Journal of Thrombosis and Thrombolysis最新文献

{"title":"Impact of tranexamic acid on outcomes in early-admitted patients with aneurysmal subarachnoid hemorrhage: a systematic review and bayesian meta-analysis of randomized controlled trials.","authors":"Paweł Łajczak, Yami Bhaskar, Leonardo Di Cosmo, Aisha Rizwan Ahmed, Jad El Choueiri, Santiago Nieto Cuervo, Anna Łajczak, Raphael Bertani, Wellingson Silva Paiva","doi":"10.1007/s11239-026-03371-8","DOIUrl":"https://doi.org/10.1007/s11239-026-03371-8","url":null,"abstract":"<p><p>Aneurysmal subarachnoid hemorrhage (aSAH) represents one of the acute neurological conditions associated with the highest morbidity and mortality, often complicated by early rebleeding in the hyperacute phase. Tranexamic acid (TXA), an antifibrinolytic agent, has been proposed to reduce the risk of rebleeding; however, its impact on outcomes in patients admitted early (≤ 72 h) remains unclear. The authors searched PubMed, Embase, Web of Science, and Cochrane for randomized controlled trials evaluating TXA use among aSAH patients admitted early to the hospital (≤ 72 h). The authors performed a traditional frequentist and Bayesian meta-analyses with informative priors for heterogeneity. Additionally, studies were stratified by whether they used a long-term or short-term TXA protocol. After a comprehensive search, 6 randomized trials were included in this review. Bayesian meta-analysis showed a significant reduction of rebleeding events (RR 0.59; 95% CrI 0.38 to 0.90) and rebleeding-related mortality (RR 0.55; 95% CrI 0.33 to 0.93) in the TXA cohort. Notably, the long-term TXA protocol subgroup showed a significant increase in cerebral ischemia events (RR 1.68; 95% CrI 1.13 to 2.51), while the short-term protocol did not yield a significant increase (96.3% probability of subgroup difference). There was no significant difference in overall-cause mortality (RR 1.01; 95% CrI 0.83 to 1.24), and poor neurological outcome at last follow-up (RR 1.02; 95% CrI 0.79 to 1.29). This study suggests that the use of TXA in early aSAH may reduce the incidence of rebleeding and rebleeding-related mortality. However, the impact of TXA does not directly translate into reduced all-cause mortality or enhanced neurological outcome. Long-term TXA protocols may increase potential ischemic complications and are not recommended.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148689549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the frequency, risk factors, and outcomes of splanchnic vein thrombosis in myeloproliferative neoplasms: a retrospective cohort study.","authors":"Ufuk Demirci, Mehmet Baysal, Elif Aksoy, Metban Mastanzade, Denis Sabriye Bozer, Duygu Gül, Emine Gültürk, Fazıl Çağrı Hunutlu, Kübra Oral, Ayfer Gedük, Reyhan Diz-Küçükkaya, Burak Canbaz, Deniz Özmen, İbrahim Beyhan, Ayşe Kaya, Ahmet Yiğitbaşı, Mehmet Yılmaz, Rafiye Çiftçiler, İlknur Kara, Ali Turunç, Sevil Sadri, Süreyya Yiğit Kaya, Samet Yaman, Ayşe Hilal Eroğlu Küçükdiler, Fatoş Dilan Köseoğlu, Serkan Güven, Ali Doğan, Mehmet Can Uğur, Serhat Çelik, Aysun Şentürk Yıkılmaz, Tarık Onur Tiryaki, Taha Ulutan Kars, Melda Cömert, Zekeriya Aksöz, Abdülkerim Yıldız, İpek Yönal Hindilerden, Fehmi Hindilerden, Güray Saydam, Vildan Özkocaman, Ayşe Uysal, Olga Meltem Akay, Ahmet Muzaffer Demir, Emel Gürkan, Leylagül Kaynar, Seval Akpınar, Fahir Özkalemkaş, Elif G Ümit, Ahmet Emre Eşkazan","doi":"10.1007/s11239-026-03363-8","DOIUrl":"https://doi.org/10.1007/s11239-026-03363-8","url":null,"abstract":"<p><p>Splanchnic vein thrombosis (SVT) is an uncommon but clinically significant complication of myeloproliferative neoplasms (MPNs), contributing to morbidity and management complexity. Evidence regarding prognostic factors and optimal anticoagulation strategies remains limited. We aimed to evaluate the clinical characteristics, risk factors, treatment strategies, and survival outcomes in patients with SVT associated with MPNs. In this multicenter retrospective cohort study, 289 adult patients with SVT associated with MPNs were analyzed. The median age at SVT diagnosis was 49 years, with 74% of patients < 60 years, indicating a predominance in younger individuals. Portal vein thrombosis was the most common presentation (87.5%). Over a median follow-up of 82 months, survival was significantly better in patients < 60 years (p < 0.01). In multivariable analysis, age ≥ 60 years and myelofibrosis were independent predictors of inferior survival (both p < 0.01), whereas early recanalization was not associated with survival. Bleeding