首页 > 最新文献

Thrombosis Update最新文献

英文 中文
Novel method for pulmonary embolism prognosis: Right to left ventricular volume ratio (RLVR) on pulmonary angiography (CTPA) 肺栓塞预后的新方法:肺动脉造影(CTPA)右左心室容积比(RLVR)
Q4 Medicine Pub Date : 2025-06-01 Epub Date: 2025-03-05 DOI: 10.1016/j.tru.2025.100203
Aykut Yucal, Mustafa Burak Sayhan

Introduction

Right ventricular dysfunction is the main cause of mortality in patients with acute massive pulmonary embolism (PE) and early diagnosis is extremely important. This study aimed to investigate whether the right/left ventricular volume ratio (RLVR) calculated using pulmonary angiography (CTPA) is a valuable tool for PE prognosis.

Method

Clinical, echocardiographic and pulmonary angiography data of cases diagnosed with pulmonary embolism in the emergency department between January 2021 and December 2023 were retrospectively evaluated. Patients were stratified according to the presence of massive PE, one month mortality and pulmonary embolism severity index (PESI) score. Clinical, laboratory and radiographic parameters were compared to search for prognostic factors.

Results

Of the 210 patients, the mean age was 67 ± 15 years, 46 % were male, and 42 % had massive PE. The right/left ventricular volume ratio was significantly higher in patients with massive PE, in those who died within one month after admission; and in patients with PESI Class III. When the cut-off value of right/left ventricular volume ratio was accepted as >1.7, its predictive value for acute PE mortality was higher than other CTPA and echocardioraphy measurements (AUC = 0.706).

Conclusion

An increased right/left ventricular volume ratio on CTPA, a valuable tool for diagnosing right ventricular dysfunction, is associated with a worse prognosis in subjects with pulmonary thromboembolism.
摘要右室功能障碍是急性大面积肺栓塞(PE)患者死亡的主要原因,早期诊断至关重要。本研究旨在探讨肺动脉造影(CTPA)计算的右/左心室容积比(RLVR)是否为PE预后的有价值的工具。方法回顾性分析2021年1月至2023年12月急诊诊断为肺栓塞病例的临床、超声心动图和肺动脉造影资料。根据是否存在大量肺栓塞、1个月死亡率和肺栓塞严重程度指数(PESI)评分对患者进行分层。临床,实验室和影像学参数进行比较,以寻找预后因素。结果210例患者平均年龄为67±15岁,男性占46%,有大量PE的占42%。在入院后1个月内死亡的大量PE患者中,右/左心室容积比明显更高;以及PESI III类患者。当接受右/左心室容积比临界值为>;1.7时,其对急性PE死亡率的预测价值高于其他CTPA和超声心动图测量值(AUC = 0.706)。结论CTPA右/左心室容积比升高与肺血栓栓塞患者预后不良相关,CTPA是诊断右室功能障碍的重要工具。
{"title":"Novel method for pulmonary embolism prognosis: Right to left ventricular volume ratio (RLVR) on pulmonary angiography (CTPA)","authors":"Aykut Yucal,&nbsp;Mustafa Burak Sayhan","doi":"10.1016/j.tru.2025.100203","DOIUrl":"10.1016/j.tru.2025.100203","url":null,"abstract":"<div><h3>Introduction</h3><div>Right ventricular dysfunction is the main cause of mortality in patients with acute massive pulmonary embolism (PE) and early diagnosis is extremely important. This study aimed to investigate whether the right/left ventricular volume ratio (RLVR) calculated using pulmonary angiography (CTPA) is a valuable tool for PE prognosis.</div></div><div><h3>Method</h3><div>Clinical, echocardiographic and pulmonary angiography data of cases diagnosed with pulmonary embolism in the emergency department between January 2021 and December 2023 were retrospectively evaluated. Patients were stratified according to the presence of massive PE, one month mortality and pulmonary embolism severity index (PESI) score. Clinical, laboratory and radiographic parameters were compared to search for prognostic factors.</div></div><div><h3>Results</h3><div>Of the 210 patients, the mean age was 67 ± 15 years, 46 % were male, and 42 % had massive PE. The right/left ventricular volume ratio was significantly higher in patients with massive PE, in those who died within one month after admission; and in patients with PESI Class III. When the cut-off value of right/left ventricular volume ratio was accepted as &gt;1.7, its predictive value for acute PE mortality was higher than other CTPA and echocardioraphy measurements (AUC = 0.706).</div></div><div><h3>Conclusion</h3><div>An increased right/left ventricular volume ratio on CTPA, a valuable tool for diagnosing right ventricular dysfunction, is associated with a worse prognosis in subjects with pulmonary thromboembolism.</div></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"19 ","pages":"Article 100203"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143680422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Optimizing end of life care in cancer Patients. Focus on antithrombotic treatment 优化癌症患者的临终关怀。关注抗血栓治疗
Q4 Medicine Pub Date : 2025-06-01 Epub Date: 2025-06-07 DOI: 10.1016/j.tru.2025.100213
Emmanouil S. Papadakis, Lucy A. Norris
{"title":"Optimizing end of life care in cancer Patients. Focus on antithrombotic treatment","authors":"Emmanouil S. Papadakis,&nbsp;Lucy A. Norris","doi":"10.1016/j.tru.2025.100213","DOIUrl":"10.1016/j.tru.2025.100213","url":null,"abstract":"","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"19 ","pages":"Article 100213"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144297415","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
Efficacy of oral aspirin in prevention of embolic events in infective endocarditis: A systematic review and meta analysis 口服阿司匹林预防感染性心内膜炎栓塞事件的疗效:一项系统综述和meta分析
Q4 Medicine Pub Date : 2025-06-01 Epub Date: 2025-05-03 DOI: 10.1016/j.tru.2025.100208
Jonathan Victor Salazar-Ore , Angie Carolina Alonso-Ramírez , Gabriela Vanessa Flores-Monar , Emily Patricia Solarte-Zabaleta , Miguel Ángel Castaneda-Diaz , Ada Lizandra Motino-Villanueva , Anuj Manish-Kakkad , Camila Sanchez-Cruz , Ernesto Calderón-Martínez

