Journal of Thrombosis and Thrombolysis最新文献

{"title":"Systematic review of venous thromboembolism (VTE) occurrence in hospitalized patients receiving prophylactic unfractionated heparin twice vs. three times daily.","authors":"Stephanie H Flint, Ashley E Woodruff, Molly K Maloney, Maya R Chilbert","doi":"10.1007/s11239-025-03137-8","DOIUrl":"https://doi.org/10.1007/s11239-025-03137-8","url":null,"abstract":"<p><p>Guidelines recommend 5000U subcutaneous unfractionated heparin (UFH) for venous thromboembolism (VTE) prophylaxis in acutely ill hospitalized adults, but data comparing dosing frequencies is limited. This systematic review aimed to compare VTE and bleeding outcomes between twice daily (BID) and three times daily (TID) UFH regimens. A literature search was completed on 3/7/2024. The primary outcome was VTE occurrence (deep vein thrombosis (DVT) or pulmonary embolism (PE)). Secondary outcomes included bleeding events. Studies reporting any relevant outcomes were included, while non-human studies, reviews, non-English texts, and high VTE risk populations were excluded. Risk of bias was assessed using the Cochrane Risk-of-Bias or Newcastle-Ottawa Quality Assessment Form. Data were synthesized using Covidence and Excel. After screening, 24 studies were included: 9 observational and 15 randomized studies. Regimens with TID UFH had a 3.1% VTE occurrence (12 studies, n = 145/4653) compared to 4.0% with BID regimens (9 studies, n = 218/5426). Three times daily regimens demonstrated 4.8% DVTs (11 studies, n = 244/5102) and 0.4% PEs (11 studies, n = 24/5372), compared to 9.7% DVTs (11 studies, n = 199/2062) and 0.9% PEs (9 studies, n = 17/1974) with BID regimens. Bleeding events occurred in 3.2% of patients with BID (9 studies, n = 196/6080) and 4.3% with TID regimens (13 studies, n = 393/9044). Three times daily UFH regimens led to fewer VTE, DVT, and PE events but more bleeding compared to BID. Newer data suggests BID dosing may be more appropriate for general medical populations. Limitations include variability in data quality and publication dates. Registered with PROSPERO. No funding was received.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497456","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":"Effect of thrombus composition on first pass recanalization and bleeding in acute ischemic stroke patients : Association between thrombus composition and first-pass effect.","authors":"Behiç Akyüz, Ezgi Işıl Turhan, Furkan Ertürk Urfalı, Süleyman Bekirçavuşoğlu, Fatih Hakan Tufanoğlu, Cemile Haki, Mustafa İşleyen, Kaya Saraç","doi":"10.1007/s11239-025-03133-y","DOIUrl":"10.1007/s11239-025-03133-y","url":null,"abstract":"<p><p>In acute ischemic stroke, the first-pass effect, the occurrence of complete reperfusion after a single pass during endovascular therapy (EVT), is linked to favorable clinical outcomes. This study aimed to investigate the association between thrombus composition and first-pass recanalization (FPR), as well as symptomatic intracranial hemorrhage (sICH), in AIS patients undergoing mechanical thrombectomy (MT). We retrospectively analyzed thrombi retrieved from 172 patients treated with MT. Clots were classified as RBC-rich or platelet-rich. FPR was defined as a modified Thrombolysis in Cerebral Infarction (mTICI) score of 2b or 3 after a single device pass. Associations with FPR and hemorrhagic outcomes were assessed. A total of 172 patients (91 women, 81 men; mean age 71 years) who were treated with mechanical thrombectomy were included in the study. First-pass recanalization (FPR) was achieved in 55.2% of the patients (95/172). There was no statistically significant relationship between clot composition and FPR (p = 0.991). The rate of intracranial hemorrhage (ICH) was 15.8% in the RBC-dominant group and 1.7% in the fibrin/platelet-dominant group. A statistically significant association was found between clot composition and ICH (p = 0.005), whereas no significant relationship was observed between clot composition and symptomatic intracranial hemorrhage (sICH) (p = 0.975). Successful FPR was associated with a lower rate of sICH (p = 0.003). The percentage of RBCs in clot composition was positively correlated with the presence of the dense artery sign. Gender was not significantly associated with clot composition (p = 0.455), and neither gender nor age showed a significant relationship with FPR (p = 0.316 and p = 0.470, respectively). These findings indicate that while clot composition does not significantly affect the success of FPR, it is significantly associated with the risk of intracranial hemorrhage. This underscores the potential clinical relevance of clot histology in predicting post-thrombectomy outcomes, beyond the well-established importance of FPR itself. Future studies with larger and more diverse patient cohorts are warranted to further elucidate these associations and optimize treatment strategies.