Journal of Thrombosis and Thrombolysis最新文献

{"title":"3-Factor prothrombin complex concentrate versus 4-factor prothrombin complex concentrate for the reversal of oral factor Xa inhibitors.","authors":"William Blake Hays, Kelsey Billups, Jessica Nicholson, Abby M Bailey, Haili Gregory, Erin R Weeda, Kyle A Weant","doi":"10.1007/s11239-024-03052-4","DOIUrl":"10.1007/s11239-024-03052-4","url":null,"abstract":"<p><p>Multiple agents exist for the reversal of oral Factor Xa inhibitor (FXa) associated bleeding, including Coagulation FXa Recombinant, Inactivated zhzo (andexanet alfa) and 4-factor prothrombin complex concentrate (4F-PCC). While classified as a 3F-PCC product, Profilnine contains up to 35 IU of Factor VII (per 100 IU of Factor IX) in addition to therapeutic levels of Factors II, IX, and X, and has demonstrated a similar impact on prothrombin time and blood product usage in non-warfarin related bleeding. This was a retrospective, multicenter study at four medical centers of adult patients who presented with major bleeding associated with oral FXa inhibitors and received either 4F-PCC (n = 64) or 3F-PCC (n = 61). The primary outcome was hemostatic effectiveness. Secondary outcomes included the incidence of thromboembolism, in-hospital mortality, and length of stay. The most common indication for reversal was intracranial bleeding. For the primary outcome, 84% of all patients were rated as effective with no difference noted between the groups (p = 0.81). No significant difference between groups was found in the multivariable analysis adjusting for baseline differences between groups including race, total body weight, type of bleeding, and the use of antiplatelet therapy. There was no difference in the length of stay, in-hospital mortality, or the incidence of thromboembolism between the groups. Overall, no significant differences were found in the effectiveness or safety of 4F-PCC and 3F-PCC use in the management of oral FXa inhibitor-associated bleeding. Further investigations are warranted to explore the use of 3F-PCC for this indication and its safety and effectiveness.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"276-283"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11885330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142522251","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":"Renal function and adverse clinical events in anticoagulated patients with atrial fibrillation: insights from the GLORIA-AF Registry Phase III.","authors":"Yang Liu, Steven Ho Man Lam, Giulio Francesco Romiti, Bi Huang, Yang Chen, Tze Fan Chao, Brian Olshansky, Kui Hong, Menno V Huisman, Gregory Y H Lip","doi":"10.1007/s11239-025-03067-5","DOIUrl":"10.1007/s11239-025-03067-5","url":null,"abstract":"<p><p>Renal function, assessed by creatinine clearance (CrCl), affects the efficacy and safety of oral anticoagulant (OAC) therapy in patients with atrial fibrillation (AF). To investigate the association between CrCl and the risk of clinical adverse events and compare the safety profiles of vitamin K antagonists (VKA) and non-vitamin K antagonist oral anticoagulants (NOAC). Patients with newly diagnosed AF (< 3 months before baseline visit) were collected from the prospective Global Registry on Long-Term Oral Anti-Thrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF) registry Phase III. Clinical events assessed included the composite outcome (all-cause death, thromboembolism, and major bleeding), cardiovascular (CV) death, myocardial infarction (MI), and other single outcomes. 10,594 AF patients (mean age 70.35 ± 9.92 years; 55% male; 73% on NOAC) were included. Increasing CrCl was associated with decreased risks of all cause death, composite outcomes and CV-death with in patients with CrCl < 80 mL/min. Multivariate Cox models indicated that compared to VKA, NOAC was associated with lower risks of all cause death (adjusted hazard ratio [aHR] 0.68, 95% CI 0.58-0.78), composite outcomes (aHR 0.77, 95% CI 0.69-0.86), CV-death (aHR 0.70, 95% CI 0.56-0.87), and major bleeding (aHR 0.74, 95% CI 0.61-0.91) in AF patients. For CrCl < 30 mL/min, lower risks of all-cause death, composite outcomes and CV death were related to NOAC therapy. In this large prospective global registry, NOACs were associated with better outcomes compared with VKA for patients with normal or impaired renal function.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"165-177"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11885355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382811","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":"Bleeding outcomes in critically ill patients on heparin with discordant aPTT and anti-Xa activity.","authors":"Hala Halawi, Mahmoud M Sabawi, Elsie Rizk, Ahmed A Mahmoud, Jenny H Petkova, Shiu-Ki Rocky Hui, Nina Srour, Kevin R Donahue","doi":"10.1007/s11239-024-03048-0","DOIUrl":"10.1007/s11239-024-03048-0","url":null,"abstract":"<p><p>Activated partial thromboplastin time (aPTT) and unfractionated heparin (UFH) level via the anti-factor Xa activity assay (anti-Xa) are commonly used assays for UFH monitoring. While discordance between the two assays is common, its impact on critically ill patient outcomes