Research and Practice in Thrombosis and Haemostasis最新文献

{"title":"Endothelial cell source dictates the expression and release of fibrinolytic markers in a proinflammatory environment","authors":"Steven J. Humphreys,&nbsp;Nicola J. Mutch,&nbsp;Claire S. Whyte","doi":"10.1016/j.rpth.2025.102929","DOIUrl":"10.1016/j.rpth.2025.102929","url":null,"abstract":"<div><h3>Background</h3><div>Endothelial cells (ECs) provide a surface for molecular interactions, secreting various factors that govern hemostasis. Inflammatory cytokines can perturb the vascular microenvironment, potentially causing endothelial dysfunction and dysregulation of hemostasis.</div></div><div><h3>Objectives</h3><div>To examine the fibrinolytic balance of ECs from different vascular beds and their response to proinflammatory stimuli.</div></div><div><h3>Methods</h3><div>Primary human umbilical vein ECs (HUVECs), human coronary artery ECs (HCAECs), and immortalized EA.hy926 cells were cultured under venous (2.5 dyne/cm²) and arterial (12 dyne/cm²) shear stress. ECs were stimulated with thrombin, interleukin 6, or tumor necrosis factor (TNF)-α for 24 hours. The expression of coagulation and fibrinolytic proteins was quantified by quantitative polymerase chain reaction and secreted proteins via ELISA or activity assay. Plasma clot lysis on ECs ± 300 pM tissue-type plasminogen activator (tPA) was monitored at 405 nm.</div></div><div><h3>Results</h3><div>Basal secretion of C-reactive protein, urokinase plasminogen activator (uPA), and plasminogen activator inhibitor-1 (PAI-1) was higher in HCAECs than in HUVECs, but tPA was similar in both. TNF-α stimulation of HCAECs increased secretion of tPA, uPA, and PAI-1. Levels of tPA/PAI-1 and uPA/PAI-1 were higher in media, as was free-active PAI-1. In contrast, stimulation of HUVECs did not significantly alter gene/protein levels. HCAECs and HUVECs delayed clot lysis relative to no-cell controls by 11 ± 8 minutes (<em>P</em> &lt; .01) and 8 ± 6 minutes (<em>P</em> &lt; .05) respectively, but were normalized by neutralizing PAI-1. TNF-α stimulation of HCAECs prolonged clot lysis in a PAI-1–dependent manner.</div></div><div><h3>Conclusion</h3><div>HCAECs respond more potently to a proinflammatory environment than HUVECs, altering expression of fibrinolytic proteins and promoting a hypofibrinolytic response. These data highlight HCAECs as a model of coronary vasculature with potential for screening novel antithrombotic strategies.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"9 5","pages":"Article 102929"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144654411","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":"Health-related quality of life in rare bleeding disorders: results from the Rare Bleeding Disorders in the Netherlands study","authors":"Sterre P.E. Willems ,&nbsp;Marjon H. Cnossen ,&nbsp;Nick van Es ,&nbsp;Paul L. den Exter ,&nbsp;Ilmar C. Kruis ,&nbsp;Karina Meijer ,&nbsp;Laurens Nieuwenhuizen ,&nbsp;Joline L. Saes ,&nbsp;Nicole M.A. Blijlevens ,&nbsp;Waander L. van Heerde ,&nbsp;Saskia E.M. Schols","doi":"10.1016/j.rpth.2025.102961","DOIUrl":"10.1016/j.rpth.2025.102961","url":null,"abstract":"<div><h3>Background</h3><div>Clinical bleeding phenotype varies substantially among patients with rare bleeding disorders (RBDs). Patient-reported outcomes may provide valuable insights into health-related quality of life (HRQoL) and disease burden.</div></div><div><h3>Objectives</h3><div>To evaluate HRQoL in patients with rare coagulation factor deficiencies and fibrinolytic disorders included in the nationwide, cross-sectional Rare Bleeding Disorders in the Netherlands (RBiN) study.</div></div><div><h3>Methods</h3><div>Bleeding scores (ie, the International Society on Thrombosis and Haemostasis Bleeding Assessment Tool [ISTH-BAT]) were assessed during a single study visit, and electronic questionnaires captured demographic and HRQoL data (36-item Short Form survey [SF-36], Patient-Reported Outcomes Measurement Information System, Profile 29 [PROMIS-29]). Only differences exceeding the minimally important difference were considered clinically relevant and reported.