Thrombosis research最新文献

{"title":"Point-of-care testing for diagnosing hypofibrinogenemia in postpartum hemorrhage: Systematic review and meta-analysis","authors":"Eishin Nakamura ,&nbsp;Takahiro Mihara ,&nbsp;Yuriko Kondo ,&nbsp;Hisashi Noma ,&nbsp;Sayuri Shimizu","doi":"10.1016/j.thromres.2025.109339","DOIUrl":"10.1016/j.thromres.2025.109339","url":null,"abstract":"<div><h3>Background</h3><div>Postpartum hemorrhage (PPH) can rapidly cause hypofibrinogenemia, requiring prompt coagulation factor replacement. Point-of-care testing (POCT) is gaining interest for early diagnosis for hypofibrinogenemia, despite limited evidence. This systematic review evaluated the diagnostic accuracy of POCT for hypofibrinogenemia in PPH.</div></div><div><h3>Materials and methods</h3><div>A literature search was conducted using MEDLINE, Embase, Cochrane, and Web of Science. Studies using POCT for PPH diagnosis, both observational and interventional, were included. Risk of bias was assessed using the QUADAS-2 tool. A meta-analysis was performed using the Reitsma bivariate random-effects model for three POCT types: dry hematology, thromboelastography, and thromboelastometry. The diagnostic accuracy was evaluated using a summary Receiver Operating Characteristic (ROC) curve and area under the curve (AUC).</div></div><div><h3>Results</h3><div>Nine articles, including 16 studies with a total of 2902 patients, were analyzed. The dry hematology group had only two studies, preventing data pooling. Thromboelastography (4 articles, including 10 studies with 1386 patients) showed a sensitivity of 0.80 (95 % CI: 0.75–0.84), specificity of 0.90 (0.85–0.93), and AUC of 0.81 (0.77–0.85). Thromboelastometry (4 articles, including 4 studies with 1394 patients) showed a sensitivity of 0.89 (0.74–0.96), specificity of 0.84 (0.63–0.94), and AUC of 0.93 (0.83–0.95).</div></div><div><h3>Conclusions</h3><div>Thromboelastography and thromboelastometry demonstrated high diagnostic accuracy for hypofibrinogenemia in PPH. However, evidence for dry hematology was insufficient. POCT may enable rapid and accurate diagnosis of hypofibrinogenemia in PPH.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"251 ","pages":"Article 109339"},"PeriodicalIF":3.7,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143947624","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":"SSA-sMLP: A venous thromboembolism risk prediction model using separable self-attention and spatial-shift multilayer perceptrons","authors":"An Gong ,&nbsp;Xintong Wei ,&nbsp;Yong Liu ,&nbsp;Zhenzhen Chen ,&nbsp;Bitian Fan ,&nbsp;Anxuan Jia ,&nbsp;Shuhui Wu","doi":"10.1016/j.thromres.2025.109334","DOIUrl":"10.1016/j.thromres.2025.109334","url":null,"abstract":"<div><div>Accurate risk assessment of Venous Thromboembolism (VTE) holds significant value for clinical decision-making. However, traditional scoring systems relying on linear assumptions and expert experience, along with machine learning models constrained by shallow architectures, fail to effectively model the high-order nonlinear interactions and local dynamic correlations among multidimensional medical features. To address the systematic deficiency in multi-dimensional feature integration of existing VTE data, this study constructed VTE <span><math><mo>_</mo></math></span> Data - a dataset encompassing multi-dimensional features - based on 113,836 clinical records from a hospital. For VTE risk assessment, we propose a deep learning model integrating separable self-attention and the improved Spatial-Shift Multi-Layer Perceptron (SSA-sMLP). The separable self-attention module enables dynamic cross-dimensional feature interaction modeling through dynamic context vectors and a linear decoupling strategy. The improved Spatial-Shift MLP (<span><math><msup><mi>S</mi><mn>2</mn></msup></math></span>-MLPv2) employs parameter-free shift operations to reorganize different feature subsets, combined with Split Attention for adaptive weight allocation, thereby precisely capturing local non-linear associations. Experimental evaluations on VTE <span><math><mo>_</mo></math></span> Data using the Caprini RAM (2010) demonstrated that the proposed model (87.99 %) achieves 33.95 % improvement in accuracy over the existing best model, along with superior robustness (F1-score: 65.9 %), while maintaining computational efficiency comparable to mainstream models. By modular integration of separable self-attention and <span><math><msup><mi>S</mi><mn>2</mn></msup></math></span>-MLPv2 architecture, the SSA-sMLP achieves dual enhancement in feature interaction modeling efficiency and precision, providing an innovative solution that balances computational efficiency and model performance for medical VTE risk assessment tasks.