Thrombosis research最新文献

{"title":"tPA-ROTEM identifies hyperfibrinolytic profile in a significant proportion of patients with bleeding disorder of unknown cause (BDUC)","authors":"A.L.L. Monard ,&nbsp;D. Hellenbrand ,&nbsp;P. Verhezen ,&nbsp;E.A.M. Beckers ,&nbsp;Y.C.M. Henskens ,&nbsp;F.C.J.I. Heubel-Moenen","doi":"10.1016/j.thromres.2025.109404","DOIUrl":"10.1016/j.thromres.2025.109404","url":null,"abstract":"<div><h3>Background</h3><div>In the majority of patients referred for evaluation of bleeding symptoms, no diagnosis can be made after extensive laboratory testing. These patients are classified as having a bleeding disorder of unknown cause (BDUC). Little is known about the role of the fibrinolytic pathway in BDUC patients.</div></div><div><h3>Aim</h3><div>To investigate the capacity of the tPA-ROTEM assay to detect fibrinolytic abnormalities in BDUC patients and to correlate these findings with fibrinolytic protein activity levels.</div></div><div><h3>Methods</h3><div>Patients with an increased bleeding tendency were included in a prospective cohort study. BDUC patients were identified based on an increased bleeding tendency and no abnormalities in extensive laboratory testing. The tPA-ROTEM assay was performed and plasma levels of PAI-1 activity and antigen, α2-antiplasmin, tPA antigen and TAFI were measured using ELISA assays. Pre-specified definitions of hyper- and hypofibrinolysis were applied.</div></div><div><h3>Results</h3><div>tPA-ROTEM identified a hyperfibrinolytic profile in 19/92 (21 %) of BDUC patients. Multivariable regression analysis showed that lower PAI-1 antigen levels were independently associated with hyperfibrinolysis.</div></div><div><h3>Conclusion</h3><div>tPA-ROTEM identified a hyperfibrinolytic profile in 21 % of BDUC patients. These findings suggest that antifibrinolytic medications may be useful to control bleeding or prevent bleeding in surgical interventions in a group of patients with BDUC.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"253 ","pages":"Article 109404"},"PeriodicalIF":3.7,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144655398","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":"Efficacy and safety of anticoagulant treatment in elderly patients with venous thromboembolism beyond the first 3 to 6 months of therapy: A narrative review","authors":"Andrea Boccatonda ,&nbsp;Chiara Simion ,&nbsp;Alice Brighenti ,&nbsp;Carla Serra ,&nbsp;Paolo Simioni ,&nbsp;Elena Campello","doi":"10.1016/j.thromres.2025.109403","DOIUrl":"10.1016/j.thromres.2025.109403","url":null,"abstract":"<div><div>Extended anticoagulation remains a crucial consideration in patients with venous thromboembolism (VTE), especially in older adults. In this population, the two main challenges are the increased risk of bleeding and the underrepresentation in clinical trials. Current guidelines recommend indefinite anticoagulation for unprovoked VTE, except in patients at high bleeding risk, where the benefits and risks must be carefully balanced. In contrast, VTE triggered by a transient risk factor typically does not require prolonged treatment once the factor has resolved. For patients with chronic risk factors, indefinite anticoagulation is often recommended, but decisions should be individualized based on patient preference, risk of recurrence, and bleeding risk. Emerging data highlight the potential role of D-dimer testing in guiding extended therapy. However, in older adults, D-dimer levels may be frequently elevated for reasons unrelated to VTE, limiting its specificity. Real-world studies show wide variability in practice, with many clinicians opting for anticoagulation beyond six months regardless of whether the VTE was provoked. Recent observational data indicate that extended therapy beyond two years may significantly lower recurrence rates, especially following pulmonary embolism, with acceptable bleeding risks. New tools, such as the VTE-PREDICT risk score, aim to support personalized decision-making by estimating both recurrence and bleeding risks over 5 years. Nevertheless, validated bleeding risk scores in older patients remain suboptimal, demonstrating limited predictive power. Alternative strategies, including low-dose DOACs and adjunctive measures such as proton pump inhibitors, may reduce bleeding risk. Balancing recurrence prevention against bleeding complications remains central to optimizing extended-phase VTE treatment, particularly in elderly or comorbid populations.