Introduction

Infective endocarditis (IE) involves inflammation of the heart's inner lining and valves, leading to complications like embolic events. The role of aspirin in preventing these events is controversial, with concerns about bleeding risk, limiting its use. This meta-analysis evaluates the effectiveness of oral aspirin in preventing embolic events and its adverse outcomes in IE patients.

Methods

A systematic search was conducted on July 20, 2024, across PubMed/MEDLINE, Cochrane, Scopus, Web of Science, EMBASE, and CINAHL for studies comparing aspirin to placebo or no treatment. The protocol was registered in PROSPERO (CRD42024573274).

Results

Five studies involving 1174 participants were included, with three eligible for meta-analysis due to data limitations. Findings on embolic event incidence were inconsistent: one randomized clinical trial (RCT) excluding prior aspirin therapy (OR 1.62, [0.68–3.86], p = 0.29) and a reanalysis examining long-term use (OR 0.80, [0.36–1.78], p = 0.582) found no significant reduction, while another study reported a possible reduction (OR 0.65, [0.43–0.98], p = 0.04). Bleeding rates trended higher in aspirin groups across two studies, though not statistically significant. Mortality data also varied; one study found higher mortality in aspirin users, while another associated chronic antiplatelet therapy with lower mortality, particularly with early initiation after admission.

