Journal of Thrombosis and Thrombolysis最新文献

{"title":"Early catheter-related thrombosis in oncology patients with central venous access devices: a narrative review of incidence, mechanisms and clinical implications.","authors":"J Kania, J Zawadzki, B Kudliński, W Ziółkowska","doi":"10.1007/s11239-026-03338-9","DOIUrl":"10.1007/s11239-026-03338-9","url":null,"abstract":"<p><p>Central venous access devices (CVADs) are widely used in oncology patients to facilitate administration of chemotherapy and supportive treatments. However, catheter-related thrombosis (CRT) remains one of the most important complications associated with their use. Although overall CRT incidence has been extensively studied, early CRT occurring shortly after catheter implantation remains insufficiently characterized. A narrative review of the literature was performed focusing on studies evaluating CRT in oncology patients with central venous access devices. Relevant studies were identified through searches of the PubMed database and reference lists of selected articles. A total of thirteen studies published between 2005 and 2025 were included in this review. The studies consisted of randomized controlled trials, observational studies, non-randomized studies and retrospective cohort studies, with sample sizes ranging from 48 to 1331 participants. Most studies focused on peripherally inserted central catheters (PICCs), while fewer evaluated centrally inserted central catheters (CICC) or implantable ports. Reported CRT incidence varied widely depending on catheter type, ranging from 3.3% to 61.3% for PICCs, 6.5% to 49% for CICCs and 1% to 7.1% for implantable ports. Early CRT (defined as ≤ 7 days after catheter implantation) was rarely evaluated and was reported in only three studies, with incidence ranging from 2.4% to 48.39%. Across studies assessing thromboprophylaxis, overall CRT incidence ranged from 3.1% to 16.1% in control groups and from 0.4% to 14.1% in intervention groups. CRT remains a clinically relevant complication in oncology patients requiring central venous access. Available evidence suggests substantial variability in thrombosis incidence across catheter types, with generally higher rates observed in PICCs compared with implantable ports. Data on early CRT remain limited and heterogeneous, underscoring the need for prospective studies specifically addressing early thrombotic events following catheter implantation. Improved risk stratification and standardized approaches to prevention and management may enhance clinical outcomes.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"1804-1816"},"PeriodicalIF":2.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13654892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148157115","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":"Autologous whole blood clot formation with actigraft in patients receiving oral anticoagulant therapy: an ex vivo feasibility study.","authors":"Barry Frank Jacobson, Elise Schapkaitz, Melanie Mc Cree","doi":"10.1007/s11239-026-03321-4","DOIUrl":"10.1007/s11239-026-03321-4","url":null,"abstract":"<p><p>The clotting characteristics of autologous whole blood clots for chronic wound management in patients on anticoagulant therapy are not well defined. An exploratory ex vivo study was performed using the ActiGraft autologous whole blood clot (RedDress Ltd, Haifa, Israel) in patients receiving oral anticoagulant therapy. Twenty-five participants were eligible for inclusion and stratified into three age-matched cohorts: vitamin K antagonist-warfarin (n = 9), factor Xa inhibitor- rivaroxaban (n = 6), and controls not receiving anticoagulation (n = 10). The primary endpoint was clot formation time. Clot formation time was defined as the time point at which no fluid movement was observed. In the study population (median [interquartile range] age 47 [42-52] years), the mean clot formation time was 10.5 ± 2.6 min (reference:8-12 min). Mean clot formation time was significantly different across groups (p < 0.001). Compared with controls (8.4 ± 1.2 min), clot formation time was significantly prolonged in both the warfarin group (11.3 ± 2.3 min; p < 0.002) and the rivaroxaban group (12.7 ± 2.4 min; p < 0.001), with no significant difference between anticoagulant groups (p = 0.297). Nonetheless, complete, stable clots were consistently formed within the expected time frame in all samples across all groups. This illustrates the feasibility of ActiGraft autologous whole blood clot in patients receiving therapeutic anticoagulation. Further studies are indicated in patients with chronic wounds to assess broader safety and efficacy.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"1960-1966"},"PeriodicalIF":2.