Thrombosis and haemostasis最新文献

{"title":"Direct Oral Anticoagulants: Quick Primer on When to Use and When to Avoid.","authors":"Antoine Bejjani, Behnood Bikdeli","doi":"10.1055/a-2451-4014","DOIUrl":"10.1055/a-2451-4014","url":null,"abstract":"<p><p>Direct oral anticoagulants (DOACs) have transformed the landscape of antithrombotic therapy in the past two decades. However, there is uncertainty about when they should or should not be used for treatment or prevention of thromboembolic events. DOACs have largely replaced warfarin for many patients with atrial fibrillation or venous thromboembolism who require anticoagulant therapy. In addition to noninferior efficacy, fewer drug-drug and food-drug interactions and improved convenience; DOACs have been shown to reduce the risk of intracranial hemorrhage. They have also received new indications compared with warfarin, such as cardiovascular risk reduction in patients with stable atherosclerotic diseases. However, there are some scenarios in which DOACs are associated with inferior efficacy or worse safety compared with standard treatment, such as warfarin. These include patients with mechanical heart valves, thrombotic antiphospholipid syndrome, and others. Although DOACs offer a streamlined and convenient option for the management of many patients with or at risk of thromboembolic events, their use should be avoided in certain high-risk scenarios. This minireview summarizes such conditions and those in which there is uncertainty for use of DOACs for particular diseases or particular patient subgroups.</p>","PeriodicalId":23036,"journal":{"name":"Thrombosis and haemostasis","volume":" ","pages":"611-617"},"PeriodicalIF":5.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669305","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, Partner Violence, and Coagulopathy: Unmasking New Triggers for Venous Thromboembolism.","authors":"Eva Soler-Espejo, Vanessa Roldán, Francisco Marín","doi":"10.1055/a-2520-8725","DOIUrl":"10.1055/a-2520-8725","url":null,"abstract":"","PeriodicalId":23036,"journal":{"name":"Thrombosis and haemostasis","volume":" ","pages":"657-659"},"PeriodicalIF":5.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053682","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 NO/ROS Equilibrium-A Novel Mechanism for COVID-19 Related Thrombotic Events?","authors":"Eli Israel Lev, Ziv Sevilya","doi":"10.1055/a-2570-9093","DOIUrl":"10.1055/a-2570-9093","url":null,"abstract":"","PeriodicalId":23036,"journal":{"name":"Thrombosis and haemostasis","volume":" ","pages":"673"},"PeriodicalIF":5.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996217","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":"Characterization of CD3+ T Lymphocytes in Human Coronary Thrombi with ST-segment Elevation Myocardial Infarction.","authors":"Muyang Gu, Ni Xia, Si Zhang, Xinyu Zhu, Meilin Liu, Yuzhi Lu, Nana Li, Haoyi Yang, Tingting Tang, Shaofang Nie, Jingyong Li, Fen Yang, Jiao Jiao, Bingjie Lv, Weimin Wang, Desheng Hu, Jiong Hu, Huirong Liu, Chen Chen, Xiang Cheng","doi":"10.1055/a-2437-6111","DOIUrl":"10.1055/a-2437-6111","url":null,"abstract":"<p><strong>Background: </strong> The occurrence and development of ST-segment elevation myocardial infarction (STEMI) are accompanied by coronary atherothrombosis and occlusion, and immune responses play prominent roles in their pathogeneses. However, the causes of atherothrombosis remain elusive, and a comprehensive study of T cell-mediated immune responses in coronary thrombi from STEMI patients is lacking.</p><p><strong>Objectives: </strong> The aim of this study was to determine the heterogeneity and clonality of CD3⁺ T lymphocytes in STEMI patients at the single-cell level.</p><p><strong>Methods: </strong> Paired single-cell RNA and T cell receptor (TCR) sequencing was performed on CD3⁺ T lymphocytes in the coronary thrombi and peripheral blood of STEMI patients, as well as the blood from control subjects without coronary artery disease (CAD).</p><p><strong>Results: </strong> Compared with those in the peripheral blood of STEMI patients, the activation, cytotoxicity, proinflammatory, and prothrombotic characteristics of CD3⁺ T lymphocytes in coronary thrombi were decreased, and the clonality of CD3⁺ T cells was increased. Compared with those from non-CAD controls, T lymphocytes from STEMI patients exhibited an upregulation of genes related to recent TCR engagement, suggesting antigen-specific stimulation in STEMI. Antigen specificity prediction using an algorithm indicated the probability of T cells from different patients binding to similar antigens for clonal expansion during STEMI.