Journal of Thrombosis and Haemostasis最新文献

{"title":"Nuclear molecular imaging of venous thromboembolism: targeting clot-specific molecular components for improved diagnosis and management","authors":"Jamal Elhasnaoui,&nbsp;Philippe Robin,&nbsp;Catherine A. Lemarie","doi":"10.1016/j.jtha.2026.05.031","DOIUrl":"10.1016/j.jtha.2026.05.031","url":null,"abstract":"<div><div>Venous thromboembolism (VTE), manifesting as deep vein thrombosis and pulmonary embolism, is a common, recurrent and potentially fatal condition. Anticoagulation remains the cornerstone of therapy, yet determining optimal treatment duration (eg, decision to shorten or extend anticoagulant treatment) is difficult due to the uncertain balance between long-term bleeding risk and recurrence. Future advances in vascular nuclear molecular imaging could critically help support this decision-making process. Current VTE diagnostic imaging relies on structural or perfusion-based techniques to infer thrombosis from abnormal vasculature structure or filling defects. While highly effective in localizing thrombi and assessing hemodynamic impact, they provide little insight into the biological activity or age of the clot. Consequently, anticoagulation strategies (duration and management) often proceed without direct clot-specific molecular information, potentially leading to suboptimal outcomes and increased risk of fatal bleeding. By contrast, nuclear VTE molecular imaging—using radiolabeled probes that selectively target key thrombus components such as fibrin or activated platelets—enables direct visualization of the clot. Single-photon emission computed tomography and positron emission tomography targeted imaging of VTE, beyond enhancing diagnostic accuracy, are expected to provide valuable insights into the structure, age, and activity of the clot. In particular, integration of these modalities with molecular findings from high throughput technologies could further elucidate the cellular and molecular mechanisms driving thrombus formation and resolution. When coupled with positron emission tomography’s ability to assess molecular processes <em>in vivo</em>, such approaches may establish precision imaging biomarkers, bridging the gap between clot biology and clinical imaging, and ultimately transform VTE management from a structural or perfusion based to molecularly informed paradigm.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"24 10","pages":"Pages 3415-3431"},"PeriodicalIF":5.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148194761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bleeding in patients with lung adenocarcinoma receiving concurrent administration of anticoagulation and vascular endothelial growth factor or epidermal growth factor receptor inhibitors","authors":"Thomas F. Fusillo,&nbsp;Avi Leader,&nbsp;Simon Mantha,&nbsp;Helen Ajufo,&nbsp;Andriy Derkach,&nbsp;Adam Schoenfeld,&nbsp;Rohan Singh,&nbsp;Peter Kaplinsky,&nbsp;Jeffrey I. Zwicker","doi":"10.1016/j.jtha.2026.05.028","DOIUrl":"10.1016/j.jtha.2026.05.028","url":null,"abstract":"<div><h3>Background</h3><div>Vascular endothelial growth factor (VEGF) inhibitors and epidermal growth factor receptor (EGFR) inhibitors are used to treat various cancers, including lung adenocarcinoma, but their associated bleeding risks when combined with anticoagulation therapy are largely unknown.</div></div><div><h3>Objectives</h3><div>We sought to determine whether coadministration of VEGF inhibitors or EGFR inhibitors with anticoagulation therapy in patients with lung adenocarcinoma is associated with higher clinically relevant bleeding risks than in patients receiving anticoagulation therapy with systemic therapy alone.</div></div><div><h3>Patients/Methods</h3><div>We conducted a single-center retrospective cohort study of patients treated for lung adenocarcinoma with therapeutic anticoagulation and concurrent systemic cancer therapy alone, VEGF inhibitors ± systemic therapy, or EGFR inhibitors ± systemic therapy. The index was the first day of concomitant anticoagulation and cancer treatment. Patients were followed for 12 months, and major bleeding and clinically relevant nonmajor bleeding (CRNMB) outcomes were collected using an internally validated natural language processing tool.