Seminars in thrombosis and hemostasis最新文献

{"title":"Automation in Platelet Function Testing: Current Challenges and Future Directions.","authors":"Federico Boggio, Juri A Giannotta, Anna Lecchi","doi":"10.1055/a-2622-3545","DOIUrl":"10.1055/a-2622-3545","url":null,"abstract":"<p><strong>Abstract: </strong>Platelet function testing is essential for diagnosing and managing platelet function disorders, but faces significant challenges due to complex protocols and variability in results. While light transmission aggregometry remains the gold standard for assessing platelet aggregation, it suffers from several limitations, including labor-intensive protocols, variability in reagents, and poor standardization. Over the decades, improvements such as lumi-aggregometry, which integrates granule secretion testing, and impedance whole-blood aggregometry, which simplifies sample handling, have addressed some of these challenges. Advanced granule secretion assays, including high-performance liquid chromatography and flow cytometry, have further enhanced diagnostic capabilities, although these techniques still depend on specialized expertise and expensive equipment. Recently, significant advancements have been made with automated aggregometers, such as the Sysmex CS series, and high-throughput 96-well plate assays, which improve consistency, throughput, and reproducibility. Nonetheless, further refinement in standardized reagents and consensus-driven protocols is required. Microfluidic technologies, exemplified by systems like the Total Thrombus Analysis System (T-TAS), incorporate physiological shear conditions and real-time thrombus formation assessment, providing enhanced diagnostic insights into platelet behavior. Despite their automation and clinical feasibility, these flow-based systems still require broader validation for routine clinical implementation. Further developments should prioritize integrating complementary assays, enhancing automation, and advancing miniaturization to improve standardization and diagnostic accuracy. Future technologies combined with artificial intelligence-based data interpretation hold the promise to transform platelet diagnostics, enabling personalized patient care. However, achieving widespread clinical adoption requires ongoing collaboration between clinicians, laboratories, industry, and regulatory bodies.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":"945-955"},"PeriodicalIF":4.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161585","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}

{"title":"Improving Lupus Anticoagulant Detection in Heparinized Patients: An Automated Heparin-Resistant Recalcifying Solution.","authors":"Agathe Herb, Nathan Drouin, Amélie Rist, Jordan Wimmer, Laurent Mauvieux, Laurent Sattler","doi":"10.1055/a-2701-0113","DOIUrl":"10.1055/a-2701-0113","url":null,"abstract":"","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":"991-995"},"PeriodicalIF":4.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145178043","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}

{"title":"Bridging the Gap in Laboratory Monitoring of Extended Half-Life Factor VIII and IX: Can Thrombin Generation Assays Overcome Assay Discrepancies?","authors":"Monica Sacco, Raimondo De Cristofaro, Stefano Lancellotti","doi":"10.1055/a-2900-6892","DOIUrl":"10.1055/a-2900-6892","url":null,"abstract":"<p><strong>Abstract: </strong>The management of hemophilia A has been transformed by the introduction of extended half-life factor VIII (EHL-FVIII) products. Similarly, the development of extended half-life factor IX (EHL-FIX) products has also impacted the treatment of hemophilia B, improving treatment adherence and reducing bleeding episodes. These bioengineered molecules, created through Fc-fusion, PEGylation, single-chain technologies, or albumin conjugation (particularly for FIX), offer patients reduced infusion frequency while maintaining effective bleed protection. However, the structural modifications of both EHL-FVIII and EHL-FIX pose significant challenges for accurate laboratory monitoring. Traditional one-stage and chromogenic substrate assays often yield discrepant results, varying by reagent, analytical platforms, and product type, complicating clinical decision-making and pharmacokinetic assessments. The thrombin generation assay (TGA) has emerged as a powerful global hemostasis tool that provides a functional readout of a patient's overall coagulation potential. By measuring the enzymatic capacity to generate thrombin over time, TGA offers a more integrated view of hemostatic efficacy than conventional factor activity tests. Although promising, TGA remains limited by lack of standardization, interplatform variability, and absence of validated clinical thresholds. Current data support its use as a complementary tool rather than a replacement for conventional assays. Future prospective studies integrating laboratory and clinical endpoints are required to define its role in precision hemophilia care and to determine whether TGA can better reflect bleeding phenotype and guide individualized therapy. Ultimately, the integration of functional assays into clinical practice will depend on harmonization efforts and demonstration of added clinical value in real-world settings and trials.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":"937-944"},"PeriodicalIF":4.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148382660","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}