</p><p><strong>Conclusion: </strong> This study provides a basis for exploring the cellular heterogeneity of CD3⁺ T lymphocytes in the coronary thrombi and peripheral blood of STEMI patients. Identifying the precise adaptive immune mechanisms driving atherothrombosis may lead to innovative therapies that selectively target the aberrant immune response, resulting in more effective treatments for STEMI.</p>","PeriodicalId":23036,"journal":{"name":"Thrombosis and haemostasis","volume":" ","pages":"697-712"},"PeriodicalIF":5.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605502","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":"Implementing an Assay Detecting Anti-drug Antibody against Emicizumab: Experience from One Center in France.","authors":"Claire Auditeau, Carla Valsecchi, Nûn Kalim Bentounes, Amandine Le-Goff, Annie Harroche, Cécile Bally, Peter J Lenting, Delphine Borgel, Flora Peyvandi, Dominique Lasne","doi":"10.1055/a-2632-3001","DOIUrl":"10.1055/a-2632-3001","url":null,"abstract":"<p><p>Emicizumab is an antibody that mimics the function of factor (F)VIII and has been approved for prophylaxis in hemophilia A patients. However, the development of anti-drug antibodies (ADA) against emicizumab, although rare, can impair its efficacy. In cases with low drug levels or bleeding events, differentiating between ADA- and adherence-related issues can be challenging.We aimed at evaluating the effectiveness of a modified bridging ELISA (Valsecchi et al, JTH 2021) in detecting ADA in patients suspected of developing this response. Clinical and laboratory data were retrospectively collected from six patients with suspected ADA and one with a confirmed case. The modified ELISA was performed blindly to identify potential ADA presence. After a new ADA case was confirmed, it was characterized by assessing its expression over time and neutralizing effect.Five patients had emicizumab levels ≤1 µg/mL, while two had higher levels (13 and 15 µg/mL). Among the patients, two experienced spontaneous bleeding, and four had traumatic bleeding. ADA was detected in two patients, including the one with a known ADA. In ADA-negative patients, emicizumab levels increased following adjustments for compliance or administration issues. The newly identified ADA was neutralizing, blocking emicizumab's binding to factors IX and X. Its pattern of expression was similar to that of the known ADA case, peaking 3 months after the loss of emicizumab efficacy and remaining positive for over a year after emicizumab discontinuation.In bleeding patients with low emicizumab levels, the modified bridging ELISA may effectively differentiate ADA patients from those with other issues leading to decreased emicizumab concentration.</p>","PeriodicalId":23036,"journal":{"name":"Thrombosis and haemostasis","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275996","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":"Direct Oral Anticoagulants for Prevention of Venous Thromboembolism after Cancer-related Surgery: Systematic Review and Network Meta-analysis.","authors":"Gerardo N Pititto, Giorgio Maraziti, Alessandro Squizzato, Cecilia Becattini","doi":"10.1055/a-2628-3967","DOIUrl":"10.1055/a-2628-3967","url":null,"abstract":"<p><p>The risk of venous thromboembolism (VTE) is high after cancer surgery and is reduced by antithrombotic prophylaxis.We conducted a systematic review and network meta-analysis to evaluate the effectiveness and safety of direct oral anticoagulants (DOACs) for VTE prophylaxis after cancer surgery. The primary study outcome was 30-day VTE after surgery. Pooled odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated.Five randomized controlled trials (RCTs; two gynecological, one abdominal, one neurosurgical, and one thoracic; 1,694 patients) and seven observational studies (three urological, two abdominal, and two gynecological; 2,042 patients) were included. DOACs reduced the incidence of 30-day (OR 0.52, 95% CI 0.27-0.98, I2 22.7%) and 90-day VTE (OR 0.51, 95% CI 0.28-0.92, I2 0%) compared to LMWH. No difference was observed between DOACs and LMWH in 30 and 90-day bleeding outcomes. In random effect analyses, apixaban (OR 0.31, 95% CI 0.11-0.84) and not rivaroxaban reduced the risk of 30 day-VTE compared to LMWH (OR 0.69, 95% CI 0.35-1.34) without increasing the risk of bleeding at 30 or 90 days. No difference in the risk of VTE or bleeding was observed between DOACs and placebo/no treatment, but these analyses were probably underpowered. Subgroup analyses were conducted on LMWH pre-treatment, extended prophylaxis, duration of surgery, and type of surgery.Our study supports apixaban and rivaroxaban as promising alternatives to LMWH in post-operative prophylaxis of VTE after cancer surgery. Further high-quality data are needed in specific surgical settings.