Journal of Thrombosis and Haemostasis最新文献

{"title":"Acquired Hemophilia A: A Narrative Review and Management Approach in the Emicizumab Era.","authors":"Patrick Ellsworth, Sheh-Li Chen, Lee Ann Jones, Alice Ma, Nigel Key","doi":"10.1016/j.jtha.2024.09.040","DOIUrl":"https://doi.org/10.1016/j.jtha.2024.09.040","url":null,"abstract":"<p><p>Acquired Hemophilia A (AHA) is a rare bleeding disorder caused by inhibitory autoantibodies to factor VIII (FVIII). The goals of treatment are two-fold, namely immunosuppressive therapy (IST) to eradicate the inhibitor and hemostatic management to control bleeding. Emicizumab, a bispecific antibody that acts as a factor VIIIa (FVIIIa) mimetic, has seen growing use in AHA following its approval for congenital hemophilia A (cHA). This review provides an overview of the epidemiology, pathophysiology, diagnosis, and treatment of AHA. Registry, trial, and case series data are assimilated and summarized with an emphasis on a standardized approach that integrates the use of emicizumab. With recent registry data suggesting the need to focus on immunosuppression-related mortality in AHA, we provide treatment recommendations in an algorithmic format that have become the standard of care at our institution. These recommendations are intended to minimize hemostatic product usage and potential toxicity related to IST, while reducing morbidity and re-hospitalization rates for bleeding. The proposed treatment algorithm, which includes key interventions by phase of therapy, can be readily implemented at centers that have rapid access to plasma FVIII activity using a one-stage assay. A case is presented to illustrate the proposed diagnostic and management considerations.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622710","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":"Deconstructing fibrin(ogen) structure.","authors":"Rebecca A Risman, Mehmet Sen, Valerie Tutwiler, Nathan E Hudson","doi":"10.1016/j.jtha.2024.10.024","DOIUrl":"https://doi.org/10.1016/j.jtha.2024.10.024","url":null,"abstract":"<p><p>Fibrinogen and its insoluble degradation product fibrin are pivotal plasma proteins that play important roles in blood coagulation, wound healing, and immune responses. This review highlights research from the last 24 months connecting our progressing view of fibrin(ogen)'s structure, and in particular its conformational flexibility and post-translational modifications (PTMs), to its (patho)physiological roles, molecular interactions, mechanical properties, use as a biomaterial, and potential as a therapeutic target. Recent work suggests that fibrinogen structure is highly dynamic, sampling multiple conformations, which may explain its myriad physiological functions and the presence of cryptic binding sites. Investigations into fibrin clot structure elucidated the impact of PTMs, therapeutic interventions, and pathological conditions on fibrin network morphology, offering insights into thrombus formation and embolization. Studies exploring the mechanical properties of fibrin reveal its response to blood flow and platelet-driven contraction, offering implications for clot stability and embolization risk. Moreover, advancements in tissue engineering leverage fibrin's biocompatibility and customizable properties for diverse applications, from wound healing to tissue regeneration and biomaterial interactions. These findings underscore the structural origins of fibrin(ogen)'s multifaceted roles and its potential as a target for therapeutic interventions.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622722","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":"Comparing One Stage, Chromogenic Assay Results and Discrepancies with Bleeding Phenotype and Genetic Variants in Females with Hemophilia A.","authors":"Lakshmi Srivaths, Joanna Larson, Sepideh Saroukhani, Mohammed Said, Deborah Brown, Nidra Rodriguez, Neethu Menon, Miguel Escobar","doi":"10.1016/j.jtha.2024.10.030","DOIUrl":"https://doi.org/10.1016/j.jtha.2024.10.030","url":null,"abstract":"<p><strong>Background: </strong>Increasing evidence in females with Hemophilia A has shown significant bleeding symptoms. Accurate factor VIII activity (FVIII:C) measurement is essential to assign correct diagnosis/severity. Assay discrepancies reported in Hemophilia A male patients, are not well studied in females.</p><p><strong>Objectives: </strong>Our research sought to assess the association of FVIII:C levels by one-stage versus chromogenic assays and the assay discrepancy with bleeding phenotype and genetic mutation in females with hemophilia A.