Journal of Thrombosis and Haemostasis最新文献

{"title":"Defective lymphangiogenesis and iron removal after hemarthrosis in factor VIII-deficient mice are rectified with therapeutic factor VIII administration-implications for joint health.","authors":"Bilgimol Chumappumkal Joseph, Juan Andres De Pablo-Moreno, Nicca Falah, Mia Lora Cacho, Annette von Drygalski","doi":"10.1016/j.jtha.2025.08.016","DOIUrl":"10.1016/j.jtha.2025.08.016","url":null,"abstract":"<p><strong>Background: </strong>Maladaptive lymphangiogenesis after hemarthrosis in factor(F)VIII-deficient (knockout [KO]) mice facilitates synovial iron accumulation.</p><p><strong>Objectives: </strong>To investigate the effect of FVIII treatment on lymphangiogenesis, iron clearance, and joint health after hemarthrosis.</p><p><strong>Methods: </strong>Two days after knee injury/bleed (subpatellar needle puncture) FVIII-KO mice were separated into 3 groups receiving (1) intravenous saline, (2) recombinant human FVIII for 2 days, or (3) murine (m)FcFVIII for 14 days. FVIII activity levels were measured repeatedly (peak/trough) for 14 days. Joint tissues were processed at 2 and 4 weeks postbleed for Prussian blue staining (iron), CD68 (macrophage), αSMA (vascular remodeling), and LYVE1 (lymphangiogenesis) immunohistochemistry, and Safranin-O-Green staining (cartilage health).</p><p><strong>Results: </strong>Joint injury caused profound hemarthrosis. Mice treated with mFcFVIII maintained stable FVIII activity levels for 14 days (troughs 29%-38%). Pronounced synovial iron accumulation colocalizing with macrophages, along with severely impaired lymphangiogenesis and joint health parameters, were present in saline-treated mice at 2 and 4 weeks when compared with baseline. Short-term recombinant human FVIII administration resulted in partially impaired lymphangiogenesis and iron clearance with delayed recovery of joint health parameters. In contrast, mice treated with mFcFVIII experienced rapid iron clearance alongside normal lymphangiogenesis, associated with fast and effective normalization of joint health parameters, particularly with respect to cartilage health.</p><p><strong>Conclusion: </strong>Prolonged FVIII availability in the \"mild hemophilia range\" (± Fc-mediated effects) after hemarthrosis seem critical for lymphangiogenesis, rapid iron removal, and joint repair, including glycosaminoglycan-dependent cartilage restoration. Intensified courses of FVIII treatment in patients may therefore be beneficial for postbleed management.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000856","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":"Interdisciplinary management of gynecologic bleeding with anticoagulation: a recommended toolkit from the Foundation for Women and Girls with Blood Disorders+ Thrombosis Subcommittee.","authors":"Bethany Samuelson Bannow, Maureen Baldwin, Madhvi Rajpurkar, Vilmarie Rodriguez, Divyaswathi Citla-Sridhar, Lakshmi V Srivaths","doi":"10.1016/j.jtha.2025.08.012","DOIUrl":"10.1016/j.jtha.2025.08.012","url":null,"abstract":"<p><p>The care of menstruating adolescents and adults requiring anticoagulation is challenging and requires close interdisciplinary collaboration. A number of collaborative clinics have been developed across the United States, and the Foundation for Women and Girls with Blood Disorders has led the effort to designate specific centers of excellence. Here, we describe the role of various team members, including hematologists, gynecologists, adolescent medicine providers, and nurses, in providing comprehensive, interdisciplinary care to menstruating individuals.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12490520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958938","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":"Diagnostic accuracy of computed tomography venography compared with ultrasonography for detection of peripherally inserted central venous catheter-related thrombosis in patients with cancer: the DETECT study.","authors":"Noori A M Guman, Bart M van Dooremaal, Ludo F Beenen, Maeke J Scheerder, Anne-Marie Becking, Michiel F Lagerweij, IJsbrand A J Zijlstra, Martijn R Meijerink, Hanneke W M van Laarhoven, Patrick M Bossuyt, Peter Verhamme, Harry R Büller, Michiel Coppens, Nick van Es","doi":"10.1016/j.jtha.2025.08.008","DOIUrl":"10.1016/j.jtha.2025.08.008","url":null,"abstract":"<p><strong>Background: </strong>Ultrasonography is the primary diagnostic imaging modality for upper extremity deep vein thrombosis related to peripherally inserted central venous catheters (PICCs). Computed tomography (CT) venography may offer higher sensitivity while additionally providing information about the superior vena cava and central pulmonary arteries.