Thrombosis research最新文献

{"title":"Outcome of catheter associated upper extremity deep vein thrombosis in cancer: A two year prospective study with enoxaparin","authors":"Michelangelo Sartori,&nbsp;Alice Trentini,&nbsp;Sofia Cavara,&nbsp;Elisabetta Favaretto,&nbsp;Laura Borgese,&nbsp;Mario Soldati,&nbsp;Benilde Cosmi","doi":"10.1016/j.thromres.2026.109755","DOIUrl":"10.1016/j.thromres.2026.109755","url":null,"abstract":"<div><h3>Background</h3><div>Current guidelines suggest three month anticoagulation for the treatment of catheter-related upper extremity deep vein thrombosis (CRT), but few data are available on outcome beyond three months in cancer patients.</div></div><div><h3>Methods</h3><div>This was a prospective, single center study to ascertain the long term venous thromboembolism (VTE) recurrences for CRT in cancer patients. We enrolled 233 participants (age: 56.8 ± 16.6y, female: 58.4%) who received enoxaparin for 3 months. The follow-up was 24 months and the primary outcome was the composite measure of recurrent VTE.</div></div><div><h3>Findings</h3><div>182 (78.1%) patients received therapeutic enoxaparin for 3 months whereas 51 (21.9%) patients continued therapeutic enoxaparin for 6 months. During the follow-up, the primary outcome occurred in 32 (13.7%) patients for a cumulative incidence rate of 9.2/100 patient years (95%CI: 6.6–12.7).There were: 28 (12.0%) CRT recurrences for a cumulative incident rate of 8.1/100 patient years, 3 (1.3%) pulmonary embolisms (0.9/100 patient years), and one (0.4%) cerebral venous sinus thrombosis (0.3/100 patient years). No patients in cancer remission had VTE recurrences. In multivariable modeling, insertion of a new vascular device (SHR 3.00, 95%CI: 1.14–7.88; <em>p</em> = 0.026) and the use prophylactic enoxaparin (SHR 0.05, 95%CI: 0.01–0.20; <em>p</em> &lt; 0.001) were associated with the primary outcome, whereas the duration of therapeutic enoxaparin was not.</div></div><div><h3>Interpretation</h3><div>Recurrent VTE was not infrequent in subgroups of patients with CRT; these data may lead to improved risk stratification and to tailored management strategies.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"263 ","pages":"Article 109755"},"PeriodicalIF":3.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148296470","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 vitamin K antagonists for the treatment of cerebral venous thrombosis: A systematic review and meta-analysis of randomized clinical trials","authors":"Maxime Delrue,&nbsp;Benjamin Crichi,&nbsp;Isabelle Crassard,&nbsp;Sylvain Le Jeune,&nbsp;Corinne Frere","doi":"10.1016/j.thromres.2026.109769","DOIUrl":"10.1016/j.thromres.2026.109769","url":null,"abstract":"<div><h3>Background</h3><div>Current guidelines consider direct oral anticoagulants (DOACs) a reasonable treatment option for cerebral venous thrombosis (CVT), but randomized evidence comparing DOACs vs. vitamin K antagonists (VKAs) remain limited.</div></div><div><h3>Objective</h3><div>To compare the efficacy and safety of DOACs vs. VKAs for CVT treatment.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing DOACs with VKAs in adults with CVT. PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception through January 2026. Odds ratios (ORs) with 95% confidence <em>intervals</em> (CIs) were calculated using the Peto method. Primary outcomes included recurrent venous thromboembolism (VTE) and intracranial hemorrhage (ICH). Secondary outcomes comprised complete venous recanalization, major bleeding, clinically relevant non-major bleeding (CRNMB), any bleeding, and all-cause mortality.</div></div><div><h3>Results</h3><div>Of 267 records screened (23 full texts assessed), 6 RCTs (428 patients: DOAC <em>n</em> = 213, VKA <em>n</em> = 215) were included. All studies had some risk of bias. Anticoagulant treatment duration ranged from 3 to 12 months, and follow-up ranged from 6 to 12 months. For recurrent VTE, the OR was 3.14 (95% CI 0.95–10.37). No significant differences between groups emerged for ICH (OR 1.37, 95% CI 0.31–6.16), recanalization, major bleeding, CRNMB, or mortality. Any bleeding risk was significantly lower with DOACs (OR 0.54, 95% CI 0.29–1.00). GRADE certainty was low across all outcomes due to imprecision.</div></div><div><h3>Conclusion</h3><div>These findings suggest comparable efficacy and safety between DOACs and VKAs for CVT but require considerable caution given the small sample size, rare events, wide CIs, and low certainty evidence.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"263 ","pages":"Article 109769"},"PeriodicalIF":3.