Journal of Thrombosis and Haemostasis最新文献

{"title":"Low-dose direct oral anticoagulants for secondary prevention in patients at high risk for recurrence due to history of recurrent venous thromboembolic events or severe thrombophilia: a retrospective analysis of the Italian Survey on anTicoagulated pAtients RegisTry 2.","authors":"Daniela Poli, Roberto Parisi, Emilia Antonucci, Luca Barcella, Eugenio Bucherini, Antonio Chistolini, Angela Di Giorgio, Rosella Di Giulio, Marcello Di Nisio, Giovanna Elmi, Marco Marzolo, Roberta Pancani, Paola Stefania Preti, Piera Sivera, Sophie Testa, Andrea Toma, Vincenzo Tonelli, Luca Puccetti, Beniamino Zalunardo, Gualtiero Palareti, Alessandro Squizzato","doi":"10.1016/j.jtha.2025.07.034","DOIUrl":"10.1016/j.jtha.2025.07.034","url":null,"abstract":"<p><strong>Background: </strong>Long-term anticoagulation is recommended in patients with venous thromboembolism (VTE) deemed at high risk for recurrence (HRR). Limited information is available on patients with recurrent VTE and/or severe thrombophilia. In addition, these patients were not included in studies evaluating long-term treatment with low doses of direct oral anticoagulants (DOACs).</p><p><strong>Objectives: </strong>The aims of our study were to (1) record the drugs and dosages used in HRR patients, and (2) to record adverse events occurring during follow-up.</p><p><strong>Methods: </strong>Among 2520 VTE patients enrolled in the Survey on anTicoagulated pAtients RegisTry 2, we retrospectively analyzed the management of patients with a history of recurrent VTE and/or severe thrombophilia (HRR patients).</p><p><strong>Results: </strong>A total of 487 HRR patients were analyzed. Anticoagulants were stopped in 11 of 487 patients (2.3%), full-dose DOACs were continued in 176 patients (36.1%), and 311 patients (63.9%) were shifted to low-dose DOACs (61.4% with apixaban 2.5 mg twice a day and 38.6% with rivaroxaban 10 mg once a day) after a median time of 1.3 years (range, 0.5-20.2 years). During follow-up, no adverse events were recorded in patients who stopped treatment. Among patients who continued treatment, 10 had recurrent VTE (rate, 0.4 × 100 patient-years) and 19 had bleeding (rate, 0.9 × 100 patient-years). The risk of recurrent VTE was similar between patients on full-dose and low-dose anticoagulation. Patients on full-dose anticoagulation had a trend toward a higher bleeding risk (relative risk, 2.2; 95% CI, 0.7-9.0).</p><p><strong>Conclusion: </strong>HRR patients with a history of unprovoked recurrent VTE and/or patients with severe thrombophilia treated with long-term low-dose DOACs showed a low risk for recurrence and bleeding events.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847172","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 antibody targeting high-molecular-weight kininogen blocks contact system activation in a model of polymicrobial sepsis.","authors":"Ana Badimon, S Julia Wu, Marissa Calvano, Sidney Strickland, Erin H Norris","doi":"10.1016/j.jtha.2025.07.032","DOIUrl":"10.1016/j.jtha.2025.07.032","url":null,"abstract":"<p><strong>Background: </strong>Polymicrobial sepsis is an infectious disease characterized by excessive inflammation and coagulation that is linked to more severe disease pathology, organ failure, and fatality. The plasma contact system is a protein cascade in the blood that can be activated by bacteria and contributes to both inflammation and coagulation.</p><p><strong>Objectives: </strong>To determine if inhibiting the plasma contact system by targeting high-molecular-weight kininogen (HK) can exert a protective effect on bacteria-induced coagulation.</p><p><strong>Methods: </strong>Polymicrobial cecal slurry (CS) was prepared from donor mice and used for ex vivo and in vivo experiments. CS was used in vivo to establish a murine model of polymicrobial sepsis. CS was incubated with mouse or human plasma ex vivo. Contact system activation was assessed by Western blot, and clotting was assessed spectroscopically. Our monoclonal antihuman HK antibody, 3E8, was used to determine how contact system inhibition could delay CS-induced coagulation ex vivo.</p><p><strong>Results: </strong>Polymicrobial CS activated the plasma contact system in vivo in mice and ex vivo in both mouse and human plasma. CS promoted coagulation in mouse and human plasma ex vivo. Treatment with our 3E8 anti-HK antibody protected against CS-induced contact system activation and coagulation.