Journal of Thrombosis and Thrombolysis最新文献

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Efficacy and safety of early intravenous administration of tirofiban after thrombolysis in acute ischemic stroke: a systematic review and meta-analysis of randomized controlled trials. 急性缺血性卒中溶栓后早期静脉给药替罗非班的疗效和安全性:随机对照试验的系统评价和荟萃分析。
IF 2.1 3区 医学
Journal of Thrombosis and Thrombolysis Pub Date : 2026-08-01 Epub Date: 2026-04-17 DOI: 10.1007/s11239-026-03273-9
Emanuele Spina, Antonio Luca Spiezia, Flavo Della Pia, Antonio de Mase, Carlo Maurea, Giovanna Servillo, Simone Aramini, Angelo Ranieri, Stefano Barbato, Claudia Cuccurullo, Stefano Tozza, Antonio Esposito, Vincenzo Andreone, Fiore Manganelli, Paolo Candelaresi
{"title":"Efficacy and safety of early intravenous administration of tirofiban after thrombolysis in acute ischemic stroke: a systematic review and meta-analysis of randomized controlled trials.","authors":"Emanuele Spina, Antonio Luca Spiezia, Flavo Della Pia, Antonio de Mase, Carlo Maurea, Giovanna Servillo, Simone Aramini, Angelo Ranieri, Stefano Barbato, Claudia Cuccurullo, Stefano Tozza, Antonio Esposito, Vincenzo Andreone, Fiore Manganelli, Paolo Candelaresi","doi":"10.1007/s11239-026-03273-9","DOIUrl":"10.1007/s11239-026-03273-9","url":null,"abstract":"<p><p>Intravenous thrombolysis (IVT) is the cornerstone of reperfusion therapy for acute ischemic stroke (AIS), yet only a minority of patients achieve functional independence with vessel re-occlusion in up to one-third of cases. IVT targets fibrin but does not inhibit platelet aggregation, providing a rationale for adjunctive early platelet inhibition; so in this context tirofiban, a short-acting glycoprotein IIb/IIIa antagonist, may synergize with thrombolysis, favoring better outcome for AIS patients. We conducted a systematic review and meta-analysis up to August 2025 on MEDLINE (via PubMed), EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) of RCTs assessing efficacy and safety of early intravenous infusion of tirofiban after thrombolysis in AIS. Outcomes presented as forest plot included functional independence (mRS 0-2), excellent outcome (mRS 0-1), mortality, symptomatic intracranial hemorrhage (sICH), any ICH and early neurological deterioration (END). Risk of Bias was evaluated through Cochrane RoB 2.0 tool. Five RCTs (1,428 patients) were included. At 90 days, functional independence occurred in 78.7% tirofiban-treated versus in 67.8% control patients (RR 1.22, 95% CI 1.05-1.40), with a lower number of END in tirofiban group (RR 0.35, 95% CI 0.15-0.82). Excellent outcome did not significantly differ (RR 2.72, 95% CI 0.26-27.97), as well as mortality (RR 1.07, 95% CI 0.55-2.09), overall ICH rate (RR 1.14, 95% CI 0.75-1.72) and sICH (RR 1.74, 95% CI 0.41-7.42), although an increased number of sICH was observed in tirofiban group. Tirofiban after thrombolysis may be associated with higher rates of functional independence and reduced END. However, given the very low certainty of evidence due to substantial heterogeneity, and imprecision, this meta-analysis should be interpreted as hypothesis-generating, and larger RCTs are required to confirm these findings. PROSPERO: number 1230163.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"1486-1498"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147717202","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}
引用次数: 0
miR-4443 alleviates myocardial injury in acute myocardial infarction by targeting and regulating TIMP2. miR-4443通过靶向调控TIMP2减轻急性心肌梗死的心肌损伤。
IF 2.1 3区 医学
Journal of Thrombosis and Thrombolysis Pub Date : 2026-08-01 Epub Date: 2026-04-07 DOI: 10.1007/s11239-026-03264-w
Huihui Zhu, Danmin Wang
