Thrombosis Update最新文献

Prothrombin concentrations in middle-aged men and women – stability over time and correlations with cardiovascular risk factors 中年男性和女性凝血酶原浓度-随时间的稳定性及其与心血管危险因素的相关性

Q4 Medicine

Thrombosis Update

Pub Date : 2026-01-14 DOI: 10.1016/j.tru.2026.100233

Bengt Zöller , Mark Jonas Haastrup , Niels Tækker Foged , Gunnar Engström

Background

Prothrombin is a vitamin K-dependent glycoprotein synthesized in the liver and circulating in blood as an inactive zymogen. The corresponding activated thrombin enzyme is a central player in hemostasis and thrombosis. Still, little is known about the individual variation over time of the prothrombin concentration in plasma in the general population.

Objectives

This study aimed to establish the prothrombin plasma level and its correlation with cardiovascular risk factors in the general population.

Methods

A novel aptamer-based electrochemical biosensor, which in a single, direct incubation step and within 5 min quantifies the prothrombin concentration in molar amounts, was used for analysis of plasma samples from 141 non-anticoagulated individuals in the Swedish cardiopulmonary bioimage study (SCAPIS). Plasma samples from baseline and from re-examination after one year of follow-up were tested.

Results

The study population consisted of 141 individuals with a mean age of 57.3 (standard deviation 3.79) years, and 66 (47 %) were females. The mean (±standard deviation) prothrombin concentrations in plasma were 1565 nM (±249) and 1526 nM (±319) at baseline and one-year follow-up, respectively. There was a strong correlation between the individual prothrombin concentration at baseline and one year later, r = 0.658, p < 0.001. Baseline prothrombin plasma levels correlated positively and weakly with weight (r = 0.183, p = 0.030), waist (r = 0.213, p = 0.011), waist-hip-ratio (r = 0.191, p = 0.023), body mass index (r = 0.244, p = 0.004), cholesterol (r = 0.281, p < 0.001), LDL-cholesterol (r = 0.220, p = 0.009), triglycerides (r = 0.257, p = 0.002), and thrombocytes (r = 0.170, p = 0,046).

Conclusions

Plasma levels of prothrombin are stable over time in most individuals and are positively and weakly correlated with cardiovascular risk factors.

凝血酶原是一种依赖维生素k的糖蛋白，在肝脏中合成，作为一种无活性的酶原在血液中循环。相应的活化凝血酶在止血和血栓形成中起着中心作用。尽管如此，人们对普通人群血浆中凝血酶原浓度随时间的个体变化知之甚少。目的探讨普通人群凝血酶原水平及其与心血管危险因素的相关性。方法在瑞典心肺生物图像研究（SCAPIS）中，采用一种新型的基于适体体的电化学生物传感器，该传感器可在5分钟内以摩尔量定量凝血酶原浓度，用于分析141例非抗凝个体的血浆样本。对基线和随访一年后复查的血浆样本进行检测。结果研究人群141例，平均年龄57.3岁（标准差3.79），其中女性66例（47%）。基线和1年随访时血浆凝血酶原浓度均值（±标准差）分别为1565 nM（±249）和1526 nM（±319）。基线时个体凝血酶原浓度与一年后个体凝血酶原浓度有很强的相关性，r = 0.658, p < 0.001。基线凝血酶原血浆水平与体重（r = 0.183, p = 0.030）、腰围（r = 0.213, p = 0.011）、腰臀比（r = 0.191, p = 0.023）、体重指数（r = 0.244, p = 0.004）、胆固醇（r = 0.281, p = 0.001）、低密度脂蛋白胆固醇（r = 0.220, p = 0.009）、甘油三酯（r = 0.257, p = 0.002）、血小板（r = 0.170, p = 0.046）呈正相关或弱相关。结论大多数人血浆凝血酶原水平随时间稳定，且与心血管危险因素呈正相关或弱相关。

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引用次数: 0

Analytical performance of the quantitative point-of-care PATHFAST D-dimer assay 定量护理点PATHFAST d -二聚体测定的分析性能

