Thrombosis research最新文献_第6页

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

Thrombosis research

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。

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引用次数: 0

Bluetooth enabled point-of-care INR device validation for warfarin management 蓝牙启用点护理INR设备验证华法林管理。

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

Pub Date : 2026-02-01 Epub Date: 2025-12-22 DOI: 10.1016/j.thromres.2025.109570

Robert D. McBane II , Jennifer Lutz , Carlee O'Connor , Anna Kramer , Michael Luker , David Hodge , Colleen S. Thomas , Harold J. Hellweg

Objective

Systems employing point-of-care (POC) INR monitoring with patient self-testing require test accuracy, data integrity, patient compliance, and prompt two-way communication for high quality warfarin management. With a goal of validating a POC Bluetooth capable device for prompt INR transfer to electronic medical record, two POC INR devices were compared against an internal plasma INR reference.

Methods

A multicenter study (February 14, 2023 – August 29, 2023) comparing concordance of two commercially available POC devices, Vantus and CoaguChek XS (Pro and Plus), against a plasma INR reference, was pursued among warfarin treated patients. Appropriateness of dosing decisions were assessed for each device.

Results

Across three Mayo Clinic sites, 151 warfarin treated patients agreed to participate. Atrial fibrillation (41.7 %), venous thromboembolism (33.1 %) and heart valve prosthesis (19.9 %) were common indications with target INR range 2.0–3.0 in 89 %. For the CoaguChek devices, 86.1 % of values fell within 0.4 INR units compared with plasma INR referent (CoaguChek - plasma INR correlation R² = 0.95). For the Vantus device, 88.7 % of values fell within 0.4 INR units of plasma INR values (Vantus – plasma INR correlation R² = 0.96). Mean (± standard deviation) deviation from plasma INR was 0.2 ± 0.3 for CoaguChek compared to 0.1 ± 0.2 for Vantus (p < 0.001). Using the plasma INR as the gold standard for dosing recommendations, appropriate dosing recommendations were similar between devices: CoaguChek 83.4 % vs Vantus 82.7 %.

Conclusions

Compared to a plasma referent, INR values obtained from the CoaguChek and Vantus devices exhibited strong correlation with plasma INR values without systemic bias.

目的：采用患者自检的护理点（POC） INR监测系统要求检测准确性、数据完整性、患者依从性和及时的双向沟通，以实现高质量的华法林管理。为了验证具有POC蓝牙功能的设备是否能够及时将INR传输到电子医疗记录，我们将两个POC INR设备与内部等离子体INR参考进行了比较。方法：一项多中心研究（2023年2月14日- 2023年8月29日）在华法林治疗的患者中比较了两种市售POC装置Vantus和CoaguChek XS （Pro和Plus）与血浆INR参考的一致性。评估每个装置的给药决定的适当性。结果：在梅奥诊所的三个地点，151名接受华法林治疗的患者同意参与。房颤（41.7%）、静脉血栓栓塞（33.1%）和心脏瓣膜置换术（19.9%）是常见的适应症，89%的患者目标INR在2.0-3.0之间。对于CoaguChek装置，与血浆INR参考值相比，86.1%的值下降在0.4 INR单位以内（CoaguChek -血浆INR相关R2 = 0.95）。对于Vantus装置，88.7%的数值落在血浆INR值的0.4 INR单位内（Vantus -血浆INR相关R2 = 0.96）。CoaguChek与血浆INR的平均（±标准差）偏差为0.2±0.3，而Vantus为0.1±0.2 (p)。结论：与血浆参考物相比，CoaguChek和Vantus装置获得的INR值与血浆INR值具有很强的相关性，无系统偏倚。

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引用次数: 0

Comparative analysis of whole blood clot viscoelastic properties via thromboelastography and plasma fibrin clot characteristics 通过血栓弹性成像与血浆纤维蛋白凝块特性对全血凝块粘弹性特性的比较分析

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

Pub Date : 2026-02-01 Epub Date: 2026-01-08 DOI: 10.1016/j.thromres.2026.109582

Joanna Natorska , Magdalena Kopytek , Aleksandra Gołąb , Anna Waśniowska , Małgorzata Konieczyńska , Anetta Undas , Michał Ząbczyk

Background

Thromboelastography (TEG) is used in various clinical settings to assess clot formation, strength, and lysis. It is unknown whether TEG measures correspond to plasma fibrin clot characteristics.

