Pub Date : 2025-10-20DOI: 10.1016/j.thromres.2025.109516
Juliette Hugueny , Anna de Ricolfis , Nicolaï Johnson , Nathalie Chabbert-Buffet , Sarra Cristofari
Objective
This review aimed to synthesize recent data on venous thromboembolism (VTE) risk in the context of masculinizing hormone therapy with testosterone.
Methods
An electronic search was performed in MEDLINE/PubMed without date restrictions. Eligible articles were peer-reviewed observational and interventional studies and had to be written in English. Results are presented by theme of analysis.
Results
Most recent large-scale studies investigating trans masculine populations have not found a statistically significant change in the risk of VTE. However, most of the available data relate to younger individuals with minimal cardiovascular risk factors. For patients with a personal or family history of VTE, the introduction of testosterone therapy should be discussed within a multidisciplinary team specializing in transgender health, balancing the risk-benefit ratio in a population where the risk of suicide is high and is largely reduced by gender-affirming hormone therapy.
Conclusions
Most of the studies did not found a significant change in the risk of venous thromboembolism in trans masculine persons taking testosterone. However, data are limited, and further robust studies are warranted to clarify these data and to generalize these results to higher veinous thromboembolic risk groups.
{"title":"Assessing the risk of venous thromboembolism in trans masculine persons on gender-affirming hormone therapy: A literature review","authors":"Juliette Hugueny , Anna de Ricolfis , Nicolaï Johnson , Nathalie Chabbert-Buffet , Sarra Cristofari","doi":"10.1016/j.thromres.2025.109516","DOIUrl":"10.1016/j.thromres.2025.109516","url":null,"abstract":"<div><h3>Objective</h3><div>This review aimed to synthesize recent data on venous thromboembolism (VTE) risk in the context of masculinizing hormone therapy with testosterone.</div></div><div><h3>Methods</h3><div>An electronic search was performed in MEDLINE/PubMed without date restrictions. Eligible articles were peer-reviewed observational and interventional studies and had to be written in English. Results are presented by theme of analysis.</div></div><div><h3>Results</h3><div>Most recent large-scale studies investigating trans masculine populations have not found a statistically significant change in the risk of VTE. However, most of the available data relate to younger individuals with minimal cardiovascular risk factors. For patients with a personal or family history of VTE, the introduction of testosterone therapy should be discussed within a multidisciplinary team specializing in transgender health, balancing the risk-benefit ratio in a population where the risk of suicide is high and is largely reduced by gender-affirming hormone therapy.</div></div><div><h3>Conclusions</h3><div>Most of the studies did not found a significant change in the risk of venous thromboembolism in trans masculine persons taking testosterone. However, data are limited, and further robust studies are warranted to clarify these data and to generalize these results to higher veinous thromboembolic risk groups.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"256 ","pages":"Article 109516"},"PeriodicalIF":3.4,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145365189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-19DOI: 10.1016/j.thromres.2025.109515
Hong-Yan Li , Hai-Shan Wang , Jing Wang , Ya-Hong Wang , Shan-Ling Jiang , Li-Hong Wang
Background
This study assessed clinical practice guidelines (CPGs) for venous thromboembolism (VTE) prophylaxis and treatment in patients with stroke to provide evidence-based reference for clinicians.
Methods
We systematically identified CPGs published between January 1, 2020 and January 1, 2025. The Appraisal of Guidelines for Research & Evaluation II (AGREE II) and the Appraisal of Guidelines for Research and Evaluation-Recommendation Excellence (AGREE-REX) instruments were utilized to evaluate the quality of methodology and recommendations, respectively. Prophylaxis and treatment recommendations for VTE were extracted and compared for consistency and divergence.
Results
12 CPGs were included. The median (interquartile range [IQR]) scores for AGREE II six domains were: scope and purpose, 85.4 % (9.0 %); stakeholder involvement, 63.2 % (29.9 %); rigour of development, 65.4 % (18.5 %); clarity of presentation, 84.7 % (4.9 %); applicability, 49.5 % (33.3 %); and editorial independence, 76.0 % (41.7 %). The AGREE-REX assessment results were as follows: clinical applicability, 68.8 % (25.4 %); values and preferences, 19.3 % (20.6 %); and implementability, 36.5 % (9.4 %). Analysis of 64 key recommendations showed consistent support for intermittent pneumatic compression but not graduated compression stockings. Pharmacological prophylaxis remains controversial across both ischemic and hemorrhagic stroke.
