Thrombosis research最新文献_第6页

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

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

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

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

Background

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

Methods

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

Results

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

Conclusions

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

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

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

Xiaoliang Ying , Ruihua Wang

引用次数: 0

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

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

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

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

Background

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

Methods

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

Results

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

Conclusions

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

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

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引用次数: 0

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

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

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

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

Background

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

Methods

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

Results

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

Conclusions

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

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

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引用次数: 0

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

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

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

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

Background

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

Methods

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

Results

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

Conclusions

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

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

{"title":"Absolute time-dependent risk of hospital-acquired venous thromboembolism in children","authors":"Maya K. Raad, Stephanie Prozora, E. Vincent S. Faustino","doi":"10.1016/j.thromres.2025.109553","DOIUrl":"10.1016/j.thromres.2025.109553","url":null,"abstract":"<div><h3>Background</h3><div>Absolute time-dependent risk of hospital-acquired venous thromboembolism (HA-VTE) is essential to evaluate the net clinical benefit of pharmacologic thromboprophylaxis. The multicenter Children's Hospital Acquired Thrombosis (CHAT) risk assessment model (RAM) identified risk factors for pediatric HA-VTE but was not designed to predict this risk. We aimed to predict the absolute time-dependent risk of HA-VTE in hospitalized children.</div></div><div><h3>Methods</h3><div>We conducted a single center case-cohort study of children ≤18 years old admitted from 2013 to 2022. Children with radiologically confirmed, symptomatic HA-VTE were considered cases. A 5 % random sample of eligible admissions formed the subcohort. Using Kaplan-Meier estimates and Cox regression with risk factors from the CHAT RAM and time to HA-VTE as outcome, we calculated the absolute time-dependent risk of HA-VTE of each child. Performance was assessed using area under the receiver operating characteristic curve (AUROC), calibration plot, and area under the precision-recall curve (AUPRC).</div></div><div><h3>Results</h3><div>We identified 81 children with HA-VTE from 23,287 admissions. Adolescent age, slightly limited mobility, and central venous catheter were associated with time to HA-VTE. Median absolute time-dependent risk of HA-VTE was 1.7 % (IQR: 1.0 %, 2.1 %) by day 12 of admission when the revised RAM performed best. AUROC by day 12 was 0.81 (95 % confidence interval, CI: 0.70, 0.93) with calibration slope of 1.13 (95 % CI: 0.38, 1.87), calibration intercept of 0.004 (95 % CI: −0.64, 0.65), and AUPRC of 0.04 (95 % CI: 0.004, 0.07).</div></div><div><h3>Conclusions</h3><div>We accurately predicted the absolute time-dependent risk of HA-VTE. Similar predictions should be developed for bleeding.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"257 ","pages":"Article 109553"},"PeriodicalIF":3.4,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145606142","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

FVIIa-AT complexes in patients with acute ischemic stroke: Impact on clinical outcomes 急性缺血性脑卒中患者的fvia - at复合物：对临床结果的影响

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

Pub Date : 2025-11-21 DOI: 10.1016/j.thromres.2025.109551

Marek Kachnic , Martyna Matysiewicz , Joanna Natorska , Jan P. Bembenek , Elżbieta Szczygieł-Pilut , Anetta Undas

Background

Plasma levels of activated factor VII-antithrombin complexes (FVIIa-AT) reflect indirectly tissue factor (TF)-FVII interaction. We investigated FVIIa-AT in acute ischemic stroke (AIS) and its prognostic value.

Methods

We prospectively studied 88 AIS patients (median age 75 years), of whom 67 (76.1 %) received thrombolysis. Plasma FVIIa-AT levels, fibrin clot properties, i.e. clot lysis time (CLT), fibrin clot permeability (Ks), and protein carbonyl (PC) levels were measured on admission, at 24 h, and at 3 months. Stroke-related mortality and functional outcomes (modified Rankin Scale, mRS) were assessed at 3 months.