</div></div><div><h3>Results</h3><div>HRQoL data from 167 adults and 34 children were available. HRQoL of patients with RBDs measured by SF-36 was not significantly different compared to the Dutch reference population. PROMIS-29 scores indicated significantly better sleep, social participation, and pain-related outcomes in patients with RBDs than the reference populations. Subgroup analyses within the RBiN population showed worse physical health in patients with a severe bleeding phenotype than in those with a mild-to-moderate phenotype. Women with a history of heavy menstrual bleeding reported worse physical health and pain-related outcomes than those without. Patients reporting severe disease had worse pain interference and mental health scores (PROMIS-29) than those reporting nonsevere disease. ISTH-BAT scores were negatively associated with physical functioning.</div></div><div><h3>Conclusions</h3><div>Overall HRQoL in patients with RBDs was comparable to the Dutch reference population. Within the RBiN population, a history of heavy menstrual bleeding, clinical bleeding phenotype, patient-reported disease severity, and ISTH-BAT scores were associated with impaired HRQoL, reflecting disease burden in patients living with RBDs.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"9 5","pages":"Article 102961"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144671058","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":"Reduced-dose vs full-dose direct oral anticoagulants for extended treatment of venous thromboembolism: a meta-analysis of randomized controlled trials","authors":"Mushood Ahmed ,&nbsp;Eeshal Zulfiqar ,&nbsp;Hadiah Ashraf ,&nbsp;Tallal Mushtaq Hashmi ,&nbsp;Raheel Ahmed ,&nbsp;Jamal S. Rana ,&nbsp;Stephen J. Greene ,&nbsp;Robert J. Mentz ,&nbsp;Marat Fudim ,&nbsp;Gregg C. Fonarow","doi":"10.1016/j.rpth.2025.102996","DOIUrl":"10.1016/j.rpth.2025.102996","url":null,"abstract":"<div><h3>Background</h3><div>Venous thromboembolism (VTE) is a major cause of cardiovascular morbidity and mortality globally. Although direct oral anticoagulants (DOACs) have improved extended VTE treatment, the optimal dose for balancing efficacy and safety remains unclear.</div></div><div><h3>Objectives</h3><div>This systematic review and meta-analysis aimed to evaluate the efficacy and safety of reduced-dose DOACs vs full-dose regimens during extended anticoagulation for VTE.</div></div><div><h3>Methods</h3><div>A literature search of PubMed, Embase, and Cochrane Library was performed up to April 2025 to identify randomized controlled trials (RCTs) comparing reduced-dose vs full-dose DOACs for extended VTE treatment in patients with or without cancer. Risk ratios (RR) and 95% CIs were estimated using a random-effects model. Primary outcomes were recurrent VTE and major or clinically relevant nonmajor bleeding. The secondary outcomes included major bleeding, clinically relevant nonmajor bleeding, all-cause mortality, and VTE-related mortality.</div></div><div><h3>Results</h3><div>Five RCTs involving 8781 patients were included in the meta-analysis. The mean ± SD age of patients was 61.3 ± 13.4 years, and median follow-up duration was 12 months. Reduced-dose DOACs were comparable with full-dose regimens in preventing recurrent VTE (RR, 0.94; 95% CI, 0.68-1.29) and all-cause death (RR, 0.86; 95% CI, 0.63-1.17). However, reduced-dose DOACs significantly lowered the risk of major or clinically relevant nonmajor bleeding (RR, 0.71; 95% CI, 0.61-0.82), major bleeding (RR, 0.62; 95% CI, 0.42-0.92), and clinically relevant nonmajor bleeding (RR, 0.75; 95% CI, 0.63-0.88) compared with full-dose regimens. No significant subgroup differences were observed between cancer-associated and general VTE populations.</div></div><div><h3>Conclusion</h3><div>Reduced-dose DOACs are as effective as full-dose regimens in preventing recurrent VTE and are associated with significantly lower bleeding risks. However, more RCTs with extended follow-up and focused inclusion of cancer patients are warranted to validate these findings.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"9 5","pages":"Article 102996"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144911577","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 impact of protein S and tissue factor pathway inhibitor on coagulation, assessed with thrombin generation, in women starting combined oral contraceptives","authors":"Jesper Strandberg ,&nbsp;Jette Nybo ,&nbsp;Inger Lise Gade ,&nbsp;Søren Risom Kristensen","doi":"10.1016/j.rpth.2025.102981","DOIUrl":"10.1016/j.rpth.2025.102981","url":null,"abstract":"<div><h3>Background</h3><div>Combined oral contraceptives (COCs) are associated with an increased risk of venous thromboembolism. Several changes are induced in both coagulant and anticoagulant factors, of which the impact on protein S (PS) and tissue factor pathway inhibitor (TFPI) may be especially important. The global thrombin generation (TG) assay, which accounts for all pro- and anticoagulant factors, can be used to evaluate the effect of the changes of PS and TFPI using antibodies to eliminate the effect of these inhibitors.