Research and Practice in Thrombosis and Haemostasis最新文献

{"title":"Clinical management of bleeding manifestations in a family with the thrombomodulin C1611>A (p.Cys537Stop) mutation","authors":"Serge Pierre-Louis ,&nbsp;Johalene Rabout ,&nbsp;Octavio Labrada ,&nbsp;Fatima Radouani ,&nbsp;Emeline Chonville ,&nbsp;Beatrice Ferrey ,&nbsp;Olivier Pierre-Louis ,&nbsp;Yesim Dargaud","doi":"10.1016/j.rpth.2025.102678","DOIUrl":"10.1016/j.rpth.2025.102678","url":null,"abstract":"<div><h3>Background</h3><div>The bleeding disorder described here is due to a heterozygous autosomal dominant C1611&gt;A variant in the thrombomodulin (TM) gene that significantly elevates plasma TM levels, which enhances the activation of protein C. This activation inhibits factors VIIIa and Va, reducing thrombin generation and potentially leading to severe hemorrhagic manifestations.</div></div><div><h3>Key Clinical Question</h3><div>What is the bleeding profile of patients with this rare condition? What are the most frequent clinical signs, and how can they be treated?</div></div><div><h3>Clinical Approach</h3><div>We present a case study of an index patient with the <em>TM</em> C1611&gt;A variant and his 20 family members. We detail the hemostatic strategies employed during various bleeding episodes and surgical procedures.</div></div><div><h3>Conclusion</h3><div>Sharing clinical experiences is crucial for hematologists managing similar cases, as it provides valuable insights into effective treatment strategies.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"9 1","pages":"Article 102678"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143156332","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":"Real-world andexanet alfa utilization and the association between delay in administration due to hospital transfer and all-cause inpatient mortality","authors":"Huiqiao Fan,&nbsp;Youssef Bessada,&nbsp;Craig I. Coleman","doi":"10.1016/j.rpth.2025.102688","DOIUrl":"10.1016/j.rpth.2025.102688","url":null,"abstract":"<div><h3>Background</h3><div>Evaluations of andexanet alfa for the reversal of factor Xa inhibitor-associated bleeding have been small, with cohorts drawn from single/limited sites. Delays in providing anticoagulation reversal due to hospital transfer may result in poorer outcomes.</div></div><div><h3>Objectives</h3><div>To describe the characteristics and outcomes of andexanet alfa users and evaluate the association between delay in andexanet alfa administration due to transfer from a different acute care hospital and the incidence of all-cause inpatient mortality.</div></div><div><h3>Methods</h3><div>This was a retrospective study using National Inpatient Sample data. Hospitalizations with procedural codes for andexanet alfa and a billing code for bleeding were included. Descriptive analysis was performed, as was multivariable logistic regression, to estimate the odds ratio and 95% CI for the association between andexanet alfa delayed due to transfer from a different acute care hospital and all-cause inpatient mortality.</div></div><div><h3>Results</h3><div>From 2019 to 2021, 4210 hospitalizations occurred in adults receiving andexanet alfa and a bleed. Most were hospitalized with intracranial hemorrhage (62.0%). The incidence of all-cause inpatient mortality was 16.6% (95% CI, 14.3%-19.3%), mean hospital stays lasted 9.1 days (95% CI, 8.4-9.8), and mean hospital costs were $73,600 (95% CI, $65,000-$82,200). Of all cases, 18.5% were transferred from a different acute care hospital prior to receiving andexanet alfa. Cases with hospital transfer had an 82% increased odds of all-cause inpatient mortality (95% CI, 17%-183%) but did not reach statistical significance when the population was limited to intracranial hemorrhage (odds ratio, 1.51; 95% CI, 0.88-2.60).</div></div><div><h3>Conclusion</h3><div>Delay in administering andexanet alfa due to hospital transfer may be associated with increased all-cause mortality.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"9 1","pages":"Article 102688"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143445817","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":"Reduced- versus full-dose anticoagulants for the extended treatment of cancer-associated venous thromboembolism in Thai patients","authors":"Kawin Vichaidit,&nbsp;Pichika Chantrathammachart,&nbsp;Pimjai Niparuck,&nbsp;Teeraya Puawilai,&nbsp;Pantep Angchaisuksiri MD,&nbsp;Kochawan Boonyawat","doi":"10.1016/j.rpth.2024.102643","DOIUrl":"10.1016/j.rpth.2024.102643","url":null,"abstract":"<div><h3>Background</h3><div>Reduced-dose anticoagulant therapy for extended treatment of cancer-associated venous thromboembolism (VTE) has been used to avoid bleeding. However, it may increase the risk of recurrent VTE.