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13654871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148005778","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":"Comparative effectiveness of figure-of-eight suture and manual compression for femoral venous hemostasis after atrial fibrillation ablation: A grade assessed meta-analysis.","authors":"Zaryab Bacha, Javeria Javed, Muhammad Hamad Khan, Hammad Saif, Munazza Sikandar, Fatima Sajjad, Mansoor Khalid, Muhammad Abbas, Muhammad Mustafa Khan, Mahnoor Qasim, Ayesha Mansoor, Ahmad Yadk, Indresh Yadav, Muhammad Usman Haider, Islam Aboumoussa","doi":"10.1007/s11239-026-03347-8","DOIUrl":"10.1007/s11239-026-03347-8","url":null,"abstract":"<p><p>Atrial fibrillation is a common cardiac arrhythmia associated with serious complications such as stroke, heart failure, and mortality. Catheter ablation is frequently used for drug-resistant cases but requires femoral venous access and anticoagulation, increasing the risk of vascular complications. Manual compression is the standard method for post-ablation hemostasis, though it can be time-consuming and uncomfortable, whereas figure-of-eight sutures have emerged as a potential alternative. To compare safety and procedural outcomes of figure-of-eight sutures versus manual compression for venous hemostasis after ablation. A systematic literature search was conducted across Cochrane Library, PubMed/MEDLINE, Scopus, and Embase up to February 2026 to identify studies comparing figure-of-eight (Fo8) sutures with manual compression for post-ablation femoral venous hemostasis. Randomized controlled trials and observational cohort studies were included. Data extraction and quality assessment were performed independently by two reviewers, with discrepancies resolved by a third reviewer. Statistical analyses and meta-analyses were performed using RevMan software version 5.4. Nine studies with a total of 2,125 patients were analyzed. Figure-of-Eight (Fo8) suturing demonstrated no significant difference compared with manual compression for total, major, or minor vascular access site complications, bleeding, or hematoma. However, FO8 suturing was associated with significantly shorter time to hemostasis, earlier ambulation, and reduced time to discharge. Figure-of-eight suturing is as safe as manual compression for post-ablation femoral venous hemostasis, showing no increase in vascular access-site complications, bleeding, or hematoma. It provides the added benefit of faster hemostasis, earlier ambulation, and reduced discharge time.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"2029-2044"},"PeriodicalIF":2.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148361260","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":"Patient-centred anti-platelet therapy following coronary artery bypass graft surgery.","authors":"Eleonora De Laurentis, Nikhil Sahdev, Marjan Jahangiri","doi":"10.1007/s11239-026-03331-2","DOIUrl":"10.1007/s11239-026-03331-2","url":null,"abstract":"<p><p>While lifelong aspirin mono-therapy remains the standard of care following coronary artery bypass graft surgery (CABG), the optimal antiplatelet strategy remains a subject of ongoing debate. The evidence argues against a 'one-size-fits-all' strategy and supports a patient-centred approach. Antiplatelet treatment decisions should incorporate bleeding risk which is often multifactorial and necessitates careful individualised evaluation based on patient characteristics and procedural factors. Conduit selection should also be considered as graft failure following CABG remains an important problem and varies according to conduit type, highlighting the critical role of antiplatelet therapy. Saphenous vein grafts are particularly susceptible to early thrombosis and late atherosclerotic degeneration, making optimisation of antiplatelet therapy especially relevant for preserving vein graft patency, whereas its impact on arterial grafts is less well defined. Current guideline recommendations are largely extrapolated from studies involving patients with acute or chronic coronary syndromes treated with percutaneous intervention or medical therapy. Clinical presentation is also a key determinant of antiplatelet strategy. Although current guidelines support resumption of dual antiplatelet therapy (DAPT) after CABG in patients with acute coronary syndromes (ACS), these recommendations are largely inherited from CABG subgroups of broader ACS trials rather than dedicated CABG randomised studies, and recent CABG-specific evidence has challenged the routine use of ticagrelor-based DAPT in this setting. DAPT in chronic coronary syndromes may be considered only in selected patients at low bleeding risk. Although, observational and randomised data suggest that DAPT can improve vein graft patency, but this has not consistently translated into short-term clinical benefit and is offset by increased bleeding risk. In fact, emerging evidence suggests shorter or de-escalated DAPT strategies may offer a more favourable balance between graft protection and bleeding.