Methods

In 90 individuals free of cardiovascular disease (51 [56.7%] women, aged 49.3 ± 5.2 years, body-mass index [BMI], 26 [23.8–29.3] kg/m²) we assessed whole blood clot parameters (reaction [R] and clot formation [K] time, clot growth kinetics [angle], maximum amplitude [MA], and clot lysis [LY30]) using the TEG 6s analyzer (Haemonetics, Boston, US), plasma clot permeability (Ks), and clot lysis time (CLT) using three assays: (1) by Pieters (CLT-2018), (2) by Lisman (CLT), and (3) by Carter (Lys50).

Results

There were associations of Ks with K time (R = 0.29, p = 0.0053), angle (R = -0.31, p = 0.0033), and MA (R = −0.47, p < 0.0001), while CLT tended to correlate with LY30. In women compared to men Ks was 8.4% lower corresponding to 7% higher MA (both p < 0.001). In obese (n = 19, 21.1%) vs. non-obese individuals angle was 5% larger (p = 0.029) but BMI did not correlate with TEG measures. TEG parameters and fibrin clot properties were unaffected by smoking, hypertension or hyperlipidemia. More efficient fibrinolysis (LY30 > 2.6%) was detected in 15 (16.7%) individuals who had also shorter CLT-2018 and CLT (both p < 0.05). Hypofibrinolysis (CLT-2018 > 300 min; n = 8, 8.9%) was detected only using CLT with no differences in TEG indices or Lys50.

Conclusions

TEG and plasma fibrin clot properties are complementary methods for assessing hemostasis, however, fibrin clot properties better reflect the impact of clinical risk factors on fibrinogen modification.

背景血栓弹性成像（TEG）在各种临床环境中用于评估血栓形成、强度和溶解。目前尚不清楚TEG测量是否符合血浆纤维蛋白凝块特征。方法90例无心血管疾病患者（51例[56.7%]女性，年龄49.3±5.2岁，体重指数[BMI]， 26 [23.8-29.3] kg/m2），采用TEG 6s分析仪（Haemonetics, Boston， US）评估全血凝块参数（反应[R]和凝块形成[K]时间，凝块生长动力学[角度]，最大幅度[MA]和凝块溶解[LY30]），血浆凝块渗透性（Ks）和凝块溶解时间（CLT）。(1) Pieters (CLT-2018), (2) Lisman (CLT), (3) Carter （Lys50）。结果Ks与K时间（R = 0.29, p = 0.0053）、角度（R = -0.31, p = 0.0033）、MA （R = - 0.47, p < 0.0001）相关，而CLT倾向于与LY30相关。与男性相比，女性的Ks低8.4%，MA高7% （p < 0.001）。肥胖者（n = 19, 21.1%）比非肥胖者的角度大5% (p = 0.029)，但BMI与TEG测量无关。TEG参数和纤维蛋白凝块特性不受吸烟、高血压或高脂血症的影响。在CLT-2018和CLT较短的15例（16.7%）患者中检测到更有效的纤维蛋白溶解（LY30 > 2.6%）（p < 0.05）。低纤溶（CLT-2018 > 300 min; n = 8,8.9%）仅使用CLT检测，TEG指数或Lys50无差异。结论steg和血浆纤维蛋白凝块特性是评估止血效果的互补方法，但纤维蛋白凝块特性更能反映临床危险因素对纤维蛋白原修饰的影响。

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引用次数: 0

Improvements in pharmacokinetics, bleeding control, and cost analysis after PK-guided transition to extended-half-life factor IX in hemophilia B: A multicentric study 血友病B患者在pk引导下过渡到延长半衰期因子IX后药代动力学、出血控制和成本分析的改善：一项多中心研究

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

Pub Date : 2026-02-01 Epub Date: 2026-01-06 DOI: 10.1016/j.thromres.2025.109580

Maria Chovi-Trull , Juan Eduardo Megías-Vericat , Tomás Palanques-Pastor , Ana Cid Haro , Manuel Rodriguez López , Antonio Palomero Massanet , Shally Marcellini Antonio , Saturnino Haya Guaita , Javier García Pellicer , Jose Luis Poveda Andrés , Santiago Bonanad Boix

Introduction

Extended half-life factor IX concentrates (FIX-EHL) have been shown to improve clinical outcomes and reduce treatment burden in patients with hemophilia B (HB).

