Journal of Thrombosis and Haemostasis最新文献

{"title":"Long-term outcomes after heparin versus low-dose thrombolysis in patients with intermediate-high-risk pulmonary embolism - a secondary analysis of the low dose thrombolysis, ultrasound assisted thrombolysis or heparin for intermediate high risk pulmonary embolism randomized controlled trial.","authors":"Emilie Sonne-Holm, Lia E Bang, Jørn Carlsen, Matilde Winther-Jensen, Peter Sommer Ulriksen, Samir Jawad, Camilla Stedstrup Mosgaard, Pernille Palm, Connie Søe, Ekim Seven, Mathias Greve Lindholm, Søren Fanø, Kristian Eskesen, Ole P Kristiansen, Jesper Kjaergaard","doi":"10.1016/j.jtha.2026.09.023","DOIUrl":"10.1016/j.jtha.2026.09.023","url":null,"abstract":"","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008537","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":"Venous thrombosis and air pollution: a systematic review and meta-analysis of 1.4 million adult patients.","authors":"Yan Fang, Yeqing Gu, Gang Li, Kaiyuan He, Haojun Li, Fenghua Wang, Jinhan Wang, Yuhui Zhang, Mary A Fox, Qiang Liu, Wei Huang, Hongbing Xu","doi":"10.1016/j.jtha.2026.09.022","DOIUrl":"10.1016/j.jtha.2026.09.022","url":null,"abstract":"<p><strong>Background: </strong>The comprehensive relationship between air pollutants and venous thrombosis is currently not available.</p><p><strong>Objectives: </strong>To review the role of ambient air pollution in the risk of venous thrombosis.</p><p><strong>Methods: </strong>The Web of Science, PubMed, Scopus, and Embase databases were searched up to July 1, 2025, for population-based studies of the associations of air pollutants with venous thrombotic events, including deep vein thrombosis (DVT), pulmonary embolism (PE), or both (venous thromboembolism [VTE]). The relative risks (RRs) and corresponding 95% CIs were derived using a random-effects meta-analysis. A total of 23 studies were identified from an initial screening of 944 articles, which incorporated more than 1.4 million venous thrombotic events (DVT only, PE only, or both [VTE]).</p><p><strong>Results: </strong>Meta-analysis showed that the occurrence of venous thrombosis was positively associated with long-term particle exposures but not with short-term particle exposures or with any metrics of gaseous pollutants. Specifically, the increased risk of VTE was associated with a 10 μg/m³ increase in particulate matter 2.5 (PM_2.5; RR, 1.0804; 95% CI, 1.0015-1.1656) and PM₁₀ (RR, 1.0369; 95% CI, 1.0260-1.0479) during average pollutant concentrations of 1 year or more. Subgroup analyses further indicated that the associations with PM_2.5 remained statistically significant for DVT and among older participants. We estimated that reducing the annual average of PM_2.5 concentrations to meet the World Health Organization Air Quality Guideline of 5 μg/m³ would prevent 98 233 venous thrombotic events globally.</p><p><strong>Conclusions: </strong>This analysis suggests that PM air pollution might be a risk factor for venous thrombosis, highlighting that environmental policies to reduce population exposure levels may mitigate the burden of venous thrombotic events.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008529","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":"Platelet peptidylarginine deiminase 4 is not essential for platelet function in homeostasis or fibrosis during normal aging.","authors":"Katrien Bomhals, Sirima Kraisin, Valérie Spalart, Alison C Livada, Chen Li, Craig N Morrell, Marilena Crescente, Kimberly Martinod","doi":"10.1016/j.jtha.2026.09.017","DOIUrl":"https://doi.org/10.1016/j.jtha.2026.09.017","url":null,"abstract":"<p><strong>Background and objectives: </strong>Fibrotic remodeling is a key feature of cardiac aging and a major contributor to heart failure. The bidirectional interplay between platelets and neutrophil extracellular traps (NETs), with peptidylarginine deiminase 4 (PAD4) facilitating NET formation, has emerged as a mediator of fibrotic remodeling. Systemic PAD4-deficiency protects mice against age-related cardiac fibrosis and platelet accumulation in response to pressure overload injury. While PAD4 has been extensively studied in neutrophils, its functional significance in platelets and megakaryocytes (MK), which also express PAD4, remains unexplored.