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"1728-1738"},"PeriodicalIF":2.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13654880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148055265","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":"Thromboinflammatory biomarkers and thrombotic risk in virologic failure and drug-resistant HIV: Emerging roles of d-dimer, fibrinogen, and coagulation dysregulation.","authors":"Emmanuel Ifeanyi Obeagu, Michael Ben Okon","doi":"10.1007/s11239-026-03343-y","DOIUrl":"10.1007/s11239-026-03343-y","url":null,"abstract":"<p><p>HIV infection that is highly resistant is marked by ongoing viral replication, long-lasting immune activation, endothelial activation, and a prothrombotic condition with heightened risk of thromboembolic complications. Elevated D-dimer and fibrinogen remain important indicators of fibrin formation, degradation, inflammation, and coagulation activation in this group. However, contemporary interpretation of these markers should also consider von Willebrand factor (VWF), tissue factor activity, and thrombin generation as mechanistic links between endothelial perturbation and intravascular clot formation. The molecular mechanisms behind these increases entail prolonged endothelial damage, release of VWF from Weibel-Palade bodies, heightened levels of pro-inflammatory cytokines such as IL-6, augmented tissue factor expression on monocytes and endothelial cells, and downstream thrombin generation that converts fibrinogen to fibrin. Simultaneously, fibrinolysis produces D-dimer fragments, acting as sensitive indicators of ongoing thrombogenesis. In individuals with drug-resistant HIV or virologic failure, these mechanisms are heightened, associating biomarker increases with greater risks of venous thromboembolism, cardiovascular events, stroke, and death. Assessing D-dimer and fibrinogen concentrations alongside endothelial and thrombin-generation biomarkers may provide valuable diagnostic and prognostic insight, facilitating early detection of patients with heightened thrombotic risk and guiding prompt clinical actions. Nevertheless, standardized guidelines for biomarker application in HIV-resistant populations remain limited, emphasizing the necessity for additional studies to confirm thresholds, elucidate mechanisms, and enhance management strategies to minimize morbidity and mortality linked to thrombotic complications.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"2007-2028"},"PeriodicalIF":2.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148277781","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":"Bleeding history is associated with lower risk of cardiovascular events in a cohort undergoing lower extremity revascularization.","authors":"David J Bresnahan, Yuhe Xia, Nathaniel R Smilowitz, Elliot Luttrell-Williams, Lila Murphy, Tessa J Barrett, Caron B Rockman, Jeffrey S Berger","doi":"10.1007/s11239-026-03311-6","DOIUrl":"10.1007/s11239-026-03311-6","url":null,"abstract":"<p><p>Patients with peripheral artery disease undergoing lower extremity revascularization remain at high risk for cardiovascular events despite intervention. This retrospective analysis of 289 participants examined the relationship between pre-procedural bleeding history and post-procedural outcomes using a modified International Society on Thrombosis and Haemostasis bleeding assessment tool. After median 18-month follow-up, participants with significant bleeding history experienced lower risk of major adverse cardiovascular events (18.4% versus 30.6%, p = 0.034) and mortality (13.6% versus 24.2%, p = 0.047). An inverse exposure-outcome relationship was observed between bleeding severity and outcomes. Bleeding history may identify patients at lower risk for thrombotic complications.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"1967-1971"},"PeriodicalIF":2.