</p><p><strong>Objectives: </strong>We compared the diagnostic accuracy of CT venography with ultrasonography for screen-detected PICC-related venous thromboembolism (VTE).</p><p><strong>Methods: </strong>Consecutive adult patients with cancer were enrolled before PICC placement. On day 20 ± 5, screening was performed by compression ultrasonography and duplex of the neck and upper extremity and CT venography of the neck, upper extremity, and chest. The primary outcome included upper extremity deep vein thrombosis, vena cava and right atrial thrombosis, and pulmonary embolism. CT scans were adjudicated by 2 radiologists blinded to initial readings. The sensitivity of CT and ultrasonography was estimated using VTE on either test as a combined standard.</p><p><strong>Results: </strong>Forty one patients participated (median age 61 years, 51% female), of whom 18 (44%) were diagnosed with PICC-related VTE, including 15 asymptomatic detected at screening and 3 symptomatic VTE prior to screening. Screening CT venography missed 6 events (sensitivity, 60%; 95% CI, 36-80) and ultrasonography missed 3 (sensitivity, 80%; 95% CI, 55-93). Thrombi missed by CT venography were located across cannulated upper extremity deep veins, while ultrasonography missed thrombi in the brachiocephalic and more central veins.</p><p><strong>Conclusion: </strong>Both CT venography and ultrasonography missed VTE at screening. Results indicate that it is unlikely that the sensitivity of CT venography alone exceeds that of ultrasonography in detection of asymptomatic PICC-related VTE.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958883","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":"Association of coagulation dysfunction with thrombosis, bleeding, and mortality in patients supported by veno-venous extracorporeal membrane oxygenation for viral pneumonia.","authors":"Deepa J Arachchillage, Mihaela Gaspar, Magdalena Gierula, Farah Kamani, Alex Rosenberg, Golzar Mobayen, Nilanthi Karawitage, Saravanan Vinayagam, Mike Laffan, Stephane Ledot, Josefin Ahnström","doi":"10.1016/j.jtha.2025.08.010","DOIUrl":"10.1016/j.jtha.2025.08.010","url":null,"abstract":"<p><strong>Background: </strong>Bleeding and thrombosis remain leading causes of morbidity and mortality in patients supported by extracorporeal membrane oxygenation (ECMO).</p><p><strong>Objectives: </strong>To assess hemostatic changes during veno-venous (VV)-ECMO support after respiratory failure due to viral pneumonia and their association with major bleeding, thrombosis, and mortality.</p><p><strong>Methods: </strong>Coagulation factors (factors [F]II, FV, FVII, FVIII, FIX, FX, FXI, FXII), von Willebrand profile, and thrombin generation (TG) were measured at cannulation, during VV-ECMO (every fifth day), 1 hour, and 24 hours after decannulation in 50 patients (August 2018-January 2020).</p><p><strong>Results: </strong>Median age was 47 (18-68) years, 56% were men, and median VV-ECMO duration was 9 (3-41) days. Intracranial hemorrhage and ischemic stroke were detected in 10% and 4%, respectively, within 24 hours of initiating VV-ECMO. The 180-day mortality was 10%; 58% developed thrombosis and 28% major bleeding (43% were intracranial hemorrhage). Coagulation factor levels fell significantly within 24 hours of initiating VV-ECMO but returned to normal by day 5. TG decreased significantly throughout VV-ECMO, with nadir at decannulation. Tissue factor pathway inhibitor alpha level increased throughout VV-ECMO and correlated with reduced (r = -0.54, P < .001) and delayed (r = 0.6, P < .001) TG. The von Willebrand factor (VWF) Ristocetin cofactor activity (VWF:RCo)/VWF antigen (VWF:Ag) ratio was significantly reduced by 24 hours of initiation and during VV-ECMO compared to precannulation. In multivariate analyses, older age, thrombocytopenia, increased creatinine level, and reduced TG at cannulation were associated with mortality. VWF:RCo/VWF:Ag ratio <0.7 and low TG (< 500 nM·min) at precannulation predicted major bleeding while raised fibrinogen level and TG increased thrombotic risk. Major bleeding was associated with increased mortality (3.6-fold) while thrombosis had no impact.