</div></div><div><h3>Results</h3><div>A total of 464 patients were included, comprising 156 (34%) systemic therapy alone, 208 (45%) EGFR inhibitors, and 100 (22%) VEGF inhibitors. The 12-month cumulative incidence of major bleeding was statistically similar in the 3 cohorts: VEGF inhibitor (10%; 95% CI, 3.4%-22%), EGFR inhibitor (11%; 95% CI, 6.5%-17%), and systemic therapy cohort (9.3%; 95% CI, 4.1%-17%). We observed statistically similar risks of CRNMB with VEGF inhibitors (hazard ratio, 1.51; 95% CI, 0.71-3.20) and EGFR inhibitors (hazard ratio, 1.35; 95% CI, 0.65-2.80) versus systemic therapy alone. Epistaxis was the most common site, accounting for 25% of clinically relevant events.</div></div><div><h3>Conclusions</h3><div>Concomitant administration of VEGF inhibitors and anticoagulation therapy was not associated with statistically significant increased risks of major bleeding or CRNMB.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"24 10","pages":"Pages 3553-3563"},"PeriodicalIF":5.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148194743","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":"Disseminated intravascular coagulopathy in pregnancy: lessons from an international registry of the International Society for Thrombosis and Hemostasis: communication from the SSC of the ISTH","authors":"Offer Erez,&nbsp;Limor Besser,&nbsp;Adi Dayan Schwartz,&nbsp;Sebastian Illanes,&nbsp;Benjamin Quezada,&nbsp;Maha Othman,&nbsp;Rezan Abdul Kadir,&nbsp;Toshi Iba,&nbsp;Robert Sidonio,&nbsp;Ecaterina Scarlatescu,&nbsp;Jecko Thachil","doi":"10.1016/j.jtha.2026.06.030","DOIUrl":"10.1016/j.jtha.2026.06.030","url":null,"abstract":"<div><div>Disseminated intravascular coagulopathy (DIC) in pregnancy is a severe maternal morbidity that is associated with short- and long-term complications. However, information regarding the causes of DIC treatments and outcomes in pregnancy is based on local reports. To address this gap, 2 Scientific and Standardization Committees, the Women’s Health Issues in Thrombosis and Hemostasis and Disseminated Intravascular Coagulation of the International Society on Thrombosis and Hemostasis, joined to establish an international global registry. This registry was developed to examine the current definitions, clinical presentations, and current practices around laboratory diagnosis and management of DIC worldwide. We collected data between 2018 and 2024; there were 148 data entries to the registry (13 countries); 104 of them included patients’ clinical and laboratory information. Placental abruption is the leading cause for ante- and intrapartum DIC, especially when associated with stillbirth. The leading etiology for postpartum DIC was uterine atony, especially following/during caesarean sections. The contribution of abnormally implanted placenta (ie, placenta accreta and/or previa) to the development of DIC is increasing. The leading pregnancy complications associated with DIC were placental abruption in HIC and preeclampsia in LMIC. Hemostatic parameters differed between women who had a positive pregnancy–specific DIC score and those who did not meet that criterion. Women with placental-mediated pregnancy complications had a lower median pregnancy–specific DIC score than those without such complications at the time of diagnosis of DIC and following recovery, suggesting a different mechanism of disease in the 2 groups.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"24 10","pages":"Pages 3784-3796"},"PeriodicalIF":5.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148339088","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":"Direct oral anticoagulant use and drug–drug interactions in transplant recipients receiving calcineurin inhibitors","authors":"Andreas Verstraete,&nbsp;Erwin Dreesen,&nbsp;Quentin Van Thillo,&nbsp;Margot Erard,&nbsp;Dirk R.J. Kuypers,&nbsp;Marc Jacquemin,&nbsp;Filip Rega,&nbsp;Johan Van Cleemput,&nbsp;Jef Verbeek,&nbsp;Robin Vos,&nbsp;Peter Verhamme,&nbsp;Lorenz Van der Linden,&nbsp;Thomas Vanassche","doi":"10.1016/j.jtha.2026.06.038","DOIUrl":"10.1016/j.jtha.2026.06.038","url":null,"abstract":"<div><h3>Background</h3><div>Direct oral anticoagulants (DOACs) are metabolized by CYP3A4 and/or transported by P-glycoprotein. Cyclosporine and tacrolimus can inhibit these pathways, potentially increasing DOAC exposure and bleeding risk. However, data on the relevance of these interactions in transplant recipients are limited.