Thrombosis research最新文献

{"title":"Direct oral anticoagulants in venous thrombotic antiphospholipid syndrome: Residual confounding behind an apparent arterial signal","authors":"Güney Sarıoğlu","doi":"10.1016/j.thromres.2026.109856","DOIUrl":"10.1016/j.thromres.2026.109856","url":null,"abstract":"","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"266 ","pages":"Article 109856"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075813","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":"Perioperative haemostatic management and bleeding outcomes in congenital factor VII deficiency: a retrospective cohort study","authors":"Friederike Töpper,&nbsp;Philipp Brandhorst,&nbsp;Thomas Dörner,&nbsp;Christoph Sucker,&nbsp;Ralf Hammerich,&nbsp;Christoph Dibiasi,&nbsp;Sascha Treskatsch,&nbsp;Johannes Gratz","doi":"10.1016/j.thromres.2026.109865","DOIUrl":"10.1016/j.thromres.2026.109865","url":null,"abstract":"<div><h3>Background</h3><div>Congenital factor VII (FVII) deficiency is characterised by a poor and inconsistent relationship between FVII activity (FVII:C) and bleeding phenotype, making perioperative haemostatic management challenging. We aimed to describe perioperative management strategies, identify factors associated with haemostatic treatment, and evaluate perioperative outcome.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of patients with congenital FVII deficiency (severe FVII:C &lt; 10%, moderate 10–19%, mild ≥20% according to ISTH) undergoing surgical procedures or delivery at Charité – Universitätsmedizin Berlin between January 2015 and June 2023. Procedural bleeding risk was classified as minor, low or high according to 2022 ESC non-cardiac surgery guidelines. Haemostatic management, bleeding and thromboembolic outcomes were assessed; univariate logistic regression explored factors associated with haemostatic treatment.</div></div><div><h3>Results</h3><div>Ninety-three procedures were analysed in 70 patients; 73% were performed in patients with mild, 14% with moderate and 13% with severe deficiency. Haemostatic treatment was administered in 71% of procedures, most commonly tranexamic acid (56%) and factor replacement therapy (38%). Lower FVII:C was associated with factor replacement therapy (OR 0.96, 95% CI: 0.92–0.99; <em>P</em> = 0.006), bleeding risk and bleeding history were not. Perioperative bleeding occurred in 9 (9.7%) procedures, all in patients with mild deficiency (FVII:C 24–45%) and all during high-risk procedures. Two arterial thromboembolic events (2.2%) occurred.</div></div><div><h3>Conclusions</h3><div>In clinical practice, perioperative treatment in congenital FVII deficiency appeared driven primarily by FVII:C, whereas bleeding events clustered among patients with mild deficiency undergoing high-risk procedures. As treatment itself may have influenced this pattern, our findings highlight the need for an individualised perioperative risk assessment that integrates FVII:C, bleeding phenotype and procedural risk, rather than relying on FVII:C alone.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"266 ","pages":"Article 109865"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anticoagulation management and outcomes in cancer-associated gonadal and renal vein thrombosis: A multicenter retrospective cohort study","authors":"Elena Butera,&nbsp;Chiara Cavallaro,&nbsp;Alessandro D'Errico,&nbsp;Rosa Talerico,&nbsp;Ranjeeta Mallick,&nbsp;Roger Kou,&nbsp;Marc Carrier,&nbsp;Roberto Pola,&nbsp;Tzu-Fei Wang","doi":"10.1016/j.thromres.2026.109864","DOIUrl":"10.1016/j.thromres.2026.109864","url":null,"abstract":"","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"266 ","pages":"Article 109864"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115261","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":"Fibrinogen activity and postpartum hemorrhage risk in women with congenital fibrinogen disorders: A multicenter real-world study","authors":"Jie Sun,&nbsp;Hai-xia Fu,&nbsp;Wei Xie,&nbsp;Guang-han Wang,&nbsp;Ying Feng,&nbsp;Yuan Wei,&nbsp;Jie Zhao,&nbsp;Jin Wu,&nbsp;Zhi-xue Li,&nbsp;Zhuo-yu An,&nbsp;Qiu-sha Huang,&nbsp;Peng Zhao,&nbsp;Qiu-yu Guo,&nbsp;Xiu-li Sun,&nbsp;Xiao-hong Zhang,&nbsp;Xue Xu,&nbsp;Mei-ying Liang,&nbsp;Guo-li Liu,&nbsp;Jian-liu Wang,&nbsp;Xiao-hui Zhang","doi":"10.1016/j.thromres.2026.109862","DOIUrl":"10.1016/j.thromres.2026.109862","url":null,"abstract":"<div><h3>Background</h3><div>Congenital fibrinogen disorders (CFDs) are associated with an increased risk of adverse pregnancy outcomes, including postpartum hemorrhage (PPH). However, the relationship between fibrinogen activity and PPH risk remains poorly defined.