Journal of Thrombosis and Haemostasis最新文献

{"title":"Validation of clinical risk assessment scores for venous thromboembolism in patients with cancer: a population-based cohort study","authors":"Vincent Lanting ,&nbsp;Emese Vágó ,&nbsp;Erzsébet Horváth-Puhó ,&nbsp;Frits Mulder ,&nbsp;Marcello Di Nisio ,&nbsp;Pieter W. Kamphuisen ,&nbsp;Lars Pedersen ,&nbsp;Nick van Es ,&nbsp;Henrik T. Sørensen","doi":"10.1016/j.jtha.2024.10.021","DOIUrl":"10.1016/j.jtha.2024.10.021","url":null,"abstract":"<div><h3>Background</h3><div>Guidelines recommend using risk assessment tools to identify ambulatory patients with cancer at high risk of venous thromboembolism (VTE).</div></div><div><h3>Objectives</h3><div>We aimed to validate a new cancer-associated thrombosis (CAT) risk score in a population-based healthcare setting.</div></div><div><h3>Methods</h3><div>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 6 months after initiation of therapy. The outcome was any VTE identified through hospital discharge diagnoses. Discrimination was assessed using C statistics.</div></div><div><h3>Results</h3><div>We included 12 471 patients from 2012 to 2020. Of these, 416 (3.3%) developed VTE. The C statistic was 0.71 (95% CI, 0.68-0.74) for the new CAT score and 0.66 (95% CI, 0.63-0.70) for the Khorana score. The 6-month cumulative VTE incidence was 5.0% in 6175 patients classified as high risk by the new CAT score compared with 1.7% in 6296 patients classified as low risk. The 6-month cumulative VTE incidence was 5.2% in 4263 patients classified as high risk by the Khorana score compared with 2.4% in 8208 patients classified as low risk.</div></div><div><h3>Conclusion</h3><div>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 the implementation of the new CAT score to identify ambulatory patients with cancer who are at high risk of VTE.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"23 2","pages":"Pages 600-609"},"PeriodicalIF":5.5,"publicationDate":"2025-02-01","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deconstructing fibrin(ogen) structure","authors":"Rebecca A. Risman ,&nbsp;Mehmet Sen ,&nbsp;Valerie Tutwiler ,&nbsp;Nathan E. Hudson","doi":"10.1016/j.jtha.2024.10.024","DOIUrl":"10.1016/j.jtha.2024.10.024","url":null,"abstract":"<div><div>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 posttranslational modifications, to its (patho)physiologic 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 physiologic functions and the presence of cryptic binding sites. Investigations into fibrin clot structure elucidated the impact of posttranslational modifications, therapeutic interventions, and pathologic 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.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"23 2","pages":"Pages 368-380"},"PeriodicalIF":5.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786978/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine learning models for risk prediction of cancer-associated thrombosis: a systematic review and meta-analysis","authors":"Keya Chen ,&nbsp;Ying Zhang ,&nbsp;Lufang Zhang ,&nbsp;Wei Zhang ,&nbsp;Yu Chen","doi":"10.1016/j.jtha.2024.11.001","DOIUrl":"10.1016/j.jtha.2024.11.001","url":null,"abstract":"<div><h3>Background</h3><div>Although the number of models for predicting the risk of cancer-associated thrombosis has been rising, there is still a lack of comprehensive assessment for machine learning prediction models.</div></div><div><h3>Objectives</h3><div>This study aimed to critically appraise and quantify the performance studies using machine learning to predict cancer-associated thrombosis.</div></div><div><h3>Methods</h3><div>We conducted searches on PubMed, Embase, The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and other related databases for the related publications (from inception to December 1, 2023). The Prediction Model Risk of Bias Assessment Tool checklist was employed to evaluate the risk of bias and applicability. The Grading of Recommendations Assessment, Development and Evaluation system was used to evaluate the quality of evidence in systematic reviews. Meta-analyses were conducted using R (version 4.3.2).</div></div><div><h3>Results</h3><div>A total of 32 studies were included. Mostly included literature exhibited a high risk of bias, and the applicability of the prediction models was deemed acceptable. The 21 included studies in the meta-analysis demonstrated the high predictive capacity of the machine learning models for cancer-associated thrombosis.</div></div><div><h3>Conclusion</h3><div>Most of the prediction models included in the study showed good applicability and excellent prediction performance, but there was a high risk of bias.