Thrombosis research最新文献

{"title":"Expanding the discussion of DIC score performance in severe postpartum hemorrhage. In response to Ii et al.","authors":"Caroline M. Kane, Hisako Okada, Kenichi A. Tanaka, Amir L. Butt","doi":"10.1016/j.thromres.2026.109826","DOIUrl":"10.1016/j.thromres.2026.109826","url":null,"abstract":"","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"265 ","pages":"Article 109826"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148913624","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":"External validation and model updating of the Cleveland Clinic Model for risk assessment of venous thromboembolism in medical inpatients","authors":"Robin V. Hofstetter,&nbsp;Odile Stalder,&nbsp;Christine Baumgartner,&nbsp;Tobias Tritschler,&nbsp;Drahomir Aujesky,&nbsp;Marie Méan","doi":"10.1016/j.thromres.2026.109830","DOIUrl":"10.1016/j.thromres.2026.109830","url":null,"abstract":"<div><h3>Background</h3><div>Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in medical inpatients. The Cleveland Clinic Model (CCM), a novel risk assessment model (RAM) to guide thromboprophylaxis, has never been independently validated.</div></div><div><h3>Objective</h3><div>To validate and update the CCM, and compare its prognostic accuracy with the Padua Prediction Score (PPS) and the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) score.</div></div><div><h3>Methods</h3><div>We used data from a prospective cohort of medical inpatients admitted &gt;24 h to general internal medicine wards at 3 Swiss university hospitals (06/2020–01/2022). The outcome was objectively confirmed symptomatic VTE within 90 days. Patients were stratified into higher and low VTE-risk groups by RAM. We compared test characteristics across 3 versions of the CCM (original CCM and 2 updated versions, 1 with a derived cut-off, and 1 modified derived cut-off version with 45-day follow-up and without missing variables), the PPS, and the IMPROVE score and drew calibration plots for the original and modified derived cut-off CCM.</div></div><div><h3>Results</h3><div>Of 1352 medical inpatients, 28 (2.1%) experienced VTE within 90 days. The 90-day VTE cumulative incidence was 2.48% in higher-risk vs. 1.91% in low-risk patients (<em>P</em> = 0.52) according to the original CCM. Discrimination was poor across all RAMs (areas under the receiver operating characteristics curve ≤60%). In calibration plots, the original and modified derived cut-off CCMs underestimated the VTE risk.</div></div><div><h3>Conclusion</h3><div>In this non-U.S., non-ICU cohort, all RAMs showed comparable but limited accuracy for predicting VTE up to 90 days. Updating the original CCM did not improve predictive performance.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"265 ","pages":"Article 109830"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148913630","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":"Study of centrifugal blood pump non-physiological shear stress induced platelet hemostatic dysfunction","authors":"Yuan Li,&nbsp;Xiaoning Zhang,&nbsp;Hongyu Wang,&nbsp;Yifeng Xi,&nbsp;Zengsheng Chen","doi":"10.1016/j.thromres.2026.109821","DOIUrl":"10.1016/j.thromres.2026.109821","url":null,"abstract":"<div><h3>Objective</h3><div>To clarify how centrifugal blood pump-induced non-physiological shear stress affects platelet adhesion and aggregation, explaining the coexistence of thrombosis and bleeding during centrifugal pump support.</div></div><div><h3>Methods</h3><div>Blood samples collected before and after centrifugal pump operation were used. Platelet adhesion, aggregation, and binding forces were evaluated using collagen and fibrinogen coated microfluidic chips and micropost arrays. Platelet receptor expression, vWF function, and pro-aggregatory factors were further investigated.