</p><p><strong>Methods: </strong>Data from 64 females with hemophilia A from our center were reviewed with center's IRB approval. Descriptive statistics, Chi-square, Fisher's exact and Bland-Altman plot analysis were applied.</p><p><strong>Results: </strong>Abnormal ISTH BAT score was seen in 52% (FVIII:C<40 IU/dL: 72%/73%; FVIII:C>40 IU/dL: 41%/45%; by OSA/CSA respectively), more often in adults and post-menarchal patients. Assay discrepancies were present, direct more often than inverse. Based on one assay result only, 11 (17%) patients would have been incorrectly diagnosed and 1 (1.5%) patient would have been assigned incorrect hemophilia severity. No association of genetic variants with FVIII:C levels and bleeding phenotype were found.</p><p><strong>Conclusions: </strong>Our study emphasizes the importance of evaluating female hemophilia A patients for bleeding phenotype. Our study is the first to document prevalence of assay discrepancies exclusively in females with Hemophilia A, which can lead to inaccurate diagnosis/severity assignment. Future larger, multi-center studies are needed to validate our findings, to help develop recommendations regarding the appropriate use of assays for accurate diagnosis and to further elucidate the association of genetic variants with bleeding phenotype and assay discrepancies.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622717","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 dynamic range of immunoassays for heparin-induced thrombocytopenia.","authors":"Henning Nilius, Samra Naas, Jan-Dirk Studt, Dimitrios A Tsakiris, Andreas Greinacher, Adriana Mendez, Adrian Schmidt, Walter A Wuillemin, Bernhard Gerber, Prakash Vishnu, Lukas Graf, Johanna A Kremer Hovinga, Tamam Bakchoul, Christos Nakas, Michael Nagler","doi":"10.1016/j.jtha.2024.10.026","DOIUrl":"https://doi.org/10.1016/j.jtha.2024.10.026","url":null,"abstract":"<p><strong>Background: </strong>Following the current guidelines, immunoassays for the diagnosis of heparin-induced thrombocytopenia (HIT) are interpreted dichotomously, with test results categorized as either positive or negative. However, the extent to which test results hold diagnostic significance across the entire dynamic range remains unclear.</p><p><strong>Objectives: </strong>We utilized data from the prospective TORADI-HIT study, comprising 1,393 consecutive patients with suspected HIT, to assess the diagnostic significance of two H/PF4 immunoassay test results across their respective dynamic ranges: HemoSil Acustar HIT IgG [CLIA] and Lifecodes PF4 IgG [ELISA].</p><p><strong>Methods: </strong>HIT diagnosis was determined by a washed-platelet heparin-induced platelet activation assay (HIPA). For each measurement point in the dataset, we computed likelihood ratios (LR), sensitivities, and specificities. To provide post-test probabilities for individual test results, we calculated interval-specific likelihood ratios and integrated it into a web-based calculator.</p><p><strong>Results: </strong>The prevalence of HIT was 8.5% (n = 119). A likelihood ratio of ≥ 10 was first achieved at 0.3% of the dynamic range (0.4 U/ml; CLIA) and 16% (0.64 OD; ELISA), respectively. A likelihood ratio of ≥ 100 was present at 9.4% (12 U/ml; CLIA) and 75.0% (3.0 OD; ELISA). The slope of the linear regression line (LR ∼ dynamic range) was 9.5 (CLIA) and 0.9 (ELISA).</p><p><strong>Conclusion: </strong>Despite both immunoassays showing an association between results and diagnostic significance, the strength of that association varies by assay. CLIA has a larger increase per measurement unit. Post-test probabilities for individual patients can be estimated using a web-based calculator: https://pcd-research.shinyapps.io/BayesianCalculator/.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622792","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 severe von Willebrand Disease variant p.M771V leads to impaired anterograde trafficking of Von Willebrand factor in patient-derived and base-edited ECFCs.","authors":"Isabel Bär, Alastair Barraclough, Petra E Bürgisser, Calvin van Kwawegen, Karin Fijnvandraat, Jeroen C J Eikenboom, Frank W G Leebeek, Jan Voorberg, Ruben Bierings","doi":"10.1016/j.jtha.2024.10.023","DOIUrl":"https://doi.org/10.1016/j.jtha.2024.10.023","url":null,"abstract":"<p><strong>Background: </strong>Von Willebrand disease (VWD) is the most common inherited bleeding disorder caused by quantitative or qualitative defects of VWF. The p.M771V VWF variant leads to a severe bleeding phenotype in homozygous patients. However, the exact molecular mechanism remains unclear, which prevents personalized treatment of those VWD patients.