Objectives

To analyze the differences in pharmacokinetic (PK) and clinical parameters one year before and after the PK-guided switch from standard half-life FIX (FIX-SHL) to FIX-EHL in patients with severe/moderate HB on prophylaxis.

Methods

A multicenter, comparative, observational, sequential, retrospective, and multidisciplinary study was conducted. PK parameters were calculated with WAPPS-Hemo®, and annualized total (ABR) and joint bleeding rates, the t_1/2 ratio and area under the curve (AUC), FIX consumption, infusion frequency, and cost were recorded.

Results

A total of 21 patients (9 pediatric and 12 adult) with HB who switched from FIX-SHL to FIX-EHL were analyzed. All PK parameters improved significantly, with median improvement ratios for t_1/2 and AUC of 4.1 (IQR: 3.4–4.8) and 4.2 (IQR: 2.6–5.0), respectively. Regarding clinical outcomes, the difference in ABR reached statistical significance and among the 6 patients with target joints, 5 (83.3 %) achieved resolution after switching. Infusion frequency and weekly dose were reduced by 50.0 % and 56.3 %, respectively, avoiding 52.1 (IQR: 26.1–67.8) injections and 130,357.3 (IQR: 5142.9–203,357.3) IU of FIX per patient per year. However, the switch resulted in an additional cost of € 28,254.9 (IQR: 4432.1- 44,060.8) per patient per year.

Conclusions

The PK-guided switch from FIX-SHL to FIX-EHL was associated with improvements in all PK parameters, and a significant clinical benefit was also demonstrated with the reduction of the bleeding rates. Following the switch, the weekly dose and administration frequency were reduced; however, this did not result in a cost reduction.

延长半衰期因子IX浓缩物（FIX-EHL）已被证明可以改善血友病B （HB）患者的临床结果并减轻治疗负担。目的：分析重/中度HB患者从标准半衰期FIX （FIX- shl）转向FIX- ehl治疗前后一年药代动力学（PK）和临床参数的差异。方法：采用多中心、比较、观察、顺序、回顾性和多学科研究。采用WAPPS-Hemo®软件计算PK参数，记录年化总出血率（ABR）、关节出血率、t1/2比和曲线下面积（AUC）、FIX消耗、输注次数、成本。结果：共分析了21例HB患者（9例儿童和12例成人）从FIX-SHL切换到FIX-EHL。所有PK参数均显著改善，t1/2和AUC的中位改善率分别为4.1 （IQR: 3.4-4.8）和4.2 （IQR: 2.6-5.0）。临床结果方面，ABR差异有统计学意义，6例靶关节患者中，5例（83.3%）转换后得到缓解。注射频率和周剂量分别减少50.0%和56.3%，避免每位患者每年52.1 （IQR: 26.1-67.8）次注射和130357.3 (IQR: 5142.9- 203357.3) IU的FIX。然而，这一转变导致每位患者每年的额外费用为28,254.9欧元（IQR: 4432.1- 44,060.8）。结论：PK引导下从FIX-SHL切换到FIX-EHL与所有PK参数的改善有关，并且出血率的降低也证明了显著的临床益处。切换后，每周剂量和给药频率减少；然而，这并没有导致成本的降低。

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引用次数: 0

Enhanced efficacy of fibrin hemostatic patch through rational design at the molecular level 通过分子水平的合理设计，提高纤维蛋白止血贴片的疗效

