Thrombosis and haemostasis最新文献

{"title":"Psychometric Validation of the Hemophilia Functional Ability Scoring Tool (Hemo-FAST).","authors":"Virginie Barbay, Yohann Repessé, Dominique Desprez, Nicolas Drillaud, Birgit Frotscher, Marie-Léa Piel-Julian, Sabine Castet, Fabienne Genre-Volot, Brigitte Tardy, Annie Harroche, Corinne Gandossi, Meriem Zidi, Sara Carlsson, Nana Kragh, Eva Bednar, Claude Négrier, Aurélien Lebreton","doi":"10.1055/a-2501-1369","DOIUrl":"10.1055/a-2501-1369","url":null,"abstract":"<p><p>The Hemophilia Functional Ability Scoring Tool (Hemo-FAST), consisting of a patient-reported outcome (PRO) part and a clinician-reported outcome (ClinRO) part, was developed as a rapid and effective tool to assess functional mobility in clinical practice. This study (NCT04731701) aimed to validate the psychometric properties of Hemo-FAST for assessment of joint health in people with haemophilia (PwH).PwH A or B aged ≥18 years completed questionnaires including the PRO part of Hemo-FAST and the short-form 36 health survey (SF-36) during one study visit. Clinicians completed the Haemophilia Joint Health Score (HJHS) and the ClinRO part of Hemo-FAST at the same visit. Validation was performed using reliability, construct validity, and structure validity assessments.The study enrolled 180 PwH A or B from 14 centres across France. Estimated time to complete the PRO part was mean (standard deviation) 4.6 (5.4) minutes. PRO items showed good test-retest reliability (intraclass correlation coefficient value ≥0.70). Inter-rater values were >0.70 for 7/9 ClinRO items, indicating good reliability. All items (15 PRO; 9 ClinRO) had high internal consistency (Cronbach's coefficient alpha: 0.97). Hemo-FAST demonstrated convergent construct validity with HJHS and the SF-36 physical component and discriminant construct validity with the SF-36 mental health component. Hemo-FAST scores distinguished between subgroups of people with expected differences in joint health status, including by haemophilia severity (<i>p</i> < 0.0001).This study successfully validated Hemo-FAST as a rapid and reliable tool for the functional assessment of joint health in adults with haemophilia, both in clinical practice and clinical research settings.</p>","PeriodicalId":23036,"journal":{"name":"Thrombosis and haemostasis","volume":" ","pages":"960-971"},"PeriodicalIF":4.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12457003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Roles of ROCK/Myosin Pathway in Macrothrombocytopenia in Bernard-Soulier Syndrome.","authors":"Ponthip Mekchay, Praewphan Ingrungruanglert, Netchanok Leela-Adisorn, Noppacharn Uaprasert, Nipan Israsena, Ponlapat Rojnuckarin","doi":"10.1055/a-2474-5644","DOIUrl":"10.1055/a-2474-5644","url":null,"abstract":"<p><p>Megakaryocytes (MK) from Bernard-Soulier syndrome (BSS) induced pluripotent stem cells (iPSCs) yielded reduced numbers but increased sizes of platelets. The molecular mechanisms remain unclear. This study aims to determine roles of signaling molecules involved in this process.Wild-type (WT) iPSCs and iPSCs from BSS patients with <i>GP1BA</i> (BSS-A) or <i>GP1BB</i> (BSS-B) mutations were differentiated into MKs and platelets with or without myosin II inhibitor (blebbistatin), ROCK inhibitor (Y27632), and procaspase-3 activator (PAC-1). Proplatelet and platelet numbers and sizes were characterized. The iPSC lines containing tubulin-green fluorescent protein (GFP) reporters were constructed to observe proplatelet formation under time-lapse microscopy.BSS-derived MKs (BSS-MKs) yielded fewer but larger platelets compared with the WT. In the presence of blebbistatin, ROCK inhibitor, or PAC-1, WT, BSS-A, and BSS-B MKs could generate more platelets with decreased sizes, but PAC-1 caused CD42 loss on WT platelets. The proportions of proplatelet formation from MKs carrying tubulin-GFP were not different between WT and BSS-MKs, as well as among inhibitors. Notably, initially thick cytoplasmic processes were transformed into thin branching proplatelets over the observation time. The proplatelet shafts of BSS-MK became thinner in the presence of blebbistatin or ROCK inhibitor, but not of PAC-1, which displayed uneven F-actin distribution.Inhibition of the ROCK/myosin pathway, downstream of GpIb, could restore normal morphology of proplatelets in BSS-MKs. Procaspase-3 activation could increase platelet yields, but with abnormal proplatelet and platelet structures. Our model can be used for therapeutic drug screening and a disease model for platelet production in the future.