Results

Baseline FVIIa-AT (median 134.7 (IQR, 118.2–149.8 pM)), correlated with age (r = 0.51; p < 0.001), NIHSS (r = 0.54; p < 0.001), Ks (r = 0.32; p = 0.002), CLT (r = 0.34; p = 0.001), PC (r = 0.36; p < 0.001), and mRS at 3 months (r = 0.51; p < 0.001). After 24 h, FVIIa-AT increased by 8.3 % (p < 0.001) and correlated with NIHSS (r = 0.52; p < 0.001), PC (r = 0.35; p = 0.001), and mRS (r = 0.59; p < 0.001). At 24 h, thrombolysis had no impact on FVIIa-AT. After 3 months, FVIIa-AT decreased by 20.9 % compared to baseline (p < 0.0001). Baseline and 24-hour FVIIa-AT levels increased the odds of hemorrhagic transformation at 48 h (OR = 1.62, 95 %CI 1.09–2.42 and OR = 1.46, 95 %CI 1.04–2.03) and mRS > 2 at 3 months (OR = 1.48, 95 %CI 1.12–1.95 and OR = 1.61, 95 %CI 1.23–2.10, respectively). Stroke-related mortality was associated with FVIIa-AT solely at 24 h (OR = 1.59, 95 %CI 1.18–2.14).

Conclusions

FVIIa-AT levels are linked to acute stroke severity and worse clinical outcomes, in association with prothrombotic fibrin clot properties and enhanced protein carbonylation.

血浆活化因子7 -抗凝血酶复合物（FVIIa-AT）水平间接反映了组织因子(TF)-FVII相互作用。研究急性缺血性脑卒中（AIS）的fvia - at及其预后价值。方法前瞻性研究88例AIS患者（中位年龄75岁），其中67例（76.1%）接受溶栓治疗。入院时、24小时和3个月分别测量血浆FVIIa-AT水平、纤维蛋白凝块特性，即凝块溶解时间（CLT）、纤维蛋白凝块通透性（Ks）和蛋白羰基（PC）水平。3个月时评估卒中相关死亡率和功能结局（改良Rankin量表，mRS）。ResultsBaseline FVIIa-AT(平均134.7(下午差,118.2 - -149.8),与年龄相关(r = 0.51, p & lt; 0.001),署(r = 0.54, p & lt; 0.001), Ks (r = 0.32; p = 0.002),此时此地(r = 0.34; p = 0.001), PC (r = 0.36, p & lt; 0.001),和夫人在3个月(r = 0.51, p & lt; 0.001)。24小时后,FVIIa-AT增加了8.3% (p & lt; 0.001)和与署相关(r = 0.52, p & lt; 0.001), PC (r = 0.35; p = 0.001),和夫人(r = 0.59, p & lt; 0.001)。24 h溶栓对FVIIa-AT无影响。3个月后，与基线相比，fvia - at下降了20.9% （p < 0.0001）。基线和24小时FVIIa-AT水平增加了48小时出血转化的几率（OR = 1.62, 95% CI 1.09-2.42和OR = 1.46, 95% CI 1.04-2.03）和3个月mRS >； 2 （OR = 1.48, 95% CI 1.12-1.95和OR = 1.61, 95% CI 1.23-2.10）。卒中相关死亡率仅在24小时与fvia - at相关（OR = 1.59, 95% CI 1.18-2.14）。结论：sfvia - at水平与急性卒中严重程度和较差的临床结果有关，与血栓原纤维蛋白凝块特性和蛋白羰基化增强有关。

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引用次数: 0

Corrigendum to “Activation of the pentose phosphate pathway mitigates platelet storage lesions and improves platelet preservation quality” [Thromb. Res. 252 (2025) 109377] “戊糖磷酸途径的激活可减轻血小板储存损伤并提高血小板保存质量”[Thromb]的更正。Res. 252 (2025) 109377]

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

Pub Date : 2025-11-20 DOI: 10.1016/j.thromres.2025.109539

Liujun Guo , Chengrui Qian , Chengyan Gao , Hasiyati Heililahong , Min Xin , Lei Hang , Can Lou , Jiaming Li , Xuefeng Wang , Jing Dai , Xuemei Fan , Xiaohong Cai

引用次数: 0

Thrombocytopenia in antiphospholipid syndrome: predictors, prognostic implications, and thrombotic risk in a large cohort study 抗磷脂综合征中的血小板减少症：一项大型队列研究中的预测因素、预后意义和血栓形成风险

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

Pub Date : 2025-11-19 DOI: 10.1016/j.thromres.2025.109544

David Galarza , Massimo Radin , Irene Cecchi , Alessandro Morotti , Isabella Russo , Sofia Camerlo , Alice Barinotti , Roberta Fenoglio , Savino Sciascia

Background

Antiphospholipid syndrome (APS) is a multifaceted autoimmune disorder associated with thrombosis and pregnancy morbidity. Thrombocytopenia, a frequent manifestation of APS, presents unique clinical challenges due to its dual association with thrombotic and hemorrhagic risks. This study investigates the incidence, characteristics, and predictors of thrombocytopenia in a large cohort of antiphospholipid antibodies (aPL)-positive patients and its association with other clinical manifestations.

