{"title":"Heparin and Posttraumatic Stress Disorder.","authors":"Giuseppe Lippi, Emmanuel J Favaloro","doi":"10.1055/s-0044-1788697","DOIUrl":"10.1055/s-0044-1788697","url":null,"abstract":"","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":"471-473"},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141760762","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}
Angela Napolitano, Luca Spiezia, Marta Biolo, Claudia Maria Radu, Serena Toffanin, Elena Campello, Paolo Simioni
{"title":"Anti-platelet Factor 4 Antibody-Mediated Disorders: An Updated Narrative Review.","authors":"Angela Napolitano, Luca Spiezia, Marta Biolo, Claudia Maria Radu, Serena Toffanin, Elena Campello, Paolo Simioni","doi":"10.1055/a-2528-5425","DOIUrl":"10.1055/a-2528-5425","url":null,"abstract":"<p><p>Anti-platelet factor 4 (PF4) antibody-mediated disorders are a heterogeneous group of diseases characterized by the presence of highly pathogenic immunoglobulins G directed against PF4 and/or PF4/heparin complexes. These antibodies are able to activate platelets, neutrophils, and monocytes, thus resulting in thrombocytopenia and a hypercoagulable state. Five different forms of anti-PF4 antibody-mediated disorders have been identified: (1) classic heparin-induced thrombocytopenia (HIT) mediated by heparin and certain polyanionic drugs; (2) autoimmune HIT characterized by the presence of anti-PFA/polyanion antibodies that can strongly activate platelets even in the absence of heparin; (3) spontaneous HIT characterized by thrombocytopenia and thrombosis without proximate exposure to heparin, with two subtypes: (a) post-total knee arthroplasty and cardiac surgery using cardiopulmonary bypass or extracorporeal membrane oxygenation and (b) postinfections; (4) vaccine-induced immune thrombotic thrombocytopenia (VITT) characterized by thrombocytopenia, arterial and venous thrombosis, or secondary hemorrhage after receiving adenoviral vector vaccines for coronavirus disease 2019; (5) VITT-like disorders triggered by adenoviral infections. Although extremely rare and largely unknown, there has been growing interest in the VITT syndrome in recent years due to its clinical relevance. Timely detection of these antibodies is crucial for the diagnosis and treatment of anti-PF4 antibody-mediated disorders, via anti-PF4 antibody immunoassays using several antibody capture systems (e.g., enzyme-linked immunosorbent assay-based, particle gel, turbidimetry) and functional assays (e.g., serotonin release assay or heparin-induced platelet activation). We aimed to present the latest on laboratory findings, clinical characteristics, and therapeutic approaches for anti-PF4 antibody-mediated disorders.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":"578-593"},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067722","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":"Use of Oral Anti-Xa Inhibitor in Prosthetic Mechanical Aortic Valve with Warfarin Hypersensitivity Due to the FIX p.(Ala37Thr) Propeptide Variant: Case Report and Literature Review.","authors":"Antonella Tufano, Carmine Fierarossa, Ferdinando Cirillo, Ciro Miele, Filomena Capasso, Cristina Mazzaccara, Lucia Micale, Gennaro Vecchione, Marco Castori, Ignazio Frangipane, Luca Mocerino, Ernesto Cimino, Matteo Di Minno","doi":"10.1055/a-2546-7180","DOIUrl":"10.1055/a-2546-7180","url":null,"abstract":"<p><p>Bleeding is the most common side effect during treatment with vitamin K antagonists (VKAs). Sometimes, VKA use causes bleeding episodes due to rare variants in the factor IX (FIX) propeptide that modify the affinity of FIX propeptide to the binding of γ-glutamyl carboxylase. We report on a 51-year-old patient who presented with recurrent spontaneous and severe intramuscular and cutaneous bleedings during VKA (warfarin) treatment for the presence of a prosthetic mechanical aortic valve. Laboratory evaluation revealed INR within the therapeutic range with markedly prolonged aPTT and a large reduction of FIX levels. Laboratory parameters significantly improved when warfarin was switched with low-molecular-weight heparin. Next-generation sequencing analysis revealed the variant p.(Ala37Thr) in the F9 gene, which has been previously associated with VKA sensitivity. As an alternative to warfarin, apixaban 5 mg twice daily and aspirin 100 mg daily were started, with no thrombosis or recurrence of hemorrhage and normalization of INR, aPTT, and FIX levels, at 12-month follow-up. We also performed a literature search across PubMed and Scopus, until January 2025. The analysis evidenced five case reports and two case series. The mechanisms of this rare VKA hypersensitivity have also been reviewed. In conclusion, while VKA hypersensitivity is a rare phenomenon, awareness of this complication and the current accessibility to molecular testing make it important to identify patients at risk. The efficacy/safety of direct thrombin or factor Xa inhibitors in patients with a mechanical heart valve and VKA hypersensitivity due to the F9 p.(Ala37Thr) variant deserves more attention and further investigation.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":"594-599"},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524324","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}