</div></div><div><h3>Results</h3><div>After centrifugal pump operation, platelet adhesion to collagen decreased, especially under higher perfusion shear rates. The platelet and collagen binding force decreased from 33.04 nN to 8.73 nN, indicating impaired adhesive stability. This was associated with reduced platelet GPVI and GPIbα receptor expression, decreased vWF activity, and weakened platelet-vWF binding, suggesting inhibition of both GPVI mediated and vWF/GPIbα mediated adhesion. In contrast, platelet binding to fibrinogen increased, especially under higher perfusion shear rates. The platelet and fibrinogen binding force increased from 12.85 nN to 42.29 nN, indicating enhanced aggregation stability. This was accompanied by increased platelet GPIIb/IIIa receptor activation and elevated pro-aggregatory factors. However, prolonged centrifugal pump operation reduced platelet responsiveness to secondary stimulation and decreased GPIIb/GPIIIa subunit availability, suggesting that sustained shear exposure limits further platelet activation and aggregation.</div></div><div><h3>Conclusion</h3><div>Centrifugal blood pump induced non-physiological shear stress impairs collagen mediated initial adhesion while enhancing fibrinogen mediated aggregation. Sustained shear exposure weakens platelet secondary responsiveness and limits further enhancement of aggregation hemostasis. These findings reveal a potential mechanism for the coexistence of thrombosis and bleeding and provide a microfluidic method for hemocompatibility assessment.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"265 ","pages":"Article 109821"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978100","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":"Subclinical carotid atherosclerosis in patients with retinal vein occlusion: Differential cardiovascular risk profiles","authors":"Zaida Salmon,&nbsp;Magdalena Fernández-García,&nbsp;Sandra De la Roz Fernández,&nbsp;Pilar Alonso-Martínez,&nbsp;Andrea Cerveró Varona,&nbsp;Belén González-Mesones,&nbsp;Marcos López-Hoyos,&nbsp;Víctor Manuel Martínez-Taboada,&nbsp;José Luis Hernández","doi":"10.1016/j.thromres.2026.109812","DOIUrl":"10.1016/j.thromres.2026.109812","url":null,"abstract":"<div><h3>Background</h3><div>The burden of subclinical atherosclerosis in patients with retinal vein occlusion (RVO) remains incompletely understood.</div></div><div><h3>Methods</h3><div>Cross-sectional study of consecutive adult patients with RVO underwent cardiovascular risk assessment using SCORE2/SCORE2-OP and bilateral carotid ultrasonography. Patients were stratified into three groups: antiphospholipid syndrome (APS), conventional cardiovascular risk factors (CRF+), and those without (CRF−). Carotid plaque was defined according to Mannheim consensus criteria. Receiver operating characteristic (ROC) analysis evaluated the discriminative performance of SCORE2 in plaque detection.</div></div><div><h3>Results</h3><div>A total of 500 patients were included (55 APS; 413 CRF+ and 32 CRF−). Carotid plaque prevalence increased progressively across SCORE2 categories (27.1% in low–moderate, 55.6% in high, and 75.3% in very high risk; <em>p</em> &lt; 0.001). APS patients demonstrated a plaque burden comparable to CRF+ individuals, with 55–75% plaque prevalence in high/very high-risk strata. Notably, plaque was detected in a subset of patients classified as low–moderate risk, particularly within the APS group. SCORE2/SCORE2-OP showed a moderate discrimination for plaque detection (AUC 0.76; 95% CI 0.72–0.80).</div></div><div><h3>Conclusions</h3><div>RVO is associated with a substantial burden of subclinical atherosclerosis measured by carotid ultrasonography. APS confers an accelerated atherosclerotic phenotype comparable to conventional cardiovascular risk. SCORE2/SCORE2-OP tools alone may underestimate vascular burden in this population.