Q4 Medicine

Thrombosis Update

Pub Date : 2025-12-01 DOI: 10.1016/j.tru.2025.100228

L. Talon , B. Pereira , J. Douxfils , A.F. Sapin , T. Dureng , V. Fourneyron , M. Maugis , S. Senectaire , M. Tardieu , M. Tillier , A. Trapani , A. Trayaud , T. Sinegre , A. Lebreton

Background

In the diagnosis of venous thromboembolism (VTE), the use of point-of-care (POC) D-dimer testing is emerging as a promising alternative to laboratory-based D-dimer assays. These POC devices, easier to use, raise the question of their analytical and clinical performances. We evaluated the analytical performances of the POC Pathfast D-dimer chemiluminescence assay and compared its results with two laboratory-based D-dimer assays: Vidas D-dimer Exclusion II and STA-Liatest D-Di Plus.

Methods

Within- and between-run imprecision were evaluated using low-and high-level quality control plasma samples and healthy controls and patients’ whole blood. Limit of quantification and linearity were determined according to the Clinical and Laboratory Standards Institute (CLSI). Comparisons were performed using the Passing-Bablok and Bland-Altman analysis, using fresh citrated whole blood and plasma samples collected from 150 consecutive routine samples.

Results

The within- and between-run imprecision of the assay did not exceed 4.4 % and 5.8 %, respectively. Our study found higher D-Dimer results with the Pathfast D-dimer assay (whole blood) than with the Vidas D-dimer Exclusion II and STA-Liatest D-Di Plus assays (plasma) with mean bias of 1.16 and 1.20 μg/mL FEU, respectively. Around the most clinically relevant area (<1 μg/mL FEU), bias was smallest, from 0.07 to 0.15 μg/mL FEU.

Conclusion

The Pathfast D-dimer assay is a rapid POC test for determination of D-dimer with good analytical performance. However, these results may be further investigated by a well-designed prospective clinical evaluation in a context of VTE suspicion and appropriate scoring.

背景：在静脉血栓栓塞（VTE）的诊断中，使用护理点（POC） d -二聚体检测正在成为一种有希望的替代实验室为基础的d -二聚体检测的方法。这些POC设备，更容易使用，提出了他们的分析和临床性能的问题。我们评估了POC Pathfast d -二聚体化学发光法的分析性能，并将其结果与两种基于实验室的d -二聚体测定法（Vidas d -二聚体Exclusion II和STA-Liatest D-Di Plus）进行了比较。方法采用低、高质量对照血浆样本、健康对照和患者全血，评价运行内和运行间不精确度。定量限和线性按照临床与实验室标准协会（CLSI）确定。采用Passing-Bablok和Bland-Altman分析进行比较，使用从150个连续常规样本中收集的新鲜柠檬酸全血和血浆样本。结果该方法的运行内和运行间不精密度分别不超过4.4%和5.8%。我们的研究发现，Pathfast d -二聚体检测（全血）的d -二聚体结果高于Vidas d -二聚体排除II和STA-Liatest D-Di Plus检测（血浆），平均偏差分别为1.16和1.20 μg/mL FEU。在与临床最相关的区域（1 μg/mL FEU）附近，偏差最小，在0.07 ~ 0.15 μg/mL FEU之间。结论Pathfast d -二聚体法是一种快速测定d -二聚体的POC方法，具有良好的分析性能。然而，这些结果可以通过在静脉血栓栓塞怀疑和适当评分的背景下设计良好的前瞻性临床评估进一步研究。

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引用次数: 0

Anticoagulation in renal impairment: Indications, clinical profiles, and complications from a colombian high-complexity hospital 抗凝治疗肾损害：指征、临床概况和来自哥伦比亚一家高复杂性医院的并发症

Q4 Medicine

Thrombosis Update

Pub Date : 2025-12-01 DOI: 10.1016/j.tru.2025.100227

Arturo D. Mora , David Alejandro Pantoja , Wikler Bernal Torres , Saulo Andrés Quiñones-Cañaveral , Hoover León-Giraldo , María Camila Naranjo-Ramírez , Clara Isabel Marín Chaves , Judith Andrea Rivas Amaris , Maribel Ñañez Jauregui , Carlos E. Durán-Rebolledo , Juan Esteban Gómez-Mesa

Background

Anticoagulation in patients with renal impairment (RI) carries an increased risk of complications. This study aimed to assess clinical and therapeutic differences among anticoagulated patients across stages of renal dysfunction.

