Journal of Thrombosis and Thrombolysis最新文献

{"title":"The clot cases conference: a proposed model to enhance multidisciplinary thrombosis care.","authors":"Anna L Parks, Stephen L Jenkins, Sara R Vazquez, Erica Swenson, Ming Y Lim, Karen A Moser, Daniel M Witt","doi":"10.1007/s11239-025-03149-4","DOIUrl":"https://doi.org/10.1007/s11239-025-03149-4","url":null,"abstract":"<p><p>Care of patients with thrombosis requires application of rapidly advancing science, complex decisions balancing risks and benefits, interpretation of multiple data sources, and coordination across fields. To meet these challenges, we describe our collaborative meeting for discussion and coordination of complex thrombosis cases, the Clot Cases Conference. Based loosely on the tumor board model from oncology, we describe the multidisciplinary nature, with attendees from multiple disciplines and institutions, and hybrid format, including both case- and topic-based sessions. We present survey data on how conference participants perceive their attendance affected learning, patient care, and professional satisfaction. Finally, we discuss opportunities for improvement and expansion of the Clot Cases Conference model to meet the complexity of modern thrombosis care.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atrial cardiopathy and thrombus composition in acute ischemic stroke: histological examination reveals insights into etiology and outcomes.","authors":"Yixin Zhao, Jie Lian, Meng Wei, Wanying Chen, Guanjun Zhang, Guogang Luo, Fude Liu","doi":"10.1007/s11239-025-03155-6","DOIUrl":"https://doi.org/10.1007/s11239-025-03155-6","url":null,"abstract":"<p><strong>Introduction: </strong>In a subset of acute ischemic stroke (AIS) patients, particularly those with large-artery atherosclerosis (LAA) and atrial cardiopathy, multiple embolic sources may coexist. Histological analysis of thrombi presents an opportunity for discerning insights into both etiology and prognosis.</p><p><strong>Methods: </strong>In our investigation, we meticulously examined 97 retrieved thrombi through histological staining and immunohistological techniques.</p><p><strong>Results: </strong>Thrombi originating from patients diagnosed with atrial fibrillation (AF) (n = 43) presented notably elevated levels of fibrin (54.16 ± 18.57% vs. 36.07 ± 18.23%, P < 0.001) and neutrophil extracellular traps (NETs) [13.21 (9.42, 15.36)% vs. 7.96 (4.98, 15.13)%, P = 0.01], alongside reduced red blood cell content (35.09 ± 16.74% vs. 51.58 ± 19.67%, P < 0.001). Within the subgroup of AIS patients with LAA, those presenting with atrial cardiopathy (n = 29) presented higher platelet levels within the thrombus (12.44 (7.59, 19.25)% vs. 8.90 (0.60, 12.37)%, P = 0.04), with the association remaining significant after generalized linear model (GLM) adjustments (P = 0.004). Notably, NETs identified within the thrombus emerged as an independent prognostic indicator for poor outcomes, defined as the modified Rankin scale (mRS) score > 2 at 90 days (OR: 1.12, 95% CI: 1.02-1.25; P = 0.02).</p><p><strong>Conclusions: </strong>These observations provide histopathological evidence supporting the presence of overlapping mechanisms contributing to thromboembolism that are potentially associated with underlying atrial cardiopathy. Consequently, histopathological evaluation of thrombi holds promise as a valuable tool for distinguishing between various etiologies and predicting clinical outcomes in AIS patients.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary plaque healing: a safety net or a hazard indicator?","authors":"Kyriakos Dimitriadis, Eleni Adamopoulou, Nikolaos Pyrpyris, Eirini Dri, Sofia Vaina, Eirini Beneki, Panagiotis Tsioufis, Alexandros Kasiakogias, Alexios Antonopoulos, Konstantinos Aznaouridis, Konstantina Aggeli, Konstantinos Tsioufis","doi":"10.1007/s11239-025-03152-9","DOIUrl":"https://doi.org/10.1007/s11239-025-03152-9","url":null,"abstract":"<p><p>Coronary atherosclerotic plaques can lead to acute coronary syndrome (ACS) occurrence through three main mechanisms: plaque rupture, plaque erosion and calcified nodule. Many destabilized plaques, however, do not cause cardiovascular events. Instead, thrombus