complications occurred in 27% of anticoagulated patients, with no fatal events. Direct oral anticoagulants and vitamin K antagonists showed comparable bleeding profiles, although major bleeding was more frequent with vitamin K antagonists. Despite early recanalization, most patients continued long-term anticoagulation. In conclusion, MPN-associated SVT predominantly affects younger patients, underscoring an age-independent prothrombotic risk. Survival is primarily driven by age and disease subtype rather than thrombotic characteristics. Given the persistent thrombotic risk despite bleeding complications, long-term anticoagulation remains central to management and requires individualized decision-making. Prospective studies are needed to optimize treatment strategies.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685143","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":"Thrombotic molecular markers after intravenous thrombolysis are associated with early neurological deterioration in acute ischemic stroke.","authors":"Wei Sun, Bin Li, Shuhua Xie, Fugan Liu, Zhijuan Lu, Jinchun Ye, Guoyong Zeng, Xianghong Liu","doi":"10.1007/s11239-026-03306-3","DOIUrl":"10.1007/s11239-026-03306-3","url":null,"abstract":"<p><p>Early neurological deterioration (END) is a frequent and serious complication after intravenous thrombolysis in acute ischemic stroke (AIS), yet the clinical relevance of thrombotic molecular markers related to coagulation, fibrinolysis, and endothelial dysfunction remains incompletely understood. In this retrospective cohort study, 91 patients with AIS treated with intravenous thrombolysis were included between November 2022 and February 2025. Plasma levels of thrombin-antithrombin complex (TAT), plasmin inhibitor-plasmin complex (PIC), thrombomodulin (TM), and tissue-type plasminogen activator-plasminogen activator inhibitor-1 complex (t-PAIC) were measured before thrombolysis and at 1, 6, and 24 h thereafter. Stroke etiology was classified according to the Trial of Org 10,172 in Acute Stroke Treatment criteria into large artery atherosclerosis (LAA) and small vessel disease (SVD) subtypes, and patients were further categorized into END and non-END groups. Patients with LAA exhibited significantly higher plasma TAT levels at all time points and a higher incidence of END than those with SVD. Plasma TM levels were higher in the non-END group, with statistically significant differences observed at 24 h after thrombolysis. Multivariable analysis identified higher TM levels at 24 h as an independent protective factor against END, whereas elevated t-PAIC levels were independently associated with increased END risk. Given that END may occur early after thrombolysis, these associations should be interpreted cautiously in terms of temporal sequence. A combined model incorporating TM and t-PAIC demonstrated good discriminative performance for END, with an area under the curve of 0.849. These findings indicate distinct coagulation-endothelial response patterns between AIS subtypes and suggest that TM and t-PAIC may serve as complementary biomarkers associated with END risk following intravenous thrombolysis, although further validation is required.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"1528-1539"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13447323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147930780","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":"Platelet FcɣRIIa: a novel biomarker of risk for thromboembolism and death in cancer.","authors":"Chris E Holmes, George A Davis, Heidi S Taatjes-Sommer, Naomi E Sai-Hardebeck, Peter W Callas, Ikechukwu Chidobem, Ryan Thomas, David J Schneider","doi":"10.1007/s11239-026-03315-2","DOIUrl":"10.1007/s11239-026-03315-2","url":null,"abstract":"<p><p>Cancer is associated with arterial and venous thrombotic events (ATE/VTE). Platelet FcγRIIa (pFCG) impacts platelet activation that contributes to ATE/VTE. Recurrent myocardial infarction (MI) and death are predicted by pFCG in patients with MI. Crosstalk between platelets and malignant cells that may promote cell invasion and cancer progression is mediated by pFCG. The objective is to determine whether pFCG (high vs. low) identifies cancer patients at greater risk of thrombosis and death. Ambulatory patients with cancer (n = 219) initiating cancer directed therapy were enrolled in a prospective translational study. The pFCG test was performed at study initiation and used flow cytometry to quantify mean fluorescence intensity that was translated