</div></div><div><h3>Objectives</h3><div>To study the rate of recurrent VTE and bleeding complications in Thai patients with cancer-associated VTE who were treated with full-dos/e or reduced-dose anticoagulants.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted in a single-center academic hospital. Electronic medical records were reviewed from 2016-2023. Patients with cancer-associated VTE who received anticoagulants for at least 3 months were evaluated. Reduced-dose anticoagulant was defined as a dose that was lower than the recommended standard dosage. The primary outcome was recurrent VTE. The secondary outcomes were major bleeding and clinically relevant nonmajor bleeding.</div></div><div><h3>Results</h3><div>A total of 229 patients were included. The median age was 65 years (IQR, 54-72). In the reduced-dose group, age and history of previous bleeding were higher than in the full-dose group. There were 169 (74%) patients and 60 (26%) patients who received full- and reduced-dose anticoagulants. The median time to reduce the dose was 3.6 months (IQR, 0.7-5.5). Of a total of 7 (3.1%) recurrent VTEs, 4 (2.4%) occurred in the full-dose and 3 (5.0%) in the reduced-dose groups (<em>P</em> = .4), respectively. The median time to recurrent VTE was 7.2 months (IQR, 3.5-12.4). There were 8 (3.5%) bleeding events, 7 (4.1%) and 1 (1.7%) in the full and reduced-dose anticoagulant groups (<em>P</em> = .35), respectively. The median follow-up time was 1.5 years (IQR, 1-3.1).</div></div><div><h3>Conclusion</h3><div>Older age and a history of previous bleeding were associated with the use of reduced-dose anticoagulants. Patients with cancer-associated VTE receiving reduced-dose anticoagulants had a numerically higher risk of recurrent VTE and lower bleeding outcomes compared with those receiving full-dose anticoagulants.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"9 1","pages":"Article 102643"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932615","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":"Andexanet alfa: trials just leave us with more questions","authors":"Richard J. Buka","doi":"10.1016/j.rpth.2024.102628","DOIUrl":"10.1016/j.rpth.2024.102628","url":null,"abstract":"<div><div>Andexanet Alfa in Acute Intracranial Hemorrhage in Patients Receiving an Oral Factor Xa Inhibitor (ANNEXA-I), the first ever randomized controlled trial of a reversal agent for direct oral anticoagulants, was published in 2024. The trial, which randomized patients with intracranial hemorrhage to andexanet alfa or usual care, was mandated by the United States Food and Drug Administration as part of its conditional approval in 2018. This approval was originally based on the single-arm trial, The Andexanet Alfa, a Novel Antidote to the Anticoagulation Effects of Factor Xa Inhibitors (ANNEXA-4). ANNEXA-I was stopped early for benefit and showed a reduction in the number of patients with significant hematoma expansion. However, the study was not powered for clinical endpoints such as disability or death and showed no difference in these outcomes. It did, however, show an increased risk of thrombosis, predominantly stroke with andexanet alfa. In this perspective, I reflect on some of the key criticisms of the trial and the implications for its interpretation.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"9 1","pages":"Article 102628"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11760292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047731","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":"Transfusion in trauma: empiric or guided therapy?","authors":"Liam Barrett ,&nbsp;Nicola Curry","doi":"10.1016/j.rpth.2024.102663","DOIUrl":"10.1016/j.rpth.2024.102663","url":null,"abstract":"<div><div>A state of the art lecture titled “Transfusion therapy in trauma—what to give? Empiric vs guided” was presented at the International Society on Thrombosis and Haemostasis Congress in 2024. Uncontrolled bleeding is the commonest preventable cause of death after traumatic injury. Hemostatic resuscitation is the foundation of contemporary transfusion practice for traumatic bleeding and has 2 main aims: to immediately support the circulating blood volume and to treat/prevent the associated trauma-induced coagulopathy. There are 2 broad types of hemostatic resuscitation strategy: empiric ratio-based therapy, often using red blood cells and fresh frozen plasma in a 1:1 ratio, and targeted therapy where the use of platelets, plasma, or fibrinogen is guided