Methods

An observational study was conducted in patients receiving anticoagulation with creatinine clearance <60 mL/min. Based on creatinine clearance, patients were classified as G3a, G3b, G4, or G5. Baseline characteristics, treatment regimens, and complications were evaluated.

Results

A total of 802 patients were included in the study (median age 79.5 years [IQR 70.1–86.5]; 53.2 % female): G3a (n = 418), G3b (n = 244), G4 (n = 100), and G5 (n = 40). Among atrial fibrillation (AF) patients (n = 314), direct oral anticoagulants (DOAC) were preferred, with apixaban the most frequently used therapy; reduced-dose regimens predominated in advanced RI (G4: 65.8 %, G5: 94.4 %). In venous thromboembolism (VTE) patients (n = 294), low-molecular-weight heparin (LMWH) was the predominant therapy (70.6 % in G5). For other indications (n = 181), LMWH and warfarin were the most frequently used. Hemorrhagic events occurred in 78 patients (10.1 %), including 36 patients with major bleeds (4.5 %), numerically higher rates in were found in G4–G5. Thromboembolic events were observed in 36 patients (4.9 %), mainly cerebral ischemia. The overall cohort showed a median HASBLED score of 3, consistent with a high bleeding risk.

Conclusion

In RI patients, DOAC were preferred in the AF group, often at reduced doses in advanced stages, whereas LMWH was mostly used for VTE. This elderly, multimorbid population showed high bleeding and thrombotic event rates, underscoring the need for individualized anticoagulant strategies and close monitoring.

背景：肾损害（RI）患者的抗凝治疗会增加并发症的风险。本研究旨在评估不同阶段肾功能不全患者抗凝治疗的临床和治疗差异。方法对肌酐清除率≤60 mL/min的抗凝治疗患者进行观察性研究。根据肌酐清除率，将患者分为G3a、G3b、G4和G5。评估基线特征、治疗方案和并发症。结果共纳入802例患者（中位年龄79.5岁[IQR 70.1 ~ 86.5]，女性占53.2%）：G3a （n = 418）、G3b （n = 244）、G4 （n = 100）、G5 （n = 40）。在房颤（AF）患者（n = 314）中，首选直接口服抗凝剂（DOAC），阿哌沙班是最常用的治疗方法；减少剂量方案在晚期RI中占主导地位（G4: 65.8%, G5: 94.4%）。在静脉血栓栓塞（VTE）患者（n = 294）中，低分子肝素（LMWH）是主要的治疗方法（G5中占70.6%）。对于其他适应症（n = 181），低分子肝素和华法林是最常用的。78例（10.1%）患者发生出血事件，其中36例（4.5%）为大出血，G4-G5的发生率较高。36例（4.9%）患者发生血栓栓塞事件，主要是脑缺血。整个队列的HASBLED评分中位数为3分，与出血风险高一致。结论在房颤患者中，DOAC优先用于房颤组，通常在晚期减少剂量，而低分子肝素主要用于静脉血栓栓塞。这些老年、多病人群显示出高出血和血栓事件发生率，强调了个体化抗凝策略和密切监测的必要性。

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引用次数: 0

Primary antiphospholipid syndrome and severe mental illness: preliminary results of a long-term case-control study 原发性抗磷脂综合征与严重精神疾病：一项长期病例对照研究的初步结果

Q4 Medicine

Thrombosis Update

Pub Date : 2025-12-01 DOI: 10.1016/j.tru.2025.100226

Silvia Hoirisch-Clapauch , Antonio E. Nardi

Background

Lupus anticoagulant, multiple or high-titer antiphospholipid antibodies identify patients at high risk of thrombosis and obstetric complications. We aimed to determine whether this antibody profile also increases the risk of severe mental illness (SMI).

