Journal of Thrombosis and Haemostasis最新文献

{"title":"Lack of overt bleeding or platelet dysfunction in a mouse model of vascular Ehlers-Danlos syndrome.","authors":"Robert H Lee, Summer R Jones, Alexey A Martyanov, Matthew R Vander Ploeg, Carmen F Sagues, Wolfgang Bergmeier","doi":"10.1016/j.jtha.2025.05.009","DOIUrl":"https://doi.org/10.1016/j.jtha.2025.05.009","url":null,"abstract":"","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multicenter study to improve clinical interpretation of anticardiolipin and anti-beta2-glycoprotein I antibody test results for diagnosis of antiphospholipid syndrome.","authors":"Lieve Van Hoovels, Silvia Piantoni, Els Bailleul, Sofie Schouwers, Massimo Radin, Maria Infantino, Emirena M Garrafa, Bo Massa, Siska Blomme, Stefanie Van Den Bremt, Bert Vander Cruyssen, Katrien M Devreese, Angela Tincani, Savino Sciascia, Xavier Bossuyt","doi":"10.1016/j.jtha.2025.05.008","DOIUrl":"https://doi.org/10.1016/j.jtha.2025.05.008","url":null,"abstract":"<p><strong>Introduction: </strong>Anti-cardiolipin (aCL) and anti-beta2-glycoprotein I (aβ₂GPI) antibodies are laboratory markers important for antiphospholipid syndrome (APS) diagnosis and classification. There is an important inter-assay variation among aCL and aβ₂GPI assays. This study aims to harmonize aCL and aβ₂GPI test result interpretation across assays.</p><p><strong>Materials and methods: </strong>Commercial aCL IgG/M and aβ₂GPI IgG/M assays of three different diagnostic companies (Thermo Fisher Scientific, Orgentec, Werfen) were evaluated using 176 diagnostic samples from patients with APS and 433 disease controls. International APS reference materials (Harris/Louisville, Koike/Sapporo, NIBSC 21/266) were analysed to evaluate traceability. Reference values were verified using 120 healthy controls.</p><p><strong>Results: </strong>Using manufacturer's proposed cut-offs, there was large variability in diagnostic sensitivity and specificity among assays. Thresholds corresponding to 97.5% and 99.5% specificity in diseased controls were used to delimit test result intervals [negative (<97.5% specificity threshold), weak positive and high positive (>99.5% specificity threshold)]. Test result interval-specific likelihood ratios (LRs) were concordant across the different aCL and aβ₂GPI assays. For all assays, the LR for APS increased with increasing antibody level. Higher LRs were found for IgG than for IgM assays and for double and triple antibody positivity. The added diagnostic value of aβ₂GPI IgM was limited.</p><p><strong>Conclusion: </strong>Defining thresholds for antibody levels and assigning test result interval-specific LRs allows alignment of clinical interpretation for aCL and aβ₂GPI assays.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality, diagnosis, and etiology of disseminated intravascular coagulation - A systematic review and meta-analysis: Communication from the ISTH SSC Subcommittee on Disseminated Intravascular Coagulation.","authors":"Yutaka Umemura, Ecaterina Scarlatescu, Theresa U Nwagha, Jerrold H Levy, Maha Othman, Hunter Moore, Daniel O'Reilly, Julie Helms, Toshiaki Iba","doi":"10.1016/j.jtha.2025.04.033","DOIUrl":"https://doi.org/10.1016/j.jtha.2025.04.033","url":null,"abstract":"<p><strong>Background and aims: </strong>Establishing global standards for diagnosis and treatment of disseminated intravascular coagulation (DIC) requires a comprehensive evaluation of its global epidemiology. However, obtaining epidemiological evidence on DIC from a single cohort study is challenging. We evaluated global epidemiology and mortality of DIC by conducting a systematic literature review.</p><p><strong>Methods: </strong>We conducted proportional meta-analyses of observational studies on DIC patients. We searched MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials and selected studies reporting mortality of patients with DIC. The diseases underlying DIC included sepsis, trauma, solid cancer, hematological neoplasia, burn, heat stroke, snakebite, and others. We measured all-cause mortality as the primary outcome.