Thrombosis research最新文献

{"title":"Pre-infection anticoagulant exposure and SARS-CoV-2 infection outcomes - Differential mortality by age.","authors":"Itshak Amsalem, Asher Shafrir, Yosef Kalish, Ora Paltiel","doi":"10.1016/j.thromres.2025.109254","DOIUrl":"https://doi.org/10.1016/j.thromres.2025.109254","url":null,"abstract":"<p><strong>Background: </strong>The risk of thrombosis increases after SARS-CoV-2 infection. This study aimed to assess associations between pre-infection anticoagulant exposure and SARS-CoV-2 infection-related outcomes in a population-based cohort.</p><p><strong>Methods: </strong>Members of the \"Meuhedet\" health maintenance organization aged >45 years who tested positive for SARS-CoV-2 infection (03/2020-04/2022) were followed. Pre-infection anticoagulant exposure (PAE) was defined as any anticoagulant therapy prescribed ≥1 month prior to SARS-CoV-2 testing. Univariate analyses, multivariable models adjusting for confounders, propensity-score matching, and an age-stratified analysis were performed to assess associations between PAE and hospitalization, intensive care unit (ICU) admission, 30-day and one-year mortality.</p><p><strong>Results: </strong>Of the 127,801 patients included, 2951(2.3 %) had PAE. Comorbidities including ischemic heart disease, diabetes mellitus, hypertension, heart failure, and atrial fibrillation were more common among anticoagulant-exposed than unexposed individuals (p < 0.001). Patients with PAE experienced higher hospitalization (22.7 % vs 5.6 %), ICU admissions (1.9 % vs 0.5 %), 30-day and 1-year mortality rates (4.8 % vs. 0.6, and 8.8 % vs. 1.1 %, respectively), than unexposed individuals, but similar lengths-of-stay. In the multivariable analysis, PAE was independently associated only with hospitalizations (adjusted odds ratio (aOR) = 1.29 [95 % confidence interval (CI): 1.13-1.47]), whereas in the propensity-matched analysis, none of the outcomes differed significantly between the groups. However, in the stratum aged >75 years, 30-day and one-year mortality were significantly reduced in those with PAE (aOR = 0.68 [CI:0.48-0.97], and aOR = 0.73 [CI:0.55-0.97], respectively).</p><p><strong>Conclusion: </strong>SARS-CoV-2-infected individuals with prior exposure to anticoagulants have more comorbidities and experienced a higher incidence of hospitalization but not mortality compared to unexposed patients. Paradoxically, mortality risks decreased in the oldest stratum of anticoagulant-exposed individuals. Further research is required to assess mechanisms for this apparent protective effect.</p>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"246 ","pages":"109254"},"PeriodicalIF":3.7,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of an algorithm to better identify pregnant women with inherited bleeding disorders within electronic health records.","authors":"Ming Y Lim, Vasee Sivaloganathan, George M Rodgers, Sara E Simonsen","doi":"10.1016/j.thromres.2025.109253","DOIUrl":"https://doi.org/10.1016/j.thromres.2025.109253","url":null,"abstract":"<p><strong>Background: </strong>When using electronic health records (EHRs) to conduct population-based studies on inherited bleeding disorders (IBDs), using diagnosis codes alone results in a high number of false positive identifications.</p><p><strong>Objective: </strong>The objective of this study was to develop and validate an algorithm that uses multiple data elements of EHRs to identify pregnant women with IBDs.</p><p><strong>Methods: </strong>The population included pregnant women who had at least one live birth or fetal death (>20 weeks gestation) at our institution from 2016 to 2023. We iteratively developed the algorithm using a composite criteria of encounter diagnosis codes, laboratory and medications data. We assessed the performance of the algorithm for sensitivity and positive predictive value (PPV) using our local registry and manual chart review.</p><p><strong>Results: </strong>Using the source population between 2016 and 2020, the initial algorithm identified 25 pregnant women with IBDs. Eight women with a known diagnosis of an IBD were missed resulting in a sensitivity of 75.8 % and a PPV of 100 %. We revised the algorithm to remove certain IBD diagnosis codes that resulted in contamination and added additional criteria to improve the sensitivity. The revised algorithm had a sensitivity of 97.0 % and a PPV of 91.4 %. The revised algorithm was validated using the source population between 2021 and 2023 and had a sensitivity of 97.1 % and a PPV of 91.7 %.