Conclusion
Current stroke VTE guidelines demonstrate strengths in scope and clarity, but critical limitations in applicability and values and preferences. Although consensus on mechanical prophylaxis is clear, evidence for pharmacological prevention remains controversial. Future guideline development must enhance methodological rigour and address these critical evidence gaps through targeted primary research. This study provides a foundational synthesis of evidence-based insights to inform both clinical decision-making and the development of more applicable, trustworthy guidelines.
{"title":"Management of venous thromboembolism in stroke: A deep appraisal exposing discordance in guideline quality and recommendations","authors":"Hong-Yan Li , Hai-Shan Wang , Jing Wang , Ya-Hong Wang , Shan-Ling Jiang , Li-Hong Wang","doi":"10.1016/j.thromres.2025.109515","DOIUrl":"10.1016/j.thromres.2025.109515","url":null,"abstract":"<div><h3>Background</h3><div>This study assessed clinical practice guidelines (CPGs) for venous thromboembolism (VTE) prophylaxis and treatment in patients with stroke to provide evidence-based reference for clinicians.</div></div><div><h3>Methods</h3><div>We systematically identified CPGs published between January 1, 2020 and January 1, 2025. The Appraisal of Guidelines for Research & Evaluation II (AGREE II) and the Appraisal of Guidelines for Research and Evaluation-Recommendation Excellence (AGREE-REX) instruments were utilized to evaluate the quality of methodology and recommendations, respectively. Prophylaxis and treatment recommendations for VTE were extracted and compared for consistency and divergence.</div></div><div><h3>Results</h3><div>12 CPGs were included. The median (interquartile range [IQR]) scores for AGREE II six domains were: scope and purpose, 85.4 % (9.0 %); stakeholder involvement, 63.2 % (29.9 %); rigour of development, 65.4 % (18.5 %); clarity of presentation, 84.7 % (4.9 %); applicability, 49.5 % (33.3 %); and editorial independence, 76.0 % (41.7 %). The AGREE-REX assessment results were as follows: clinical applicability, 68.8 % (25.4 %); values and preferences, 19.3 % (20.6 %); and implementability, 36.5 % (9.4 %). Analysis of 64 key recommendations showed consistent support for intermittent pneumatic compression but not graduated compression stockings. Pharmacological prophylaxis remains controversial across both ischemic and hemorrhagic stroke.</div></div><div><h3>Conclusion</h3><div>Current stroke VTE guidelines demonstrate strengths in scope and clarity, but critical limitations in applicability and values and preferences. Although consensus on mechanical prophylaxis is clear, evidence for pharmacological prevention remains controversial. Future guideline development must enhance methodological rigour and address these critical evidence gaps through targeted primary research. This study provides a foundational synthesis of evidence-based insights to inform both clinical decision-making and the development of more applicable, trustworthy guidelines.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"256 ","pages":"Article 109515"},"PeriodicalIF":3.4,"publicationDate":"2025-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145365127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-18DOI: 10.1016/j.thromres.2025.109517
Francesca Nencini , Enrico La Spina , Serena Borghi , Elvira Giurranna , Flavia Rita Argento , Eleonora Fini , Cesarina Giallongo , Andrea Duminuco , Giovanni Li Volti , Giuseppe Alberto Palumbo , Niccolò Taddei , Claudia Fiorillo , Daniele Tibullo , Matteo Becatti
Myelofibrosis (MF) is a myeloproliferative neoplasm characterized by stem cell-derived clonal myeloproliferation, bone marrow fibrosis, extramedullary hematopoiesis and aberrant inflammation. About 90 % of MF patients carry mutations in JAK2, CALR, or MPL, with JAK2 mutations promoting cytokine independence, STAT proteins activation and enhances reactive oxygen species (ROS) production. Inflammation and oxidative stress are key contributors to thrombotic risk, a major cause of morbidity and mortality in MF. Fibrinogen, a key factor in coagulation and inflammation, may play a central role due to its susceptibility to oxidative modifications. In particular, in MPN patients, impaired fibrinolysis associated with endothelial cell dysfunction, increased ROS and proinflammatory cytokines production have been reported.
This study investigates the role of oxidation-induced structural and functional changes in fibrinogen in MF patients compared to healthy controls, also analyzing the effects of ruxolitinib, a first-in-class JAK inhibitor.