to molecules of FCG/platelet. Outcomes of VTE/ATE and all cause death were abstracted from the Electronic Health Record at least 6 months after enrollment. Hazard ratios (HR) were analyzed with Kaplan-Meier analysis. Risk of the composite endpoint (ATE/VTE/death) was increased in patients with high pFCG (HR 1.9, 95% confidence interval [CI] 1.1-3.2, p = 0.02). A consistent non-significant trend for increased composite of ATE/VTE was associated with high pFCG (HR 1.7, 95% CI 0.8-3.3, p = 0.14). High pFCG identified patients at greater risk of all-cause death (HR 2.5, 95% CI 1.3-5.0, p = 0.009). Among patients who died (n = 50), ATE/VTE was a cause of death in 4 (8%) and temporally not associated with death in 19 (38%). The pFCG test identifies cancer patients at greater risk of death and could predict risk of thromboembolism. Additional studies are warranted to evaluate this novel biomarker of risk. Clinical trial registration: NCT05240508.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"1393-1401"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13447332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964109","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":"CircRNA_0007444 modulates cardiomyocyte inflammation and apoptosis induced by myocardial ischemia-reperfusion injury via miR-16-5p/MFN2.","authors":"Zhaoxia Teng, Lijing Fan, Sheng Li, Zhuo Lv, Yihao Wang","doi":"10.1007/s11239-026-03297-1","DOIUrl":"10.1007/s11239-026-03297-1","url":null,"abstract":"<p><p>Myocardial ischemia-reperfusion injury (MIRI) seriously affects myocardial function, with circular RNA's mechanism in MIRI under exploration. This study seeks to elucidate the clinical value and function of circRNA_0007444 in MIRI. The levels of circRNA_0007444 in the serum of 94 non-MIRI patients and 80 MIRI patients were compared. The clinical significance of circRNA_0007444 was evaluated from the perspectives of differentiating MIRI patients and identifying independent risk factors for MIRI. In vitro experiments, a hypoxia/reoxygenation (H/R)-induced human cardiomyocytes AC16 cell model was used to evaluate the regulatory effects of circRNA_0007444 on cell viability, apoptosis, myocardial injury and inflammation. In mechanism, the downstream miRNAs and target genes of circRNA_0007444 were predicted, and the participation of miR-16-5p and MFN2 was evaluated through the recovery experiment. Decreasing circRNA_0007444 could discriminate MIRI patients and severs as an independent risk factor for MIRI onset. CircRNA_0007444 was negatively correlated with myocardial injury indicators. In AC16 cells, H/R induced significant downregulation of circRNA_0007444, suppressed cell viability, promoted cell apoptosis, enhanced inflammation, and induced myocardial injury. Promoting circRNA_0007444 could protect AC16 cells from H/R-induced injury. CircRNA_0007444 could target and negatively regulate miR-16-5p. miR-16-5p could target and negatively regulate MFN2. The overexpression of miR-16-5p could reverse the protective effect of circRNA_0007444 overexpressing, while overexpression of MFN2 could eliminate this effect. circRNA_0007444 can be used as a biomarker for the early screening and identification of independent risk factors of MIRI. Promoting circRNA_0007444 could alleviate H/R-induced AC16 cell injury through the miR-16-5p/MFN2 axis.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"1467-1478"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147868762","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":"Impact of an Anticoagulation Management Service-Led Annual Review on Antiplatelet Use and Gastrointestinal Bleeding Prophylaxis in Ambulatory Patients on Background Direct Oral Anticoagulants.","authors":"Chau Hoang, Peter Collins, David DeiCicchi, Ewan McNicol, Devan Hawkins, Kathy Zaiken","doi":"10.1007/s11239-026-03283-7","DOIUrl":"10.1007/s11239-026-03283-7","url":null,"abstract":"<p><p>Patients on long-term anticoagulation face increased bleeding risk when antiplatelets are co-prescribed, especially upper gastrointestinal (GI) bleeding. Guidelines recommend limiting antiplatelet use to highly select patients on background anticoagulants and promoting GI prophylaxis with proton pump inhibitors (PPIs) for those requiring dual antithrombotic therapy. To assess the impact of an anticoagulation management service (AMS)-led intervention on reducing excess antiplatelet use and increasing PPI prescribing in patients who require continued antiplatelet therapy. This study of retrospective chart review