</p><p><strong>Methods: </strong>This study investigates the role of platelet PAD4 in platelet function and its contribution to age-related fibrotic remodeling. Platelet function was assessed using flow cytometry and light transmission aggregometry in murine and human samples, using platelet/MK-specific PAD4-knockout mice or pharmacological inhibition of PAD4 by GSK484.</p><p><strong>Results: </strong>Cytoplasmic expression of PAD4 was confirmed in human and mouse platelets and megakaryocytes. At the gene level, Padi4 was the second highest expressed of the PAD family members in mouse platelets and megakaryocytes. Genetic deletion or pharmacological inhibition of PAD4 with GSK484 did not impair platelet activation or aggregation. Moreover, platelet/MK PAD4 deficiency did not prevent the development of age-related cardiac fibrosis in mice, indicating that acting on platelet-derived PAD4 is insufficient to phenocopy the cardioprotective phenotype seen in systemic PAD4-deficient mice.</p><p><strong>Conclusion: </strong>Collectively, these findings suggest that non-platelet sources of PAD4 are likely driving age-related cardiac fibrosis and provide supporting evidence that PAD4 inhibition to combat excessive NET formation in disease is unlikely to negatively impact platelet function.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002128","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":"Venous thromboembolism and suicide: a Danish nationwide case-control study.","authors":"Henrik Toft Sørensen, Bianka Darvalics, Erzsébet Horváth-Puhó, Cathrine Fonnesbech Hjorth, Jens Sundbøll, Hans Erik Bøtker","doi":"10.1016/j.jtha.2026.09.016","DOIUrl":"10.1016/j.jtha.2026.09.016","url":null,"abstract":"<p><strong>Background: </strong>Venous thromboembolism (VTE) has been associated with depression, but its relationship with suicide is uncertain.</p><p><strong>Objectives: </strong>To examine the association between VTE and suicide risk.</p><p><strong>Methods: </strong>This nationwide Danish case-control study (1996-2022) included individuals who died by suicide, each matched with 10 population controls by age and sex. VTE, identified from health registries, was the exposure. Odds ratios (ORs) with 95% CIs were estimated using conditional logistic regression, adjusting for socioeconomic factors and psychiatric and major somatic comorbidities.</p><p><strong>Results: </strong>We included 16 722 suicide cases and 167 220 controls. VTE was associated with a modestly increased risk of suicide (OR 1.18, 95% CI, 1.04-1.33). The association was strongest within the first month after VTE, particularly among individuals without psychiatric comorbidity (OR 5.70, 95% CI, 1.95-16.64), whereas no clear increase was observed among those with psychiatric comorbidity. Between 1 and 12 months, risk remained elevated only among individuals without psychiatric comorbidity (OR 2.28, 95% CI, 1.47-3.53). After 12 months, no association was observed. Unprovoked VTE was not associated with suicide, whereas provoked VTE was associated with increased risk among individuals without psychiatric comorbidity (OR 1.58, 95% CI, 1.16-2.16). Associations were most evident in individuals without cancer and with low comorbidity burden.</p><p><strong>Conclusions: </strong>VTE was associated with a modest increase in suicide risk. Although the number of events was limited, the association appeared strongest within the first months after diagnosis and among people without prior psychiatric comorbidity, but the absolute risk of suicide remained low.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990480","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":"Pretest direct oral anticoagulant removal is highly effective in lupus anticoagulant testing while on direct oral anticoagulants: a real-life experience.","authors":"Michał Słaboszewski, Michał Ząbczyk, Elżbieta Papuga-Szela, Ewa Wypasek, Anetta Undas","doi":"10.1016/j.jtha.2026.08.023","DOIUrl":"10.1016/j.jtha.2026.08.023","url":null,"abstract":"<p><strong>Background: </strong>Direct oral anticoagulants (DOACs) may cause false-positive lupus anticoagulant (LA) results by interfering with phospholipid-dependent coagulation assays. Current guidelines discourage LA testing during DOAC therapy unless anticoagulant interference is removed.</p><p><strong>Objective: </strong>To evaluate the real-life efficacy of routine pretest DOAC removal in LA testing.