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148340380","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 rituximab and caplacizumab for immuno-mediated Thrombotic Thrombocytopenic Purpura: an overview of systematic reviews","authors":"Mayra Carvalho-Ribeiro,&nbsp;Camila Peña,&nbsp;Thaís D.R. Nóbrega,&nbsp;Marília Berlofa Visacri,&nbsp;Fernanda A. Orsi","doi":"10.1016/j.thromres.2026.109767","DOIUrl":"10.1016/j.thromres.2026.109767","url":null,"abstract":"<div><h3>Background</h3><div>Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is a life-threatening disorder caused by anti-ADAMTS13 (A Disintegrin And Metalloproteinase with a ThromboSpondin type 1 motif, member 13) antibodies. Although therapeutic plasma exchange (TPE) and corticotherapy have long been the standard of care (SOC), rituximab and caplacizumab are increasingly incorporated into clinical practice. Given that these drugs significantly increase the costs of iTTP treatment, synthesizing the available evidence is important for coverage decisions in resource-limited settings.</div></div><div><h3>Objectives</h3><div>To summarize and critically appraise systematic reviews with meta-analyses (SRMAs) evaluating effectiveness and safety of rituximab and caplacizumab for iTTP treatment.</div></div><div><h3>Methods</h3><div>PubMed, EMBASE, the Cochrane Library, and LILACS were searched up to August 2025. Two reviewers screened citations, with disagreements resolved by a third reviewer. Data extraction was performed by one reviewer and verified by another. Findings were synthesized narratively.</div></div><div><h3>Results</h3><div>Seven SRMAs were included: two evaluated rituximab and five caplacizumab. SRMAs of rituximab included non-randomized studies and reported reductions in mortality and relapse when added to SOC, although exacerbation and safety were not assessed. SRMAs of caplacizumab included two randomized and nine non-randomized studies. Mortality reduction with caplacizumab was not demonstrated in randomized trials, although real-world data suggested a survival benefit. Randomized trials showed reduced risk of exacerbation and increased risk of bleeding, but no consistent effect on relapse. All SRMAs were rated as critically low methodological quality.</div></div><div><h3>Conclusion</h3><div>Although SRMAs suggest rituximab and caplacizumab may improve clinical response and survival, with more consistent evidence favoring rituximab, their critically low methodological quality highlights limitations in the current evidence base.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"263 ","pages":"Article 109767"},"PeriodicalIF":3.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148333151","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":"Apoptotic versus procoagulant platelets: similar “necrotic” phenotype and procoagulant activity in vitro, but distinct adhesive protein composition","authors":"N.A. Podoplelova,&nbsp;S.I. Obydennyi,&nbsp;A.A. Ignatova,&nbsp;P.A. Soloveva,&nbsp;I.A. Chabin,&nbsp;A.K. Garzon Dasgupta,&nbsp;A.A. Filkova,&nbsp;N.N. Starostin,&nbsp;A.V. Sokolov,&nbsp;I.I. Kireev,&nbsp;E.N. Balashova,&nbsp;P.E. Trakhtman,&nbsp;G.A. Novichkova,&nbsp;A.N. Sveshnikova,&nbsp;M.A. Panteleev","doi":"10.1016/j.thromres.2026.109764","DOIUrl":"10.1016/j.thromres.2026.109764","url":null,"abstract":"<div><div>Platelets can undergo at least two distinct types of regulated cell death, apoptosis and mPTP-driven necrosis. Apoptosis is believed to be responsible for platelet clearance, while strong platelet activation by physiological agonists leads to necrosis, producing procoagulant platelet remnants that are essential for blood coagulation during thrombosis and hemostasis. To thoroughly compare morphological and functional features of apoptotic and necrotic-like procoagulant platelets in vitro, their procoagulant activity, ability to bind coagulation proteins, and adhesive protein composition were evaluated. Confocal and electron microscopy were used to analyze morphology. Both apoptotic and necrotic-like procoagulant platelets had balloon-shaped morphology with phosphatidylserine-enriched “caps”, as well as similar abilities to bind blood coagulation factors and participate in procoagulant reactions. However, apoptotic platelets did not release their alpha-granules and, consequently, did not have the “coat” of alpha-granular proteins such as P-selectin, fibrin(ogen), and von Willebrand factor on their surface, which was characteristic for the necrotic-like procoagulant ones. They were completely unable to bind external fibrinogen. They were completely unable to bind external fibrinogen. During storage of platelet concentrates, PS-positive platelets of both apoptotic (PS⁺/CD62P⁻) and necrotic-like procoagulant (PS⁺/CD62P⁺) phenotypes were observed to accumulate.