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

Pub Date : 2026-02-01 Epub Date: 2026-01-10 DOI: 10.1016/j.thromres.2026.109584

Fengting Yuan , Huan Zhang , Dong Zhang , Xiong Zhao , Qiang Wang , Junting Jia , Rui Wang , Zhenpeng Fu , Linsheng Zhan , Jingang Zhang , Fang Yuan , Yuyuan Ma

Internal hemorrhage remains a critical challenge requiring immediate intervention. Recent advances in biomaterials have positioned fibrin hemostatic patches (FHPs) as a promising therapeutic option through targeted fibrinogen-to-fibrin conversion at the injured organ; however, insufficient understanding of the stoichiometric coupling between active components of FHP may limit its coagulation performance. Here, we report a novel FHP (nFHP) through orthogonal optimization of fibrinogen, thrombin, and calcium chloride. Systematic screening identified fibrinogen concentration as the primary determinant of clotting time, with fibrinogen-to-thrombin and fibrinogen-to-calcium chloride ratios further impacting. nFHP, fabricated with the optimal formulation (17 mg/cm² fibrinogen, 40 IU/cm² thrombin, 115 μg/cm² calcium chloride), achieved rapid fibrin network formation and superior adhesive strength on the porcine aorta, surpassing commercial FHP (cFHP). In vivo evaluations across hepatic resection, cardiac stab wound, and arterial hemorrhage models demonstrated nFHP's universal efficacy, achieving the minimal blood loss compared to commercial products. Our work identifies stoichiometric proportion as a key factor in fibrin-based biomaterial rational design and provides a translatable solution for uncontrolled internal hemorrhage.

内出血仍然是一个严重的挑战，需要立即干预。生物材料的最新进展使纤维蛋白止血贴片（fhp）成为一种有前途的治疗选择，它通过在受伤器官靶向纤维蛋白原到纤维蛋白的转化；然而，对FHP活性组分之间的化学计量耦合认识不足可能会限制其凝血性能。在这里，我们报告了一种新的纤维蛋白原、凝血酶和氯化钙正交优化的FHP （nFHP）。系统筛选发现纤维蛋白原浓度是凝血时间的主要决定因素，纤维蛋白原与凝血酶和纤维蛋白原与氯化钙的比例进一步影响凝血时间。以纤维蛋白原17 mg/cm2、凝血酶40 IU/cm2、氯化钙115 μg/cm2为最优配方制备的nFHP在猪主动脉上的纤维蛋白网络形成速度快，粘接强度高，超过了商品FHP （cFHP）。肝脏切除、心脏刺伤和动脉出血模型的体内评估表明，nFHP具有普遍的疗效，与商业产品相比，它的失血量最小。我们的工作确定了化学计量比例是基于纤维蛋白的生物材料合理设计的关键因素，并为不受控制的内出血提供了可翻译的解决方案。

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引用次数: 0

A model to guide successful living with venous thromboembolism (VTE): Recommendations derived from the qualitative phase of a study of diagnostic Delay of VTE (DOVE) 指导静脉血栓栓塞（VTE）患者成功生活的模型：来自VTE诊断延迟研究（DOVE）定性阶段的建议

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

Pub Date : 2026-02-01 Epub Date: 2026-01-12 DOI: 10.1016/j.thromres.2026.109585

Alexandra C. Frost , Veysel K. Baris , Michael Sainlaire , Jin Chen , Minakshi V. Shukla , Md Shifatul A. Apurba , Ann C. Hurley , Patricia C. Dykes

Introduction

Delayed diagnosis (DDx) of Venous thromboembolism (VTE) contributes to preventable mortality. Our prior work resulted in an electronic Clinical Quality Measure (eCQM) for Diagnostic Delay of VTE (DOVE) [1] and a phenotyping algorithm to identify cases of VTE [2]. Current work incorporates voices of VTE survivors to extend that research.

Methods

We interviewed 8 and surveyed 68 VTE survivors, coded and categorized text, and uploaded data into the DOVE qualitative database. Drawing on this database and patient self-management literature, notably the concepts: patient engagement [3,4] and patient activation [5,6] we developed a model to guide “Successful Living with VTE.”

