Seminars in thrombosis and hemostasis最新文献

{"title":"Extended Anticoagulation Therapy with Rivaroxaban for Cancer-Associated Low-Risk Pulmonary Embolism According to Status of Concomitant Deep Vein Thrombosis: Insights from the ONCO PE Randomized Trial.","authors":"Wei Xiong, Yugo Yamashita, Takeshi Morimoto, Nao Muraoka, Wataru Shioyama, Yoshihisa Nakagawa, Ryuki Chatani, Hiromi Yamamoto, Tatsuhiro Shibata, Nagisa Morikawa, Yoshihiro Fukumoto, Yuji Nishimoto, Koh Ono, Takeshi Kimura","doi":"10.1055/a-2938-3392","DOIUrl":"10.1055/a-2938-3392","url":null,"abstract":"<p><strong>Abstract: </strong>The ONCO PE trial showed that 18-month rivaroxaban was superior to 6-month rivaroxaban for preventing recurrent venous thromboembolism (VTE) in patients with cancer-associated low-risk pulmonary embolism (PE). However, the influence of concomitant deep vein thrombosis (DVT) on this benefit was unclear. The current post-hoc subgroup analysis of the ONCO PE trial categorized patients into DVT subgroup (<i>N</i> = 104) and no DVT subgroup (<i>N</i> = 74) based on the presence or absence of a concomitant DVT at PE diagnosis. We compared the primary endpoint of 18-month recurrent VTE and the major secondary endpoint of 18-month major bleeding between the 18- and 6-month rivaroxaban groups in the DVT and no DVT subgroups. The cumulative 18-month incidence of recurrent VTE in the 18-month rivaroxaban group was numerically lower compared with that in the 6-month rivaroxaban group in the DVT subgroup (11.5 vs. 20.9%, log-rank <i>p</i> = 0.25) and was significantly lower in the no DVT subgroup (0.0 vs. 24.2%, log-rank <i>p</i> = 0.006), without significant interaction between treatment durations and concomitant DVT (Pinteraction = 0.99). There were no significant differences in the cumulative 18-month incidence of major bleeding between the 18- and 6-month rivaroxaban groups in both the DVT (4.6 vs. 5.8%, log-rank <i>p</i> = 0.70) and no DVT (13.4 vs. 5.8%, log-rank <i>p</i> = 0.29) subgroups, without significant interaction (Pinteraction = 0.34). The current exploratory analysis showed that extended rivaroxaban treatment might have a potential benefit for patients with cancer-associated low-risk PE in preventing recurrent VTE, irrespective of concomitant DVT status, without a significantly increased risk of major bleeding.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761190","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":"Thromboelastography Parameters Thresholds for Optimal Prediction of Major Bleeding after On-Pump Cardiac Surgery.","authors":"Zhili Xu, Xinchen Tao, Han Cao, Junyu Zhou, Qi Gao, Jingcheng Zou, Jie Xiao, Jing Yu, Kai Sun, Ge Luo, Tingting Ni, Yuanyuan Yao, Min Yan","doi":"10.1055/a-2924-0114","DOIUrl":"https://doi.org/10.1055/a-2924-0114","url":null,"abstract":"<p><strong>Abstract: </strong>As cardiac surgery volumes increase worldwide, major bleeding remains a significant complication following cardiopulmonary bypass (CPB) surgery. Accurate prediction of postoperative hemorrhage risk is crucial. This study aimed to establish optimal thromboelastography (TEG) parameter thresholds for predicting major postoperative hemorrhage in patients undergoing CPB during cardiac procedures, thereby creating a reliable early warning system to reduce hemorrhagic complications. This study retrospectively analyzed 3,810 cardiac surgery patients requiring CPB, divided into major bleeding, defined as 1,000 mL or more chest tube drainage within 24 hours (<i>n</i> = 245), and non-major bleeding (<i>n</i> = 3,565) groups. To identify independent risk factors, logistic regression analysis was used to compare the two groups. Then, the receiver operating characteristic (ROC) curves were developed to determine optimal predictive thresholds and evaluate sensitivity and specificity. The immediate postoperative coagulation index of -1.75 demonstrated a specificity of 60.0% (95% confidence interval [CI]: 58.4-61.7%) and sensitivity of 78.5% (95% CI: 73.3-83.8%) for predicting major bleeding following CPB surgery, with an odds ratio (OR) of 4.55 (95% CI: 3.24-6.38). Other immediate postoperative TEG parameters also showed predictive value, including reaction time (<i>R</i>; area under the curve [AUC] = 0.70), kinetics time (<i>K</i>) (AUC = 0.71), α-angle (AUC = 0.69), and maximum amplitude (MA; AUC = 0.67). Additionally, post-CPB MA of 58.05 mm also demonstrated predictive value for predicting postoperative major bleeding. TEG parameter analysis demonstrated that the immediate postoperative coagulation index provides high predictive accuracy for major postoperative hemorrhage in cardiac surgery patients undergoing CPB. Furthermore, other postoperative TEG parameters also demonstrate moderate predictive significance. These findings may help clinicians identify high-risk patients at an early stage and provide a reference for enhanced monitoring and clinical decision-making.