</p><p><strong>Methods: </strong>Consecutive DOAC-treated patients screened for LA at a tertiary center between August 2020 and December 2024 were analyzed. Blood samples were collected between 1 and 24 hours after the last DOAC dose. LA testing was performed after the DOAC-Stop (Haematex Research) treatment. Positive LA results were repeated within 1 month (≥24 hours after the last DOAC dose), and if still positive, after ≥3 months. Antiphospholipid antibodies were determined by enzyme-linked immunosorbent assay.</p><p><strong>Results: </strong>Among 701 patients (51.4% women; median age 49 years [40.0-60.0]), mostly with venous thromboembolism (n = 548, 78.2%), 56 (8.0%) had positive LA screening and 31 (4.4%) had positive confirmatory tests after DOAC removal. Baseline characteristics were comparable, except for a higher proportion of women among screening-positive patients. Within 1 month, 26 of 31 patients available for retesting remained LA-positive. Persistent antiphospholipid antibody positivity after ≥12 weeks was confirmed in all 26 patients, including 19 with triple-positive antiphospholipid syndrome (APS), 4 double-positive APS, and 3 single-positive APS (isolated LA).</p><p><strong>Conclusions: </strong>Pretest DOAC removal followed by 3-step LA testing using dilute Russell's viper venom time and activated partial thromboplastin time-based assays enabled reliable LA assessment in routine practice, with positive results observed exclusively in patients fulfilling APS criteria.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850978","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":"Reproductive safety of direct oral anticoagulants after maternal exposure in early pregnancy: a comparative European Network of Teratology Information Services cohort study.","authors":"Kim Dao, Evelin Beck, Veronique Pizzoglio-Billaudaz, Judith Cottin, Svetlana Shechtman, Orna Diav-Citrin, Reem Murad, Maria Moran, Debra Kennedy, Jonathan Luke Richardson, Maja Ratajczak-Enselme, Kuntheavy Ing Lorenzini, Miranda van Tuyl, Petra J Woestenberg, Georgios Eleftheriou, Mikako Goto, Izumi Fujioka, Laurent Chouchana, Katarina Dathe, Maya Berlin, Michael Ceulemans, Lina Camacho-Arteaga, Valentin Rousson, Leonore Diezi, David Baud, Joanna Sichitiu, Stephanie Padberg, Alice Panchaud, Ursula Winterfeld, Maria Hoeltzenbein","doi":"10.1016/j.jtha.2026.08.037","DOIUrl":"10.1016/j.jtha.2026.08.037","url":null,"abstract":"<p><strong>Background: </strong>Direct oral anticoagulants (DOACs) are increasingly prescribed to women of childbearing age, making inadvertent first-trimester exposure more likely.</p><p><strong>Objectives: </strong>We prospectively evaluated the risks of major birth defects and pregnancy loss following first-trimester DOAC exposure.</p><p><strong>Methods: </strong>We conducted a multicenter, observational prospective cohort study comparing pregnancy outcomes in women exposed to a DOAC during the first trimester of pregnancy and a reference group of women exposed to a low molecular weight heparin (LMWH) during the first trimester, between 2008 and 2024.</p><p><strong>Results: </strong>A total of 343 DOAC-exposed and 698 LMWH-exposed pregnancies were included. DOAC exposure was not associated with an increased risk of major birth defects (DOAC n = 8/279, 2.9%; LMWH n = 25/586, 4.3%; adjusted odds ratio, 0.74; 95% CI, 0.33-1.67). In the cumulative incidence analysis (340 DOAC and 688 LMWH), the rates of live birth, pregnancy loss, and pregnancy termination were 73%, 13%, and 14% in the DOAC group and 75%, 20%, and 5% in the LMWH reference group. Cox proportional hazards cause-specific models indicated no increased risks for pregnancy loss after DOAC exposure, but a higher hazard of pregnancy termination.</p><p><strong>Conclusions: </strong>First-trimester DOAC exposure was not associated with a substantially increased risk of major birth defects or pregnancy loss, and the observed defects did not suggest a teratogenic pattern, consistent with reported findings in the existing literature. These results offer further reassurance for counseling in case of inadvertent exposure. Larger studies are still warranted to validate these findings due to a limited sample size and window of exposure.