formation is confined, lumen patency is preserved and the arterial wall is restored in a process termed as plaque healing. Early studies regarding coronary plaque healing used arterial specimens to determine its prevalence and histological characteristics. Advances in imaging modalities later enabled the implementation of in vivo studies, which have used optical coherence tomography (OCT) to identify the repaired plaques. They are visualized as lesions with a heterogeneous signal-rich layered or multilayered pattern and a distinct optical density from underlying plaque components. On one hand, plaque healing acts as a protective mechanism against myocardial infarction and unstable angina. On the other hand, the presence of layered plaques indicates previous plaque destabilization and therefore increased cardiovascular risk. Clinicians ought to bear these in mind in order to better apply patient risk stratification and adjust medical interventions. The aim of this review is to discuss the physiology of coronary plaque healing, determine its prevalence and clinical significance, as well as propose possible pathophysiological mechanisms behind impaired plaque healing along with therapeutic options.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elevated remnant cholesterol predicts poor outcome in patients with premature acute coronary syndrome: a retrospective, single-center study.","authors":"Ming Zhang, Jibin Chen, Wei Xia, Zhen Yu, Chunquan Zhang, Wenying Wang, Yibing Shao, Bin Wang","doi":"10.1007/s11239-025-03147-6","DOIUrl":"https://doi.org/10.1007/s11239-025-03147-6","url":null,"abstract":"<p><strong>Background: </strong>The association between remnant cholesterol (RC) and recurrent cardiovascular events following acute coronary syndrome (ACS) is well-documented. However, RC-stratified analysis specifically focusing on patients with premature ACS (PACS), defined as initial disease onset occurring at ≤ 55 years of age in men or ≤ 65 years of age in women, remains limited.</p><p><strong>Objectives: </strong>This study aimed to elucidate the clinical characteristics and subsequent cardiovascular events in patients with PACS, comparing those with high RC levels to those with low RC levels.</p><p><strong>Methods: </strong>In this retrospective cohort study, 820 PACS patients were consecutively recruited between January 2019 and January 2020. RC was calculated as total cholesterol minus high-density lipoprotein cholesterol minus low-density lipoprotein cholesterol. Patients with RC levels ≥ 66.6 percentile were classified as high RC. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), including cardiovascular death, myocardial infarction (MI), stroke, ischemia-driven revascularization, or hospitalization for unstable angina or heart failure.</p><p><strong>Results: </strong>Among the 820 patients enrolled, 277 (33.8%) were classified as high RC and 543 (66.2%) as low RC. The high RC group exhibited a higher prevalence of traditional risk factors, including diabetes (33.6% vs. 27.3%, p = 0.04), hypertension (68.2% vs. 61.3%, p = 0.04), and hyperlipidemia (43.3% vs. 31.3%, p = 0.001). Levels of glucose (p < 0.001), hemoglobin A1C (p = 0.005), triglyceride (p < 0.001), total cholesterol (p < 0.001) and LDL-C (p = 0.017) were significantly higher in the high RC group, while HDL-C levels were lower (p = 0.001). Over 3 years of follow-up, the high RC group had a significantly higher cumulative incidence of MACCE (16.2% vs. 10.9%; adjusted HR 1.68, 95% CI 1.10-2.59; p = 0.02). The increased risk was primarily driven by higher rates of hospitalization for unstable angina (12.3% vs. 7.9%; adjusted HR 1.69, 95% CI 1.03-2.75; p = 0.03) and composite cardiac events (14.8% vs. 9.8%; adjusted HR 1.75, 95% CI 1.12-2.73; p = 0.01).</p><p><strong>Conclusions: </strong>In hospitalized PACS patients, the cumulative incidence of MACCE was significantly higher in the high RC group compared to the low RC group over a median follow-up of nearly 3 years. The incremental risk in the high RC group was mainly attributable to higher rates of hospitalization for unstable angina and composite cardiac events. Therefore, close attention should be paid to RC levels, and further exploration is warranted.