P Wändell, M A Enarsson, T Feldreich, L Lind, J Ärnlöv, A C Carlsson
{"title":"Risk of venous thromboembolism in relation to high physical activity level in men over 27 year follow up.","authors":"P Wändell, M A Enarsson, T Feldreich, L Lind, J Ärnlöv, A C Carlsson","doi":"10.1007/s11239-024-03013-x","DOIUrl":"10.1007/s11239-024-03013-x","url":null,"abstract":"<p><p>Venous thromboembolism (VTE) is the third most common type of cardiovascular disease. An association between high level of physical activity (PA) and the onset of VTE has been found in some, but not all previous studies. We aim to study the association between PA-level and VTE in a cohort of men with updated data on PA levels at four occasions. We used data from the Uppsala Longitudinal Study of Adult Men (ULSAM) study initiated in 1970, a study of men at age 50 years (n = 2,294 at baseline) examined on leisure time PA by questionnaire and traditional cardiovascular risk factors. Examinations were repeated at ages 60, 70, and 77, and follow-up was completed after a median time of 33 years. Cox regression analysis with hazard ratios (HRs) using updated covariates for PA and risk factors was performed on the association of PA levels with incident VTE, with adjustments for established cardiovascular risk factors (systolic blood pressure, LDL- and HDL-cholesterol, BMI, diabetes, and smoking). Totally 186 men experienced a VTE during follow-up of 68,263 person-years at risk. Individuals with the highest PA level had an increased relative risk of VTE, adjusted HR, 2.22 (95% CI 1.05-4.67), when compared to individuals with the lowest level of PA. In this cohort of men with a follow-up of 27 years, the risk of VTE was increased at the highest PA level. Findings indicate that there could be an increased VTE risk with higher PA level including strenuous activities.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"1126-1132"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11496364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141563659","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":"The use of non-vitamin K antagonist oral anticoagulants in chronic thromboembolic pulmonary hypertension: an updated meta-analysis.","authors":"Dexi Wu, Huiling Liang, Wulamiding Kaisaier, Jia Li, Gang Sun, Yugang Dong, Chen Liu, Xuefang Zhang, Wengen Zhu","doi":"10.1007/s11239-024-03021-x","DOIUrl":"10.1007/s11239-024-03021-x","url":null,"abstract":"<p><p>Studies have demonstrated the beneficial effects of non-vitamin K antagonist oral anticoagulants (NOACs) for the treatment of atrial fibrillation and venous thromboembolism (VTE). The impact of NOACs on chronic thromboembolic pulmonary hypertension (CTEPH) remains controversial. This meta-analysis was conducted to investigate the effectiveness and safety of NOACs compared with vitamin K antagonists (VKAs) in patients with CTEPH. A comprehensive search of PubMed, Embase, and Cochrane Library was conducted for relevant studies, encompassing data from inception until November 2023. The data were pooled using a fixed-effects model if the I2 value was less than 50%; otherwise, a random-effects model was employed. Overall, two randomized controlled trials (RCTs) and eight observational studies involving 4556 patients with CTEPH were included. Patients receiving NOACs exhibited a significantly lower incidence of all-cause mortality (odds ratio [OR] = 0.52, 95% confidence interval [CI]: 0.36-0.76) and major bleeding (OR = 0.58, 95% CI: 0.36-0.92) compared to those with VKAs. There were no significant differences in the rate of VTE recurrence (OR = 1.07, 95% CI: 0.72-1.59), total bleeding (OR = 0.78, 95% CI: 0.60-1.01), and minor bleeding (OR = 1.11, 95% CI: 0.73-1.69) between the two studied groups. Similar results were found in the subgroup analysis and sensitivity analysis.This meta-analysis provided evidence that NOACs could be superior to VKAs for the treatment of CTEPH. NOACs might be safe and a convenient alternative to VKAs for thromboprophylaxis in patients with CTEPH.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"1256-1267"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141855917","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}
