Thrombosis research最新文献

{"title":"Early outpatient use of low-molecular-weight heparin benefits COVID-19 outcome in association with hospitalization - Lessons learned","authors":"Miika Koskinen ,&nbsp;Eeva Ruotsalainen ,&nbsp;Mia Wallin ,&nbsp;Hilkka Kivelä ,&nbsp;Kerstin Carlsson ,&nbsp;Jari Petäjä ,&nbsp;Eero Hirvensalo ,&nbsp;Markku Mäkijärvi ,&nbsp;Riitta Lassila","doi":"10.1016/j.thromres.2025.109555","DOIUrl":"10.1016/j.thromres.2025.109555","url":null,"abstract":"<div><h3>Background</h3><div>Covid-19 and venous thromboembolism (VTE) share risk factors and thrombo-inflammatory pathophysiology. In-hospital low-molecular-weight heparin (LMWH) use improved outcomes. Before vaccinations or available treatments, the Helsinki university hospital in Finland, initiated LMWH thromboprophylaxis to Covid-19 <em>outpatients</em> with progressing illness and high-risk of VTE (LMWH+ group), aligning with the existing in-hospital guidance for thromboprophylaxis.</div></div><div><h3>Methods</h3><div>We observationally studied whether pre-admission LMWH thromboprophylaxis impacted outcomes: hospital and ICU stay, and respiratory support after Covid-19 hospitalization. We compared control group (LMWH-) by propensity score-matching comorbidities, medications and Covid-19 severity and VTE risk with the LMWH+ group with 30-day follow-up.</div></div><div><h3>Results</h3><div>Among 1189 hospitalized patients, 241 were stratified in the LMWH+ group and 482 were propensity-matched into the LMWH- group. The mean time (±SD) from Covid-19 diagnosis until outpatient thromboprophylaxis in the LMWH+ group was 1.9 (±3.0) days; ~80 % of patients received thromboprophylaxis ≤2 days after the diagnosis. Longer duration of pre-admission LMWH use was associated with shorter hospital stays and less days with respiratory support (<em>p</em> &lt; 0.006–0.008). The incidences of bleeds and VTE (LMWH+ 4.6 %, LMWH- 5.4 %) were similar. Overall, 2.9-fold higher mortality (<em>p</em> = 0.014) occurred in the LMWH- (10.6 %) versus the LMWH+ group (3.7 %).</div></div><div><h3>Conclusions</h3><div>Outpatient LMWH given pre-admission for high-risk Covid-19 patients was associated with improved outcome following diagnosis: shorter respiratory support and hospital stay with reduced need for intensive care. Our findings support early initiation of LMWH in risk-stratified patients to manage thrombo-inflammation. While being Covid-19 aftermath, our study is relevant for any other severe viral outbursts associated with thrombogenicity.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"257 ","pages":"Article 109555"},"PeriodicalIF":3.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145783017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thrombocytopenia in antiphospholipid syndrome: predictors, prognostic implications, and thrombotic risk in a large cohort study","authors":"David Galarza ,&nbsp;Massimo Radin ,&nbsp;Irene Cecchi ,&nbsp;Alessandro Morotti ,&nbsp;Isabella Russo ,&nbsp;Sofia Camerlo ,&nbsp;Alice Barinotti ,&nbsp;Roberta Fenoglio ,&nbsp;Savino Sciascia","doi":"10.1016/j.thromres.2025.109544","DOIUrl":"10.1016/j.thromres.2025.109544","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 %).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"257 ","pages":"Article 109544"},"PeriodicalIF":3.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145616789","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}

{"title":"Comparative outcomes of ultrasound-assisted catheter-directed thrombolysis between patients with acute and acute-on-chronic pulmonary embolism","authors":"Riccardo M. Fumagalli ,&nbsp;Conrad von Stempel ,&nbsp;William Pleming ,&nbsp;Frederikus A. Klok ,&nbsp;Stavros V. Konstantinides ,&nbsp;Nils Kucher ,&nbsp;Bhavin Rawal ,&nbsp;Luca Valerio ,&nbsp;Stefano Barco","doi":"10.1016/j.thromres.2025.109552","DOIUrl":"10.1016/j.thromres.2025.109552","url":null,"abstract":"<div><h3>Background</h3><div>Radiologic signs of chronic thrombi are present in approximately 20 % of patients with acute pulmonary embolism (PE). We assessed the effectiveness of ultrasound-assisted catheter-directed thrombolysis (USAT) in patients with acute PE with or without signs of chronic PE and the accuracy of radiologic parameters predicting chronic thromboembolic pulmonary hypertension (CTEPH).</div></div><div><h3>Methods</h3><div>Index CT scans of patients who underwent USAT for acute PE with right ventricular strain were reviewed by three radiologists blinded to clinical and hemodynamic outcomes. At least 3 validated radiological criteria of chronic thromboembolism defined acute-on-chronic PE. Changes in mean pulmonary arterial pressure (mPAP) 20 h after USAT and presence of post-PE impairment (PPEI) or CTEPH at 3–6 months were compared between patients with and without acute-on-chronic PE.