by laboratory or viscoelastic hemostatic tests. There are benefits, and limitations, to each strategy and neither approach has yet been shown to improve outcomes across all patient groups. Questions remain, and future directions for improving transfusion therapy are likely to require novel approaches that have greater flexibility to evaluate and treat heterogeneous trauma cohorts. Such approaches may include the integration of machine learning technologies in clinical systems, with real-time linkage of clinical and laboratory data, to aid early recognition of patients at the greatest risk of bleeding and to direct and individualize transfusion therapies. Greater mechanistic understanding of the underlying pathobiology of trauma-induced coagulopathy and the direct effects of common treatments on this process will be of equal importance to the development of new treatments. Finally, we summarize relevant new data on this topic presented at the 2024 ISTH Congress.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"9 1","pages":"Article 102663"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067431","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":"Validation of the 5-SNP score for the prediction of venous thromboembolism in a Danish fast-track cohort of 6789 total hip and total knee arthroplasty patients","authors":"Mark J.R. Smeets ,&nbsp;Pelle B. Petersen ,&nbsp;Christoffer C. Jørgensen ,&nbsp;Suzanne C. Cannegieter ,&nbsp;Sisse R. Ostrowski ,&nbsp;Henrik Kehlet ,&nbsp;Banne Nemeth","doi":"10.1016/j.rpth.2024.102644","DOIUrl":"10.1016/j.rpth.2024.102644","url":null,"abstract":"<div><h3>Background</h3><div>Venous thromboembolism (VTE) is a serious complication following total hip arthroplasty (THA) and total knee arthroplasty (TKA). Despite improvements with fast-track treatment protocols, 0.5% of patients still develop a VTE within 90-days postoperatively. Previously, the 5-single nucleotide polymorphism (SNP) genetic risk scores (weighted and simplified) were developed to identify people at a high risk for VTE within the general population.</div></div><div><h3>Objectives</h3><div>We aimed to assess whether the 5-SNP scores could be used to identify high-risk patients in a cohort of fast-track THA/TKA patients.</div></div><div><h3>Methods</h3><div>A subset of patients from the Lundbeck Centre for Fast-track Hip and Knee Replacement Database was included based on the availability of genetic information. The 5-SNP scores were calculated for these patients, and their discriminatory performance was determined by c-statistic. Furthermore, the 5-SNP scores were added to a simple logistic prediction model containing clinical predictors to assess the added predictive value.</div></div><div><h3>Results</h3><div>A total of 7753 THA and TKA procedures (6798 patients) were included in this study. The c-statistics for the weighted and simple 5-SNP scores were 0.50 (95% CI, 0.39-0.61) and 0.48 (95% CI, 0.38-0.58), respectively. For the model with clinical predictors, the c-statistic was 0.67 (95% CI, 0.56-0.77). Addition of either of the 5-SNP scores did not improve discrimination in this model.</div></div><div><h3>Conclusion</h3><div>These findings do not support genetic risk profiling in fast-track THA/TKA patients to predict VTE. Hence, efforts should be directed at optimizing prediction models with clinical predictors.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"9 1","pages":"Article 102644"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11731481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984634","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":"Intermediate-dose immune tolerance induction outperforms with faster success, less bleeding, and no added cost in comparison with low dose: a multicenter randomized clinical trial","authors":"Zhengping Li ,&nbsp;Zekun Li ,&nbsp;Xiaoling Cheng ,&nbsp;Heng Zhang ,&nbsp;Can Yang ,&nbsp;Qian Xu ,&nbsp;Zhenping Chen ,&nbsp;Yingzi Zhen ,&nbsp;Gang Li ,&nbsp;Guoqing Liu ,&nbsp;Wanru Yao ,&nbsp;Min Zhou ,&nbsp;Jiao Jin ,&nbsp;Jie Huang ,&nbsp;Yongjun Fang ,&nbsp;Liangzhi Xie ,&nbsp;Man-Chiu Poon ,&nbsp;Runhui Wu","doi":"10.1016/j.rpth.2024.102639","DOIUrl":"10.1016/j.rpth.2024.102639","url":null,"abstract":"<div><h3>Background</h3><div>Low-dose (LD) or intermediate-dose (MD) immune tolerance induction (ITI) is effective in children with severe hemophilia A (SHA) with high-titer inhibitors (HTIs) and is attractive in countries with economic constraints. However, high-quality evidence of their use is lacking.</div></div><div><h3>Objectives</h3><div>This was a multicenter randomized clinical trial comparing the efficacy, safety, and medication cost between LD-ITI and MD-ITI for SHA-HTI children.