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977210","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 in patients with provoked venous thromboembolism and enduring risk factors: insights from the HI-PRO trial.","authors":"Mariana Pfeferman, Sina Rashedi, Arvind K Pandey, Darsiya Krishnathasan, Junyang Lou, Samuel Z Goldhaber, Behnood Bikdeli, Gregory Piazza","doi":"10.1016/j.jtha.2026.09.009","DOIUrl":"10.1016/j.jtha.2026.09.009","url":null,"abstract":"","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969611","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":"Incidence, risk factors, and outcomes of thromboembolism in patients with melanoma receiving immune checkpoint inhibitors, chemotherapy, or targeted therapy: a Surveillance, Epidemiology, and End Results-Medicare analysis.","authors":"Tamara A Sussman, Long Vu, Siran M Koroukian, Alok A Khorana","doi":"10.1016/j.jtha.2026.09.005","DOIUrl":"10.1016/j.jtha.2026.09.005","url":null,"abstract":"<p><strong>Background: </strong>Little is known about venous thromboembolism (VTE) and arterial thromboembolism (ATE) risk in melanoma patients receiving immune checkpoint inhibitors (ICIs) compared with other therapies.</p><p><strong>Objectives: </strong>We assessed the incidence, risk factors, and impact of thromboembolism (TE) on survival in patients receiving ICIs, chemotherapy, or targeted therapy.</p><p><strong>Methods: </strong>We conducted a cohort study using the Surveillance, Epidemiology, and End Results-Medicare database to evaluate TE rates in patients treated with ICIs, chemotherapy, or BRAF/MEK inhibitors from 2008 to 2019, within 2 years after treatment initiation. Associations among TE, treatment, and clinical risk factors were evaluated using weighted competing risk regression. Overall survival was estimated by Kaplan-Meier and Cox regression models.</p><p><strong>Results: </strong>Among 6218 patients, 62.1% (n = 3860) received first-line ICIs, 30.4% (n = 1890) received chemotherapy, and 7.5% (n = 468) received targeted therapy. The cumulative incidence of VTE was similar across all treatment types: 7.7% for ICIs, 8.4% for chemotherapy, and 7.4% for targeted therapy at 12 months (P = .80). Similarly, ATE rates were 5.3% for ICIs, 5.0% for chemotherapy, and 6.5% for targeted therapy at 12 months (P = .30). A history of VTE (subdistribution hazard ratio [SHR], 2.81 [95% CI, 2.19-3.61]) and brain metastases (SHR, 1.33 [95% CI, 1.06-1.66]) were associated with an increased risk of VTE. Compared with chemotherapy, ICIs and targeted therapy had a similar VTE risk (P > .05). For ATE, cardiovascular disease (SHR, 1.49 [95% CI, 1.14-1.93]), diabetes mellitus (SHR, 1.27 [95% CI, 1.04-1.57]), a history of ATE (SHR, 1.61 [95% CI, 1.13-2.29]), and antiplatelet therapy (SHR, 1.37 [95% CI, 1.03-1.83]) were associated with increased risk. Patients with VTE or ATE experienced a 2-fold worse survival (hazard ratio [HR], 2.17 [95% CI, 1.64-2.87] and HR, 2.58 [95% CI, 1.92-3.47], respectively). In the ICI subanalysis, the ipilimumab/nivolumab combination had a higher cumulative incidence of VTE: 11.9% at 12 months, 9.3% for ipilimumab, 7.5% for pembrolizumab, and 5.8% for nivolumab (P < .05). Compared with nivolumab, the ipilimumab/nivolumab combination (SHR, 1.66 [95% CI, 1.09-2.54]) and ipilimumab (SHR, 1.43 [95% CI, 1.03-2.00]) had a higher VTE risk. VTE and ATE were associated with worse survival (HR, 3.24 [95% CI, 2.30-4.58] and HR, 1.89 [95% CI, 1.20-2.99], respectively).</p><p><strong>Conclusion: </strong>ICIs, chemotherapy, and targeted therapy are associated with a high incidence of TE, and TE is associated with substantially worse survival.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956202","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":"FRONTIER5: Safety and patient experience of a direct switch from emicizumab to denecimig (Mim8) in patients with haemophilia A with or without inhibitors.","authors":"Cédric Hermans, Gary Benson, Davide Matino, Keiji Nogami, Johannes Oldenburg, Flora Peyvandi, Michele Schiavulli, Allison P Wheeler, Julien Bovet, Amalie Roar Høgh, Robert Klamroth","doi":"10.1016/j.jtha.2026.09.004","DOIUrl":"https://doi.org/10.1016/j.jtha.2026.09.004","url":null,"abstract":"<p><strong>Background: </strong>Denecimig (Mim8) is an activated factor VIII mimetic, fully human, bispecific IgG4 antibody in development for subcutaneous prophylaxis in patients with haemophilia A (HA) with/without inhibitors.