is unclear. This study aimed to compare the incidence of major bleeding events among critically ill patients with discordant aPTT and anti-Xa activity while on UFH, to patients with no discordance. This was a single-center, retrospective cohort study of critically ill adult patients who had simultaneous anti-Xa and aPTT levels while receiving continuous UFH infusion. The primary outcome was the incidence of a major bleeding event up to 24 h after UFH discontinuation. Secondary outcomes included incidence of 30-day thrombosis and hospital length of stay (LOS). Among 264 included patients, 156 patients (59%) had at least one discordant paired level. Patients with discordance had an increased risk of major bleeding events (14% versus 5%; unadjusted risk ratio, 3.0; 95% CI 1.2-7.8; p = 0.01), and increased risk of thrombotic events (4% versus 0%; p = 0.04). Hospital LOS was similar between the two groups (13.8 days versus 11.4 days; p = 0.08). In this cohort of critically ill patients receiving continuous UFH, discordance in aPTT and anti-Xa activity was frequently observed and was associated with an increased risk of major bleeding events. While both assays remain viable monitoring options, evaluating simultaneous levels may aid in the management of critically ill patients. In patients with discordance, an individualized approach balancing bleeding and thrombotic risks should be considered.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"210-219"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142377997","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":"Letter by Pirera et al regarding the paper \"Direct oral anticoagulants in embolic stroke of undetermined source: an updated meta-analysis\" by Marinheiro and colleagues.","authors":"Edoardo Pirera, Lucio D'Anna, Domenico Di Raimondo, Antonino Tuttolomondo","doi":"10.1007/s11239-024-03063-1","DOIUrl":"10.1007/s11239-024-03063-1","url":null,"abstract":"","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"351-352"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780596","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":"Clot lysis time and thrombin generation in patients undergoing transcatheter aortic valve implantation.","authors":"Aleksander Siniarski, Aleksandra Gąsecka, Katarzyna Krysińska, Marta Frydrych, Jadwiga Nessler, Grzegorz Gajos","doi":"10.1007/s11239-024-03027-5","DOIUrl":"10.1007/s11239-024-03027-5","url":null,"abstract":"<p><strong>Background: </strong>Aortic valve stenosis (AS) is the most prevalent valvular heart disease and is associated with a significant increase in mortality. AS has been shown to be linked with numerous coagulation system abnormalities, including increased fibrin deposition on the stenotic aortic valves. Transcatheter aortic valve implantation (TAVI) is the primary treatment method for patients at high surgical risk.</p><p><strong>Objectives: </strong>The aim of the study was to assess the impact of treating severe AS with TAVI on thrombin generation and clot lysis time (CLT).</p><p><strong>Methods: </strong>We studied 135 symptomatic AS patients recommended for TAVI by the local Heart Team. All measurements were performed before and 5-7 days after TAVI. Alongside clinical assessment and echocardiographic analysis, we assessed clot lysis time (CLT) and thrombin generation parameters, including lag time, peak thrombin generation, time to peak thrombin generation (ttPeak), and endogenous thrombin potential (ETP).</p><p><strong>Results: </strong>70 patients were included in the final analysis. After TAVI, there was a significant 9% reduction in CLT despite a 12% increase in fibrinogen concentration. We observed significant increase in lag time and ttPeak (20% and 12%, respectively), and 13% decrease in peak thrombin concentration compared to pre-procedural levels. Multivariable linear regression analysis demonstrated that baseline CLT and C-reactive protein (CRP) levels were independent predictors of significant reduction in mean aortic gradient, defined as TAVI procedure success.</p><p><strong>Conclusions: </strong>CLT and peak thrombin concentration decreased, while Lag time and ttPeak increased significantly after TAVI. Multivariable linear regression analysis demonstrated CLT and CRP levels as independent predictors of achieving a reduction in mean aortic gradient, defining TAVI procedure success.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"50-61"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11762420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141902180","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":"Prognostic outcome of intravenous thrombolysis in elderly patients aged ≥ 60 years with acute ischemic stroke by ASTRAL and THRIVE scales.","authors":"Yani Fan, Guoyan Shi, Sujie Wang, Yadan Lu, Xianghui Kong, Lili Chen","doi":"10.1007/s11239-024-03039-1","DOIUrl":"10.1007/s11239-024-03039-1","url":null,"abstract":"<p><p>This study aimed to validate the predictive performance of ASTRAL and THRIVE scales when used for patients aged 60 years and older with acute ischemic stroke (AIS) after intravenous thrombolysis (IVT). All enrolled patients received IVT therapy. The enrolled patients