</p><p><strong>Conclusion: </strong>Precannulation reduced TG (<500 nM·min), reduced VWF:RCo/VWF:Ag ratio and increased tissue factor pathway inhibitor alpha levels had significant impacts on major bleeding, which was associated with increased mortality.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958909","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":"Association of fibrinogen and Rotational Thromboelastometry (ROTEM) parameters with age and race in a diverse pediatric population: a single-center study.","authors":"Marium Malik, Maha Al-Ghafry, Maribel Lema, Vijay Nandi, Vera Ignjatovic, Linda Shore-Lesserson, Suchitra S Acharya","doi":"10.1016/j.jtha.2025.07.042","DOIUrl":"10.1016/j.jtha.2025.07.042","url":null,"abstract":"<p><strong>Background: </strong>Rotational thromboelastometry (ROTEM) is a whole-blood viscoelastic analyzer providing a global assessment of coagulation. Reference intervals (RIs) for ROTEM are limited in pediatrics, often not accounting for race. Moreover, discrete RIs may be misleading.</p><p><strong>Objectives: </strong>Our objective was to investigate the relationship between age (as a continuous variable) and race in ROTEM and conventional coagulation tests.</p><p><strong>Methods: </strong>Prospective data from 105 racially diverse pediatric subjects (aged 1-21 years) were collected. ROTEM and conventional coagulation tests (prothrombin time, activated partial thromboplastin time, and fibrinogen) were obtained. The cohort was analyzed as a whole and then stratified by race.</p><p><strong>Results: </strong>There was a positive association of age with fibrinogen levels (R² = .189; P < .0001), FIBTEM amplitude at 10 minutes after clotting time (A10; R² = .154; P = .0001), and FIBTEM maximum clot firmness (MCF; R² = .157; P = .0001) in the entire cohort. For race stratification, only Black/African American subjects showed a negative association of age with EXTEM clot formation time, but a positive association with EXTEM/INTEM A10 and MCF (P < .001), as well as FIBTEM A10 and MCF (P < .001), revealing a propensity for a prothrombotic state in Black/African American subjects.</p><p><strong>Conclusion: </strong>This study reports race-specific age-related differences in fibrinogen and ROTEM, and describes ROTEM parameters as continuous variables by age. Inclusion of a diverse population in establishing race-specific pediatric RIs has clinical and public health relevance for a more accurate diagnosis and personalized treatment.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958918","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":"Molecular insights into the comorbidity of vitamin K-dependent clotting factor deficiency and chondrodysplasia punctata.","authors":"Da-Yun Jin, Xuejie Chen, Mengying Wang, Xiaofeng Qi, Darrel W Stafford, Sara Lewis, Mitchell J Weiss, Ulrike M Reiss, Jian-Ke Tie","doi":"10.1016/j.jtha.2025.08.011","DOIUrl":"10.1016/j.jtha.2025.08.011","url":null,"abstract":"<p><strong>Background: </strong>Autosomal recessive mutations in genes encoding vitamin K cycle enzymes cause hereditary vitamin K-dependent clotting factor deficiency, a disorder characterized by excessive bleeding and a spectrum of nonbleeding phenotypes. While high-dose vitamin K therapy can partially or fully correct coagulopathy, its effect on nonbleeding symptoms is limited.</p><p><strong>Objectives: </strong>To investigate the molecular basis underlying the differential response to vitamin K therapy, we characterized novel gamma-glutamyl carboxylase (GGCX) mutations identified in a patient with vitamin K-dependent clotting factor deficiency.</p><p><strong>Methods: </strong>We employed bioluminescent immunoassays, fluorescence confocal imaging, split-nanoluciferase complementation assays, and structural modeling to investigate how GGCX mutations affect its interaction with, and carboxylation of, various vitamin K-dependent proteins (VKDPs) in live cells.