</div></div><div><h3>Methods</h3><div>Children with SHA aged &lt;8 years with historical/pre-ITI inhibitor titer 5 to 200 Bethesda Units/mL in 3 centers were randomized 1:1 to receive LD-ITI (recombinant factor VIII [rFVIII] 50 IU/kg every other day) or MD-ITI (rFVIII 100 IU/kg/d) from January 2022 to June 2024 (ChiCTR2200056603, <span><span>https://www.chictr.org.cn</span><svg><path></path></svg></span>).</div></div><div><h3>Results</h3><div>Thirty-one patients (16 in MD-ITI and 15 in LD-ITI) were enrolled and followed for &gt;24 months (median, 26.9; range, 24.0-29.5 months). The 2 groups had similar baseline clinical characteristics and similar success rates (93.8% [MD-ITI] vs 86.7% [LD-ITI]). Compared with LD-ITI, MD-ITI patients took a shorter median time to success (4.2 months vs 10.1 months) and partial success (2.7 months vs 6.6 months) and had lower mean rates for all bleeding (0.38/mo vs 1.40/mo) and joint bleeding (0.11/mo vs 0.83/mo). Between the 2 groups, although the MD-ITI group had higher rFVIII consumption (12,775 vs 7680 IU/kg), their total medication costs to success were similar (3626.49 vs 3240.38 US$/kg).</div></div><div><h3>Conclusion</h3><div>For SHA-HTI children, the success rate and cost for MD-ITI and LD-ITI regimens were similar. MD-ITI regimen would be a priority for regions with economic constraints, considering the shorter time to success, better bleeding control, and no increase in medication cost.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"9 1","pages":"Article 102639"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984631","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":"Management of patients with venous thromboembolism and a high recurrence risk estimated by the Vienna Prediction Model: a prospective cohort study","authors":"Hana Šinkovec ,&nbsp;Paul A. Kyrle ,&nbsp;Lisbeth Eischer ,&nbsp;Paul Gressenberger ,&nbsp;Thomas Gary ,&nbsp;Marianne Brodmann ,&nbsp;Georg Heinze ,&nbsp;Sabine Eichinger","doi":"10.1016/j.rpth.2024.102649","DOIUrl":"10.1016/j.rpth.2024.102649","url":null,"abstract":"<div><h3>Background</h3><div>The Vienna Prediction Model (VPM) identifies patients with a first unprovoked deep vein thrombosis of the leg and/or pulmonary embolism who have a low recurrence risk and may, therefore, not benefit from extended-phase anticoagulation.</div></div><div><h3>Objectives</h3><div>The aim of this study was to evaluate patients with a predicted high risk of recurrent venous thromboembolism (VTE).</div></div><div><h3>Methods and Results</h3><div>We prospectively followed 266 patients in whom the VPM had predicted a recurrence risk of more than 5.5% at 1 year for a median of 13.5 months. Their median age was 56 years, and 96% were men. After the VPM risk assessment, 196 patients restarted anticoagulation. While on anticoagulation, none of the patients experienced recurrent VTE, whereas 4 patients had nonmajor clinically relevant bleeding (absolute bleeding rate, 1.8 [95% CI, 0.5-4.5] events per 100 patient-years). Seventy patients were left untreated after VPM risk assessment for various reasons. Among patients not using anticoagulation, 15 had recurrence (absolute recurrence rate, 18.1 [95% CI, 10.1, 29.9] events per 100 person-years). According to the extended Kaplan–Meier analysis, the probability of VTE recurrence in patients not on anticoagulation was 10.1% and 17.9% at 6 and 12 months after VPM risk assessment, respectively.</div></div><div><h3>Conclusion</h3><div>Anticoagulant therapy is effective and safe in patients with an unprovoked VTE, in whom the VPM had predicted a high risk of recurrent VTE. If these patients are left untreated, the risk of recurrence is high.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"9 1","pages":"Article 102649"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11742295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143010680","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":"Time trends of catheter-directed treatment in acute pulmonary embolism in Germany","authors":"Karsten Keller ,&nbsp;Frank P. Schmidt ,&nbsp;Ioannis T. Farmakis ,&nbsp;Stefano Barco ,&nbsp;Karl Fengler ,&nbsp;Maike Knorr ,&nbsp;Tommaso Gori ,&nbsp;Thomas Münzel ,&nbsp;Philipp Lurz ,&nbsp;Lukas Hobohm","doi":"10.1016/j.rpth.2024.102651","DOIUrl":"10.1016/j.rpth.2024.102651","url":null,"abstract":"<div><h3>Background</h3><div>Catheter-directed treatment (CDT) is an innovative treatment for patients with elevated risk pulmonary embolism (PE) to resolve embolus and restore pulmonary perfusion.