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"263 ","pages":"Article 109764"},"PeriodicalIF":3.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148376978","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 of bleeding and recurrence risk scores in patients with cancer-associated thrombosis on anticoagulant therapy","authors":"Maria Barca-Hernando,&nbsp;Carmen Rosa-Linares,&nbsp;Victor Garcia-Garcia,&nbsp;Sergio Lopez-Ruz,&nbsp;Teresa Elias-Hernandez,&nbsp;Remedios Otero-Candelera,&nbsp;Henry Andrade-Ruiz,&nbsp;Melisa González-Acosta,&nbsp;Luis Jara-Palomares","doi":"10.1016/j.thromres.2026.109751","DOIUrl":"10.1016/j.thromres.2026.109751","url":null,"abstract":"<div><h3>Background</h3><div>Cancer-associated thrombosis (CAT) requires balancing recurrent venous thromboembolism (VTE) risk against bleeding from anticoagulation. Most risk scores are not specific for CAT, limiting their accuracy, while cancer-specific tools lack robust external validation.</div></div><div><h3>Objectives</h3><div>This study aimed to externally validate risk scores for predicting bleeding and recurrent VTE within 6 months in patients with CAT receiving anticoagulants.</div></div><div><h3>Patients/methods</h3><div>We conducted a retrospective cohort study of 1203 patients with CAT from a hospital registry between 2007 and 2022. Primary outcomes were clinically relevant bleeding (CRB) and recurrent VTE within 6 months. Ten bleeding (B-CAT, CAT-BLEED, ACCP-VTE, HAS-BLED, HEMORR2HAGES, VTE-BLEED, Kuijer, Martinez, Nieto and RIETE) and four recurrence scores (Ottawa, RIETE, HERDOO2, DASH) were assessed. Predictive performance was evaluated using the area under the receiver operating characteristic curve (AUC) for discrimination. For risk stratification analyses, odds ratios (OR) were calculated to assess the association between risk categories and primary outcomes.</div></div><div><h3>Results</h3><div>Among 1203 patients (mean age 63.9 ± 12.7 years; 52.6% male), 65 experienced CRB (5.4%) and 60 developed recurrent VTE (5.0%) within 6 months. Of the bleeding models, only the original three-category B-CAT score showed acceptable discriminative performance (c-statistic 0.70; 95% CI: 0.64–0.75), stratifying patients into low-, intermediate-, and high-risk groups with CRB incidences of 1.6%, 5.8%, and 20.4% (p &lt; 0.001). For recurrent VTE, only the modified DASH score showed modest predictive ability (c-statistic 0.58; 95% CI: 0.52–0.64; p = 0.01), with recurrent VTE rates of 3.3% in the low-risk group and 6.3% in the high-risk group.</div></div><div><h3>Conclusions</h3><div>In this real-world CAT cohort, the B-CAT score was externally validated as the best predictor of 6-month bleeding risk, while the modified DASH score showed only modest predictive ability for VTE recurrence.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"263 ","pages":"Article 109751"},"PeriodicalIF":3.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148284608","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 stepwise laboratory-based approach for early risk assessment of disseminated intravascular coagulation","authors":"Dajie Zhou,&nbsp;Jing Wang,&nbsp;Chengming Sun,&nbsp;Qi Zhao,&nbsp;Lei Chen","doi":"10.1016/j.thromres.2026.109727","DOIUrl":"10.1016/j.thromres.2026.109727","url":null,"abstract":"<div><h3>Background</h3><div>Disseminated intravascular coagulation (DIC) is a life-threatening condition in which early identification is essential for timely clinical management. However, existing diagnostic approaches are often complex. This study aimed to develop and validate a laboratory-based prediction model for early DIC risk assessment, while additionally evaluating different D-dimer interpretation strategies in relation to current diagnostic recommendations.</div></div><div><h3>Methods</h3><div>This single-center retrospective observational study consecutively included adult patients with overt disseminated intravascular coagulation (DIC) diagnosed between January 2015 and December 2024, together with individuals without DIC. An independent cohort from January to December 2025 was used for external validation. Ten routinely available coagulation and platelet-related biomarkers measured within 24 h prior to DIC diagnosis were analyzed. The diagnostic performance of D-dimer alone was evaluated using both the Chinese expert consensus cut-off strategy and the 2025 International Society on Thrombosis and Haemostasis (ISTH) upper limit of normal (ULN)–based classification. A multivariable prediction model was subsequently developed using routinely available laboratory parameters.