</p><p><strong>Objective: </strong>This study aims to characterize the underlying molecular mechanisms of the p.M771V variant in multiple representative ex-vivo cell models.</p><p><strong>Methods: </strong>ECFCs were isolated from venous blood of VWD patients from the Willebrand in the Netherlands (WiN) cohort carrying homozygous and heterozygous p.M771V VWF variants. The p.M771V variant was also introduced in cord-blood derived ECFCs (CB-ECFCs) through adenine base editing and was overexpressed in HEK293 cells. Biosynthesis, storage, and secretion of VWF was studied using biochemical methods and confocal microscopy.</p><p><strong>Results: </strong>Two unrelated homozygous p.M771V patients presented with very low VWF activity and antigen levels in plasma. Patient ECFCs showed impaired proVWF processing into mature VWF with secreted VWF being severely reduced when compared to ECFCs of healthy donors. Multimer analysis of p.M771V ECFCs showed a deficiency of high molecular weight VWF multimers. Immunofluorescent staining revealed VWF retention in the endoplasmic reticulum (ER); this was confirmed in various populations of base edited CB-ECFCs harboring the p.M771V variant.</p><p><strong>Conclusion: </strong>The severe endothelial phenotype observed in patient-derived p.M771V ECFCs, HEK293 cells, and an original base-edited CB-ECFC modelling system, show that ER retention of VWF and failure to undergo subsequent proteolytic processing underpins the severe bleeding phenotype of patients with homozygous variants at M771.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605179","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":"An update on laboratory detection and interpretation of antiphospholipid antibodies for diagnosis of antiphospholipid syndrome: Guidance from the International Society on Thrombosis and Haemostasis Scientific and Standardization Committee (ISTH-SSC) Subcommittee on Lupus Anticoagulant/Antiphospholipid Antibodies.","authors":"Katrien M J Devreese, Maria Laura Bertolaccini, D Ware Branch, Bas de Laat, Doruk Erkan, Emmanuel J Favaloro, Vittorio Pengo, Thomas L Ortel, Denis Wahl, Hannah Cohen","doi":"10.1016/j.jtha.2024.10.022","DOIUrl":"https://doi.org/10.1016/j.jtha.2024.10.022","url":null,"abstract":"<p><p>APS diagnosis is dependent on accurate detection and interpretation of antiphospholipid antibodies (aPL). Lupus anticoagulant (LA), anticardiolipin antibodies (aCL) and anti-beta2 glycoprotein I antibodies (aβ2GPI) remain the cornerstone of the laboratory part of APS diagnosis. In the 2023 ACR/EULAR APS classification criteria, the type of laboratory parameters remain essentially unchanged compared to the updated Sapporo classification criteria, and aCL and aβ2GPI antibody measurement is still restricted to enzyme-linked immunosorbent assays (ELISA) with moderate and high titer aPL thresholds defined as 40 and 80 units, respectively, and a cutoff calculated by the 99^th percentile has been abandoned. We must differentiate between classification criteria and assessment of aPL in clinical care. Classification criteria are strict and meant for participant inclusion in studies and trials to study homogeneous populations of patients. In contrast, laboratory detection for APS diagnosis in daily practice is broader meant to diagnose each APS patient to optimize their management. Nowadays, there is increasing use of measurement of aPL by methods other than ELISA, the semiquantitative reporting of titers is a matter of debate, as well as the role of the isotypes IgM and IgA, and the role of other aPL, such as antiphosphatidylserine/prothrombin antibodies. Patients diagnosed with the disease may or may not fulfill the classification criteria and inappropriate use of classification criteria may lead to mis(under)diagnosis. The aim of this guidance, based on literature and expert opinion, is to provide guidance recommendations for laboratory workers and clinicians, on routine diagnostic assessment of patients with suspected APS.