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"23 2","pages":"Pages 610-626"},"PeriodicalIF":5.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644068","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":"Citrullination of tissue factor pathway inhibitor alpha by peptidylarginine deiminase 4 impairs its natural anticoagulant activity toward factors Xa and VIIa/tissue factor and reduces binding to its cofactor protein S","authors":"Bryan R.C. Bouwens ,&nbsp;Elke Magdeleyns ,&nbsp;M. Christella L.G.D. Thomassen ,&nbsp;Freek G. Bouwman ,&nbsp;Dennis P. Suylen ,&nbsp;Tilman M. Hackeng ,&nbsp;Rory R. Koenen","doi":"10.1016/j.jtha.2024.11.009","DOIUrl":"10.1016/j.jtha.2024.11.009","url":null,"abstract":"<div><h3>Background</h3><div>Neutrophils are known to externalize their DNA and intracellular contents to neutralize invading pathogens. This process may enhance blood coagulation during inflammation. Tissue factor (TF) pathway inhibitor (TFPI) binds to extracellular DNA and may be citrullinated by peptidylarginine deiminase 4. Citrullination of TFPI reduces its anticoagulant activity toward factor (F)Xa but appears to retain its inhibition of TF-triggered thrombin generation, indicating differential regulation of TFPI functions by peptidylarginine deiminase 4.</div></div><div><h3>Objectives</h3><div>This work aimed to study the effects of citrullination of TFPI-alpha on the inhibition of FXa, FVIIa/TF, and the cofactor activity of protein S.</div></div><div><h3>Methods</h3><div>The effect of TFPI citrullination on the inhibition of FXa and FVIIa/TF was measured by chromogenic assays using purified components and by calibrated automated thrombography. Interaction with protein S was assessed by surface plasmon resonance and solid-phase binding assays using immobilized protein S, recombinant TFPI, and synthetic TFPI domains.</div></div><div><h3>Results</h3><div>Citrullination of TFPI abolished its ability to inhibit FXa- and FXIa-triggered thrombin generation. However, its impaired inhibition of TF-triggered thrombin generation was still enhanced by protein S. Chromogenic assays revealed that citrullinated TFPI was essentially inactive as an inhibitor of the FVIIa-TF complex in the absence of protein S but partially restored by protein S. Interaction studies revealed that binding of citrullinated TFPI to protein S was reduced approximately 4-fold.</div></div><div><h3>Conclusion</h3><div>Citrullinated TFPI shows impaired natural anticoagulant activity. While anti-FXa activity is essentially absent, its anti-TF/FVIIa activity can still be enhanced by protein S. This enhancement is incomplete; however, protein S binding to citrullinated TFPI is impaired.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"23 2","pages":"Pages 641-650"},"PeriodicalIF":5.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755336","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":"Insoluble proteomics analysis of acute intracranial large vessel occlusive thrombus","authors":"Liuchang He ,&nbsp;Yunchao Wang ,&nbsp;Hanghang Zhu ,&nbsp;Kaihao Han ,&nbsp;Sen Wei ,&nbsp;Tao Quan ,&nbsp;Panxing Li ,&nbsp;Bo Yang ,&nbsp;Ke Sun ,&nbsp;Yazhou Jin ,&nbsp;Anran Wang ,&nbsp;Xinli Xue ,&nbsp;Lei Zhang ,&nbsp;Conghui Liu ,&nbsp;Yuan Gao ,&nbsp;Yuming Xu","doi":"10.1016/j.jtha.2024.09.033","DOIUrl":"10.1016/j.jtha.2024.09.033","url":null,"abstract":"<div><h3>Background</h3><div>Acute large vessel occlusion (LVO) stroke is highly prevalent and severe. Despite thrombolytic therapy, many patients experience substantial complications. Understanding the origins, constituents, and pathologic processes involved in thrombus formation in acute intracranial large artery occlusion is crucial.</div></div><div><h3>Objectives</h3><div>To identify the characteristics of insoluble proteins from different sources of cerebral thrombus.</div></div><div><h3>Methods</h3><div>This study included 13 patients with cardiogenic embolic (CE) thrombus and 15 with large artery atherosclerotic (LAA) thrombus. High-performance liquid chromatography and liquid chromatography-tandem mass spectrometry were used to analyze insoluble proteins in thrombi. Bioinformatics analyses explored differential proteins and associated functional pathways. Least absolute shrinkage and selection operator and random forest identified biomarkers for diagnosing thrombus sources, validated by parallel reaction monitoring.