Thrombosis Update最新文献

{"title":"Detection of abnormally high DOAC plasma concentrations using PT/INR in three different reagents in frail older patients: the DOAC-FRAIL study","authors":"M.J. de Jong,&nbsp;D.L.S. Hellenbrand,&nbsp;D.C.W. Braeken,&nbsp;H. ten Cate,&nbsp;A.K. Stroobants,&nbsp;Y.M.C. Henskens,&nbsp;F.J.H. Magdelijns,&nbsp;K. Winckers","doi":"10.1016/j.tru.2026.100250","DOIUrl":"10.1016/j.tru.2026.100250","url":null,"abstract":"<div><h3>Background</h3><div>DOACs are prescribed for the prevention and treatment of thromboembolism. Frail older patients represent a vulnerable population with altered pharmacokinetics. This may result in elevated DOAC plasma concentrations with an increased bleeding risk. DOAC plasma concentrations are not routinely measured. PT and INR are widely available, but diagnostic value for detecting elevated DOAC plasma concentrations is uncertain and may be reagent-dependent.</div></div><div><h3>Methods</h3><div>We evaluated the correlation between INR and DOAC plasma concentrations using spiking- and plasma samples from acutely admitted frail older patients. INR was measured using three different reagents (Neoplastin, RecombiPlasTin and Innovin). Diagnostic performance was assessed using predefined INR thresholds. Sensitivity, specificity, predictive values, and diagnostic accuracy were calculated.</div></div><div><h3>Results</h3><div>Neoplastin demonstrated the strongest correlation with rivaroxaban plasma concentrations. An INR cut-off ≥1.8 showed a sensitivity of 100% and specificity of 66.7% for detecting rivaroxaban concentrations ≥300 ng/mL (PPV 82.4%, NPV 100%). RecombiPlasTin showed high sensitivity but lower specificity. Innovin demonstrated low sensitivity but high specificity. For apixaban, RecombiPlasTin was evaluated due to lower linearity of the other reagents. An INR cut-off ≥1.6 yielded a sensitivity of 62.5% and specificity of 75.0% for detecting apixaban concentrations ≥300 ng/mL (PPV 33.3%, NPV 90.9%). Sensitivity increased for apixaban concentrations ≥350 ng/mL, reaching 100% across all INR thresholds.</div></div><div><h3>Conclusion</h3><div>The INR performance for detecting elevated DOAC plasma concentrations varies substantially between reagents and DOAC-type. Routine coagulation assays may offer a screening tool for detecting elevated DOAC plasma concentrations in frail older patients when specific DOAC measurements are not available.</div></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"24 ","pages":"Article 100250"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149004132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying barriers and facilitators to timely venous thromboembolism prevention in newly diagnosed pancreatic cancer: a qualitative study","authors":"Karlyn A. Martin,&nbsp;Ryan Thomas,&nbsp;Sean Britton,&nbsp;Chris E. Holmes,&nbsp;Richard S. Zubarik,&nbsp;Lisa R. Hirschhorn,&nbsp;Kenzie A. Cameron","doi":"10.1016/j.tru.2026.100249","DOIUrl":"10.1016/j.tru.2026.100249","url":null,"abstract":"<div><ul><li><span>•</span><span><div>Guideline use of primary prophylaxis for pancreatic cancer is very low.</div></span></li><li><span>•</span><span><div>Barriers and facilitators to prophylaxis initiation are unknown.</div></span></li><li><span>•</span><span><div>We conducted a qualitative study of multidisciplinary clinicians and patients.</div></span></li><li><span>•</span><span><div>Clinicians and patients value VTE prevention; clinicians feel capable with support.</div></span></li><li><span>•</span><span><div>Barriers include limited evidence awareness and delays establishing with oncology.</div></span></li></ul></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"24 ","pages":"Article 100249"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148935730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Air pollution and VTE-emerging risks in a warming world","authors":"Lucy Norris (Editor in Chief),&nbsp;Emmanuel Papadakis (Editor in Chief)","doi":"10.1016/j.tru.2026.100252","DOIUrl":"10.1016/j.tru.2026.100252","url":null,"abstract":"","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"24 ","pages":"Article 100252"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FGG p.Ser384Cys causes thrombin source-dependent underestimation of fibrinogen by Clauss assay: a familial case report","authors":"Emad Muhammad,&nbsp;Yarden Caspin,&nbsp;Gharam Shama,&nbsp;Avital Shushan,&nbsp;Shoshan Perek,&nbsp;Amir Warwar,&nbsp;Mouna Balan Haj,&nbsp;Amin Ibraheem,&nbsp;Marwa Naamne,&nbsp;Narmine Elkhateeb,&nbsp;Meir Preis","doi":"10.1016/j.tru.2026.100248","DOIUrl":"10.1016/j.tru.2026.100248","url":null,"abstract":"<div><h3>Background</h3><div>Congenital dysfibrinogenemia is characterized by reduced functional fibrinogen despite normal antigen levels. In some variants, assay specific effects may lead to diagnostic misclassification and inappropriate clinical management.