</p>","PeriodicalId":23036,"journal":{"name":"Thrombosis and haemostasis","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235263","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":"Diagnostic Performance of Commercial Antithrombin Activity Assays: Do We Get What We Expect?","authors":"Christelle Orlando, Céline Drèze, Anton Evenepoel, Sara Seneca, Kristin Jochmans","doi":"10.1055/a-2628-4046","DOIUrl":"10.1055/a-2628-4046","url":null,"abstract":"<p><p>Hereditary antithrombin (AT) deficiency is a rare autosomal dominant disorder that predisposes to the development of recurrent venous thromboembolism (VTE). Diagnosis is based on the measurement of reduced AT activity in plasma. However, not all commercial AT activity assays are equally suited for diagnosis since they differ in sensitivity toward different AT mutations.The aim of this study was to compare the ability of commonly used AT activity assays to diagnose inherited antithrombin deficiency, with a focus on type II AT deficiencies. We used samples from genetically confirmed AT deficient subjects (<i>n</i> = 76) and from patients with request for AT activity measurement for diagnostic purposes (<i>n</i> = 152). AT activity was measured with five commercial assays on three analyzers.All reagent/analyzer combinations showed specificities varying from 87 to 100%, except for 1 assay (56.5% specificity). Diagnostic sensitivity varied widely between assays, from 36.8% to 100%. All reagent-analyzer combinations correctly identified variants causing type I AT deficiencies but only one variant responsible for type II heparin binding site (HBS) deficiency: p.Arg79Cys. For one of the assays, we observed a large difference in sensitivity (82.9 versus 55.3%) toward antithrombin type II HBS variants depending on the coagulation analyzer on which it is performed, suggesting that incubation time of sample and substrate could be a crucial driver of the sensitivity toward variants causing type II antithrombin deficiency. Our results suggest that inherited antithrombin deficiency is probably underestimated and improved diagnostic strategies are mandatory.</p>","PeriodicalId":23036,"journal":{"name":"Thrombosis and haemostasis","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235262","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":"Management of Anticoagulant Therapy in Athletes and Sportspeople: Italian Federation of Centers for Diagnosis and Surveillance of the Antithrombotic Therapies (FCSA) Position Paper.","authors":"Elena Campello, Chiara Cappugi, Filippo Catalani, Daniela Poli, Paolo Bucciarelli","doi":"10.1055/a-2632-3197","DOIUrl":"10.1055/a-2632-3197","url":null,"abstract":"<p><p>This position paper offers expert guidance on managing anticoagulant therapy in athletes and sportspeople, addressing the unique challenges posed by the dual need for effective thromboprophylaxis and maintenance of athletic performance. Recognizing that conditions such as atrial fibrillation and venous thromboembolism occur with higher prevalence in athletes due to factors like intense physical training, dehydration, trauma, and long-haul travel, the paper reviews current literature and expert opinions from the Italian Federation of Centers for Diagnosis and Surveillance of the Antithrombotic Therapies. The manuscript highlights that although direct oral anticoagulants (DOACs) are generally preferred for their favorable efficacy and safety profile compared with traditional vitamin K antagonists (VKAs), their use in sports demands careful risk stratification. To balance effective anticoagulation with the risk of bleeding, individualized treatment strategies-including intermittent dosing regimens with DOACs-are suggested. These strategies aim to minimize bleeding risk during periods of high physical demand while preserving therapeutic effectiveness. In athletes requiring VKA therapy, sport participation-especially contact or high-impact activities-should be strongly discouraged due to the inability to manage bleeding and thrombotic risks safely. Moreover, the paper emphasizes the importance of periodic re-assessment of thromboembolic and hemorrhagic risks, multidisciplinary collaboration among cardiologists, hematologists, and sports medicine specialists, and shared decision-making with the athlete. By offering practical suggestions on treatment modifications, return-to-play protocols, and patient education, this position paper serves as a critical resource for clinicians striving to optimize anticoagulant therapy in athletic populations without compromising competitive performance.