{"title":"miR-4443 alleviates myocardial injury in acute myocardial infarction by targeting and regulating TIMP2.","authors":"Huihui Zhu, Danmin Wang","doi":"10.1007/s11239-026-03264-w","DOIUrl":"10.1007/s11239-026-03264-w","url":null,"abstract":"<p><p>Acute myocardial infarction (AMI) continues to be a leading cause of global morbidity and mortality, where adverse left ventricular remodeling and subsequent heart failure serve as primary determinants of long-term prognosis. This study aimed to delineate the expression pattern, clinical significance, and molecular mechanisms of miR-4443 in AMI. The study included 100 patients diagnosed with AMI and 100 normal healthy controls. Serum miR-4443 levels were measured by qRT-PCR, and their correlations with patient prognosis were analyzed by Kaplan-Meier curve and Cox regression analysis. To mimic ischemia-reperfusion injury in vitro, human AC16 cardiomyocytes underwent hypoxia/reoxygenation (H/R) treatment. MTT for cell viability, flow cytometry for apoptosis, and ELISA for TNF-α, IL-1β, and IL-6 levels were performed to determine the regulatory role of miR-4443. A bioinformatics analysis predicted the targeting relationship between miR-4443 and TIMP2, and this was validated by the dual-luciferase reporter assay. For matrix remodeling evaluation, MMP2 and MMP9 mRNA expressions were detected by qRT-PCR. The expression of miR-4443 in serum samples from AMI patients was significantly downregulated. The low levels of miR-4443 indicate a poor prognosis for AMI. During H/R injury, miR-4443 expression was downregulated in AC16 cells, its overexpression significantly rescued H/R-induced cell viability decline, increased apoptosis, inflammatory factor release, and upregulation of MMP2/MMP9 expression. TIMP2 was a direct target gene for miR-4443. Functional rescue experiments showed that overexpression of TIMP2 could reverse the protective effect of miR-4443 mimics on H/R injury in cells. Our findings demonstrate that miR-4443 is downregulated in AMI and exerts protective effects against H/R injury in cardiomyocytes, at least in part, through targeting TIMP2, suggesting that the miR-4443/TIMP2 axis may be a potential critical regulatory target in AMI. Further in vivo validation is warranted to substantiate its therapeutic potential.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"1431-1444"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147628293","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}
引用次数: 0
Anaemia and long-term outcomes after surgical treatment of uterine fibroids: evidence from real-world data. 子宫肌瘤手术治疗后贫血和长期预后:来自真实世界数据的证据。
IF 2.1 3区 医学
Journal of Thrombosis and Thrombolysis Pub Date : 2026-08-01 Epub Date: 2026-05-23 DOI: 10.1007/s11239-026-03326-z
Hani Essa, Dharani K Hapangama, Ingeborg Welters, Gregory Y H Lip
{"title":"Anaemia and long-term outcomes after surgical treatment of uterine fibroids: evidence from real-world data.","authors":"Hani Essa, Dharani K Hapangama, Ingeborg Welters, Gregory Y H Lip","doi":"10.1007/s11239-026-03326-z","DOIUrl":"10.1007/s11239-026-03326-z","url":null,"abstract":"<p><p>Uterine leiomyomas are the most common benign gynaecological tumours and a major cause of heavy menstrual bleeding, frequently resulting in iron deficiency anaemia. However, the long-term cardiovascular and thromboembolic consequences of fibroid-related anaemia remain poorly understood. We conducted a retrospective cohort study using the TriNetX health research network (~ 160 million patients). Women with uterine fibroids undergoing surgical management were identified and stratified by the presence or absence of anaemia within three years before surgery. Propensity score matching (1:1) was applied to balance demographics and comorbidities. Twelve-month outcomes included all-cause mortality, myocardial infarction, stroke, atrial fibrillation/flutter, heart failure, and venous thromboembolism. Risk ratios (RR) with 95% confidence intervals (CI) were calculated. From 83,319 eligible patients, 9,581 anaemic and 9,581 non-anaemic women were well matched. At one year, the