</div></div><div><h3>Methods</h3><div>We performed a multicenter retrospective cohort study of 75 women with CFDs from three tertiary centers in China between 2012 and 2025. Pregnancy outcomes and changes in fibrinogen activity during pregnancy were assessed. Deliveries with and without PPH were compared to evaluate the association between fibrinogen activity and PPH risk.</div></div><div><h3>Results</h3><div>Among 163 pregnancies, 107 (65.6%) resulted in live births. Detailed delivery data were available for 92 of 107 live births, with PPH occurring in 15 deliveries (16.3%). Fibrinogen activity increased significantly across pregnancy (<em>P</em> &lt; 0.01), but baseline and pre-delivery levels were similar between deliveries with and without PPH (0.72 vs. 0.68 g/L, <em>P</em> = 0.49; 1.24 vs. 1.16 g/L, <em>P</em> = 0.55). Neither the absolute nor the fold change in fibrinogen activity differed significantly between groups. Pre-delivery fibrinogen activity was not associated with PPH after adjustment for maternal age, previous PPH, and induction of labor (adjusted OR per 0.1-g/L increase, 0.99; 95% CI, 0.87–1.12; <em>P</em> = 0.918). Prophylactic fibrinogen replacement was more common in deliveries with PPH (93.3% vs. 68.8%, <em>P</em> = 0.06).</div></div><div><h3>Conclusions</h3><div>Most pregnancies in women with CFDs resulted in live births. PPH remained an important maternal complication, but fibrinogen activity alone may be insufficient for assessing PPH risk. The role of prophylactic fibrinogen replacement therapy requires evaluation in prospective studies.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"266 ","pages":"Article 109862"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138340","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":"Left atrial appendage isolation and thrombotic and thromboembolic outcomes in atrial fibrillation: A systematic review and meta-analysis","authors":"Xiaoxia Bai,&nbsp;Haoxin Huang,&nbsp;Zhenzhen Zhang,&nbsp;Juanjuan Yuan,&nbsp;Sen Yan,&nbsp;Xiaojun Xiang","doi":"10.1016/j.thromres.2026.109839","DOIUrl":"10.1016/j.thromres.2026.109839","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Electrical left atrial appendage isolation (LAAI) may be accompanied by impaired appendage function and thromboembolic complications. We evaluated the association between LAAI and clinical stroke or transient ischemic attack (TIA), while separately examining imaging-detected left atrial appendage (LAA) thrombus and related supportive outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to December 6, 2024 for comparative clinical studies reporting thrombotic or thromboembolic outcomes after LAAI. Clinical stroke or TIA was the primary outcome. Risk ratios (RRs) were pooled using an inverse-variance random-effects model with restricted maximum-likelihood estimation and Hartung-Knapp-adjusted confidence intervals (CIs). The preferred primary analysis excluded the smaller Rillig cohort because of possible participant overlap with the Heeger cohort. Imaging-detected LAA thrombus, anticoagulation-at-event data, and LAA functional findings were evaluated separately.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Five comparative observational studies were included. The preferred primary analysis comprised four studies and 3876 patients, including 801 who underwent LAAI and 3075 controls. Clinical stroke or TIA occurred in 42 and 66 patients, respectively. LAAI was associated with a higher cumulative risk of clinical stroke or TIA (RR = 4.96, 95% CI 1.10–22.42; &lt;em&gt;P&lt;/em&gt; = 0.043; I&lt;sup&gt;2&lt;/sup&gt; = 55.6%). The 95% prediction interval was 0.21–115.69. Inclusion of the potentially overlapping Rillig cohort yielded an RR of 5.26 (95% CI 1.80–15.36; &lt;em&gt;P&lt;/em&gt; = 0.013), but the prediction interval remained compatible with no association. Leave-one-out analyses were directionally consistent, although