</div></div><div><h3>Objective</h3><div>To describe a thrombin source-dependent discrepancy in fibrinogen activity assays associated with the FGG p.Ser384Cys variant.</div></div><div><h3>Methods</h3><div>Three asymptomatic members of one family underwent coagulation testing, including fibrinogen activity by Clauss assays using bovine and human thrombin, fibrinogen antigen measurement, thrombin time (TT), reptilase time (RT), ROTEM SIGMA viscoelastic testing, and next generation sequencing of fibrinogen genes.</div></div><div><h3>Results</h3><div>All individuals showed markedly reduced fibrinogen activity using bovine thrombin-based Clauss assays (38-68 mg/dL) but substantially higher activity with human thrombin (101-129 mg/dL), alongside normal fibrinogen antigen levels (327-362 mg/dL). TT and RT were prolonged in all cases. ROTEM SIGMA FIBTEM clotting time and maximum clot firmness were within normal reference ranges. A heterozygous FGG c.1151C &gt; G (p.Ser384Cys) variant was identified in all affected family members.</div></div><div><h3>Conclusions</h3><div>FGG p.Ser384Cys causes dysfibrinogenemia with selective resistance to bovine thrombin-based Clauss assays, leading to falsely low fibrinogen results despite preserved whole blood fibrin clot formation.</div></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"24 ","pages":"Article 100248"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148958918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term increases in traffic-related nitrogen oxides are associated with acute venous thromboembolism admissions: An 18-year data linkage study in Scotland","authors":"Catherine A. Fitton,&nbsp;Bianca Cox,&nbsp;Jill JF. Belch","doi":"10.1016/j.tru.2026.100251","DOIUrl":"10.1016/j.tru.2026.100251","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic exposure to air pollution is strongly associated with subsequent development of cardiovascular conditions, including the development of Venous thromboembolism (VTE), however short-term effects have been less well explored.</div></div><div><h3>Aim</h3><div>To determine whether short-term variations in air quality are associated with hospital admissions for venous thromboembolism (VTE).</div></div><div><h3>Methods</h3><div>We conducted a time-series analysis using routinely collected hospital admission data from Ninewells Hospital, Dundee, Scotland (2000–2017). Outcomes included hospital admissions for deep vein thrombosis only (DVT), pulmonary embolism only (PE) or DVT and PE. Air pollution types included were: Nitrogen oxides (NOx), Nitrogen dioxide (NO2), Nitric oxide (NO) and Particulate matter smaller than 10 μm (PM10). Associations were estimated using quasi-Poisson regression with distributed lag models, adjusting for temperature, humidity, day of week, month, year and public holiday. Risk ratios (RR) and 95% confidence intervals (CI) were calculated for a 10μg/m3 increase in air pollutant concentrations, reported for day 0 (day of exposure), and cumulative exposure over days 0-9.</div></div><div><h3>Outcomes/results</h3><div>Cumulative exposure to NO was associated with increased risk of admission for any VTE (RR 1.03; 95% CI 1.00-1.07). PE admissions were significantly associated with cumulative NOx (RR 1.02; 95% CI 1.00-1.05) and NO exposure (RR 1.05; 95% CI 1.01-1.09).</div></div><div><h3>Conclusions</h3><div>This study provides novel evidence that short-term exposure to nitrogen oxides may increase the risk of VTE hospital admission. While arterial events such as myocardial infarction and stroke are known to cluster around high air pollution episodes, our findings suggest that venous disease may also be affected. Further research is needed to confirm these associations and clarify underlying mechanisms.