Plasma samples from 15 untreated MF patients, 39 ruxolitinib-treated MF patients, and 40 matched healthy controls were analyzed for redox status and fibrinogen properties.
MF patients showed elevated plasma lipid peroxidation and nitrate/nitrite levels, reduced antioxidant capacity, and lower free thiol content. These changes were associated with significant fibrinogen oxidation, leading to structural alterations and impaired function, including reduced fibrin polymerization and decreased plasmin-mediated fibrinolysis. Strong correlations were observed between oxidative stress markers and fibrinogen dysfunction. Treatment with ruxolitinib improved redox balance and restored fibrinogen structure and function.
These findings provide the first evidence of a prothrombotic profile in MF patients, driven by structural and functional fibrinogen modifications.
{"title":"Prothrombotic profiles in myelofibrosis: Fibrinogen oxidation and the beneficial effects of ruxolitinib","authors":"Francesca Nencini , Enrico La Spina , Serena Borghi , Elvira Giurranna , Flavia Rita Argento , Eleonora Fini , Cesarina Giallongo , Andrea Duminuco , Giovanni Li Volti , Giuseppe Alberto Palumbo , Niccolò Taddei , Claudia Fiorillo , Daniele Tibullo , Matteo Becatti","doi":"10.1016/j.thromres.2025.109517","DOIUrl":"10.1016/j.thromres.2025.109517","url":null,"abstract":"<div><div>Myelofibrosis (MF) is a myeloproliferative neoplasm characterized by stem cell-derived clonal myeloproliferation, bone marrow fibrosis, extramedullary hematopoiesis and aberrant inflammation. About 90 % of MF patients carry mutations in JAK2, CALR, or MPL, with JAK2 mutations promoting cytokine independence, STAT proteins activation and enhances reactive oxygen species (ROS) production. Inflammation and oxidative stress are key contributors to thrombotic risk, a major cause of morbidity and mortality in MF. Fibrinogen, a key factor in coagulation and inflammation, may play a central role due to its susceptibility to oxidative modifications. In particular, in MPN patients, impaired fibrinolysis associated with endothelial cell dysfunction, increased ROS and proinflammatory cytokines production have been reported.</div><div>This study investigates the role of oxidation-induced structural and functional changes in fibrinogen in MF patients compared to healthy controls, also analyzing the effects of ruxolitinib, a first-in-class JAK inhibitor.</div><div>Plasma samples from 15 untreated MF patients, 39 ruxolitinib-treated MF patients, and 40 matched healthy controls were analyzed for redox status and fibrinogen properties.</div><div>MF patients showed elevated plasma lipid peroxidation and nitrate/nitrite levels, reduced antioxidant capacity, and lower free thiol content. These changes were associated with significant fibrinogen oxidation, leading to structural alterations and impaired function, including reduced fibrin polymerization and decreased plasmin-mediated fibrinolysis. Strong correlations were observed between oxidative stress markers and fibrinogen dysfunction. Treatment with ruxolitinib improved redox balance and restored fibrinogen structure and function.</div><div>These findings provide the first evidence of a prothrombotic profile in MF patients, driven by structural and functional fibrinogen modifications.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"256 ","pages":"Article 109517"},"PeriodicalIF":3.4,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145365128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-14DOI: 10.1016/j.thromres.2025.109505
Benjamin Crichi , Maxime Delrue , Tamim Alsuliman , Sylvain Le Jeune , Corinne Frere
{"title":"Reduced-dose versus full-dose apixaban for extended treatment of cancer-associated venous thromboembolism: A systematic review and meta-analysis of randomized controlled trials with trial sequential analysis","authors":"Benjamin Crichi , Maxime Delrue , Tamim Alsuliman , Sylvain Le Jeune , Corinne Frere","doi":"10.1016/j.thromres.2025.109505","DOIUrl":"10.1016/j.thromres.2025.109505","url":null,"abstract":"","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"256 ","pages":"Article 109505"},"PeriodicalIF":3.4,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145327363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-13DOI: 10.1016/j.thromres.2025.109504
Mohamed Nazem Alibrahim , Khaled A. Sahli , Fahad S. Alshehri