Methods

We conducted a multicenter retrospective cohort study from 2014 to 2024 involving 211 aPL-positive patients at San Giovanni Bosco and San Luigi Gonzaga Hospital, Turin, Italy. Data on demographic, laboratory, and clinical features were collected every six months or at the occurrence of new clinical events. Thrombocytopenia definitions excluded other etiologies. Laboratory and clinical evaluations included thrombosis risk factors, autoantibody profiles, and treatment regimens.

Results

Thrombocytopenia occurred in 42 patients (20 %), with varying severity: mild (33 %), moderate (38 %), and severe (29 %). Severe cases primarily exhibited platelet counts below 20 × 10^9/L. Patients with thrombocytopenia demonstrated higher rates of thrombotic events, venous recurrences, deep vein thrombosis, pulmonary embolism, and catastrophic APS (CAPS). Renal involvement was more frequent, while inflammatory manifestations (pericarditis, pleuritis, and arthralgia) were less common. Patients with thrombocytopenia showed higher frequency of anti-β2 glycoprotein I antibodies IgG positivity and leukopenia. Therapeutic interventions included increased use of steroids, intravenous immunoglobulins, mycophenolate, and rituximab. Thrombocytopenia was more prevalent in systemic APS diagnoses (21 % vs. 3 %).

Conclusion

Thrombocytopenia in APS patients, particularly in severe cases, correlates with heightened thrombotic risk and systemic manifestations. These findings highlight the importance of customized strategies that balance thrombosis prevention with bleeding risk, especially in complex cases.

背景：抗磷脂综合征（APS）是一种与血栓形成和妊娠发病率相关的多方面自身免疫性疾病。血小板减少症是APS的一种常见表现，由于其与血栓和出血风险的双重关联，提出了独特的临床挑战。本研究调查了大量抗磷脂抗体（aPL）阳性患者中血小板减少症的发生率、特征和预测因素及其与其他临床表现的关系。方法对2014 - 2024年意大利都灵San Giovanni Bosco和San Luigi Gonzaga医院211例apl阳性患者进行多中心回顾性队列研究。每六个月或在发生新的临床事件时收集人口统计学、实验室和临床特征的数据。血小板减少的定义排除了其他病因。实验室和临床评估包括血栓危险因素、自身抗体谱和治疗方案。结果42例（20%）患者发生血小板减少症，严重程度不同：轻度（33%）、中度（38%）和重度（29%）。重症患者主要表现为血小板计数低于20 × 10^9/L。血小板减少患者表现出更高的血栓事件、静脉复发、深静脉血栓形成、肺栓塞和灾难性APS （CAPS）的发生率。肾脏受累更为常见，而炎症表现（心包炎、胸膜炎和关节痛）较少见。血小板减少患者抗β2糖蛋白I抗体IgG阳性和白细胞减少的频率较高。治疗干预包括增加类固醇、静脉注射免疫球蛋白、霉酚酸酯和利妥昔单抗的使用。血小板减少症在全身性APS诊断中更为普遍（21%对3%）。结论血小板减少症患者，尤其是重症患者，与血栓形成风险和全身性表现升高相关。这些发现强调了定制策略的重要性，以平衡血栓预防和出血风险，特别是在复杂的情况下。

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引用次数: 0

Psychometric properties of patient-related outcome measures used for patients surviving a pulmonary embolism: A systematic review 用于肺栓塞存活患者的患者相关结果测量的心理测量特性：一项系统综述

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

Pub Date : 2025-11-18 DOI: 10.1016/j.thromres.2025.109543

Stian Ingemann-Molden , Christina Krogner Caspersen , Nanna Rolving , Anette Arbjerg Højen , Frederikus A. Klok , Erik Lerkevang Grove , Jane Andreasen

