Seminars in thrombosis and hemostasis最新文献

From Puerperal Fever to Ovarian Vein Thrombosis: An Historical Journey and Contemporary Challenges in Diagnosis and Management. 从产褥热到卵巢静脉血栓：诊断和治疗的历史历程和当代挑战。

IF 4.1 2区医学

Seminars in thrombosis and hemostasis Pub Date : 2025-07-29 DOI: 10.1055/a-2651-7717

Elvira Grandone, Francesco Marongiu, Doris Barcellona

{"title":"From Puerperal Fever to Ovarian Vein Thrombosis: An Historical Journey and Contemporary Challenges in Diagnosis and Management.","authors":"Elvira Grandone, Francesco Marongiu, Doris Barcellona","doi":"10.1055/a-2651-7717","DOIUrl":"10.1055/a-2651-7717","url":null,"abstract":"Puerperal sepsis (PPS) is a severe postpartum infection that remains a significant maternal health concern. Recent evidence suggests a potential link between PPS and ovarian vein thrombosis (OVT), a rare but life-threatening complication occurring in 0.01 to 0.18% of pregnancies. Despite the historical significance of PPS and its well-documented consequences, its association with thrombosis remains underrecognized in obstetric practice. This narrative review explores the historical context, clinical presentation, diagnosis, and management of PPS and OVT while emphasizing the need for increased awareness and preventive strategies. Sepsis triggers a hypercoagulable state through inflammatory cytokine release, endothelial injury, and coagulation activation, contributing to thrombotic complications such as OVT. The right ovarian vein is more commonly affected due to anatomical factors, including uterine dextrorotation during pregnancy. OVT typically presents with abdominal pain and fever, requiring imaging modalities such as Doppler ultrasound and magnetic resonance imaging for diagnosis. Although anticoagulation therapy is widely used for deep vein thrombosis, its application in OVT remains inconsistent, despite comparable recurrence rates between the two conditions. The review also highlights the lack of consensus on thromboprophylaxis in septic postpartum patients. Although guidelines from major obstetric organizations are inconsistent, emerging evidence suggests that low-molecular-weight heparins may reduce thrombotic risk in PPS. In the absence of large-scale randomized trials, observational studies remain essential for guiding clinical decisions.","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Evolution of Clinical Trials in Anticoagulation for Sepsis: Bridging Past to Future. 败血症抗凝治疗临床试验的演变：连接过去与未来。

IF 4.1 2区医学

Seminars in thrombosis and hemostasis Pub Date : 2025-07-29 DOI: 10.1055/a-2657-6380

Toshiaki Iba, Julie Helms, Cheryl L Maier, Ricard Ferrer, Jerrold H Levy

{"title":"Evolution of Clinical Trials in Anticoagulation for Sepsis: Bridging Past to Future.","authors":"Toshiaki Iba, Julie Helms, Cheryl L Maier, Ricard Ferrer, Jerrold H Levy","doi":"10.1055/a-2657-6380","DOIUrl":"https://doi.org/10.1055/a-2657-6380","url":null,"abstract":"Demonstrating the efficacy of new treatments in any condition may be a challenging endeavor, and is particularly the case in sepsis. In the early 21st century, recombinant activated protein C showed a survival benefit in severe sepsis; however, subsequent studies could not replicate these results, leading to the discontinuation of this agent. Several potential reasons have been proposed for the unfavorable results of trials, including choosing an inappropriate outcome target. Concerning anticoagulant therapies, some studies have targeted sepsis with disseminated intravascular coagulation (DIC) and demonstrated clinical benefits, while other studies have focused on severe sepsis or septic shock independent of whether patients had DIC. The timing for treatment initiation, dosage, and duration of anticoagulant agents could be significant factors contributing to the limitations faced in these trials. Moreover, relying solely on 28-day mortality as the primary endpoint for sepsis trials may not be appropriate, as it can be influenced by various factors beyond anticoagulant therapies, and discernment in a shorter period might be more pertinent. Success in clinical trials is more likely if these issues are addressed and improvements are made. Recent clinical trials concentrating on anticoagulants are increasingly targeting sepsis or septic shock with coagulopathy, and adopting composite endpoints, including DIC resolution, is anticipated to overcome some of these challenges.","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144744624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Transfusion-dependent thalassemia and venous thromboembolism: Position Statement from the Steering Committees of Hemostasis and Erythrocyte & Hemoglobinopathies study groups -Hellenic Society. 输血依赖性地中海贫血和静脉血栓栓塞：止血和红细胞及血红蛋白病研究小组指导委员会的立场声明-希腊学会。