</p><p><strong>Conclusion: </strong>The plasma contact system was activated in the CS model of polymicrobial sepsis. Targeting HK in polymicrobial sepsis may have beneficial effects in limiting excessive coagulation and could represent a novel therapeutic avenue to promote survival in sepsis.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12422282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816987","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":"Anti-Xa directed low-molecular-weight heparin dosing to reduce the risk of venous thromboembolism in pregnant women with inherited antithrombin deficiency.","authors":"Caroline Dix, Karen Breen, Susan Robinson, Aine McCormick, Beverley J Hunt","doi":"10.1016/j.jtha.2025.07.031","DOIUrl":"10.1016/j.jtha.2025.07.031","url":null,"abstract":"<p><strong>Background: </strong>Inherited antithrombin deficiency (ATD) is associated with a high risk of venous thromboembolism (VTE), particularly during risk periods, including pregnancy. Guidelines vary regarding thromboprophylaxis with low-molecular-weight heparin (LMWH). LMWH use in women with inherited ATD is hampered by the fact that antithrombin is the substrate for its anticoagulant effect, and therefore, larger doses of LMWH are needed.</p><p><strong>Objectives: </strong>Assess the rate of VTE in pregnant women with inherited ATD after our institution changed practice to using anti-Xa-guided LMWH in 2012.</p><p><strong>Methods: </strong>This was a retrospective single-center cohort study of pregnant women with inherited ATD, followed from positive pregnancy test to 6 weeks postpartum.</p><p><strong>Results: </strong>We identified 32 pregnancies in 17 women, 12 with type 1 and 5 with type 2 inherited ATD. Twenty-two (69%) resulted in a live birth. There were 4 cases of VTE (12.5%): 2 occurred in women prior to referral to our unit on subtherapeutic doses of LMWH; 1 in a nonadherent patient with homozygous AT Budapest; and 1 postpartum VTE in the setting of nonadherence. The median starting dose of LMWH in the whole cohort was 6250 units (96 units/kg), increasing to 16 750 units (247 units/kg) by the end of pregnancy. Antithrombin concentrate was given peripartum in 20 pregnancies. There were 4 postpartum hemorrhages (12.5%), 1 minor and 3 moderate.</p><p><strong>Conclusion: </strong>In this retrospective cohort study of 32 pregnancies, 12.5% of our cohort had a VTE. However, there was no VTE in those who were adherent and received anti-Xa monitored LMWH with risk-assessed use of peripartum antithrombin concentrate.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816988","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":"Reduced dose versus full dose of direct oral anticoagulation in extended treatment of venous thromboembolism: an updated meta-analysis of randomized controlled trials.","authors":"Lucas M Barbosa, Vinícius Martins Rodrigues Oliveira, Beatriz Araujo, Maria do Carmo P Nunes, Humberto Graner Moreira","doi":"10.1016/j.jtha.2025.07.029","DOIUrl":"10.1016/j.jtha.2025.07.029","url":null,"abstract":"","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816989","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":"Anti-osteopontin antibodies replicate the tumor suppression phenotype in thrombin cleavage-resistant osteopontin knock-in mice.","authors":"Qin Zhou, Lei Zhao, Timothy Myles, John Morser, Lawrence L K Leung","doi":"10.1016/j.jtha.2025.07.028","DOIUrl":"10.1016/j.jtha.2025.07.028","url":null,"abstract":"<p><strong>Background: </strong>The multifunctional proinflammatory matricellular protein, osteopontin (OPN), is a prognostic marker in multiple human cancers. OPN is cleaved by thrombin to reveal a cryptic binding site for α₄β₁ and α₉β₁ integrins at the C-terminus of the N-terminal cleaved fragment (OPN-R). Preventing thrombin cleavage of full-length OPN (OPN-FL) improves outcomes in tumor models.</p><p><strong>Objective: </strong>Test if anti-OPN antibodies phenocopy the anti-tumor effects of inhibiting thrombin cleavage of OPN.</p><p><strong>Methods: </strong>A monoclonal antibody that binds to OPN-FL at the thrombin cleavage site (ie, mA6) and one that binds to the C-terminus of OPN-R (ie, mC6R) were tested in both the B16 mouse melanoma subcutaneous implant and metastasis models.</p><p><strong>Results: </strong>Purified mA6 bound to OPN-FL and mC6R bound to OPN-R with high affinity for their respective target antigens, whether mouse or human OPN. Thrombin cleavage of both mouse and human OPN-FL was inhibited by mA6, but mA6 did not affect coagulation or platelet aggregation assays. The clearance half-life of both antibodies was >7 days in mice. Mice treated with either antibody had reduced B16 melanoma growth in the subcutaneous model, resulting in fewer pulmonary metastases than control-treated wild-type mice. Antibody treatment replicated the tumor suppression phenotype of the thrombin resistant OPN mouse that expresses thrombin-resistant OPN. Growth of CT26, a colon carcinoma cell line, was reduced by treatment with either antibody in BALB/c mice.