Udaya S Tantry, Kevin P Bliden, William W Ashley, Paul A Gurbel
{"title":"New interest in fibrinogen as an ischemic risk factor.","authors":"Udaya S Tantry, Kevin P Bliden, William W Ashley, Paul A Gurbel","doi":"10.1007/s11239-024-03024-8","DOIUrl":"10.1007/s11239-024-03024-8","url":null,"abstract":"<p><p>Platelet-fibrin clot formation is a key process in acute arterial thrombosis. The relationship between thrombin-induced platelet-fibrin clot strength (P-FCS) and fibrinogen levels in patients with cardiovascular disease (CVD) and COVID-19 has not been studied. In thhe current study, the contribution of fibrinogen to P-FCS has been explored in healthy subjects (n=157), patients hospitalized with COVID-19 (n=116), and patients with CVD (n=93) using thrombelastography (TEG 6s) with citrate cartridge. We found that thrombin-induced P-FCS, fibrin clot strength (F-CS) and fibrinogen levels (FLEV) were higher among patients with CVD and COVID-19 compared to HS (p<0,05 for all) and highest among patients with COVID-19. P-FCS, an established risk factor for post-PCI ischemic event occurrences, was associated with both F-CS and FLEV (R2=0.67, p<0.001 for both comparisons. These data indicate that fibrinogen levels strongly influence the viscoelastic strength of the platelet-fibrin clot, fibrinogen may be an important driving factor for arterial thrombosis in the presence of potent platelet inhibition and may be as equally important a risk factor as high platelet reactivity. Since P-FCS is significantly associated with fibrinogen levels, the role of fibrinogen as a risk factor for arterial ischemic event occurrences should be further studied to improve antithrombotic therapy personalization.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"1122-1125"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141897737","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":"COVID-19 vaccination and short-term anti-coagulation levels in warfarin treatment: correspondence.","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.1007/s11239-024-03030-w","DOIUrl":"10.1007/s11239-024-03030-w","url":null,"abstract":"","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"1237-1238"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995980","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}
Ruijie Wang, Zezhong Tian, Meiyan Zhu, Bingying Zhang, Yanzhang Li, Yiqi Zheng, Yuheng Mao, Yimin Zhao, Yan Yang
{"title":"SARS-CoV-2 spike protein potentiates platelet aggregation via upregulating integrin αIIbβ3 outside-in signaling pathway.","authors":"Ruijie Wang, Zezhong Tian, Meiyan Zhu, Bingying Zhang, Yanzhang Li, Yiqi Zheng, Yuheng Mao, Yimin Zhao, Yan Yang","doi":"10.1007/s11239-024-03008-8","DOIUrl":"10.1007/s11239-024-03008-8","url":null,"abstract":"<p><p>Platelet hyperreactivity is one of the crucial causes of coagulative disorders in patients with COVID-19. Few studies have indicated that integrin αIIbβ3 may be a potential target for spike protein binding to platelets. This study aims to investigate whether spike protein interacts with platelet integrin αIIbβ3 and upregulates outside-in signaling to potentiate platelet aggregation. In this study, we found that spike protein significantly potentiated platelet aggregation induced by different agonists and platelet spreading in vitro. Mechanism studies revealed that spike protein upregulated the outside-in signaling, such as increased thrombin-induced phosphorylation of β3, c-Src. Moreover, using tirofiban to inhibit spike protein binding to αIIbβ3 or using PP2 to block outside-in signaling, we found that the potentiating effect of spike protein on platelet aggregation was abolished. These results demonstrate that SARS-CoV-2 spike protein directly enhances platelet aggregation via integrin αIIbβ3 outside-in signaling, and suggest a potential target for platelet hyperreactivity in patients with COVID-19. HIGHLIGHTS: • Spike protein potentiates platelet aggregation and upregulates αIIbβ3 outside-in signaling. • Spike protein interacts with integrin αIIbβ3 to potentiate platelet aggregation. • Blocking outside-in signaling abolishes the effect of spike protein on platelets.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"1225-1232"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141563660","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}