statistical significance was lost after omission of Kim, Heeger, or Romero. Comparative LAA thrombus estimates were available only from Rillig (RR = 22.31, 95% CI 1.34–370.43) and Heeger (RR = 10.31, 95% CI 2.50–42.56) and were not pooled because potential cohort overlap could not be excluded. Anticoagulation-at-event and LAA functional data were unsuitable for quantitative synthesis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;The available evidence suggests that LAAI may be associated with a higher cumulative risk of clinical stroke or TIA. However, the extremely wide prediction interval crossing the null and the loss of statistical significance after omission of several individual studies indicate considerable uncertainty regarding the magnitude and consistency of this potential association across different practice settings. Comparative imaging findings also suggested a higher frequency of postprocedural LAA thrombus, although the available evidence was limited and potentially overlapping. Independent comparative studies with standardized TEE surveillance, clearly defined anticoagulation exposure, and complete clinical and imaging outcome reporting are","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"266 ","pages":"Article 109839"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075849","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 calf clot of the lungs: Detection, overdiagnosis, and structured surveillance in isolated subsegmental pulmonary embolism","authors":"Thomas Christian Landry,&nbsp;Youjin Kim,&nbsp;Riley Meister,&nbsp;Kylee L. Martens,&nbsp;Pascale Packia Raj,&nbsp;Joseph J. Shatzel","doi":"10.1016/j.thromres.2026.109866","DOIUrl":"10.1016/j.thromres.2026.109866","url":null,"abstract":"<div><div>Multidetector CT pulmonary angiography has increased detection of pulmonary embolism at the subsegmental level without a corresponding fall in overall PE mortality, placing isolated subsegmental pulmonary embolism (iSSPE) at the center of a management conflict: the 2021 CHEST guideline permits structured surveillance in selected patients, whereas the 2026 multisociety guideline recommends anticoagulation for all acute pulmonary embolism. We review iSSPE definition, diagnostic reliability, natural history, treatment-versus-surveillance outcomes, and guideline divergence. Across mixed cohorts, anticoagulation has not clearly reduced recurrence or mortality but increases bleeding; cancer-associated thrombosis is the clearest exception however. We propose a four-gate framework to guide surveillance versus anticoagulation.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"266 ","pages":"Article 109866"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138271","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":"Age-related reduction in D-dimer cut-off specificity: Diagnostic relevance in geriatric patients","authors":"Francesca Marchegiani,&nbsp;Roberta Galeazzi,&nbsp;Luca Antognoli,&nbsp;Fausto Moroni,&nbsp;Stefania Appolloni,&nbsp;Antonio Cherubini,&nbsp;Fabio Salvi,&nbsp;Sara Cecchini,&nbsp;Enrico Paci,&nbsp;Fabiola Olivieri,&nbsp;Jacopo Sabbatinelli","doi":"10.1016/j.thromres.2026.109837","DOIUrl":"10.1016/j.thromres.2026.109837","url":null,"abstract":"<div><h3>Introduction</h3><div>D-dimer testing is widely used to exclude pulmonary embolism (PE), but its specificity declines sharply with age. Evidence in very old adults is limited, as most validation studies include few patients aged ≥80 years. This study aimed to identify and validate a clinically appropriate D-dimer threshold for geriatric patients.</div></div><div><h3>Methods</h3><div>Two large cohorts of adults evaluated for suspected PE in a Geriatric Emergency Department were included. The derivation cohort included 1617 patients; the validation cohort included 2861 patients. D-dimer performance was assessed using ROC analysis, and specificity was compared across the conventional 500 μg/L FEU cut-off, the age-adjusted threshold, a fixed 1000 μg/L FEU threshold, and the optimized threshold. PE diagnosis was confirmed by CT pulmonary angiography.