Journal of Thrombosis and Thrombolysis最新文献

{"title":"Left atrial appendage occlusion in patients with cancer.","authors":"Nathaniel E Davis, Samuel A Shabtaie, Nicholas Y Tan","doi":"10.1007/s11239-025-03098-y","DOIUrl":"https://doi.org/10.1007/s11239-025-03098-y","url":null,"abstract":"<p><p>Atrial fibrillation (AF) and malignancy share a complex relationship, significantly complicating patient management. Patients with cancer, particularly those with lung, gastrointestinal, genitourinary, and hematologic malignancies, are at increased risk of AF due to cancer-related hypercoagulability, proinflammatory cytokines, and treatment-related factors. This population faces unique thrombotic and bleeding risks, challenging standard management approaches. Anticoagulation is often complicated by drug-drug interactions with cancer therapies and heightened bleeding risks, including thrombocytopenia and coagulopathy. Left atrial appendage occlusion (LAAO) offers an alternative stroke prevention strategy for patients unable to tolerate long-term anticoagulation. By isolating the left atrial appendage, LAAO reduces thromboembolic risk while minimizing bleeding complications. Indications include patients with elevated stroke risk with contraindications to anticoagulation due to nonreversible causes, such as recurrent bleeding or significant drug interactions. Surgical LAAO may also be considered during cardiac surgery in patients with AF and high thromboembolic risk, with previous studies showing reduced risk of thromboembolic complications. Outcomes of LAAO in cancer patients are generally favorable, with studies showing comparable stroke rates, bleeding risks, and mortality to non-cancer populations. However, malignancy-specific complications, such as device-related thrombus, require further investigation. LAAO provides a promising option for stroke prevention in this complex population, but further research is needed to refine patient selection and optimize outcomes.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788673","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":"Thrombin generation and clot lysis time to predict outcomes in patients undergoing transcatheter aortic valve implantation.","authors":"Aleksander Siniarski, Jakub Michal Zimodro, Aleksandra Gąsecka, Michał Łomiak, Marta Frydrych, Jadwiga Nessler, Grzegorz Gajos","doi":"10.1007/s11239-025-03090-6","DOIUrl":"https://doi.org/10.1007/s11239-025-03090-6","url":null,"abstract":"<p><p>Transcatheter aortic valve implantation (TAVI) is an established treatment method in patients with severe aortic stenosis at high surgical risk. TAVI might reduce thrombin generation and fibrin clot resistance to lysis. We aimed to evaluate the predictive value of thrombin generation and clot lysis time on TAVI outcomes. We screened 135 patients referred for TAVI. Thrombin generation (lag time, time to peak, peak thrombin concentration, and endogenous thrombin potential) and clot lysis time were assessed before TAVI and at hospital discharge. Major adverse cardiac and cerebrovascular events (MACCE) including all-cause death, cardiovascular death, myocardial infarction, stroke, transient ischemic attack, heart failure decompensation, and clinical valve thrombosis were assessed during 1-year follow-up. Among 70 patients who underwent TAVI, 14 (20%) experienced MACCE during the median follow-up of 361 days. Before TAVI, thrombin generation and clot lysis time were similar in patients with vs. without MACCE. Post-TAVI peak thrombin concentration was significantly lower in patients with MACCE (157.5 vs. 240.38 nM, p = 0.016), discriminated between those with and without MACCE (AUC: 0.773, p = 0.016), and was predictive for MACCE in both univariable (OR: 10.733, 95% CI: 1.197-96.283, p = 0.034) and multivariable (OR: 11.551, 95% CI: 1.104-120.828, p = 0.041) regression analyses. Pre-TAVI lag time was a predictor of MACCE in univariable regression analysis (OR: 5.304, 95% CI: 1.074-26.182, p = 0.041). Post-TAVI peak thrombin concentration and pre-TAVI lag time might potentially serve as novel predictors of MACCE in patients undergoing TAVI.