</div></div><div><h3>Results</h3><div>We constructed an insoluble protein atlas of cerebral thrombi, identifying 6975 insoluble proteins, including 143 extracellular matrix (ECM)-related proteins. The enrichment pathways considerably varied between thrombi from different sources. Inflammation-related pathways, such as acute inflammatory response, along with ECM-related pathways such as laminin interactions, were notably upregulated in LAA compared with CE. Additionally, 2 biomarkers (IDH2 and HSPG2) exhibited strong diagnostic performance (area under the curve = 1) and robustness.</div></div><div><h3>Conclusion</h3><div>In the insoluble proteomics of thrombus, we highlighted the crucial roles of immune responses and ECM proteins in thrombus formation, providing new insights into its mechanisms and potential drug development. Additionally, we identified 2 biomarkers that offer new methods for determining thrombus sources in patients with LVO.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"23 2","pages":"Pages 565-576"},"PeriodicalIF":5.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502855","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":"Non-immunogenic recombinant staphylokinase versus alteplase for patients with massive pulmonary embolism: a randomized open-label, multicenter, parallel-group, non-inferiority trial, FORPE","authors":"Alexander I. Kirienko ,&nbsp;Stanislav G. Leontyev ,&nbsp;Sergey N. Tereschenko ,&nbsp;Igor S. Yavelov ,&nbsp;Roman M. Shakhnovich ,&nbsp;Alexey D. Erlikh ,&nbsp;Oleg B. Talibov ,&nbsp;Elena B. Yarovaya ,&nbsp;Andrey M. Semenov ,&nbsp;Michail P. Semenov ,&nbsp;Sergey V. Ivanov ,&nbsp;Valery V. Beregovykh ,&nbsp;Alexander I. Archakov ,&nbsp;Sergey S. Markin","doi":"10.1016/j.jtha.2024.09.035","DOIUrl":"10.1016/j.jtha.2024.09.035","url":null,"abstract":"<div><h3>Background</h3><div>Non-immunogenic staphylokinase is a modified recombinant staphylokinase with low immunogenicity, high thrombolytic activity, and fibrin selectivity.</div></div><div><h3>Objectives</h3><div>To assess the safety and efficacy of a single intravenous bolus of non-immunogenic staphylokinase compared with those of alteplase in patients with massive pulmonary embolism and hemodynamic instability.</div></div><div><h3>Methods</h3><div>A randomized, open-label, multicenter, parallel-group, non-inferiority trial, the FORPE (FORtelyzin Pulmionary Embolism), was conducted in Russia. A total of 310 patients aged 18 years and older with computed tomography pulmonary angiography confirmed diagnosis of massive pulmonary embolism and right ventricular dysfunction were included. The patients were randomly assigned to receive either non-immunogenic staphylokinase (15 mg) or alteplase (100 mg), both administered intravenously. The primary efficacy endpoint was death from all causes within 7 days of randomization.</div></div><div><h3>Results</h3><div>A total of 155 patients were randomly assigned to receive non-immunogenic staphylokinase, and 155 received alteplase. In the non-immunogenic staphylokinase group, the primary efficacy endpoint was 2% in the intention-to-treat population, while in the alteplase group, it was 3% (odds ratio, 0.75; 95% CI, 0.11-4.49; <em>P</em> = 1.00). The difference in the primary efficacy endpoint was 0.6% (95% CI, –2.8% to 4.0%). Thus, the lower limit of the 95% CI did not cross the margin of non-inferiority. No cases of major bleeding were recorded in the non-immunogenic staphylokinase group, whereas there were 5 cases of major bleeding (3%; <em>P</em> = .09) in the alteplase group.</div></div><div><h3>Conclusion</h3><div>Non-immunogenic staphylokinase was non-inferior to alteplase in patients with massive pulmonary embolism. Future observational studies are needed to assess its safety and efficacy.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"23 2","pages":"Pages 657-667"},"PeriodicalIF":5.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502858","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 ,&nbsp;Joanna Larson ,&nbsp;Sepideh Saroukhani ,&nbsp;Mohammed Said ,&nbsp;Deborah Brown ,&nbsp;Nidra Rodriguez ,&nbsp;Neethu Menon ,&nbsp;Miguel Escobar","doi":"10.1016/j.jtha.2024.10.030","DOIUrl":"10.1016/j.jtha.2024.10.030","url":null,"abstract":"<div><h3>Background</h3><div>Increasing evidence in females with hemophilia A has shown significant bleeding symptoms. Accurate factor (F) VIII activity (FVIII:C) measurement is essential to assign correct diagnosis and severity. Assay discrepancies reported in male patients with hemophilia A are not well studied in females.</div></div><div><h3>Objectives</h3><div>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.</div></div><div><h3>Methods</h3><div>Data from 64 females with hemophilia A from our center were reviewed with center’s institutional review board approval. Descriptive statistics, chi-squared, Fisher’s exact, and Bland–Altman plot analysis were applied.