</p><p><strong>Conclusion: </strong>This study demonstrates the utility of an algorithm to better identify pregnant women with specific types of IBD, mainly hemophilia and hemophilia carriers, and von Willebrand disease, within EHRs.</p>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"246 ","pages":"109253"},"PeriodicalIF":3.7,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A new hereditary PROS1 gene mutation caused isolated cortical venous thrombosis.","authors":"Jieming Huang, Yiming Li, Yueping Li, Qianwen Yu, Xiaochun Chen, Qinyong Ye, Ying Chen","doi":"10.1016/j.thromres.2025.109252","DOIUrl":"https://doi.org/10.1016/j.thromres.2025.109252","url":null,"abstract":"<p><strong>Background: </strong>Protein S deficiency is a rare inherited disease. We report the case of a young man who unexpectedly developed isolated cortical vein thrombosis (ICoVT) associated with a novel PROS1 mutation.</p><p><strong>Methods: </strong>Clinical symptoms were recorded, and physical examinations conducted. Comprehensive laboratory tests included routine coagulation function tests, protein C activity, and antithrombin III levels. Advanced imaging techniques, such as magnetic resonance imaging (MRI), magnetic resonance venography (MRV), and computed tomography angiography (CTA) were employed. We also performed genetic analysis on the patient and his parents.</p><p><strong>Results: </strong>The patient presented with headaches and paroxysmal convulsions without identifiable triggers. Physical examinations and routine coagulation tests were generally normal, except for a markedly reduced protein S activity at 21.2 %. MRI scans revealed right parietal cerebral hemorrhage and thickening of the cortical vein, characterized by high T1-weighted Imaging and low T2-weighted Imaging and Fluid-Attenuated Inversion Recovery signals. CTA and Doppler ultrasound of the lower limbs showed no abnormalities. Family history revealed that his father had suffered from multiple venous thromboses. Genetic testing identified a missense mutation (c.1912G>T p.Gly638Cys) in both the patient and his father, along with a duplication of approximately 403.6 kb on chromosome 3q26.32-33 in the patient.</p><p><strong>Conclusions: </strong>This case highlights a novel PROS1 missense mutation and its significant role in development of cortical venous thrombosis. It provides a new insight into the genetic basis of autosomal dominant thrombophilia associated with protein S deficiency (THPH5).</p>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"246 ","pages":"109252"},"PeriodicalIF":3.7,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between the simplified Pulmonary Embolism Severity Index (sPESI) score and hospitalization in emergency department patients diagnosed with pulmonary embolism.","authors":"Pranav Tandon, Cameron Thompson, Karen Li, Shelley L McLeod, Kerstin de Wit, Keerat Grewal","doi":"10.1016/j.thromres.2024.109234","DOIUrl":"10.1016/j.thromres.2024.109234","url":null,"abstract":"","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"245 ","pages":"109234"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anticoagulation stewardship in the ambulatory settings of long-term care and rehabilitation - A multi-centric descriptive pilot study.","authors":"Maria Macoviciuc, Christina Furneri, Léa Callens, Bao Ling Wei, Helen Mantzanis, Nikki Kampouris, Maral Koolian, Vincent Dagenais-Beaulé, Ryan S Kerzner","doi":"10.1016/j.thromres.2024.109238","DOIUrl":"10.1016/j.thromres.2024.109238","url":null,"abstract":"<p><strong>Background: </strong>Anticoagulants have consistently emerged as the leading cause of adverse drug events in both inpatient and outpatient settings. While literature on anticoagulation stewardship programs (ACSP) exists for hospital settings, there is a paucity of data in long-term care and rehabilitation settings.</p><p><strong>Objective: </strong>Assess the feasibility of a pharmacist led ACSP in the ambulatory healthcare settings of long-term care facilities (LTC) and rehabilitation centers (RC).