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144368941","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":"Safety and efficacy of routine anticoagulation after primary PCI in STEMI: a systematic review and meta-analysis.","authors":"Anika Chowdhury, Dhruvkumar Arvindbhai Vasoya, Mahfuja Jahan Ima, Srija Reddy Koppula, Ashesh Das, Kiran Kumar Dhivakaran, Muhammad Muneeb Khawar, Aadya Mishra, Muhammad Safiullah, Saman Siddique, Deng Siang Lee, Muhammad Hamza, Hemeesh Tandel, Aniket Chatterjee","doi":"10.1007/s11239-025-03130-1","DOIUrl":"10.1007/s11239-025-03130-1","url":null,"abstract":"<p><p>Percutaneous Coronary Intervention (PCI) is a widely used minimally invasive procedure that restores blood flow to the coronary artery, improving survival in STEMI patients. Despite its widespread application in clinical settings, the necessity and efficacy of postprocedural anticoagulation (PPAC) remain contentious. Our study aims to assess the outcomes of PPAC in STEMI patients who have undergone PCI. A comprehensive search of Embase, PubMed, and Clinicaltrials was conducted to identify randomized controlled trials (RCTs) comparing the clinical outcomes between PPAC and control (placebo or no PPAC) for STEMI after primary PCI. Statistical analyses were performed using RevMan version 5.4.1, employing a random-effects model to calculate odds ratios (ORs) and their 95% confidence intervals (CIs). Risk of Bias Assessment of the articles was assessed using RoB 2.0 software by the Cochrane Collaboration. A total of 5 RCTs comprising 13,586 patients were included, of which 6,829 patients (50.26%) received PPAC. Compared to the non-PPAC group, PPAC did not significantly reduce all-cause mortality (OR 1.08; 95% CI 0.84-1.39; P = 0.54, I² = 0%), cardiovascular mortality (OR 1.08; 95% CI 0.83-1.39; P = 0.57, I² = 0%), and MACE (major adverse cardiovascular events) (OR 1.13; 95% CI 0.92-1.37; P = 0.25, I² = 22%). Additionally, the odds of stent thrombosis (OR 1.07; 95% CI 0.77-1.47; P = 0.69, I² = 0%) and stroke (OR 1.50; 95% CI 0.49-4.57; P = 0.48, I² = 58%) did not differ significantly between the groups. However, PPAC was associated with higher odds of bleeding (OR 1.78; 95% CI 1.07-2.97; P = 0.03, I² = 94%). This meta-analysis reveals no significant differences in the odds of all-cause mortality, cardiovascular mortality, stent thrombosis, and stroke between PPAC and control following PCI for the management of STEMI. However, PPAC was associated with higher odds of bleeding. Further randomized controlled trials are warranted to corroborate these findings.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144368957","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":"Potential association of TGFβ1 plasma levels and fibrinolysis parameters with the risk of recurrence and vascular obstruction after a first unprovoked pulmonary embolism episode.","authors":"Marc Danguy des Déserts, Claire de Moreuil, Jamal Elhasnaoui, Lenaïck Gourhant, Virginie Gourdou-Latyszenok, Benjamin Espinasse, Juliette Menguy, Cécile Tromeur, Rozenn Le Corre, Raphael Le Mao, Daniel Kraemmer, Olivier Sanchez, Francis Couturaud, Catherine A Lemarié","doi":"10.1007/s11239-025-03113-2","DOIUrl":"10.1007/s11239-025-03113-2","url":null,"abstract":"<p><p>The pathophysiology of residual pulmonary vascular obstruction (RPVO) and recurrent venous thromboembolism (VTE) after unprovoked pulmonary embolism (PE) remains poorly understood. The purpose was to evaluate fibrinolytic and tissue remodeling markers as indicators of RPVO and recurrence after a first unprovoked PE. Analyses were conducted in the 18 to 70-year-old patients included in the PADIS-PE trial, with a pulmonary vascular obstruction (PVO) index ≥ 30% at PE diagnosis. After an initial six-month vitamin K antagonist treatment, patients were randomised to receive placebo or warfarin for 18 months and assessed for the absence or presence of residual pulmonary vascular obstruction (RPVO < or ≥ 5%, respectively). Quantitative assessment of fibrinolytic (D-dimer, tPA, uPA, TFPI) and tissue remodeling (TGFβ1) markers, and a tissue-factor-based turbidimetric clot lysis assay (CLA) were performed one month after warfarin discontinuation. Symptomatic recurrent VTE was monitored for 42 months after randomisation. Among the 371 patients included in PADIS-PE, 23 fulfilled clinico-radiological criteria and had an available blood sample. Six (26%) patients presented RPVO ≥ 5% and symptomatic recurrent VTE occurred in nine (39%) patients. Clot formation and lysis parameters were not associated with RPVO. TGFβ1 plasma levels were higher in patients with RPVO. Clot formation potential measured with CLA was higher in patients with recurrent VTE. No association between recurrent VTE and TGFβ1 was observed. In adult patients with a first unprovoked PE and a PVO index ≥ 30%, TGFβ1 plasma levels were associated with RPVO, whereas clot formation parameters measured with CLA were associated with VTE recurrence.