included adults (≥ 18 years) on long-term direct oral anticoagulant (DOAC) therapy from October 2023 to September 2024. The intervention group included AMS-enrolled patients who received structured annual anticoagulation review. The control group consisted of DOAC patients receiving usual care outside AMS. The AMS annual review aims to optimize antithrombotic therapy by deprescribing unnecessary antiplatelets and initiating PPIs when clinically indicated. Of 8,462 eligible patients, 3,125 were in the AMS group and 5,337 in the non-AMS group. Antiplatelet use was significantly lower in AMS patients at baseline (9% vs. 15%) and study end (7% vs. 16%) (p < 0.0001). PPI use was significantly higher in AMS patients at both time points (50% vs. 30% for baseline, 67% vs. 38% at the end of study) (p < 0.0001). Acceptance rates for AMS recommendations were 18.8% for antiplatelet discontinuation and 33% for PPI initiation. AMS-led interventions effectively reduced concurrent antiplatelet use in patients on background DOAC and increased PPI prescribing in those on dual therapy, demonstrating the value of centralized anticoagulation services in primary care.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"1600-1610"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13447394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775296","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":"Association of IgA antiphospholipid antibodies with hypercoagulability and inflammation in antiphospholipid syndrome.","authors":"Isabella Constantini Soares de Andrade, Luísa Reis Figueiredo Pinto, Silmara Aparecida de Lima Montalvão, Marina Pereira Colella, Gabriela Goés Yamaguti-Hayakawa, Joyce Maria Annichino-Bizzacchi, Erich Vinícius De Paula, Fernanda Andrade Orsi","doi":"10.1007/s11239-026-03316-1","DOIUrl":"10.1007/s11239-026-03316-1","url":null,"abstract":"<p><p>Although IgA isotype testing does not enhance diagnostic accuracy of antiphospholipid syndrome (APS), recent studies suggest that IgA aCL/aβ2GPI are associated with systemic lupus erythematosus (SLE) and thrombosis, contributing to thromboinflammatory responses and potentially serving as prognostic markers. This study's objective is to determine whether IgA aCL/aβ2GPI are associated with coagulation and inflammatory responses, as well as a high-risk thrombotic APS (t-APS) profile. A total of 81 patients with t-APS were included. IgA aCL and IgA aβ2GPI were measured using chemiluminescence. Coagulation and inflammatory markers (TNF-α, IL-6, IL-8, IFN-α, TF, VWF, ADAMTS13) were measured by ELISA, and then, their levels and activity compared between IgA-positive and negative patients. The association of IgA and relevant outcomes (antiphospholipid [aPL] profile, recurrent thrombosis, SLE), was assessed by logistic models adjusted for age and sex. IgA aCL or aβ2GPI positivity was observed in 24 patients (29.6%), mostly with both antibodies (n = 23). IgA positivity was not associated with demographics, comorbidities or pregnancy complications, but correlated with triple aPL positivity (48% vs. 13%, P = 0.004) and higher risk of progression to SLE (17% vs. 0%, P = 0.004). IgA-positive patients showed significantly elevated TNF-α, IL-8, and TF levels (P = 0.03, P = 0.03 and P = 0.05, respectively). In conclusion, IgA aCL/aβ2GPI positivity is associated with triple aPL positivity, progression to SLE, and altered thromboinflammatory markers, thus highlighting their association with a pronounced thromboinflammatory APS profile. This emphasizes the association of IgA antibodies with a high-risk serological profile and the potential utility of IgA testing in APS. Clinical trial registration: This study is not a clinical trial that requires registration.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"1644-1653"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13447459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964041","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":"Multi-step computational identification of small molecules targeting the TLT-1 stalk peptide: structural insights into platelet function and thrombosis.","authors":"Fawaz O Alenazy","doi":"10.1007/s11239-026-03302-7","DOIUrl":"10.1007/s11239-026-03302-7","url":null,"abstract":"<p><p>The need for safer and more targeted antithrombotic medications is highlighted by the fact that platelet activation and thrombosis are significant causes of cardiovascular morbidity and mortality. Potential small molecules targeting Triggering Receptor Expressed on Myeloid Cells-Like