Thrombosis Update最新文献

{"title":"Hospitalizations for bleeding associated with apixaban versus rivaroxaban according to dose in Medicare beneficiaries","authors":"Luke S. Vest ,&nbsp;Seo H. Baik ,&nbsp;Fitsum Baye ,&nbsp;Kin-Wah Fung ,&nbsp;Clement J. McDonald","doi":"10.1016/j.tru.2025.100220","DOIUrl":"10.1016/j.tru.2025.100220","url":null,"abstract":"<div><h3>Introduction</h3><div>Apixaban and rivaroxaban are the most prescribed direct oral anticoagulants, and the safety of different doses in patients at high risk for bleeding is not fully defined. The objective of this study was to compare the rate of hospitalizations due to bleeding in patients prescribed apixaban versus rivaroxaban at specific doses.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of more than 1.9 million Medicare beneficiaries who filled prescriptions for apixaban or rivaroxaban from 2014 to 2020 using the Medicare Parts A, B, C and D encounter and prescription claims database. The primary outcomes measured were hospitalizations due to bleeding categorized by location (intracranial, gastrointestinal [GI], and other) and all-cause mortality.</div></div><div><h3>Results</h3><div>Among the population studied, 1,022,170 (53 %) filled a prescription for apixaban 5 mg during the study period, followed by rivaroxaban 20 mg (27 %) and rivaroxaban 10 mg (11 %). Compared to the reference group of apixaban 5 mg, combination prescriptions for rivaroxaban 15–20 mg were associated with more than twice the risk of hospitalization due to GI bleeding (hazard ratio [HR] = 2.41, 95 % confidence interval [CI]: 2.15–2.70) and other bleeding (HR = 2.42, 95 % CI: 1.92–3.05) and were associated with a 51 % higher risk of hospitalization due to intracranial bleeding (HR = 1.51, 95 % CI: 1.15–1.98). There were 88,740 (4.6 %) deaths during the study period, with a 27 % increased risk of death associated with prescriptions for apixaban 2.5 mg (HR = 1.27, 95 % CI: 1.24–1.30) and a 19 % decreased risk of death associated with prescriptions for rivaroxaban 10 mg (HR = 0.81, 95 % CI: 0.78–0.85).</div></div><div><h3>Conclusion</h3><div>Rivaroxaban doses of 15 mg and greater were associated with higher bleeding risk. This data may aid clinicians in making an informed decision when prescribing specific doses of apixaban and rivaroxaban, particularly for patients with a high risk of bleeding.</div></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"20 ","pages":"Article 100220"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144852853","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":"Characterizing anticoagulation reversal practices in Colombia: Initial insights from a national registry","authors":"Sebastián Seni-Molina ,&nbsp;Santiago Posso Marín ,&nbsp;Juan Esteban Masmela ,&nbsp;María Camila Naranjo-Ramírez ,&nbsp;Arturo D. Mora ,&nbsp;Juliana María Gutiérrez-Posso ,&nbsp;Julio Diez-Sepúlveda ,&nbsp;Juan David Victoria-Salcedo ,&nbsp;Ana Cristina Montenegro Arenas ,&nbsp;Camilo Andrés Rueda Ortiz ,&nbsp;Edgar David Gómez Lahitton ,&nbsp;Hoover O. León-Giraldo ,&nbsp;Juan Esteban Gómez-Mesa ,&nbsp;On behalf of the RECCANT-AR Research Group","doi":"10.1016/j.tru.2025.100215","DOIUrl":"10.1016/j.tru.2025.100215","url":null,"abstract":"<div><h3>Background</h3><div>Anticoagulation reversal is critical in emergency settings for patients experiencing anticoagulant-related bleeding or requiring invasive or surgical procedures. Despite its importance, evidence in Colombia is limited.</div></div><div><h3>Methods</h3><div>RECCANT-AR (<strong><em>Re</em></strong><em>gistro</em> <strong><em>C</em></strong><em>olombiano de</em> <strong><em>C</em></strong><em>línicas de</em> <strong><em>Ant</em></strong><em>icoagulación y el Uso de</em> <strong><em>A</em></strong><em>gentes</em> <strong><em>R</em></strong><em>eversores</em>) is a multicenter, observational, ambispective study analyzing anticoagulated patients requiring reversal therapy due to bleeding or procedural needs. Data from the first 144 patients across four institutions were analyzed to describe their sociodemographic and clinical profiles.