Methods

This study included 34 adults with primary antiphospholipid syndrome (APS), regularly screened for mental disorders for at least 5 years. Data from 19 APS + SMI patients without cerebral ischemia were compared with those of 15 APS controls never diagnosed with SMI.

Results

Of the 12 APS + SMI who experienced psychosis, four were treatment-resistant. Four patients experienced severe unipolar depression, two of them were treatment-resistant. Fourteen were highly impulsive, ten of them also had psychosis or severe unipolar depression. Sixteen APS + SMI individuals and nine controls had lupus anticoagulant (RR: 1.4; 95% CI: 0.8-2.2). Thirteen APS + SMI and none of the controls had multiple antibodies (RR: 21; 95% CI: 1.3-336). Ten APS + SMI and one control had either a strong lupus anticoagulant, i.e. dRVVT ≥ 2 or anticardiolipin/anti-β2-glycoprotein I antibody titers ≥ 80 GPL/MPL, range 80–314 GPL/MPL (RR: 7; 95% CI: 1.1-54). The APS + SMI group had more venous or arterial thrombosis per subject than the control group (1.5 vs 0.8). The frequency of obstetric complications was similar in both groups.

Conclusion

Our preliminary results suggest that patients with multiple or high-titer antiphospholipid antibodies are at high risk of psychosis, severe depression, and/or high impulsivity. Future studies are needed to establish the role of antibody-reduction protocols in SMI associated with antiphospholipid antibodies, especially in patients resistant to standard treatment.

狼疮抗凝血、多重或高滴度抗磷脂抗体可识别血栓和产科并发症高危患者。我们的目的是确定这种抗体谱是否也会增加严重精神疾病（SMI）的风险。方法本研究纳入34例患有原发性抗磷脂综合征（APS）的成年人，定期筛查精神障碍至少5年。19例无脑缺血的APS + SMI患者的数据与15例未诊断为SMI的APS对照进行比较。结果12例APS + SMI患者出现精神病，4例出现治疗抵抗。4名患者经历了严重的单极抑郁症，其中2名患者治疗抵抗。其中14人高度冲动，10人同时患有精神病或严重的单极抑郁症。16例APS + SMI患者和9例对照组使用狼疮抗凝剂（RR: 1.4; 95% CI: 0.8-2.2）。13例APS + SMI患者和对照组均无多种抗体（RR: 21; 95% CI: 1.3-336）。10例APS + SMI患者和1例对照患者具有强狼疮抗凝剂，即dRVVT≥2或抗心磷脂/抗β2-糖蛋白I抗体滴度≥80 GPL/MPL，范围为80 - 314 GPL/MPL （RR: 7; 95% CI: 1.1-54）。APS + SMI组的静脉或动脉血栓发生率高于对照组（1.5 vs 0.8）。两组的产科并发症发生率相似。结论多重或高滴度抗磷脂抗体患者出现精神病、重度抑郁和/或高冲动性的风险较高。未来的研究需要确定抗体减少方案在与抗磷脂抗体相关的SMI中的作用，特别是在对标准治疗有抵抗力的患者中。