presence of anaemia was associated with higher risks of mortality (RR 1.93, 95% CI 1.04-3.60, p = 0.03), stroke (RR 1.65, 1.05-2.60, p = 0.02), atrial fibrillation/flutter (RR 1.60, 1.03-2.48, p = 0.03), heart failure (RR 1.97, 1.43-2.70, p < 0.0001), and venous thromboembolism (RR 2.15, 1.67-2.80, p < 0.0001). No significant difference was observed for myocardial infarction (RR 1.44, 0.80-2.60, p = 0.22). The composite cardiovascular outcome was significantly elevated (HR 1.74, 95% CI 1.44-2.09, p < 0.0001). Preoperative anaemia in women undergoing fibroid surgery independently predicts adverse cardiovascular and thromboembolic events and nearly doubled 12-month mortality. Early recognition and optimisation of anaemia may improve clinical outcomes.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"1659-1666"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13447403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148005711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical outcomes of anemia in patients with spontaneous coronary artery dissection: a retrospective cohort analysis. 自发性冠状动脉夹层患者贫血的临床结局:回顾性队列分析。
IF 2.1 3区 医学
Journal of Thrombosis and Thrombolysis Pub Date : 2026-08-01 Epub Date: 2026-05-18 DOI: 10.1007/s11239-026-03314-3
Emmanuel Olumuyide, Ezaz Rahman, Shengnan Zheng, Mefri Yanni, Ehimen Aneni, Bruce Samuels, Jiun-Ruey Hu
{"title":"Clinical outcomes of anemia in patients with spontaneous coronary artery dissection: a retrospective cohort analysis.","authors":"Emmanuel Olumuyide, Ezaz Rahman, Shengnan Zheng, Mefri Yanni, Ehimen Aneni, Bruce Samuels, Jiun-Ruey Hu","doi":"10.1007/s11239-026-03314-3","DOIUrl":"10.1007/s11239-026-03314-3","url":null,"abstract":"<p><p>Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome, especially in younger patients and women. Anemia, a common comorbidity in patients with cardiovascular disease, may modulate outcomes in SCAD, but its influence remains poorly defined. We identified adult hospitalizations for SCAD in the Nationwide Inpatient Sample (2016-2022), stratified by anemia status. Multivariable logistic regression models were constructed to examine the relationship between anemia and in-hospital outcomes, while adjusting for demographics, comorbidities, and hospital characteristics. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included cardiac arrest (CA), mechanical circulatory support (MCS), cardiogenic shock (CS), heart failure reduced ejection fraction (HFrEF), heart failure preserved ejection fraction (HFpEF), blood transfusion (BT), vasopressor use (VU), mechanical ventilation (MV), acute kidney injury (AKI), atrial fibrillation (AF), length of stay (LOS) and total hospital charges (THC). Among 63,450 SCAD hospitalizations, 24.8% had comorbid anemia. Patients with anemia were older (63.4 vs. 59.7 years) and had a higher comorbidity burden. While no significant difference in in-hospital mortality was observed (10.8% vs. 4.6%; adjusted odds ratio [aOR] 1.15, 95% confidence interval [CI]: 0.96-1.38; p = 0.115), anemia was associated with significantly greater odds of MCS (28.2% vs. 9.5%; aOR 2.64, CI: 2.34-2.99; p < 0.001), CS (23.5% vs. 6.9%; aOR 2.27, CI: 1.98-2.61; p < 0.001), HFrEF (20.7% vs. 12.1%; aOR 0.99, CI: 0.88-1.14; p = 0.324), HFpEF (8.8% vs. 4.3%; aOR 1.26, CI: 1.04-1.52; p = 0.020), VU (9.3% vs. 2.1%; aOR 2.56, CI: 2.04-3.20; p < 0.001) AKI (33.2% vs. 9.5%; aOR 2.28, CI: 2.02-2.59; p < 0.001) AF (27.0% vs. 12.9%; aOR 1.74, CI: 1.55-1.97; p < 0.001) BT (17.8% vs. 1.3%; aOR 12.71, CI: 10.07-16.04; p < 0.001). Anemia was associated with increased hospital length of stay (LOS) (10 vs. 4 days; β = 3.9; p < 0.001) and higher THC ($285,660 vs. $114,861; β = $117,902; p < 0.001). Among patients hospitalized with SCAD, anemia was associated with higher risks of hemodynamic compromise, acute kidney injury, atrial fibrillation, and greater resource utilization, although mortality differences were not statistically significant. Recognition of anemia may help identify high-risk SCAD patients needing closer monitoring and tailored management.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"1459-1466"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147963952","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}