</p>","PeriodicalId":23036,"journal":{"name":"Thrombosis and haemostasis","volume":" ","pages":"985-997"},"PeriodicalIF":4.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855536","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":"Clinical and Genetic Characterization of 51 Patients with Congenital Fibrinogen Disorders from China.","authors":"Yaohua Cai, Hui Lu, Wenyi Lin, Yunqing Xia, Tingting Wu, Zhipeng Cheng, Liang V Tang, Yu Hu","doi":"10.1055/a-2514-7520","DOIUrl":"10.1055/a-2514-7520","url":null,"abstract":"<p><p>To investigate the classification, clinical manifestations, laboratory findings, and genetic mutations associated with hereditary fibrinogen disorders in Chinese population.Between February 2015 and February 2022, 65 patients with congenital fibrinogen disorders (CFD) were identified at Wuhan Union Hospital. Comprehensive data were available for 51 patients, allowing for a retrospective analysis.The cohort comprised 17 males (33.3%) and 34 females (66.7%), with a median diagnosis age of 35.0 years (interquartile range: 25.5-42.5). Of the patients, 35 (68.6%) were diagnosed with dysfibrinogenemia, 8 (15.7%) with hypofibrinogenemia, 7 (13.7%) with hypodysfibrinogenemia, and 1 (2.0%) with afibrinogenemia. The median diagnosis ages for the asymptomatic, Grade 1, Grade 2, and Grade 3 groups were 44.5 years (range: 37-58.5), 28 years (22.5-36.5), 35.5 years (21.75-41), and 28 years (22.75-30.75), respectively. The asymptomatic group had the latest diagnosis age, whereas Grade 3 had the earliest. A negative correlation was observed between Fg:C levels and bleeding severity (rs = - 0.2937, <i>p</i> = 0.0365). In total, 52 variants were found in 51 unrelated patients, with one patient carrying two mutations. The 37 distinct mutations included 11 in FGA, 3 in FGB, and 23 in FGG.This study investigates the clinical, laboratory, and genetic characteristics of patients with CFD in China, revealing a negative correlation between Fg:C levels and bleeding severity. Female patients are at higher risk for gynecological complications due to physiological traits. Additionally, R35 in FGA and R301 in FGG were identified as hotspot mutations.</p>","PeriodicalId":23036,"journal":{"name":"Thrombosis and haemostasis","volume":" ","pages":"972-984"},"PeriodicalIF":4.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12457006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142979620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socioeconomic Burden of Pulmonary Embolism in Europe: Shifting Priorities and Challenges for Novel Reperfusion Strategies.","authors":"Katharina Mohr, Stefano Barco, Thomas Neusius, Stavros Konstantinides","doi":"10.1055/a-2505-8711","DOIUrl":"10.1055/a-2505-8711","url":null,"abstract":"<p><p>In-hospital case fatality related to acute pulmonary embolism (PE) has been falling since the beginning of this century. However, annual incidence rates continue to climb, and an increasing number of PE survivors need long-term follow-up, chronic anticoagulation treatment, and readmission(s) to the hospital. In European countries, median reimbursed hospital costs for acute PE are still moderate compared with the United States but can increase several-fold in patients with comorbidities and those necessitating potentially life-saving reperfusion treatment. The use of catheter-directed treatment (CDT) has constantly increased in the United States since the past decade, and it has now entered a rapid growth phase in Europe as well, estimated to reach an annual penetration rate of up to 31% among patients with intermediate-high- or high-risk PE by 2030. Ongoing randomised controlled trials are currently investigating the clinical efficacy and safety of these devices. In addition, they will deliver data permitting calculation of their cost-effectiveness in different health care reimbursement systems, by revealing the extent to which they can reduce complications and consequently the need for intensive care and the overall length of hospital stay. After discharge, key cost drivers are related to chronic cardiopulmonary diseases (other than PE itself) leading to frequent readmissions, persistent symptoms, and functional limitations which result in poor quality of life, productivity loss, and substantial indirect costs. Implementation of structured outpatient programmes with a holistic approach to post-PE care, targeting overall cardiovascular health and the patient's well-being, bears the potential to cost-effectively reduce the overall socioeconomic burden of PE.