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144368954","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":"Eptifibatide as an adjuvant therapy to thrombolysis versus thrombolysis alone in stroke management: a systematic review and meta-analysis of randomized controlled trials.","authors":"Lucca Tamara Alves Carretta, Ocílio Ribeiro Gonçalves, Luiz Guilherme Silva Almeida, Sandy Souza, Christian Fukunaga, Fernando Baía Bezerra, Luiz Felipe Simões Antunes Nery Dos Santos, Pedro Rodrigues Teixeira, Ítalo Barros Andrade, Fabrício Salazar Fiorio Marques, Yasmin Picanço Silva, Gustavo Noleto","doi":"10.1007/s11239-025-03131-0","DOIUrl":"10.1007/s11239-025-03131-0","url":null,"abstract":"<p><p>Stroke is a leading cause of death and disability. Thrombolysis with recombinant tissue plasminogen activator (rt-PA) is the primary treatment for acute ischemic stroke (AIS), but outcomes remain suboptimal. Eptifibatide, a glycoprotein IIb/IIIa inhibitor, has been explored as an adjunct to enhance reperfusion. This systematic review and meta-analysis assesses its effectiveness and safety compared to rt-PA alone. We searched PubMed, Embase, and Cochrane Library for randomized controlled trials (RCTs). Primary outcomes included 90-day functional independence (modified Rankin Scale, mRS 0-1), mortality, and symptomatic intracranial hemorrhage (sICH). Meta-analyses used random-effects models to calculate Odds Ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was assessed with I². We included 988 patients from four RCTs. Eptifibatide was administered to 566 patients (57.3%). Adjuvant therapy did not significantly improved mRS 0-1 rates at 90 days (OR 1.12, 95% CI 0.60-2.09, p = 0.72, I²=74%) and did not reduce mortality (OR 1.55, 95% CI 0.92-2.61, p = 0.099, I²=0%). sICH was not statistically significantly different between the groups (OR 0.38, 95% CI 0.09-1.65, p = 0.196, I²=56%). Eptifibatide as an adjunct to rt-PA does not significantly impact functional independence, mortality, or sICH risk in AIS. Larger studies are needed to clarify its potential benefits and risks.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144368952","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":"Prediction of thrombotic events in patients with autoimmune hemolytic anemia: a multicenter retrospective observational study.","authors":"Lucie Carneiro Esteves, Lucile Grange, Jean-Baptiste Gaultier, Baptiste Gramont, Emilie Chalayer, Martin Killian","doi":"10.1007/s11239-025-03129-8","DOIUrl":"10.1007/s11239-025-03129-8","url":null,"abstract":"<p><strong>Background: </strong>Autoimmune hemolytic anemia (AIHA) is recognized to increase the risk of thrombotic events (TE), including venous thromboembolism (VTE) and arterial thromboembolism (ATE), but little is known about specific risk factors and characteristics.</p><p><strong>Methods: </strong>This retrospective multicenter observational study, sought to assess TE incidence, identify associated thrombotic risk factors and assess the external validity of the Padua score in AIHA for predicting VTE.</p><p><strong>Results: </strong>TE incidence during the study period was 25% (CI95%: 17-36), consisting of 19 VTE in 16 patients (18% [CI95%: 9-28]) and 11 ATE in 7 (8% [CI95%: 4-16]). A high number (≥ 5) of hemolysis attacks was associated with overall TE (OR 6.9 [CI95%: 1-82], p = 0.03). Univariate analysis confirmed splenectomy and VTE history as the strongest VTE-related risk factors (OR 7.5 [CI95%: 1-44], p = 0.009 and OR 3.8 [CI95%: 1-14], p = 0.04), whereas having primary warm AIHA was identified as a novel risk factor (3.1 [1-11] p = 0.05) which needs to be confirmed in further studies. ATE risk factors were age≥ 80 years at diagnosis (OR 8.9 [CI95%: 1-68] p = 0.02), and having ≥ 3 cardiovascular risk factors (OR 8.9 [CI95%: 1-70] p = 0.01). The area under the Receiver Operating Characteristic curve of the Padua score was 0.66.</p><p><strong>Conclusions: </strong>TE incidence is high in AIHA, especially when there are repeated hemolysis attacks and associated VTE and/or ATE-related risk factors, thus warranting the conduct of prospective clinical trials to allow for an improved TE risk stratification and to design adapted management for both VTE and ATE.