<div><h3>Background</h3><div>Patients who survive a pulmonary embolism (PE) often suffer several negative long-term physical and mental consequences, limiting their ability to stay physically- and socially active ultimately deteriorating their quality of life. Patients with PE therefore need evidence-based rehabilitation, targeting what is important to each individual patient. Valid and reliable patient-reported outcome measures (PROMs) are crucial to help clinicians plan and track rehabilitation outcomes in a reliable manner.</div></div><div><h3>Purpose</h3><div>A systematic review to generate an overview over psychometric properties (reliability, validity, responsiveness, floor/ceiling effect and accessibility) of 34 PROMs used to assess PE, identified in a previous review by the research group.</div></div><div><h3>Methods</h3><div>A literature search was performed in PUBMED, CINAHL and EMBASE from inception to September 2024 and included psychometric studies of 34 specific PROMs. The evidence for each psychometric property was evaluated according to the COSMIN criteria for good measurement properties and graded according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach for systematic reviews. Methodological quality was assessed using the COSMIN Risk of Bias checklist for PROMs.</div></div><div><h3>Results</h3><div>The literature search yielded 3.801 records after removal of duplicates; 3.778 records were excluded based on title and abstract and further 10 articles were excluded during full-text reading leaving 13 articles evaluating the psychometric properties of PROMs. The Pulmonary Embolism Quality of life Questionnaire (PEmb-QoL) was assessed in 10 studies, showing very good internal consistency, reliability, criterion validity, construct validity, responsiveness and floor/ceiling effects. Structural validity for the PEmb-QoL was considered inadequate. One study found moderate evidence for the EQ-5D-5l showing adequate convergent construct validity. EQ-5D-5L also showed very good divergent construct validity, as well as good floor/ceiling effects and acceptability but inadequate structural validity. Low evidence for Perception of anticoagulation treatment questionnaire (PACT-Q) showed very good construct validity and internal consistency as well as adequate structural validity. Structural validity for the PACT-Q was acceptable, while content validity was doubtful and poor floor/ceiling effects. Finally moderate to high evidence for the Post-VTE functional status scale (PVFS) showing very good construct validity but inadequate structural validity and doubtful content validity.</div></div><div><h3>Conclusion</h3><div>Some aspects of psychometric properties has been assessed in four out of the 34 PROMs used to assess patients with PE. Future studies should strive towards assessing all psychometric properties of PROMs used both clinically and in research.</div></div><div><h3>Implications</h3><div>The r

肺栓塞（PE）存活的患者通常会遭受一些长期的身体和精神上的负面后果，限制了他们保持身体和社会活动的能力，最终使他们的生活质量恶化。因此，PE患者需要循证康复，针对每个患者的重要方面。有效和可靠的患者报告结果测量（PROMs）对于帮助临床医生以可靠的方式计划和跟踪康复结果至关重要。目的对研究小组在之前的综述中确定的34个用于评估PE的prom的心理测量特性（信度、效度、反应性、地板/天花板效应和可及性）进行系统综述。方法检索PUBMED、CINAHL和EMBASE数据库自成立至2024年9月的文献，纳入34例特定人群的心理测量学研究。每个心理测量属性的证据根据COSMIN良好测量属性标准进行评估，并根据推荐、评估、发展和评估分级（GRADE）方法进行系统评价。方法学质量采用COSMIN PROMs偏倚风险检查表进行评估。结果去除重复后，共检索到文献3.801条；根据标题和摘要排除了3.778条记录，在全文阅读中又排除了10篇文章，留下13篇评价PROMs心理测量特性的文章。在10项研究中评估了肺栓塞生活质量问卷（PEmb-QoL），显示出非常好的内部一致性、信度、标准效度、结构效度、响应性和下限/上限效应。PEmb-QoL的结构效度被认为不足。一项研究发现了EQ-5D-5l的适度证据，显示出足够的收敛结构效度。EQ-5D-5L也表现出非常好的发散性构效度，地板/天花板效应和可接受性良好，但结构效度不足。低证据抗凝治疗感知问卷（PACT-Q）具有很好的结构效度和内部一致性，具有足够的结构效度。PACT-Q的结构效度是可以接受的，而内容效度是值得怀疑的，下限/上限效应很差。中高证据表明，vte后功能状态量表（PVFS）具有很好的结构效度，但结构效度不足，内容效度值得怀疑。结论在34个用于评估PE患者的PROMs中，有4个已经评估了心理测量学的某些方面。未来的研究应该努力评估临床和研究中使用的PROMs的所有心理测量特性。本综述的结果对跟踪PE患者的可靠性提出了质疑，可能会扭曲先前研究的结果，更重要的是显示了PE后康复的不完整图景。