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788081","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 severity of ischemic stroke and risk of all-cause mortality in patients with atrial fibrillation on different oral anticoagulant treatments admitted to the emergency department.","authors":"Tommasa Vicario, Danilo Menichelli, Alfredo Paolo Mascolo, Marina Diomedi, Sara Cerretti, Francesco Marconi, Pasquale Pignatelli, Carla Paganelli, Daniele Pastori","doi":"10.1007/s11239-025-03095-1","DOIUrl":"https://doi.org/10.1007/s11239-025-03095-1","url":null,"abstract":"<p><p>Although direct oral anticoagulants (DOACs) are non-inferior to Vitamin K antagonists (VKA) in preventing ischemic stroke (IS) in atrial fibrillation (AF) patients, there are limited data regarding stroke severity and prognosis of patients admitted with IS during DOAC treatment. We performed a single center retrospective study including patients with AF on oral anticoagulants admitted to the Emergency Department for IS were included. The primary endpoint was to analyse the severity of stroke evaluated through NIHSS scale according to anticoagulant therapy. The secondary endpoint was 3-month all-cause mortality. A total of 106 AF patients were included, with a mean age of 81.3 ± 7.5 years. Overall, 54.7% were women and 61.3% on DOAC. The AF patients on DOAC were older, with no other clinical differences. Median NIHSS was 12 (Interquartile Range [IQR] 5-19). At multivariable logistic regression analysis DOAC use (compared to warfarin) was associated with lower risk of moderate-severe/severe stroke (NIHSS ≥ 16) (Odds Ratio [OR] 0.355, 95% confidence interval [95% CI] 0.127-0.995). Mechanical thrombectomy was strongly associated with higher severity of stroke (OR 6.113, 95%CI 2.186-17.099). During follow-up, 42 patients died. DOAC use inversely correlated with mortality risk (OR 0.323, 95%CI 0.127-0.822) after adjusting for CHA₂DS₂-VASc, time to hospital admission from symptom onset and type of acute treatment. In conclusion, in our contemporary real-world population, patients on DOACs treatment admitted for IS had better outcomes in terms of stroke severity and all-cause mortality compared with patients on VKAs.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788653","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":"Evaluation of unfractionated heparin dosing using an antifactor-Xa-based protocol in non-obese vs. obese patients for acute venous thromboembolism.","authors":"Trenton Flanagan, Monica Sharma, Uyen-Thi Cao, Xuan Wang, Vivek Kataria","doi":"10.1007/s11239-025-03097-z","DOIUrl":"https://doi.org/10.1007/s11239-025-03097-z","url":null,"abstract":"<p><p>The pharmacokinetic profile of heparin may result in supratherapeutic antifactor-Xa levels using total weight-based protocols for the treatment of venous thromboembolism (VTE) in obese patients. Previous literature has been limited by choice of monitoring assay and inconsistent dosing strategies. The goal of this study was to evaluate safety and efficacy outcomes of an antifactor-Xa based UFH VTE protocol in obese vs. non-obese patients. This was a single center, retrospective study of adult patients with an acute VTE treated with our institution specific UFH VTE protocol. Patients were screened from the preceding 3 years for inclusion into the obese (BMI ≥ 30 kg/m²) or non-obese (BMI < 30 kg/m²) groups. The primary outcome was the weight-based rate of UFH (units/kg/hr) required to attain a therapeutic anti-Xa level. Secondary outcomes included rate required to attain steady state, time to first therapeutic anti-Xa level and steady state, proportion of patients to attain at least one therapeutic anti-Xa level and steady state, number of rate changes required to attain steady state, and proportion of anti-Xa levels being therapeutic, subtherapeutic, or supratherapeutic at the first anti-Xa level drawn, within the first 24 h of treatment, and for the duration of treatment with UFH. Safety outcomes evaluated the incidence of any major or non-major bleeding event, requiring reversal agents, or having additional thrombotic events. The primary outcome of weight-based rate at first therapeutic anti-Xa level was significantly lower