{"title":"Primary antiphospholipid syndrome and severe mental illness: preliminary results of a long-term case-control study","authors":"Silvia Hoirisch-Clapauch , Antonio E. Nardi","doi":"10.1016/j.tru.2025.100226","DOIUrl":"10.1016/j.tru.2025.100226","url":null,"abstract":"<div><h3>Background</h3><div>Lupus anticoagulant, multiple or high-titer antiphospholipid antibodies identify patients at high risk of thrombosis and obstetric complications. We aimed to determine whether this antibody profile also increases the risk of severe mental illness (SMI)<em>.</em></div></div><div><h3>Methods</h3><div>This study included 34 adults with primary antiphospholipid syndrome (APS), regularly screened for mental disorders for at least 5 years. Data from 19 APS + SMI patients without cerebral ischemia were compared with those of 15 APS controls never diagnosed with SMI<em>.</em></div></div><div><h3>Results</h3><div>Of the 12 APS + SMI who experienced psychosis, four were treatment-resistant. Four patients experienced severe unipolar depression, two of them were treatment-resistant. Fourteen were highly impulsive, ten of them also had psychosis or severe unipolar depression. Sixteen APS + SMI individuals and nine controls had lupus anticoagulant (RR: 1.4; 95% CI: 0.8-2.2). Thirteen APS + SMI and none of the controls had multiple antibodies (RR: 21; 95% CI: 1.3-336). Ten APS + SMI and one control had either a strong lupus anticoagulant, i.e. dRVVT ≥ 2 or anticardiolipin/anti-β2-glycoprotein I antibody titers ≥ 80 GPL/MPL, range 80–314 GPL/MPL (RR: 7; 95% CI: 1.1-54). The APS + SMI group had more venous or arterial thrombosis per subject than the control group (1.5 vs 0.8). The frequency of obstetric complications was similar in both groups.</div></div><div><h3>Conclusion</h3><div>Our preliminary results suggest that patients with multiple or high-titer antiphospholipid antibodies are at high risk of psychosis, severe depression, and/or high impulsivity. Future studies are needed to establish the role of antibody-reduction protocols in SMI associated with antiphospholipid antibodies, especially in patients resistant to standard treatment.</div></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"21 ","pages":"Article 100226"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Antiphospholipid antibodies and psyche 抗磷脂抗体和心理

Q4 Medicine

Thrombosis Update

Pub Date : 2025-12-01 DOI: 10.1016/j.tru.2025.100231

Emmanouil S. Papadakis, Lucy A. Norris

引用次数: 0

Sex differences in clinical characteristics, management, and outcomes in patients with venous thromboembolism in the direct oral anticoagulant era: Insight from the COMMAND VTE Registry-2 直接口服抗凝剂时代静脉血栓栓塞患者临床特征、管理和结局的性别差异：来自命令静脉血栓栓塞登记的见解-2

Q4 Medicine

Thrombosis Update

Pub Date : 2025-12-01 DOI: 10.1016/j.tru.2025.100229

Takahiro Kuno , Norimichi Koitabashi , Yugo Yamashita , Takeshi Morimoto , Yoshiaki Ohyama , Noriaki Takama , Masaru Obokata , Ryuki Chatani , Kazuhisa Kaneda , Yuji Nishimoto , Nobutaka Ikeda , Yohei Kobayashi , Satoshi Ikeda , Kitae Kim , Moriaki Inoko , Toru Takase , Shuhei Tsuji , Maki Oi , Takuma Takada , Kazunori Otsui , Takeshi Kimura

Introduction

Sex-specific differences in the prognosis of venous thromboembolism (VTE) remain controversial, particularly in the current era of widespread use of direct oral anticoagulants. Real-world management and outcomes of VTE stratified by sex were investigated in a nationwide registry.

Methods

The COMMAND VTE Registry-2 is a multicenter registry that enrolled 5197 consecutive acute symptomatic VTE patients from 31 centers in Japan between January 2015 and August 2020. In this cohort, baseline characteristics, anticoagulation strategies, and long-term clinical outcomes were compared between men and women. Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios for clinical outcomes.

Results

The study population consisted of 2134 men (41.1 %) and 3063 women (58.9 %). Compared with women, men were younger (mean age ± standard deviation, 66.1 ± 14.7 vs. 68.9 ± 16.2 years, P < 0.001), more frequently had active cancer (31.1 % vs. 27.6 %, P = 0.006), and were less likely to present with transient risk factors (32.4 % vs. 40.5 %, P < 0.001). Pulmonary embolism was more common in men (56.7 % vs. 51.5 %, P < 0.001). There were no significant differences in the cumulative 5-year incidences of recurrent VTE or major bleeding between men and women (7.3 % vs. 7.8 %, P = 0.77; 10.8 % vs. 12.4 %, P = 0.20). Although the incidence of all-cause death was higher in men (34.5 % vs. 30.6 %, P = 0.02), this difference was not significant after multivariable adjustment (hazard ratio 1.05, 95 % confidence interval 0.94–1.17, P = 0.39).