</div></div><div><h3>Results</h3><div>A total of 2750 participants were included in the main cohort, with an additional 363 individuals in the external validation cohort. D-dimer interpreted using the ISTH ULN-based classification demonstrated better overall diagnostic performance than fixed cut-off strategies, with the &gt;3 × ULN threshold providing the most balanced sensitivity and specificity. The final model incorporated four laboratory parameters—prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer, and mean platelet volume (MPV)—and demonstrated strong discrimination, with areas under the receiver operating characteristic curve (AUCs) of 0.908 in the training cohort, 0.894 in the validation cohort, and 0.971 in the external validation cohort. Predicted risk showed a clear stepwise increase in DIC prevalence across risk strata.</div></div><div><h3>Conclusions</h3><div>This four-parameter laboratory-based model provides an interpretable and externally validated tool for early DIC risk assessment using routinely available laboratory tests. The model may support preliminary risk stratification and facilitate timely clinical evaluation in patients at risk for DIC.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"263 ","pages":"Article 109727"},"PeriodicalIF":3.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148284653","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 short history of anticoagulant therapy","authors":"Noel C. Chan,&nbsp;Anna M. Imiela,&nbsp;Stephanie Carlin,&nbsp;Jack Hirsh","doi":"10.1016/j.thromres.2026.109753","DOIUrl":"10.1016/j.thromres.2026.109753","url":null,"abstract":"<div><div>Anticoagulant therapy has undergone a remarkable evolution over the past century, transforming the prevention and treatment of thromboembolic disease. The accidental discovery of vitamin K antagonists (VKAs) in the 1940s, following investigations of fatal bleeding in cattle fed spoiled sweet clover, led to the identification of dicoumarol and the development of warfarin. Despite limitations in study design, studies from the 1960s onward established the foundations of modern anticoagulation. Subsequent advances refined the dosing and monitoring of heparin and VKAs, while the introduction of weight-based subcutaneous dosing of low molecular weight heparins (LMWH) represented a breakthrough by enabling more predictable, safer, and more convenient parenteral anticoagulation, particularly in the outpatient setting. More recently, direct oral anticoagulants (DOACs) have revolutionized clinical practice as they can be used in fixed doses without routine laboratory monitoring, thereby simplifying oral anticoagulation and are now preferred over VKAs for many indications. Unlike existing anticoagulants which suppress thrombin generation or inhibit factor Xa or thrombin, novel anticoagulants in development selectively target coagulation proteins within the contact activation pathway (such as Factor XI). These novel anticoagulants offer the potential to uncouple bleeding risk from antithrombotic efficacy and may also be effective for conditions in which clotting is driven by the contact activation pathway such as mechanical heart valves, for which DOACs are inadequate. However, their role and clinical indications remain to be defined in ongoing phase III trials.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"263 ","pages":"Article 109753"},"PeriodicalIF":3.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148296463","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":"The perils of extrapolation: Lessons from a prospective registry of catheter-related thrombosis in patients with cancer","authors":"Mariana Pfeferman,&nbsp;Gregory Piazza","doi":"10.1016/j.thromres.2026.109756","DOIUrl":"10.1016/j.thromres.2026.109756","url":null,"abstract":"","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"263 ","pages":"Article 109756"},"PeriodicalIF":3.