状。利妥昔单抗对TTP复发有保护作用。总之,巴西的TTP死亡率高于最近队列中观察到的死亡率。该国的TTP诊断和治疗是延迟和过时的,对疾病预后产生负面影响。确保快速诊断和提供TPE和利妥昔单抗(一种具有成本效益的治疗策略)对于改善结果和降低发病率至关重要,包括在低收入和中等收入国家。
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引用次数: 0
Factors associated with venous and arterial thrombosis in patients with Systemic Lupus Erythematosus: A systematic review and meta-analysis 系统性红斑狼疮患者静脉和动脉血栓形成的相关因素:系统回顾和荟萃分析。
IF 3.4 3区 医学 Q1 HEMATOLOGY Pub Date : 2026-02-01 Epub Date: 2025-12-29 DOI: 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 ,&nbsp;Yuqiong Cao ,&nbsp;Yuhong He ,&nbsp;Shan Zeng ,&nbsp;Na Ye ,&nbsp;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}
引用次数: 0
Standard coagulation assays during cardiopulmonary bypass predict post-bypass levels in cardiac surgery 体外循环期间的标准凝血测定可预测心脏手术中体外循环后的血凝水平。
IF 3.4 3区 医学 Q1 HEMATOLOGY Pub Date : 2026-02-01 Epub Date: 2026-01-19 DOI: 10.1016/j.thromres.2026.109593
Victor-Emmanuel Brett , Antoine Beurton , Alexandre Ouattara , Céline Delassasseigne , Christine Mouton

Background

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.
背景:心脏手术合并体外循环(CPB)需要精确的止血管理来限制术后出血。纤维蛋白原、血小板计数和促凝因子指导输血决策,但CPB期间的Clauss纤维蛋白原测量存在争议,而且由于高剂量肝素的干扰,凝血酶原时间(PT)无法准确测量。本研究探讨了CPB术中纤维蛋白原、凝血酶原(FII)、V因子(FV)和血小板的测量是否能可靠地预测CPB后的值。方法:我们进行了一项单中心前瞻性观察研究,涉及73例接受心脏手术合并CPB的成年患者。在主动脉开锁前和鱼精蛋白给药结束后5分钟采集血样。在ACL TOP分析仪上使用haemsil试剂测定纤维蛋白原(Clauss法)、FII和FV活性。结果:使用合适的试剂,在CPB期间,尽管使用高剂量肝素,纤维蛋白原、FII和FV的测量是可靠的。纤维蛋白原(r = 0.81)、FII (r = 0.78)和FV (r = 0.73)在cpb内和cpb后的值之间存在很强的相关性,这支持了它们预测搭桥后凝血状态的可靠性。ROC曲线分析显示输血相关阈值具有良好的预测性能,血小板计数的auc为0.93。结论:本研究显示,成人心脏手术患者CPB期和给予鱼精蛋白后,纤维蛋白原和因子II (PT的替代物)水平保持一致,证实了其术中评估的可靠性。
{"title":"Standard coagulation assays during cardiopulmonary bypass predict post-bypass levels in cardiac surgery","authors":"Victor-Emmanuel Brett ,&nbsp;Antoine Beurton ,&nbsp;Alexandre Ouattara ,&nbsp;Céline Delassasseigne ,&nbsp;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 &lt;100 G/L, 0.86 for fibrinogen &lt;1.5 g/L, and 0.84 for FII &lt; 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}
引用次数: 0
Characterizing the impact of traumatic brain injury phenotype on coagulation dynamics in severely injured patients 表征创伤性脑损伤表型对重型颅脑损伤患者凝血动力学的影响
IF 3.4 3区 医学 Q1 HEMATOLOGY Pub Date : 2026-02-01 Epub Date: 2026-01-14 DOI: 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.
在严重受伤的患者中,凝血功能改变会损害稳定的凝块形成并增加死亡率。外伤性脑损伤(TBI)引起血栓形成和破裂的改变。在这项研究中,我们旨在表征TBI患者的凝血动力学、力学、纤维蛋白网络和循环蛋白质组学标志物,并将这些生物标志物与结果联系起来。方法63例外伤患者就诊时采集血浆标本。分析了凝血动力学、结构、纤维蛋白溶解标志物、凝血酶生成和蛋白质组学特征。临床图表审查使用我们机构的创伤登记和医疗记录。结果分析34例非脑外伤患者、29例脑外伤患者和7例健康供者的凝血及临床因素。患者组间的人口统计数据具有可比性。TBI患者死亡率增高,凝血功能紊乱较大,主要表现为内在凝血功能和纤溶功能紊乱。入院时,与非TBI患者相比,TBI患者的d -二聚体较高,因子VIII较低,血管性血液病因子较低。TBI患者凝血因子XIII α链较健康供者降低。亚组分析包括孤立性TBI、多发创伤合并TBI和不同的TBI严重程度。我们确定了颅内和颅外损伤对凝血功能、凝血酶生成和凝血因子浓度的不同贡献。与此同时,严重TBI与院前纤维蛋白溶解增加有关,而组织纤溶酶原激活物浓度或抽血时纤维蛋白溶解未增加。结论脑外伤患者表现出院前纤维蛋白原消耗和纤维蛋白溶解的规律。在TBI的表型之间观察到独特的差异,严重的孤立性TBI患者表现出较低的vWF、凝血因子VIII、凝血因子XIII α链和PAI-1水平。这些发现强调了颞叶和损伤表型对tbi诱导的凝血病的贡献。
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引用次数: 0
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 开发一种决策支持工具,用于接受临终关怀的患者继续或减少抗血栓治疗的处方:欧洲德尔菲研究的结果
IF 3.4 3区 医学 Q1 HEMATOLOGY Pub Date : 2026-02-01 Epub Date: 2026-01-02 DOI: 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.