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"265 ","pages":"Article 109812"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841232","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":"Plasma kallikrein in breast cancer cells: Interactions with urokinase plasminogen activator system and syndecans","authors":"Samara M.M. Shimon,&nbsp;Maria Cecília Z. Meneghetti,&nbsp;Natalia Bromberg,&nbsp;Renan P. Cavalheiro,&nbsp;Carlos M.V. Palomino,&nbsp;Raquel S.M. Carvalho,&nbsp;Ariana C. Ferreira,&nbsp;Helena B. Nader,&nbsp;Maria Aparecida S. Pinhal,&nbsp;Fabio D. Nascimento,&nbsp;Guacyara Motta","doi":"10.1016/j.thromres.2026.109810","DOIUrl":"10.1016/j.thromres.2026.109810","url":null,"abstract":"<div><h3>Background</h3><div>During invasive migration, cancer cells use secreted proteases to remove various extracellular matrix components. The urokinase plasminogen activator (uPA) and its receptor (uPAR), together with kallikreins, perform key functions in this proteolytic network through control of various proteases. Plasma kallikrein (PKa) is an important activator of pro-uPA on the cell surface.</div></div><div><h3>Objectives</h3><div>To examine the role of plasma kallikrein in malignancy, with a particular focus on breast cancer.</div></div><div><h3>Methods</h3><div>The MCF-7 (non-metastatic) and MDA-MB-231 (metastatic) breast cancer cell lines were analyzed using immunodetection, PCR, and various enzyme activity and cell dynamics assays.</div></div><div><h3>Results</h3><div>Relative mRNA expression of plasma prekallikrein (PK) was detected in both MCF-7 cells and MDA-MB-231 cells. In addition, in both cell types, PK/PKa was found either on the cell surface or inside cells. In MCF-7 cells, fragments of the PKa active site were found in lysates, whereas in MDA-MB-231 cells, PKa was found most inside lysosomes. PKa colocalized better with syndecan-1 (syn-1) on the surface but with syn-4 in cytoplasm. Both cell lines showed activity of either uPA or PKa, but the small increase in PKa activity after treatment with PKa inhibitor PKSI (or with 4-Cl in MDA-MB-231 cells) suggested regulation of PKa on the cell surface by proteolysis.</div></div><div><h3>Conclusions</h3><div>Our results suggest that PKa has roles in migration, uPAR cleavage, and pro-uPA activation and can be controlled by proteolysis and endocytosis, and that syndecans may function as receptors for these proteins, suggesting a role in recycling processes.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"265 ","pages":"Article 109810"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851586","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":"Risk of cancer after incident venous thromboembolism or cerebral venous thrombosis: Evidence from an Italian administrative healthcare database cohort (2002–2023)","authors":"Luisa Ojeda Fernández,&nbsp;Patrick Prada,&nbsp;Federico Longari,&nbsp;Ida Fortino,&nbsp;Marta Baviera,&nbsp;Claudio Cimminiello","doi":"10.1016/j.thromres.2026.109808","DOIUrl":"10.1016/j.thromres.2026.109808","url":null,"abstract":"<div><h3>Background</h3><div>Unprovoked venous thromboembolism (VTE) is a marker of occult malignancy. While this association is well established for deep vein thrombosis (DVT) and pulmonary embolism (PE), evidence for cerebral venous thrombosis (CVT) remains limited. We evaluated the incidence and risk of newly diagnosed cancer following DVT/PE and CVT.</div></div><div><h3>Methods</h3><div>Using administrative healthcare databases from the Lombardy region (2002–2023), we included subjects aged ≥30 years hospitalised for incident DVT/PE or CVT and age- and sex-matched controls. Cancer incidence was assessed by cumulative incidence functions (CIFs) and standardized incidence ratios (SIRs), with subdistribution hazard ratios (sHRs).</div></div><div><h3>Results</h3><div>109,371 DVT/PE (mean age 73 years; 57% female) and 1929 CVT patients (mean age 53 years; 68% female) were included. During follow-up, cancer was diagnosed in 10% and 4% of DVT/PE and CVT patients, respectively, corresponding to a higher cancer risk in DVT/PE (sHR 1.73 95% CI, 1.68–1.79) and CVT patients (sHR 1.42 95% CI 1.08–1.89) in comparison with matched controls. Incidence differences narrowed over time; SIRs of 3.85 [95% CI 2.11–7.26] and 4.61 [95% CI 4.37–4.87] at 1 year, and 1.47 [95% CI 1.10–1.95] and 2.12 [95% CI 2.06–2.19] at 5 years, in CVT and DVT/PE, respectively. In comparison with control group, the incidence of cancer was always higher in the DVT/PE group while for CVT patients for hematologic and central nervous system (CNS) cancers.