Ismael Conejero, Mathias Chea, Philippe Courtet, Sylvie Bouvier, Fabricio Pereira
{"title":"Alterations in the Blood-Brain Barrier in Mood Disorders and Neurodegenerative Diseases.","authors":"Ismael Conejero, Mathias Chea, Philippe Courtet, Sylvie Bouvier, Fabricio Pereira","doi":"10.1055/s-0045-1804893","DOIUrl":"10.1055/s-0045-1804893","url":null,"abstract":"<p><p>Depressive disorders and suicidal behaviors represent major causes of health loss. Modifications of brain microvasculature, and specifically alterations of the blood-brain barrier have been supposed to participate in the vulnerability to those disorders along with cognitive impairment, especially in the older adults. In this article, we addressed evidence linking blood-brain barrier impairments with mood disorders and suicide. Secondly, we investigated their relationship with depression in old age, and with neurodegenerative processes. Particular attention was drawn toward the potential interactions between the coagulation processes and the blood-brain barrier dysfunctions, as innovative treatment strategies may emerge from research in those fields. Overall, the studies reviewed highlight the implication of multiple dysfunctions of the blood-brain barrier in mood disorders and suicide. Impairments of the blood-brain barrier show relationships with altered expression of endothelial cell junction proteins. These modifications also implicate receptors of the extracellular matrix, the vascular endothelial growth factor, changes in perivascular astrocytes, and has links with local and systemic inflammatory processes. Dysfunctions of the blood-brain barrier underly chronic stress and participate in psychiatric diathesis in old age. In addition, we outline that coagulation processes are likely to interact with the blood-brain barrier and further contribute to neurodegenerative disorders. In conclusion, new pathophysiological models offer perspectives toward detecting new biomarkers in mood disorders and suicide. In parallel, these models open avenues for developing innovative therapeutic agents, although further considering their potential risks and eventual benefits is needed.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":"457-464"},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586794","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":"2025 Eberhard F. Mammen Award Announcements: Part I-Most Popular Articles.","authors":"Emmanuel J Favaloro","doi":"10.1055/s-0045-1806855","DOIUrl":"10.1055/s-0045-1806855","url":null,"abstract":"","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":"366-380"},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014890","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":"Stress and Pregnancy Outcomes: A Review of the Literature.","authors":"Shayna Miodownik, Eyal Sheiner","doi":"10.1055/s-0044-1792002","DOIUrl":"10.1055/s-0044-1792002","url":null,"abstract":"<p><p>The human body has the ability to adapt to changing circumstances, and mobilizes various biological systems in order to do so. When exposed to stressful conditions, the endocrine, nervous, and immune systems come together to aid in maintaining homeostasis; however, during periods of chronic stress, these systems can become maladaptive and lead to long-term detrimental health outcomes. Amongst the lingering effects associated with chronic stress exposure, increasingly, studies are identifying a link to adverse pregnancy and neonatal outcomes. This review explores what has been uncovered in the field to date, and examines the effects of stress on fertility and gestation. Establishing additional factors which put women at risk for adverse pregnancy outcomes can aid in identifying a vulnerable population who could benefit from early stress-reducing interventions.