were divided into two groups in accordance with the modified Rankin scale(mRS) score at the time of discharge: good-outcome (mRS ≤ 2) and poor-outcome (mRS ≥ 3) groups. The receiver operating characteristic (ROC) curve was plotted using MedCalc software, the area under the ROC curve (AUC) was calculated. The Delong test was used to compare the predictive performance of ASTRAL and THRIVE scales, with P < 0.05 being considered a statistically significant difference. The AUCs of ASTRAL and THRIVE in predicting poor outcomes after thrombolysis in elderly patients with AIS were 0.771 and 0.701, respectively. The difference in AUC between ASTRAL and THRIVE was 0.070, and a statistically significant difference (P < 0.05) was found. ASTRAL's predictive performance was better than that of THRIVE. ASTRAL is a reliable predictive tool for assessing the poor outcome of IVT therapy for elderly patients aged ≥ 60 years with AIS.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"120-125"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145907","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":"Letter to the editor to ''Elevated plasma protein carbonylation increases the risk of ischemic cerebrovascular events in patients with atrial fibrillation: association with a prothrombotic state''.","authors":"Qinmei Huang, Wenjing Cheng","doi":"10.1007/s11239-024-03035-5","DOIUrl":"10.1007/s11239-024-03035-5","url":null,"abstract":"","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"159-160"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142377998","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 COVID-19 thrombus: distinguishing pathological, mechanistic, and phenotypic features and management.","authors":"Luis Del Carpio-Orantes","doi":"10.1007/s11239-024-03056-0","DOIUrl":"10.1007/s11239-024-03056-0","url":null,"abstract":"","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"161"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575970","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":"Ghrelin may protect against vascular endothelial injury in Acute traumatic coagulopathy by mediating the RhoA/ROCK/MLC2 pathway.","authors":"Chengjian He, Xiaojing Song, Zigui Zhu, Yan Xiao, Jiacheng Chen, Hongyi Yao, Rongjun Xie","doi":"10.1007/s11239-024-03029-3","DOIUrl":"10.1007/s11239-024-03029-3","url":null,"abstract":"<p><p>Ghrelin exerts widespread effects in several diseases, but its role and mechanism in Acute Traumatic Coagulopathy (ATC) are largely unknown. The effect of ghrelin on cell proliferation was examined using three assays: 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide (MTT), Lactate Dehydrogenase (LDH), and flow cytometry. The barrier function of the endothelial cells was evaluated using the Trans-Endothelial Electrical Resistance (TEER) and the endothelial permeability assay. An ATC mouse model was established to evaluate the in vivo effects of ghrelin. The Ras homolog family member A (RhoA) overexpression plasmid or adenovirus was used to examine the molecular mechanism of ghrelin. Ghrelin enhanced Human Umbilical Vein Endothelial Cells (HUVEC) proliferation and endothelial cell barrier function and inhibited HUVEC permeability damage in vitro. Additionally, ghrelin decreased the activated Partial Thromboplastin Time (aPTT) and Prothrombin Time (PT) in mice blood samples in the ATC mouse model. Ghrelin also improved the pathological alterations in postcava. Mechanistically, ghrelin acts through the RhoA/ Rho-associated Coiled-coil Containing Kinases (ROCK)/ Myosin Light Chain 2 (MLC2) pathway. Furthermore, the protective effects of ghrelin, both in vitro and in vivo, were reversed by RhoA overexpression. Our findings demonstrate that ghrelin may reduce vascular endothelial cell damage and endothelial barrier dysfunction by blocking the RhoA pathway, suggesting that ghrelin may serve as a potential therapeutic target for ATC treatment.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"84-95"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11762449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142046850","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":"Correction to: Anticoagulation control among patients on vitamin K antagonists in nine countries in SubSaharan Africa.","authors":"Julius Chacha Mwita, Joel Msafri Francis, Chriselda Pillay, Okechukwu S Ogah, Yadeta Dejuma Goshu, Francis Agyekum, John Mukuka Musonda, Maduka Chiedozie James, Endale Tefera, Tsie Kabo, Irene Keolebile Ditlhabolo, Kagiso Ndlovu, Ayoola Yekeen Ayodele, Wigilya P Mikomangwa, Pilly Chillo, Albertino Damasceno, Aba Ankomaba Folson, Anthony Oyekunle, Erius Tebuka, Fredrick Kalokola, Karen Forrest, Helena Dunn, Kamilu Karaye, Fina Lubaki Jean-Pierre, Chala Fekadu Oljira, Tamrat Assefa, Tolulope Shogade Taiwo, Chibuike E Nwafor, Olufemi Omole, Raphael Anakwue, Karen Cohen","doi":"10.1007/s11239-024-03037-3","DOIUrl":"10.1007/s11239-024-03037-3","url":null,"abstract":"","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"162-163"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11762409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349251","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}