</div></div><div><h3>Conclusions</h3><div>Similar to unprovoked VTE, CVT should be considered a marker of occult cancer, particularly hematologic and CNS malignancies, with the highest vigilance warranted during the first year.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"265 ","pages":"Article 109808"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851631","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":"Residual VTE risk after early ICU thromboprophylaxis: risk stratification in MIMIC-IV and an imaging-follow-up cohort","authors":"Yidan Fu,&nbsp;Xueying Chen,&nbsp;Suwei Li,&nbsp;Xiaonan Li,&nbsp;Zhiyao Fang,&nbsp;Xianyao Wan","doi":"10.1016/j.thromres.2026.109834","DOIUrl":"10.1016/j.thromres.2026.109834","url":null,"abstract":"<div><h3>Background/objectives</h3><div>Pharmacological thromboprophylaxis reduces but does not eliminate venous thromboembolism (VTE) risk in critically ill patients. We assessed whether early routine ICU data stratify clinically recognized VTE risk among patients receiving early pharmacological thromboprophylaxis.</div></div><div><h3>Patients/methods</h3><div>We performed a retrospective 24-hour landmark prediction-model study using MIMIC-IV v3.1. Adult ICU stays with pharmacological thromboprophylaxis within 24 h were included. The primary endpoint was clinically recognized VTE before hospital exit, defined by the VTE diagnosis phenotype and temporally anchored to the first positive radiology evidence; death was not included in the endpoint. Six models were compared using fold-contained preprocessing, five-fold outer cross-validation and three-fold inner tuning. Conventional multivariable logistic regression, cause-specific Cox regression and Fine-Gray competing-risk regression were used to identify independent determinants; VTE-free hospital exit was treated as the competing event in time-to-event analyses. A prospective observational hospital imaging-follow-up cohort provided descriptive imaging results, exploratory local classification and a landmark-aligned independent validation subset for the frozen MIMIC model.</div></div><div><h3>Results</h3><div>The MIMIC-IV cohort included 5702 ICU stays and 174 VTE events (3.1%). Elastic net achieved AUROC 0.709, average precision 0.083 and Brier score 0.029. The highest-risk 20% captured 48.3% of events (event rate 7.36%; sensitivity 48.3%; specificity 80.9%; positive predictive value 7.4%). Among patients without preceding VTE, 717 deaths and 4811 discharges were treated as competing hospital exits. Estimated cumulative VTE incidence was 1.58% at day 7 and 2.24% at day 14. Fine-Gray regression identified invasive ventilation (adjusted subdistribution hazard ratio [sHR] 1.82, 95% CI 1.28–2.60), vasopressor/inotrope use (adjusted sHR 2.02, 95% CI 1.40–2.93) and renal replacement therapy (adjusted sHR 1.92, 95% CI 1.03–3.60) as independent determinants. In the hospital cohort, 25 of 138 patients had imaging-confirmed PE (18.1%). The landmark-aligned validation subset included 96 patients and 36 post-landmark imaging-confirmed VTE events; the frozen common-variable MIMIC model yielded AUROC 0.581 and average precision 0.461.</div></div><div><h3>Conclusions</h3><div>Early routine ICU data stratified clinically recognized VTE risk after early prophylaxis exposure. At the 4.33% threshold, the highest-risk 20% contained nearly half of recognized VTE events. This fixed threshold provides a candidate entry rule for prospective evaluation of structured reassessment and imaging-priority strategies.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"265 ","pages":"Article 109834"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148936774","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":"Direct oral anticoagulants versus low-molecular-weight heparin in Asian patients with cancer-associated venous thromboembolism: A systematic review and meta-analysis","authors":"Yee-Jen Wu,&nbsp;Hung-Ju Lin,&nbsp;Yen-Hung Lin,&nbsp;Chi-Sheng Hung","doi":"10.1016/j.thromres.2026.109832","DOIUrl":"10.1016/j.thromres.2026.109832","url":null,"abstract":"<div><h3>Background</h3><div>Direct oral anticoagulants (DOACs) are increasingly used as an alternative to low-molecular-weight heparin (LMWH) for cancer-associated venous thromboembolism (VTE), but evidence in Asian patients remains limited.