引用次数: 0
Predictive value of thromboelastography with platelet mapping on hematoma expansion in spontaneous intracerebral hemorrhage. 血小板定位血小板弹性成像对自发性脑出血血肿扩张的预测价值。
IF 2.1 3区 医学
Journal of Thrombosis and Thrombolysis Pub Date : 2026-08-01 Epub Date: 2026-04-29 DOI: 10.1007/s11239-026-03292-6
Nora Sammani, John J Radosevich, Sydni Martinez, Travis Lam, Daniel Gonzalez, Tracie Schroeder, Sai Alekha Challa, John Tyler Haller
{"title":"Predictive value of thromboelastography with platelet mapping on hematoma expansion in spontaneous intracerebral hemorrhage.","authors":"Nora Sammani, John J Radosevich, Sydni Martinez, Travis Lam, Daniel Gonzalez, Tracie Schroeder, Sai Alekha Challa, John Tyler Haller","doi":"10.1007/s11239-026-03292-6","DOIUrl":"10.1007/s11239-026-03292-6","url":null,"abstract":"","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"1479-1485"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775291","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}
引用次数: 0
Number of thrombosed venous segments and clinical outcomes in cancer-associated isolated distal deep vein thrombosis: insights from the ONCO DVT Study. 癌症相关孤立远端深静脉血栓形成的静脉段数量和临床结果:来自ONCO DVT研究的见解
IF 2.1 3区 医学
Journal of Thrombosis and Thrombolysis Pub Date : 2026-08-01 Epub Date: 2026-04-29 DOI: 10.1007/s11239-026-03287-3
Kanna Nakamura, Yugo Yamashita, Takeshi Morimoto, Nao Muraoka, Michihisa Umetsu, Yuji Nishimoto, Takuma Takada, Yoshito Ogihara, Tatsuya Nishikawa, Nobutaka Ikeda, Kazunori Otsui, Daisuke Sueta, Yukari Tsubata, Masaaki Shoji, Ayumi Shikama, Yutaka Hosoi, Yasuhiro Tanabe, Ryuki Chatani, Kengo Tsukahara, Naohiko Nakanishi, Kitae Kim, Satoshi Ikeda, Koh Ono, Takeshi Kimura
{"title":"Number of thrombosed venous segments and clinical outcomes in cancer-associated isolated distal deep vein thrombosis: insights from the ONCO DVT Study.","authors":"Kanna Nakamura, Yugo Yamashita, Takeshi Morimoto, Nao Muraoka, Michihisa Umetsu, Yuji Nishimoto, Takuma Takada, Yoshito Ogihara, Tatsuya Nishikawa, Nobutaka Ikeda, Kazunori Otsui, Daisuke Sueta, Yukari Tsubata, Masaaki Shoji, Ayumi Shikama, Yutaka Hosoi, Yasuhiro Tanabe, Ryuki Chatani, Kengo Tsukahara, Naohiko Nakanishi, Kitae Kim, Satoshi Ikeda, Koh Ono, Takeshi Kimura","doi":"10.1007/s11239-026-03287-3","DOIUrl":"10.1007/s11239-026-03287-3","url":null,"abstract":"","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"1379-1388"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775274","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}
引用次数: 0
External validation of established clinical risk scores for cancer-associated venous thromboembolism in a Brazilian registry. 在巴西注册的癌症相关静脉血栓栓塞建立临床风险评分的外部验证。
IF 2.1 3区 医学
Journal of Thrombosis and Thrombolysis Pub Date : 2026-08-01 Epub Date: 2026-05-18 DOI: 10.1007/s11239-026-03303-6
Márcia Fayad Marcondes de Abreu, Mohamad Al Bannoud, Sandra Martins, Stephany C Huber, Beatriz de Moraes Martinelli, Maria Carmen Gl Fernandes, Júlio C Teixeira, José Bc Carvalheira, Carmen Sp Lima, Nelson A Andreollo, Maurício Etchebehere, Lair Zambon, Ubirajara Ferreira, Alfio José Tincani, Antônio Santos Martins, Cláudio Sr Coy, José Ct Seabra, Ricardo K Mussi, Helder Tedeschi, Daniel Dias Ribeiro, Cyrillo Cavalheiro Filho, Tiago Dias Martins, Gabriel Yoshiaki Ottaiano, Rubens Maciel Filho, Silmara Aparecida de Lima Montalvão, Joyce Maria Annichino-Bizzacchi