IF 4.1 2区医学

Seminars in thrombosis and hemostasis Pub Date : 2025-07-29 DOI: 10.1055/a-2669-7739

Vasiliki Danilatou, Emmanouil Papadakis, Elias Kyriakou, Efrosyni Nomikou, Sophia Delicou, Fotios Girtovitis

{"title":"Transfusion-dependent thalassemia and venous thromboembolism: Position Statement from the Steering Committees of Hemostasis and Erythrocyte & Hemoglobinopathies study groups -Hellenic Society.","authors":"Vasiliki Danilatou, Emmanouil Papadakis, Elias Kyriakou, Efrosyni Nomikou, Sophia Delicou, Fotios Girtovitis","doi":"10.1055/a-2669-7739","DOIUrl":"https://doi.org/10.1055/a-2669-7739","url":null,"abstract":"Venous thromboembolism is often under-estimated in transfusion dependent thalassemia (TDT) patients, as arterial thrombotic events are more commonly observed. Although therapeutic advancements have transformed this disease from a once-fatal childhood disease into a manageable chronic condition, some treatments may contribute to an increased risk of thrombosis. Additionally, the prolonged life expectancy of these patients further contributes to the overall thrombotic risk. Patients with thalassemia major present multiple challenges when considering anticoagulation therapy. The decision-making process is complicated by a delicate balance between thrombotic risk-driven by disease-related and treatment-associated factors-and potential bleeding tendencies, particularly in the presence of comorbid conditions such as liver dysfunction, hypersplenism, or thrombocytopenia. Therefore, ongoing assessment of both thrombotic and bleeding risk and the implementation of appropriate preventive strategies are essential to optimize patient outcomes. This document presents a consensus statement from the Steering Committee of the Hemostasis Working Group of the Hellenic Society of Hematology, offering guidance on thromboprophylaxis and anticoagulation management in adult TDT patients.","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144744625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

COVID-19 and Anticoagulant Use: Did the Pandemic Push DOACs Ahead of Warfarin? COVID-19和抗凝血剂的使用：大流行是否使DOACs领先于华法林？

IF 4.1 2区医学

Seminars in thrombosis and hemostasis Pub Date : 2025-07-28 DOI: 10.1055/a-2667-6770

Bingwen Eugene Fan, Jia Hui Melissa Tan, Doreen Su-Yin Tan

{"title":"COVID-19 and Anticoagulant Use: Did the Pandemic Push DOACs Ahead of Warfarin?","authors":"Bingwen Eugene Fan, Jia Hui Melissa Tan, Doreen Su-Yin Tan","doi":"10.1055/a-2667-6770","DOIUrl":"https://doi.org/10.1055/a-2667-6770","url":null,"abstract":"The COVID-19 pandemic introduced unprecedented disruptions to healthcare delivery, compelling rapid adaptations in anticoagulation management. Direct oral anticoagulants (DOACs), already displacing warfarin due to their convenience and reduced monitoring requirements, appeared well-positioned for broader adoption during pandemic-induced lockdowns. This commentary examines whether the pandemic catalyzed a meaningful shift in anticoagulant prescribing patterns from vitamin K antagonists (VKAs) to DOACs, drawing on data from the United Kingdom, Australia, the United States, Europe, and Asia. In the UK, national guidance led to an abrupt and large-scale switch to DOACs, with sustained changes post-pandemic. In contrast, Australia and the US exhibited continuity in pre-existing trends, with modest, transient shifts that did not persist. Asian and European data revealed a gradual trajectory toward DOACs, likely driven by long-term policy and infrastructure rather than acute pandemic pressures. While no universal transformation occurred, the pandemic accentuated existing preferences and exposed system-level vulnerabilities in warfarin monitoring. The global experience suggests that the COVID-19 crisis served as a selective accelerant of DOACs adoption where healthcare systems and policies facilitated change. As health systems prepare for future disruptions, equitable access to DOACs and investment in remote care infrastructure will be essential to ensuring continuity and safety in anticoagulation therapy.","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144732958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Lupus Anticoagulant-hypoprothrombinemia Syndrome: A Review Enriched by a New Particular Patient. 狼疮抗凝血-低凝血酶原血症综合征：一个新的特殊患者丰富的回顾。