</div></div><div><h3>Methods</h3><div>We searched PubMed, Embase, Web of Science, and the Cochrane Library for randomized or comparative observational studies comparing DOACs with LMWH for cancer-associated VTE in Asian patients. Primary outcomes were recurrent VTE and major bleeding. Weighted hazard ratios (wHR) were pooled as the primary analysis; subdistribution hazard ratios (sHRs) from competing-risk models were pooled as a sensitivity analysis.</div></div><div><h3>Results</h3><div>Seven observational studies comprising 13,387 patients were included; one early-terminated randomized trial was included in sensitivity analyses. In the primary analysis, DOACs were associated with lower recurrent VTE than LMWH (wHR 0.71, 95% CI 0.54–0.93), with similar major bleeding (wHR 0.85, 95% CI 0.70–1.04). All-cause mortality was lower with DOAC (wHR 0.66, 95% CI 0.60–0.71). After accounting for competing mortality, associations were attenuated for recurrent VTE (sHR 0.95, 95% CI 0.67–1.33) and shifted upward for major bleeding (sHR 1.09, 95% CI 0.95–1.26). In subgroup analyses, major bleeding was higher with a DOAC switching strategy (sHR 1.19, 95% CI 1.01–1.41); and in an exploratory competing-risk analysis, gastrointestinal bleeding was higher among patients with gastrointestinal cancer (p for subgroup difference = 0.041).</div></div><div><h3>Conclusions</h3><div>In Asian patients with cancer-associated VTE, DOACs showed favorable associations in weighted analyses, but these were attenuated after accounting for competing mortality. Given the observational nature of the available evidence and marked mortality imbalance between treatment groups, these findings should be considered hypothesis-generating.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"265 ","pages":"Article 109832"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931099","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 validation of AHA/ACC 2026 and ESC 2019 risk stratification in hospitalized patients with acute pulmonary embolism","authors":"Yiyao Li,&nbsp;Jun Feng,&nbsp;Simiao Yu,&nbsp;Xuefeng Sun,&nbsp;Juhong Shi","doi":"10.1016/j.thromres.2026.109794","DOIUrl":"10.1016/j.thromres.2026.109794","url":null,"abstract":"<div><h3>Background</h3><div>The 2026 AHA/ACC guideline introduced an A–E classification with a respiratory (R) modifier for pulmonary embolism (PE), but real-world validation is limited.</div></div><div><h3>Methods</h3><div>We classified 1050 inpatients with CTPA-confirmed acute PE (2014–2025) at a single tertiary center by ESC 2019 and AHA/ACC 2026 criteria. The primary endpoint was in-hospital all-cause mortality; the key secondary endpoint was a composite of death, hemodynamic decompensation, or rescue therapy; the secondary endpoint added unplanned ICU transfer or invasive ventilation. Discrimination was compared by AUC.</div></div><div><h3>Results</h3><div>Median age was 63 years; 46/1050 (4.4%) died in hospital. ESC 2019 classified 792/1050 (75.4%) as intermediate-low risk; AHA/ACC 2026 reclassified 611/792 (77.1%) of these to C2 or higher, including 272/792 (34.3%) to D2/D2R (mortality 22/272 [8.1%], two-thirds of intermediate-low deaths). AHA/ACC 2026 showed higher discrimination for in-hospital death (AUC, 0.716 vs 0.610; <em>P</em> &lt; .001), the key secondary endpoint (0.611 vs 0.545; <em>P</em> = .007), and the secondary endpoint (0.676 vs 0.535; P &lt; .001). The advantage persisted after collapsing AHA/ACC into a 4-group ordinal score. In patients with active cancer, AHA/ACC 2026 discriminated in-hospital death better than ESC 2019 (AUC, 0.745 vs 0.535; <em>P</em> &lt; .001), whereas no significant difference was observed in those without cancer (0.698 vs 0.683; <em>P</em> = .734).