</p><p><strong>Results: </strong>The patient harbored 2 novel compound heterozygous GGCX mutations: c.1760A>G (p.H587R) and c.1787del (p.P596fs). While oral vitamin K improved coagulation deficiency, it failed to correct defects associated with calcification abnormalities. Functional analysis revealed that the P596fs variant abolished enzymatic activity, whereas H587R impaired extrahepatic VKDPs more profoundly than hepatic VKDPs, thereby explaining the distinct clinical responses to vitamin K therapy. The H587R mutation significantly altered GGCX binding to extrahepatic VKDPs, such as the calcification inhibitor matrix Gla protein, while having a lesser effect on hepatic VKDPs. Structural modeling and biochemical characterization further revealed that conserved residues H587 and Y601 form an internal hydrogen bond critical for stabilizing the GGCX molecule.</p><p><strong>Conclusion: </strong>These findings show how rare patient mutations can provide new insights into the biochemistry of GGCX and how its unique interactions with different VKDPs lead to distinct disease phenotypes.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958972","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":"External validation of the VTE-PREDICT score for predicting recurrence and bleeding in venous thromboembolism: results from the Registro Informatizado Enfermedad TromboEmbὀlica Registry.","authors":"Timothy Hoberstorfer, Stephan Nopp, Daniel Steiner, Luis Hernández-Blasco, Inés Jou, Juan José López-Núñez, Ángeles Fidalgo, Patricia López-Miguel, Manuel Monreal, Cihan Ay","doi":"10.1016/j.jtha.2025.08.007","DOIUrl":"10.1016/j.jtha.2025.08.007","url":null,"abstract":"<p><strong>Background: </strong>The VTE-PREDICT score predicts venous thromboembolism (VTE) recurrence and clinically relevant bleeding (CRB; major and clinically relevant nonmajor bleeding) after acute VTE.</p><p><strong>Objectives: </strong>We aimed to externally validate the VTE-PREDICT score in the Registro Informatizado Enfermedad TromboEmbὀlica, a prospective registry of patients with VTE.</p><p><strong>Methods: </strong>Exclusion criteria included enrollment before 2012, active cancer, and anticoagulation other than direct oral anticoagulants, vitamin K antagonists, or low-molecular-weight heparin. VTE recurrence and CRB risks were calculated using VTE-PREDICT for a prediction period of 3 months after the index VTE until the following 1 to 5 years. Predicted risks were then compared with observed risks. C-statistics and calibration plots were assessed.</p><p><strong>Results: </strong>In total, 17 850 patients (50.3% women) were included in the final analysis, of whom 64.3% had pulmonary embolism. The median age was 67 years (IQR, 52-78). Regarding long-term anticoagulation, 21.8% of patients were treated with a direct oral anticoagulant, 39.9% with a vitamin K antagonist, and 4.8% with low-molecular-weight heparin, whereas 33.6% received no anticoagulant treatment. Cumulative incidences of VTE recurrence and CRB at 1 year were 3.7% (95% CI, 3.4%-4.0%) and 2.6% (95% CI, 2.4%-2.9%), respectively. The c-statistics of VTE-PREDICT for 1 to 5 years varied between 0.70 (95% CI, 0.67-0.72) and 0.73 (95% CI, 0.69-0.76) for VTE recurrence and between 0.65 (95% CI, 0.63-0.67) and 0.67 (95% CI, 0.64-0.70) for CRB. Calibration analysis revealed underestimation of VTE recurrence and overestimation of CRB risk.</p><p><strong>Conclusion: </strong>VTE-PREDICT showed good discrimination for VTE recurrence and moderate discrimination for CRB, but underestimated the risk of VTE recurrence in high-risk patients.