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148303311","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":"Short-term performance of bleeding risk scores in anticoagulated older patients with acute pulmonary embolism","authors":"Yuzhi Tao,&nbsp;Xianglong Meng,&nbsp;Han Tian,&nbsp;Xincheng Li,&nbsp;Rui Liang,&nbsp;Yinong Chen,&nbsp;Hong Chen,&nbsp;Chunling Dong,&nbsp;Yiwei Shi,&nbsp;Xiaomao Xu,&nbsp;Maoyun Wang,&nbsp;Ling Zhu,&nbsp;Yingqun Ji,&nbsp;Juhong Shi,&nbsp;Hong Chen,&nbsp;Zhe Cheng,&nbsp;Yanxia Li,&nbsp;Chaosheng Deng,&nbsp;Qin Luo,&nbsp;Pinyao Lu,&nbsp;Chen Wang","doi":"10.1016/j.thromres.2026.109744","DOIUrl":"10.1016/j.thromres.2026.109744","url":null,"abstract":"<div><h3>Background</h3><div>Older patients with pulmonary embolism (PE) are at increased risk of bleeding, which is associated with adverse outcomes, making early risk assessment particularly important. This study evaluated the short-term performance of commonly used bleeding risk scores in patients aged ≥65 years.</div></div><div><h3>Methods</h3><div>An analysis was conducted in a multicenter, prospective study of patients aged ≥65 years with PE receiving anticoagulation (<span><span>NCT02943343</span><svg><path></path></svg></span>, 2016). The performance of the PE-SARD, Kuijer, RIETE, BACS, and ATRIA scores was evaluated using the time-dependent area under the curve (AUC) analysis. Calibration was assessed with calibration plots. Sensitivity, specificity, and positive predictive values were calculated. The primary outcomes were major bleeding (MB) at 7 and 14 days.</div></div><div><h3>Results</h3><div>Among 3661 anticoagulated patients aged ≥65 years with acute PE, MB occurred in 18 (0.5%) and 36 (1.0%) patients at 7 and 14 days, respectively, and clinically relevant non-major bleeding (CRNMB) in 69 (1.9%) and 105 (2.9%) patients. Patients with bleeding events had higher mortality than those without bleeding. Discrimination for short-term MB was low to moderate across scores, with RIETE (AUC 0.76, 95% CI 0.65–0.87) and PE-SARD (AUC 0.74, 95% CI 0.63–0.85) showing the most consistent performance at 7 days. Overall discrimination declined at 14 days. All scores demonstrated limited ability to predict CRNMB, and no model showed a consistent net clinical benefit.</div></div><div><h3>Conclusions</h3><div>In older patients with PE, bleeding risk scores showed low-to-moderate discrimination for short-term bleeding, with moderate early performance observed only in selected scores. None of the scores reliably identified CRNMB, highlighting the limitations of baseline risk assessment in acute care settings.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"263 ","pages":"Article 109744"},"PeriodicalIF":3.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273136","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":"Infection site modifies the prognostic impact of disseminated intravascular coagulation in sepsis","authors":"Wataru Takayama,&nbsp;Natsuko Tomita,&nbsp;Yuhi Matsuo,&nbsp;Koji Morishita","doi":"10.1016/j.thromres.2026.109761","DOIUrl":"10.1016/j.thromres.2026.109761","url":null,"abstract":"<div><h3>Background</h3><div>Disseminated intravascular coagulation (DIC) is a common, life-threatening sepsis complication. Although DIC severity is widely used for risk stratification, whether its prognostic impact varies by infection site remains unclear.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of adults with sepsis admitted to a tertiary critical care center between 2015 and 2025. DIC was defined as a Japanese Association for Acute Medicine score of ≥4 on hospital days 1–3. Patients were grouped by infection site. The primary outcome was in-hospital mortality, and secondary outcomes were ventilator-free days (VFD) and intensive care unit-free days (IFD). Multivariable regression models adjusted for age and sex were used to evaluate the association between DIC and outcomes, including interaction analysis by infection site.</div></div><div><h3>Results</h3><div>Among 933 patients, 568 (60.9%) developed DIC. DIC was associated with higher mortality and fewer VFD and IFD, with the strongest mortality association in pulmonary (aOR 4.5, 95% confidence interval [CI] 2.2–8.3) and urinary tract infections (aOR 3.2, 95% CI 1.4–9.4) (<em>P</em> for interaction = 0.02). DIC most commonly became apparent on hospital day 2.</div></div><div><h3>Conclusions</h3><div>The prognostic impact of DIC in sepsis varies by infection site. Sepsis-associated DIC may not represent a uniform entity across infection phenotypes. Further studies are needed to clarify site-specific risks and mechanisms to optimize treatment strategies.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"263 ","pages":"Article 109761"},"PeriodicalIF":3.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148309449","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}