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148055275","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":"Association between cerebrospinal fluid metabolites and ischemic stroke: a Mendelian randomization analysis.","authors":"Zhen Wei, Chunshu Rong, Qiyi Ta, Xu Wang, Dexi Zhao","doi":"10.1007/s11239-026-03324-1","DOIUrl":"10.1007/s11239-026-03324-1","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Ischemic stroke (IS) is one of the leading causes of disability and mortality worldwide. Cerebrospinal fluid (CSF) metabolites can reflect the pathophysiological state of the central nervous system, but their causal relationship with IS remains unclear. This study aims to assess the causal association between CSF metabolites and IS prognosis using Mendelian randomization (MR) methodology. A two-sample MR design was employed, with genetic data on CSF metabolites sourced from the WADRC and WRAP cohorts (a total of 338 metabolites in a European ancestry population), and IS prognosis outcome data obtained from the GISCOME network (6021 IS patients). Single nucleotide polymorphisms (SNPs) significantly associated at P &lt; 5 × 10&lt;sup&gt;-6&lt;/sup&gt; were selected as instrumental variables, while those in linkage disequilibrium (r&lt;sup&gt;2&lt;/sup&gt; &lt; 0.001) and weak instruments (F &lt; 10) were excluded. Causal estimates were primarily obtained using the inverse variance weighted (IVW) method, with sensitivity analyses conducted using Cochran's Q test, MR-Egger regression, MR-PRESSO, and leave-one-out analysis. Additionally, metabolomic validation was performed using the MetaboLights database (MTBLS6279), ROC curve analysis was conducted to evaluate predictive performance, and KEGG enrichment analysis was undertaken to explore potential mechanisms. The IVW analysis identified 23 CSF metabolites that have a significant causal association with the prognosis of IS. Among these, 18 are protective metabolites (such as sphingolipids, glucuronic acid, N-acetylserotonin, 2'-deoxyuridine, S-adenosylmethionine, cyclic adenosine monophosphate, guanosine, etc.), while 5 are risk metabolites (cholesterol, phenylalanine, erythritol, glutamine, and methionine). Metabolomics validation revealed that 2'-deoxyuridine, S-adenosylmethionine, cyclic adenosine monophosphate, guanosine, and methionine overlapped with the MR results. The ROC curve indicated that deoxyuridine has a high discriminative power (AUC = 0.944, 95% CI: 0.75-1). Sensitivity analysis showed no detected heterogeneity and pleiotropy, and the leave-one-out analysis supported the robustness of the results. KEGG enrichment analysis suggested that the relevant metabolites may be involved in pathways such as autophagy, AMPK signaling, and vascular smooth muscle contraction. This study is the first to systematically evaluate the causal relationship between CSF metabolites and the prognosis of IS, revealing that 23 metabolites may be involved in the occurrence and development of IS. Among these, risk metabolites such as low-density lipoprotein-related cholesterol and phenylalanine are consistent with the mechanisms of atherosclerosis and neuroinflammation. Deoxyuridine, a key intermediate in DNA synthesis and repair, may influence the progression of IS by regulating nucleotide homeostasis and oxidative stress. The MR design effectively avoids confounding and reverse causation bias, while external metabolomics validation and","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"1898-1909"},"PeriodicalIF":2.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148032003","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":"Association between JAK2 mutations and thoracic aortic aneurysms in myeloproliferative neoplasms.","authors":"Mohamad Wajeh Dulli, Ashraf Ahmed, Mohammad Altermanini, Rasha Kaddoura, Abdulrahman F Al-Mashdali, Mohammed Abdulgayoom, Yahia Imam, Shehab F Mohamed","doi":"10.1007/s11239-026-03280-w","DOIUrl":"10.1007/s11239-026-03280-w","url":null,"abstract":"<p><p>The Janus kinase 2 (JAK2) V617F mutation is recognized as a defining molecular lesion in Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs). This mutation was recognized in the context of clonal hematopoiesis of indeterminate potential, which has recently been linked with cardiovascular disease. Recent evidence has demonstrated a significant correlation between JAK2 mutations and thoracic aortic aneurysm (TAA) a condition frequently lacking identifiable risk factors. A scoping review, involving MEDLINE, Embase, Web of Science, Google Scholar, and prominent hematology and cardiology conference abstracts (from inception to August 2025) was performed. All studies that indicate a correlation between JAK2 mutations and aortic aneurysms were included. Seven studies with a total of 446,839 participants were found. Among these, 745 (0.17%) tested positive for JAK2. Data consistently indicated an elevated risk of thoracic aortic aneurysm (TAA), but not abdominal aortic aneurysm, in individuals with JAK2 mutations. Proposed mechanisms include inflammatory cytokine signaling, macrophage activation, and degradation of the extracellular matrix. Emerging clinical data indicate a consistent association between JAK2 V617F-mutated clonal hematopoiesis or myeloproliferative neoplasms and thoracic aortic aneurysm, with less consistent findings for abdominal aneurysm. Although experimental studies suggest that JAK2-driven inflammatory signaling and extracellular matrix remodeling may contribute to vascular wall injury, these mechanisms remain largely inferential and do not establish causality. Well-designed prospective investigations incorporating standardized imaging, uniform aneurysm definitions, and stratification by clonal burden and disease context will be necessary to better define risk and determine whether JAK2-associated clonal hematopoiesis has implications for vascular surveillance or prevention strategies.