in the obese group, and this was consistent for attainment of steady state, as well (14 units/kg/hour vs. 16 units/kg/hour, p < 0.001). Patients in the obese group had significantly more supratherapeutic anti-Xa levels within 24 h (50% vs. 33%, p < 0.0001) and for the total duration of UFH therapy (40% vs. 25%, p < 0.0001) No significant differences in clinically overt bleeding rates were found. Obese patients required a lower weight-based rate of UFH to attain therapeutic anti-Xa levels for the treatment of VTE. Additionally, there appears to be an inverse relationship between weight-based UFH rate and total UFH rate at the first therapeutic anti-Xa and steady state as BMI increases. Future studies should focus on dosing strategies that improve attainment of therapeutic anti-Xa levels in obese patients.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788670","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 use of oral anticoagulation at the time of acute COVID-19 infection and subsequent development of long-COVID/post-acute sequelae of SARS-CoV-2 infection.","authors":"Freddy Frost, José Miguel Rivera-Caravaca, Gregory Y H Lip","doi":"10.1007/s11239-025-03096-0","DOIUrl":"https://doi.org/10.1007/s11239-025-03096-0","url":null,"abstract":"<p><p>Long COVID (LC) or post-acute sequelae of SARS-CoV-2 infection (PASC) is defined as ongoing, relapsing or new symptoms/conditions persisting after an acute COVID-19 infection. Given the potential role of oral anticoagulants (OAC) in treating thrombotic sequelae of LC/PASC, we investigated whether prevalent OAC use at the time of acute COVID-19 infection was associated with reduced development of LC/PASC. Retrospective cohort study within the TriNetx network. The primary cohort was defined as adults with a confirmed diagnosis of COVID-19. We defined OAC users as those who had received OACs (either direct-acting OACs [DOACs] or vitamin K antagonists [VKA]) in the preceding 3-months and non-users as those without OAC use within the previous 12-months. The primary outcome was a composite of 9 features associated with LC/PASC We identified 38,409 DOAC users, 19,243 VKA users, and 2,329,771 non-OAC users with acute COVID-19 infection. After successful propensity score matching (PSM), we found an increased risk of LC/PASC features in those receiving DOAC compared to non-OAC (HR [95% CI] 1.50 [1.35 to 1.68], p < 0.0001), and in VKA users compared to non-OACs (HR [95% CI] 1.98 [1.78 to 2.20], p < 0.0001), while DOAC users were at reduced risk compared to VKA users (HR [95% CI] 0.71 [0.62 to 0.81], p < 0.0001). We found no evidence that prevalent OAC at the time of acute COVID-19 infection was associated with reduced risk of LC/PASC. Further work is needed to understand whether there is a role for OAC therapy in the management of LC/PASC.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788080","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":"Acute myocardial infarction in patients with cancer: outcomes and P2Y12 inhibition.","authors":"Andres Cordova Sanchez, Chris E Holmes, Harold L Dauerman, Tanush Gupta","doi":"10.1007/s11239-025-03092-4","DOIUrl":"https://doi.org/10.1007/s11239-025-03092-4","url":null,"abstract":"<p><p>Cancer patients are at an elevated risk of bleeding and ischemic events. There are limited comparative real-world data on outcomes of all-comer cancer patients after percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) compared with non-cancer patients. There are also limited comparative data to guide P2Y12 inhibitor choice in cancer patients undergoing PCI. We queried the TriNetX research database from 2015 to 2023 to identify adult patients who received PCI for AMI. AMI patients were then stratified into cancer and non-cancer patients. Propensity score matching was used to account for imbalances in baseline characteristics. Cancer patients were further categorized into those who received dual antiplatelet therapy (DAPT) with ticagrelor or clopidogrel in addition to aspirin. Outcomes of interest included all-cause mortality and major bleeding at 30-days and 1-year. Of 139,342 patients who underwent PCI for AMI, 6,766 (4.9%) had a history of