</div></div><div><h3>Conclusions</h3><div>AHA/ACC 2026 improved discrimination over ESC 2019 mainly by identifying normotensive shock (D2/D2R) within the ESC intermediate-low stratum. The advantage was concentrated in patients with active cancer and may partly reflect comorbidity rather than PE-specific risk. Prospective multicenter validation is needed.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"265 ","pages":"Article 109794"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148856324","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":"Effectiveness and safety of postoperative hemostatic drugs in colorectal cancer: A retrospective analysis of a prospectively collected multicenter database using inverse probability of treatment weighting","authors":"Qi Wei,&nbsp;Yang Li,&nbsp;Changqing Lin,&nbsp;Liting Sun,&nbsp;Hongwei Yao,&nbsp;Yongxiang Li,&nbsp;the CRC-VTE Investigators","doi":"10.1016/j.thromres.2026.109827","DOIUrl":"10.1016/j.thromres.2026.109827","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Hemostatic drugs are frequently prescribed after colorectal cancer (CRC) surgery to prevent bleeding. However, in real–world practice, their net clinical benefit and thrombotic safety remain uncertain. This study aimed to evaluate the effectiveness and safety of prophylactic postoperative hemostatic drug use after CRC surgery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This retrospective analysis was based on a prospectively collected multicenter CRC–venous thromboembolism (VTE) database involving 46 tertiary centers across 17 provinces in China between May 2021 and May 2022. Adults who underwent elective curative CRC surgery were included and followed up for 28 days. Exposure was defined as initiation of any prophylactic postoperative hemostatic drug (tranexamic acid, hemocoagulase, or carbazochrome sodium sulfonate) within 0–48 h after surgery in the absence of active bleeding at the first administration. Primary outcome was postoperative bleeding within 28 days; a surrogate outcome was hemoglobin decrease (dHb) ≥20 g/L. The secondary outcome was imaging-confirmed VTE, defined as postoperative DVT and/or PE; DVT was systematically screened within prespecified follow-up windows, whereas PE was assessed when clinically suspected. Inverse probability of treatment weighting (IPTW) based on propensity scores was used to balance baseline covariates, followed by weighted logistic regression.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among 1810 patients, 322 (17.8%) received prophylactic postoperative hemostatic drugs. After IPTW, all covariates achieved adequate balance, with standardized mean differences &lt;0.10. Hemostatic drug use was not associated with reduced postoperative bleeding (2.9% vs. 1.7%; weighted odds ratio [OR]: 1.72, 95% confidence interval [CI]: 0.77–3.86) or dHb ≥20 g/L (21.4% vs. 26.1%; weighted OR: 0.77, 95% CI: 0.55–1.06). In contrast, hemostatic drug use was associated with a higher postoperative VTE rate (13.8% vs. 9.5%; weighted OR: 1.51, 95% CI: 1.02–2.24), mainly driven by DVT without PE, whereas PE events were rare and did not differ significantly between groups. Additional analyses showed that this association was also observed for symptomatic VTE (4.7% vs. 2.3%; weighted OR: 2.12, 95% CI: 1.03–4.37), whereas the association for asymptomatic/screening-detected VTE was not statistically significant after IPTW. Most VTE events with a DVT component involved distal DVT. Sensitivity analyses using winsorized weights yielded consistent estimates, and Propensity score trimming excluded no participants, supporting adequate overlap. In multivariable analysis, tumor–node–metastasis stage III–IV (OR: 3.20, 95% CI: 1.31–7.79) and intraoperative blood loss ≥50 mL (OR: 3.15, 95% CI: 1.20–8.22) were independent predictors of postoperative bleeding.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;In this retrospective analysis of a prospectively collected multicenter database, routine prophylactic postoperative hemostatic dru","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"265 ","pages":"Article 109827"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148913661","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}