</p><p><strong>Results: </strong>Among 119 studies, the most common diseases underlying DIC were sepsis in 52 studies and trauma in 31 studies. ISTH overt DIC and the JAAM DIC criteria were most frequently used to diagnose DIC. Pooled odds ratio (i.e., increased risk) of mortality associated with development of DIC varied depending on the underlying disease: 3.15 in sepsis and 4.80 in trauma. Pooled raw mortality of DIC patients also varied widely by underlying disease: 42% in sepsis, 36% in trauma, 8% in snakebite, 28% in leukemia, and 32% in heat stroke. Pooled mortality and odds ratio for mortality also varied by the diagnostic criteria. We observed no clear yearly trend of improvement in mortality.</p><p><strong>Conclusions: </strong>Mortality of DIC was very high but heterogeneous depending on underlying disease and diagnostic criteria, which should be taken into consideration in standardization of diagnosis and treatment of DIC.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Intracranial Atherosclerotic Stenosis Burden, the Use of Dual Antiplatelet Therapy and Stroke Recurrence in Patients with Minor Stroke.","authors":"Tingting Liu, Yongle Wang, Kaili Zhang, Haimei Fan, Xinyi Li, Xuemei Wu, Xiaoyuan Niu","doi":"10.1016/j.jtha.2025.04.034","DOIUrl":"https://doi.org/10.1016/j.jtha.2025.04.034","url":null,"abstract":"<p><strong>Background: </strong>Intracranial atherosclerotic stenosis (ICAS) is a primary cause of ischaemic stroke, but it might not be the main predictor of stroke recurrence.</p><p><strong>Objectives: </strong>A comprehensive assessment of dual antiplatelet therapy (DAPT) effectiveness via the ICAS burden (ICASB) is crucial for patients with minor stroke.</p><p><strong>Patients/methods: </strong>This prospective, multicentre cohort study included patients with minor (National Institutes of Health Stroke Scale score ≤ 5) stroke. The ICASB was determined by the degree and number of ICAS occurrences. The primary efficacy outcomes were all stroke types (ischaemic or haemorrhagic). Ninety-day and one-year follow-up evaluations were conducted.</p><p><strong>Results: </strong>Among the 3,061 patients (age=61.7±12.0 years; males, 73.3%), 61.0% (n=1,868) received DAPT, and 39.0% (n=1,193) received single APT (SAPT). Finally, 2,900 and 2,709 patients were included in the 90-day and one-year outcome assessments, respectively. The primary outcome occurred in 242 patients (8.3%) at 90 days and 353 patients (13.0%) at the one-year follow-up. In patients with high ICASBs (but not those with low ICASBs), compared with SAPT, DAPT was associated with a lower recurrent stroke rate at the 90-day (weighted absolute risk difference, 7.3%; IPTW HR==0.58 [95% CI=0.39-0.87]) and one-year (weighted absolute risk difference, 3.9%; IPTWHR==0.68 [95% CI=0.45-1.03]) follow-ups. Significant interactions were observed at the 90-day (P_interaction=0.021) and one-year (P_interaction=0.086) follow-ups. Similar results were observed for the propensity score matching model.</p><p><strong>Conclusions: </strong>For minor stroke patients receiving APT, DAPT reduced stroke recurrence at 90 days in the high ICASB group but not in the low ICASB group.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Use of Aflibercept for High Cardiac Output in Hereditary Hemorrhagic Telangiectasia after Failure of Pazopanib and Bevacizumab Therapy.","authors":"Akshay Mathavan, Akash Mathavan, Urszula Krekora, Krunal Shukla, Marc S Zumberg, Ali Ataya","doi":"10.1016/j.jtha.2025.05.007","DOIUrl":"https://doi.org/10.1016/j.jtha.2025.05.007","url":null,"abstract":"<p><p>Hereditary hemorrhagic telangiectasia (HHT) can manifest with hepatic arteriovenous malformations, leading to a high cardiac output state as well as pulmonary hypertension. Bevacizumab is commonly used to treat this complication, but