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"250 ","pages":"Article 109334"},"PeriodicalIF":3.7,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143923924","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":"Prescribing preferences for reduced-dose direct oral anticoagulation for extended-phase venous thromboembolism treatment","authors":"Danielle Groat ,&nbsp;Karlyn A. Martin ,&nbsp;Rachel P. Rosovsky ,&nbsp;Kristen M. Sanfilippo ,&nbsp;Manila Gaddh ,&nbsp;Lisa Baumann Kreuziger ,&nbsp;Elizabeth Federici ,&nbsp;Scott C. Woller ,&nbsp;Venous thromboEmbolism Network US (VENUS) VTE Treatment and Anticoagulation Management Group","doi":"10.1016/j.thromres.2025.109338","DOIUrl":"10.1016/j.thromres.2025.109338","url":null,"abstract":"<div><h3>Background</h3><div>Direct anticoagulants (DOACs), apixaban and rivaroxaban, are used for the treatment of venous thromboembolism (VTE) and have product labeling to dose-reduce for extended-phase secondary prevention of VTE. The objective of this study was to better understand prescribing patterns of DOACs among a broad cohort of clinicians.</div></div><div><h3>Methods</h3><div>In this secondary analysis of a survey deployed to two distinct populations of clinicians, thrombosis specialists and primary care physicians (PCPs), we used descriptive statistics, Fisher's exact test, and regression to explore relationships between respondent demographics and prescribing behaviors.</div></div><div><h3>Results</h3><div>Among 336 respondents, 12 % were pharmacists, 23 % were PCPs, and 65 % were specialists. Most (59 %) practiced in an academic setting, and 18 % practiced outside of North America. When considering provider type, 88 % of pharmacists, 78 % of specialists, and 61 % of PCPs indicated that they dose-reduce DOACs for extended-phase therapy for the secondary prevention of VTE (p-value = 0.002). PCPs were most likely to engage in temporary dose-escalation (p-value &lt; 0.001) when presented with various scenarios of increased risk. Providers who prescribed DOACs in &gt;250 patients were also more likely to dose-reduce (aOR 2.41, 1.24–4.82 95 % CI, p-value = 0.01). Pharmacists overwhelmingly preferred prescribing apixaban, while PCPs and specialists were more balanced between prescribing apixaban and rivaroxaban (p-value &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Most clinicians elect to dose-reduce DOACs during the extended phase of anticoagulation. Provider type and number of patients correlated with prescribing practices. These findings identify opportunities to advance clinician education surrounding dose-reduction when clinically indicated.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"250 ","pages":"Article 109338"},"PeriodicalIF":3.7,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143923923","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":"Cost of immune tolerance induction according to its outcome in people with hemophilia A and inhibitors: results from the Co$tIT study","authors":"Vivian Karla Brognoli Franco ,&nbsp;Ricardo Mesquita Camelo ,&nbsp;Maíse Moreira Dias ,&nbsp;Andrea Gonçalves de Oliveira ,&nbsp;Andrea Vilela de Oliveira Santos ,&nbsp;Cláudia Santos Lorenzato ,&nbsp;Camila Stephanes ,&nbsp;Rosângela de Albuquerque Ribeiro ,&nbsp;Nathália Martins Beserra ,&nbsp;Juliana Alvares Teodoro ,&nbsp;Suely Meireles Rezende","doi":"10.1016/j.thromres.2025.109336","DOIUrl":"10.1016/j.thromres.2025.109336","url":null,"abstract":"<div><h3>Background</h3><div>Immune Tolerance Induction (ITI) is indicated for people with hemophilia A (PwHA) with inhibitors. It is not known whether the costs differ among ITI outcomes.</div></div><div><h3>Aim</h3><div>To assess the costs of clotting factor concentrates (CFC) according to ITI outcomes.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included 91 PwHA who completed a first course of ITI. We evaluated the costs with CFC 12 months before (pre-ITI), during and 12 months after ITI (post-ITI), according to ITI outcome. We compared costs in each period, between pre- and post-ITI, and evaluated the determinants of costs during ITI.</div></div><div><h3>Results</h3><div>A total of 32 %, 38 % and 30 % of PwHA achieved complete (CS), partial success (PS), and failed ITI, respectively. The mean cost per PwHA during ITI was US$1.18 million; US$355,838 in CS, US$724,986 in PS, and US$2,653,217 in the failure group. During ITI, approximately 65 % of the variability of the mean cost/kg was explained by the outcome of ITI (failure or PS), duration of ITI, use of prophylactic bypassing agents, and use of incremental FVIII regimen. In post-ITI, we observed about 50 % and 22 % reduction of mean cost/kg in CS and PS, respectively, while failing ITI resulted in increased costs of over 100 % compared with pre-ITI. Regardless of the outcome, in post-ITI, the annualized bleeding rate reduced when compared with pre-ITI.