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605177","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":"Validating International Classification of Diseases Code 10th Revision algorithms for accurate identification of pulmonary embolism.","authors":"Behnood Bikdeli, Candrika D Khairani, Antoine Bejjani, Ying-Chih Lo, Shiwani Mahajan, César Caraballo, Jose Victor Jimenez, Darsiya Krishnathasan, Mehrdad Zarghami, Sina Rashedi, David Jimenez, Stefano Barco, Eric A Secemsky, Frederikus A Klok, Andetta R Hunsaker, Ayaz Aghayev, Alfonso Muriel, Mohamad A Hussain, Abena Appah-Sampong, Yuan Lu, Zhenqiu Lin, Hamid Mojibian, Sanjay Aneja, Rohan Khera, Stavros Konstantinides, Samuel Z Goldhaber, Liqin Wang, Li Zhou, Manuel Monreal, Gregory Piazza, Harlan M Krumholz","doi":"10.1016/j.jtha.2024.10.013","DOIUrl":"10.1016/j.jtha.2024.10.013","url":null,"abstract":"<p><strong>Background: </strong>Many research investigations for pulmonary embolism (PE) rely on the International Classification of Diseases 10th Revision (ICD-10) codes for analyses of electronic databases. The validity of ICD-10 codes in identifying PE remains uncertain.</p><p><strong>Objectives: </strong>The objective of this study was to validate an algorithm to efficiently identify pulmonary embolism using ICD-10 codes.</p><p><strong>Methods: </strong>Using a prespecified protocol, patients in the Mass General-Brigham hospitals (2016-2021) with ICD-10 principal discharge codes for PE, those with secondary codes for PE, and those without PE codes were identified (n = 578 from each group). Weighting was applied to represent each group proportionate to their true prevalence. The accuracy of ICD-10 codes for identifying PE was compared with adjudication by independent physicians. The F1 score, which incorporates sensitivity and positive predictive value (PPV), was assessed. Subset validation was performed at Yale-New Haven Health System.</p><p><strong>Results: </strong>A total of 1712 patients were included (age: 60.6 years; 52.3% female). ICD-10 PE codes in the principal discharge position had sensitivity and PPV of 58.3% and 92.1%, respectively. Adding secondary discharge codes to the principal discharge codes improved the sensitivity to 83.2%, but the PPV was reduced to 79.1%. Using a combination of ICD-10 PE principal discharge codes or secondary codes plus imaging codes for PE led to sensitivity and PPV of 81.6% and 84.7%, respectively, and the highest F1 score (83.1%; P < .001 compared with other methods). Validation yielded largely similar results.</p><p><strong>Conclusion: </strong>Although the principal discharge codes for PE show excellent PPV, they miss 40% of acute PEs. A combination of principal discharge codes and secondary codes plus PE imaging codes led to improved sensitivity without severe reduction in PPV.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591030","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":"High risk of long-term recurrence after a first episode of venous thromboembolism during pregnancy or postpartum: the REcurrence after a PrEgnAncy related Thrombosis (REPEAT) Study.","authors":"Manal Ibrahim-Kosta, Sarah El Harake, Barbara Leclercq, Céline De Mari, Jean-François Secondi, Emilie Paoletti, Pierre Suchon, Yasmine Benredouane, Dominique Brunet, Marie-Christine Barthet, Maria Bruzelius, Gaëlle Munsch, David-Alexandre Trégouët, Pierre-Emmanuel Morange, Louisa Goumidi, Gabrielle Sarlon-Bartoli","doi":"10.1016/j.jtha.2024.09.039","DOIUrl":"https://doi.org/10.1016/j.jtha.2024.09.039","url":null,"abstract":"<p><strong>Introduction: </strong>Long term-recurrence risk following a pregnancy associated venous thromboembolism (VTE) is sparsely assessed.</p><p><strong>Objective: </strong>To determine the rate of recurrence after a pregnancy associated VTE, and identify associated risk factors.</p><p><strong>Method: </strong>Five hundred and eighty-seven women with a history of first VTE occurring during pregnancy or until 3 months after delivery were referred to La Timone Hospital, Marseille, France. Women were consecutively included between 2000 and 2015. VTE characteristics and biological parameters were collected at inclusion. During the 2016-2019 period, patients were recontacted to gather information on post-inclusion VTE. A weighted Cox model, adapted to the study's ambispective design, was used to analyse pre- and post-inclusion VTE recurrences.