</div></div><div><h3>Objectives</h3><div>We aimed to study DOAC doses, plasma level monitoring, and interactions with calcineurin inhibitors in transplant recipients.</div></div><div><h3>Methods</h3><div>We retrospectively (2013-2024) included all adults treated at the University Hospitals Leuven, Belgium, who received both a DOAC and tacrolimus or cyclosporine and had at least 1 DOAC plasma level measurement. DOAC concentrations were compared with on-therapy ranges from phase 3 trials. Levels exceeding the 95th percentile of peak ranges (for peak and intermediate samples) or trough ranges (for trough samples) were classified as above range.</div></div><div><h3>Results</h3><div>Among 495 patients with coprescription, 216 patients had 360 DOAC measurements. The median age was 66 years (IQR, 59-72). Lung (31%) and kidney (29%) transplants were the most common. DOAC dosing was consistent with product labeling in 73% of measurements. Samples were obtained at peak (12%), trough (58%), or intermediate intervals (30%). Overall, 11% of measurements were above range: 4% for edoxaban, 18% for apixaban, and 20% for rivaroxaban. Above-range levels were associated with concomitant strong CYP3A4 or P-glycoprotein inhibitors, lower body weight, lower estimated glomerular filtration rate, cyclosporine use, and DOAC type.</div></div><div><h3>Conclusion</h3><div>In transplant recipients selected for DOAC plasma level monitoring, above-range DOAC concentrations were observed in a minority of patients but were more frequent among those with strong CYP3A4 or P-glycoprotein inhibitors, lower body weight, impaired kidney function, or cyclosporine use.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"24 10","pages":"Pages 3647-3658"},"PeriodicalIF":5.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405236","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":"SrcE97A Mediates convergent regulation of arterial/venous thrombosis and immune homeostasis via β3–Src dissociation","authors":"Shuang Liu,&nbsp;Jiayi Chen,&nbsp;Yan Shen,&nbsp;Bing Xiao,&nbsp;Yun Wang,&nbsp;Huan Xiong,&nbsp;Zheng Ruan,&nbsp;Jingqiu Liu,&nbsp;Kankan Wang,&nbsp;Cheng Luo,&nbsp;Xiaodong Xi,&nbsp;Jianhua Mao","doi":"10.1016/j.jtha.2026.06.035","DOIUrl":"10.1016/j.jtha.2026.06.035","url":null,"abstract":"<div><h3>Background</h3><div>Integrin β3 orchestrates thrombotic and inflammatory processes through bidirectional signaling, with Src acting as a key downstream effector.</div></div><div><h3>Objectives</h3><div>To dissect this axis, we generated Src^E97A mice that selectively disrupt the interaction between Src and integrin β3, impairing outside-in signaling while preserving inside-out signaling through integrin β3.</div></div><div><h3>Methods</h3><div>Platelet function was assessed through clot retraction, irreversible aggregation, thrombus stabilization under flow, and soluble fibrinogen binding. Thrombosis models included FeCl₃-induced carotid artery and laser-induced cremaster arteriole injury for arterial thrombosis, and the inferior vena cava ligation for deep vein thrombosis. Hemostasis was evaluated in parallel. The impact on cerebral infarction was measured <em>in vivo</em>. In addition, the biological functions of αvβ3 outside-in signaling were also analyzed.</div></div><div><h3>Results</h3><div>The Src^E97A mutation impaired outside-in signaling while preserving inside-out signaling in platelets. This suppressed αIIbβ3-mediated clot retraction, secondary aggregation, and thrombus stabilization under flow. Src^E97A mice showed reduced arterial and venous thrombosis without hemostatic compromise. These antithrombotic effects were reinforced by protection against cerebral infarction <em>in vivo</em>. Furthermore, the E97A mutation influenced immunologic regulation. Specifically, it promoted pulmonary inflammation by skewing T helper (Th) cell differentiation toward Th1, via disruption of the αvβ3–Src–STAT4/6 signaling axis.