</div></div><div><h3>Results</h3><div>Abnormal International Society on Thrombosis and Haemostasis bleeding assessment tool score was seen in 52% (FVIII:C &lt;40 IU/dL: 72%/73%; FVIII:C ≥40 IU/dL: 41%/45%; by one-stage and chromogenic assays, respectively), more often in adults and postmenarchal 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 associations of genetic variants with FVIII:C levels and bleeding phenotype were found.</div></div><div><h3>Conclusion</h3><div>Our study emphasizes the importance of evaluating female patients with hemophilia A 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 and severity assignment. Future larger, multicenter 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.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"23 2","pages":"Pages 504-512"},"PeriodicalIF":5.5,"publicationDate":"2025-02-01","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":"Use of antithrombotic therapy in patients with hemophilia: a selected synopsis of the European Hematology Association - International Society on Thrombosis and Haemostasis - European Association for Hemophilia and Allied Disorders - European Stroke Organization Clinical Practice Guidance document","authors":"Miguel Escobar ,&nbsp;Riitta Lassila ,&nbsp;Carine Bekdache ,&nbsp;Tarek Owaidah ,&nbsp;Michelle Sholzberg","doi":"10.1016/j.jtha.2024.10.033","DOIUrl":"10.1016/j.jtha.2024.10.033","url":null,"abstract":"<div><div>Here, we summarize the European Hematology Association - International Society on Thrombosis and Haemostasis - European Association for Hemophilia and Allied Disorders - European Stroke Organization Clinical Practice Guidance document recommendations on antithrombotic therapy for cardiovascular indications among patients with hemophilia. This summary includes a discussion on primary and secondary prevention of venous and arterial thrombosis. The guidance document considers distinct and controversial challenges presented by various clinical scenarios in this aging patient population and provides thoughtful recommendations to assist the hemophilia care provider in clinical decision-making.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"23 2","pages":"Pages 745-749"},"PeriodicalIF":5.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687456","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":"Evaluating plasma vesicle signatures in chronic coronary artery disease patients for tailored dual therapy with low-dose rivaroxaban and aspirin","authors":"Paola Patrignani,&nbsp;Alessandra De Michele,&nbsp;Stefania Tacconelli","doi":"10.1016/j.jtha.2024.11.011","DOIUrl":"10.1016/j.jtha.2024.11.011","url":null,"abstract":"","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"23 2","pages":"Pages 397-400"},"PeriodicalIF":5.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074750","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":"Splanchnic vein thrombosis: management for the thrombosis specialist","authors":"Kevin J. Barnum ,&nbsp;Rushad Patell ,&nbsp;Jonathan Berry ,&nbsp;Kenneth A. Bauer","doi":"10.1016/j.jtha.2024.10.012","DOIUrl":"10.1016/j.jtha.2024.10.012","url":null,"abstract":"<div><div>Splanchnic vein thrombosis (SpVT) is an uncommon site of venous thrombosis that is associated with complications including portal hypertension and hepatic dysfunction. The evaluation and management of this patient population has evolved in recent years, but there are limited data from clinical trials to guide management. Given the various acquired and biologic risk factors leading to the development of SpVT and the potential complications that can arise from it, input from a multidisciplinary team can be valuable in managing such patients, including thrombosis specialists or hematologists, gastroenterologists or hepatologists, interventional radiologists, and surgeons. In this article, we present 4 cases that highlight important issues and considerations in the evaluation of SpVT, including initial diagnostic approach in a patient with a new diagnosis of SpVT, considerations for anticoagulant therapy, management of SpVT in patients with myeloproliferative neoplasms, and the role of interventional vascular procedures in the management of SpVT. By reviewing the current literature, we address clinically relevant questions that are posed to clinicians managing patients with SpVT; we also point out gaps in our current knowledge that merit future investigation.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"23 2","pages":"Pages 404-416"},"PeriodicalIF":5.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502862","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}