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797747","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":"Interim Efficacy Analysis of Different Anticoagulation Regimens in Patients with Long-Term Implantation of Inferior Vena Cava Filter.","authors":"Lei Qi, Hongzhi Sun, Yihao Wang, Huagang Li, Shuangshuang Li, Jian Zhou","doi":"10.1055/a-2930-7434","DOIUrl":"10.1055/a-2930-7434","url":null,"abstract":"<p><strong>Abstract: </strong>This study aimed to analyze the interim efficacy of different anticoagulation regimens for patients with long-term inferior vena cava filter (IVCF) implantation. From August 2021 to August 2024, a retrospective analysis of patients who underwent long-term IVCF implantation in multiple centers was performed. Group A (46 cases) did not receive anticoagulation, Group B (66 cases) received extended secondary prophylaxis dose anticoagulation, and Group C (63 cases) received extended therapeutic dose anticoagulation, with 12 months follow-up. The primary endpoint was lower extremity deep vein thrombosis (LEDVT) recurrence rate. The secondary endpoints were IVCF thrombosis (IVCFT) incidence, bleeding-related adverse events incidence, all-cause mortality, and venous clinical severity score (VCSS). LEDVT recurrence rate and IVCFT incidence in Group A (37.0 and 19.6%) were higher than that in Group B (13.6 and 6.1%) and Group C (15.9 and 4.8%). Bleeding-related adverse events incidence in Group C (17.5%) was higher than that in Group B (4.5%) and Group A (2.2%). There was no significant difference in all-cause mortality among the three groups. VCSS at 12 months in Group A was higher than that in Group B and Group C. In the interim follow-up of the extended treatment phase in patients with long-term IVCF implantation and rivaroxaban anticoagulation may reduce LEDVT recurrence and IVCFT occurrence compared with non-anticoagulation, and alleviate patients' clinical symptoms. The extended secondary prophylaxis dose may exhibit comparable efficacy to the extended therapeutic dose, while potentially reducing the bleeding risk.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148689894","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 Historical Painting of the \"Bleeding Woman\": Its Relevance for Today and the Future.","authors":"Gerard Gurumurthy, Laura Knox, Jo Traunter, Karin van Galen, Bethany Samuelson Bannow, Jecko Thachil","doi":"10.1055/a-2931-1364","DOIUrl":"https://doi.org/10.1055/a-2931-1364","url":null,"abstract":"<p><strong>Abstract: </strong>Heavy menstrual bleeding (HMB) is a common yet underrecognized manifestation in girls and women with bleeding disorders and in those receiving antithrombotic therapy. HMB remains poorly defined and insufficiently explored and managed in clinical encounters. We explore HMB using the Limbourg Brothers' miniature as a historical and visual point to examine how menstrual bleeding has long remained visible yet unspoken. We argue that the burden of recognition still falls too heavily on the individual, particularly when clinicians fail to ask the right questions or when symptoms are normalized within families and society. We further propose that menstrual health should be treated as a core quality indicator in thrombosis and hemostasis clinics. We call for more recognition, standardized assessment, and proactive management so that women and girls are no longer left to seek help from the margins.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797808","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":"Early versus Late Pharmacologic Thromboprophylaxis in Traumatic Brain Injury: A Propensity-Score Matched Cohort Study.","authors":"Wei Jiang, Lianwei Ma, Mohamed Gamal Eldin Abd El Hamid Elashhab, Xiang Wu, Lijun Bai, Zhuonan Wang","doi":"10.1055/a-2927-6855","DOIUrl":"10.1055/a-2927-6855","url":null,"abstract":"<p><strong>Abstract: </strong>The optimal timing of pharmacological thromboprophylaxis in traumatic brain injury (TBI) remains uncertain due to competing risks of thrombosis and bleeding. This study evaluated whether early heparin initiation (≤72 hours) reduces