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"253 ","pages":"Article 109403"},"PeriodicalIF":3.7,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614031","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":"Absorption and anticoagulant management of rivaroxaban in patients with short bowel syndrome","authors":"Filippa Lunau ,&nbsp;Katrine Woldbye Andersen ,&nbsp;Søren Risom Kristensen ,&nbsp;Henrik Højgaard Rasmussen ,&nbsp;Mette Holst ,&nbsp;Lars Vinter-Jensen","doi":"10.1016/j.thromres.2025.109398","DOIUrl":"10.1016/j.thromres.2025.109398","url":null,"abstract":"<div><h3>Background</h3><div>Patients with short bowel syndrome (SBS) often rely on parenteral nutrition via central venous catheters, increasing the risk of thrombosis. Many also require long-term anticoagulation due to other conditions. While warfarin was traditionally preferred, direct oral anticoagulants like rivaroxaban are now more common. However, no larger studies have assessed rivaroxaban absorption in SBS patients.</div></div><div><h3>Aim</h3><div>The aim of this study was to do a further characterization of the absorption of rivaroxaban in patients with SBS. The secondary aim was to assess thromboses and bleeding events in patients on continuous treatment with rivaroxaban.</div></div><div><h3>Methods</h3><div>A retrospective, five-year cohort study following a 20 mg dose rivaroxaban, plasma concentrations were measured at 1.5, 2.5, and 3.5 h, in 34 patients with SBS. Thrombotic and bleeding events and clinical data were sought in medical records. Patients were characterized with the length of the small intestine and the weekly volume of intravenous fluid support.</div></div><div><h3>Results</h3><div>The Cmax of rivaroxaban correlated positively with intestinal length (<em>p</em> = 0.005) and negatively with the weekly total fluid support (<em>p</em> = 0.0001). A cut-off value regarding intestinal length and adequate absorption was estimated between 125 and 150 cm. In a cumulative follow up time of 19.6 years, one event of thrombosis and one event of bleeding was observed.</div></div><div><h3>Conclusion</h3><div>Rivaroxaban absorption correlates with intestinal length and functionality. Anticipating few thrombotic and bleeding events during treatment, rivaroxaban seemed efficient and safe, but further studies are warranted to clarify its role in SBS patients.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"253 ","pages":"Article 109398"},"PeriodicalIF":3.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144655396","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":"Evaluation of modified pediatric sepsis-induced coagulopathy score in pediatric septic shock","authors":"Chenhao Wang ,&nbsp;Bian Jin ,&nbsp;Fang Fang ,&nbsp;Feng Xu","doi":"10.1016/j.thromres.2025.109400","DOIUrl":"10.1016/j.thromres.2025.109400","url":null,"abstract":"<div><h3>Background</h3><div>Sepsis-induced coagulopathy (SIC) is highly prevalent and plays an important role in the pathophysiology of sepsis. However, validated assessment tools for pediatric SIC under the 2024 pediatric sepsis criteria remain lacking. This study aimed to develop and validate a modified pediatric SIC (pSIC) score based on the Phoenix Sepsis Score (PSS) and evaluate its diagnostic and prognostic utility in children.</div></div><div><h3>Methods</h3><div>This retrospective study enrolled pediatric patients with septic shock admitted to the Pediatric Intensive Care Unit of Children's Hospital of Chongqing Medical University between May 2015 and August 2023. A modified pSIC score was developed by replacing the Sequential Organ Failure Assessment (SOFA) score with the PSS based on the existing adult SIC criteria.