Conclusion

In this large, multicenter registry, sex was not associated with recurrent thrombosis, major bleeding, or long-term mortality after multivariable adjustment.

静脉血栓栓塞（VTE）预后的性别差异仍然存在争议，特别是在目前广泛使用直接口服抗凝剂的时代。在全国范围内对静脉血栓栓塞的实际管理和按性别分层的结果进行调查。COMMAND VTE registry -2是一项多中心注册，在2015年1月至2020年8月期间，从日本31个中心招募了5197名连续急性症状性VTE患者。在这个队列中，比较了男性和女性的基线特征、抗凝策略和长期临床结果。多变量Cox比例风险模型用于估计临床结果的校正风险比。结果研究人群中男性2134人（41.1%），女性3063人（58.9%）。与女性相比，男性更年轻（平均年龄±标准差，66.1±14.7岁对68.9±16.2岁，P < 0.001），更频繁地患有活动性癌症（31.1%对27.6%,P = 0.006），并且更不可能出现短暂的危险因素（32.4%对40.5%,P < 0.001）。肺栓塞在男性中更为常见（56.7%比51.5%,P < 0.001）。在静脉血栓栓塞复发或大出血的5年累积发生率方面，男女之间没有显著差异（7.3%比7.8%,P = 0.77； 10.8%比12.4%,P = 0.20）。尽管男性的全因死亡发生率较高（34.5%比30.6%,P = 0.02），但多变量调整后差异不显著（风险比1.05,95%可信区间0.94-1.17,P = 0.39）。结论：在这项大型、多中心的研究中，性别与血栓复发、大出血或多变量调整后的长期死亡率无关。

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引用次数: 0

A scoping review protocol on active drug monitoring of direct oral anticoagulants on vulnerable patient groups to detect potential adverse risks 针对弱势患者群体直接口服抗凝药物的活性药物监测以发现潜在不良风险的范围审查方案

Q4 Medicine

Thrombosis Update

Pub Date : 2025-09-04 DOI: 10.1016/j.tru.2025.100223

Rebecca Vicente-Steijn , Janneke Spiegelenberg , Sanna R. Rijpma , Yvonne M.C. Henskens , Jenneke Leentjens , Gabriëlle Ponjee , An Stroobants

Background

Emerging data show an increased risk of adverse effects (thrombotic or bleeding events) in patients using the direct oral anticoagulants (DOAC) rivaroxaban, apixaban, edoxaban and dabigatran. Although DOAC are prescribed with a fixed-dose and generally do not require routine drug-level monitoring, certain clinical circumstances may require drug-level monitoring to prevent or manage adverse drug effects. Currently, there is limited evidence whether drug-level monitoring is beneficial for specific patient population or clinical circumstances, and the lack of a specific therapeutic window is a huge knowledge gap in clinical practice.

Methods

A systematic search of the electronic database Pubmed (including MEDLINE) will be conducted to identify studies on active drug monitoring of DOAC to detect potential adverse events such as bleeding or thrombotic complications. At least two investigators will independently perform a two-stage study selection of the identified studies. The first stage will consist of title and abstract screening while the second stage will consist of a full-text review followed by data extraction. Once completed, a thematic analysis will be conducted to evaluate whether drug-monitoring is beneficial for specific clinical circumstances or at risk patient populations and initial inventory of clinical guidance opportunities by applying target concentrations in DOAC monitoring.

Conclusion

We anticipate that this review will summarize available data on monitoring of DOACs used in clinical practice and provide evidence of patients at risk of adverse effects. When available, the application of specific target concentrations for guidance of DOAC treatment for the identified patient populations will be summarized. Addressing this knowledge gap will help guide the development of future clinical trials on monitoring strategies for high risk patients using DOAC.