</p><p><strong>Methods: </strong>We conducted a prospective pilot project in 3 rehabilitation centers and 7 long-term care facilities. Patients were selected over 5 months in 2023. Patient and anticoagulant prescription-related characteristics were collected. The primary feasibility outcome was the proportion of anticoagulant prescription reviews leading to a pharmacist intervention.</p><p><strong>Results: </strong>A total of 411 patients were enrolled. Common indications for anticoagulants were atrial fibrillation (n = 255, 62.0 %), medical thromboprophylaxis (n = 52, 12.7 %) and venous thromboembolism (n = 53, 12.9 %). Direct oral anticoagulants (DOAC) were most frequently prescribed (n = 309, 75.2 %). Of 411 prescription reviews, 93 led to at least one intervention (22.6 %), for a total of 100 interventions. Interventions mainly concerned laboratory ordering (n = 29) and DOAC dose adjustment (n = 24). Baseline anticoagulant characteristics and outcomes varied by healthcare setting.</p><p><strong>Conclusion: </strong>Expanding ACSP into outpatient LTC and RC settings is feasible. ACSP should include both therapeutic and thromboprophylactic anticoagulants. Additional research is warranted to evaluate the viability of ongoing ACSP monitoring, and more extensive prospective studies are required to assess clinical outcomes effectively.</p>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"245 ","pages":"109238"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding European patterns of deprescribing antithrombotic medication during end-of-life care in patients with cancer.","authors":"E S L Martens, D Becker, C Abele, D Abbel, W P Achterberg, J J Bax, L Bertoletti, M E Edwards, C Font, A Gava, J Goedegebuur, A A Højen, M V Huisman, M J H A Kruip, I Mahé, S P Mooijaart, M Pearson, K Seddon, S Szmit, S I R Noble, F A Klok, S V Konstantinides","doi":"10.1016/j.thromres.2024.109205","DOIUrl":"10.1016/j.thromres.2024.109205","url":null,"abstract":"<p><strong>Background: </strong>Even though antithrombotic therapy (ATT) probably has little or even negative effect on the well-being of patients with cancer near the end of life, it is often continued until death, possibly leading to excess bleeding complications, increased disease burden, reduced quality of life and higher healthcare costs.</p><p><strong>Aim: </strong>To explore and describe European practice patterns and perspectives of healthcare professionals from different disciplines and specialties on ATT in the end-of-life care (EOLC) of patients with cancer.</p><p><strong>Methods: </strong>We performed a two-week international cross-sectional survey study using flash-mob research methodology. Eligible were healthcare professionals from different institutions across Europe, who prescribed ATT and/or dealt with EOLC of patients with cancer. The survey comprised three parts, including a series of choice sets (hypothetical scenarios involving a set of characteristics changing in level [e.g., high vs. low thrombotic risk]) on ATT management in EOLC. The discrete choice experiment analysis was conducted using multinomial logistic regression.</p><p><strong>Results: </strong>Out of 467 pre-registrants, 208 participated in the survey from 4 to 18 July 2023. The majority (53 %) considered a patient with cancer as in EOLC when life expectancy is below 3 months. Respondents reported seeing or treating 20 patients with cancer on ATT in EOLC per year (IQR 10-50). The median estimated frequency of considering ATT deprescription per healthcare professional was 10 times per year (IQR 4-10), while the frequency of actual deprescription was 5 times per year (IQR 2-10). Twenty percent of respondents had never deprescribed ATT in the context of EOLC. Across the eight choice sets, five respondents (2.7 %) found deprescribing inappropriate in any scenario. Deprescribing was more often considered in patients with poor ECOG-performance status, high bleeding risk and low-molecular-weight heparin use as opposed to oral ATT. Haemato-oncology and cardiovascular medicine specialists were more inclined to deprescribe antiplatelet therapy than other specialties.</p><p><strong>Conclusion: </strong>Our study describes medical decision-making regarding ATT in EOLC of patients with cancer. Healthcare professionals' perspectives and practice patterns vary, and some preferences appear associated with the therapists' professional focus and region of practice.