Results

The 76 VTE survivors provided rich descriptions of their journeys from questioning that something may be wrong to making recommendations to help others. Participants were articulate, highly educated, mostly female and white, and geographically diverse. Recommendations were defined as “Recommendations for patients, providers and health care sites targeted to achieve timely VTE diagnosis and treatment across the trajectory from first concern through follow-up care.” Patients are advised to be assertive, obtain education and bring a support person. Providers are advised to listen, be knowledgeable and consider genetic testing.

Conclusions

The recommendations make common sense, do not require expensive equipment or intensive training or extra staff. VTE survivors' recommendations merged with the science of patient self-management provided the model's structure. The model will inform a VTE curriculum and clinical decision support application, and guide research to promote successful living with VTE.

静脉血栓栓塞（VTE）的延迟诊断（DDx）会导致可预防的死亡。我们之前的工作导致了VTE诊断延迟（DOVE）[1]的电子临床质量测量（eCQM）和识别VTE[1]病例的表型算法。目前的工作纳入了静脉血栓栓塞幸存者的声音来扩展这项研究。方法对8例VTE幸存者进行访谈和调查，对文本进行编码和分类，并将数据上传到DOVE定性数据库。利用该数据库和患者自我管理文献，特别是患者参与[3,4]和患者激活[5,6]的概念，我们开发了一个模型来指导“静脉血栓栓塞患者的成功生活”。结果76名静脉血栓栓塞幸存者对他们的经历进行了丰富的描述，从质疑可能出了什么问题到提出帮助他人的建议。参与者口齿伶俐，受过高等教育，主要是女性和白人，地理位置不同。建议被定义为“针对从第一次关注到后续护理的整个过程中及时实现静脉血栓栓塞诊断和治疗的患者、提供者和医疗机构的建议。”建议患者果断果断，接受教育，并带一个支持人员。医生建议医生多倾听，多了解情况，并考虑进行基因检测。结论这些建议是常识性的，不需要昂贵的设备或密集的培训或额外的人员。静脉血栓栓塞幸存者的建议与患者自我管理的科学相结合，提供了模型的结构。该模型将为VTE课程和临床决策支持应用提供信息，并指导研究以促进VTE患者的成功生活。

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引用次数: 0

Rethinking thrombophilia testing in pediatric VTE: A decade of real-world evidence 重新思考儿科静脉血栓栓塞测试：十年的真实世界证据

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

Pub Date : 2026-02-01 Epub Date: 2025-12-13 DOI: 10.1016/j.thromres.2025.109565

Mahdi Asleh , Hadeel Musa , Shirly Ammar , Hagit Miskin

Background

The clinical utility of routine thrombophilia testing to guide management in pediatric venous thromboembolism (VTE) is debated. This study sought to evaluate the real-world impact of thrombophilia testing on anticoagulation duration and clinical outcomes.

Methods

We conducted a 10-year retrospective cohort study of 67 pediatric patients with VTE. We analyzed the association between thrombophilia status and anticoagulation duration, VTE recurrence, and thrombus resolution on follow-up imaging.

Results

The majority of VTE events (80.6 %) were provoked. A positive thrombophilia workup did not significantly alter the median anticoagulation duration compared to a negative workup (p = 0.582). A positive thrombophilia status was not a significant predictor of VTE recurrence in survival analysis (HR 2.22, p = 0.281). However, a positive workup was significantly associated with a higher rate of Residual Vein Obstruction (RVO) (73.3 % vs. 36.4 %, p = 0.045). This imaging finding did not, in turn, predict VTE recurrence (p = 0.388).

Conclusion

Thrombophilia testing did not influence treatment duration or predict recurrence. Our findings provide real-world evidence supporting current guidelines that advocate for a selective, clinically driven approach to testing rather than its routine use after a first pediatric VTE.