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引用次数: 0

Haemostatic changes following ECMO circuit replacement in adult patients with COVID-19: An exploratory retrospective study 成人COVID-19患者ECMO回路置换术后的止血变化：一项探索性回顾性研究

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research

Pub Date : 2025-11-17 DOI: 10.1016/j.thromres.2025.109542

Bernhard Nagler , Sabrina Thurner , Peter Schellongowski , Oliver Robak , Alexander Hermann , Thomas Staudinger , Nina Buchtele

Background

Extracorporeal membrane oxygenation (ECMO) is an important intervention for severe respiratory failure, yet coagulation abnormalities and circuit thrombosis remain significant challenges. Circuit exchanges are frequently performed to restore oxygenator function and mitigate ECMO-related coagulopathies, but optimal criteria for their indication remain unclear.

Methods

This retrospective analysis included adult patients with coronavirus disease 2019 associated acute respiratory distress syndrome (ARDS) receiving venovenous (VV) ECMO at a tertiary hospital between January 2020 and April 2023. The primary endpoint was the change in d-dimer level on the third day after a circuit exchange compared to the last value before the circuit exchange. Secondary analyses included parameters such as fibrinogen, platelet count, LDH, post‑oxygenator pO₂ and transmembrane pressure. Statistical comparisons were made using Wilcoxon-signed-rank tests and linear mixed models.

Results

Among 48 patients, 37 (77.1 %) underwent at least one coagulation-related circuit exchange, totalling 96 exchanges. D-dimer levels significantly decreased from 19 μg/ml (IQR 11–25) before exchange to 4 μg/ml (IQR 2–7) after exchange (p < 0.001). Platelet counts increased significantly (p = 0.024), while LDH levels decreased (p = 0.001). No significant changes were observed in fibrinogen levels. A sharp increase in d-dimer prior to exchange correlated with subsequent decreases post-exchange (R = −0.66, p < 0.001).

Conclusions

ECMO circuit exchanges are associated with significant improvements in coagulation parameters, particularly d-dimer reduction, suggesting that d-dimer trends may serve as a key indicator for elective circuit replacement. Future prospective studies should refine exchange criteria to optimize patient outcomes while minimizing unnecessary interventions.

体外膜氧合（ECMO）是严重呼吸衰竭的重要干预措施，但凝血异常和回路血栓形成仍然是一个重大挑战。电路交换经常用于恢复氧合器功能和减轻ecmo相关的凝血疾病，但其适应症的最佳标准尚不清楚。方法回顾性分析2020年1月至2023年4月在某三级医院接受静脉静脉（VV） ECMO治疗的2019冠状病毒病相关急性呼吸窘迫综合征（ARDS）成年患者。主要终点是d-二聚体水平在电路交换后第三天的变化，与电路交换前的最后一个值相比。二次分析包括纤维蛋白原、血小板计数、LDH、氧合后pO2和跨膜压力等参数。采用Wilcoxon-signed-rank检验和线性混合模型进行统计学比较。结果48例患者中，37例（77.1%）接受了至少1次凝血相关循环交换，共96次。d -二聚体水平从交换前的19 μg/ml （IQR 11-25）显著降至交换后的4 μg/ml (IQR 2-7) （p < 0.001）。血小板计数显著升高（p = 0.024）， LDH水平显著降低（p = 0.001）。纤维蛋白原水平未见明显变化。交换前d-二聚体的急剧增加与随后交换后的减少相关（R = - 0.66, p < 0.001）。结论secmo电路交换与凝血参数的显著改善有关，特别是d-二聚体的减少，提示d-二聚体趋势可能是选择性电路更换的关键指标。未来的前瞻性研究应完善交换标准，以优化患者预后，同时尽量减少不必要的干预。

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引用次数: 0