Conclusion

Aspirin may reduce embolic events in IE, but evidence remains inconclusive due to mixed findings. Aspirin showed a non-significant increase in bleeding risk and mortality, so routine use for embolic prevention in IE is not recommended, highlighting the need for further research to clarify its potential role.
感染性心内膜炎(IE)涉及心脏内膜和瓣膜的炎症,可导致栓塞事件等并发症。阿司匹林在预防这些事件中的作用是有争议的,由于担心出血风险,限制了它的使用。本荟萃分析评估了口服阿司匹林在预防IE患者栓塞事件及其不良后果方面的有效性。方法于2024年7月20日在PubMed/MEDLINE、Cochrane、Scopus、Web of Science、EMBASE和CINAHL上进行系统检索,比较阿司匹林与安慰剂或不治疗的研究。该协议已在PROSPERO (CRD42024573274)中注册。结果纳入5项研究,涉及1174名受试者,其中3项由于数据限制符合meta分析。栓塞事件发生率的研究结果不一致:一项不包括既往阿司匹林治疗的随机临床试验(RCT) (OR 1.62, [0.68-3.86], p = 0.29)和一项检查长期使用阿司匹林的再分析(OR 0.80, [0.36-1.78], p = 0.582)未发现显著降低,而另一项研究报告可能降低(OR 0.65, [0.43-0.98], p = 0.04)。在两项研究中,阿司匹林组的出血率呈上升趋势,尽管没有统计学意义。死亡率数据也各不相同;一项研究发现阿司匹林使用者死亡率较高,而另一项研究发现慢性抗血小板治疗死亡率较低,特别是入院后早期开始治疗。结论:阿司匹林可能减少IE患者的栓塞事件,但由于研究结果不一,证据仍不确定。阿司匹林显示出血风险和死亡率无显著增加,因此不建议常规使用阿司匹林预防IE栓塞,强调需要进一步研究以阐明其潜在作用。
{"title":"Efficacy of oral aspirin in prevention of embolic events in infective endocarditis: A systematic review and meta analysis","authors":"Jonathan Victor Salazar-Ore ,&nbsp;Angie Carolina Alonso-Ramírez ,&nbsp;Gabriela Vanessa Flores-Monar ,&nbsp;Emily Patricia Solarte-Zabaleta ,&nbsp;Miguel Ángel Castaneda-Diaz ,&nbsp;Ada Lizandra Motino-Villanueva ,&nbsp;Anuj Manish-Kakkad ,&nbsp;Camila Sanchez-Cruz ,&nbsp;Ernesto Calderón-Martínez","doi":"10.1016/j.tru.2025.100208","DOIUrl":"10.1016/j.tru.2025.100208","url":null,"abstract":"<div><h3>Introduction</h3><div>Infective endocarditis (IE) involves inflammation of the heart's inner lining and valves, leading to complications like embolic events. The role of aspirin in preventing these events is controversial, with concerns about bleeding risk, limiting its use. This meta-analysis evaluates the effectiveness of oral aspirin in preventing embolic events and its adverse outcomes in IE patients.</div></div><div><h3>Methods</h3><div>A systematic search was conducted on July 20, 2024, across PubMed/MEDLINE, Cochrane, Scopus, Web of Science, EMBASE, and CINAHL for studies comparing aspirin to placebo or no treatment. The protocol was registered in PROSPERO (CRD42024573274).</div></div><div><h3>Results</h3><div>Five studies involving 1174 participants were included, with three eligible for meta-analysis due to data limitations. Findings on embolic event incidence were inconsistent: one randomized clinical trial (RCT) excluding prior aspirin therapy (OR 1.62, [0.68–3.86], p = 0.29) and a reanalysis examining long-term use (OR 0.80, [0.36–1.78], p = 0.582) found no significant reduction, while another study reported a possible reduction (OR 0.65, [0.43–0.98], p = 0.04). Bleeding rates trended higher in aspirin groups across two studies, though not statistically significant. Mortality data also varied; one study found higher mortality in aspirin users, while another associated chronic antiplatelet therapy with lower mortality, particularly with early initiation after admission.</div></div><div><h3>Conclusion</h3><div>Aspirin may reduce embolic events in IE, but evidence remains inconclusive due to mixed findings. Aspirin showed a non-significant increase in bleeding risk and mortality, so routine use for embolic prevention in IE is not recommended, highlighting the need for further research to clarify its potential role.</div></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"19 ","pages":"Article 100208"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144088817","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
Antithrombin supplementation to prevent venous thromboembolism: A case of hereditary antithrombin deficiency with increased antithrombin clearance during pregnancy and peripartum 补充抗凝血酶预防静脉血栓栓塞:一例遗传性抗凝血酶缺乏症在妊娠和围产期抗凝血酶清除率增高
Q4 Medicine Pub Date : 2025-06-01 Epub Date: 2025-05-20 DOI: 10.1016/j.tru.2025.100211
Ayako Kaneda-Takeuchi , Tomoaki Oda , Mei Kitamoto , Emiyu Fujiwara , Kenta Kawai , Megumi Narumi , Yoshimasa Horikoshi , Masako Matsumoto , Yukiko Kohmura-Kobayashi , Naomi Furuta-Isomura , Toshiyuki Uchida , Kazunao Suzuki , Naohiro Kanayama , Hiroaki Itoh , Naoaki Tamura