</div></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"24 ","pages":"Article 100251"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149004131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editor's Choice: Anticoagulation Control: Lessons earned from the COVID-19 Pandemic","authors":"Dr. Emmanouil S. Papadakis MD,&nbsp;Dr. Lucy A. Norris PhD","doi":"10.1016/j.tru.2026.100243","DOIUrl":"10.1016/j.tru.2026.100243","url":null,"abstract":"","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"23 ","pages":"Article 100243"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148565610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of venous thromboembolism in persons with cancer – a population-based cohort study in Sweden","authors":"Lovisa Hägg,&nbsp;Annelie Behndig,&nbsp;Magdalena Johansson","doi":"10.1016/j.tru.2026.100244","DOIUrl":"10.1016/j.tru.2026.100244","url":null,"abstract":"<div><h3>Background</h3><div>Venous thromboembolism (VTE) is a well-recognised complication of cancer, but reported incidence rates vary due to differences in population characteristics and study design.</div></div><div><h3>Objective</h3><div>To estimate incidence rates of VTE among persons with cancer and to assess the association between cancer and first-ever VTE in a population-based Swedish cohort.</div></div><div><h3>Methods</h3><div>This cohort study was based on participants in the Västerbotten Intervention Programme who underwent health examinations between 1985 and 2014. Individuals with prior cancer or VTE were excluded. Cancer and VTE diagnoses were identified through Swedish national registers, and all potential VTE events were manually validated. Participants were followed prospectively from health examination until incident VTE, death, emigration, or end of follow-up. Incidence rates were calculated by time since diagnosis. Cox proportional hazards models with cancer as a time-varying exposure were used to estimate HRs for first-ever VTE.</div></div><div><h3>Results</h3><div>Among 105,997 participants, 9,643 developed cancer during follow-up, and 677 experienced a first-ever VTE after cancer diagnosis. The VTE incidence in individuals with cancer was 13.2 per 1000 person-years (95% CI 12.3–14.3). Incidence was highest during the first six months after diagnosis (60.2 per 1000 person-years). The incidence varied across cancer types (4.9–201.1 per 1000 person-years). Cancer was significantly associated with VTE, with an adjusted hazard ratio of 8.3 (95% CI 7.5–9.2).</div></div><div><h3>Conclusion</h3><div>In a population-based cohort we found a high incidence of VTE after cancer diagnosis. The incidence declined rapidly over time and varied across cancer types. Our study confirms the association between cancer and VTE.</div></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"23 ","pages":"Article 100244"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148565609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of reduced INR monitoring frequency on anticoagulation control during the COVID-19 pandemic: A dutch dynamic cohort study","authors":"Tessa Elling ,&nbsp;Nic.J.G.M. Veeger ,&nbsp;Derk Hardeman ,&nbsp;Adrian Kruit ,&nbsp;Jos.G.J. Pouwels ,&nbsp;Jenneke Stegeman ,&nbsp;Vladimir Tichelaar ,&nbsp;Karina Meijer","doi":"10.1016/j.tru.2026.100242","DOIUrl":"10.1016/j.tru.2026.100242","url":null,"abstract":"<div><h3>Background</h3><div>Regular international normalized ratio (INR) monitoring is essential for maintaining optimal anticoagulation intensity in vitamin K antagonist (VKA)-treated patients. Unforeseen circumstances, such as the COVID-19 pandemic, led to temporary adjustments in anticoagulation clinic protocols, potentially reducing INR testing frequency and affecting INR control. We evaluated whether these adjustments resulted in increased INR intervals and affected INR control.</div></div><div><h3>Methods</h3><div>All patients managed by four Dutch Anticoagulation services were included in a dynamic cohort (December 2018 to December 2020). The study was divided into eight quartiles, with eligibility assessed at the start of each quartile. INR return interval and INR control (time under/in/above the therapeutic range, INR variability, mean INR and proportion of high INR values) were calculated per quartile. Pandemic quartiles were compared with corresponding calendar quartiles from the previous year to account for seasonal variation.