{"title":"A Comparative In Vitro Study of the Anticoagulant Effects of Branded versus Biosimilar Preparations of Enoxaparin.","authors":"Luca Sammut, Kevin Vella, Steve Kitchen, Kieron Hickey, Denise Borg-Aquilina, Alexander Gatt, Nicoletta Riva","doi":"10.1055/a-2971-6729","DOIUrl":"https://doi.org/10.1055/a-2971-6729","url":null,"abstract":"<p><strong>Abstract: </strong>Several biosimilars of the low-molecular-weight heparin enoxaparin are available on the market, but no studies have compared the effects of branded versus biosimilar enoxaparin on coagulation assays. The aim of this study was to compare the in vitro anticoagulant effects of the branded enoxaparin (Clexane) and three biosimilar versions (Critinox, Inhixa, and Qnox) on a panel of coagulation assays. A platelet-poor plasma pool was spiked with five concentrations of four different enoxaparins (range 0.2-2.0 IU/mL). These were measured using the chromogenic anti-Xa assay and chromogenic anti-IIa assay. The following coagulation assays were performed in duplicates for each enoxaparin preparation: prothrombin time (PT), activated partial thromboplastin time (aPTT), PT-derived fibrinogen, Clauss fibrinogen, thrombin time (TT), dilute Russell's viper venom time (dRVVT) screen and confirm, one-stage factors VII, VIII, and IX, and chromogenic assays for factors VIII and IX. Positive correlations were observed between increasing concentrations of the different enoxaparins and PT, aPTT, TT, and dRVVT screen and confirm. Negative correlations were observed with all one-stage factor assays and chromogenic FVIII. No consistent correlation was observed for the fibrinogen assays and chromogenic FIX. All enoxaparin preparations had an estimated mean anti-Xa:anti-IIa activity ratio between 3.12:1 and 3.92:1. There were no statistically significant differences between the four preparations of enoxaparin. This study showed that branded and biosimilar versions of enoxaparin exhibited very similar in vitro anticoagulant effects across the coagulation assay panel tested.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138183","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}

{"title":"What Stops Menstrual Bleeding? Hemostatic Mechanisms in the Menstruating Endometrium.","authors":"Raphaelle Dodart, David N Ku","doi":"10.1055/a-2967-9335","DOIUrl":"https://doi.org/10.1055/a-2967-9335","url":null,"abstract":"<p><strong>Abstract: </strong>Menstrual bleeding is one of the most common physiological bleeding events in humans, yet the mechanisms that terminate bleeding remain poorly defined. Current models of menstruation focus primarily on progesterone withdrawal, inflammation, vascular changes, tissue breakdown, local coagulation and fibrinolysis, and endometrial repair. However, considerably less is known about how hemostasis is controlled at individual bleeding vessels exposed during endometrial shedding. The functional endometrium is supplied by spiral arterioles that terminate in a dense capillary network, and their distal segments are disrupted during menstruation. Control of bleeding may depend on several interacting mechanisms, including uterine contraction, vascular tone, platelet-mediated primary hemostasis, coagulation, fibrin stabilization, fibrinolysis, and rapid tissue repair. Importantly, the relative contribution of these mechanisms depends on local hemodynamics. In arterial and arteriolar vessels, high shear rates trigger primary hemostasis through von Willebrand factor (VWF)-mediated platelet adhesion, also known as shear-induced platelet aggregation. This review examines current evidence on menstrual hemostasis and considers how vascular anatomy and hemodynamics may influence the mechanisms available to stop bleeding at the exposed endometrial surface. The flow conditions at bleeding spiral arterioles during menstruation have not been directly characterized. Defining these conditions may help determine how uterine contraction, platelet-VWF interactions, coagulation, and fibrinolysis interact to limit physiological menstrual blood loss and how disruption of this balance may contribute to heavy menstrual bleeding.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128610","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}

{"title":"How Do Muscles Protect Joints in Hemophilia? Integrating Mechanical, Neural, and Endocrine Mechanisms.","authors":"Carlos Cruz-Montecinos, Joaquín Calatayud, Rodrigo Núñez-Cortés, Daniel C Ogrezeanu, Andrea Tur-Boned, Fangxin Xiao, Verónica Soto-Arellano, Lars L Andersen, Huub Maas","doi":"10.1055/a-2788-1715","DOIUrl":"10.1055/a-2788-1715","url":null,"abstract":"<p><strong>Abstract: </strong>People with hemophilia (PwH) face persistent joint damage risk despite prophylactic factor replacement therapies. Although muscles are recognized as biomechanical stabilizers, their broader protective mechanisms remain poorly understood. This review provides an integrative theoretical framework that examines how muscles protect joints in PwH through three interconnected dimensions: (1) mechanical-via joint stabilization and force absorption; (2) neuromuscular control; and (3) biochemical regulation through exercise-induced myokines (exerkines). Muscle contractions provide joint stabilization and attenuate mechanical impacts via eccentric actions and muscle-tendon buffering, thereby reducing joint loading during daily activities. Neuromuscular control maintains joint stability through coordinated muscle activation, though excessive co-contraction in arthropathy can paradoxically increase joint stress. Critically, the endocrine function of skeletal muscle, producing anti-inflammatory and cartilage-protective exerkines including interleukin-6, irisin, and lubricin (among others), represents an underexplored yet crucial protective mechanism. Physical inactivity and intramuscular fat accumulation impair these protective functions, accelerating joint degeneration. This integrative theoretical perspective offers a comprehensive framework for understanding how muscles protect joints in hemophilia. Understanding these integrated mechanisms is essential for developing targeted rehabilitation strategies and guiding future research to optimize joint health in PwH.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":"816-826"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145985383","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}