</div></div><div><h3>Conclusions</h3><div>Costs with CFC during ITI were the lowest with CS, followed by PS and failure. In comparison with pre-ITI, successful ITI was associated with reduced costs, already noticed in the first year post-ITI.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"250 ","pages":"Article 109336"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143918439","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":"Letter-To-The-Editor: Long-term outcomes of patients with isolated subsegmental pulmonary embolism managed without anticoagulant therapy","authors":"Cameron Brown ,&nbsp;Ranjeeta Mallick ,&nbsp;Amanda Pecarskie ,&nbsp;Joseph R. Shaw ,&nbsp;Marc Carrier ,&nbsp;Grégoire Le Gal","doi":"10.1016/j.thromres.2025.109335","DOIUrl":"10.1016/j.thromres.2025.109335","url":null,"abstract":"<div><h3>Introduction</h3><div>The management of patients with subsegmental pulmonary embolism (SSPE) is controversial. The long-term risk of recurrent venous thromboembolism (VTE) in patients with SSPE managed without anticoagulation is unknown. We sought to establish the long-term incidence of recurrent VTE and clinically relevant bleeding complications in this patient population.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study of patients enrolled in the SSPE prospective management cohort study included at The Ottawa Hospital between 2011 and 2021. The outcomes included major recurrent VTE (proximal deep vein thrombosis or pulmonary embolism) and clinically relevant bleeding (major + clinically relevant non-major bleeding). Incidence rates along with their 95 % confidence intervals (CI) for the primary and secondary outcome measures were computed by performing time-to-event analyses.</div></div><div><h3>Results</h3><div>A total of 138 patients with SSPE were included in the analysis. Mean age was 57 ± 15.5 years and 50.7 % were female. Median follow-up period was 69 months (IQR: 44–96 months). Overall, recurrent major VTE occurred in 15 out of the 138 patients leading to an incidence of 1.9 per 100 patient-years (95 % CI: 1.2–3.2). Clinically relevant bleeding was reported in 15 patients corresponding to a cumulative incidence of 1.9 per 100 patient-years (95 % CI: 1.1–3.1). Of these, 3 patients experienced major bleeding.</div></div><div><h3>Conclusion</h3><div>The long-term incidence of VTE is relatively low in patients with isolated SSPE managed without anticoagulation. Future studies are needed to assess the risk benefit ratio of anticoagulation in this patient population.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"250 ","pages":"Article 109335"},"PeriodicalIF":3.7,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143905850","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":"EKITE phase 2: A valuable readily available resource for patient education on thrombosis and warfarin anticoagulation therapy","authors":"Mary Bauman ,&nbsp;Rukhmi Bhat ,&nbsp;Reider Hagtvedt ,&nbsp;Joel Livingston ,&nbsp;Aisha Bruce","doi":"10.1016/j.thromres.2025.109322","DOIUrl":"10.1016/j.thromres.2025.109322","url":null,"abstract":"<div><div>Long-term anticoagulation (LTA) is a chronic therapy. Like many chronic therapies, the foundation of effective LTA management lies in developing and maintaining patient knowledge about the treatment. Children and their families often struggle to understand and stay motivated to ensure safe and effective therapy, which includes routine monitoring. This study aims to evaluate the effectiveness of the <u>e</u>lectronic <u>K</u>idClot <u>i</u>nteractive <u>T</u>hrombophilia <u>E</u>ducation (eKITE) Warfarin web-based training modules in reinforcing and enhancing anticoagulation knowledge for children on long-term warfarin and their families as part of routine clinical follow-up by KidClot/Stollery Children's Hospital.</div><div>Methods: This prospective study utilized the eKITE Warfarin series (thrombosis, safety of anticoagulation, lab INR, and home INR testing) as an annual requirement for patients on warfarin as part of their ongoing clinical care. This approach aimed to refresh and build knowledge about warfarin and educate those transitioning to warfarin self-management. Patients conducted INR testing at home using a coagulometer or visited the laboratory for venipuncture INR testing. Children and their families accessed online warfarin education from home. Participants completed eKITE modules, quizzes, and surveys to assess and reinforce their warfarin knowledge. The validated Patient Preference Survey assessed patient preferences for learning styles. The State Anxiety Score was used to evaluate patient stress and anxiety related to learning warfarin management, while the KidClot PAC QL assessed warfarin's impact on quality of life. INRs were collected, and time in therapeutic range was calculated.