</div></div><div><h3>Results</h3><div>Among 432 pediatric patients with septic shock, those with elevated modified pSIC score demonstrated significantly worse baseline characteristics and higher risks of adverse outcomes. The modified pSIC score exhibited higher predictive value for 28-day mortality compared to previous scores and maintained good predictive ability and high sensitivity for overt DIC. Survival curves confirmed significantly higher 28-day mortality in the high pSIC group than in the low pSIC group (38.2 % vs 12.8 %, <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>In this single-center cohort of pediatric septic shock patients, the modified pSIC score demonstrated good diagnostic and prognostic utility for sepsis-induced coagulopathy under updated sepsis criteria. However, its effectiveness still needs to be further validated in broader pediatric sepsis population.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"253 ","pages":"Article 109400"},"PeriodicalIF":3.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144634122","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":"Joint health in Chilean children with haemophilia on primary prophylaxis","authors":"Verónica Soto-Arellano ,&nbsp;Agustina María Petracco ,&nbsp;Carlos Cruz-Montecinos","doi":"10.1016/j.thromres.2025.109401","DOIUrl":"10.1016/j.thromres.2025.109401","url":null,"abstract":"<div><h3>Introduction</h3><div>Primary prophylaxis is the gold standard in severe haemophilia A and B. Proper monitoring and follow-up of this treatment are essential for achieving good outcomes. Haemophilia Early Arthropathy Ultrasound (HEAD-US) helps assess joint status and detect initial damage.</div><div>Our study aimed to evaluate the effectiveness of primary prophylaxis on joint health through HEAD-US in the paediatric population in Chile.</div></div><div><h3>Method</h3><div>We selected all patients under 15 years old in the country with severe haemophilia A or B who had received primary prophylaxis with plasma-derived FVIII/FIX products. Variables included in the analysis were joint health, treatment adherence (Veritas-Pro), morning prophylaxis treatment, home and hospital administration of treatment, and residence in the metropolitan region.</div></div><div><h3>Results</h3><div>Eighty-six children from 23 public centres were assessed (covers 85 % of the total population in Chile). Half of the children receiving standard half-life FVIII/IX prophylaxis still present joint damage, with the ankle the most affected joint. Among protective factors for joint health, adherence and living in the metropolitan region showed a significant odds ratio (<em>p</em> &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>Joint damage was present in 50% of the children, with the ankle being the most affected. Cartilage damage is a key marker in children over eight, while synovitis is predominant in younger ones. Adherence to prophylaxis and living in the metropolitan region are protective factors. These results highlight the importance of monitoring joint health and using HEAD-US for early screening in children on primary prophylaxis.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"253 ","pages":"Article 109401"},"PeriodicalIF":3.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144634121","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":"Real-world safety and effectiveness of rurioctocog alfa pegol in 338 patients with hemophilia A in South Korea: A postmarketing surveillance study","authors":"Ji Yoon Kim ,&nbsp;Taiju Hwang ,&nbsp;Sang Kyu Park ,&nbsp;Ki-Young Yoo ,&nbsp;Eun Jin Choi ,&nbsp;Soyon Kim ,&nbsp;Chur Woo You ,&nbsp;Eungsun Kim ,&nbsp;Aeran Jung ,&nbsp;Young-Shil Park","doi":"10.1016/j.thromres.2025.109402","DOIUrl":"10.1016/j.thromres.2025.109402","url":null,"abstract":"<div><h3>Introduction</h3><div>Rurioctocog alfa pegol is a recombinant coagulation factor VIII (FVIII) with an extended half-life versus the parent product. Limited real-world data exist on the treatment of hemophilia A with rurioctocog alfa pegol in South Korea. This postmarketing surveillance study assessed its safety and effectiveness in a real-world setting, according to Korean regulatory requirements.