Hereditary antithrombin deficiency (HATD) is an autosomal dominant disorder that significantly increases the risk of venous thromboembolism (VTE) during pregnancy. Based on our experience with three previous cases and the Japanese clinical guidelines, we manage high-risk VTE in pregnant women with HATD using unfractionated heparin (UFH) and antithrombin (AT) supplementation from early pregnancy to the peripartum period. Herein, we report another case of HATD type 1 in pregnancy and evaluate changes in AT clearance. A 29-year-old woman had a history of pulmonary embolism (PE) at 14 years and a family history of HATD with AT activity of 47 % at baseline, which decreased to 31 % when she developed PE after an abortion. During her second pregnancy, she was treated with UFH and AT concentrate (ATC) with doses increasing from 50 to 100 IU/kg to achieve target AT activity levels of 50–60 % throughout pregnancy and 70 % during delivery. She delivered a healthy male infant at 39 weeks of gestation. She started to take warfarin on postpartum day 1, with an uneventful postpartum course. AT clearance, calculated using plasma AT antigen levels, showed notable increases in the first and late third trimesters, peaking around delivery and coinciding with elevated thrombin-antithrombin complex levels. These findings suggest increased AT consumption during these periods, which may contribute to unexpected decreases in AT activity. We propose close monitoring of AT activity and providing adequate ATC supplementation alongside anticoagulation throughout pregnancy, particularly during periods of elevated AT clearance, to minimize VTE risks in HATD patients.
遗传性抗凝血酶缺乏症(HATD)是一种常染色体显性遗传病,可显著增加妊娠期间静脉血栓栓塞(VTE)的风险。根据我们之前三个病例的经验和日本临床指南,我们从妊娠早期到围产期使用未分级肝素(UFH)和抗凝血酶(AT)补充治疗患有HATD的孕妇的高危静脉血栓栓塞。在此,我们报告另一例妊娠期HATD 1型,并评估AT清除率的变化。一名29岁女性,14岁时有肺栓塞(PE)史,有HATD家族史,at活性基线时为47%,流产后发生PE后降至31%。在她第二次怀孕期间,她接受UFH和AT浓缩物(ATC)治疗,剂量从50增加到100 IU/kg,以达到整个怀孕期间50 - 60%和分娩期间70%的AT活性目标水平。她在怀孕39周时生下了一个健康的男婴。她在产后第一天开始服用华法林,在产后过程中一切顺利。使用血浆AT抗原水平计算的AT清除率显示,在妊娠早期和晚期显著增加,在分娩前后达到峰值,并与凝血酶-抗凝血酶复合物水平升高相吻合。这些发现表明,在这些时期,AT消耗增加,这可能导致AT活动意想不到的减少。我们建议密切监测AT活性,并在整个妊娠期间,特别是AT清除率升高期间,在抗凝治疗的同时补充足够的ATC,以最大限度地降低HATD患者的静脉血栓栓塞风险。
{"title":"Antithrombin supplementation to prevent venous thromboembolism: A case of hereditary antithrombin deficiency with increased antithrombin clearance during pregnancy and peripartum","authors":"Ayako Kaneda-Takeuchi ,&nbsp;Tomoaki Oda ,&nbsp;Mei Kitamoto ,&nbsp;Emiyu Fujiwara ,&nbsp;Kenta Kawai ,&nbsp;Megumi Narumi ,&nbsp;Yoshimasa Horikoshi ,&nbsp;Masako Matsumoto ,&nbsp;Yukiko Kohmura-Kobayashi ,&nbsp;Naomi Furuta-Isomura ,&nbsp;Toshiyuki Uchida ,&nbsp;Kazunao Suzuki ,&nbsp;Naohiro Kanayama ,&nbsp;Hiroaki Itoh ,&nbsp;Naoaki Tamura","doi":"10.1016/j.tru.2025.100211","DOIUrl":"10.1016/j.tru.2025.100211","url":null,"abstract":"<div><div>Hereditary antithrombin deficiency (HATD) is an autosomal dominant disorder that significantly increases the risk of venous thromboembolism (VTE) during pregnancy. Based on our experience with three previous cases and the Japanese clinical guidelines, we manage high-risk VTE in pregnant women with HATD using unfractionated heparin (UFH) and antithrombin (AT) supplementation from early pregnancy to the peripartum period. Herein, we report another case of HATD type 1 in pregnancy and evaluate changes in AT clearance. A 29-year-old woman had a history of pulmonary embolism (PE) at 14 years and a family history of HATD with AT activity of 47 % at baseline, which decreased to 31 % when she developed PE after an abortion. During her second pregnancy, she was treated with UFH and AT concentrate (ATC) with doses increasing from 50 to 100 IU/kg to achieve target AT activity levels of 50–60 % throughout pregnancy and 70 % during delivery. She delivered a healthy male infant at 39 weeks of gestation. She started to take warfarin on postpartum day 1, with an uneventful postpartum course. AT clearance, calculated using plasma AT antigen levels, showed notable increases in the first and late third trimesters, peaking around delivery and coinciding with elevated thrombin-antithrombin complex levels. These findings suggest increased AT consumption during these periods, which may contribute to unexpected decreases in AT activity. We propose close monitoring of AT activity and providing adequate ATC supplementation alongside anticoagulation throughout pregnancy, particularly during periods of elevated AT clearance, to minimize VTE risks in HATD patients.</div></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"19 ","pages":"Article 100211"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144166909","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
Discordance and bleeding in critically ill patients with COVID-19 receiving unfractionated heparin: A comparison between aPTT and anti-factor Xa activity level monitoring aPTT与抗Xa因子活性水平监测在重症COVID-19患者未分离肝素治疗中的差异及出血
Q4 Medicine Pub Date : 2025-06-01 Epub Date: 2025-02-27 DOI: 10.1016/j.tru.2025.100202
Merijn C. Reuland , Thijs F. van Haaps , Pieter O.L.P. Broeren , Nick van Es , Claire E. Dijkslag-van der Laan , Alexander P.J. Vlaar , Michiel Coppens , Marcella C.A. Müller