新出现的数据显示，使用直接口服抗凝剂（DOAC）利伐沙班、阿哌沙班、依多沙班和达比加群的患者出现不良反应（血栓或出血事件）的风险增加。虽然DOAC处方为固定剂量，通常不需要常规药物水平监测，但某些临床情况可能需要药物水平监测，以预防或管理药物不良反应。目前，药物水平监测是否对特定患者群体或临床情况有益的证据有限，缺乏特定的治疗窗口是临床实践中巨大的知识缺口。方法系统检索Pubmed（包括MEDLINE）电子数据库，筛选DOAC活性药物监测的研究，以发现出血或血栓形成并发症等潜在不良事件。至少有两名研究者将独立地对确定的研究进行两阶段的研究选择。第一阶段将包括标题和摘要筛选，第二阶段将包括全文审查，然后提取数据。一旦完成，将进行专题分析，以评估药物监测是否有利于特定临床情况或高危患者人群，并通过在DOAC监测中应用目标浓度来初步盘点临床指导机会。结论本综述将总结临床实践中使用的doac监测的现有数据，并提供患者存在不良反应风险的证据。在可用的情况下，将总结用于指导DOAC治疗的特定目标浓度对确定的患者群体的应用。解决这一知识差距将有助于指导未来使用DOAC的高风险患者监测策略的临床试验的发展。

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引用次数: 0

Thrombophilia in women undergoing medically assisted reproduction – prevalence and clinical consequence 接受医学辅助生殖的妇女的血栓病——患病率和临床后果

Q4 Medicine

Thrombosis Update

Pub Date : 2025-09-01 DOI: 10.1016/j.tru.2025.100222

Jesper Strandberg , Anne-Mette Hvas , Jurgita Janukonyté , Søren Risom Kristensen , Ulrik Schiøler Kesmodel , Anette Tarp Hansen

Introduction

In Denmark, 10 % of new-borns are being conceived with the aid of medically assisted reproduction (MAR). MAR can imply induction of high levels of oestradiol, which in turn leads to increased coagulation activity, decreased natural anticoagulant activity, and reduced fibrinolytic activity. Venous thromboembolism (VTE) is therefore a feared complication, especially in women with other risk factors for VTE, such as family history of VTE, previous VTE, or thrombophilia. Thrombophilia screening is advised in women with clinical risk factors of VTE prior to undergoing MAR. Women with thrombophilia should be handled according to current thrombosis prophylaxis guidelines.

Aim

The aim of this study was to investigate the prevalence of thrombophilia in women undergoing MAR compared to the general population, to get an overview of the clinical consequences for women with thrombophilia, and to ensure that the national recommendations regarding thrombophilia screening, are being complied with.

Materials and methods

A total of 160 women referred from three public fertility clinics, from 1 May 2015 to 1 May 2020, for thrombophilia investigation prior to MAR, were included. Thrombophilia analyses included both the genetic factors and acquired factors.

Results

A higher prevalence of heterozygous factor V Leiden (14 %) and protein S deficiency (2 %) was found in our study population as compared with the general Western population.

Conclusion

We found a higher prevalence of some thrombophilias in women referred to MAR.

在丹麦，10%的新生儿是在医学辅助生殖（MAR）的帮助下怀孕的。MAR可能暗示诱导高水平雌二醇，这反过来导致凝血活性增加，天然抗凝血活性降低，纤溶活性降低。因此，静脉血栓栓塞（VTE）是一种令人恐惧的并发症，特别是对于有其他静脉血栓栓塞危险因素的女性，如静脉血栓栓塞家族史、既往静脉血栓栓塞或血栓倾向。建议有静脉血栓栓塞临床危险因素的妇女在接受静脉血栓栓塞治疗前进行血栓筛查。患有血栓栓塞的妇女应按照目前的血栓预防指南进行治疗。目的：本研究的目的是调查与普通人群相比，接受MAR的女性血栓形成的患病率，对血栓形成女性的临床后果进行概述，并确保国家关于血栓形成筛查的建议得到遵守。材料和方法纳入2015年5月1日至2020年5月1日从三家公共生育诊所转介的160名妇女，在MAR之前进行血栓性疾病调查。血栓形成分析包括遗传因素和获得性因素。结果与西方普通人群相比，本研究人群的杂合因子V Leiden患病率（14%）和蛋白S缺乏症（2%）较高。结论：我们发现一些血栓性疾病在被称为MAR的女性中有较高的患病率。