</p><p><strong>Conclusion: </strong>Treatment with either antibody reduced B16 melanoma tumor growth in both models and also reduced CT26 colon carcinoma growth. mC6R had similar effects to mA6, suggesting that the active OPN fragment generated by thrombin cleavage of OPN-FL is OPN-R.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812198","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":"Improving stroke risk prediction in atrial fibrillation with circulating biomarkers: the CHA2DS2-VASc–Biomarkers model","authors":"Samuel A.P. Short ,&nbsp;Katherine Wilkinson ,&nbsp;Erin Hald ,&nbsp;George Howard ,&nbsp;Virginia Howard ,&nbsp;Suzanne E. Judd ,&nbsp;Elsayed Z. Soliman ,&nbsp;Brett Kissela ,&nbsp;David Robinson ,&nbsp;Robert Stanton ,&nbsp;Mary Cushman","doi":"10.1016/j.jtha.2025.06.007","DOIUrl":"10.1016/j.jtha.2025.06.007","url":null,"abstract":"<div><h3>Background</h3><div>Anticoagulation reduces ischemic stroke in atrial fibrillation (AF) but increases bleeding. Existing risk calculators guiding anticoagulation decisions in AF have substantial limitations.</div></div><div><h3>Objectives</h3><div>To determine whether biomarkers of stroke risk for general populations are associated with stroke risk in AF and improve predictive performance of the CHA₂DS₂-VASc (Congestive heart failure, Hypertension, Age &gt;74, Diabetes, prior Stroke or transient ischemic attack or thromboembolism, Vascular disease, Age 65-74, Sex category) score.</div></div><div><h3>Methods</h3><div>The REasons for Geographic And Racial Differences in Stroke (REGARDS) is a prospective cohort study of 30 239 adults enrolled in 2003 to 2007 and monitored for stroke. Participants with AF not taking anticoagulants and with no prior stroke history were studied. Nine circulating biomarkers were measured in stored baseline samples. Cox models, adjusted for demographics and stroke risk factors estimated associations of each biomarker with incident stroke. Then, models with CHA₂DS₂-VASc score alone or adding biomarkers were compared using tests of fit (likelihood ratio test and Akaike information criterion) and risk discrimination (continuous net reclassification index, [NRI^&gt;0]).</div></div><div><h3>Results</h3><div>Among 2411 participants with AF (median age 69 years, 55% female, 36% Black), 163 (7%) developed first-time ischemic stroke over 13 years. Higher N-terminal pro-B-type natriuretic peptide, growth differentiation factor 15, cystatin C, interleukin 6, and lipoprotein (a) were independently associated with higher stroke risk. Biomarkers substantially improved CHA₂DS₂-VASc model fit (change in Akaike information criterion −13, <em>P</em> &lt; .001) and predictive ability (5-year NRI^&gt;0 0.42). Adding only N-terminal pro-B-type natriuretic peptide and growth differentiation factor 15 yielded the best model fit and a similar NRI^&gt;0 compared with all biomarkers.</div></div><div><h3>Conclusions</h3><div>Five biomarkers were associated with stroke risk in AF, and 2 of these improved CHA₂DS₂-VASc performance. This improved CHA₂DS₂-VASc–Biomarkers score can allow better selection of patients for anticoagulation to reduce stroke in AF.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"23 10","pages":"Pages 3160-3172"},"PeriodicalIF":5.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799490","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":"Circulating biomarkers and ischemic stroke risk in adults with atrial fibrillation taking anticoagulation: the Reasons for Geographic And Racial Differences in Stroke study","authors":"Samuel A.P. Short ,&nbsp;Erin Hald ,&nbsp;Katherine Wilkinson ,&nbsp;George Howard ,&nbsp;Virginia Howard ,&nbsp;Suzanne E. Judd ,&nbsp;Elsayed Z. Soliman ,&nbsp;Brett Kissela ,&nbsp;David Robinson ,&nbsp;Robert Stanton ,&nbsp;Mary Cushman","doi":"10.1016/j.jtha.2025.05.029","DOIUrl":"10.1016/j.jtha.2025.05.029","url":null,"abstract":"<div><h3>Background</h3><div>Anticoagulation reduces ischemic stroke risk in atrial fibrillation (AF), but “breakthrough” stroke occurs. Blood biomarkers might help identify patients at risk for this, but existing studies are limited in examining few biomarkers in select populations.