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravenous thrombolysis in the context of stroke and cancer.","authors":"Alessandra Burini, Maurizio Paciaroni, Lucio D'Anna, Fedra Kuris, Valentina Maniaci, Mariarosaria Valente, Gian Luigi Gigli, Giovanni Merlino","doi":"10.1007/s11239-025-03156-5","DOIUrl":"https://doi.org/10.1007/s11239-025-03156-5","url":null,"abstract":"<p><strong>Background: </strong>Cancer patients are at an increased risk for ischemic and hemorrhagic strokes. Ischemic stroke in this population often presents with distinctive features, such as cryptogenic etiology and multiple ischemic lesions, and is driven by cancer-associated coagulopathy, complicating management strategies.</p><p><strong>Methods: </strong>We reviewed current literature on intravenous thrombolysis (IVT) for acute ischemic stroke in cancer patients through PubMed search with no time limits. We included international guidelines, meta-analyses, cohort studies, and case series to evaluate its safety and efficacy. This descriptive review aims to evaluate the risks and benefits of thrombolytic treatment in patients with acute stroke and cancer.</p><p><strong>Discussion: </strong>Despite limited high-quality evidence (no randomized trial), studies suggest that IVT is generally safe and effective in cancer patients with ischemic stroke. However, treatment should be individualized, considering specific contraindications and the patient's tumor characteristics. The 2019 American Heart Association/American Stroke Association guidelines contraindicate IVT in patients with gastrointestinal or intra-axial tumors; conversely, these conditions are not explicitly mentioned in the 2021 European Stroke Organization guidelines, as recent studies have not proven them to be at higher risk per se. Particular attention should be given to coagulation abnormalities, recent surgery, and concomitant medications. Thus, cautious and multidisciplinary management is needed. Further research is essential to define risk stratification for this complex population better. Multicentered, well-designed prospective studies are crucial and should also differentiate patients based on tumor site, histology, and molecular characteristics that could impact both thrombotic and hemorrhagic risk.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immune checkpoint inhibitors and cardiovascular toxicity: immunology, pathophysiology, diagnosis, and management.","authors":"Richard C Becker","doi":"10.1007/s11239-025-03146-7","DOIUrl":"https://doi.org/10.1007/s11239-025-03146-7","url":null,"abstract":"<p><p>Immune checkpoint inhibitors (ICIs) are pivotal in cancer therapy, particularly but not solely for metastatic and advanced lung cancer. These monoclonal antibodies, targeting programmed cell death (PD)-1, ligand PD-L1, and cytotoxic T-lymphocyte antigen (CTLA)-4, enhance immune responses against tumors but can also trigger immune-related adverse events, including cardiotoxicity and vascular toxicity. Cardiotoxic effects, such as myocarditis, pericarditis, atrial arrhythmias, thrombosis, and vasculitis are significant concerns, particularly myocarditis that can be fatal. ICIs like pembrolizumab, nivolumab, and atezolizumab are widely used, with combination immunotherapy showing improved survival but higher myocarditis risk. Effective management of ICI-induced cardiovascular toxicity involves regular monitoring for physical findings, cardiac, inflammatory, and autoimmune biomarkers, electrocardiograms, CT angiograms, echocardiograms, and cardiac MRI as needed. Emergent treatment for ICI myocarditis and vasculitis includes immediate discontinuation of ICIs, high-dose corticosteroids, and supportive care. In severe or steroid-refractory cases, additional immunosuppressive therapies should be considered.