</div></div><div><h3>Results</h3><div>The cohort had a mean age of 66.9 years (SD ± 15.3) and a nearly equal sex distribution. Ethnicity was predominantly Mestizo (67.5%), followed by White (17.5%) and Afrodescendant (13.3%). The most common comorbidities were hypertension (61.8%), previous venous thromboembolism episodes (31.3%), dyslipidemia (30.6%), and diabetes mellitus (21.5%). Warfarin was the predominant anticoagulant (84%), followed by apixaban (4.9%) and dabigatran (4.2%). Bleeding was the primary indication for reversal (92.4%), while surgical needs accounted for 7.6% of cases. The most used reversal agents were vitamin K (75%) and prothrombin complex concentrates (27.1%). Hospitalization was required in 82% of cases, with 55.1% admitted to intensive care. The mortality rate was 7.6%.</div></div><div><h3>Conclusion</h3><div>Our study is the first multicenter characterization of anticoagulated patients requiring reversal therapy in Colombia. Cardiovascular comorbidities were highly prevalent, highlighting their association with hemorrhagic complications. Bleeding was the leading indication for reversal, and warfarin the most used anticoagulant, likely reflecting its higher bleeding risk. The limited availability of direct oral anticoagulant-specific reversal agents remains a challenge. The high hospitalization and mortality rates underscore the high-risk nature of this population, emphasizing the need for improved access to reversal agents and optimized anticoagulation practices. Further research is warranted.</div></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"20 ","pages":"Article 100215"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766902","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":"Impacts of the carceral environment on autopsy-verified venous thromboembolism mortality","authors":"Lisette Valenzuela ,&nbsp;Muryam Hasan ,&nbsp;Nikolas Brandt ,&nbsp;Amy Woods ,&nbsp;Shamsher Samra ,&nbsp;Nona Bhatia ,&nbsp;Nicholas Shapiro","doi":"10.1016/j.tru.2025.100221","DOIUrl":"10.1016/j.tru.2025.100221","url":null,"abstract":"<div><div>Venous thromboembolism (VTE), encompassing deep vein thrombosis and pulmonary embolism, is a leading cause of mortality globally, with increasing incidence in the United States. However, no studies have examined VTE risk factors in carceral settings. This study evaluates VTE-related deaths in jailed and non-jailed populations in Los Angeles County over 16 years (2008–2023). Using death records, we compiled two datasets: one for deaths in Los Angeles County jails (n = 512) and another for deaths in the free population (n = 107,608). VTE cases were identified through keyword searches and reviewed for diagnostic consistency. Statistical analyses compared mortality rates and demographics, and a qualitative review of jailed VTE decedent autopsy records was conducted to identify risk factors linked to incarceration. VTE-related deaths in the jailed population were over three times higher than in the free population (3.5 % vs. 1.1 %, p = 0.0014). Crude mortality rates in jails have risen since 2014, peaking in 2021. Black individuals, while comprising 7.9 % of the county population and 29.4 % of the jail population, accounted for 66.67 % of VTE deaths in jails, highlighting exacerbated racial disparities. Structural and environmental factors in carceral settings, including restricted mobility, antipsychotic medication use, and restraints, likely contribute to elevated risks. Improving restraint use reporting and post-mortem toxicology findings for pulmonary embolism deaths can enhance etiology understanding. Diversion programs for mental health populations and other decarceral approaches, alongside anticoagulant prescriptions, could mitigate VTE risks and reduce health inequities in incarcerated populations.