</div></div><div><h3>Conclusions</h3><div>These findings establish integrin β3 as a dual regulator of thrombosis and immune homeostasis. Selective disruption of outside-in signaling attenuates pathologic thrombosis without compromising hemostasis and reshapes Th1/Th2 balance. Targeting the Src E97 interface may offer strategies to inhibit pathologic thrombosis and modulate inflammation.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"24 10","pages":"Pages 3619-3636"},"PeriodicalIF":5.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412233","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":"Immunogenic risk assessment of porcine, bovine, and ovine heparins for diversifying the global heparin supply","authors":"Bin Zhang,&nbsp;Changkai Bu,&nbsp;Yuxin Geng,&nbsp;Zizhe An,&nbsp;Lexin Chen,&nbsp;Qunye Zhang,&nbsp;Fuming Zhang,&nbsp;Deling Shi,&nbsp;Lianli Chi","doi":"10.1016/j.jtha.2026.07.009","DOIUrl":"10.1016/j.jtha.2026.07.009","url":null,"abstract":"<div><h3>Background</h3><div>The global heparin supply relies heavily on porcine mucosa, prompting renewed interest in ruminant-derived alternatives. However, concerns regarding heparin-induced thrombocytopenia remain a major barrier to their clinical reintroduction.</div></div><div><h3>Objectives</h3><div>To systematically evaluate the platelet factor 4 (PF4)–dependent immunogenic potential of porcine mucosal heparin, bovine lung heparin, and ovine mucosal heparin, as well as their low-molecular-weight heparin (LMWH) derivatives, and to delineate the structural features governing these interactions.</div></div><div><h3>Methods</h3><div>Size-exclusion chromatography and a competitive ELISA established in this study were used to monitor PF4–heparin complex stoichiometry and antibody recognition. Flow cytometry quantified functional heparin-induced platelet activation (CD62P/CD63 expression). PF4 affinity chromatography–hydrophilic interaction liquid chromatography–mass spectrometry and molecular docking characterized high-affinity glycan features and evaluated sulfation patterns in stabilizing PF4–heparin interactions.</div></div><div><h3>Results</h3><div>Under equipotent dosing conditions, PF4 complex formation, antibody recognition, and platelet activation followed the order bovine lung heparin &gt; ovine mucosal heparin &gt; porcine mucosal heparin. Differences among heparins were largely explained by molecular weight–dependent stoichiometry. In contrast, source-dependent differences among LMWHs persisted after potency normalization, with bovine LMWH forming significantly more PF4 complexes and triggering the most robust platelet activation. Affinity profiling identified degree of polymerization 6–degree of polymerization 8 (dp6–dp8) as minimal PF4-binding units and revealed that increased sulfation and reduced N-acetylation enhance PF4 affinity. Molecular docking confirmed that N-sulfation stabilizes PF4–heparin interactions.</div></div><div><h3>Conclusion</h3><div>Heparins derived from different animal sources exhibit distinct PF4-binding properties and immunogenic profiles. These findings provide mechanistic insight into species-dependent heparin-induced thrombocytopenia risk—driven by stoichiometry in heparin and fine structural features in LMWH—and support diversification of the global heparin supply.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"24 10","pages":"Pages 3732-3745"},"PeriodicalIF":5.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497781","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 the determinants of factor VIII and factor IX levels, bleeding score, and health-related quality of life in the Canadian hemophilia carriers (CHiC) study","authors":"Laura L. Swystun,&nbsp;Julie Grabell,&nbsp;Megan Hinds,&nbsp;Maria Avgeropoulos,&nbsp;Mackenzie Bowman,&nbsp;Megan Chaigneau,&nbsp;Kali de Repentigny,&nbsp;Mark Belletrutti,&nbsp;Wilma Hopman,&nbsp;Alfonso Iorio,&nbsp;Shannon Jackson,&nbsp;Arun Keepanasseril,&nbsp;Jennifer Leung,&nbsp;Sue Robinson,&nbsp;Natalia Rydz,&nbsp;Michelle Sholzberg,&nbsp;Paula D. James","doi":"10.1016/j.jtha.2026.06.043","DOIUrl":"10.1016/j.jtha.2026.06.043","url":null,"abstract":"<div><h3>Background</h3><div>Hemophilia carriers can experience abnormal bleeding and reduced health-related quality of life (HRQoL). Determinants of clinical phenotype remain unclear.