IF 4.1 2区医学

Seminars in thrombosis and hemostasis Pub Date : 2025-07-25 DOI: 10.1055/a-2657-6291

Doris Barcellona, Antonella Mameli, Roberta Montisci, Patol Maria Filomena Clin Ruberto, Patol Lara Clin Fenu, Francesco Marongiu

{"title":"Lupus Anticoagulant-hypoprothrombinemia Syndrome: A Review Enriched by a New Particular Patient.","authors":"Doris Barcellona, Antonella Mameli, Roberta Montisci, Patol Maria Filomena Clin Ruberto, Patol Lara Clin Fenu, Francesco Marongiu","doi":"10.1055/a-2657-6291","DOIUrl":"https://doi.org/10.1055/a-2657-6291","url":null,"abstract":"Lupus anticoagulant-hypoprothrombinemia syndrome (LAHS) is a rare hemorrhagic disorder that should be differentiated from classical antiphospholipid syndrome. Literature review shows that LAHS may affect people at any age but approximately 40% are children younger than 10 years. Autoimmune and infectious diseases are the most frequent triggering causes, and the laboratory profile is characterized by a prolongation of prothrombin time (PT) and activated partial thromboplastin time (aPTT) with a mild to severe reduction in factor II levels. In more than half the patients, the other coagulation factors are normal, while anti-cardiolipin and anti-β2-glycoprotein I antibodies show a high titer. Lupus anticoagulant (LA) is positive in 100% of cases, as this represents a defining feature. The majority of patients have mucocutaneous bleeding events (44%); cerebral bleeding can occur in 10% of patients and other common bleeding sites are the gastrointestinal and genitourinary tracts. There is no standard treatment for LAHS. Supportive measures, such as fresh frozen plasma, packed red blood, and platelet transfusion, are frequently administered in association with steroids alone or in combination with intravenous immunoglobulin or cyclophosphamide, azathioprine, and rituximab. Death, recurrent bleeding, and thrombosis can occur in approximately 3, 13, and 14% of patients, respectively. Our patient was an old man with a myocardial infarction and a systemic infection from Candida parapsilosis. Thrombin generation and clot waveform analysis were performed before and after treatment. Thrombin generation better reflected the role of prothrombin, revealing that a factor II value of below around 15% can represent a risk for major bleeding. Treatment with methylprednisolone and three-factor human prothrombin complex concentrate allowed the patient to reach a complete recovery 1 month after initial diagnosis.","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144732959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Current Understandings on Biological Characteristics of Thrombolytics in Acute Ischemic Stroke. 急性缺血性脑卒中溶栓生物学特性的新认识。

IF 3.6 2区医学

Seminars in thrombosis and hemostasis Pub Date : 2025-07-25 DOI: 10.1055/a-2655-4120