</div></div><div><h3>Results</h3><div>Among 180 consecutive patients (median age 65 years), 31 (17 %) had acute-on-chronic PE. Absolute mPAP reduction was 11 (Q1-Q3: 5–17) mmHg in acute vs. 10 (Q1-Q3: 5–17) mmHg in acute-on-chronic PE from similar baseline mPAP. PPEI or CTEPH were recorded in 2.0 % of patients in the acute group vs. 13 % in the acute-on-chronic group (odds ratio 7.0, 95 %C.I. 1.4–40). Of 3 (1.7 %) patients diagnosed with CTEPH, all presented with ≥3 radiological criteria suggesting pre-existing CTEPH at index CT scan.</div></div><div><h3>Conclusions</h3><div>CT signs of chronic thromboembolism at the time of acute PE did not appear to influence the immediate hemodynamic response to USAT in most patients but may raise the suspicion of pre-existing CTEPH if ≥3 validated radiological criteria are present.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"257 ","pages":"Article 109552"},"PeriodicalIF":3.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145616915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thrombin generation reference values using the ST Genesia and STG-Thromboscreen assay in pregnant women","authors":"Mathieu Fortier ,&nbsp;Marie Portes ,&nbsp;Christophe Demattei ,&nbsp;Eva Nouvellon ,&nbsp;Eric Mercier ,&nbsp;Chloé Bourguignon ,&nbsp;Mathias Chea ,&nbsp;Jean-Christophe Gris ,&nbsp;Vincent Letouzey ,&nbsp;Sylvie Bouvier","doi":"10.1016/j.thromres.2025.109558","DOIUrl":"10.1016/j.thromres.2025.109558","url":null,"abstract":"","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"257 ","pages":"Article 109558"},"PeriodicalIF":3.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145726186","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}

{"title":"Platelets display immunophenotypic alterations and dysregulated transcriptomic signature in Philadelphia-negative myeloproliferative neoplasms","authors":"Vitor Leonardo Bassan ,&nbsp;Poliana Carina Paolini ,&nbsp;Lilian Maria Garcia Ramos ,&nbsp;Fabiana Rossetto de Morais ,&nbsp;Luciana Ambrosio ,&nbsp;Luiz Fernando Princi Chaim ,&nbsp;Patrícia Vianna Bonini Palma ,&nbsp;Camila Menezes Bonaldo ,&nbsp;Rafaela de Freitas Martins Felício ,&nbsp;Lorena Lobo de Figueiredo-Pontes ,&nbsp;Fabíola Attié de Castro","doi":"10.1016/j.thromres.2025.109559","DOIUrl":"10.1016/j.thromres.2025.109559","url":null,"abstract":"<div><h3>Introduction &amp; objectives</h3><div>Polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (MF) are Philadelphia-negative myeloproliferative neoplasms (MPN) associated with gain-of-function mutations in <em>JAK2, CALR,</em> and <em>MPL</em> genes. Chronic inflammation is a central hallmark of MPN, significantly contributing to disease pathogenesis and progression and severe complications such as thrombosis. Alterations in platelet immunophenotype and gene expression may influence the thromboinflammatory state observed in MPN patients. We aimed to characterize platelet immunophenotype, <em>ex vivo</em> activation, and transcriptomic signatures in MPN patients compared to healthy controls.</div></div><div><h3>Methods</h3><div>Inflammatory indices, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII), were assessed to determine the thromboinflammatory <em>status.</em> Platelet immunophenotyping was performed at baseline and following stimulation with calcium ionophore A23187 or thrombin. Control platelets were exposed to MPN plasma to evaluate inflammatory activation. Transcriptomic data were analyzed <em>in silico</em> to identify dysregulated platelet-related pathways.</div></div><div><h3>Results</h3><div>MPN patients exhibited elevated NLR, PLR, and SII, consistent with systemic inflammation. Their platelets showed a pre-activated phenotype, with increased baseline expression of CD62P, CD36, CD63, and CD154. Compared to controls, MPN platelets were less responsive to thrombin stimulation, whereas control platelets exposed to MPN plasma acquired an activated phenotype. Transcriptomic profiling revealed downregulation of genes associated with cytoskeleton organization, integrin signaling, adhesion, metabolism, and trafficking.</div></div><div><h3>Conclusion</h3><div>MPN platelets are intrinsically activated and transcriptionally dysregulated, even in treated patients. These findings underscore the critical role of platelets in MPN-associated thromboinflammation, highlighting platelet contribution to hemostatic and thrombotic complications.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"257 ","pages":"Article 109559"},"PeriodicalIF":3.