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144368955","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":"Proteomics of arterial thrombi in acute limb ischemia.","authors":"Robert D Stegman, Lauren R Schmitt, Kirk C Hansen, Adrianna Kayden, Ahana Ghosh, Ara Metjian, Max V Wohlauer","doi":"10.1007/s11239-025-03123-0","DOIUrl":"10.1007/s11239-025-03123-0","url":null,"abstract":"<p><p>Acute limb ischemia (ALI) is characterized by a sudden decrease in limb perfusion due to arterial occlusion. Without urgent revascularization, patients are at risk of ischemic damage and amputation. This study uses novel proteomic techniques to investigate the molecular architecture of ALI thrombi, identifying key proteins that may influence coagulation dynamics and fibrinolysis resistance. Arterial thromboemboli (n = 12) collected after revascularization procedures were analyzed and compared to in vitro clots (n = 10) generated from healthy donor blood via tissue factor‒induced coagulation. Proteins were identified and quantified via liquid chromatography‒mass spectrometry (LC-MS/MS). A comprehensive literature review of the most abundant proteins allowed for categorization based on their functional roles in fibrinolysis, red blood cell (RBC) degradation, complement activation, and platelet activation. Compared to in vitro clots, ALI clots contained 141 proteins with significantly increased abundance (fold change) and 38 with decreased abundance (p < 0.05). These include 17 fibrinolysis regulators, 8 RBC-related proteins, 6 complement proteins, and 36 platelet regulators. The antifibrinolytic protein vitronectin (VTN) was strikingly enriched (1067-fold), suggesting a substantial role in fibrinolysis resistance and clot stability. Scavengers of heme/hemoglobin, thromboinflammatory complement proteins, and platelet activators were highly abundant. This proof-of-concept study introduces novel proteomic methods for arterial thrombus analysis and identifies key proteins involved in ALI pathology. Our findings reveal a delicate balance between antifibrinolytic and profibrinolytic proteins, offering potential therapeutic targets to enhance thrombolysis and improve ALI management.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144368956","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":"From \"time is brain\" to \"time is collaterals\": updates on the role of cerebral collateral circulation in stroke.","authors":"Mangiardi Marilena, Pezzella Francesca Romana, Alfano Guido, De Rubeis Gianluca, Fabiano Sebastiano, Pampana Enrico, Anticoli Sabrina","doi":"10.1007/s11239-025-03135-w","DOIUrl":"10.1007/s11239-025-03135-w","url":null,"abstract":"<p><strong>Background: </strong>Acute ischemic stroke (AIS) remains the leading cause of mortality and disability worldwide. While revascularization therapies-such as intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT)-have significantly improved outcomes, their success is strongly influenced by the status of cerebral collateral circulation. Collateral vessels sustain cerebral perfusion during vascular occlusion, limiting infarct growth and extending therapeutic windows. Despite this recognized importance, standardized methods for assessing collateral status and integrating it into treatment strategies are still evolving. This narrative review synthesizes current evidence on the role of collateral circulation in AIS, focusing on its impact on infarct dynamics, treatment efficacy, and functional recovery. We highlight findings from major clinical trials-including MR CLEAN, DAWN, DEFUSE-3, and SWIFT PRIME which consistently demonstrate that robust collateral networks are associated with improved outcomes and expanded eligibility for reperfusion therapies. Advances in neuroimaging, such as multiphase CTA and perfusion MRI, alongside emerging AI-driven automated collateral grading, are reshaping patients' selection and clinical decision-making. We also discuss novel therapeutic strategies aimed at enhancing collateral flow, such as vasodilators, neuroprotective agents, statins, and stem cell therapies. Despite growing evidence supporting collateral-based treatment approaches, real-time clinical implementation remains limited by challenges in standardization and access.</p><p><strong>Conclusion: </strong>Cerebral collateral circulation is a critical determinant of stroke prognosis and treatment response. Incorporating collateral assessment into acute stroke workflows-supported by advanced imaging, artificial intelligence, and personalized medicine-offers a promising pathway to optimize outcomes. As the field moves beyond a strict \"time is brain\" model, the emerging paradigm of \"time is collaterals\" may better reflect the dynamic interplay between perfusion, tissue viability, and therapeutic opportunity in AIS management.