</div></div><div><h3>Methods</h3><div>In this prospective, multicenter study (NCT03824522), data were collected from medical records of patients, including children, with hemophilia A receiving rurioctocog alfa pegol as standard clinical practice in South Korea. Safety (adverse events [AEs], adverse drug reactions [ADRs], and unexpected AEs/ADRs) and hemostatic effectiveness were analyzed.</div></div><div><h3>Results</h3><div>In total, 338 patients were included (mean age [range], 25.0 [1.0–61.0] years; children &lt;12 years, <em>n</em> = 54 [16 %]; all had a history of FVIII treatment). AEs occurred in 20 (5.9 %) patients (unexpected AEs, <em>n</em> = 18 [5.3 %]; ADRs, <em>n</em> = 4 [1.2 %]; unexpected ADRs, <em>n</em> = 2 [0.6 %]; serious AEs, n = 4 [1.2 %]; serious ADRs, <em>n</em> = 0 [0.0 %]). Among children, AEs occurred in 1 (50 %) and 6 (11.5 %) patients aged &lt;2 and ≥2 to &lt;12 years, respectively. No new safety signals were observed. No bleeding events occurred in 239 (76.1 %) patients on prophylaxis. Hemostatic effectiveness was rated by physicians as excellent/good in most patients. Bleeding events were managed with 1–2 infusions. Treatment effectiveness was maintained in children during the study period. No patients developed inhibitor antibodies against rurioctocog alfa pegol.</div></div><div><h3>Conclusion</h3><div>Rurioctocog alfa pegol was effective in children and adults, with no new safety signals; most patients on prophylaxis experienced no bleeds during the study.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"253 ","pages":"Article 109402"},"PeriodicalIF":3.7,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144655397","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":"“Who am I to say that I'm not going to take it”: patient perspectives on decisions about antithrombotic therapy in the context of advanced cancer","authors":"Elin Baddeley ,&nbsp;Carme Font ,&nbsp;Isabelle Mahé ,&nbsp;Michelle Edwards ,&nbsp;Stephanie Sivell ,&nbsp;Kate J. Lifford ,&nbsp;Victoria Mailen Arfuch ,&nbsp;Nuri Coma-Auli ,&nbsp;Mette Søgaard ,&nbsp;Helle Enggaard ,&nbsp;Hélène Helfer ,&nbsp;Nassima Si Mohammed ,&nbsp;Kathy Seddon ,&nbsp;Mark Pearson ,&nbsp;Simone P. Mooijaart ,&nbsp;Sebastian Szmit ,&nbsp;F.A. Klok ,&nbsp;Simon Noble ,&nbsp;Anette Arbjerg Højen ,&nbsp;SERENITY consortium","doi":"10.1016/j.thromres.2025.109399","DOIUrl":"10.1016/j.thromres.2025.109399","url":null,"abstract":"<div><h3>Introduction</h3><div>The decision to reconsider antithrombotic therapy (ATT) in cancer patients nearing the end of life is complex given the increasing risk of haemorrhage and thrombosis. A decision support tool (DST) is being developed to facilitate this process. Understanding patients' experiences, values, and perspectives are an essential component, yet remain largely unexplored.</div></div><div><h3>Aim</h3><div>To explore these patients' experiences, values and perspectives regarding ATT use.</div></div><div><h3>Methods</h3><div>Qualitative study using semi-structured interviews with patients with advanced cancer receiving ATT, across Denmark, France, Spain, and the United Kingdom. Data were analysed using Framework Analysis.</div></div><div><h3>Results</h3><div>Sixty patients and 13 relatives participated. Three major themes were generated:<ul><li><span>1.</span><span><div>ATT is important and lifelong: Deprescription was perceived as counterintuitive; continuation was preferred, providing a sense of security.</div></span></li><li><span>2.</span><span><div>Varying perspectives regarding roles and responsibilities in ATT decision-making: Patients' views regarding their role varied. When a good relationship existed with their clinician, patients trusted them to lead on the decision. Relatives played a key supportive role.