</p><p><strong>Results: </strong>After quality controls, 583 women were analyzed. Incidence of recurrent VTE was 2.4% person-years. Cumulative risk of VTE recurrence was 38% (n=221), with a median follow-up of 31 years (95%CI [27-35]); 6%, 13%, 17%, 30% at 2, 5, 10 and 30 years respectively. Pulmonary embolism (PE) at first event was associated with a 2-fold increased risk of PE at recurrence compared with isolated deep venous thrombosis (DVT, Hazard Ratio (HR)=2.63, 95%CI [1.44-4.82]). Risk factors significantly associated with recurrence were: interrupted pregnancies (HR=1.85, 95%CI [1.18-2.90]; lower limb DVT (HR=2.95, 95%CI [1.16-7.49] and AB blood group (HR=1.71, 95%CI [1.06-2.77]).</p><p><strong>Conclusion: </strong>Although the recurrence risk is low within the first 10 years after a pregnancy associated VTE, 1/3 patients experienced a new event over a 30-year period. Interrupted pregnancies, lower limb DVT, and AB blood group were associated with higher risk of recurrence.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564310","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":"Validation of clinical risk assessment scores for venous thromboembolism in patients with cancer: a population-based cohort study.","authors":"Vincent Lanting, Emese Vágó, Erzsébet Horváth-Puhó, Frits Mulder, Marcello Di Nisio, Pieter W Kamphuisen, Lars Pedersen, Nick van Es, Henrik T Sørensen","doi":"10.1016/j.jtha.2024.10.021","DOIUrl":"https://doi.org/10.1016/j.jtha.2024.10.021","url":null,"abstract":"<p><strong>Background: </strong>Guidelines recommend using risk assessment tools to identify ambulatory patients with cancer at high risk of venous thromboembolism (VTE).</p><p><strong>Objective: </strong>We aimed to validate a new cancer-associated thrombosis (CAT) risk score in a population-based healthcare setting.</p><p><strong>Methods: </strong>We used healthcare registry data and electronic medical records from the Central Denmark Region to calculate the new CAT risk score and the guideline-recommended Khorana score in patients with a first-time cancer diagnosis who initiated systemic cancer therapy. Patients were followed for six months after initiation of therapy. The outcome was any VTE identified through hospital discharge diagnoses. Discrimination was assessed using c-statistics.</p><p><strong>Results: </strong>We included 12,471 patients from 2012 through 2020. Of these, 416 (3.3%) developed VTE. The c-statistic was 0.71 (95% confidence interval [CI]: 0.68-0.74) for the new CAT score and 0.66 (95% CI: 0.63-0.70) for the Khorana score. The six-month cumulative VTE incidence was 5.0% in 6,175 patients classified as high risk by the new CAT score, compared with 1.7% in 6,296 patients classified as low risk. The six-month cumulative VTE incidence was 5.2% in 4,263 patients classified as high risk by the Khorana score, compared with 2.4% in 8,208 patients classified as low risk.</p><p><strong>Conclusion: </strong>The new CAT score had a discriminatory ability similar to that reported in the derivation study. The c-statistic was numerically higher than that of the Khorana score. Our findings support implementation of the new CAT score to identify ambulatory patients with cancer who are at high risk of VTE.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558140","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":"Déjà vu all over again: a recurrent flaw in anticoagulant study design.","authors":"Bethany Samuelson Bannow, Alison Edelman, Marc Carrier","doi":"10.1016/j.jtha.2024.10.019","DOIUrl":"10.1016/j.jtha.2024.10.019","url":null,"abstract":"<p><p>The availability of direct oral anticoagulants rapidly changed the landscape of anticoagulation between 2010 and the present. Randomized controlled trials demonstrating efficacy with similar or superior safety compared with warfarin led to the widespread use of direct oral anticoagulants in male and female patients of all ages. Years later, postmarketing data demonstrated a markedly increased rate of heavy menstrual bleeding (HMB) with rivaroxaban that had gone undetected in registry trials. Factor (F)XI inhibitors are currently being investigated as another alternative to available anticoagulation agents. While generally mild, the phenotype of inherited FXI deficiency includes bleeding in tissues with enhanced fibrinolysis, including HMB. Thus, we aimed to perform a systematic review of published studies on FXI inhibitors in order to estimate rates of HMB. However, we found that few studies included menstruating individuals, and even fewer specifically reported on uterine bleeding, highlighting once again a flaw in our approach to conducting trials of new anticoagulants.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546156","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}