</div></div><div><h3>Results</h3><div>A total of 136 children on warfarin participated; twenty-nine (21 %) underwent laboratory INR testing, while 107 (79 %) performed INR tests at home using the CoaguChek XS INR meter. The primary indication for long-term warfarin therapy was an underlying cardiac disorder with varied INR target ranges. Yearly mean follow-up knowledge scores were 84(IQR 70–100) and 90(IQR 80–100) at 6 and 18 months post-enrollment, respectively. The time in therapeutic range was 70.1(IQR 63–76) and 70.5 (IQR 57–74 for self-testing and self-management at 18 months post-enrollment. Stress-related to learning decreased, and health-related quality of life (HrQOL) improved over the study period.</div></div><div><h3>Conclusion</h3><div>eKITE is a practical, cost-effective, readily available, diverse online education series that teaches and provides always-available resources to children and families about thrombosis and anticoagulation, supporting knowledge and improving HrQOL.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"250 ","pages":"Article 109322"},"PeriodicalIF":3.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143894649","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":"Comparative effectiveness and safety of direct oral anticoagulants in atrial fibrillation patients with dementia","authors":"Chen-Wen Fang ,&nbsp;Cheng-Yang Hsieh ,&nbsp;Hsin-Yi Yang ,&nbsp;Ching-Fang Tsai ,&nbsp;Sheng-Feng Sung","doi":"10.1016/j.thromres.2025.109332","DOIUrl":"10.1016/j.thromres.2025.109332","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients with atrial fibrillation (AF) and dementia face unique challenges in stroke prevention, particularly in selecting appropriate anticoagulation therapy. Direct oral anticoagulants (DOACs) effectively reduce stroke and embolism risks, but evidence comparing their effectiveness and safety in this population remains limited.</div></div><div><h3>Methods</h3><div>This retrospective, population-based cohort study used data from Taiwan’s National Health Insurance Research Database to evaluate outcomes of four DOACs (dabigatran, apixaban, edoxaban, and rivaroxaban) in AF patients with dementia aged 50 years or older. We used propensity score matching to balance baseline characteristics across six DOAC comparison pairs.</div></div><div><h3>Results</h3><div>Dabigatran demonstrated superior outcomes, reducing the composite risk of ischemic stroke, acute myocardial infarction, intracranial hemorrhage, major bleeding, and all-cause mortality compared to apixaban (hazard ratio [HR], 0.82; 95 % confidence interval [CI], 0.73–0.92), edoxaban (HR, 0.81; 95 % CI, 0.71–0.92), and rivaroxaban (HR, 0.82; 95 % CI, 0.73–0.91). It also showed lower risks of intracranial hemorrhage and all-cause mortality. Sensitivity analyses excluding patients with nasogastric tubes or severe renal impairment showed smaller differences in overall outcomes but maintained dabigatran's advantage in reducing intracranial hemorrhage risk.</div></div><div><h3>Conclusions</h3><div>This study demonstrates the need for tailored anticoagulation strategies in this vulnerable population, with dabigatran emerging as a potentially safer and more effective option for stroke prevention in AF patients with dementia. Future research should examine individual DOAC effects across diverse clinical settings to optimize treatment outcomes.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"250 ","pages":"Article 109332"},"PeriodicalIF":3.7,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143887850","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":"Haemostatic changes detected by thromboelastography in chronic kidney disease: A systematic review and meta-analysis","authors":"Nao Shimada Ramos,&nbsp;Denise E. Jackson","doi":"10.1016/j.thromres.2025.109333","DOIUrl":"10.1016/j.thromres.2025.109333","url":null,"abstract":"<div><div>Haemostasis in Chronic Kidney Disease (CKD) is complex, with patients experiencing both thrombotic and haemorrhagic risks. Current therapies, such as dialysis and blood transfusions, often rely on clinical judgment, which may not fully address these haemostatic abnormalities. This systematic review and meta-analysis aimed to determine