</div></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"20 ","pages":"Article 100221"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144904473","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":"Venous and arterial thromboembolism in out-patients with inflammatory bowel disease: a single center study","authors":"Antonella Tufano ,&nbsp;Anna Testa ,&nbsp;Marta Patturelli,&nbsp;Antonio Rispo,&nbsp;Vincenzo Fotticchia,&nbsp;Paola Rufolo,&nbsp;Federica Strano,&nbsp;Alessia Dalila Guarino,&nbsp;Antonietta Vitale,&nbsp;Olga Maria Nardone,&nbsp;Mario Ferrante,&nbsp;Rossella Caso,&nbsp;Fabiana Castiglione","doi":"10.1016/j.tru.2025.100212","DOIUrl":"10.1016/j.tru.2025.100212","url":null,"abstract":"<div><h3>Background</h3><div>Patients affected by inflammatory bowel diseases (IBD), namely Crohn's disease (CD) and ulcerative colitis (UC), are at risk for thromboembolic events (TE). Patients with active/relapsing disease and those needing hospitalization and surgery show the highest risk. The thrombotic risk in out-patients with IBD is underestimated and poorly investigated.</div></div><div><h3>Objectives</h3><div>to evaluate the prevalence, clinical features and risk factors for thromboembolism in IBD out-patients.</div></div><div><h3>Methods</h3><div>From May 2021 to September 2023, consecutive IBD out-patients were evaluated for the presence of cardiovascular risk factors (smoking, arterial hypertension, diabetes mellitus, hypercholesterolemia) and history of TE. Patients with a history of TE (including coronary heart disease, stroke, transient ischemic attack- TIA-, deep vein thrombosis- DVT-, superficial vein thrombosis- SVT-, pulmonary embolism- PE-) were studied for thrombophilia.</div></div><div><h3>Results</h3><div>A total of 302 IBD outpatients were included in the study (154 CD; 148 UC; mean age: 41.23 ± 17.4 years). Twenty-three patients (23/302; 7.6 %) showed a thrombotic event: 14 UC patients (14/148; 9.4 %) and 9 CD patients (9/154; 5.8 %).</div><div>Among the 23 patients with TE, we observed 12 arterial thromboses (12/23; 52.2 %), including 7 cases of Myocardial Infarction (7/12; 58.3 %), 3 Ischemic Stroke (3/12; 25 %), 2 TIA (2/12; 16.7 %); and 11 episodes of venous thromboembolism (VTE) (11/23; 47.8 %), including 7 DVT (7/11; 63.6 %), 2 SVT (2/11; 18.2 %) and 2 PE (2/11; 18.2 %).</div><div>Among the 11 VTE patients 6 were affected by UC and 5 patients were affected by CD. 5 out of 12 arterial thrombosis patients were affected by CD and 7 patients by UC.</div><div>In the univariable analysis, several predictors showed a significant association with TE, including IBD activity (OR = 4.98, 95 % CI: 1.93–12.81), arterial hypertension (OR = 4.44, 95 % CI: 1.86–10.60), hypercholesterolemia (OR = 4.68, 95 % CI: 1.38–15.92), hematologic disease (OR = 6.55, 95 % CI: 1.13–37.85).</div><div>IBD activity (OR = 7.03, 95 % CI: 2.48–19.85), arterial hypertension (OR = 3.35, 95 % CI: 1.32–8.50), hypercholesterolemia (OR = 5.06, 95 % CI: 1.21–18.77), hematologic disease (OR = 12.58, 95 % CI: 1.87–69.87) and immune disease (OR = 19.39, 95 % CI: 1.29–289.60) were significantly correlated to TE events at multivariable analysis.</div></div><div><h3>Conclusions</h3><div>Out-patients with IBD presented a low but not negligible risk of TE, mainly correlated to the common cardiovascular risk factors described in the general population and to the presence of immunological and hematological disease. Clinicians should not underestimate thrombotic risk in these patients.