{"title":"External validation of established clinical risk scores for cancer-associated venous thromboembolism in a Brazilian registry.","authors":"Márcia Fayad Marcondes de Abreu, Mohamad Al Bannoud, Sandra Martins, Stephany C Huber, Beatriz de Moraes Martinelli, Maria Carmen Gl Fernandes, Júlio C Teixeira, José Bc Carvalheira, Carmen Sp Lima, Nelson A Andreollo, Maurício Etchebehere, Lair Zambon, Ubirajara Ferreira, Alfio José Tincani, Antônio Santos Martins, Cláudio Sr Coy, José Ct Seabra, Ricardo K Mussi, Helder Tedeschi, Daniel Dias Ribeiro, Cyrillo Cavalheiro Filho, Tiago Dias Martins, Gabriel Yoshiaki Ottaiano, Rubens Maciel Filho, Silmara Aparecida de Lima Montalvão, Joyce Maria Annichino-Bizzacchi","doi":"10.1007/s11239-026-03303-6","DOIUrl":"10.1007/s11239-026-03303-6","url":null,"abstract":"<p><p>Cancer-associated thrombosis (CAT) is a relevant cause of morbidity and mortality in oncology patients. Although several venous thromboembolism (VTE) risk assessment models (RAMs) are recommended to guide thromboprophylaxis in ambulatory cancer patients, their performance varies across populations. Data from Brazilian cohorts are limited, and the real-world performance of these models in this setting remains unclear. We conducted a prospective external validation study of four established VTE RAMs-Khorana, PROTECHT, CONKO, and Vienna CATS-in ambulatory cancer patients from a Brazilian tertiary-care registry. A total of 803 adult patients with complete data were followed for 12 months for objectively confirmed symptomatic VTE. Predictors included baseline variables from each RAM, applied according to their original definitions. Discrimination was assessed using the area under the receiver operating characteristic curve (AUC), with 95% confidence intervals (CI) obtained by bootstrap resampling. Vienna CATS was evaluated in a biomarker-defined subcohort of 470 patients. During follow-up, 36 of 803 patients (4.5%) developed VTE. The Khorana (AUC 0.567; 95% CI 0.462-0.672), PROTECHT (AUC 0.575; 95% CI 0.470-0.680), and CONKO (AUC 0.567; 95% CI 0.464-0.671) scores showed limited and comparable discrimination, with sensitivities of approximately 30% at the conventional high-risk threshold (≥3 points). In the Vienna CATS subcohort, 24 of 470 patients (5.1%) developed VTE. Vienna CATS demonstrated modest but statistically significant discrimination (AUC 0.672; 95% CI 0.559-0.779) over chance. However, pairwise comparisons using DeLong's test showed no significant differences in AUC between the clinical-only scores and the same subcohort. Additional analyses suggested heterogeneity in risk across component combinations despite equal point weighting. Among patients with very-high-risk tumors plus one additional component, VTE incidence varied substantially depending on the specific factor present, ranging from 0% for BMI to 38.5% for low hemoglobin. Overall, current RAMs demonstrated limited sensitivity for identifying patients who developed VTE in this Brazilian cohort. These findings indicate that RAMs alone may be insufficient to guide thromboprophylaxis decisions in this setting, particularly given their limited sensitivity and the occurrence of VTE events among patients classified as low risk. Furthermore, the results support the need to develop locally validated models for Brazilian patients, as well as to explore novel biomarkers, alternative predictor thresholds, and potentially nonlinear approaches to variable weighting.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"1411-1430"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13447457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Validity of ICD-10 codes for identifying gastrointestinal bleeding in anticoagulated patients: an encounter-level diagnostic accuracy study. ICD-10代码识别抗凝患者胃肠道出血的有效性:遭遇水平诊断准确性研究。
IF 2.1 3区 医学
Journal of Thrombosis and Thrombolysis Pub Date : 2026-08-01 Epub Date: 2026-05-16 DOI: 10.1007/s11239-026-03317-0
Abdelrahman G Tawfik, Ainhoa Gomez-Lumbreras, Spencer J Gilbert, Heeseung Hong, Xiangyang Ye, Vanessa Patterson, Guilherme Del Fiol, Daniel C Malone, Daniel M Witt