</div></div><div><h3>Results</h3><div>D-dimer levels increased with age, inflammation, and renal dysfunction. In the derivation cohort, the conventional cut-off showed low specificity, particularly in patients aged ≥90 years. The age-adjusted threshold improved performance but remained insufficient in the oldest age groups. An optimized threshold of 1050 μg/L FEU provided the best balance between sensitivity (100% in the derivation cohort and 97.8% in the validation cohort) and specificity, with a negative predictive value of 99.8%. This threshold correctly reclassified 23% of patients who were false-positive at the 500 μg/L FEU cut-off.</div></div><div><h3>Conclusion</h3><div>In very old adults, the conventional D-dimer cut-off is clinically inadequate, and the age-adjusted threshold remains suboptimal. A threshold of 1050 μg/L FEU, validated in two very old geriatric cohorts, offers a safer and more specific alternative for ruling out PE in geriatric emergency care.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"266 ","pages":"Article 109837"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor regarding “Comparative validation of AHA/ACC 2026 and ESC 2019 risk stratification in hospitalized patients with acute pulmonary embolism” by Li Y et al","authors":"Anabel Franco-Moreno,&nbsp;Cristina Lucía de Ancos-Aracil","doi":"10.1016/j.thromres.2026.109857","DOIUrl":"10.1016/j.thromres.2026.109857","url":null,"abstract":"","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"266 ","pages":"Article 109857"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082172","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 quality in antiphospholipid syndrome according to INR testing strategy","authors":"Sara R. Vazquez,&nbsp;Alyssa Lovell,&nbsp;Spencer J. Gilbert,&nbsp;Daniel M. Witt","doi":"10.1016/j.thromres.2026.109858","DOIUrl":"10.1016/j.thromres.2026.109858","url":null,"abstract":"<div><h3>Background</h3><div>Uncertainty exists regarding the accuracy and clinical utility of point-of-care (POC) International Normalized Ratio (INR) testing in patients with antiphospholipid syndrome (APS) prescribed warfarin.</div></div><div><h3>Methods</h3><div>The objective of this study was to evaluate anticoagulation quality among APS patients using different INR testing methods. This retrospective observational cohort included adult patients on warfarin with ≥8 months of INR data and investigator-confirmed APS classification. Patients were categorized by INR testing methods during the 13-month period as POC, venipuncture (VP), or mixed if neither POC nor VP methods accounted for ≥75% of INRs. Outcomes included time in therapeutic range (TTR) and clinical adverse events during the study period.</div></div><div><h3>Results</h3><div>A total of 93 patients were included (POC <em>n</em> = 49, VP <em>n</em> = 27, and mixed <em>n</em> = 17). The TTR in the overall non-APS clinic population was 63.1% compared to 62.7% in all APS patients. Mean TTR was similar between POC (64.8%) and VP (64.9%) groups, and numerically lower in the mixed group (53.2%), <em>p</em> = 0.18. Patients with arterial thrombosis, triple positivity, or lupus anticoagulant had statistically significantly poorer TTR using the mixed method compared to POC or VP methods. Two thromboembolic events (2.2%) occurred, both in the POC group; and 10 clinically relevant bleeding events occurred (10.8%), distributed among groups.</div></div><div><h3>Conclusions</h3><div>POC INR testing method demonstrated similar anticoagulation control compared to VP testing among APS patients; however, mixed testing strategies were associated with poorer INR control, especially in patients with arterial thrombosis, lupus anticoagulant, and triple positivity. Further study is needed to explore patient characteristics that predict stability with the POC vs VP method.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"266 ","pages":"Article 109858"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115216","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":"Reply to the letter: “From Apicat to Apicath?”","authors":"Michelangelo Sartori,&nbsp;Benilde Cosmi","doi":"10.1016/j.thromres.2026.109861","DOIUrl":"10.1016/j.thromres.2026.109861","url":null,"abstract":"","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"266 ","pages":"Article 109861"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115296","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}