response is often partial and may diminish over time. We present a patient with ACVRL1-related HHT and high cardiac output who failed pazopanib and developed apparent bevacizumab resistance with symptom recurrence despite maintenance and reintroduced therapy. Aflibercept, a vascular endothelial growth factor and placental growth factor-binding decoy receptor, was initiated intravenously, resulting in improved dyspnea, decreased epistaxis severity, and a reduction in cardiac index from 3.92 to 2.90 L/min/m². Hemoglobin and iron indices remained stable without transfusion or iron support. This case highlights aflibercept as a potential alternative anti-angiogenic agent for HHT-related high-output states following bevacizumab failure. Mechanistic distinctions between these agents and prior reports of aflibercept efficacy in other refractory vascular contexts suggest a role for broader investigation.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bleeding Risk and Performance of Bleeding Risk Assessment Models in Patients with Venous Thromboembolism on Anticoagulation: Results from the prospective BACH-VTE Study.","authors":"Timothy Hoberstorfer, Stephan Nopp, Daniel Steiner, Julia Deinsberger, Oliver Schlager, Ingrid Pabinger, Benedikt Weber, Cihan Ay","doi":"10.1016/j.jtha.2025.05.005","DOIUrl":"https://doi.org/10.1016/j.jtha.2025.05.005","url":null,"abstract":"<p><strong>Background: </strong>Patients with venous thromboembolism (VTE) are at risk of bleeding during anticoagulation.</p><p><strong>Objectives: </strong>To assess bleeding risk and the performance of risk assessment models (RAMs) VTE-PREDICT, HAS-BLED, RIETE, and VTE-BLEED in patients with acute VTE initiating anticoagulation.</p><p><strong>Methods: </strong>We utilized data from a prospective observational cohort study (BACH-VTE) including patients with acute VTE who initiated anticoagulation with a follow-up period of up to two years. Exclusion criteria were active cancer, pregnancy, and postpartum period. Major, clinically relevant non-major (CRNMB), and minor bleeding were recorded and their frequencies calculated. RAM performance was evaluated by discrimination and calibration. Predictors associated with clinically relevant bleeding (CRB, composite of major and CRNMB) were assessed.</p><p><strong>Results: </strong>In total, 308 patients (median age: 55 years, 42% women, 47% pulmonary embolism, 62% unprovoked VTE) were included. During a median follow-up time of 12.6 months, we observed 2 major, 41 CRNMBs, and 66 minor bleedings, corresponding to 2-year cumulative incidences (95% CI) of 0.9% (0-2.1), 16.2% (10.7-21.3), and 20.6% (15.1-25.8), respectively, and of 33.4% (26.7-39.5) for any bleeding. RAM discrimination was poor to moderate with C-statistics (95% CI) for CRB of 0.71 (0.61-0.80) for VTE-PREDICT, 0.59 (0.49-0.68) for HAS-BLED, 0.52 (0.41-0.62) for RIETE, and 0.56 (0.45-0.68) for VTE-BLEED. Calibration analysis revealed underestimation of bleeding risk. Female sex, lower hemoglobin, and bleeding history were associated with CRB in a univariable but not in a multivariable model.</p><p><strong>Conclusion: </strong>In patients anticoagulated for VTE, we found high rates of CRB. Only the VTE-PREDICT model showed acceptable discrimination, but poor calibration.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Benefits of Anticoagulation Prophylaxis in Children Undergoing Kidney Transplant: Systematic Review and Meta-Analysis.","authors":"Ahmad H Al-Huniti, Caroline Malcolmson, Valerie Langlois, Ashlene M McKay, Armando Lorenzo, Zhen Wang, Suzan Williams, Chia Wei Teoh, Leonardo R Brandão","doi":"10.1016/j.jtha.2025.04.032","DOIUrl":"https://doi.org/10.1016/j.jtha.2025.04.032","url":null,"abstract":"<p><strong>Background: </strong>Graft thrombosis is a preventable cause of early allograft loss after pediatric kidney transplant, but the role of primary thromboprophylaxis is uncertain.