Introduction

COVID-19 is associated with hypercoagulability and an increased risk of thrombotic complications. In critically ill COVID-19 patients with thrombosis receiving unfractionated heparin (UFH), heparin resistance is frequently observed when the activated Partial Thromboplastin Time (aPTT) is used for monitoring. It is unclear whether UFH monitoring with anti-factor Xa (anti-Xa) is beneficial.

Methods

Retrospective cohort of critically ill COVID-19 patients treated with UFH in a single center tertiary Intensive Care Unit (ICU) before and after changing treatment protocol from a nurse-driven aPTT guided to an anti-Xa guided UFH dosing protocol. Measurements of aPTT and anti-Xa were simultaneously collected to evaluate discordance. Next, bleeding events while treated using the different treatments protocols was assessed, using the validated HEME scoring system.

Results

We included 149 patients with a median age of 63 years (interquartile range: 59, 70). Among the 715 samples with simultaneous measurements of aPTT and anti-Xa, discordance was observed in 57 % of samples. This was based on a low aPTT and normal anti-Xa activity in 40 %, and a normal aPTT and high anti-Xa activity in 9 %. In the aPTT period 43 of 83 patients developed any bleeding (52 %) compared to 23 of 68 patients (34 %) in the anti-Xa-guided period. In the 83 patients in the aPTT guided group, there were 43 bleeding events in 19 patients, compared to 23 bleeding events in 16 patients in the group guided by anti-Xa activity.