</p>","PeriodicalId":23036,"journal":{"name":"Thrombosis and haemostasis","volume":" ","pages":"933-943"},"PeriodicalIF":4.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12457008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital Costs of Intracranial Haemorrhage in Patients with Acute Pulmonary Embolism: Possible Implications for Emerging Therapies.","authors":"Konstantinos C Christodoulou, Katharina Mohr, Timo Uphaus, Max Jägersberg, Luca Valerio, Ioannis T Farmakis, Lukas Hobohm, Harald Binder, Stavros V Konstantinides, Karsten Keller","doi":"10.1055/a-2511-4599","DOIUrl":"10.1055/a-2511-4599","url":null,"abstract":"","PeriodicalId":23036,"journal":{"name":"Thrombosis and haemostasis","volume":" ","pages":"1048-1051"},"PeriodicalIF":4.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12457004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Deficiency and Excessive Condition of Thrombin Burst Using Laboratory Tests.","authors":"Hideo Wada, Katsuya Shiraki, Hideto Shimpo, Toshiyuki Miyata","doi":"10.1055/a-2703-4175","DOIUrl":"10.1055/a-2703-4175","url":null,"abstract":"<p><p>Thrombin burst is an important mechanism for hemostasis, which is enhancement and amplification of the coagulation cycle, especially activation of coagulation factors XI, VIII, and V by thrombin on the activated platelets. Thrombin burst monitoring has been performed using hemostatic molecular markers, thrombin generation test (TGT), thromboelastography (TEG), and clot waveform analysis (CWA). In particular, CWA is a routine laboratory test that is neither time consuming nor expensive. Arterial thromboses, such as acute myocardial thrombosis and acute cerebral thrombosis, are associated with excessive condition of thrombin burst, and clotting time using a small amount of thrombin in CWA can detect activated or procoagulant platelets. Thrombin burst deficiency is caused by abnormalities of platelets such as thrombocytopenia or clotting factors such as hemophilia and acquired clotting factor deficiency, showing different CWA patterns. Patients with clotting factor VIII inhibitors are treated with bypass therapy, such as recombinant activated clotting factor VII and activated prothrombin complex concentrate, which can be monitored by CWA, TEG, or TGT.</p>","PeriodicalId":23036,"journal":{"name":"Thrombosis and haemostasis","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087421","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":"C-reactive Protein, Genetic Susceptibility, and the Long-Term Risk of Venous Thromboembolism in Patients with Past Cancer.","authors":"Yunlong Guan, Zeyu Gan, Si Li, Xi Cao, Ao Zeng, Jing Li, Wei Gong, Jun Deng, Xingjie Hao","doi":"10.1055/a-2495-1350","DOIUrl":"10.1055/a-2495-1350","url":null,"abstract":"<p><p>Several studies have indicated that C-reactive protein (CRP) level is associated with the risk of venous thromboembolism (VTE) in the general population. However, CRP appears to be unrelated to VTE events in patients newly diagnosed with cancer. As the survival time of cancer patients increases, the effect of CRP on the long-term risk of VTE may change. We aimed to investigate the association between CRP and VTE in cancer survivors and further assess the modification effect of genetic susceptibility.The Cox proportional hazards model was used to evaluate the association between CRP levels and VTE risk as well as to investigate the joint effect of CRP and genetic susceptibility. The Kaplan-Meier curve and restricted cubic spline were used to visualize the relationship between CRP and VTE.This study included 27,806 participants with cancer diagnosis at baseline in