</div></div><div><h3>Results</h3><div>Over 23,000 patients were included per quartile (mean age 80 years, 55% male). In each quartile, 52.7-56.0% of the patients maintained therapeutic range (TTR) above 70%. INR return interval increased during the pandemic, especially at the start (28.0 [IQR 19.3-38.5] vs. 25.1 [IQR 16.3-32.7] days, p-value &lt;0.001). No decrease in TTR was observed. Instead, a statistically significant but clinically modest increase occurred (72.8 [IQR 51.1-100.0] vs. 75.0 [IQR 54.4-100.0], p-value &lt;0.01). Other INR control measures showed similar stability.</div></div><div><h3>Conclusion</h3><div>Compared with the pre-pandemic period, INR testing frequency decreased during the COVID-19 pandemic due to temporary protocol adjustments. INR control was not negatively affected. VKA therapy stability was maintained despite a 16% reduction in monthly INR measurements.</div></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"23 ","pages":"Article 100242"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148231232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thank you reviewers","authors":"","doi":"10.1016/j.tru.2026.100238","DOIUrl":"10.1016/j.tru.2026.100238","url":null,"abstract":"","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"22 ","pages":"Article 100238"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147750637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-sensitivity thrombin generation profiling identifies divergent coagulation states across peripheral artery disease severity","authors":"Yosuke Morodomi ,&nbsp;Shinichiro Yoshino ,&nbsp;Koichi Morisaki ,&nbsp;Yuichi Kamikubo ,&nbsp;Rina Inoue ,&nbsp;Yusuke Fujioka ,&nbsp;Kentaro Inoue ,&nbsp;Sachiko Kanaji ,&nbsp;Taisuke Kanaji ,&nbsp;Kenta Ishimoto ,&nbsp;Zheng Situo ,&nbsp;Seiichiro Kizaki ,&nbsp;Noriko Yasuda-Yoshihara ,&nbsp;Yui Harada ,&nbsp;Tomoharu Yoshizumi ,&nbsp;Yoshikazu Yonemitsu","doi":"10.1016/j.tru.2026.100235","DOIUrl":"10.1016/j.tru.2026.100235","url":null,"abstract":"<div><h3>Background</h3><div>Factor Xa inhibition has demonstrated clinical benefit in peripheral artery disease (PAD), yet the mechanisms underlying this effect remain poorly defined. Uncertainty also persists regarding which patient subgroups derive net benefit, particularly given concerns about bleeding risk. Conventional thrombin generation assays primarily capture late and amplified coagulation phases and may overlook subtle abnormalities in the early-phase. We therefore investigated stage-specific profiles of the initial activated Factor II (FIIa) generation (ITG) during the early phase of coagulation in PAD using two high-sensitivity thrombin generation assays.</div></div><div><h3>Methods</h3><div>TF-driven ITG (TF-ITG) and FVIIIa/FIXa-dependent ITG (FVIIIa/FIXa-ITG) were measured in plasma samples from patients with intermittent claudication (IC), chronic limb-threatening ischemia (CLTI), and healthy controls. Tissue factor pathway inhibitor (TFPI) activity levels were also assessed.</div></div><div><h3>Results</h3><div>Distinct early-phase coagulation phenotypes emerged across PAD severity. Patients with IC showed selective intrinsic coagulation pathway hypercoagulability with significantly elevated FVIIIa/FIXa-ITG compared to controls (<em>p</em> &lt; 0.005), while TF-ITG remained normal. Conversely, patients with CLTI demonstrated paradoxical suppression of both TF-ITG and FVIIIa/FIXa-ITG (<em>p</em> &lt; 0.005), accompanied by elevated TFPI activity levels. The TFPI levels correlated negatively with both TF-ITG (r = −0.696, <em>p</em> = 0.0057) and FVIIIa/FIXa-ITG (r = −0.535, <em>p</em> = 0.049) only in CLTI.</div></div><div><h3>Conclusions</h3><div>Early-phase thrombin generation differs fundamentally between IC and CLTI. These exploratory findings provide hypothesis-generating mechanistic insights for the variable clinical effects of Factor Xa inhibition in PAD. Prospective studies are warranted to determine whether early-phase thrombin generation profiling can inform biomarker-guided antithrombotic strategies.</div></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"22 ","pages":"Article 100235"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147750635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}