</div></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"20 ","pages":"Article 100212"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144711545","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":"Reduction in D-dimer levels after treatment with Auxora in patients with severe COVID-19 pneumonia","authors":"Peter C. Hou ,&nbsp;Joseph Miller ,&nbsp;Charles Bruen ,&nbsp;Fady Youssef ,&nbsp;Michael J. Schnaus ,&nbsp;Kathyrn Brouillette ,&nbsp;Raul Mendoza-Ayala ,&nbsp;Jeffrey Zhang ,&nbsp;Kenneth Stauderman ,&nbsp;Sudarshan Hebbar","doi":"10.1016/j.tru.2025.100217","DOIUrl":"10.1016/j.tru.2025.100217","url":null,"abstract":"<div><h3>Introduction</h3><div>A phase 2 double-blinded trial (CARDEA) (<span><span>NCT04345614</span><svg><path></path></svg></span>) in patients diagnosed with COVID-19 revealed that intravenous zegocractin treatment (Auxora™) was associated with improved clinical outcomes compared to standard of care (SOC). D-dimer serum level is a biomarker of thrombosis in COVID-19, and elevated levels are directly correlated with a high risk of poor outcomes. Here, we report biomarker analyses from blood samples collected from patients in that study.</div></div><div><h3>Methods</h3><div>Quantification of D-dimer levels was the primary endpoint of the study. Secondary endpoints measured levels of angiopoietin 1 (Ang1), angiopoietin 2 (Ang2), soluble CD25 (sCD25), and renin. CARDEA was conducted in 17 U S. clinical centers. Patients were randomly assigned to receive Auxora plus SOC (n = 143) or placebo plus SOC (n = 141). The medications were administered by a 4-h intravenous infusion at 2.0 mg/kg (1.25 mL/kg) at 0-h and 1.6 mg/kg (1 mL/kg) at 24 h and 48 h.</div></div><div><h3>Findings</h3><div>Patients in the Auxora group had a baseline mean D-dimer value of 2.61 mg/L and those in the placebo group had a value of 2.05 mg/L. Treatment with Auxora resulted in a statistically significant decrease in D-dimer levels within the first 72 h compared to placebo (delta = −0.92; [95 % CI: −1.82, −0.02]; <em>p</em> &lt; 0.046). The decrease in D-dimer levels correlated with an increase in imputed PaO₂/FiO₂ at 72 h (r: −0.193; <em>p</em> &lt; 0.05) and improved clinical status at 168 h (r: 0.218, <em>p</em> &lt; 0.01). Auxora treatment reduced levels of Ang2 and sCD25, and increased Ang1 levels compared to placebo.</div></div><div><h3>Conclusion</h3><div>Auxora treatment significantly reduced D-dimer levels in patients diagnosed with COVID-19, and the decrease was associated with an improved clinical status.</div></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"20 ","pages":"Article 100217"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144653782","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":"Asymptomatic patients with carotid atherosclerosis present a higher coagulation state compared to healthy subjects","authors":"Laurie Josset ,&nbsp;Mathilde Mura ,&nbsp;Mathis Damon ,&nbsp;Emma de Cartier d’Yves ,&nbsp;Michèle Weiss-Gayet ,&nbsp;Anaelle Boreau ,&nbsp;Emeraude Rivoire ,&nbsp;Nellie Della-Schiava ,&nbsp;Anne Long ,&nbsp;Sandrine Horman ,&nbsp;Antoine Millon ,&nbsp;Vincent Pialoux ,&nbsp;Amandine Thomas","doi":"10.1016/j.tru.2025.100219","DOIUrl":"10.1016/j.tru.2025.100219","url":null,"abstract":"<div><h3>Background</h3><div>In pro-inflammatory conditions, such as atherosclerosis, circulating monocytes may express tissue factor (TF), increasing thromboembolic risk. Regular physical activity (PA) has been shown to modulate hemostasis by reducing fibrinogen concentration and platelet activation, though its effects on coagulation are limited.</div></div><div><h3>Objectives</h3><div>We aim to evaluate the procoagulant and proinflammatory state in asymptomatic patients with atherosclerotic carotid stenosis, compared to healthy subjects and to assess the impact of a 6-month PA intervention.</div></div><div><h3>Methods</h3><div>This study included patients with asymptomatic carotid stenosis and healthy subjects. Patients were randomized into a PA group (6-month individualized PA intervention), and a control group. Blood analyses were performed to assess monocyte phenotype and TF expression by flow cytometry, and coagulation parameters using rotative thromboelastometry.