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145678953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The in vitro anticoagulant effect of milvexian in healthy neonates and children","authors":"Natasha Letunica ,&nbsp;Vasiliki Karlaftis ,&nbsp;Paul Monagle ,&nbsp;Hernando Patino ,&nbsp;Madhu Chintala ,&nbsp;Chantal Attard","doi":"10.1016/j.thromres.2025.109564","DOIUrl":"10.1016/j.thromres.2025.109564","url":null,"abstract":"<div><h3>Background</h3><div>Effective anticoagulant therapies are crucial for managing thrombotic disorders, especially in children. While currently available direct oral anticoagulants offer many advantages over current standard of care anticoagulants, including predictable pharmacokinetics and reduced need for monitoring, they still have significant bleeding risks. Milvexian, a direct factor XIa inhibitor, has demonstrated potential in reducing bleeding risks compared to traditional anticoagulants and warrants further investigation in neonates and children.</div></div><div><h3>Objectives</h3><div>This study aimed to investigate the age-related anticoagulant effect of milvexian <em>in vitro.</em></div></div><div><h3>Patients/methods</h3><div>Plasma samples from healthy participants from the following age groups: neonates, 28 days–23 months, 2–6 years, 7–11 years, 12–18 years, and adults were spiked with increasing concentrations of milvexian (0.1, 1.0, 3.0 and 10 μM). Clotting time was measured using an activated partial thromboplastin time (aPTT) assay, and thrombin generation parameters were assessed.</div></div><div><h3>Results</h3><div>A dose-dependent increase in clotting time was observed across all age groups. Thrombin generation parameters, including Lag time and time to peak (ttPeak), showed a linear dose-dependent increase, while endogenous thrombin potential (ETP), Peak, and Velocity index decreased dose-dependently. Significant age-specific differences were noted primarily in neonates and children less than two years of age compared to adults.</div></div><div><h3>Conclusion</h3><div><em>In vitro</em> findings indicate a predictable, linear dose-response to milvexian, with significant <em>in vitro</em> anticoagulant effect differences in neonates and children under two years of age. Further <em>in vivo</em> studies are required to confirm these findings, determine dosing strategies, and assess clinical implications in the paediatric population.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"257 ","pages":"Article 109564"},"PeriodicalIF":3.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145775879","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}

{"title":"The risks and benefits of disseminated intravascular coagulation-targeted anticoagulant therapy in abdominal sepsis","authors":"Tadashi Matsuoka ,&nbsp;Kazuma Yamakawa ,&nbsp;Noritaka Ushio ,&nbsp;Ryo Hisamune ,&nbsp;Koichiro Homma ,&nbsp;Junichi Sasaki","doi":"10.1016/j.thromres.2025.109562","DOIUrl":"10.1016/j.thromres.2025.109562","url":null,"abstract":"<div><h3>Background</h3><div>Abdominal sepsis frequently leads to disseminated intravascular coagulation (DIC), exacerbating organ dysfunction and bleeding complications. Although anticoagulant therapy is a potential treatment for DIC, its use in this context raises concerns about bleeding risks.</div></div><div><h3>Objectives</h3><div>The purpose of this study is to investigate the risks and benefits of DIC-targeted anticoagulant therapy in patients with abdominal sepsis.</div></div><div><h3>Methods</h3><div>Data were analyzed from a dataset from a multicenter nationwide retrospective cohort study (J-Septic DIC registry) in Japan between 2011 and 2013. The study included 987 patients with abdominal sepsis-induced DIC, diagnosed within three days of ICU admission. Patients were divided into DIC-targeted anticoagulant therapy (recombinant thrombomodulin or antithrombin) and non-use groups. Propensity score matching was used to adjust for confounding factors. The primary outcome was all-cause 90-day mortality, with bleeding complications requiring blood transfusion as the primary safety outcome.</div></div><div><h3>Results</h3><div>The results indicated that anticoagulant therapy was associated with improved survival (hazard ratio: 0.662, 95 % confidential interval: 0.472–0.929), but a higher risk of bleeding complications (OR: 2.451, 95 % confidential interval:1.372–4.379). Dual combination of anticoagulant therapy did not provide additional survival benefits and increased bleeding risks. The efficacy of DIC-targeted anticoagulant therapy correlated with disease severity, while bleeding risk was inversely correlated with severity.</div></div><div><h3>Conclusion</h3><div>DIC-targeted anticoagulant therapy in patients with abdominal sepsis was related with improved prognosis but increased bleeding risks. The risk-benefit profile varies with disease severity, suggesting a need for cautious and personalized treatment strategies.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"257 ","pages":"Article 109562"},"PeriodicalIF":3.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145783029","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}