背景常规血栓检测在指导小儿静脉血栓栓塞（VTE）治疗中的临床应用一直存在争议。本研究旨在评估血栓形成试验对抗凝时间和临床结果的实际影响。方法对67例静脉血栓栓塞患儿进行10年回顾性队列研究。我们分析了血栓形成状态与抗凝时间、静脉血栓栓塞复发和随访影像中血栓溶解的关系。结果静脉血栓栓塞（VTE）以诱发性为主（80.6%）。与阴性检查相比，阳性血栓形成检查没有显著改变中位抗凝时间（p = 0.582）。在生存分析中，血栓倾向阳性状态不是静脉血栓栓塞复发的显著预测因子（HR 2.22, p = 0.281）。然而，阳性检查与较高的残余静脉阻塞（RVO）率显著相关（73.3%对36.4%,p = 0.045）。这一影像学发现并不能预测静脉血栓栓塞复发（p = 0.388）。结论血栓检测不影响治疗时间或预测复发。我们的研究结果提供了现实世界的证据，支持当前的指导方针，即提倡选择性的、临床驱动的检测方法，而不是在首次小儿静脉血栓栓塞后常规使用。

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引用次数: 0

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

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

Pub Date : 2026-01-01 Epub Date: 2025-11-24 DOI: 10.1016/j.thromres.2025.109554

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

Background

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

Methods

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

Results

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

Conclusions

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

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

{"title":"Thrombosis, bleeding, and mortality in patients with sepsis-induced coagulopathy: Analysis of a prospective cohort","authors":"Gianni Turcato , Arian Zaboli , Lucia Filippi , Paolo Ferretto , Alice Bresolin , Fabrizio Lucente , Alessandro Cipriano , Lorenzo Ghiadoni , Walter Ageno , Christian J. Wiedermann","doi":"10.1016/j.thromres.2025.109554","DOIUrl":"10.1016/j.thromres.2025.109554","url":null,"abstract":"<div><h3>Background</h3><div>Sepsis-induced coagulopathy (SIC) is an early phase of disseminated intravascular coagulation and a candidate marker for risk stratification. Although SIC is linked to higher mortality, its value for predicting thrombotic and hemorrhagic events remains uncertain. We assessed the prevalence of SIC and its association with hemostatic complications and mortality in sepsis.</div></div><div><h3>Methods</h3><div>In a prospective cohort of 389 adults with sepsis admitted to an intermediate care unit, SIC was defined by International Society of Thrombosis and Haemostasis criteria (score ≥ 4). Primary outcomes were 30-day venous thromboembolism, arterial thrombosis, and bleeding; all-cause 30-day mortality was secondary. Predictive performance of the SIC score was evaluated with receiver operating characteristic analysis, bootstrap resampling, and Monte Carlo simulation.</div></div><div><h3>Results</h3><div>SIC was present in 33.4 % of patients. Thirty-day mortality was 27.1 % in SIC-positive patients versus 13.1 % in SIC-negative patients (<em>p</em> = 0.001), and SIC remained independently associated with death (adjusted OR 1.43; 95 % CI 1.13–1.80; <em>p</em> = 0.003). SIC positivity was not associated with overall thrombotic events: 42.9 % (12/28) of patients with thrombosis and 32.7 % (118/361) without thrombosis had SIC (<em>p</em> = 0.301). Discrimination for thrombotic and hemorrhagic events was poor (AUROC 0.573 and 0.576, respectively), with further decline after resampling; simulation analyses confirmed limited predictive capacity for either complication.</div></div><div><h3>Conclusions</h3><div>In this cohort, SIC was associated with higher mortality but not with thrombotic or hemorrhagic events. This association likely reflects overall severity of illness rather than clinically overt vascular complications. These findings do not support using SIC alone to guide anticoagulation or transfusion decisions and support the development of outcome-specific risk models, potentially integrating dynamic clinical variables and serial laboratory trajectories.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"257 ","pages":"Article 109554"},"PeriodicalIF":3.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145606239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

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

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

Pub Date : 2026-01-01 Epub Date: 2025-11-26 DOI: 10.1016/j.thromres.2025.109557

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

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

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

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引用次数: 0

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

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

Pub Date : 2026-01-01 Epub Date: 2025-11-25 DOI: 10.1016/j.thromres.2025.109538

Xiaoliang Ying , Ruihua Wang

引用次数: 0