</p>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"245 ","pages":"109205"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exogenous Protein S inhibits pancreatic ductal adenocarcinoma.","authors":"Teagan Prouse, Kristina Larter, Sonali Ghosh, Narender Kumar, Mohammad A Mohammad, Luis Del Valle, Rinku Majumder, Samarpan Majumder","doi":"10.1016/j.thromres.2024.109233","DOIUrl":"10.1016/j.thromres.2024.109233","url":null,"abstract":"","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"245 ","pages":"109233"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of discussions around left atrial appendage occlusion as a treatment option in patients on oral anticoagulation experiencing a major bleeding event.","authors":"Amber Co, Chloe Kazaglis, Deborah DeCamillo, Brian Haymart, Brindha Rajakumar, Geoffrey D Barnes","doi":"10.1016/j.thromres.2024.109239","DOIUrl":"10.1016/j.thromres.2024.109239","url":null,"abstract":"<p><strong>Background: </strong>Guidelines recommend considering percutaneous left atrial appendage occlusion (LAAO) in patients with atrial fibrillation (AF) at moderate to high stroke risk and contraindications to long-term anticoagulation. Discontinuation of anticoagulation in this patient population, without an alternative treatment option, may place patients at unnecessary risk. This study aimed to assess the prevalence of discussions around LAAO as a treatment option following major bleeding adverse events in patients on oral anticoagulation for AF and to identify the proportion of patients stopping anticoagulation without evidence of LAAO discussions.</p><p><strong>Methods: </strong>From a single, large medical center in the United States, patients on an oral anticoagulant for AF and having at least one major bleeding adverse event, defined by the International Society on Thrombosis and Haemostasis, between January 2015 and October 2023 were identified within a quality improvement registry. Information about LAAO discussions, subsequent procedures, and permanent discontinuation of anticoagulation was assessed using the Electronic Medical Record Search Engine and manual electronic medical record reviews.</p><p><strong>Results: </strong>A total of 222 patients experienced major bleeding (54.5 % male, 86.9 % white, median age 77 years, 58.6 % on warfarin). From this group, 283 major bleeds were documented (44.2 % gastrointestinal, 17.7 % intracranial). LAAO discussions were documented in 51 patients (23 %), with LAAO procedures performed in 9 of these patients (17.6 %). After the major bleed, 54 (24.3 %) patients permanently stopped anticoagulation. Of these patients, 18 (33.3 %) had LAAO discussions prior to discontinuation and only 1 (1.9 %) had LAAO implantation.</p><p><strong>Conclusions: </strong>In patients experiencing a major bleed, less than a quarter had documented discussions about LAAO and over a quarter permanently stopped anticoagulation.</p>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"245 ","pages":"109239"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drug-drug interactions between direct oral anticoagulants and anticancer drugs: A single center daily practice evaluation of the occurrence, prescriber response, and subsequent thrombotic and bleeding complications in the Netherlands.","authors":"E M Appelman, E S L Martens, D M Burger, T van Gelder, T van der Hulle, N van Rein, F A Klok","doi":"10.1016/j.thromres.2024.109232","DOIUrl":"10.1016/j.thromres.2024.109232","url":null,"abstract":"","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"245 ","pages":"109232"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The efficacy and safety of andexanet alfa in the treatment of anticoagulation-related major bleedings: An Italian perspective.","authors":"Paolo Simioni, Alessandro Cipriano, Armando D'Angelo, Gianfranco Giannasi, Giorgio Ricci, Elena Campello, Beniamino Susi, Vincenzo Andreone, Paolo Candelaresi","doi":"10.1016/j.thromres.2024.109241","DOIUrl":"10.1016/j.thromres.2024.109241","url":null,"abstract":"","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"245 ","pages":"109241"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}