</p><p><strong>Objective: </strong>To evaluate the safety and patient experience of a direct switch from emicizumab to denecimig prophylaxis without a washout period or loading dose.</p><p><strong>Methods: </strong>FRONTIER5 (NCT05878938) was a 26-week, single-arm, open-label, phase 3b study in patients aged ≥12 years with HA with or without factor VIII inhibitors. Patients transitioned directly from emicizumab to denecimig maintenance doses administered subcutaneously once-every week, once-every-two-weeks, or once-every-month by a pen-injector. The primary endpoint was the number of treatment-emergent adverse events (TEAEs); secondary and exploratory endpoints included thrombin generation, and patient-reported pen-injector experience, treatment burden, joint pain, and physical activity.</p><p><strong>Results: </strong>All 61 enrolled patients completed the study. TEAEs occurred in 70.5% of patients (3.48 per patient-year of exposure). Most TEAEs were mild or moderate in severity and not treatment-related. No thromboembolic events, hypersensitivity reactions, or clinical evidence of neutralising anti-denecimig antibodies were observed. Injection-site reactions were observed in 15/990 (1.5%) injections. Thrombin generation with denecimig increased into the normal reference range by week 1, without exaggerated haemostatic response. Without a loading dose, denecimig reached steady-state plasma concentrations by week 16. Most participants (98.3%) rated the denecimig pen-injector as 'easy' or 'very easy' to use.</p><p><strong>Conclusion: </strong>The direct switch from emicizumab to denecimig without a washout period was well tolerated in adolescents and adults with HA with or without inhibitors. No new safety concerns were observed.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956285","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":"Every step counts: incremental mobility and venous thromboembolism risk among adult general medicine inpatients.","authors":"Erik H Hoyer, Daniel J Brotman, Daniel L Young, Brandyn D Lau, Elizabeth Colantuoni, Karli Funk, Eric Stewart, Elliott R Haut, Ximin Li, Michael B Streiff","doi":"10.1016/j.jtha.2026.09.006","DOIUrl":"10.1016/j.jtha.2026.09.006","url":null,"abstract":"<p><strong>Background: </strong>Hospital-associated venous thromboembolism (VTE) is a leading but preventable cause of morbidity and mortality. Immobility is a key risk factor, yet commonly used scores such as Padua treat it as binary and static, overlooking the physiological and temporal continuum of mobility. The Johns Hopkins Highest Level of Mobility (JH-HLM) scale captures 8 milestones across this continuum.</p><p><strong>Objectives: </strong>We investigated whether lower JH-HLM levels are associated with progressively higher VTE rates and whether this relationship differs by prescribed pharmacologic prophylaxis.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study (2021-2024) of adult medicine inpatients admitted to 2 academic medical centers. Daily JH-HLM scores were averaged over 3 consecutive hospital days to define a time-varying mobility exposure. The primary outcome was first radiologically confirmed, symptomatic VTE during the same admission. A pooled Poisson regression model correlated time-varying mobility with subsequent VTE rates, adjusting for day of hospitalization, demographics, comorbidities, Padua elements (excluding mobility), payer, and prophylaxis status.</p><p><strong>Results: </strong>Among 25 763 patients, 169 developed VTE (0.7%). VTE rates increased stepwise with lower preceding mobility (P = .001): 0.064, 0.088, 0.121, and 0.195 events per 1000 patient-days when preceded by a 3-day average JH-HLM of level 8 (walk ≥250 feet), 6 (walk ≥10 steps), 4 (move to chair/commode), and 1 (lying in bed), respectively. This relationship did not differ by prescribed chemoprophylaxis (P = .37).</p><p><strong>Conclusion: </strong>Lower inpatient mobility conferred a dose-response increase in VTE rates independent of prophylaxis. These findings highlight limitations of binary mobility items in current risk models and support integrating objective mobility assessments into prevention strategies.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956249","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}