</div></div><div><h3>Objectives</h3><div>To determine whether established biomarkers of ischemic stroke risk will be associated with ischemic stroke risk in people with AF on anticoagulation sampled from the general population.</div></div><div><h3>Methods</h3><div>The REasons for Geographic and Racial Differences in Stroke study is a prospective cohort study of 30 239 Black or White adults aged ≥45 years at enrollment in 2003 to 2007 monitored for stroke. Nine biomarkers were measured at baseline in participants with AF, no prior stroke, and who were taking oral anticoagulation at baseline. Hazard ratios of ischemic stroke were estimated by Cox models adjusted for demographics and stroke risk factors.</div></div><div><h3>Results</h3><div>Among 713 participants with AF on warfarin (median age 76, 36% female, 17% Black), 67 (9%) developed a first-time ischemic stroke over 12 years. Adjusting for confounders, each SD higher N-terminal pro–B-type natriuretic peptide (NTproBNP), factor VIII, D-dimer, and growth differentiation factor 15 (GDF-15) were positively associated with incident stroke, with hazard ratios ranging from 1.49 (95% CI, 1.11-2.02) for NTproBNP to 1.28 (95% CI, 0.92-1.77) for GDF-15. Associations for D-dimer and GDF-15 did not meet statistical significance.</div></div><div><h3>Conclusion</h3><div>Biomarkers of atriopathy, coagulation, and vascular inflammation were associated with higher ischemic stroke risk in people with AF on anticoagulation at baseline. Findings highlight new avenues for reducing stroke risk in AF, but a larger study is needed for validation.</div></div>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":"23 10","pages":"Pages 3148-3159"},"PeriodicalIF":5.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799489","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":"Anticoagulants and immunosuppressive therapy for thrombosis in Behçet's syndrome: a systematic review and meta-analysis.","authors":"Arisa Chuklin, Thita Chiasakul, Noppacharn Uaprasert","doi":"10.1016/j.jtha.2025.07.025","DOIUrl":"10.1016/j.jtha.2025.07.025","url":null,"abstract":"<p><strong>Background: </strong>Behçet's syndrome is a systemic vasculitis commonly associated with thrombotic manifestations. The primary treatment of vascular Behçet's syndrome involves immunosuppression; however, the role of anticoagulation remains unestablished.</p><p><strong>Objectives: </strong>We conducted a systematic review and meta-analysis to evaluate the effectiveness of immunosuppressives alone, anticoagulants alone, and combined immunosuppressives and anticoagulants in preventing thrombosis relapse in Behçet's syndrome.</p><p><strong>Methods: </strong>A systematic search was conducted using PubMed, EMBASE, and Cochrane Library from inception until April 1, 2025. Original studies enrolling ≥10 Behçet's syndrome patients with venous or arterial thrombosis were included if they reported intervention-specific recurrence or relapse rates of thrombosis. The primary outcome was the pooled relapse rate for each intervention group (immunosuppressives alone, anticoagulants alone, and combined immunosuppressives and anticoagulants), calculated using a random-effects model with 95% CIs. Subgroup analyses were performed to compare the pooled rates among the groups.</p><p><strong>Results: </strong>A total of 20 studies (19 retrospective and 1 prospective) were included. Ten studies (315 patients) provided disaggregated data for the meta-analysis. The pooled relapse rate in the group receiving immunosuppressives and anticoagulants combined (17.7%; 95% CI, 9.7%-30.1%; I² = 56%) was significantly lower than that of those who received immunosuppressives alone (43.7%; 95% CI, 25.8%-63.4%; I² = 63%; P = .017) or anticoagulants alone (54.9%; 95% CI, 0.322%-0.758%; I² = 48%; P = .004).</p><p><strong>Conclusion: </strong>Combined immunosuppressives and anticoagulants were associated with lower risks of thrombosis relapse compared with either treatment alone in Behçet's syndrome-associated thrombosis.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144794811","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 use of artificial intelligence to improve detection of acute incidental pulmonary emboli.","authors":"Ronald S Kuzo, David L Levin, Alexander K Bratt, Lara A Walkoff, Garima Suman, Damon E Houghton","doi":"10.1016/j.jtha.2025.07.024","DOIUrl":"10.1016/j.jtha.2025.07.024","url":null,"abstract":"<p><strong>Background: </strong>Incidental pulmonary emboli (IPE) are frequently overlooked by radiologists. Artificial intelligence (AI) algorithms have been developed to aid detection of pulmonary emboli.