The fibrinolytic system, essential in maintaining hemostatic balance, tightly regulates blood clot dissolution through a complex interplay of activators (e.g., t-PA, u-PA), inhibitors (e.g., PAI-1, α2-antiplasmin), and modulators such as thrombin-activatable fibrinolysis inhibitor (TAFI). Dysregulation of fibrinolysis contributes significantly to various pathological states. In liver diseases, alterations in fibrinolytic proteins, including elevated tissue plasminogen activator (t-PA) and reduced plasminogen activator inhibitor-1 (PAI-1), predispose patients variably toward bleeding or thrombosis, with clinical implications for management in liver transplantation and cirrhosis. In cardiovascular disease, impaired fibrinolysis, characterized by increased clot density and elevated PAI-1, associates with heightened risks of myocardial infarction, stroke, and peripheral arterial disease, driving current therapeutic strategies toward enhancing fibrinolytic potential. Sepsis frequently induces fibrinolytic shutdown, driven by elevated PAI-1 and TAFI, exacerbating microthrombosis, disseminated intravascular coagulation (DIC), and organ dysfunction, emerging therapeutic targets include PAI-1 modulation. In trauma, fibrinolytic dysregulation manifests as either hyperfibrinolysis, primarily induced by shock-associated elevations in t-PA, or fibrinolysis shutdown, often following severe tissue injury, each demanding distinct therapeutic approaches such as timely antifibrinolytic administration (tranexamic acid) or experimental profibrinolytic treatments. This review highlights critical insights into fibrinolytic mechanisms across these clinical conditions, advocating further research toward refining diagnostics, personalized interventions, and targeted modulation of the fibrinolytic system to optimize clinical outcomes.
{"title":"The fibrinolytic system in disease: From molecular pathways to clinical outcomes","authors":"Mohamed Nazem Alibrahim , Khaled A. Sahli , Fahad S. Alshehri","doi":"10.1016/j.thromres.2025.109504","DOIUrl":"10.1016/j.thromres.2025.109504","url":null,"abstract":"<div><div>The fibrinolytic system, essential in maintaining hemostatic balance, tightly regulates blood clot dissolution through a complex interplay of activators (e.g., t-PA, u-PA), inhibitors (e.g., PAI-1, α2-antiplasmin), and modulators such as thrombin-activatable fibrinolysis inhibitor (TAFI). Dysregulation of fibrinolysis contributes significantly to various pathological states. In liver diseases, alterations in fibrinolytic proteins, including elevated tissue plasminogen activator (t-PA) and reduced plasminogen activator inhibitor-1 (PAI-1), predispose patients variably toward bleeding or thrombosis, with clinical implications for management in liver transplantation and cirrhosis. In cardiovascular disease, impaired fibrinolysis, characterized by increased clot density and elevated PAI-1, associates with heightened risks of myocardial infarction, stroke, and peripheral arterial disease, driving current therapeutic strategies toward enhancing fibrinolytic potential. Sepsis frequently induces fibrinolytic shutdown, driven by elevated PAI-1 and TAFI, exacerbating microthrombosis, disseminated intravascular coagulation (DIC), and organ dysfunction, emerging therapeutic targets include PAI-1 modulation. In trauma, fibrinolytic dysregulation manifests as either hyperfibrinolysis, primarily induced by shock-associated elevations in t-PA, or fibrinolysis shutdown, often following severe tissue injury, each demanding distinct therapeutic approaches such as timely antifibrinolytic administration (tranexamic acid) or experimental profibrinolytic treatments. This review highlights critical insights into fibrinolytic mechanisms across these clinical conditions, advocating further research toward refining diagnostics, personalized interventions, and targeted modulation of the fibrinolytic system to optimize clinical outcomes.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"256 ","pages":"Article 109504"},"PeriodicalIF":3.4,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-13DOI: 10.1016/j.thromres.2025.109506
Mohammad Reza Moghaddasnejad , Negar Sadat Sherafat , Najmaldin Saki
Myeloid-derived suppressor cells (MDSCs) are a heterogeneous group of immune regulatory cells that play crucial roles in suppressing immune responses and promoting immune tolerance in autoimmune diseases. Platelets, historically recognized for their role in hemostasis, have recently attracted significant attention for their immune regulatory functions, mainly through their interactions with immune cells, including MDSCs. In patients with immune thrombocytopenia (ITP), both the quantity and suppressive function of MDSCs are decreased. However, following treatment and subsequent elevation of platelet counts, the mean level and suppressive capacity of MDSCs increase. Studies have indicated that platelet-derived products can increase the suppressive capacity of MDSCs in ITP, thereby promoting immune tolerance and reducing inflammation. Conversely, specific platelet-secreted molecules such as TGF-β and histamine play complex roles and are capable of both augmenting and inhibiting MDSC activity, depending on the context. Understanding these interactions reveals potential targets in platelet-MDSC signaling pathways as novel approaches for ITP management. Future research could investigate targeted therapies that modulate MDSC function by enhancing or inhibiting specific platelet-derived mediators, leading to the development of innovative treatments for autoimmune diseases such as ITP.