the UK Biobank. Over a follow-up period of 344,636 person-years, a total of 1,151 VTE events were recorded. Participants were divided into four groups based on CRP level quartiles. The adjusted hazard ratios (95% CIs) of Q1, Q2, Q3, and Q4 were 1.00, 1.20 (0.99-1.44), 1.25 (1.04-1.50), and 1.51 (1.25-1.82), respectively. For those with high genetic risk of VTE, high CRP had an additional increased risk for VTE.CRP can be used as a predictive biomarker for VTE risk in cancer survivors, especially in those with high genetic risk. Future research can explore whether prevention and treatment strategies for VTE can be developed based on CRP for cancer survivors.</p>","PeriodicalId":23036,"journal":{"name":"Thrombosis and haemostasis","volume":" ","pages":"1038-1047"},"PeriodicalIF":4.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772623","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":"Usefulness and Limits of DOAC Removal Agents Based on Activated Charcoal in Thrombophilia Testing: Literature Review and Expert Proposals.","authors":"Georges Jourdi, Claire Flaujac, Emmanuel De Maistre, Nicolas Gendron, Valérie Eschwège, Laetitia Mauge","doi":"10.1055/a-2695-2674","DOIUrl":"https://doi.org/10.1055/a-2695-2674","url":null,"abstract":"<p><p>Although inherited and acquired thrombophilia screening should ideally be performed outside of any direct oral anticoagulant (DOAC) therapy, it is sometimes performed in patients who are anticoagulated. However, DOACs have been shown to interfere with many hemostasis tests, with a risk of false-positive/negative results in lupus anticoagulant testing and overestimation of natural coagulation inhibitor levels, which may lead to misdiagnosis. Devices have been developed to overcome DOAC interference but their role in thrombophilia testing is not clearly established. In this comprehensive review, we provide an in-depth overview of the literature on the impact of DOACs on thrombophilia assays, including lupus anticoagulant testing, antithrombin, protein C, and protein S assessment. DOACs can interfere with the results of thrombophilia testing even at low concentrations; therefore information on current or recently discontinued anticoagulant treatment should be provided when prescribing thrombophilia testing. Data on the usefulness of the most used DOAC removal systems based on activated charcoal to circumvent DOAC interference are heterogeneous. They are summarized in this critical review. Although activated charcoal could be useful to remove DOACs from plasma prior to thrombophilia testing, it may not be completely effective, particularly with apixaban. Hence, and in the light of the available literature, we provide 22 practical proposals for reliable thrombophilia testing and accurate result interpretation in samples from patients receiving DOACs and treated in vitro with activated charcoal.</p>","PeriodicalId":23036,"journal":{"name":"Thrombosis and haemostasis","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193137","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":"Elevated Factor XI is Associated with First and Recurrent Left Atrial Appendage Thrombus of Unknown Origin.","authors":"Aleksandra Banaś, Szymon Glanowski, Michał Ząbczyk, Elżbieta Paszek, Anetta Undas","doi":"10.1055/a-2703-4109","DOIUrl":"https://doi.org/10.1055/a-2703-4109","url":null,"abstract":"<p><p>Formation of denser and poorly lysable fibrin networks characterizes patients with left atrial appendage thrombus (LAAT) of unknown origin. Elevated factor (F)XI is associated with thromboembolism, including left ventricular thrombus. We investigated whether FXI is increased in LAAT and might predispose to its recurrence and complications.In a case-control study, we studied 36 consecutive patients with LAAT of unknown origin following thrombus resolution, versus 36 age-, sex-, and diabetes-matched controls, all without current anticoagulant treatment. Plasma FXI levels were assessed, along with von Willebrand factor (vWF), clot permeability (K_s), clot lysis time (CLT), fibrinolysis proteins, thrombin generation, and platelet markers. Ischemic cerebrovascular events and LAAT recurrence were evaluated during a median follow-up of 10 years.FXI levels were 14% higher in the LAAT