whether Thromboelastography (TEG) offers a better ability to assess coagulation abnormalities in CKD compared to standard coagulation tests like activated partial thromboplastin time (aPTT), and prothrombin time (PT). A search across five databases identified 10 studies comparing TEG parameters in CKD patients versus healthy controls. TEG detected hypercoagulability in CKD, with significant reductions in Kinetics Time (P = 0.04), increases in Alpha angles (P = 0.02), and elevated Maximum Amplitude values (P = 0.0006). However, Reaction Time (P = 0.43) and Lysis 30 (P = 0.28) showed no significant differences. Standard coagulation tests, including aPTT and PT, also showed no significant differences between groups (P = 0.30 and P = 1.00), suggesting their limitations in detecting the complex haemostatic changes in CKD. Platelet counts were lower in CKD patients (P = 0.0009) but remained within normal ranges. Elevated fibrinogen levels (P = 0.003), linked to chronic inflammation, indicated a prothrombotic profile. Despite high heterogeneity in some parameters due to variability in CKD stages and treatment types, TEG demonstrates a more detailed assessment of haemostatic changes in CKD, suggesting its potential as a predictive tool for managing coagulation abnormalities.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"250 ","pages":"Article 109333"},"PeriodicalIF":3.7,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143868506","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-time risk stratification in acute pulmonary embolism: the utility of RV/LV diameter ratio","authors":"Robert S. Zhang ,&nbsp;Eugene Yuriditsky ,&nbsp;Hannah P. Truong ,&nbsp;Peter Zhang ,&nbsp;Allison A. Greco ,&nbsp;Lindsay Elbaum ,&nbsp;Vikramjit Mukherjee ,&nbsp;Kerry Hena ,&nbsp;Radu Postelnicu ,&nbsp;Carlos L. Alviar ,&nbsp;James M. Horowitz ,&nbsp;Sripal Bangalore","doi":"10.1016/j.thromres.2025.109323","DOIUrl":"10.1016/j.thromres.2025.109323","url":null,"abstract":"<div><h3>Background</h3><div>This study evaluates the prognostic utility of the RV/LV diameter ratio in predicting low cardiac index (CI) in patients with acute intermediate-risk PE.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of 112 patients with acute PE who underwent catheter-based therapies. The RV/LV diameter ratio was measured from standard axial views on computed tomography pulmonary angiogram (CTPA). Multivariable regression models were used to assess the relationship between the RV/LV diameter ratio and invasive hemodynamic parameters.</div></div><div><h3>Results</h3><div>A total of 63 patients (56.3 %) had a low CI (≤2.2 L/min/m²). The optimal cut-off for the RV/LV ratio to predict low cardiac index was 1.0 (area under the curve: 0.64). In a multivariable model, the RV/LV ratio (every 0.1 increase) was a significant predictor of low CI (OR: 1.11, 95 % CI 1.01–1.23, p = 0.03). Patients with a high RV/LV ratio (&gt;1.0) had a lower pre-procedure cardiac index (2.0 [IQR 1.7, 2.6] vs 2.7 [IQR 2.4, 3.0] L/min/m², p &lt; 0.001), higher pre-procedure mPAP (34.0 [IQR 27.0, 41.0] mm Hg vs 28.0 [IQR 20.0, 35.0] mm Hg, p = 0.015), and were more likely to have a low cardiac index (65 % vs 3 %, p = 0.001). Every 0.1 increase in the ratio was associated with a 0.5 mm Hg increase in mPAP (p &lt; 0.001) and a 0.05 L/min/m² lower cardiac index (p = 0.002). The RV/LV ratio demonstrated moderate sensitivity (64.5 %) and high specificity (84.2 %) for predicting low cardiac index.</div></div><div><h3>Conclusion</h3><div>The RV/LV diameter ratio offers real-time risk stratification and is a predictor of low cardiac index in patients with acute PE.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"250 ","pages":"Article 109323"},"PeriodicalIF":3.7,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143887768","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":"Suboptimal CT pulmonary angiography for PE diagnosis, is it worth further study? A retrospective 7.5-year evaluation in a large academic medical center","authors":"Pedro Parra Caballero ,&nbsp;Fernando Ruiz Berraco ,&nbsp;Ana Salvador Rodríguez ,&nbsp;Ángela Sánchez Juez ,&nbsp;Nuria Ruiz-Giménez Arrieta ,&nbsp;Jaime Bustos Carpio ,&nbsp;Ana Rodríguez Revillas ,&nbsp;Isabel López Villar ,&nbsp;María del Carmen de Benavides Bernaldo de Quirós ,&nbsp;María Jesús Delgado Heredia","doi":"10.1016/j.thromres.2025.109324","DOIUrl":"10.1016/j.thromres.2025.109324","url":null,"abstract":"","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"250 ","pages":"Article 109324"},"PeriodicalIF":3.7,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143873582","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}