为了开发欧洲共享决策支持工具(SDST),采用两轮德尔菲过程来达成与抗血栓治疗(ATT)描述讨论和临终癌症患者过程相关方面的共识。德尔菲调查于2024年9月至2025年3月进行,由一个24人组成的多学科指导委员会(SC)制定,包括肿瘤学、血液学、姑息治疗、初级保健、老年医学和血管医学的医学专家。这项调查涉及来自8个欧洲国家的188名专家。共识被定义为与SC最终决定的一致度≥70%。主题包括描述时间、利益相关者、ATT、SDST患者的重新评估和临床驱动因素,以及评估SDST的随机对照试验(RCT)结果的选择。结果第1轮对7个汇总问题(37%)达成共识,尤其是对ATT处方的重新评估。考虑到这些结果,安理会重新制定了第二轮谈判,以减少歧义,朝着达成共识的方向迈进。最高法院做出了最后的决定。三种医学专业应参与ATT的处方:姑息治疗专家、肿瘤学家和在临床触发或3个月预后后的全科医生。对于SDST设计,研究结果证实该工具对临床医生有意义。为未来的RCT选择了11个预定义结果。结论:这些结果成功地塑造了未来SDST的内容,并绘制了其在整个欧洲姑息治疗临床路径中的可用性,以支持知情决策,减少并发症,提高这一人群的生活质量。
{"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,&nbsp;Isabelle Mahé ,&nbsp;Skerdi Haviari ,&nbsp;Nassima Si Mohammed ,&nbsp;Anette Arbjerg Højen ,&nbsp;Carme Font ,&nbsp;Stavros Konstantinides ,&nbsp;Marieke J.H.A. Kruip ,&nbsp;Luigi Maiorana ,&nbsp;Sebastian Szmit ,&nbsp;Denise Abbel ,&nbsp;Laurent Bertoletti ,&nbsp;Adrian Edwards ,&nbsp;Michelle Edwards ,&nbsp;Alessandra Gava ,&nbsp;Jacobijn Gussekloo ,&nbsp;Miriam J. Johnson ,&nbsp;Rashmi Kumar ,&nbsp;Johan Langendoen ,&nbsp;Kate J. Lifford ,&nbsp;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}
引用次数: 0
Impact of enduring risk factors on efficacy and safety of extended anticoagulation for provoked venous thromboembolism: Post-hoc analysis of the HI-PRO trial 持久危险因素对诱发性静脉血栓栓塞延长抗凝疗效和安全性的影响:HI-PRO试验的事后分析
IF 3.4 3区 医学 Q1 HEMATOLOGY Pub Date : 2026-02-01 Epub Date: 2026-01-12 DOI: 10.1016/j.thromres.2026.109588
Mariana Pfeferman , Sina Rashedi , Arvind K. Pandey , Darsiya Krishnathasan , Candrika D. Khairani , Antoine Bejjani , Ruth H. Morrison , Heather Hogan , Junyang Lou , John Fanikos , Nicole Porio , Lisa Rosenbaum , Piotr Sobieszczyk , Zhou Lan , Marie Gerhard-Herman , Umberto Campia , Samuel Z. Goldhaber , Behnood Bikdeli , Gregory Piazza , HI-PRO Trial Investigators
{"title":"Impact of enduring risk factors on efficacy and safety of extended anticoagulation for provoked venous thromboembolism: Post-hoc analysis of the HI-PRO trial","authors":"Mariana Pfeferman ,&nbsp;Sina Rashedi ,&nbsp;Arvind K. Pandey ,&nbsp;Darsiya Krishnathasan ,&nbsp;Candrika D. Khairani ,&nbsp;Antoine Bejjani ,&nbsp;Ruth H. Morrison ,&nbsp;Heather Hogan ,&nbsp;Junyang Lou ,&nbsp;John Fanikos ,&nbsp;Nicole Porio ,&nbsp;Lisa Rosenbaum ,&nbsp;Piotr Sobieszczyk ,&nbsp;Zhou Lan ,&nbsp;Marie Gerhard-Herman ,&nbsp;Umberto Campia ,&nbsp;Samuel Z. Goldhaber ,&nbsp;Behnood Bikdeli ,&nbsp;Gregory Piazza ,&nbsp;HI-PRO Trial Investigators","doi":"10.1016/j.thromres.2026.109588","DOIUrl":"10.1016/j.thromres.2026.109588","url":null,"abstract":"","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"258 ","pages":"Article 109588"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977992","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
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Thrombosis research
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