Mark J R Smeets, Eskild Bendix Kristiansen, Banne Nemeth, Menno V Huisman, Suzanne C Cannegieter, Alma Becic Pedersen
{"title":"Risks of major bleeding and venous thromboembolism in patients undergoing total hip or total knee arthroplasty using therapeutic dosages of DOACs.","authors":"Mark J R Smeets, Eskild Bendix Kristiansen, Banne Nemeth, Menno V Huisman, Suzanne C Cannegieter, Alma Becic Pedersen","doi":"10.1007/s11239-024-03015-9","DOIUrl":"10.1007/s11239-024-03015-9","url":null,"abstract":"<p><p>About 1.5% of patients undergoing total hip (THA) or total knee arthroplasty (TKA) still develop postoperative venous thromboembolism (VTE), indicating that the current thromboprophylaxis strategy is not optimal. To evaluate the feasibility of therapeutic dosages of direct oral anticoagulants (DOACs) as thromboprophylaxis for high VTE risk patients, we determined the risks of major bleeding and VTE in patients who underwent THA/TKA and were treated with DOACs in therapeutic dosages for atrial fibrillation (AF). We conducted a registry-based cohort study from 2010 to 2018 in Denmark and included AF patients on therapeutic DOACs dose who underwent THA/TKA. AF patients were utilized as proxy since they have a life-long indication for therapeutic anticoagulant medication. The 49-days cumulative incidence (with death as competing risk) of major bleeding was assessed. The same was done for VTE at 49- and 90-days. 1,354 THA and TKA procedures were included. The 49-days cumulative incidence of major bleeding was 1.40% (95%Confidence Interval[CI] 0.88-2.14%). Most bleeding events occurred at the surgical site. The cumulative incidence of VTE at 49-days was 0.59% (95%CI 0.28-1.13%) and 0.74% (95%CI 0.38-1.32%) at 90-days. The incidence of major bleeding in THA/TKA patients on DOACs in therapeutic dosages was in line with previously reported incidences among THA/TKA patients on thromboprophylaxis dosages, while the incidence of VTE was relatively low. These data provide a solid basis for the design of randomized controlled trials to establish the safety and efficacy of therapeutic dosages of DOACs to prevent VTE in high-risk patients.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"1249-1255"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141627110","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}
Francisco Galeano-Valle, Pablo Demelo-Rodríguez, Rubén Alonso-Beato, José María Pedrajas, José Luis Fernández-Reyes, Romain Chopard, Parham Sadeghipour, Jana Hirmerova, Behnood Bikdeli, Manuel Monreal
{"title":"Comparative analysis of COVID-19-associated venous thromboembolism outcomes: evolution from 2020 to 2021-2022.","authors":"Francisco Galeano-Valle, Pablo Demelo-Rodríguez, Rubén Alonso-Beato, José María Pedrajas, José Luis Fernández-Reyes, Romain Chopard, Parham Sadeghipour, Jana Hirmerova, Behnood Bikdeli, Manuel Monreal","doi":"10.1007/s11239-024-03026-6","DOIUrl":"10.1007/s11239-024-03026-6","url":null,"abstract":"<p><p>Patients with COVID-19 are at an increased risk for venous thromboembolism (VTE). With the advent of vaccinations and novel treatments from 2020 through 2022, the landscape of COVID-19 has evolved. Notably, the effects of such interventions on the outcomes of COVID-19-associated VTE have not been thoroughly examined. Data from the RIETE registry were analyzed to evaluate 90-day VTE-related outcomes (all-cause mortality, major bleeding, and VTE recurrences) in patients with COVID-19-associated VTE. We compared the periods before and after the widespread introduction of COVID-19 vaccines: March to December 2020 (pre-vaccine period) and March 2021 to December 2022 (post-vaccine period). Statistical analysis included mixed-effects parametric survival-time models. Among 1,620 patients with COVID-19-associated VTE, most (74.1%) were identified during 2020 period. The analysis revealed a more than two-fold increase in the risk of death within 90 days (adjusted hazard ratio [HR]: 2.27; 95% confidence interval, CI: 1.18-4.38) and major bleeding (adjusted HR: 2.91; 95%CI: 1.08-7.84) for patients from the 2020 period compared to those from the 2021-2022 period. Inpatient subgroup analysis confirmed the observed mortality differences. The frequency of recurrent VTE was low (1.1 vs. 0.7%, respectively), and did not show significant variation between the two periods. Our research provides a comparative perspective on the clinical outcomes of COVID-19-associated VTE before and after the introduction of vaccines. Our findings reveal a significant decrease in the incidence of 90-day mortality and major bleeding in patients with COVID-19-associated VTE in the 2021-2022 period.