</p><p><strong>Objectives: </strong>To measure diagnostic performance of AI compared with prospective interpretation by radiologists.</p><p><strong>Methods: </strong>A commercially available AI algorithm was used to retrospectively review 14 453 contrast-enhanced outpatient computed tomography examinations of the chest, abdomen, and pelvis in 9171 patients, where pulmonary embolism was not clinically suspected. Natural language processing searches of reports identified IPE detected prospectively. Thoracic radiologists reviewed all cases read as positive by AI or natural language processing to confirm IPE and assess the most proximal level of clot and overall clot burden. A total of 1400 cases read as negative by both the initial radiologist and AI were rereviewed to assess for additional IPE.</p><p><strong>Results: </strong>Radiologists prospectively detected 218 IPE, and AI detected an additional 36 unreported cases. AI missed 30 cases of IPE detected by the radiologists and had 94 false positives. For 36 IPE missed by the radiologists, median clot burden was 1, and 19 were solitary segmental or subsegmental. For 30 IPE missed by AI, 1 case had large central emboli, and the others were small with 23 solitary subsegmental emboli. Radiologist rereview of 1400 examinations interpreted as negative found 8 additional cases of IPE.</p><p><strong>Conclusion: </strong>Compared with radiologists, AI had similar sensitivity but reduced positive predictive value. Our experience indicates that the AI tool is not ready to be used autonomously without human oversight, but a human observer plus AI is better than either alone for detection of IPE.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144794813","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":"Racial disparities in the incidence and risk factors of major bleeding during extended anticoagulant therapy for venous thromboembolism.","authors":"Duale Omar, Michael J Kovacs, Alejandro Lazo-Langner, David R Anderson, Susan R Kahn, Lana A Castellucci, Jeannot Schmidt, Antoine Elias, Marc Righini, Thomas L Ortel, Menno V Huisman, Marc Carrier, Jude-Mary Cénat, Ranjeeta Mallick, Marc A Rodger, Grégoire Le Gal, Philip S Wells, Yan Xu","doi":"10.1016/j.jtha.2025.07.026","DOIUrl":"10.1016/j.jtha.2025.07.026","url":null,"abstract":"<p><strong>Background: </strong>Guidelines recommend extended anticoagulation after a first unprovoked venous thromboembolism (VTE) for individuals at low risk of bleeding. However, racial disparities in bleeding risks during extended treatment remain understudied.</p><p><strong>Objectives: </strong>To compare risks of anticoagulant-associated bleeding and performance of a risk assessment model by racial group during extended VTE treatment.</p><p><strong>Methods: </strong>We analyzed 2 prospective cohorts of patients (223 Black participants and 4314 White participants) with a first unprovoked/weakly provoked VTE who continued anticoagulation after ≥3 months of initial treatment. Primary outcome was adjudicated International Society on Thrombosis and Haemostasis-defined major bleeding. Secondary outcomes included intracranial hemorrhage, fatal bleeding, and clinically relevant nonmajor bleeding. We determined incidence and hazard ratios (HRs) by race, then adjusted for bleeding risk factors that included the Creatinine, Hemoglobin, Age, antiPlatelet model.</p><p><strong>Results: </strong>Black participants had higher prevalence of bleeding risk factors and a 1.9-fold higher risk of major bleeding (HR, 1.87; 95% CI, 1.04-3.36) compared with White participants. Adjustment attenuated racial difference for major bleeding but not intracranial hemorrhage (adjusted HR, 2.35; 95% CI, 1.23-4.48). Among those classified as low risk by Creatinine, Hemoglobin, Age, antiPlatelet model, Black participants had numerically higher major bleeding incidence than White participants (2.5 vs 1.1 per 100 person-years). We did not observe racial disparities in fatal bleeding or clinically relevant nonmajor bleeding.</p><p><strong>Conclusion: </strong>Black individuals on extended anticoagulation have higher risk of major bleeding compared with White individuals. This effect appears to persist in those classified as low risk for bleeding. Risk assessment models for anticoagulant-associated bleeding that are generalizable to racialized populations are needed.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144794812","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}