</div></div><div><h3>Objectives</h3><div>The aim of this study was to investigate the effect of PS, TFPI, and activated protein C (APC) on coagulation, as assessed with the TG assay in individuals before and after starting COCs.</div></div><div><h3>Methods</h3><div>Twenty-four women between 15 and 34 years of age who were starting COC treatment were included in the study. Blood samples were drawn at baseline, before first COC dose, and at follow-up, approximately 3 to 4 months later. TG assays were performed on all samples, with the addition of anti-PS, anti-TFPI, and APC, to evaluate their impact on TG.</div></div><div><h3>Results</h3><div>A reduction in APC sensitivity was demonstrated after COC start, reflected in a twofold increased normalized APC sensitivity ratio. TG potential increased significantly after addition of anti-PS and anti-TFPI, both at baseline and after 3 months of COC treatment, but increased relatively less at follow-up.</div></div><div><h3>Conclusion</h3><div>While we previously found only modest COC-induced decreases in PS activity and TFPI levels in this population, indicated a substantial reduction of anticoagulant activity after 3 months of COC use.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"9 5","pages":"Article 102981"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842863","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":"Natural killer cell granule protein 7 contributes to CD8+ T cell-mediated platelet apoptosis in immune thrombocytopenia","authors":"Xiaolin Wang ,&nbsp;Qiang Liu ,&nbsp;Xiaojing Li ,&nbsp;Wei Xing ,&nbsp;Ping Chen ,&nbsp;Qi Feng ,&nbsp;Ming Hou ,&nbsp;Qian Wang ,&nbsp;Hai Zhou ,&nbsp;Jun Peng","doi":"10.1016/j.rpth.2025.102977","DOIUrl":"10.1016/j.rpth.2025.102977","url":null,"abstract":"<div><h3>Background</h3><div>CD8⁺ T cells participate in the pathogenesis of primary immune thrombocytopenia (ITP). Natural killer cell granule protein 7 (NKG7) is essential for natural killer cell and CD8⁺ T cell cytotoxicity. The function of NKG7 in CD8⁺ T cells in ITP remains unclear.</div></div><div><h3>Objectives</h3><div>We investigated the expression and roles of NKG7 in CD8⁺ T cells in ITP.</div></div><div><h3>Methods</h3><div>We analyzed NKG7 and CD107a expression and CD8⁺ T cell-mediated platelet apoptosis in patients with ITP and controls. NKG7 knockdown was performed using small interfering RNA, and the extracellular signal-regulated kinases 1 and 2 pathway was analyzed by western blot analysis.</div></div><div><h3>Results</h3><div>NKG7 was significantly increased in CD8⁺ T cells and positively correlated with CD107a and CD8⁺ T cell-induced platelet apoptosis in ITP. Based on NKG7 levels, patients with ITP were divided into NKG7 high-expression and low-expression groups. Patients with high expression of NKG7 had significantly higher levels of CD107a and CD8⁺ T cell-induced platelet apoptosis than controls, whereas no difference was found between patients with low NKG7 expression and controls. Platelet counts in patients with high NKG7 expression were significantly lower than those in patients with low NKG7 expression. We knocked down NKG7 in CD8⁺ T cells from patients with ITP and found decreased CD107a expression and less platelet apoptosis <em>in vitro</em>. We further found that NKG7 affected the cytotoxicity of CD8⁺ T cells through the extracellular signal-regulated kinase 1 and 2 pathway.</div></div><div><h3>Conclusion</h3><div>NKG7 plays an important role in CD8⁺ T cell-mediated cytotoxicity might be a potential therapeutic target for ITP.