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"1239-1248"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792736","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}
Gabriel Marinheiro, Beatriz Araújo, André Rivera, Gabriel de Almeida Monteiro, Laís Silva Santana, Marianna Leite, Antonio Mutarelli, Agostinho C Pinheiro, Eberval Gadelha Figueiredo, João Paulo Mota Telles
{"title":"Direct oral anticoagulants in embolic stroke of undetermined source: an updated meta-analysis.","authors":"Gabriel Marinheiro, Beatriz Araújo, André Rivera, Gabriel de Almeida Monteiro, Laís Silva Santana, Marianna Leite, Antonio Mutarelli, Agostinho C Pinheiro, Eberval Gadelha Figueiredo, João Paulo Mota Telles","doi":"10.1007/s11239-024-03017-7","DOIUrl":"10.1007/s11239-024-03017-7","url":null,"abstract":"<p><p>The efficacy and safety of direct oral anticoagulants (DOAC) in patients with embolic stroke of undetermined source (ESUS) remains unclear. We systematically searched PubMed, Embase, and Cochrane Library for randomized controlled trials (RCT) comparing DOACs versus aspirin in patients with ESUS. Risk ratios (RR) and 95% confidence intervals (CI) were computed for binary endpoints. Four RCTs comprising 13,970 patients were included. Compared with aspirin, DOACs showed no significant reduction of recurrent stroke (RR 0.95; 95% CI 0.84-1.09; p = 0.50; I<sup>2</sup> = 0%), ischemic stroke or systemic embolism (RR 0.97; 95% CI 0.80-1.17; p = 0.72; I<sup>2</sup> = 0%), ischemic stroke (RR 0.92; 95% CI 0.79-1.06; p = 0.23; I<sup>2</sup> = 0%), and all-cause mortality (RR 1.11; 95% CI 0.87-1.42; p = 0.39; I<sup>2</sup> = 0%). DOACs increased the risk of clinically relevant non-major bleeding (CRNB) (RR 1.52; 95% CI 1.20-1.93; p < 0.01; I<sup>2</sup> = 7%) compared with aspirin, while no significant difference was observed in major bleeding between groups (RR 1.57; 95% CI 0.87-2.83; p = 0.14; I<sup>2</sup> = 63%). In a subanalysis of patients with non-major risk factors for cardioembolism, there is no difference in recurrent stroke (RR 0.98; 95% CI 0.67-1.42; p = 0.90; I<sup>2</sup> = 0%), all-cause mortality (RR 1.24; 95% CI 0.58-2.66; p = 0.57; I<sup>2</sup> = 0%), and major bleeding (RR 1.00, 95% CI 0.32-3.08; p = 1.00; I<sup>2</sup> = 0%) between groups. In patients with ESUS, DOACs did not reduce the risk of recurrent stroke, ischemic stroke or systemic embolism, or all-cause mortality. Although there was a significant increase in clinically relevant non-major bleeding, major bleeding was similar between DOACs and aspirin.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"1163-1171"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792737","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}
Karel Kostev, Oliver Laduch, Sven Scheimann, Marcel Konrad, Jens Bohlken, Mark Luedde
{"title":"Mortality rate and factors associated with in-hospital mortality in patients hospitalized with pulmonary embolism in Germany.","authors":"Karel Kostev, Oliver Laduch, Sven Scheimann, Marcel Konrad, Jens Bohlken, Mark Luedde","doi":"10.1007/s11239-024-03036-4","DOIUrl":"10.1007/s11239-024-03036-4","url":null,"abstract":"<p><p>Pulmonary embolism (PE) is a life-threatening condition, the prognosis of which is determined in particular by acute decompensation and hospitalization. The goal of this study was to investigate the prevalence of and the factors associated with the in-hospital mortality of patients hospitalized with acute PE. This multicenter cross-sectional study was based on the data of PE patient cases from 36 hospitals across Germany. A multivariable logistic regression analysis was conducted to assess the associations between demographic and clinical variables and in-hospital mortality. A total of 7136 hospitalization cases were included (mean age: 68.6 years, 49.2% female). 