</div></span></li><li><span>3.</span><span><div>Challenges in navigating ATT management in the context of advanced cancer and multiple comorbidities: Decisions relating to ATT were rarely made in isolation. Patients prioritised cancer management and described difficulties navigating multiple health concerns.</div></span></li></ul></div></div><div><h3>Conclusion</h3><div>Patients found decision-making around ATT near the end of life multifaceted, occurring amid a myriad of competing priorities. While patients reported a reticence to discontinuing, ultimately many deferred such decisions to a clinician, whose role was highly valued. These findings support a need for a DST, to support informed and shared choices in ATT decisions.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"253 ","pages":"Article 109399"},"PeriodicalIF":3.7,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144596057","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":"Hemostatic alterations in metabolic dysfunction-associated steatotic liver disease (MASLD) and their link to venous thromboembolism (VTE)","authors":"David E. González-Mendoza ,&nbsp;Francisco Fernández-Nogueira ,&nbsp;Misael Uribe ,&nbsp;Norberto C. Chávez-Tapia ,&nbsp;Natalia Nuño-Lámbarri","doi":"10.1016/j.thromres.2025.109395","DOIUrl":"10.1016/j.thromres.2025.109395","url":null,"abstract":"<div><div>Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver condition worldwide. It is associated with obesity, insulin resistance, type 2 diabetes, hypertension, and dyslipidemia, contributing to increased cardiovascular risk. As MASLD progresses, it may evolve into more advanced liver damage, namely metabolic dysfunction-associated steatohepatitis (MASH), fibrosis, cirrhosis, and, in advanced stages, hepatocellular carcinoma. The liver plays a central role in hemostasis by synthesizing procoagulant, anticoagulant, and fibrinolytic factors. In MASLD patients, alterations in these hemostatic pathways may contribute to a prothrombotic state. Insulin resistance and chronic inflammation further exacerbate these disturbances, increasing the risk of thromboembolism. In conclusion, MASLD may represent not only a hepatic disorder but also an emerging cardiovascular and thromboembolic risk factor. This review aims to provide an updated overview of MASLD and its relationship with venous thromboembolism (VTE), focusing on physiological mechanisms, molecular alterations, and current clinical evidence on both conditions.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"253 ","pages":"Article 109395"},"PeriodicalIF":3.7,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144570012","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":"Comparison of rivaroxaban with warfarin for intracardiac thrombosis in the pediatric population at different cardiac sites: Early experience of anticoagulation approach and treatment outcomes","authors":"Deborah Cappelletti ,&nbsp;Francesco Bianco ,&nbsp;Valentina Bucciarelli ,&nbsp;Elena Raffaelli ,&nbsp;Linda Bordignon ,&nbsp;Gianluca Di Cesare ,&nbsp;Benedetta Bucciarelli ,&nbsp;Alessandro Bacchiocchi ,&nbsp;Camilla Manini ,&nbsp;Ettore Merlino ,&nbsp;Sergio Filippelli ,&nbsp;Maria Elena Lionetti","doi":"10.1016/j.thromres.2025.109397","DOIUrl":"10.1016/j.thromres.2025.109397","url":null,"abstract":"<div><h3>Aims</h3><div>To compare the rivaroxaban treatment with warfarin for intracardiac thrombi resolution in pediatric patients diagnosed with intracardiac thrombosis (ICT).</div></div><div><h3>Methods</h3><div>In 2020–24, we enrolled 18 [0.7 (0.3–12, Q1-Q3) years-old, 67 % males] consecutive ICT pediatric patients (&lt; 16 years old) treated in 2020–22 with warfarin (<em>n</em> = 9, 0.1 mg/Kg/day) and in 2023–24 with rivaroxaban (n = 9, dosage based on patient's body weight). ICT was suspected by echocardiography and confirmed with cardiac computed tomography (CCT) or magnetic resonance (CMR) imaging. All the participants were treated with enoxaparin for 7 days before the rivaroxaban implementation. CCT/CMR was repeated to confirm ICT resolution. <em>N</em> = 9/18 (50 %) patients presented with right atrial thrombosis, <em>n</em> = 5/18 (28 %) and <em>n</em> = 3/18 (17 %) with right/left ventricular thrombi, respectively, and <em>n</em> = 1/18 (5 %) with left atrial appendage thrombus.