{"title":"Validity of ICD-10 codes for identifying gastrointestinal bleeding in anticoagulated patients: an encounter-level diagnostic accuracy study.","authors":"Abdelrahman G Tawfik, Ainhoa Gomez-Lumbreras, Spencer J Gilbert, Heeseung Hong, Xiangyang Ye, Vanessa Patterson, Guilherme Del Fiol, Daniel C Malone, Daniel M Witt","doi":"10.1007/s11239-026-03317-0","DOIUrl":"10.1007/s11239-026-03317-0","url":null,"abstract":"<p><p>International Classification of Diseases, Tenth Revision (ICD-10) encounter diagnosis codes are commonly used to identify gastrointestinal bleeding (GIB) in electronic health record (EHR)-based research and clinical decision-support (CDS) tools. However, variability in coding accuracy may introduce misclassification bias, particularly among patients receiving oral anticoagulants (OACs). Contemporary, institution-specific validation of ICD-10 GIB codes is needed in the post-ICD-10 implementation era. We conducted a diagnostic accuracy study of ICD-10 encounter diagnosis codes for GIB among adults receiving warfarin or direct oral anticoagulants (DOACs) within a large academic healthcare system. A random sample of inpatient and emergency department encounters between June and December 2024 was identified. Manual chart review served as the reference standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic odds ratio (DOR) were calculated overall and stratified by anatomic bleeding site, anticoagulant class, and admission status. Among 656 anticoagulated encounters, 26 (4.0%) had chart-confirmed GIB. Overall sensitivity was 81% (95% CI, 60%-93%), specificity 98% (95% CI, 96%-99%), PPV 64% (95% CI, 45%-79%), and NPV 99% (95% CI, 98%-100%). The DOR was 215.6 (95% CI, 69.6-667.6). Sensitivity was higher for upper versus lower GIB (86% vs. 50%), while specificity remained high across subgroups. Diagnostic performance was similar between DOAC- and warfarin-treated encounters, though estimates for warfarin were imprecise due to small event counts. PPV varied across individual ICD-10 codes, with symptom-specific codes demonstrating higher predictive accuracy. ICD-10 encounter diagnosis codes demonstrated high specificity and NPV for identifying GIB among patients receiving OACs, supporting their use for ruling out bleeding events in EHR-based research and CDS. However, moderate PPV and heterogeneity across codes and clinical contexts indicate that ICD-10 codes alone should be used cautiously when defining GIB outcomes. Local validation remains essential to ensure reliable bleeding identification in anticoagulated populations.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"1584-1590"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13496968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147960067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Complement Factor H as a Novel Predictive Biomarker for Deep Vein Thrombosis Recurrence: A Prospective Cohort Study. 补体因子H作为深静脉血栓复发的新型预测生物标志物:一项前瞻性队列研究。
IF 2.1 3区 医学
Journal of Thrombosis and Thrombolysis Pub Date : 2026-08-01 Epub Date: 2026-04-17 DOI: 10.1007/s11239-026-03279-3
Qian Yi, Fei Wang, Mingyi Zhang, Xue Chen, Yueqin Liu, Mingdong Wu, Wu Yu, Yikuan Chen, Xiaoqing Bu
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引用次数: 0
Combined circuit-directed (pre-oxygenator) nafamostat and low-dose systemic unfractionated heparin anticoagulation in ecmo patients with high bleeding risk: A case series and safety evaluation. 电路导向(预充氧器)纳莫他与低剂量全身无分级肝素联合抗凝治疗ecmo高危出血患者:病例系列和安全性评价
IF 2.1 3区 医学
Journal of Thrombosis and Thrombolysis Pub Date : 2026-08-01 Epub Date: 2026-04-29 DOI: 10.1007/s11239-026-03293-5
Yunjiu Hu, Shihui Lin, Mu Zhang, Lin Ye, Zhijiao Zhang, Jing Fan, Fang Xu
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引用次数: 0
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