{"title":"Diagnostic performance of ultrasound, computed tomography and magnetic resonance imaging in portal vein thrombosis: A systematic review with meta-analysis","authors":"Laura Girardi ,&nbsp;Farah Zarka ,&nbsp;Michelle Pradier ,&nbsp;Sarah Visintini ,&nbsp;Mattia Poletti ,&nbsp;Grégoire Le Gal ,&nbsp;Tzu-Fei Wang ,&nbsp;Aurélien Delluc","doi":"10.1016/j.thromres.2025.109560","DOIUrl":"10.1016/j.thromres.2025.109560","url":null,"abstract":"<div><h3>Background</h3><div>Ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) are commonly used for the diagnosis of portal vein thrombosis (PVT), however, their accuracy compared to invasive tests is not clearly known.</div></div><div><h3>Methods</h3><div>We systematically searched MEDLINE, Embase, Cochrane Central, and Scopus databases for studies assessing the sensitivity and specificity of US, CT, and MRI for PVT diagnosis. Inclusion criteria required at least 10 participants and comparison with invasive gold standards (angiography or surgery/pathology). The quality assessment was performed using the QUADAS-2 tool. Pooled estimates of sensitivity and specificity were calculated through mixed-effects logistic regression model and reported with 95 % confidence intervals (CI). Based on the obtained results, we computed Bayesian models simulating the work-up of PVT in case of different clinical pre-test probabilities of PVT.</div></div><div><h3>Results</h3><div>Out of 8526 identified citations, 26 studies with 1499 patients were included in the meta-analysis. The risk of bias was low in 3 studies. Pooled sensitivities and specificities were 0.84 (95 %CI 0.69–0.92) and 0.96 (95 %CI 0.92–0.98) for US, 0.81 (95 %CI 0.66–0.90) and 0.96 (95 %CI 0.88–0.99) for CT, and 0.81 (95 %CI 0.65–0.90) and 0.98 (95 %CI 0.96–0.99) for MRI. In patients with a pre-test probability of PVT of 30 %, a positive US yields a post-test probability of PVT of 90 % and a second positive imaging result leads to a post-test probability of 99 %.</div></div><div><h3>Conclusions</h3><div>US, CT, and MRI demonstrate comparable accuracy for PVT diagnosis, with a high specificity across modalities. A stepwise diagnostic approach integrating clinical probability and imaging results could optimize diagnostic confidence.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"257 ","pages":"Article 109560"},"PeriodicalIF":3.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145737195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Absolute time-dependent risk of hospital-acquired venous thromboembolism in children","authors":"Maya K. Raad,&nbsp;Stephanie Prozora,&nbsp;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":"2026-01-01","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}

{"title":"The maternal hemostatic shift: Understanding VTE risk in pregnancy and postpartum","authors":"Marie Didembourg ,&nbsp;Laure Morimont ,&nbsp;Emilie De Gottal ,&nbsp;Jonathan Douxfils","doi":"10.1016/j.thromres.2025.109561","DOIUrl":"10.1016/j.thromres.2025.109561","url":null,"abstract":"<div><div>Venous thromboembolism (VTE) remains a leading cause of maternal morbidity and mortality, with pregnancy increasing the risk of VTE four- to five-fold compared with the non-pregnant state and up to 60-fold in the postpartum period. The incidence of pregnancy-related VTE ranges from 0.5 to 2.0 per 1000 pregnancies, with deep vein thrombosis (DVT) and pulmonary embolism (PE) accounting for most cases. The heightened thrombotic risk during pregnancy and postpartum stems from physiological adaptations in hemostasis, creating a hypercoagulable state to mitigate hemorrhage risk at delivery. These changes involve increased coagulation activation, reduced fibrinolysis, and venous stasis, fulfilling Virchow's triad. The risk rises as pregnancy progresses, peaking in the third trimester and postpartum period, with both hormonal fluctuations and mechanical factors playing key roles. Estrogen and progesterone contribute to early pregnancy risk by enhancing clotting factor synthesis, while later stages involve uterine compression of venous structures, impairing venous return. The postpartum period presents the highest risk, driven by endothelial injury during delivery, inflammatory responses, and hemodynamic shifts. Evolving obstetric practices, such as early ambulation and compression therapy, may have influenced the temporal distribution of VTE events. This review aims to clarify how pregnancy-specific hemostatic adaptations influence thrombotic risk and to identify strategies for improved, individualized prevention. Despite updated international guidelines, major discrepancies persist in risk scoring and prophylaxis thresholds, underscoring the limitations of current empirical approaches. Functional biomarkers such as thrombin generation and the Endogenous thrombin potential (ETP)-based activated protein C (APC) resistance assay, could represent promising tools to bridge the gap between mechanistic understanding and clinical application.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"257 ","pages":"Article 109561"},"PeriodicalIF":3.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}