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clot formation, structure, and fibrinolysis of plasma from pancreatic cancer patients.","authors":"Rebecca A Risman, Noam Milman, Hajer Ali Sinan, Valerie Tutwiler","doi":"10.1007/s11239-025-03118-x","DOIUrl":"https://doi.org/10.1007/s11239-025-03118-x","url":null,"abstract":"<p><p>Pancreatic cancer (PC) has the highest risk of venous thromboembolisms amongst all cancer types. If not degraded through a process known as fibrinolysis, thrombi will continue to restrict blood flow and the transport of nutrients to downstream organs, which can lead to heart attack or stroke. While PC patients are known to be hypercoagulable and thus have an elevated thrombosis risk, the mechanism behind this behavior is not fully understood. We aimed to characterize alterations in clotting and fibrinolytic profiles in PC patients compared to healthy controls. Human blood plasma was collected from PC patients and healthy donor controls following institutional review board approval. We used kinetic turbidity to define the rates/timing of blood clot formation/degradation. Confocal and scanning electron microscopy were used to probe the effect PC has on fibrin network structure. Concentrations of proteins for clotting/fibrinolytic pathways were measured using ELISAs. PC patients were hypercoagulable compared to healthy donors with heightened fibrinogen concentration. A subset of patients were hypofibrinolytic, while most had similar fibrinolytic profiles to healthy. A comprehensive analysis revealed that delayed lysis in this subset was only present in patients with diabetes and/or COVID-19 due delayed clotting and, notably, elevated plasminogen activator inhibitor (PAI-1). In the general PC population, an extended PTT correlated with thicker fiber diameters while faster clotting resulted in smaller network pore size but was not correlated with lysis rate. Healthy, pooled plasma spiked with relevant concentrations of PAI-1 showed no difference in clot structure and comparable delays in lysis to patients. PAI-1, rather than network structure or other clotting/fibrinolytic factors, played a more significant role in hypofibrinolysis. PAI-1 inhibitors could be a prospective target for development of improved therapeutics to prevent restricted fibrinolysis.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel metacyte metafer classifier for platelet morphology using long COVID as a model.","authors":"Chantelle Venter, Jan H Pretorius, Douglas B Kell, Etheresia Pretorius","doi":"10.1007/s11239-025-03144-9","DOIUrl":"https://doi.org/10.1007/s11239-025-03144-9","url":null,"abstract":"","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The future of stroke care: how telestroke is bridging the gap in stroke care.","authors":"Lucio D'Anna, Marilena Mangiardi, Francesco Corea, Christoph Gumbinger, Rene Handschu, Olfa Kaaouana, Vasileios Tentolouris-Piperas, Laetitia Yperzeele, Vaso Zisimopoulou","doi":"10.1007/s11239-025-03150-x","DOIUrl":"https://doi.org/10.1007/s11239-025-03150-x","url":null,"abstract":"","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Venous thromboembolism prevention and treatment with factor XI/XIa inhibitors: current status and future perspectives.","authors":"Raul Del Toro-Mijares, Mateo Porres-Aguilar, Laurent Bertoletti, Alfonso J Tafur, Ilham Benzidia, Guillermo Cueto-Robledo, James D Douketis","doi":"10.1007/s11239-025-03132-z","DOIUrl":"https://doi.org/10.1007/s11239-025-03132-z","url":null,"abstract":"<p><p>Current treatments for venous thromboembolism include warfarin, various heparins, and direct oral anticoagulants. While effective, there's ongoing research for safer alternatives, especially for high-risk patients (e.g., cancer, post-operative, and those with end-stage renal disease). Factor XI has been identified as crucial in abnormal thrombosis but less so in normal hemostasis, suggesting that inhibiting it could reduce thrombosis while also limiting bleeding risks. Recent phase 2 trials on factor XI inhibitors show promise for preventing venous thromboembolism in patients undergoing total knee arthroplasty, in cancer patients, and in patients with end-stage renal disease. Three key unmet needs include: need for large-scale phase 3 clinical trials, broader surgical applications and management of bleeding complications/reversal strategies. Further research on these aspects is essential, especially as factor XI inhibitors progress towards clinical use.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}