</div></div><div><h3>Objectives</h3><div>We aimed to analyse the use and the benefit of CDT in PE patients in Germany.</div></div><div><h3>Methods</h3><div>The German nationwide inpatient sample was used to include all hospitalizations of patients with PE from 2005 to 2020 in Germany. PE patients were stratified for CDT usage. Temporal trends and the impact of CDT on case fatality and other outcomes were investigated.</div></div><div><h3>Results</h3><div>Overall, 1,373,084 hospitalizations of patients with PE (55.9% aged ≥70 years; 53.0% females) were included in this study from 2005 to 2020, and among these, 427,238 (31.1%) patients were categorized as having elevated-risk PE and 3330 (0.2%) were treated with CDT with annual increase from 0.17% (2005) to 0.51% (2020). PE patients of younger age, male sex, with previous surgery, and elevated-risk PE were more often treated with CDT. In patients with elevated risk-PE, CDT attributed to a lower observed rate of major adverse cardiac and cerebrovascular events (major adverse cardiac and cerebrovascular events [MACCE]; 28.2% vs 34.2%; <em>P</em> &lt; .001) and in-hospital case fatality (24.9% vs 31.0%; <em>P</em> &lt; .001). CDT was associated with reduced MACCE (OR, 0.91; 95% CI, 0.83-0.99) and with a trend toward lower case fatality (OR, 0.92; 95% CI, 0.84-1.01). The benefit of CDT regarding case fatality was age-dependent.</div></div><div><h3>Conclusion</h3><div>Although the annual rate of CDT increased in Germany between 2005 and 2020, only 0.2% of the PE patients were treated with CDT. Selection criteria for CDT treatment were younger age, male sex, previous surgery, and elevated risk-PE. CDT treatment was associated with reduced MACCE and case-fatality rate in PE patients with elevated-risk PE.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"9 1","pages":"Article 102651"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11743116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143010683","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":"Histologic evidence of neutrophil extracellular traps and fibrin(ogen) deposition in liver biopsies from patients with inflammatory liver disease","authors":"Fien A. von Meijenfeldt ,&nbsp;Ton Lisman ,&nbsp;Alessandra Pacheco ,&nbsp;Yoh Zen ,&nbsp;William Bernal","doi":"10.1016/j.rpth.2024.102666","DOIUrl":"10.1016/j.rpth.2024.102666","url":null,"abstract":"<div><h3>Background</h3><div>Liver disease is often characterized by the activation of coagulation and inflammation. Experimental studies suggest that the interaction between neutrophils and platelets with local activation of coagulation could contribute to liver injury progression, but there have been limited studies in humans.</div></div><div><h3>Objectives</h3><div>We studied the hemostatic components and neutrophil extracellular traps (NETs) in liver biopsies from patients with different inflammatory liver diseases.</div></div><div><h3>Methods</h3><div>Liver biopsies from patients with inflammatory liver disease (alcoholic steatohepatitis [ASH], autoimmune hepatitis, primary sclerosing cholangitis, metabolic-associated steatohepatitis, and allograft ischemia-reperfusion injury (IRI), each <em>n</em> = 20) were stained for fibrin(ogen), platelets, and NETs. The correlation of NET formation with deposition of hemostatic components and laboratory measures of disease severity was investigated.</div></div><div><h3>Results</h3><div>In 75% of the liver biopsies, no fibrin(ogen) was detectable, and only 20% of the biopsies showed minimal deposition. Overall, 50% of liver biopsies stained positive for NETs. Platelet deposition and NET formation were highest in IRI, where it correlated with histologic severity of injury (r = .61 [95% CI, .22-.84]; <em>P</em> &lt; .01) and ASH. Platelet deposition was associated with NET formation (r = .44 [95% CI, .27-.59]; <em>P</em> &lt; .001) and colocalized in the biopsies. NET formation, but not fibrin and platelet deposition, was moderately associated with the model of end-stage liver disease score (r = .29 [95% CI, .07-.49]; <em>P</em> &lt; .01).</div></div><div><h3>Conclusion</h3><div>In contrast to experimental studies, we demonstrated minimal intrahepatic fibrin(ogen) deposition in different types of human inflammatory liver disease. Histologic evidence for intrahepatic NETs was common and most pronounced in acute ASH and IRI and was associated with platelet deposition and disease severity.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"9 1","pages":"Article 102666"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143156206","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}