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":"412-422"},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576859","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":"2024 Eberhard F. Mammen Award Announcements: Part II-Young Investigator Awards.","authors":"Emmanuel J Favaloro","doi":"10.1055/s-0045-1807739","DOIUrl":"10.1055/s-0045-1807739","url":null,"abstract":"","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":"481-490"},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022515","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":"The Erythrocyte-ROS Axis in Thrombosis and Hemostasis.","authors":"Serena Borghi, Francesca Nencini, Elvira Giurranna, Claudia Fiorillo, Matteo Becatti","doi":"10.1055/a-2615-0136","DOIUrl":"https://doi.org/10.1055/a-2615-0136","url":null,"abstract":"<p><p>Thrombosis and hemostasis are critical processes that maintain vascular integrity, yet imbalances can lead to life-threatening cardiovascular events. Traditionally, erythrocytes were considered passive bystanders in coagulation, but emerging evidence highlights their active role in thrombogenesis, particularly through redox biology. Erythrocytes generate reactive oxygen and nitrogen species (RONS) via Hb autoxidation, NADPH oxidase activation, and external uptake from other blood components. This oxidative environment induces structural and functional modifications, including increased rigidity, phosphatidylserine exposure, microvesicle release, and enhanced adhesion to endothelial cells and platelets, all contributing to a prothrombotic phenotype. Hemorheological alterations such as increased aggregation and decreased deformability further exacerbate blood stasis and thrombus formation. Oxidative stress also accelerates hemolysis, releasing free Hb and heme, which trigger inflammatory responses and endothelial dysfunction, further amplifying thrombogenic potential. Additionally, erythrocyte-derived microvesicles act as carriers of procoagulant factors, enhancing thrombin generation and fibrin network formation. These mechanisms underscore the erythrocyte-ROS axis as a crucial determinant of thrombosis. Despite these insights, the full scope of erythrocyte-mediated redox signaling in thrombotic processes remains incompletely understood. This review discusses the multifaceted impact of erythrocyte oxidative stress on thrombosis and hemostasis, exploring its implications in cardiovascular diseases, metabolic disorders, and hematological conditions. Understanding these pathways may lead to novel therapeutic approaches targeting erythrocyte redox homeostasis to mitigate thrombotic risk and improve patient outcomes.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187872","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}
Marco Marietta, Valeria Coluccio, Stefano Cordella, Mario Luppi
{"title":"Impact of Viral Infections on the Hemostatic System.","authors":"Marco Marietta, Valeria Coluccio, Stefano Cordella, Mario Luppi","doi":"10.1055/a-2601-9302","DOIUrl":"10.1055/a-2601-9302","url":null,"abstract":"<p><p>The coronavirus disease 2019 (COVID-19) pandemic has brought renewed attention to the significant but often overlooked impact of viral infections on the hemostatic system. This review explores the pathophysiological mechanisms underlying the interaction between viruses and hemostasis, directly through viral components or immune-mediated processes. Viruses are recognized as pathogen-associated molecular patterns (PAMPs) by pattern recognition receptors (PRRs) on innate immune cells such as neutrophils, monocytes, and platelets. This recognition triggers immune responses, including the production of type I interferons (IFN-α and IFN-β) and proinflammatory cytokines like interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α), which recruit immune cells and induce pyroptotic cell death. Inflammatory cytokines contribute to endothelial dysfunction and coagulation activation, interacting with platelets, neutrophils, neutrophil extracellular traps (NETs), and the kallikrein-kinin system. Hyperactivation of the cytokine system, known as the \"cytokine storm,\" correlates with disease severity. Common features of viral infections include platelet activation and endotheliitis, leading to thrombocytopenia and microvascular thrombosis. Interestingly, similar pathogenic mechanisms in COVID-19 and viral hemorrhagic fevers (VHFs) result in contrasting clinical manifestations. While COVID-19 predominantly induces a thrombotic response characterized by endothelial damage, platelet hyperactivity, and complement activation, VHFs typically lead to hemorrhagic complications due to thrombocytopenia, consumptive coagulopathy, and vascular injury. These differences are influenced by the timing and location of coagulation activation, as well as the dynamics of immune responses. In COVID-19, coagulation initially occurs in the lungs, followed by systemic thrombotic phases, whereas VHFs rapidly progress to consumptive coagulopathy with hemorrhage, compounded by immune suppression.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044497","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}