cancer. Compared with AMI patients without cancer, cancer patients had higher 1-year all-cause mortality (20.1% vs. 12.7%; HR 1.59; 95% CI, 1.46-1.73) and major bleeding (16.9% vs. 10.2%; HR 1.69; 95% CI 1.54-1.86). Among cancer patients with AMI, those treated with ticagrelor-based DAPT after PCI had similar incidence of bleeding complications compared with those treated with clopidogrel (HR 1.04; 95% CI 0.77-1.40). Cancer is an adverse prognostic marker for AMI outcomes and is independently associated with substantially higher mortality and bleeding risk. Among cancer patients undergoing PCI for AMI, ticagrelor use is associated with similar bleeding events compared with clopidogrel.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753462","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":"In reply: letter to the editor about \"Direct oral anticoagulants in embolic stroke of undetermined source: an updated meta-analysis\".","authors":"Gabriel Marinheiro, Beatriz Araújo, André Rivera, Gabriel de Almeida Monteiro, Laís Silva Santana, Marianna Leite, Antonio Mutarelli, Agostinho C Pinheiro, Eberval Gadelha Figueiredo, João Paulo Mota Telles","doi":"10.1007/s11239-025-03080-8","DOIUrl":"https://doi.org/10.1007/s11239-025-03080-8","url":null,"abstract":"","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764484","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":"Khorana risk score in lung cancer patients treated with immune checkpoint inhibitors: a real-world study.","authors":"Junmin Song, Ahmed Ashraf Morgan, Ana Maria Diaz Abram, Daniel Hong, Gagi Kim, Wing Fai Li, Jaeun Ahn, Yu Chang, Kuan-Yu Chi, Cho-Han Chiang","doi":"10.1007/s11239-025-03086-2","DOIUrl":"https://doi.org/10.1007/s11239-025-03086-2","url":null,"abstract":"<p><strong>Background: </strong>Lung cancer patients are at increased risk of venous thromboembolism (VTE) and arterial thrombosis, particularly when treated with immune checkpoint inhibitors (ICIs). The Khorana Risk Score (KRS), an effective tool for predicting VTE risk in chemotherapy recipients, needs further validation in lung cancer patients treated with ICIs.</p><p><strong>Methods: </strong>We utilized a global database and conducted a retrospective cohort study. Lung cancer patients receiving ICIs were classified into intermediate (KRS 1-2) and high-risk (KRS ≥ 3) groups. The primary outcome was VTE, including deep vein thrombosis (DVT) and pulmonary embolism (PE); secondary outcomes included arterial thrombosis and all-cause mortality. Risk comparisons were performed using Cox proportional hazards analysis.</p><p><strong>Results: </strong>Among 5,378 patients, those with a high KRS had a greater risk of VTE (HR: 1.38, 95% CI: 1.15-1.65), including DVT (HR: 1.43, 95% CI: 1.12-1.82) and PE (HR: 1.32, 95% CI: 1.05-1.67). High KRS was also associated with increased arterial thrombosis (HR: 1.60, 95% CI: 1.29-1.96), ischemic stroke (HR: 1.73, 95% CI: 1.32-2.25), and elevated mortality (HR: 1.66, 95% CI: 1.48-1.87).</p><p><strong>Conclusion: </strong>A high KRS (≥ 3) is associated with a higher risk of thrombotic events and mortality in lung cancer patients treated with ICIs. These findings suggest that KRS may aid risk stratification in this population, warranting further prospective research.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753468","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":"Efficacy and safety of intravenous tirofiban combined with reperfusion therapy versus reperfusion therapy alone in acute ischemic stroke: a meta-analysis of randomized controlled trials.","authors":"Gabriel de Almeida Monteiro, Marianna Leite, Ocílio Ribeiro Gonçalves, Marcio Yuri Ferreira, Antonio Mutarelli, Gabriel Marinheiro, Beatriz Araujo, Paulo Roberto Lacerda Leal, Espartaco Moraes Lima Ribeiro, Eberval Gadelha Figueiredo, João Paulo Mota Telles","doi":"10.1007/s11239-025-03094-2","DOIUrl":"https://doi.org/10.1007/s11239-025-03094-2","url":null,"abstract":"<p><p>Several studies have shown an additional benefit of tirofiban administration in patients with acute ischemic stroke (AIS) who underwent reperfusion therapy. According to the last revised guidelines, the