</div></div><div><h3>Objectives</h3><div>To identify modifiers of factor VIII (FVIII) and factor IX (FIX) levels, bleeding phenotype, and HRQoL in hemophilia carriers.</div></div><div><h3>Methods</h3><div>This cross-sectional study included 108 Canadian hemophilia carriers aged ≥18 years. Outcomes included Self-administered Bleeding Assessment Tool (Self-BAT) scores, 36-Item Short Form Health Survey, version 2 (SF-36v2) HRQoL, and joint health. Central laboratory testing assessed <em>F8/F9</em> genotypes, factor levels, and ABO group. Associations were evaluated by nonparametric analyses, Spearman’s rho, and multivariable regression.</div></div><div><h3>Results</h3><div>In hemophilia A carriers (<em>N</em> = 92), Self-BAT score correlated with FVIII coagulant activity (FVIII:C; <em>r</em>_<em>s</em> = −0.298, 95% CI: −0.482 to −0.09). Participants with mild hemophilia A had lower mean von Willebrand factor (VWF) antigen (VWF:Ag; 82.8 IU/dL) than symptomatic (129.6) and asymptomatic carriers (164.2). VWF:Ag and VWF propeptide (VWFpp)/VWF:Ag ratio correlated with FVIII:C (<em>r</em>_<em>s</em> = 0.622, 95% CI: 0.47-0.737) and Self-BAT score (<em>r</em>_<em>s</em> = 0.255, 95% CI: 0.043-0.445). Blood type O was present in 83.3% of patients with mild hemophilia A, 59.1% of symptomatic carriers, and 37.5% of asymptomatic carriers and associated with 29.8% lower VWF:Ag, 15.2% lower FVIII:C, and 1.44-fold elevated VWFpp/VWF:Ag. Multivariable analysis confirmed associations between FVIII:C and VWF:Ag (β: 0.26; 95% CI: 0.17-0.34), Self-BAT score and FVIII:C (β: −0.06, 95% CI: −0.1 to −0.01), and Self-BAT score and ABO group (β: −2.73, 95% CI: −5.41 to −0.04). The SF-36v2 Physical Component Summary correlated with Self-BAT score (<em>r</em>_<em>s</em> = −0.255, 95% CI: −0.444 to −0.044) and joint health (<em>r</em>_<em>s</em> = −0.325, 95% CI: −0.512 to −0.111), while mental health domains were linked with feelings of guilt and burden.</div></div><div><h3>Conclusion</h3><div>In hemophilia A carriers, FVIII:C and Self-BAT score associate with VWF and ABO group. A better understanding of these determinants may improve health-related outcomes.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"24 10","pages":"Pages 3489-3504"},"PeriodicalIF":5.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148447747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between thrombus neutrophil extracellular trap content and ischemic stroke recurrence","authors":"Hyungwoo Lee,&nbsp;JoonNyung Heo,&nbsp;Jae Wook Jung,&nbsp;Hyo Suk Nam,&nbsp;Minyoul Baik,&nbsp;Joonsang Yoo,&nbsp;Jinkwon Kim,&nbsp;Tae-Jin Song,&nbsp;Gyu Sik Kim,&nbsp;Kwon-Duk Seo,&nbsp;Tae Dong Ok,&nbsp;Jin Kyo Choi,&nbsp;Il Kwon,&nbsp;Young Dae Kim,&nbsp;Specialized Multi-Center Attributed Registry of Stroke-Clot (SMART-CLOT) Study Group","doi":"10.1016/j.jtha.2026.06.028","DOIUrl":"10.1016/j.jtha.2026.06.028","url":null,"abstract":"<div><h3>Background</h3><div>Neutrophil extracellular traps (NETs) are key mediators of immunothrombosis, linking inflammation and coagulation. Although the presence of NETs within retrieved thrombi has been associated with unfavorable procedural and short-term functional outcomes after ischemic stroke, the prognostic significance of thrombus NET burden for long-term ischemic stroke recurrence remains unclear.</div></div><div><h3>Objectives</h3><div>We investigated the association between thrombus NET content and stroke recurrence in patients undergoing endovascular thrombectomy.</div></div><div><h3>Methods</h3><div>This retrospective analysis of a prospective registry study included patients with acute ischemic stroke who underwent endovascular thrombectomy and had thrombi retrieved for histological analysis. Thrombus NET content was quantitatively assessed using immunohistochemistry. The primary endpoint was recurrent ischemic stroke during follow-up.