</p><p><strong>Objectives: </strong>To determine the effectiveness and safety of thromboprophylaxis in preventing graft thrombosis among children (0-21 years) undergoing kidney transplant.</p><p><strong>Methods: </strong>We performed a systematic literature review of MEDLINE, Embase, and Cochrane Libraries from inception until September 2024. The primary outcome assessed by meta-analysis was graft thrombosis, and the secondary outcome was major bleeding (per International Society on Thrombosis and Haemostasis criteria).</p><p><strong>Results: </strong>Twenty-five observational studies (21 retrospective, 4 prospective) describing 2,094 patients (1,659 cases, 435 controls) met eligibility criteria. Thromboprophylaxis was used universally (ie, all kidney recipients in the study) in 64% (1,055/1,659) or only in high-risk patients (recipient weight <20 kg, age <5 years) in 36% (604/1,659). Compared with no preventive measures for thrombosis, thromboprophylaxis was associated with reduced risk of graft thrombosis (odds ratio, 0.31; 95% CI, 0.18-0.53). Subgroup analyses of heparinoid-only, universal thromboprophylaxis, and high-risk-only protocols revealed similar findings. Thromboprophylaxis was not associated with increased risk of bleeding resulting in surgical exploration or graft loss. The overall risk of bias was moderate. Studies showed high clinical and methodologic heterogeneity in study populations and thromboprophylaxis protocols.</p><p><strong>Conclusions: </strong>Primary thromboprophylaxis appears effective in preventing kidney graft loss from vascular thrombosis in pediatric recipients. This benefit may be offset by the risk of bleeding, although clarity on bleeding risk factors is lacking. We identified knowledge gaps, including uncertainty about optimal thromboprophylaxis regimens and treatment duration.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recombinant ADAMTS13 for Acute and Prophylactic Treatment of Congenital Thrombotic Thrombocytopenic Purpura in Pregnancy.","authors":"Taeer Avnon, Anat Rabinovich, Oleg Pikovsky, Gali Pariente, Offer Erez","doi":"10.1016/j.jtha.2025.05.006","DOIUrl":"https://doi.org/10.1016/j.jtha.2025.05.006","url":null,"abstract":"<p><p>Thrombotic thrombocytopenic purpura (TTP) is a disorder of the absence or severe depletion of ADAMTS13 protease, which cleaves VWF multimers. In its absence, exposed platelet binding sites on large VWF multimers bind and aggregate platelets, causing microangiopathic hemolytic anemia and thrombosis. The rare congenital form (cTTP) is caused by mutations in the ADAMTS13 gene. Pregnant cTTP patients are at very high risk of developing complications. Current recommendations for pregnant cTTP patients are prophylactic fresh frozen plasma infusions, however, efficacy varies among patients. Recombinant ADAMTS13 (rADAMTS13) is a novel alternative to plasma infusions, recently reported to be effective and safe for treating non-pregnant cTTP patients. Few studies have attempted to treat pregnant cTTP patients with rADAMTS13. We present a case of successful treatment with rADAMTS13 for an acute TTP exacerbation and maintenance during pregnancy in a cTTP patient with a history of pregnancy complications and an insufficient response to plasma infusions.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The factor VIII K1693N mutation (FVIII-Nara) in a patient with moderate hemophilia A confers resistance to thrombin-catalyzed cleavage at Arg¹⁶⁸⁹ involving P₄' position.","authors":"Shoko Furukawa, Nemekhbayar Baatartsogt, Takeshi Kawamura, Kaoru Horiuchi, Masaaki Doi, Yuji Kashiwakura, Tsukasa Ohmori, Keiji Nogami","doi":"10.1016/j.jtha.2025.05.002","DOIUrl":"https://doi.org/10.1016/j.jtha.2025.05.002","url":null,"abstract":"<p><strong>Background: </strong>Some patients with non-severe hemophilia (H)A are diagnosed with reduced factor VIII activity (FVIII:C) relative to FVIII antigen (FVIII:Ag) and are classed as cross-reactive material-positive (CRM+). We previously found a novel FVIII-Lys1693Asn (K1693N) natural mutation to have HA with moderate phenotype (FVIII:C/FVIII:Ag=1.9 IU/dL/124 IU/dL).