Surasak Wichaiyo, Chuthamanee Suthisisang

{"title":"Current Understandings on Biological Characteristics of Thrombolytics in Acute Ischemic Stroke.","authors":"Surasak Wichaiyo, Chuthamanee Suthisisang","doi":"10.1055/a-2655-4120","DOIUrl":"10.1055/a-2655-4120","url":null,"abstract":"Acute ischemic stroke leads to rapid and progressive neuronal losses. Early revascularization with thrombolytics and/or endovascular thrombectomy plays an important role in salvaging brain infarction. Currently, alteplase and tenecteplase are approved thrombolytics for the treatment of acute ischemic stroke, whereas favorable outcomes of reteplase have recently been reported in a phase 3 clinical trial. These thrombolytics share common and distinct pharmacological characteristics, which contribute to their efficacy and safety in patients. In this review, biological profiles of alteplase, tenecteplase, and reteplase, including their advantages versus disadvantages in acute ischemic stroke, are discussed. Tenecteplase has high fibrin specificity, increased resistance to plasminogen activator inhibitor-1 (PAI-1), wider concentration-response curve, and less off-target activities, which support its efficacy with low incidence of symptomatic intracranial hemorrhage (sICH). Reteplase greatly penetrates into the clot with prolonged retention, generating durable clot lysis. This activity might be associated with its excellent clinical outcomes in patients, although reteplase is sensitive to PAI-1. Notably, reteplase and alteplase produce off-target activities by inducing hypofibrinogenemia and hypoplasminogenemia, which may increase risk of hemorrhagic transformation. Moreover, orolingual angioedema is a life-threatening complication of all thrombolytics. Mechanistically, an increase in plasmin by thrombolytics leads to bradykinin generation. In addition, plasmin activates mast cell degranulation (e.g., histamine release). Together, these biopharmacological data of thrombolytics promote insights into their clinical outcomes, and might provide comprehensive bases for future research.","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Red Blood Cell Extracellular Vesicles as Key Players in Thromboinflammation. 红细胞胞外囊泡在血栓炎症中的关键作用。

IF 4.1 2区医学

Seminars in thrombosis and hemostasis Pub Date : 2025-07-24 DOI: 10.1055/a-2664-0871

Denis F Noubouossie, Nigel S Key

引用次数: 0

Sudden Cardiac Arrest and Death in Sports: An Updated Overview of Epidemiology, Etiologies and Prevention Strategies, with Emphasis on Inherited Cardiomyopathies. 运动中的心脏骤停和死亡：流行病学、病因学和预防策略的最新综述，重点是遗传性心肌病。

IF 4.1 2区医学

Seminars in thrombosis and hemostasis Pub Date : 2025-07-24 DOI: 10.1055/a-2664-0950

Giorgia Beffagna, Fabian Sanchis-Gomar, Flavio Ribichini, Giuseppe Lippi

{"title":"Sudden Cardiac Arrest and Death in Sports: An Updated Overview of Epidemiology, Etiologies and Prevention Strategies, with Emphasis on Inherited Cardiomyopathies.","authors":"Giorgia Beffagna, Fabian Sanchis-Gomar, Flavio Ribichini, Giuseppe Lippi","doi":"10.1055/a-2664-0950","DOIUrl":"https://doi.org/10.1055/a-2664-0950","url":null,"abstract":"Sudden cardiac arrest (SCA) and sudden cardiac death (SCD) in sports, although rare, remain pressing concerns with rising global participation in athletics. Recent epidemiological analyses indicate that athlete SCA/SCD incidence is low and has remained relatively stable over the past two decades. However, outcomes have improved as survival rates increase, reflecting advances in emergency response. Key risk factors are well-established, such as male athletes face a markedly higher risk than females, older master athletes have higher SCD risk rates than those under 35 (largely due to acquired coronary artery disease), and certain high-intensity sports (e.g., basketball, American football, soccer, and endurance exercise) present higher SCA/SCD risk. In young competitive athletes, most SCDs are a consequence of undetected hereditary or congenital heart disorders. Predominant causes in this group include structural cardiomyopathies, such as hypertrophic cardiomyopathy and arrhythmogenic cardiomyopathy, and primary electrical diseases (channelopathies like long QT syndrome, Brugada syndrome, or catecholaminergic polymorphic ventricular tachycardia). Contrarily, occult atherosclerotic coronary disease becomes the leading cause of fatal events in master athletes. Multi-faceted prevention strategies have expanded in recent years. Pre-participation cardiac screening programs aim to detect at-risk individuals and have successfully prevented SCD. Equally important, widespread implementation of emergency action plans, including on-site automated external defibrillators and cardiopulmonary resuscitation training, has improved resuscitation outcomes. Heightened public awareness, catalyzed by high-profile on-field cardiac arrests, has catalyzed policy changes that mandate better cardiac screening and emergency preparedness. Collectively, these efforts are shaping a safer sporting environment and reducing the SCA/SCD risk in athletes.","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144732961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Postpartum Disseminated Intravascular Coagulation: A Comprehensive Review of Pathophysiology, Diagnosis, Management, and Prevention. 产后弥散性血管内凝血：病理生理学、诊断、管理和预防的综合综述。