</p>","PeriodicalId":23036,"journal":{"name":"Thrombosis and haemostasis","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275997","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":"Distinct Platelet Phenotype and Reactivity in Individuals with Permanent Atrial Fibrillation Treated with Direct Oral Anticoagulants: A Pilot Study.","authors":"Marzia Miglionico, Francesca Maiorca, Annamaria Sabetta, Ludovica Lombardi, Tania D'amico, Alessandro Cincione, Giovanni Buoninfante, Marin Pecani, Marco Proietti, Giulio Francesco Romiti, Roberto Cangemi, Stefania Basili, Valeria Raparelli, Lucia Stefanini","doi":"10.1055/a-2632-3100","DOIUrl":"10.1055/a-2632-3100","url":null,"abstract":"<p><p>Atrial fibrillation (AF) is linked to an elevated risk of thromboembolic events. Despite the use of guideline-recommended direct anticoagulants (DOACs), a significant proportion of AF patients show a residual risk of thromboembolic events, driven by mechanisms that are not fully understood.We conducted a pilot study to characterize the platelet function in DOACs-treated AF patients, to explore whether an association between platelets and the residual thromboembolic risk exists.Within the Age-It project of the National Recovery and Resilience Plan, we examined by flow cytometry the platelet phenotype, reactivity, and mitochondrial function and quantified 12 inflammatory cytokines of individuals with DOACs-treated permanent AF without a history of stroke (<i>n</i> = 18, 66 ± 13 years, 39% females), compared with an age-, sex-, and comorbidity-matched control group without AF (<i>n</i> = 18, 65 ± 11 years, 39% females).Unstimulated circulating platelets of DOACs-treated AF displayed a low-adhesive phenotype compared with matched controls. Upon stimulation, platelets of DOACs-treated AF were hyporeactive to ADP and PAR1 stimulation, but hyper-reactive to GPVI stimulation (adjusted <i>p</i> < 0.01). The lower responsiveness to ADP correlated with increased plasmatic concentrations of IFN-γ (r = - 0.539; <i>p</i> < 0.05) and TNF-α (r = - 0.472; <i>p</i> < 0.05). The higher reactivity to GPVI associated with an increased mitochondrial function, which positively correlated with TNF-α levels.Individuals with AF treated with DOACs exhibit low-grade inflammation and an altered platelet reactivity, suggesting a potential mechanism behind their residual thromboembolic risk. Further well-powered studies are warranted to test whether the observed platelet phenotype is implicated with the residual thromboembolic events in DOACs-treated AF patients.</p>","PeriodicalId":23036,"journal":{"name":"Thrombosis and haemostasis","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275995","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":"Venous Thromboembolism Outcomes by Geographic Region and Self-Reported Race: Insights from the RIETE Registry.","authors":"Alfonso J Tafur, Benjamin Brenner, Pablo Demelo-Rodríguez, Leticia Guirado, José María Pedrajas, Lucia Mazzolai, Ana Cristina Montenegro, Raimundo Tirado, Aurora Villalobos, Manuel Monreal","doi":"10.1055/a-2615-4591","DOIUrl":"10.1055/a-2615-4591","url":null,"abstract":"<p><p>Venous thromboembolism (VTE) outcomes are influenced by various factors, including race and geographic location. This study aimed to evaluate the associations between race, geographic location, and VTE-related outcomes using real-world data.We analyzed data from 42,206 patients with acute VTE enrolled in the RIETE registry between June 2016 and June 2024. Patients were categorized by self-reported race/ethnicity: White (40,258), Arab (995), Asian (689), and Black (264). Baseline characteristics, comorbidities, treatment strategies, and outcomes (including recurrences, major bleeding, and mortality) were compared across groups and regions. Multivariable analyses were performed to adjust for confounders, including geographic location and comorbidities.Arabic and Asian patients were generally younger, had fewer comorbidities, and were more likely to receive direct oral anticoagulants than White patients. In unadjusted analysis, non-White patients had higher rates of deep vein thrombosis (DVT) recurrence and mortality. After multivariable adjustment, most differences disappeared. Notably, White patients enrolled in Asian centers had higher DVT recurrence (4.54 vs. 1.10/100 patient-years, respectively) and mortality rates (27.9 vs. 8.88/100 patient-years, respectively) than those in European centers, and Arab patients in Asia had higher mortality compared to those in Europe (24.1 vs. 8.26/100 patient-years, respectively).Geographic location, likely representing healthcare infrastructure, had a greater influence on VTE outcomes than self-reported race alone.</p>","PeriodicalId":23036,"journal":{"name":"Thrombosis and haemostasis","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102499","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}