</p><p><strong>Aim: </strong>To examine the mechanism(s) involving the P₄' site on thrombin cleavage site at Arg¹⁶⁸⁹ in a CRM+ phenotype.</p><p><strong>Methods/results: </strong>Recombinant FVIII-K1693N prepared using BHK cells demonstrated severely-delayed cleavage at Arg¹⁶⁸⁹ and very low levels of peak FVIII:C after thrombin activation. Mildly reduced peak FVIII:C and similar cleavage to wild-type was illustrated, however, with the FVIII-K1693A mutation after thrombin activation. These findings indicated that the conversion to Asn at P₄' site mediated thrombin resistance. FVIII-K376N, listed in HA genetic database, were examined due to their similarity to FVIII-K1693N, which involves Lys-to-Asn mutation at P4' in thrombin cleavage site, may suggesting a common mechanism. FVIII specific activities of FVIII-K376N and FVIII-K376A were 6.1%/3.1% (one-stage assay) of wild-type, respectively. Thrombin-catalyzed cleavage at Arg³⁷² was comparable to wild-type with both mutants, but thrombin-catalyzed FVIII activation was severely-depressed. Spontaneous decay rates of FVIIIa activity with FVIII-K376N (k=0.53) and FVIII-K376A (k=0.99) were greater compared to wild-type (k=0.32), suggesting that cleavage of P₄' site following cleavage at Arg³⁷² contributed to A1-A2 domainal interaction.</p><p><strong>Conclusion: </strong>Lys¹⁶⁹³ and Lys³⁷⁶, both located at P4' sites, were suggested to influence FVIII function via distinct mechanisms, indicating that patient-derived mutations can reveal functional aspects of FVIII activation.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elevated levels of (active) von Willebrand Factor during anticoagulation are associated with early recurrence of venous thromboembolism.","authors":"Geke C Poolen, Rolf T Urbanus, Mark Roest, Geert-Jan Geersing, Bas de Laat, Roger E G Schutgens","doi":"10.1016/j.jtha.2025.04.030","DOIUrl":"https://doi.org/10.1016/j.jtha.2025.04.030","url":null,"abstract":"<p><strong>Background: </strong>Venous thromboembolism (VTE) can recur shortly after stopping anticoagulation, highlighting the need for reliable biomarkers to identify high-risk patients during treatment.</p><p><strong>Objectives: </strong>To determine whether platelet and endothelial markers predict VTE recurrence.</p><p><strong>Methods: </strong>We used data and samples from the randomized controlled VISTA trial (2011-2015), which included patients with unprovoked VTE who were treated with vitamin K antagonists (VKA) for six months. After treatment cessation, patients were followed for two years to assess recurrence. This dataset formed the basis for the current prospective analysis, in which plasma levels of VWF, aVWF, soluble P-selectin, soluble thrombomodulin, CXCL4, and CXCL7 were measured before and after cessation of anticoagulation. Associations between biomarker levels and recurrence were analyzed using Cox regression.</p><p><strong>Results: </strong>Plasma samples from 629 patients with a first unprovoked VTE who discontinued VKA were analyzed. Recurrence occurred in 75 patients (12%); 11 (15%) within one month, 29 (39%) within three months and 46 (61%) after 3 months. Elevated levels of VWF and aVWF were associated with an increased risk of recurrence per 10-unit increase (VWF: HR: 1.03, 95%CI: 1.01-1.06; aVWF: HR: 1.02, 95%CI: 1.00-1.05). Associations were stronger for early recurrence (<3 months), while (a)VWF levels were not associated with late recurrence (>3 months). Stratification by sex showed VWF and aVWF were associated with increased recurrence risk in men, but not in women.</p><p><strong>Conclusions: </strong>Elevated levels of VWF and aVWF during anticoagulation were associated with early recurrence in men and might serve as biomarkers for predicting VTE recurrence.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}