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"9 5","pages":"Article 102977"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144827482","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":"Should thrombopoietin receptor agonists be used for chemotherapy-induced thrombocytopenia?","authors":"Hanny Al-Samkari","doi":"10.1016/j.rpth.2025.102980","DOIUrl":"10.1016/j.rpth.2025.102980","url":null,"abstract":"<div><div>Chemotherapy-induced thrombocytopenia (CIT) is a common complication of cancer therapy for solid tumors that results in increased bleeding risk and chemotherapy dose reductions, treatment delays, and agent discontinuation. Unlike other chemotherapy-induced cytopenias, CIT remains without any licensed therapies in most of the world. Multiple thrombopoietin receptor agonists (TPO-RAs) have been approved for other thrombocytopenic indications, however, and are widely available, offering an accessible option for CIT management. In this Research and Practice in Thrombosis and Haemostasis Forum article, the historical reasons for the current state of CIT treatment are explained, the potential benefits and risks of TPO-RA use in CIT are discussed, and the patient populations who are likely to benefit and not benefit from TPO-RA support are described.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"9 5","pages":"Article 102980"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144852351","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":"To anticoagulate or not to anticoagulate—that is the question in patients with fall risks","authors":"Tzu-Fei Wang","doi":"10.1016/j.rpth.2025.102963","DOIUrl":"10.1016/j.rpth.2025.102963","url":null,"abstract":"","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"9 5","pages":"Article 102963"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144654409","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 asundexian on a panel of coagulation assays","authors":"Julie Vassart ,&nbsp;Diane Bangoup Ndzatou ,&nbsp;Marie Didembourg ,&nbsp;Laure Morimont ,&nbsp;Clotilde Brisbois ,&nbsp;Laurent Jamart ,&nbsp;Fabian Demeure ,&nbsp;Aurélien Lebreton ,&nbsp;François Mullier ,&nbsp;Julien Favresse ,&nbsp;Michaël Hardy ,&nbsp;Jean-Michel Dogné ,&nbsp;Jonathan Douxfils","doi":"10.1016/j.rpth.2025.102950","DOIUrl":"10.1016/j.rpth.2025.102950","url":null,"abstract":"<div><h3>Background</h3><div>During the last few years, the small, oral, activated factor XI inhibitor, asundexian, has been investigated in different cardiovascular disorders. However, little is known about its impact on laboratory coagulation assays.</div></div><div><h3>Objectives</h3><div>To describe the effects of asundexian on a panel of laboratory coagulation assays.</div></div><div><h3>Methods</h3><div>The following assays were performed in normal pooled plasma spiked with increasing concentrations of asundexian (0-2000 ng/mL): activated partial thromboplastin time (aPTT), prothrombin time (PT), fibrinogen quantification (PT-derived and Clauss method), one-stage aPTT and PT-based coagulation factor assays, chronometric protein C and immunoturbidimetric protein S assays, reptilase time, chromogenic ecarin assay, dilute Russell’s viper venom time assays, thrombin generation assay initiated by tissue factor (1, 5, and 20 pM) and ellagic acid (0.42 μM), rotational thromboelastometry intrinsically- and extrinsically-triggered assays, kaolin-activated clotting time, and glass bead-activated clotting time. This latter assay was also carried out in whole blood.</div></div><div><h3>Results</h3><div>Asundexian up to 2000 ng/mL impacted aPTT and one-stage aPTT-based coagulation factor assays, with high variability between reagents and methodologies. Asundexian reduced thrombin generation triggered by ellagic acid and 1 or 5 pM tissue factor. The rotational thromboelastometry intrinsically-triggered assays and kaolin- and glass bead-activated clotting time assays were affected by asundexian 2000 ng/mL, while overall, no significant interference was observed with any of the remaining assays.</div></div><div><h3>Conclusion</h3><div>Despite this study including a comprehensive panel of coagulation assays, asundexian may still affect other coagulation assays not assessed here. Further investigations in patients treated with asundexian are therefore warranted.