Journal of Thrombosis and Thrombolysis最新文献

{"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":"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":"538-546"},"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":"Predictors of venous thromboembolic events in hospitalized patients with COVID-19.","authors":"Giovanni Scimeca, Darsiya Krishnathasan, Sina Rashedi, Zhou Lan, Alyssa Sato, Nada Hamade, Antoine Bejjani, Candrika D Khairani, Julia Davies, Nicole Porio, Ali A Assi, Andre Armero, Anthony Tristani, Marcos D Ortiz-Rios, Victor Nauffal, Zaid Almarzooq, Eric Wei, Valeria Zuluaga-Sánchez, Mehrdad Zarghami, Aditya Achanta, Sirus J Jesudasen, Bruce Tiu, Geno J Merli, Orly Leiva, John Fanikos, Aditya Sharma, Samantha Rizzo, Mariana B Pfeferman, Ruth B Morrison, Alec Vishnevsky, Judith Hsia, Mark R Nehler, James Welker, Marc P Bonaca, Brett Carroll, Samuel Z Goldhaber, Umberto Campia, Behnood Bikdeli, Gregory Piazza","doi":"10.1007/s11239-025-03078-2","DOIUrl":"10.1007/s11239-025-03078-2","url":null,"abstract":"<p><p>COVID-19 is associated with an increased risk of venous thromboembolism (VTE) in hospitalized patients. Although prior studies have attempted to identify predictors of VTE, restricted sample size and use of administrative claims data have limited such analyses. We utilized data from hospitalized patients in the CORONA-VTE Network, a United States multicenter registry of adult patients with PCR-confirmed COVID-19 (N = 3,844). The primary outcome was time-to-first event for a composite of adjudicated pulmonary embolism or deep vein thrombosis during 90-day follow-up. The candidate variables were selected by a priori clinical consensus. We conducted cause-specific Cox regression analysis adjusted for the selected variables for each imputed dataset and pooled the estimated HRs for reporting (p < 0.05 for significance). VTE occurred in 206 patients, with a cumulative incidence of 5.3% at 90 days. The covariates associated with increased risk of VTE were history of VTE (HR: 1.71; 95% CI: 1.11-2.63), corticosteroid therapy (HR: 1.76; 95% CI: 1.32-2.33) and known thrombophilia (HR: 3.56; 95% CI: 1.54-8.21) while therapeutic anticoagulation at baseline (HR: 0.42; 95% CI: 0.26-0.69), antecedent use of statins (HR: 0.67; 95% CI: 0.50-0.90), and prophylactic anticoagulation during hospitalization (HR: 0.52; 95% CI: 0.38-0.71) were associated with reduced risk of VTE. While prior VTE, corticosteroid therapy, and known thrombophilia were associated with an increased risk of VTE, prescriptions of prophylactic and therapeutic anticoagulation, and statins were associated with a decreased risk. Once externally validated, these findings may inform risk assessment in hospitalized patients with COVID-19.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"485-496"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597317","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":"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":"497-502"},"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":"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":"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":"585-589"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043746/pdf/","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":"OA","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":"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":"526-537"},"PeriodicalIF":2.2,"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}

{"title":"Immune checkpoint inhibitors and myocardial infarction.","authors":"Vencel Juhasz, Giselle Alexandra Suero-Abreu, Tomas G Neilan","doi":"10.1007/s11239-025-03081-7","DOIUrl":"https://doi.org/10.1007/s11239-025-03081-7","url":null,"abstract":"<p><p>Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy since their first approval in 2011. By unleashing the adaptive immune system, non-cardiac and cardiac immune-related adverse events (irAEs) are common and often pose a challenge to multidisciplinary teams treating cancer patients. A significant body of literature reports accelerated atherosclerosis - a key precursor of acute vascular events (AVEs) - with currently approved ICIs (CTLA-4, PD-1, LAG-3, and PD-L1 inhibitors), and some preclinical research also suggests increased thrombogenicity. A large meta-analysis has reported an increased incidence of AVEs, including myocardial infarction (MI) and stroke with ICIs. In addition, dyslipidemia secondary to ICI use may lead to an increase in cardiovascular (CV) events in long-term cancer survivors. Currently, there are no specific guidelines for the treatment of MI or CV risk in cancer patients with ICIs. Overall survival (≥ 6 months), thrombogenic, and bleeding risk are key determinants in choosing the appropriate acute approach and antithrombotic therapy, while other principles of MI management do not differ between cancer and non-cancer patients. Future avenues of research include lipid-lowering therapies, including PCSK9 inhibitors and statins, which may offer dual beneficial effects by improving anti-cancer efficacy and reducing CV risk. In addition, newer immune checkpoint targets may provide atheroprotection while being effective against certain cancers (e.g., CD47). Given the tremendous potential of ICIs, intensive research is warranted to reduce CV risk and the incidence of AVE, including MI, in active cancer patients and survivors.