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144368953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Venous thromboembolism diagnosis definition in claims data: implications for research.","authors":"Vanessa Vyas, Ashlynn Fuccello, Seana L Corbin, Bradley C Martin, Mario Schootman, Michail N Mavros","doi":"10.1007/s11239-025-03125-y","DOIUrl":"10.1007/s11239-025-03125-y","url":null,"abstract":"<p><p>To examine whether the variability in ICD codes used for venous thromboembolism (VTE) definition among published studies affects VTE rates and associations detected from claims data. We extracted the ICD codes used for VTE definition from three published studies and proposed a new VTE definition based on clinical review of all utilized ICD codes. We compared these four definitions to assess differences in VTE rates and associated variables using a standardized scenario. We used a random 25% sample of the IQVIA PharMetrics® Plus for Academics database and analyzed patients undergoing gastrointestinal cancer surgery. The primary outcome was 90-day post-discharge VTE. The association of preoperative and intraoperative variables with VTE was assessed using bivariate and multivariable main effects logistic regression models. There were substantial differences in the use of ICD codes among the 4 VTE definitions (range 116 to 304 ICD-9/10 codes). Our population included 2,122 eligible patients (median age 59 years, 47% female) and the rate of VTE ranged from 2.3% to 4.4% using the four definitions. Multivariable analysis showed that the associations between VTE and age and type of surgery (esophageal surgery, gastric surgery) varied depending on the VTE definition used while the Elixhauser comorbidity score and liver surgery type were consistently associated with VTE. In this pilot study, differences in the incidence of VTE and associated risk factors were influenced by the choice of ICD9/10 codes used to define VTE. A standardized definition of VTE may improve the reproducibility and rigor of findings based on administrative claims data.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144368958","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 role of activated partial thromboplastin time-clot waveform analysis in distinguishing positive samples of lupus anticoagulant from hemophilia A.","authors":"Nithye Parvathy, Debadrita Ray, Narender Kumar, Priya Punj, Vasant Kumar, Chander Hans, Jasmina Ahluwalia, Surjit Singh, Varun Dhir","doi":"10.1007/s11239-025-03128-9","DOIUrl":"https://doi.org/10.1007/s11239-025-03128-9","url":null,"abstract":"<p><strong>Introduction: </strong>Clot waveform analysis (CWA) is a technique that continuously monitors changes in light transmittance or absorbance during fibrin clot formation in plasma, enhancing routine clotting test assessment. Patients with Lupus Anticoagulant (LA) and Hemophilia A (HA) both exhibit isolated prolongation of activated partial thromboplastin time (aPTT); however, their management differs significantly. CWA can aid in distinguishing between these conditions, particularly in cases where standard coagulation tests are inconclusive and specialized assays are unavailable.</p><p><strong>Methods: </strong>This prospective case-control study included patients with demonstrable LA (n = 69), healthy controls (n = 75) and diseased controls [HA with (n = 16) and without inhibitor (n = 36).</p><p><strong>Results: </strong>The quantitative data of aPTT-CWA including velocity peak time, acceleration peak time and height of acceleration [-] were significantly lower in LA-positive samples with prolonged aPTT in comparison with HA without inhibitors. The qualitative data comprising Shoulder in 1st derivative, Biphasic wave in 2nd derivative [-] and Serrated wave pattern in 2nd derivative were significantly common in HA samples without inhibitors. In comparison to healthy controls, LA-positive patients with normal aPTT had significantly lower velocity peak time and height of velocity along with higher width of velocity. In acceleration peak time and width of acceleration [-] peak were significantly higher along with lower height of acceleration [+] and height of acceleration [-]. AUROCs of height of acceleration [-], width of acceleration [-] and width of velocity were statistically and biologically significant. The shoulder in 2nd derivative was significantly common in LA-positive samples.</p><p><strong>Conclusion: </strong>The aPTT-CWA has limited utility for differentiating LA positive from HA samples with and without inhibitors. However, aPTT-CWA may help in selecting patients with normal aPTT who merit further confirmatory testing for LA with a compatible history.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293885","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}