{"title":"The role of platelets in the regulation of myeloid-derived suppressor cells in immune thrombocytopenia","authors":"Mohammad Reza Moghaddasnejad , Negar Sadat Sherafat , Najmaldin Saki","doi":"10.1016/j.thromres.2025.109506","DOIUrl":"10.1016/j.thromres.2025.109506","url":null,"abstract":"<div><div>Myeloid-derived suppressor cells (MDSCs) are a heterogeneous group of immune regulatory cells that play crucial roles in suppressing immune responses and promoting immune tolerance in autoimmune diseases. Platelets, historically recognized for their role in hemostasis, have recently attracted significant attention for their immune regulatory functions, mainly through their interactions with immune cells, including MDSCs. In patients with immune thrombocytopenia (ITP), both the quantity and suppressive function of MDSCs are decreased. However, following treatment and subsequent elevation of platelet counts, the mean level and suppressive capacity of MDSCs increase. Studies have indicated that platelet-derived products can increase the suppressive capacity of MDSCs in ITP, thereby promoting immune tolerance and reducing inflammation. Conversely, specific platelet-secreted molecules such as TGF-β and histamine play complex roles and are capable of both augmenting and inhibiting MDSC activity, depending on the context. Understanding these interactions reveals potential targets in platelet-MDSC signaling pathways as novel approaches for ITP management. Future research could investigate targeted therapies that modulate MDSC function by enhancing or inhibiting specific platelet-derived mediators, leading to the development of innovative treatments for autoimmune diseases such as ITP.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"256 ","pages":"Article 109506"},"PeriodicalIF":3.4,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145365125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-11DOI: 10.1016/j.thromres.2025.109507
Wen-jing Ge , Teng-fei Zhu , Wen-jie Ge , Xin-yi Zhu , Ai-qin Chu
Objective
This systematic review aims to evaluate the methodological quality, performance, and clinical applicability of machine learning (ML) models for predicting the risk of venous thromboembolism (VTE) in hospitalized patients. Specifically, we aim to assess the methodological quality and reporting transparency of the included studies, with a focus on their risk of bias and adherence to reporting guidelines.
Methods
A systematic review by use of the databases Cochrane Library, Web of Science, Embase, PubMed, CNKI, VIP Journal Database, Wanfang Database, and the Chinese Biomedical Literature Database. The study was registered at PROSPERO before data collection and PRISMA guidelines were followed. The search was conducted to identify all relevant studies published from the inception of database up to August 1, 2024. Two independent researchers screened the literature and extracted data. Model quality was assessed using the PROBAST appraisal tool and a modified TRIPOD+AI framework, alongside reported model performance metrics.
Results
A total of seventeen studies were included, comprising 65 VTE ML models with sample sizes ranging from 120 to 9213. All models demonstrated an area under the curve (AUC) >0.7. Twenty-three ML algorithms were employed, with logistic regression (LR) being the most frequently used (n = 11), followed by XGBoost (n = 10) and random forests (RF) (n = 9). Thirteen studies utilized various stochastic algorithms. Most studies used Bootstrap or 10-fold cross-validation for internal validation, but lacked external validation, leading to a high overall risk of bias. Key predictors in these models included D-dimer, history of thrombosis, history of hypertension, age, and complications.
Conclusions
Existing evidence suggests that ML models can effectively predict VTE outcomes. However, most models suffer from poor methodological quality, lack of external validation, and limited generalizability. Future research should focus on large-scale, multi-center prospective studies that are based on clinical practice, improve external validation, and develop optimized local VTE risk assessment and decision support tools for better integration into clinical practice.