Conclusion

In critically ill patients with COVID-19 receiving UFH, measurement of aPTT and anti-Xa activity are frequently discordant. Anti-Xa monitoring could potentially help in reducing the risk of bleeding.
covid -19与高凝性和血栓性并发症风险增加相关。在接受未分离肝素(UFH)治疗的COVID-19血栓形成危重患者中,当使用活化的部分凝血活素时间(aPTT)进行监测时,经常观察到肝素耐药。目前尚不清楚用抗Xa因子(anti-Xa)监测UFH是否有益。方法回顾性分析单中心三级重症监护室(ICU)重症COVID-19危重患者在从护士驱动的aPTT引导到抗xa引导的UFH给药方案改变前后的治疗方案。同时收集aPTT和抗xa的测量值以评估不一致性。接下来,使用经过验证的HEME评分系统评估使用不同治疗方案治疗时的出血事件。结果纳入149例患者,中位年龄为63岁(四分位数范围:59,70)。在715个同时测定aPTT和anti-Xa的样品中,57%的样品存在不一致。这是基于40%的低aPTT和正常的抗xa活性,9%的aPTT正常和高抗xa活性。在aPTT治疗期间,83例患者中有43例(52%)出现出血,而在抗xa引导治疗期间,68例患者中有23例(34%)出现出血。在aPTT引导组的83例患者中,19例患者发生43例出血事件,而抗xa活性引导组的16例患者发生23例出血事件。结论新冠肺炎危重患者接受UFH治疗时,aPTT和抗xa活性测定经常不一致。抗xa监测可能有助于降低出血的风险。
{"title":"Discordance and bleeding in critically ill patients with COVID-19 receiving unfractionated heparin: A comparison between aPTT and anti-factor Xa activity level monitoring","authors":"Merijn C. Reuland ,&nbsp;Thijs F. van Haaps ,&nbsp;Pieter O.L.P. Broeren ,&nbsp;Nick van Es ,&nbsp;Claire E. Dijkslag-van der Laan ,&nbsp;Alexander P.J. Vlaar ,&nbsp;Michiel Coppens ,&nbsp;Marcella C.A. Müller","doi":"10.1016/j.tru.2025.100202","DOIUrl":"10.1016/j.tru.2025.100202","url":null,"abstract":"<div><h3>Introduction</h3><div>COVID-19 is associated with hypercoagulability and an increased risk of thrombotic complications. In critically ill COVID-19 patients with thrombosis receiving unfractionated heparin (UFH), heparin resistance is frequently observed when the activated Partial Thromboplastin Time (aPTT) is used for monitoring. It is unclear whether UFH monitoring with anti-factor Xa (anti-Xa) is beneficial.</div></div><div><h3>Methods</h3><div>Retrospective cohort of critically ill COVID-19 patients treated with UFH in a single center tertiary Intensive Care Unit (ICU) before and after changing treatment protocol from a nurse-driven aPTT guided to an anti-Xa guided UFH dosing protocol. Measurements of aPTT and anti-Xa were simultaneously collected to evaluate discordance. Next, bleeding events while treated using the different treatments protocols was assessed, using the validated HEME scoring system.</div></div><div><h3>Results</h3><div>We included 149 patients with a median age of 63 years (interquartile range: 59, 70). Among the 715 samples with simultaneous measurements of aPTT and anti-Xa, discordance was observed in 57 % of samples. This was based on a low aPTT and normal anti-Xa activity in 40 %, and a normal aPTT and high anti-Xa activity in 9 %. In the aPTT period 43 of 83 patients developed any bleeding (52 %) compared to 23 of 68 patients (34 %) in the anti-Xa-guided period. In the 83 patients in the aPTT guided group, there were 43 bleeding events in 19 patients, compared to 23 bleeding events in 16 patients in the group guided by anti-Xa activity.</div></div><div><h3>Conclusion</h3><div>In critically ill patients with COVID-19 receiving UFH, measurement of aPTT and anti-Xa activity are frequently discordant. Anti-Xa monitoring could potentially help in reducing the risk of bleeding.</div></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"19 ","pages":"Article 100202"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143698092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Ultrasound assisted, catheter-directed thrombolysis for acute intermediate-high risk pulmonary embolism: Focus on safety for oncological patients 超声辅助导管溶栓治疗急性中高危肺栓塞:重点关注肿瘤患者的安全性
Q4 Medicine Pub Date : 2025-06-01 Epub Date: 2025-03-22 DOI: 10.1016/j.tru.2025.100206
Claudia Colombo , Lorenzo Tua , Nicolò Capsoni , Francesco Musca , Ilaria Emanuela Bossi , Filippo Russo , Mario Iannaccone , Andrea Discalzi , Luciana D'Angelo , Fabrizio Oliva , Marco Solcia , Alice Sacco
{"title":"Ultrasound assisted, catheter-directed thrombolysis for acute intermediate-high risk pulmonary embolism: Focus on safety for oncological patients","authors":"Claudia Colombo ,&nbsp;Lorenzo Tua ,&nbsp;Nicolò Capsoni ,&nbsp;Francesco Musca ,&nbsp;Ilaria Emanuela Bossi ,&nbsp;Filippo Russo ,&nbsp;Mario Iannaccone ,&nbsp;Andrea Discalzi ,&nbsp;Luciana D'Angelo ,&nbsp;Fabrizio Oliva ,&nbsp;Marco Solcia ,&nbsp;Alice Sacco","doi":"10.1016/j.tru.2025.100206","DOIUrl":"10.1016/j.tru.2025.100206","url":null,"abstract":"","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"19 ","pages":"Article 100206"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859914","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
Developing a decision support tool for the continuation or deprescribing of antithrombotic therapy in patients receiving end-of-life care: Protocol for a European Delphi study 开发一种决策支持工具,用于在接受临终关怀的患者中继续或减少抗血栓治疗的处方:欧洲德尔菲研究的方案
Q4 Medicine Pub Date : 2025-06-01 Epub Date: 2025-05-06 DOI: 10.1016/j.tru.2025.100209
Imene Deneche , Camille Couffignal , Nassima Si Mohammed , Anette Arbjerg Højen , Carme Font , Stavros Konstantinides , Marieke Kruip , Luigi Maiorana , Sebastian Szmit , Denise Abbel , Laurent Bertoletti , Susanne Cannegieter , Adrian Edwards , Michelle Edwards , Alessandra Gava , Jacobijn Gussekloo , Miriam J. Johnson , Rashmi Kumar , Johan Langendoen , Kate Lifford , Isabelle Mahé

Introduction

To develop a European shared decision support tool (SDST), a Delphi process will be used to reach consensus about aspects relating to the continuation or deprescribing of antithrombotic therapy (ATT) in cancer patients at the end of life. As part of the SERENITY project, this study corresponds to work package (WP) 4.

Methods

Findings from SERENITY WPs 1–3 (realist review, flash mob research, epidemiological and qualitative studies) informed the Delphi study. The WP4 steering committee had two objectives. (1) to build a representative expert panel comprising physicians, pharmacists, nurses and psychologists from eight European countries; and (2) to advise on the content of the Delphi form, divided into four sections: context, content, SDST design and trial outcomes. The form was reviewed by the SERENITY patient and public involvement group to ensure that it met patients’ needs. The Delphi study will take place in three rounds held at 6-week intervals, involving experts from eight countries. Consensus will be reached on items with at least 70 % agreement. The steering committee will review and validate the results across the different rounds.

Results

Through this Delphi study, the following aspects will be defined: characterisation of candidate patients for discussion about ATT deprescribing; healthcare team roles in ATT decision-making; specific information and communication requirements for patients when making deprescribing decisions; SDST content priorities; and optimal outcomes for the planned clinical trial.