{"title":"Blood Flow Restriction Training in Athletes: Endothelial Phenotype, Thromboembolism Risk, and Tailored Safety Protocols.","authors":"Dahan da Cunha Nascimento, Karla Helena Coelho Vilaça E Silva","doi":"10.1055/a-2863-5770","DOIUrl":"10.1055/a-2863-5770","url":null,"abstract":"<p><strong>Abstract: </strong>Low-load blood flow restriction (LLBFR) training has gained traction as a rehabilitation and performance tool, offering muscle strength and hypertrophy adaptations comparable to high-load resistance training while minimizing joint and tissue stress. However, its application in athletes at risk for venous thromboembolism, post-thrombotic syndrome (PTS), inherited thrombophilia, and special populations (pregnant competitive female athletes and paralympic athletes with spinal cord injury) raises safety concerns. This narrative review synthesizes evidence on LLBFR's hemodynamic and endothelial effects, highlighting pressure-dependent basal lamina thickening, impaired flow-mediated dilation, and transient elevations in peripheral venous pressure. It emphasizes the importance of pre-exercise risk stratification, genetic screening for factor V Leiden and prothrombin mutations, and assessment of cardiovascular and coagulation markers. For athletes with confirmed deep vein thrombosis, PTS, or multiple risk factors, LLBFR should be contraindicated. In paralympic athletes with spinal cord injury, stringent exclusion criteria (e.g., severe autonomic dysreflexia, pressure ulcers) are essential, whereas female athletes may require individualized monitoring of coagulation changes during oral contraceptive use and pregnancy. Although LLBFR shows promise for preserving muscle function when traditional loading is impractical, robust, large-scale studies measuring thrombogenesis and fibrinolysis markers are urgently needed. Tailored protocols that balance musculoskeletal benefits against thrombotic risks will ensure safe, effective implementation across diverse athlete populations.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":"827-836"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780066","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}

{"title":"Platelet Function: Acute versus Chronic Responses to Physical Exercise: A Review.","authors":"Apostolos Z Skouras, Andreas G Tsantes, Panagiotis Koulouvaris","doi":"10.1055/a-2687-8546","DOIUrl":"10.1055/a-2687-8546","url":null,"abstract":"<p><strong>Abstract: </strong>Platelets play a central role in primary hemostasis and arterial thrombosis, and accumulating evidence suggests that physical exercise can modulate platelet function. Acute vigorous or exhaustive bouts commonly produce transient thrombocytosis, enhanced aggregation and degranulation (e.g., P-selectin, β-TG, and PF4), increased thromboxane generation, and short-lived shifts toward hypercoagulability; these responses seem to scale with exercise intensity, adrenergic drive, and shear stress and may be amplified in untrained or high-risk individuals. By contrast, repeated training across modalities (aerobic, resistance, and high-intensity interval) generally lowers resting platelet reactivity, augments endothelial nitric oxide (NO) bioavailability, improves redox balance, and strengthens fibrinolytic capacity. These favorable adaptations may diminish with detraining, suggesting that the platelet-modulating effects of exercise are dynamic and contingent on consistent training exposure. In this review, we examine the association between platelet function and distinct exercise modalities, including aerobic, resistance, and high-intensity training, influence. We compare exercise modalities, intensities, and fitness states and consider major methodological sources of heterogeneity (assay selection, sampling timing, exercise prescription, and inter-individual variability) that complicate interpretation. Clinically, regularly performed, appropriately progressed exercise appears net favorable for hemostatic balance, whereas unaccustomed extreme exertion in high-risk individuals should be approached with preparation and caution. Better-standardized protocols and biomarker-informed trials are needed to refine exercise prescriptions for reducing thrombotic risk.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":"777-789"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144967302","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}

{"title":"100 Years of von Willebrand Disease: Celebrating a Significant Milestone in von Willebrand Disease Diagnostics and Management.","authors":"Emmanuel J Favaloro","doi":"10.1055/a-2877-9583","DOIUrl":"10.1055/a-2877-9583","url":null,"abstract":"","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":"762-764"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148034776","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}

{"title":"Hemostasis in Exercise and the Athlete Part II, Plus An Additional Mini-Compilation.","authors":"Murray J Adams, Brendan R Scott, Emmanuel J Favaloro","doi":"10.1055/a-2882-1053","DOIUrl":"https://doi.org/10.1055/a-2882-1053","url":null,"abstract":"","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":"52 7","pages":"759-761"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977903","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}