</div></div><div><h3>Results</h3><div>Compared with warfarin, treatment with rivaroxaban had a shorter duration (Log-rank <em>P</em> = 0.020); warfarin vs. rivaroxaban: 9.67 ± 3.6 vs. 6.6 ± 2.2 weeks (<em>P</em> = 0.0040). After rivaroxaban, all the thromboses were resolved and confirmed at the CCT/CMR imaging; no major bleeding event was documented during the treatment based on the BASIC bleeding assessment scale. Only minor bleedings were documented. In details: warfarin experienced <em>n</em> = 6/9 (67 %) gastrointestinal bleedings and <em>n</em> = 2/9 macroscopic hematuria, while 3 gingival bleedings were documented in the rivaroxaban group. After a follow-up period of 6 months, no recurrences were detected/suspected at the echocardiography evaluation.</div></div><div><h3>Conclusions</h3><div>Among pediatric patients with ICT, irrespective of the thrombosis site, rivaroxaban seemed effective in thrombus resolution.</div></div><div><h3>ClinicalTrials.gov ID</h3><div><span><span>NCT06371170</span><svg><path></path></svg></span></div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"253 ","pages":"Article 109397"},"PeriodicalIF":3.7,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144570011","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 novel Computable phENotype To Identify Pulmonary Embolism in chilDrEn: The CENTIPEDE Study","authors":"Hilary Whitworth ,&nbsp;Kristina Wagner ,&nbsp;Allison Zelinski ,&nbsp;Elana DiCocco ,&nbsp;Amy J. Goodwin Davies ,&nbsp;Rochelle Jordan ,&nbsp;Miranda Higginbotham ,&nbsp;Michael L. O'Byrne ,&nbsp;L. Charles Bailey ,&nbsp;Leslie Raffini ,&nbsp;Madhvi Rajpurkar","doi":"10.1016/j.thromres.2025.109385","DOIUrl":"10.1016/j.thromres.2025.109385","url":null,"abstract":"<div><h3>Background</h3><div>Pediatric pulmonary embolism (PE) is rare and requires multicenter research to generate meaningful results and improve care. PEDSnet is a multicenter learning health system including 10 pediatric institutions and a valuable tool to study rare diseases.</div></div><div><h3>Objectives</h3><div>We aimed to develop a computable phenotype (CP) to accurately identify pediatric PE in PEDSnet.</div></div><div><h3>Methods</h3><div>We developed an algorithm for identification of pediatric PE in Children's Hospital of Philadelphia data within PEDSnet and compared it to blinded chart review. We identified a cohort of patients from 1/1/2012–12/31/2022 who were predicted to have PE based on the CP and an equal number predicted to not have a PE. Manual chart review identified true positive and negative and false positive and negative PE. Subsequent adjustments were made to improve CP performance. In patients with a confirmed PE, we identified select outcomes in PEDSnet and compared them to chart review to evaluate the ability to assess outcomes in PEDSnet.</div></div><div><h3>Results</h3><div>There were 152 PE patients identified by the best performing CP which included: 1) Anticoagulant prescribed, dispensed, or administered in an inpatient or emergency department encounter, 2) SNOMED-CT code for PE, 3) Chest CT or perfusion study in the encounter. CP performance characteristics were as follows: sensitivity 96 %, specificity 88 %, positive predictive value 90 %, and negative predictive value 95 %. Preliminary outcome validation highlighted areas for improvement in identifying transfusions and thrombolysis.</div></div><div><h3>Conclusions</h3><div>We report the first pediatric PE CP. Future research will include multicenter CP validation and improved identification of interventions and outcomes.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"253 ","pages":"Article 109385"},"PeriodicalIF":3.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556946","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}