Conclusion

This study will feed directly into the development and evaluation of the SDST, aimed at reducing complications and improving quality-of-life in end-of-life cancer patients receiving ATT.
为了开发欧洲共享决策支持工具(SDST),将使用德尔福过程就癌症患者生命末期抗血栓治疗(ATT)的继续或处方达成共识。作为SERENITY项目的一部分,本研究符合工作包(WP) 4。方法SERENITY WPs 1-3(现实主义综述、快闪族研究、流行病学和定性研究)的研究结果为Delphi研究提供了依据。WP4指导委员会有两个目标。(1)建立一个由来自欧洲8个国家的医生、药剂师、护士和心理学家组成的具有代表性的专家小组;(2)对德尔菲表的内容提出建议,分为语境、内容、SDST设计和试验结果四个部分。该表格由SERENITY患者和公众参与小组审查,以确保它满足患者的需求。德尔菲研究将分三轮进行,每隔6周进行一次,涉及来自8个国家的专家。在70%以上的共识项上达成共识。指导委员会将审查和验证不同回合的结果。结果通过德尔菲研究,将定义以下方面:讨论ATT处方的候选患者的特征;医疗团队在ATT决策中的作用;患者在作出处方决定时的具体信息和沟通要求;SDST内容优先级;以及计划临床试验的最佳结果。结论本研究将直接为SDST的开发和评估提供依据,旨在减少接受ATT治疗的晚期癌症患者的并发症和提高生活质量。
{"title":"Developing a decision support tool for the continuation or deprescribing of antithrombotic therapy in patients receiving end-of-life care: Protocol for a European Delphi study","authors":"Imene Deneche ,&nbsp;Camille Couffignal ,&nbsp;Nassima Si Mohammed ,&nbsp;Anette Arbjerg Højen ,&nbsp;Carme Font ,&nbsp;Stavros Konstantinides ,&nbsp;Marieke Kruip ,&nbsp;Luigi Maiorana ,&nbsp;Sebastian Szmit ,&nbsp;Denise Abbel ,&nbsp;Laurent Bertoletti ,&nbsp;Susanne Cannegieter ,&nbsp;Adrian Edwards ,&nbsp;Michelle Edwards ,&nbsp;Alessandra Gava ,&nbsp;Jacobijn Gussekloo ,&nbsp;Miriam J. Johnson ,&nbsp;Rashmi Kumar ,&nbsp;Johan Langendoen ,&nbsp;Kate Lifford ,&nbsp;Isabelle Mahé","doi":"10.1016/j.tru.2025.100209","DOIUrl":"10.1016/j.tru.2025.100209","url":null,"abstract":"<div><h3>Introduction</h3><div>To develop a European shared decision support tool (SDST), a Delphi process will be used to reach consensus about aspects relating to the continuation or deprescribing of antithrombotic therapy (ATT) in cancer patients at the end of life. As part of the SERENITY project, this study corresponds to work package (WP) 4.</div></div><div><h3>Methods</h3><div>Findings from SERENITY WPs 1–3 (realist review, flash mob research, epidemiological and qualitative studies) informed the Delphi study. The WP4 steering committee had two objectives. (1) to build a representative expert panel comprising physicians, pharmacists, nurses and psychologists from eight European countries; and (2) to advise on the content of the Delphi form, divided into four sections: context, content, SDST design and trial outcomes. The form was reviewed by the SERENITY patient and public involvement group to ensure that it met patients’ needs. The Delphi study will take place in three rounds held at 6-week intervals, involving experts from eight countries. Consensus will be reached on items with at least 70 % agreement. The steering committee will review and validate the results across the different rounds.</div></div><div><h3>Results</h3><div>Through this Delphi study, the following aspects will be defined: characterisation of candidate patients for discussion about ATT deprescribing; healthcare team roles in ATT decision-making; specific information and communication requirements for patients when making deprescribing decisions; SDST content priorities; and optimal outcomes for the planned clinical trial.</div></div><div><h3>Conclusion</h3><div>This study will feed directly into the development and evaluation of the SDST, aimed at reducing complications and improving quality-of-life in end-of-life cancer patients receiving ATT.</div></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"19 ","pages":"Article 100209"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144166908","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
Multimorbidity and VTE 多发病和静脉血栓栓塞
Q4 Medicine Pub Date : 2025-03-01 Epub Date: 2025-03-07 DOI: 10.1016/j.tru.2025.100204
Lucy A. Norris (Editors in Chief), Emmanouil S. Papadakis (Editors in Chief)