vascular occlusive events (VOEs), mortality, and hospital stay without increasing bleeding. We compared early versus late (>72 hours) heparin use via propensity score matching (PSM), subgroup analyses, and multivariable logistic regression. Outcomes included VOEs (deep vein thrombosis, pulmonary embolism, myocardial infarction, and ischemic stroke), bleeding, 30- and 180-day mortality, and length of stay. After PSM, late heparin was associated with higher VOEs (25.16 vs. 12.24%, <i>p</i> < 0.001), 30-day mortality (20 vs. 11.89%, <i>p</i> = 0.03), 180-day mortality (32.26 vs. 19.58%, <i>p</i> = 0.004), and prolonged hospitalization (median: 15.7 vs. 9.7 days, <i>p</i> < 0.001), without increased bleeding risk (16.77 vs. 22.03%, <i>p</i> = 0.24). Subgroup analyses revealed late heparin as an independent risk factor for VOEs in mild TBI (odds ratio: 2.62, 95% confidence interval: 1.54-4.45; <i>p</i> < 0.001) regardless of fracture status, coagulation profile, or hemorrhagic classification, with nonsignificant associations in nonhemorrhagic and moderate-to-severe TBI subgroups. Multivariable analysis identified late heparin, higher comorbidity index, elevated platelet count, and cranial surgery as independent predictors of VOEs, with late heparin also independently associated with increased mortality. These findings suggest early heparin initiation reduces thromboembolic complications, mortality, and hospital stay without markedly increasing bleeding risk, supporting early anticoagulation in selected patients following individualized risk-benefit assessment.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670623","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":"PAI-1 as a Therapeutic Target: A State-of-the-Art Review.","authors":"Jacob Wortley, Lily Crone, Neha Soogoor, Mebeli Becerra, Justin Vu, Mohanakrishnan Sathyamoorthy","doi":"10.1055/a-2924-5438","DOIUrl":"10.1055/a-2924-5438","url":null,"abstract":"<p><strong>Abstract: </strong>Plasminogen activator inhibitor (PAI-1) is a member of the serine protease inhibitor family critical in regulating fibrinolysis and is associated with diverse pathologies including cardiovascular disease, metabolic disorders, cancer, aging, and many others. Despite its clinical significance and extensive research, there are as of yet still no FDA- or EMA-approved therapeutics that specifically target PAI-1. This review examines therapeutic strategies including small molecules, RNA aptamers, monoclonal antibodies, and repurposed pharmaceuticals. Notable challenges in the development of these therapies include the interplay of PAI-1 with tissue-specific mediators such as vitronectin and the multi-dimensional, tissue-specific effects of PAI-1 modulation. Promising approaches will require tissue- and temporal expression-based interventions. Further characterization of PAI-1's structural dynamics and its role in various disease processes will shape its potential as a therapeutic target across broad fields in medicine.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670539","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 Case Report on the Rare C.-35G>C F9 Variant and Genotype-Phenotype Analysis in Hemophilia B Leyden.","authors":"Catarina Silva Pinto, Patrícia Martinho, Artur Pereira, Emília Araújo, M Fátima Rodrigues, Cristina Oliveira, Ana Francisca Fernandes, Tânia Costa, Catarina Geraldes, Teresa Fidalgo","doi":"10.1055/a-2925-2784","DOIUrl":"https://doi.org/10.1055/a-2925-2784","url":null,"abstract":"","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713624","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":"Emicizumab and Recombinant FVIIa for Safe Surgical Removal of a Massive Pseudotumor in Severe Hemophilia A with Inhibitor.","authors":"Cale Burge, Daniel Franks, Richard Pow, Peter Luk, Stephen Matthews, Liane Khoo","doi":"10.1055/a-2924-5496","DOIUrl":"https://doi.org/10.1055/a-2924-5496","url":null,"abstract":"","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702021","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":"Sex-Related Differences and Predictors of Mortality in Patients Undergoing Major Orthopaedic Surgery: Insights from the ORTHO-START Registry.","authors":"Elvira Grandone, Emilia Antonucci, Gregory Piazza, Doris Barcellona, Carlo Rostagno, Donatella Colaizzo, Antonio de Laurenzo, Giovanni di Rienzo, Francesco Gorgoglione, Giuseppe Maccagnano, Francesco Marongiu, Mario Mastroianno, Marco Marzolo, Lucia Mirabella, Biagio Moretti, Anna M Moretti, Angelo