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597311","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":"Assessment of anticoagulant safety and coagulation analysis in mice using the VETSCAN^® VSpro analyzer.","authors":"Huda Moutaz Asmael Al-Azzawi, Rita Paolini, Michael McCullough, Lorraine O' Reilly, Syed Ameer Hamza, Sara Hadjigol, Tami Yap, Antonio Celentano","doi":"10.1007/s11239-024-03066-y","DOIUrl":"10.1007/s11239-024-03066-y","url":null,"abstract":"<p><p>Animal models of thrombosis play a critical role in research, helping us understand the mechanisms of hemostasis and thrombus formation, as well as in the screening of anti-thrombotic drugs. This study aimed to evaluate the safety profile of two anticoagulants in murine research and to assess coagulation parameters, including prothrombin time (PT) and activated partial thromboplastin time (aPTT), using the VETSCAN^® VSpro coagulation analyzer in wild-type (C57BL/6) mice following administration of anticoagulants. Two experiments were conducted involving a total of sixty wild-type mice that received two common anticoagulants. Warfarin was administered in the drinking water at varying dosages, while dabigatran was incorporated into a custom-chow diet at two dosages (10 mg/g and 15 mg/g chow). The VSpro was used to establish a reference range for PT and aPTT values in untreated wild-type mice and to monitor coagulation changes in mice undergoing anticoagulant therapy. Dabigatran was well tolerated at both concentrations (10 mg/g and 15 mg/g chow), while warfarin was safe at a concentration of 2.5 mg/L, resulting in a doubling of PT and aPTT compared to baseline levels. Although the VSpro effectively detected coagulation abnormalities in murine models, certain limitations were observed, including out-of-range measurements in cases of coagulopathy. This study provides insights into safe anticoagulant dosages for murine models, supporting the use of dabigatran at 10 mg/g and 15 mg/g chow and warfarin at 2.5 mg/L. The VSpro analyzer was able to monitor coagulation parameters under these conditions, making it a feasible tool for murine research.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"427-432"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864766","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":"Hydrogen sulphide alleviates platelet dysfunction in patients with type 2 diabetes.","authors":"Minqi Zhou, Difei Lu, Anna Jiang, Chenxu Zhao, Yao Lu, Bo Zheng, Linzi Miao, Youyuan Huang, Chenxue Qu, Ying Gao","doi":"10.1007/s11239-025-03071-9","DOIUrl":"10.1007/s11239-025-03071-9","url":null,"abstract":"<p><p>Hyperglycaemia stimulate platelet activation by reducing platelet H₂S concentrations, potentially leading to cardiovascular events. Exogenous supplementation with H₂S reversed this abnormal platelet activation under hyperglycaemia.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"433-442"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370801","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 therapy for venous thromboembolism using adjusted body weight in elderly or higher weight patients.","authors":"Arielle J Hopkins, Terence Chau, Benjamin Pullinger, Sungwook Kim, Justin J Delic, Lauren A Igneri, Soyoung Kim","doi":"10.1007/s11239-024-03060-4","DOIUrl":"10.1007/s11239-024-03060-4","url":null,"abstract":"<p><p>The use of weight-based unfractionated heparin (UFH) infusions is the standard of care in hospital management of venous thromboembolism (VTE). Initial dosing strategies for UFH in older adults and higher body weight patients remain uncertain given differences in pharmacokinetics and concerns for over-anticoagulation. Methods: This was a single-center, retrospective, pre-post study involving older adults aged ≥ 65 years and patients weighing ≥ 100 kg with suspected or confirmed VTE to determine if the use of adjusted body weight (AdjBW)-based UFH regimens improves time to therapeutic anti-Xa levels compared to total body weight (TBW)-based regimens Patients received weight-based UFH infusions, dosed according to either TBW or AdjBW, to target a therapeutic anti-Xa level. Each cohort consisted of 40 patients, stratified by whether they met age or weight criteria to ensure equal representation of elderly and higher body weight patients between cohorts. The median time to therapeutic anti-Xa levels was shorter in the AdjBW group compared to the TBW group (13.6 h versus 20.9 h; point estimate 5.3 h (95% CI 0.2 to 9.9)). This finding was driven by those aged ≥ 65 years and those who received a bolus dose at the start of the infusion. Among older adults and higher weight adults with suspected or confirmed VTE, the use of AdjBW to guide heparin infusion initiation was associated with shorter time to therapeutic anti-Xa levels. This finding driven by the older adult sample and the subgroup analyses did not find a statistically significant difference in time to therapeutic anti-Xa levels in higher body weight patients aged less than 65 years.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"420-426"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12009232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780476","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}