{"title":"Systematic review of a machine learning model for prediction of venous thromboembolism risk","authors":"Wen-jing Ge , Teng-fei Zhu , Wen-jie Ge , Xin-yi Zhu , Ai-qin Chu","doi":"10.1016/j.thromres.2025.109507","DOIUrl":"10.1016/j.thromres.2025.109507","url":null,"abstract":"<div><h3>Objective</h3><div>This systematic review aims to evaluate the methodological quality, performance, and clinical applicability of machine learning (ML) models for predicting the risk of venous thromboembolism (VTE) in hospitalized patients. Specifically, we aim to assess the methodological quality and reporting transparency of the included studies, with a focus on their risk of bias and adherence to reporting guidelines.</div></div><div><h3>Methods</h3><div>A systematic review by use of the databases Cochrane Library, Web of Science, Embase, PubMed, CNKI, VIP Journal Database, Wanfang Database, and the Chinese Biomedical Literature Database. The study was registered at PROSPERO before data collection and PRISMA guidelines were followed. The search was conducted to identify all relevant studies published from the inception of database up to August 1, 2024. Two independent researchers screened the literature and extracted data. Model quality was assessed using the PROBAST appraisal tool and a modified TRIPOD+AI framework, alongside reported model performance metrics.</div></div><div><h3>Results</h3><div>A total of seventeen studies were included, comprising 65 VTE ML models with sample sizes ranging from 120 to 9213. All models demonstrated an area under the curve (AUC) >0.7. Twenty-three ML algorithms were employed, with logistic regression (LR) being the most frequently used (<em>n</em> = 11), followed by XGBoost (<em>n</em> = 10) and random forests (RF) (<em>n</em> = 9). Thirteen studies utilized various stochastic algorithms. Most studies used Bootstrap or 10-fold cross-validation for internal validation, but lacked external validation, leading to a high overall risk of bias. Key predictors in these models included D-dimer, history of thrombosis, history of hypertension, age, and complications.</div></div><div><h3>Conclusions</h3><div>Existing evidence suggests that ML models can effectively predict VTE outcomes. However, most models suffer from poor methodological quality, lack of external validation, and limited generalizability. Future research should focus on large-scale, multi-center prospective studies that are based on clinical practice, improve external validation, and develop optimized local VTE risk assessment and decision support tools for better integration into clinical practice.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"256 ","pages":"Article 109507"},"PeriodicalIF":3.4,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145419433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-09DOI: 10.1016/j.thromres.2025.109503
Gal Aviel , Bruria Raccah-Hirsh , Rafat Abu-Ghannam , Noa Oren , David Planer , Gabby Elbaz-Greener , Eyal Herzog , Ori Wald , Amit Korach
Background
Traditionally, first-line reperfusion strategy recommendation for patients with hemodynamically significant pulmonary embolism (PE) is systemic thrombolysis (ST). ST is associated with serious adverse events. Surgical embolectomy (SE) and catheter-directed interventions (CDI) are reported to be safe, improve right ventricular (RV) function and survival.
Objectives
To compare the outcomes of patients with hemodynamically significant PE treated with CDI or SE to ST.
Methods
We systematically reviewed studies of patients with intermediate- or high-risk PE that received reperfusion therapy. The primary outcome was in-hospital mortality. Secondary outcomes included major bleeding and right ventricular function. We conducted a network meta-analysis and generated pooled survival curves using approximated individual-level time-to-event data.
Results
Of 4283 studies identified, 15 studies were included in the final analysis involving 1598 patients (CDI = 683 patients, SE = 224, ST = 691), encompassing 3595.5 patient years. A network meta-analysis revealed a significant decrease in early mortality in patients treated with CDI or SE compared to ST (odds-ratio (OR) 0.34, 95 %-confidence interval (CI) 0.17–0.0.68, and OR = 0.37, 95 % CI (0.16–9.85), respectively). Ranking the different therapeutic modalities, CDI had the highest P-score (0.87), followed by SE (0.63), and ST (0.0008). Compared to ST, CDI resulted in less RV dysfunction (OR = 0.28, 95 % CI (0.1–0.76) and a trend for less bleeding complications.
Conclusions
In this study, CDI and SE were associated with superior survival compared to ST in patients with moderate- and high-risk PE. CDI resulted in improved RV function.
Well-designed randomized controlled trials are needed to confirm these findings and inform future guideline recommendations.