group compared with controls (<i>p</i> < 0.001). FXI >120% was more common in the former group (<i>p</i> = 0.0015). Current smoking and fibrinogen were associated with FXI >120%. In LAAT patients, FXI correlated positively with fibrinogen and CLT, while inversely with vWF and K_s. Most recurrent LAAT (<i>n</i> = 10 out of 11 in total) or cerebrovascular events (<i>n</i> = 18 out of 23 in total) occurred in patients with baseline FXI >120% (both <i>p</i> < 0.001). FXI was associated with LAAT recurrence (OR for 10% = 2.73, 95% CI: 1.32-5.66) and cerebrovascular events (OR for 10%: 1.79, 95% CI: 1.06-3.04).Higher FXI is associated with LAAT of unknown origin, its recurrence and occurrence of cerebrovascular events following anticoagulation withdrawal. Further studies are needed to evaluate whether FXI may help identify patients with LAAT who require prolonged anticoagulation.</p>","PeriodicalId":23036,"journal":{"name":"Thrombosis and haemostasis","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193042","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 Impact of NOACS versus VKAS on Absolute and Relative Cognitive Function Decline Over Time: A Machine Learning Approach.","authors":"Sergio Ferrantelli, Mario Daidone, Giuseppe Armentaro, Gaetano Pacinella, Stefania Scaglione, Anna M Ciaccio, Edoardo Pirera, Carlo D Maida, Giuseppe Miceli, Giuliana Rizzo, Vittoriano Della Corte, Domenico Di Raimondo, Daniele Pastori, Angela Sciacqua, Antonino Tuttolomondo","doi":"10.1055/a-2698-3739","DOIUrl":"10.1055/a-2698-3739","url":null,"abstract":"<p><p>Atrial fibrillation (AF) is the most common arrhythmia in older adults and is associated with an increased risk of cognitive impairment and dementia, even in patients without prior stroke. Nonvitamin K antagonist oral anticoagulants (NOACs) offer a better safety profile than vitamin K antagonists (VKAs), but their cognitive benefit remains uncertain.To assess the impact of NOACs versus VKAs on cognitive decline in elderly AF patients using a machine learning approach.This multicenter prospective cohort study included 983 AF outpatients enrolled between 2008 and 2022 at the Geriatrics Department, University of Catanzaro, and the ProMISE Department, University of Palermo. Stroke and bleeding risks were assessed using CHA₂DS₂-VASc and HAS-BLED scores. Cognitive function was evaluated using the Mini-Mental State Examination (MMSE). Cognitive decline was defined as a decrease in MMSE score between baseline and follow-up. Patients with prior anticoagulant therapy (OAT), severe dementia, or comorbidities affecting cognition were excluded. Multivariable logistic regression and a random forest classifier were used to assess whether anticoagulant type independently predicted cognitive decline. Class imbalance was addressed using both class-weighted learning and the synthetic minority over-sampling technique (SMOTE), with model performance evaluated through repeated stratified cross-validation and threshold optimization.At baseline, cognitive performance was comparable between groups (<i>p</i> = 0.11). After a mean follow-up of 7.2 ± 3.4 years, MMSE scores declined significantly more in VKA-treated patients (-1.7 vs. -0.3 points, <i>p</i> < 0.001). In logistic regression, NOAC use was independently associated with a lower risk of cognitive decline (odds ratio: 0.322; 95% confidence interval: 0.221-0.469; <i>p</i> < 0.0001). The random forest classifier achieved a mean cross-validated AUC of 0.8719 (standard deviation: 0.0273) and a test-set AUC of 0.880. Threshold adjustment and SMOTE improved sensitivity (recall increased: 0.47-0.84), with a precision-recall AUC of 0.763. Permutation importance analysis identified \"OAT\" as the top predictor. Predicted probabilities of cognitive decline were significantly higher in VKA users (median = 0.70) than in NOAC users (median = 0.09), confirmed by a Kolmogorov-Smirnov test (KS = 0.385, <i>p</i> < 0.001).NOAC use is associated with a lower predicted probability of cognitive decline, suggesting potential cognitive benefits over VKAs.</p>","PeriodicalId":23036,"journal":{"name":"Thrombosis and haemostasis","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034203","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}