Ostuni, Gualtiero Palareti, Maurizio Margaglione","doi":"10.1055/a-2918-4154","DOIUrl":"https://doi.org/10.1055/a-2918-4154","url":null,"abstract":"<p><strong>Abstract: </strong>Sex-related differences in outcomes after major orthopaedic surgery remain under-investigated, and the prognostic relevance of a history of venous thromboembolism (VTE) is unclear. The ORTHO-START registry is a prospective, multicenter study including 1,077 consecutive adults undergoing major orthopaedic surgery (elective hip/knee arthroplasty or urgent hip fracture repair) across six Italian centers between July 2018 and March 2022. Baseline characteristics, perioperative complications, and antithrombotic therapy were collected. The primary outcome was all-cause mortality at 24 months; secondary outcomes were thromboembolic and bleeding events. Multivariable logistic regression identified predictors of mortality. Women represented 72.3% (<i>n</i> = 775) of the cohort and were older than men (80.6 ± 10.0 vs. 76.2 ± 13.0 years, <i>p</i> < 0.001). Urgent procedures comprised 65.6% (<i>n</i> = 706) of surgeries, predominantly involving women (<i>n</i> = 542). At 24 months, mortality was higher in men (31 vs. 18%, <i>p</i> = 0.018). Independent predictors of mortality included male sex (odds ratio [OR] = 2.6, 95% confidence interval [CI]: 1.8-4.0), older age, lower body mass index, urgent surgery (OR = 7.2, 95% CI: 4.1-12.4), and prior VTE (OR = 5.7, 95% CI: 1.4-23.9). Causes of death were known for 160/210 (76.2%): neurological complications were most frequent (25%), followed by cardiovascular disease (21.3%) and immobility-related causes (14.4%); pulmonary embolism accounted for 1.3% of deaths. Thrombotic and hemorrhagic events occurred in both sexes without significant differences. Male sex and a history of VTE are independent predictors of long-term mortality following major orthopaedic surgery. Incorporating these factors into preoperative risk assessment may improve management and postoperative outcomes.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649229","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":"Integrated Model Linking Hemolysis, NETosis, Ferroptosis, Lysosomal Dysfunction, and DIC in Sepsis.","authors":"Toshiaki Iba, Cheryl L Maier, Ricard Ferrer, Isao Nagaoka, Hideo Wada, Jerrold H Levy","doi":"10.1055/a-2920-1243","DOIUrl":"10.1055/a-2920-1243","url":null,"abstract":"<p><strong>Abstract: </strong>Sepsis-associated coagulopathy (SIC) and disseminated intravascular coagulation (DIC) are major determinants of organ failure and mortality in sepsis. While traditionally viewed as disorders of coagulation and fibrinolysis, emerging evidence highlights the roles of iron metabolism, oxidative stress, and regulated cell death in thromboinflammation. This article aims to propose an integrated conceptual framework linking hemolysis, neutrophil extracellular trap formation (NETosis), ferroptosis, and lysosomal dysfunction as central drivers of immunothrombosis and DIC in sepsis. A narrative review was conducted based on a structured search of NETosis, ferroptosis, lysosomal pathways, and SIC in PubMed/MEDLINE. Hemolysis releases cell-free hemoglobin and heme, leading to accumulation of redox-active iron and oxidative stress. These processes promote neutrophil activation and NET formation, thereby enhancing thrombosis and impairing fibrinolysis. In parallel, iron-driven lipid peroxidation induces ferroptosis in endothelial and parenchymal cells, contributing to barrier disruption and organ injury. Lysosomes act as central cellular regulators by controlling iron trafficking through ferritinophagy and heme degradation, thereby amplifying intracellular iron availability and oxidative damage. Experimental studies suggest that NETosis and ferroptosis may participate in a bidirectional amplification process that could further propagate thromboinflammation, although direct evidence in human sepsis remains limited. Clinically, this axis may define an iron-driven immunothrombotic endotype characterized by elevated cell-free hemoglobin, ferritin, NET markers, and D-dimer. This integrated model reframes SIC and DIC as manifestations of iron-driven immunometabolic dysregulation. Biomarker-guided identification of this endotype may enable targeted therapeutic strategies to address hemolysis, iron metabolism, NETosis, and ferroptosis, beyond conventional anticoagulation.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631399","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}