Transcript-1 (TLT-1), expressed by the TREML1 gene that regulates platelet aggregation and thrombus stabilization, were identified in this study using a thorough in silico approach. Protein-protein interaction analysis, Gene Ontology, KEGG pathway enrichment, and GTEx-based tissue expression were used in network pharmacology of TREML1 to demonstrate its connection to thrombotic processes and platelet activation. Pharmacophore models were created utilizing TLT-1 stalk peptide residues based on the 8CHE crystal structure, and Pharmit was used to screen virtual libraries of synthetic and natural chemicals. AutoDock Vina was used for molecular docking, and compounds with docking scores ≤ - 7.0 kcal/mol were shortlisted, producing 81 synthetic and 27 natural hits. Two natural (ZINC000225509830 and ZINC000015671940) and three synthetic (ZINC000063467474, ZINC000215029558, and ZINC000257255111) candidates were selected after further ADME and toxicity profiling. Interaction profiling revealed that the synthetic compound ZINC000063467474 showed strong hydrogen bonding and π-π stacking interactions with low projected toxicity, whereas the natural compound ZINC000225509830 also showed extensive engagement with TLT-1 stalk-peptide residues. According to molecular dynamics simulations, ZINC000063467474 maintained steady and persistent binding within the TLT-1 pocket for 100 ns, whereas the natural compound exhibited positional drift and decreased stability. These results indicate that ZINC000063467474 may serve as a promising scaffold for targeting the TLT-1 stalk peptide and represents a potential lead for modulating platelet function and thrombosis; however, this requires further experimental validation.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"1563-1583"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964068","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":"Four-factor prothrombin complex concentrate for the reversal of apixaban prior to deceased donor kidney transplant: A case series.","authors":"Michelle S Dierker, Anne Przybylski, Laura Cotiguala, Reynold Lopez-Soler, Kaitlin Ferguson","doi":"10.1007/s11239-026-03296-2","DOIUrl":"10.1007/s11239-026-03296-2","url":null,"abstract":"","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"1611-1617"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775298","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":"Extended anticoagulation with DOACs in patients affected by hematologic malignancies and venous thromboembolism: a monocentric experience.","authors":"M Biglietto, S Sorella, L V Cappelli, B Mandelli, D Kasmi, E Baldacci, M Breccia, Antonio Chistolini","doi":"10.1007/s11239-026-03300-9","DOIUrl":"10.1007/s11239-026-03300-9","url":null,"abstract":"<p><p>The management of cancer-associated thrombosis (CAT) in hematologic malignancies is particularly challenging due to the high competing risks of recurrence and bleeding. While international guidelines recommend extended anticoagulation for patients with active cancer, the optimal dose intensity beyond the initial six months remains uncertain. We retrospectively evaluated a risk-adapted strategy using vein recanalization to guide direct oral anticoagulant (DOAC) dosing in a monocentric cohort of 148 onco-hematologic patients. During the extended phase, patients with persistent thrombosis remained on full-dose DOACs, while those with vein recanalization and active cancer were switched to low-dose DOACs. Over a median extended treatment follow-up of 35.3 months, the incidence rate of bleeding adverse events was 9.9 per 100 patient-years for full-dose therapy compared to 0.8 for low-dose therapy. Specifically, clinically relevant non-major bleeding rates were 9.2 vs. 0.4 per 100 patient-years, respectively. Recurrent VTE incidence was 4.3 per 100 patient-years in the full-dose group and 1.3 in the low-dose group. Our findings could suggest that a \"low dose fits all\" approach may be inappropriate for this high-risk population. Onco-hematologic patients with persistent venous thrombosis may benefit from continued full-dose anticoagulation, while dose de-escalation appears safe and effective once recanalization occurs. These results should be interpreted with caution given the retrospective, single-center design and small sample size.</p>","PeriodicalId":17546,"journal":{"name":"Journal of Thrombosis and Thrombolysis","volume":" ","pages":"1654-1658"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964052","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}