</div></div><div><h3>Results</h3><div>Among 452 included patients (mean age, 73.2 years; 51.5% male), 104 (23.0%) were classified as the high NETs group based on a predefined cutoff value. During a median follow-up of 29.2 months, 41 patients (9.1%) experienced recurrent ischemic stroke. The high NETs group demonstrated a significantly higher cumulative incidence of recurrence (log-rank <em>P</em> = .013). In multivariable Cox analysis, high thrombus NET content was independently associated with stroke recurrence (hazard ratio, 2.24; 95% CI, 1.18-4.25; <em>P</em> = .014). Sensitivity analyses treating NET content as a continuous variable confirmed a linear association with recurrence risk (<em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>High NET burden within retrieved thrombi was associated with an increased risk of long-term ischemic stroke recurrence. These findings suggest that thrombus-level NET content reflects an underlying thromboinflammatory phenotype linked to recurrent ischemic events.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"24 10","pages":"Pages 3578-3587"},"PeriodicalIF":5.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338998","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":"Proposal of simplified sepsis-induced coagulopathy criteria (SIC-2) for the detection of early-phase disseminated intravascular coagulation in sepsis","authors":"Toshiaki Iba,&nbsp;Tomoki Tanigawa,&nbsp;Yutaka Kondo,&nbsp;Akira Okada,&nbsp;Hideo Wada,&nbsp;Julie Helms,&nbsp;Jerrold H. Levy,&nbsp;Marcel Levi","doi":"10.1016/j.jtha.2026.07.013","DOIUrl":"10.1016/j.jtha.2026.07.013","url":null,"abstract":"<div><h3>Background</h3><div>Sepsis-induced coagulopathy (SIC) was introduced to identify early coagulation abnormalities in sepsis and to predict progression to overt disseminated intravascular coagulation (DIC). However, inclusion of the Sequential Organ Failure Assessment (SOFA) may conflate coagulation-specific biology with overall illness severity.</div></div><div><h3>Objectives</h3><div>This study aimed to evaluate whether removal of the SOFA component preserves the diagnostic and prognostic performance of SIC and to determine whether a simplified coagulation-centered construct (SIC-2) maintains clinical utility.</div></div><div><h3>Methods</h3><div>In a retrospective cohort of 18 086 patients with sepsis from the Medical Information Mart for Intensive Care IV database, we compared the original SIC with SIC-2 using a noninferiority framework. Predictive performance for overt DIC within 5 intensive care unit days, 28-day mortality, and organ support-free outcomes was evaluated for both discrimination and calibration using the area under the receiver operating characteristic curve (AUC) and calibration slopes.</div></div><div><h3>Results</h3><div>Both definitions showed comparable and excellent discrimination for overt DIC (AUC 0.850 vs 0.854; <em>P</em> = .37). For 28-day mortality, SIC demonstrated modest but slightly higher discrimination than SIC-2 (AUC 0.621 vs 0.614; <em>P</em> &lt; .001), although the absolute difference (ΔAUC = 0.007) was small. Associations with intensive care unit-free and ventilator-free days were significant for both scores, with marginally stronger separation for SIC. Under a noninferiority interpretation, the removal of SOFA preserved the prediction of the overt DIC trajectory.</div></div><div><h3>Conclusion</h3><div>The predictive contribution of SOFA within SIC primarily reflects downstream organ dysfunction severity rather than coagulation-specific biology. The simplified, coagulation-centered SIC-2 maintains overt DIC prediction while improving conceptual clarity. These findings support considering SIC-2 as a screening phenotype for early sepsis-associated coagulopathy rather than a composite severity index.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"24 10","pages":"Pages 3520-3530"},"PeriodicalIF":5.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148584701","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":"World Thrombosis Day 2026: spotlight on women’s health","authors":"James D. Douketis,&nbsp;Kathleen Freson,&nbsp;Barbara Krolak","doi":"10.1016/j.jtha.2026.08.012","DOIUrl":"10.1016/j.jtha.2026.08.012","url":null,"abstract":"","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"24 10","pages":"Pages 3413-3414"},"PeriodicalIF":5.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}