IF 3.6 2区医学

Seminars in thrombosis and hemostasis Pub Date : 2025-07-18 DOI: 10.1055/a-2645-2845

Amir Wolfovitz, Benjamin Brenner, Ido Solt

{"title":"Postpartum Disseminated Intravascular Coagulation: A Comprehensive Review of Pathophysiology, Diagnosis, Management, and Prevention.","authors":"Amir Wolfovitz, Benjamin Brenner, Ido Solt","doi":"10.1055/a-2645-2845","DOIUrl":"https://doi.org/10.1055/a-2645-2845","url":null,"abstract":"Disseminated intravascular coagulation (DIC) in the postpartum period is a rare but potentially life-threatening complication arising from various obstetric conditions, including postpartum hemorrhage (PPH), placental abruption, intrauterine fetal demise (IUFD), and amniotic fluid embolism. This review explores pathophysiology, risk factors, diagnostic challenges, and management strategies of postpartum DIC. The delicate balance of hemostasis during pregnancy predisposes women to thromboembolic events, which, when disrupted, may lead to rapid consumption of coagulation factors and subsequent coagulopathy. The incidence of obstetric-related DIC varies globally, with higher rates reported in low-resource settings due to delayed diagnosis and management. Diagnostic criteria, including the International Society on Thrombosis and Haemostasis (ISTH), Japanese obstetric DIC, and pregnancy-specific DIC scores, are evaluated, emphasizing their applicability and limitations in obstetric practice. Preventive strategies, primarily targeting the early identification and treatment of PPH, are discussed, with particular focus on active management of the third stage of labor, the administration of uterotonic agents, and the use of antifibrinolytic medications like tranexamic acid. Timely recognition, standardized diagnostic protocols, and multidisciplinary management are essential for improving maternal outcomes and reducing the burden of postpartum DIC.","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparative Study of Venous Thromboembolic Prophylaxis Strategies for Patients with Ischemic Stroke: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. 缺血性脑卒中患者静脉血栓栓塞预防策略的比较研究：随机对照试验的系统评价和网络荟萃分析。

IF 3.6 2区医学

Seminars in thrombosis and hemostasis Pub Date : 2025-07-10 DOI: 10.1055/a-2635-2266

Changyi Wang, Maonan Han, Ling Ren, Yihan Wang, Qingchuan Wei, Ping Mou, Jing He

{"title":"Comparative Study of Venous Thromboembolic Prophylaxis Strategies for Patients with Ischemic Stroke: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.","authors":"Changyi Wang, Maonan Han, Ling Ren, Yihan Wang, Qingchuan Wei, Ping Mou, Jing He","doi":"10.1055/a-2635-2266","DOIUrl":"https://doi.org/10.1055/a-2635-2266","url":null,"abstract":"Venous thromboembolism (VTE), including deep vein thrombosis (DVT), and pulmonary embolism (PE), is a common complication in patients with ischemic stroke. Several prophylactic strategies are used to reduce the risk of VTE. However, there is still a lack of consensus on the optimal strategy due to the lack of randomized controlled trials (RCTs) directly comparing different interventions. The objective of this study was to explore the efficacy and safety of different thromboembolic prophylaxis strategies in patients with ischemic stroke. We conducted a systematic literature review to identify all eligible RCTs, searching MEDLINE and Embase up to December 31, 2024. We considered DVT and PE as efficacy outcomes and intracranial and extracranial hemorrhage as safety outcome measures. Relevant data were extracted for network meta-analyses. A random-effects model was used for the analysis. A total of 33 RCTs were included in the analysis. Network meta-analysis revealed that low-molecular-weight heparin (LMWH) and heparinoid were associated with significantly decreased risk of DVT and PE compared with no prophylaxis, with risk ratios of 0.18 (95% confidence interval: 0.10-0.32) and 0.36 (0.20-0.63), respectively. However, LMWH and heparinoid were associated with an increased risk of extracranial hemorrhage compared with no prophylaxis, with a risk ratio of 2.03 (1.24-3.34). Our study supports the use of LMWH and heparinoid as the primary thromboembolic prophylaxis measure in patients with acute ischemic stroke. Further, high-quality RCTs are needed to strengthen the evidence base and determine the optimal prophylactic strategy in these patients.","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0