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"1835-1841"},"PeriodicalIF":2.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13654883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147973488","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":"Direct oral anticoagulants versus vitamin K antagonists for atrial fibrillation patients on dialysis: A systematic review and meta-analysis of randomized controlled trials and real-world evidence.","authors":"Omar Shaheen, Mohamed Hamdy, Ibrahem Attiya Afifi, Abdelrahman Ahmed Hassan, Omar Kassar, Ahmed Ismail, Samer Sameh Bedwany, Badria Atef Ebrahim Elhalawany, Rehab Adel Diab","doi":"10.1007/s11239-026-03322-3","DOIUrl":"10.1007/s11239-026-03322-3","url":null,"abstract":"<p><p>Atrial fibrillation (AF) is the most common arrhythmia in end-stage renal disease (ESRD) patients on dialysis. These patients face high risks of both thromboembolism and bleeding. Pivotal randomized controlled trials (RCTs) of direct oral anticoagulants (DOACs) excluded these patients, leaving the optimal anticoagulant choice uncertain. We conducted a systematic review and meta-analysis investigating the efficacy and safety of DOACs versus VKAs in AF patients undergoing dialysis. We searched PubMed, Scopus, Web of Science, and Cochrane Library for RCTs and observational studies. Primary outcomes were ischemic stroke, major bleeding, and all-cause mortality. Secondary outcomes included ischemic stroke or systemic embolism, other bleeding events, hemorrhagic stroke, myocardial infarction, and cardiovascular mortality. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. Four RCTs and nine observational studies were included in this study, encompassing 31,238 patients. DOACs were associated with significantly lower risk of major bleeding (RR: 0.68, 95% CI [0.49-0.95], I² = 89.0%), gastrointestinal bleeding (RR: 0.74, 95% CI [0.61-0.90], I² = 37.1%), and hemorrhagic stroke (RR: 0.23, 95% CI [0.07-0.78], I² = 1.5%) compared to VKAs. Both groups showed similar risk of ischemic stroke (RR: 0.59, 95% CI [0.32-1.09], I² = 40.8%), all-cause mortality (RR: 0.85, 95% CI [0.68-1.07], I² = 73.2%). Other secondary outcomes also showed no significant differences. In AF patients with ESRD receiving dialysis, DOACs provide similar efficacy and lower bleeding risk compared to VKAs. Among DOACs, apixaban appears to offer the greatest net clinical benefit in this population.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"1760-1776"},"PeriodicalIF":2.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148005714","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":"Advancing cancer therapeutics: new perspectives on mechanisms, regulatory and policy challenges, and innovative multi-modality strategies for the early detection of cardiotoxicity.","authors":"Richard C Becker","doi":"10.1007/s11239-026-03282-8","DOIUrl":"10.1007/s11239-026-03282-8","url":null,"abstract":"<p><p>Recent advances in cancer therapeutics, particularly targeted agents and tissue agnostic immunotherapies, have transformed care while introducing new challenges in cardiovascular safety. Although clinical guidelines have evolved, regulatory processes critical to ensuring safe innovation remain under-leveraged and often disconnected from real-world implementation. This gap is especially concerning amid federal downsizing, which has led to significant staff reductions at the United States Food and Drug Administration (FDA) and other health agencies. To meet growing needs in patient safety and therapeutic oversight, a new paradigm is emerging-one that is collaborative, adaptive, and inclusive of all stakeholders. Drug manufacturers, oncologists, cardiologists, clinical trialists, regulators, and technology developers must integrate around shared goals. Cardiovascular endpoints should be integrated into pre-new drug application (NDA) studies, with trial designs that include at-risk populations and robust cardiac monitoring. Early detection tools and mitigation strategies should be co-developed when feasible alongside therapeutics and considered part of the approval process.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"1817-1824"},"PeriodicalIF":2.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13654902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148218202","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}