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引用次数: 0

The risk of venous thromboembolism behind bars 狱中静脉血栓栓塞的风险

Q4 Medicine

Thrombosis Update

Pub Date : 2025-09-01 DOI: 10.1016/j.tru.2025.100224

Lucy A. Norris, Emmanouil S. Papadakis (Editors in chief)

引用次数: 0

Impacts of the carceral environment on autopsy-verified venous thromboembolism mortality 癌症环境对尸检证实的静脉血栓栓塞死亡率的影响

Q4 Medicine

Thrombosis Update

Pub Date : 2025-08-14 DOI: 10.1016/j.tru.2025.100221

Lisette Valenzuela , Muryam Hasan , Nikolas Brandt , Amy Woods , Shamsher Samra , Nona Bhatia , Nicholas Shapiro

Venous thromboembolism (VTE), encompassing deep vein thrombosis and pulmonary embolism, is a leading cause of mortality globally, with increasing incidence in the United States. However, no studies have examined VTE risk factors in carceral settings. This study evaluates VTE-related deaths in jailed and non-jailed populations in Los Angeles County over 16 years (2008–2023). Using death records, we compiled two datasets: one for deaths in Los Angeles County jails (n = 512) and another for deaths in the free population (n = 107,608). VTE cases were identified through keyword searches and reviewed for diagnostic consistency. Statistical analyses compared mortality rates and demographics, and a qualitative review of jailed VTE decedent autopsy records was conducted to identify risk factors linked to incarceration. VTE-related deaths in the jailed population were over three times higher than in the free population (3.5 % vs. 1.1 %, p = 0.0014). Crude mortality rates in jails have risen since 2014, peaking in 2021. Black individuals, while comprising 7.9 % of the county population and 29.4 % of the jail population, accounted for 66.67 % of VTE deaths in jails, highlighting exacerbated racial disparities. Structural and environmental factors in carceral settings, including restricted mobility, antipsychotic medication use, and restraints, likely contribute to elevated risks. Improving restraint use reporting and post-mortem toxicology findings for pulmonary embolism deaths can enhance etiology understanding. Diversion programs for mental health populations and other decarceral approaches, alongside anticoagulant prescriptions, could mitigate VTE risks and reduce health inequities in incarcerated populations.

静脉血栓栓塞（VTE），包括深静脉血栓形成和肺栓塞，是全球死亡的主要原因，在美国发病率不断上升。然而，没有研究检查静脉血栓栓塞的危险因素在癌症环境。本研究评估了洛杉矶县16年间（2008-2023年）监狱和非监狱人口中与vte相关的死亡。使用死亡记录，我们编制了两个数据集：一个用于洛杉矶县监狱的死亡（n = 512），另一个用于自由人口的死亡（n = 107,608）。通过关键词搜索确定静脉血栓栓塞病例，并对诊断一致性进行审查。统计分析比较了死亡率和人口统计数据，并对被监禁的静脉血栓栓塞死者的尸检记录进行了定性审查，以确定与监禁有关的风险因素。被监禁人群中与静脉血栓栓塞相关的死亡率是自由人群的三倍多（3.5%对1.1%,p = 0.0014）。监狱中的粗死亡率自2014年以来一直在上升，并在2021年达到峰值。黑人虽然占该县人口的7.9%和监狱人口的29.4%，但占监狱中静脉血栓栓塞死亡人数的66.67%，突出表明种族差异加剧。监狱环境中的结构和环境因素，包括活动受限、抗精神病药物的使用和约束，可能导致风险升高。改善肺栓塞死亡的约束使用报告和尸检毒理学结果可以加强对病因学的了解。针对精神健康人群的分流计划和其他decaral方法，以及抗凝药物处方，可以降低静脉血栓栓塞的风险，减少监禁人群的健康不平等。

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