60.2% of patients received PE as primary and 39.8% as secondary diagnosis. The mortality rate was 13.2%. Age group 71-80 years (OR: 1.49; 95% CI: 1.18-1.88) and > 80 years (OR: 2.06; 95% CI: 1.61-2.62), PE as secondary diagnosis (OR: 2.12; 95% CI: 1.676-2.56), respiratory failure (OR: 2.88; 95% CI: 2.44-3.41), acute renal failure (OR: 2.65; 95% CI: 2.14-3.27), hypokalemia (OR: 1.51; 95% CI: 1.28-1.79), heart failure (OR: 1.43; 95% CI: 1.18-1.73), and acute posthemorrhagic anemia (OR: 1.34; 95% CI: 1.04-1.74) were associated with an increased mortality risk. Our findings underscore the significant impact of age, acute renal failure, and respiratory complications on the mortality of patients with PE. While our study provides a comprehensive snapshot of in-hospital mortality in acute PE patients, it also highlights the need for ongoing research to deepen our understanding of the interplay between various risk factors.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"1154-1162"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142046852","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}
Dawei Wang, Rong Chen, Wenjiang Wang, Yue Yang, Yaxi Yu, Lan Liu, Fei Yang, Shujun Cui
{"title":"Prediction of short-term adverse clinical outcomes of acute pulmonary embolism using conventional machine learning and deep Learning based on CTPA images.","authors":"Dawei Wang, Rong Chen, Wenjiang Wang, Yue Yang, Yaxi Yu, Lan Liu, Fei Yang, Shujun Cui","doi":"10.1007/s11239-024-03044-4","DOIUrl":"https://doi.org/10.1007/s11239-024-03044-4","url":null,"abstract":"<p><p>To explore the predictive value of traditional machine learning (ML) and deep learning (DL) algorithms based on computed tomography pulmonary angiography (CTPA) images for short-term adverse outcomes in patients with acute pulmonary embolism (APE). This retrospective study enrolled 132 patients with APE confirmed by CTPA. Thrombus segmentation and texture feature extraction was performed using 3D-Slicer software. The least absolute shrinkage and selection operator (LASSO) algorithm was used for feature dimensionality reduction and selection, with optimal λ values determined using leave-one-fold cross-validation to identify texture features with non-zero coefficients. ML models (logistic regression, random forest, decision tree, support vector machine) and DL models (ResNet 50 and Vgg 19) were used to construct the prediction models. Model performance was evaluated using receiver operating characteristic (ROC) curves and the area under the curve (AUC). The cohort included 84 patients in the good prognosis group and 48 patients in the poor prognosis group. Univariate and multivariate logistic regression analyses showed that diabetes, RV/LV ≥ 1.0, and Qanadli index form independent risk factors predicting poor prognosis in patients with APE(P < 0.05). A total of 750 texture features were extracted, with 4 key features identified through screening. There was a weak positive correlation between texture features and clinical parameters. ROC curves analysis demonstrated AUC values of 0.85 (0.78-0.92), 0.76 (0.67-0.84), and 0.89 (0.83-0.95) for the clinical, texture feature, and combined models, respectively. In the ML models, the random forest model achieved the highest AUC (0.85), and the support vector machine model achieved the lowest AUC (0.62). And the AUCs for the DL models (ResNet 50 and Vgg 19) were 0.91 (95%CI: 0.90-0.92) and 0.94(95%CI: 0.93-0.95), respectively. Vgg 19 model demonstrated exceptional precision (0.93), recall (0.76), specificity (0.95) and F1 score (0.84). Both ML and DL models based on thrombus texture features from CTPA images demonstrated higher predictive efficacy for short-term adverse outcomes in patients with APE, especially the random forest and Vgg 19 models, potentially assisting clinical management in timely interventions to improve patient prognosis.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349252","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}