efficacy of tirofiban in treating AIS is not well-established. Therefore, we performed a meta-analysis to assess the efficacy and safety of reperfusion therapy with tirofiban compared to reperfusion therapy alone in treating AIS. We systematically searched PubMed, Embase, and Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs) reporting the use of tirofiban combined with reperfusion therapy in AIS patients within 72 h after the onset of symptoms with 90 days minimum follow-up. We employed risk ratio (RR) and Mean Differences (MD) with 95% confidence intervals (CIs) as the measure of effect size using a random-effects model. We included seven RCTs comprising 1607 patients, of whom 815 (50.7%) received tirofiban combined with reperfusion therapy and 792 (49.3%) received reperfusion therapy alone (no-tirofiban). The addition of tirofiban to the reperfusion therapy resulted in a higher rate of favorable outcomes (RR 1.25; 95% CI 1.11-1.40; p < 0.001) with less functional disability (RR 0.72; 95% CI 0.53-0.98; p < 0.05). The administration of tirofiban significantly improved the National Institutes of Health Stroke Scale (NIHSS) after seven days (MD - 2.27; 95% CI - 4.32 to - 0.22; p = 0.03). A similar rate of successful revascularization was observed between groups (RR 1.18; 95% CI 0.97-1.45; p = 0.09). Tirofiban did not increase the risk of symptomatic intracranial hemorrhage (sICH) (RR 1.47; 95% CI 0.98-2.19; p = 0.06), but increase the risk of any intracranial hemorrhage (ICH), particularly in the endovascular thrombectomy (EVT) subgroup analysis (RR 1.25; 95% CI 1.03-1.51; p = 0.02). Mortality rates were similar between groups RR 1.05; 95% CI 0.80-1.38; p = 0.72). The addition of tirofiban to reperfusion therapy was associated with improved functional outcomes, without a significant increase in ICH. NIHSS after seven days of stroke onset was significantly improved by tirofiban. There was an increase in any ICH events, particularly in EVT patients. Mortality was not significantly altered by tirofiban.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753465","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":"Outcomes of patients with myeloproliferative neoplasms and critical limb ischemia: insights from the National readmissions database.","authors":"Orly Leiva, Michelle H Lee, Joan How, Jeffrey S Berger, Gabriela Hobbs","doi":"10.1007/s11239-025-03088-0","DOIUrl":"https://doi.org/10.1007/s11239-025-03088-0","url":null,"abstract":"<p><p>Patients with myeloproliferative neoplasms (MPNs), including polycythemia vera (PV), essential thrombocythemia (ET), and myelofibrosis (MF), are at increased risk of atherosclerosis, including peripheral arterial disease (PAD). Critical limb ischemia (CLI) may complicate PAD and is associated with significant mortality and morbidity. Despite the increased risk of thrombosis with MPN, outcomes of CLI in MPN patients are unclear. We conducted an analysis utilizing the 2017-2020 National Readmission Database (NRD) of patients hospitalized for CLI with and without MPN. Patients with MPN were propensity score matched (PSM) with patients without MPN. Primary outcome was composite outcome of major adverse cardiovascular and limb events (MACLE). Logistic regression was utilized to estimate risk of MACLE in patients with MPN vs. without MPN. Inverse-probability treatment weighted (IPTW) analysis was performed to evaluate the effect of revascularization on MACLE in patients with MPN. A total of 102,598 patients were included, 931 (0.9%) had MPN. After PSM, MPN was associated with increased risk of MACLE (47.3% vs. 39.1%; OR 1.40, 95% CI 1.21-1.62). After IPTW, revascularization was associated with decreased risk of MACLE among patients with MPN (45.0% vs. 50.7%; OR 0.80, 95% CI 0.66-0.96). Among patients admitted with CLI, MPN was associated with increased risk of MACLE especially ET and MF phenotypes. Revascularization was associated with decreased risk of MACLE among patients with MPN. Further investigation is needed in order to improve outcomes in patients with MPN and CLI.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710432","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}