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958923","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":"Being stung by the Taipan-high rates of false positivity for lupus anticoagulant using Taipan snake venom time in patients on warfarin with a low probability of antiphospholipid syndrome.","authors":"Sean Platton, Eleanor Foxton, Áine McCormick, Jude Platton, Tadbir Bariana, Andrew J Doyle","doi":"10.1016/j.jtha.2025.07.039","DOIUrl":"10.1016/j.jtha.2025.07.039","url":null,"abstract":"","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958904","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 underexplored crosstalk between hemostasis and bone metabolism: from mechanisms to clinical implications.","authors":"Gaetano Paride Arcidiacono, Elena Campello, Chiara Simion, Sandro Giannini, Paolo Simioni","doi":"10.1016/j.jtha.2025.07.037","DOIUrl":"10.1016/j.jtha.2025.07.037","url":null,"abstract":"<p><p>Hemostasis and bone metabolism, traditionally considered as distinct physiological systems, are now recognized to share a complex and bidirectional interplay. Emerging evidence reveals that several components of the hemostatic cascade-including coagulation factors and platelets-may modulate bone cell function and remodeling. Conversely, key regulators of bone and mineral metabolism, such as calcium, vitamin D, and parathyroid hormone, exert significant effects on vascular and hemostatic pathways. This interplay is especially relevant in aging populations, where the incidence of thrombotic disorders and skeletal fragility increases, and the 2 conditions often coexist, with long-term use of anticoagulants or osteoporosis therapies potentially affecting both systems. In this narrative review, we synthesize current insights into the molecular and cellular mechanisms involved in the hemostasis-bone interaction. We also discuss how disorders of mineral metabolism influence coagulation and, conversely, how hemostatic conditions may affect skeletal health. Moreover, we examine how pharmacologic agents-such as anticoagulants and osteoporosis therapies-may impact the hemostasis-bone axis. While most available evidence is preclinical or observational, emerging data point to potential clinical implications that warrant further investigation. A deeper understanding of this interplay could support more effective therapeutic strategies and improve risk assessment in patients with concurrent coagulation and skeletal disorders.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958960","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":"Absorption of apixaban following metabolic and bariatric surgery: is reluctance still warranted?","authors":"Claudia Berends, Cedric Lau, Laura Heusschen, Marcel Hovens, Bart Witteman, Eric Hazebroek, Houshang Monajemi","doi":"10.1016/j.jtha.2025.08.005","DOIUrl":"10.1016/j.jtha.2025.08.005","url":null,"abstract":"<p><strong>Background: </strong>Absorption of apixaban, a direct oral anticoagulant (DOAC), may be impaired after metabolic and bariatric surgery (MBS). The Dutch guideline advises switching to vitamin K antagonists (VKA), while patients prefer the use of DOACs. Apixaban is not regularly prescribed after MBS due to a lack of evidence regarding its efficacy and safety.</p><p><strong>Objectives: </strong>This study aimed to evaluate the efficacy and safety of apixaban after MBS.</p><p><strong>Methods: </strong>In this retrospective cohort study, chronic DOAC users who received preoperative and postoperative consultation and used apixaban (5 mg twice daily) after MBS with available anti-Xa levels were included. The outcomes were incidence rate of postoperative bleeding and thromboembolic events, number of patients switching to VKA, and percentage of anti-Xa peak levels within the expected on-therapy range up to 1 year postoperatively.</p><p><strong>Results: </strong>Of the 97 included patients, 63.9% were female, median age was 57 years (range, 51-61 years), and median preoperative body mass index was 43.2 kg/m² (range, 39.5-46.8 kg/m²), DOAC use was mostly indicated because of atrial fibrillation (59.8%), and 71.1% underwent Roux-en-Y gastric bypass. No thromboembolic events or major bleeds occurred, and 1 clinically relevant non-major bleeding was observed (incidence rate, 0.61; 95% CI, 0.02-3.38 per 100 patient-years). One patient switched to VKA, and 91.1% of patients had postoperative anti-Xa peak levels within expected on-therapy range.</p><p><strong>Conclusion: </strong>In this population of chronic DOAC users, apixaban with consultation including regular anti-Xa peak level measurements seems safe and effective after MBS. However, future prospective research in a larger population with longer follow-up is needed to confirm these results.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958957","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}