传统上，对于血流动力学显著的肺栓塞（PE）患者，一线再灌注策略推荐是全身溶栓（ST）。ST与严重不良事件相关。据报道，外科栓塞切除术（SE）和导管定向干预（CDI）是安全的，可以改善右心室（RV）功能和生存率。目的比较血液动力学意义显著的PE患者接受CDI或SE与st治疗的结果。方法系统回顾了接受再灌注治疗的中高危PE患者的研究。主要终点是住院死亡率。次要结局包括大出血和右心室功能。我们进行了网络荟萃分析，并使用近似的个人水平事件时间数据生成了合并生存曲线。结果在纳入的4283项研究中，最终分析纳入15项研究，涉及1598例患者（CDI = 683例，SE = 224, ST = 691），涵盖3595.5患者年。网络荟萃分析显示，与ST相比，接受CDI或SE治疗的患者早期死亡率显著降低（优势比（or） 0.34, 95%可信区间（CI） 0.17-0.0.68, or = 0.37, 95% CI(0.16-9.85)）。不同治疗方式中，CDI的p值最高（0.87），SE次之（0.63），ST次之（0.0008）。与ST相比，CDI导致的RV功能障碍更少（OR = 0.28, 95% CI(0.1-0.76)），出血并发症也更少。结论：在本研究中，与ST相比，CDI和SE与中高危PE患者的生存率更高。CDI改善了右心室功能。需要精心设计的随机对照试验来证实这些发现，并为未来的指南建议提供信息。
{"title":"Has systemic thrombolysis run its course? A systematic review and network meta-analysis of patients with intermediate- and high-risk pulmonary embolism","authors":"Gal Aviel , Bruria Raccah-Hirsh , Rafat Abu-Ghannam , Noa Oren , David Planer , Gabby Elbaz-Greener , Eyal Herzog , Ori Wald , Amit Korach","doi":"10.1016/j.thromres.2025.109503","DOIUrl":"10.1016/j.thromres.2025.109503","url":null,"abstract":"<div><h3>Background</h3><div>Traditionally, first-line reperfusion strategy recommendation for patients with hemodynamically significant pulmonary embolism (PE) is systemic thrombolysis (ST). ST is associated with serious adverse events. Surgical embolectomy (SE) and catheter-directed interventions (CDI) are reported to be safe, improve right ventricular (RV) function and survival.</div></div><div><h3>Objectives</h3><div>To compare the outcomes of patients with hemodynamically significant PE treated with CDI or SE to ST.</div></div><div><h3>Methods</h3><div>We systematically reviewed studies of patients with intermediate- or high-risk PE that received reperfusion therapy. The primary outcome was in-hospital mortality. Secondary outcomes included major bleeding and right ventricular function. We conducted a network meta-analysis and generated pooled survival curves using approximated individual-level time-to-event data.</div></div><div><h3>Results</h3><div>Of 4283 studies identified, 15 studies were included in the final analysis involving 1598 patients (CDI = 683 patients, SE = 224, ST = 691), encompassing 3595.5 patient years. A network meta-analysis revealed a significant decrease in early mortality in patients treated with CDI or SE compared to ST (odds-ratio (OR) 0.34, 95 %-confidence interval (CI) 0.17–0.0.68, and OR = 0.37, 95 % CI (0.16–9.85), respectively). Ranking the different therapeutic modalities, CDI had the highest P-score (0.87), followed by SE (0.63), and ST (0.0008). Compared to ST, CDI resulted in less RV dysfunction (OR = 0.28, 95 % CI (0.1–0.76) and a trend for less bleeding complications.</div></div><div><h3>Conclusions</h3><div>In this study, CDI and SE were associated with superior survival compared to ST in patients with moderate- and high-risk PE. CDI resulted in improved RV function.</div><div>Well-designed randomized controlled trials are needed to confirm these findings and inform future guideline recommendations.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"255 ","pages":"Article 109503"},"PeriodicalIF":3.4,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145269351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-09DOI: 10.1016/j.thromres.2025.109502
Shuxuan Li , Min Wang , Yongsheng Xu
Objective
Pulmonary infarction (PI) complicating pulmonary embolism (PE) is rarely reported in pediatric populations. This study aimed to identify risk factors associated with PI development and evaluate the diagnostic utility of predictive indicators.
Methods
This retrospective study enrolled patients aged <18 years diagnosed with PE by CTA. Data collected included demographics, medical histories, clinical manifestations, laboratory findings, and imaging results. Patients were assessed using simplified Wells score, simplified revised Geneva score, and Pulmonary Embolism Severity Index. Logistic regression and receiver operating characteristic curves were employed to evaluate risk factors and diagnostic efficacy.