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"9 5","pages":"Article 102950"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663135","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":"Factor XIII deficiency due to compound heterozygosity for 2 F13A1 variants","authors":"Jodie Odame ,&nbsp;Caroline Malcolmson ,&nbsp;Cindy Wakefield ,&nbsp;Tammy Bourque ,&nbsp;David Lillicrap ,&nbsp;Orla Rawley ,&nbsp;Mackenzie Bowman ,&nbsp;Manuel Carcao ,&nbsp;Vanessa Bouskill","doi":"10.1016/j.rpth.2025.102978","DOIUrl":"10.1016/j.rpth.2025.102978","url":null,"abstract":"<div><h3>Background</h3><div>Factor (F)XIII deficiency is a rare bleeding disorder. Genomic studies, adjunctive to biochemical assays, can provide valuable diagnostic and clinical clarity.</div></div><div><h3>Key Clinical Question</h3><div>We describe a case of a child with FXIII deficiency in which genomic studies were crucial for accurate diagnosis and treatment.</div></div><div><h3>Clinical Approach</h3><div>An 8-year-old male presented with a severe bleeding phenotype. His FXIII antigen, activity, and alpha-subunit (FXIIIA) levels were below detection limits. Genetic analysis identified 2 likely pathogenic variants in <em>F13A1</em>: a novel nonsense variant (c.59_60del, p.Ser20X) and a missense variant (c.211G&gt;A, p.Arg704Gln). Trio analysis revealed that compound heterozygosity for the p.Ser20X and p.Arg704Gln variants were causal for severe FXIIIA deficiency in the index case.</div></div><div><h3>Conclusion</h3><div>Family segregation studies were essential in this case for interpreting genetic analysis results and identifying the causative variants resulting in severe FXIIIA deficiency.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"9 5","pages":"Article 102978"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144860389","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":"Differences in risk factors between all-cause and pulmonary embolism-related death in acute pulmonary embolism: insights from the COMMAND VTE registry-2","authors":"Soichiro Kobayashi ,&nbsp;Yoshito Ogihara ,&nbsp;Yugo Yamashita ,&nbsp;Takeshi Morimoto ,&nbsp;Ryuki Chatani ,&nbsp;Kazuhisa Kaneda ,&nbsp;Yuji Nishimoto ,&nbsp;Nobutaka Ikeda ,&nbsp;Yohei Kobayashi ,&nbsp;Satoshi Ikeda ,&nbsp;Kitae Kim ,&nbsp;Moriaki Inoko ,&nbsp;Toru Takase ,&nbsp;Shuhei Tsuji ,&nbsp;Maki Oi ,&nbsp;Takuma Takada ,&nbsp;Kazunori Otsui ,&nbsp;Jiro Sakamoto ,&nbsp;Takeshi Inoue ,&nbsp;Shunsuke Usami ,&nbsp;Kaoru Dohi","doi":"10.1016/j.rpth.2025.102965","DOIUrl":"10.1016/j.rpth.2025.102965","url":null,"abstract":"<div><h3>Background</h3><div>Accurate risk prediction of early mortality, particularly pulmonary embolism (PE)-related death, in patients with acute PE has become more important for selecting optimal management strategies.</div></div><div><h3>Objectives</h3><div>To evaluate the cumulative 30-day incidence of and risk factors for all-cause and PE-related death within 30 days.</div></div><div><h3>Methods</h3><div>In the COMMAND VTE Registry-2, which enrolled symptomatic patients with venous thromboembolism at 31 centers in Japan, we analyzed 2035 patients with acute PE.</div></div><div><h3>Results</h3><div>The cumulative 30-day incidence of all-cause and PE-related death was 6.4% and 3.4%, respectively. Independent risk factors for all-cause and PE-related death were age &gt;80 years (hazard ratio [HR], 2.43; 95% CI, 1.45-4.08; <em>P</em> &lt; .001), hypoxemia (HR, 3.36; 95% CI, 1.07-10.5; <em>P</em> = .04), tachycardia (HR, 3.78; 95% CI, 2.20-6.50; <em>P</em> &lt; .001), hypotension (HR, 5.43; 95% CI, 3.17-9.29; <em>P</em> &lt; .001), an abnormal leukocyte count (HR, 1.78; 95% CI, 1.08-2.93; <em>P</em> = .02), and the absence of proximal deep vein thrombosis (HR, 2.58; 95% CI, 1.51-4.39; <em>P</em> &lt; .001). Active cancer (HR, 2.59; 95% CI, 1.75-3.82; <em>P</em> &lt; .001) and male sex (HR, 1.56; 95% CI, 1.07-2.28; <em>P</em> = .02) were independent risk factors for all-cause death, but not PE-related death. Chronic heart or lung disease (HR, 1.72; 95% CI, 1.02-2.90; <em>P</em> = .04) and right ventricular dysfunction (HR, 2.61; 95% CI, 1.02-6.70; <em>P</em> = .046) were independent risk factors for PE-related death, but not all-cause death.</div></div><div><h3>Conclusion</h3><div>We identified several independent risk factors for PE-related death within 30 days, which differed from those of all-cause death. Risk factors specifically for PE-related death may be useful in decision-making for optimal treatment strategies for acute PE.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"9 5","pages":"Article 102965"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144739099","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}