{"title":"Multimorbidity and VTE","authors":"Lucy A. Norris (Editors in Chief),&nbsp;Emmanouil S. Papadakis (Editors in Chief)","doi":"10.1016/j.tru.2025.100204","DOIUrl":"10.1016/j.tru.2025.100204","url":null,"abstract":"","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"18 ","pages":"Article 100204"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143681552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Reduced versus full apixaban lead-in dosing following parenteral treatment of acute venous thromboembolism 静脉外治疗急性静脉血栓栓塞后阿哌沙班引入量减少与完全引入量的对比
Q4 Medicine Pub Date : 2025-03-01 Epub Date: 2025-01-03 DOI: 10.1016/j.tru.2025.100199
Daniella Veloria , Benjamin Wang , Ran Ran , David Ha , Robert Diep , Calvin Diep
{"title":"Reduced versus full apixaban lead-in dosing following parenteral treatment of acute venous thromboembolism","authors":"Daniella Veloria ,&nbsp;Benjamin Wang ,&nbsp;Ran Ran ,&nbsp;David Ha ,&nbsp;Robert Diep ,&nbsp;Calvin Diep","doi":"10.1016/j.tru.2025.100199","DOIUrl":"10.1016/j.tru.2025.100199","url":null,"abstract":"","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"18 ","pages":"Article 100199"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143162996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Thank you reviewers 谢谢审稿人
Q4 Medicine Pub Date : 2025-03-01 Epub Date: 2025-03-17 DOI: 10.1016/j.tru.2025.100205
{"title":"Thank you reviewers","authors":"","doi":"10.1016/j.tru.2025.100205","DOIUrl":"10.1016/j.tru.2025.100205","url":null,"abstract":"","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"18 ","pages":"Article 100205"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143680956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Thrombosis Update
全部 Org. Geochem. Geobiology Clim. Change Asia-Pac. J. Atmos. Sci. Geol. Ore Deposits Environ. Technol. Innovation Entomologisk tidskrift Acta Oceanolog. Sin. Geosci. J. ASTROBIOLOGY Carbon Balance Manage. EPL-EUROPHYS LETT ECOSYSTEMS J. Earth Sci. Appl. Clay Sci. Engineering Science and Technology, an International Journal Ore Geol. Rev. Communications Earth & Environment Environmental Toxicology & Water Quality Acta Geophys. EXPERT REV RESP MED Chem. Ecol. Geosci. Model Dev. Global Biogeochem. Cycles Aquat. Geochem. Commun. Theor. Phys. J. Hydrol. Ecol. Processes Geochem. J. Memai Heiko Igaku Environmental Progress ENVIRONMENT J PHYS A-MATH THEOR Adv. Meteorol. J OPT SOC AM A Environmental Claims Journal GEOL BELG Ocean and Coastal Research GEOLOGY Appl. Phys. Rev. EUR PHYS J-SPEC TOP Ecol. Monogr. Geochem. Perspect. IEEE Trans. Appl. Supercond. Espacio Tiempo y Forma. Serie VI, Geografía Clean Technol. Environ. Policy ERN: Other Microeconomics: General Equilibrium & Disequilibrium Models of Financial Markets (Topic) OCEAN SCI J Adv. Atmos. Sci. Int. Geol. Rev. Phys. Rev. E TECTONICS Phys. Chem. Miner. J. Adv. Model. Earth Syst. J. Acoust. Soc. Am. Contrib. Plasma Phys. Environment and Natural Resources Journal Commun. Phys. Equine veterinary journal. Supplement ECOTOXICOLOGY npj Clim. Atmos. Sci. Eurasian Journal of Emergency Medicine FACIAL PLAST SURG J. Appl. Phys. AAPG Bull. Appl. Geochem. Expert Rev. Mol. Diagn. ACTA GEOL POL Aust. J. Earth Sci. Acta Geochimica Geostand. Geoanal. Res. Atmos. Meas. Tech. B SOC GEOL MEX Atmos. Chem. Phys. BIOGEOSCIENCES ACTA PETROL SIN ERN: Other Macroeconomics: Aggregative Models (Topic) Atmos. Res. Archaeol. Anthropol. Sci. ARCT ANTARCT ALP RES Contrib. Mineral. Petrol. ACTA GEOL SIN-ENGL Ecol. Res. Ann. Glaciol. Big Earth Data ARCHAEOMETRY Geochim. Cosmochim. Acta Environ. Mol. Mutagen. Basin Res. J. Atmos. Chem. IZV-PHYS SOLID EART+ 2005 Asian Conference on Sensors and the International Conference on New Techniques in Pharmaceutical and Biomedical Research Am. J. Sci. Annu. Rev. Earth Planet. Sci. Rev. Geophys. Environ. Eng. Manage. J. Environ. Toxicol. Pharmacol. ECOL RESTOR ATMOSPHERE-BASEL Yan Ke Xue Bao (Hong Kong)
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1