Results
Among 41 pediatric patients diagnosed with PE (26 non-PI vs. 15 PI), 95 % (39/41) showed no signs or history of deep vein thrombosis. The three scoring systems performed poorly in predicting pediatric PE or PI. Features nominally associated with PI (p < 0.05 but q > 0.05) included pleural effusion, maximum temperature, lymphocyte ratio, chest pain, blood urea nitrogen (BUN), neutrophil ratio, maximum D-dimer, leukocyte count, and neutrophil count. Chest pain (aOR = 6.85, p < 0.05), BUN (aOR = 2.77, p = 0.04), and maximum temperature (aOR = 3.83, p = 0.03) were identified as independent risk factors for the occurrence of PI. The logistic regression model for predicting PI (AUC = 0.846) significantly outperformed the simplified Wells model (AUC = 0.640).
Conclusions
In situ pulmonary artery thrombosis represents the primary form of PE in pediatric patients. Chest pain, BUN, and maximum temperature were identified as independent risk factors for the occurrence of PI. The logistic regression model demonstrates excellent efficacy and may serve as a tool for the future development of a PI scoring system.
{"title":"Predictors of pulmonary infarction in pediatric pulmonary embolism: A retrospective cohort study","authors":"Shuxuan Li , Min Wang , Yongsheng Xu","doi":"10.1016/j.thromres.2025.109502","DOIUrl":"10.1016/j.thromres.2025.109502","url":null,"abstract":"<div><h3>Objective</h3><div>Pulmonary infarction (PI) complicating pulmonary embolism (PE) is rarely reported in pediatric populations. This study aimed to identify risk factors associated with PI development and evaluate the diagnostic utility of predictive indicators.</div></div><div><h3>Methods</h3><div>This retrospective study enrolled patients aged <18 years diagnosed with PE by CTA. Data collected included demographics, medical histories, clinical manifestations, laboratory findings, and imaging results. Patients were assessed using simplified Wells score, simplified revised Geneva score, and Pulmonary Embolism Severity Index. Logistic regression and receiver operating characteristic curves were employed to evaluate risk factors and diagnostic efficacy.</div></div><div><h3>Results</h3><div>Among 41 pediatric patients diagnosed with PE (26 non-PI <em>vs.</em> 15 PI), 95 % (39/41) showed no signs or history of deep vein thrombosis. The three scoring systems performed poorly in predicting pediatric PE or PI. Features nominally associated with PI (<em>p</em> < 0.05 but q > 0.05) included pleural effusion, maximum temperature, lymphocyte ratio, chest pain, blood urea nitrogen (BUN), neutrophil ratio, maximum D-dimer, leukocyte count, and neutrophil count. Chest pain (aOR = 6.85, <em>p</em> < 0.05), BUN (aOR = 2.77, <em>p</em> = 0.04), and maximum temperature (aOR = 3.83, <em>p</em> = 0.03) were identified as independent risk factors for the occurrence of PI. The logistic regression model for predicting PI (AUC = 0.846) significantly outperformed the simplified Wells model (AUC = 0.640).</div></div><div><h3>Conclusions</h3><div><em>In situ</em> pulmonary artery thrombosis represents the primary form of PE in pediatric patients. Chest pain, BUN, and maximum temperature were identified as independent risk factors for the occurrence of PI. The logistic regression model demonstrates excellent efficacy and may serve as a tool for the future development of a PI scoring system.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"255 ","pages":"Article 109502"},"PeriodicalIF":3.4,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145293759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.thromres.2025.109471
Kevin Durr , Alexa Ehlebracht , Bram Rochwerg , Shannon M. Fernando , Lauralyn McIntyre , Marc Carrier , Deborah M. Siegal , Rakesh Patel , Salmaan Kanji , David Williamson , Alexandre Tran
{"title":"Anti-Xa Levels with Venous Thromboembolism Prophylaxis in Critical Care: A Systematic Review and Meta-Analysis","authors":"Kevin Durr , Alexa Ehlebracht , Bram Rochwerg , Shannon M. Fernando , Lauralyn McIntyre , Marc Carrier , Deborah M. Siegal , Rakesh Patel , Salmaan Kanji , David Williamson , Alexandre Tran","doi":"10.1016/j.thromres.2025.109471","DOIUrl":"10.1016/j.thromres.2025.109471","url":null,"abstract":"","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"254 ","pages":"Article 109471"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265685","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}
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