</div></div><div><h3>Results</h3><div>The expression of TF on the surface of circulating monocytes was significantly higher in patients than in healthy subjects (61.9 ± 11.7 % vs 33.7 ± 6.3 %, p &lt; 0.0001), mainly explained by a higher expression on classical monocytes (77.7 ± 9.5 vs 58.3 ± 15.8 %, p &lt; 0.001). Clotting times were lower in patients than in healthy subjects in basal (407.8 77.7 ± 144.6 s vs 615.5 ± 123.4 s p &lt; 0.0001) and proinflammatory (222.4 ± 48.2 s vs 307.8 ± 82.4 s p = 0.003) conditions. A 6-month PA intervention did not induce any modulation of the monocyte phenotype or coagulation parameters of patients with atherosclerosis.</div></div><div><h3>Conclusion</h3><div>Asymptomatic patients with carotid atherosclerosis have a higher proinflammatory and procoagulant profile, suggesting a higher thromboembolic risk. However, home-based PA intervention did not improve their profiles.</div></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"20 ","pages":"Article 100219"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144748937","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":"Novel method for pulmonary embolism prognosis: Right to left ventricular volume ratio (RLVR) on pulmonary angiography (CTPA)","authors":"Aykut Yucal,&nbsp;Mustafa Burak Sayhan","doi":"10.1016/j.tru.2025.100203","DOIUrl":"10.1016/j.tru.2025.100203","url":null,"abstract":"<div><h3>Introduction</h3><div>Right ventricular dysfunction is the main cause of mortality in patients with acute massive pulmonary embolism (PE) and early diagnosis is extremely important. This study aimed to investigate whether the right/left ventricular volume ratio (RLVR) calculated using pulmonary angiography (CTPA) is a valuable tool for PE prognosis.</div></div><div><h3>Method</h3><div>Clinical, echocardiographic and pulmonary angiography data of cases diagnosed with pulmonary embolism in the emergency department between January 2021 and December 2023 were retrospectively evaluated. Patients were stratified according to the presence of massive PE, one month mortality and pulmonary embolism severity index (PESI) score. Clinical, laboratory and radiographic parameters were compared to search for prognostic factors.</div></div><div><h3>Results</h3><div>Of the 210 patients, the mean age was 67 ± 15 years, 46 % were male, and 42 % had massive PE. The right/left ventricular volume ratio was significantly higher in patients with massive PE, in those who died within one month after admission; and in patients with PESI Class III. When the cut-off value of right/left ventricular volume ratio was accepted as &gt;1.7, its predictive value for acute PE mortality was higher than other CTPA and echocardioraphy measurements (AUC = 0.706).</div></div><div><h3>Conclusion</h3><div>An increased right/left ventricular volume ratio on CTPA, a valuable tool for diagnosing right ventricular dysfunction, is associated with a worse prognosis in subjects with pulmonary thromboembolism.</div></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"19 ","pages":"Article 100203"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143680422","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":"Optimizing end of life care in cancer Patients. Focus on antithrombotic treatment","authors":"Emmanouil S. Papadakis,&nbsp;Lucy A. Norris","doi":"10.1016/j.tru.2025.100213","DOIUrl":"10.1016/j.tru.2025.100213","url":null,"abstract":"","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"19 ","pages":"Article 100213"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144297415","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":"Efficacy of oral aspirin in prevention of embolic events in infective endocarditis: A systematic review and meta analysis","authors":"Jonathan Victor Salazar-Ore ,&nbsp;Angie Carolina Alonso-Ramírez ,&nbsp;Gabriela Vanessa Flores-Monar ,&nbsp;Emily Patricia Solarte-Zabaleta ,&nbsp;Miguel Ángel Castaneda-Diaz ,&nbsp;Ada Lizandra Motino-Villanueva ,&nbsp;Anuj Manish-Kakkad ,&nbsp;Camila Sanchez-Cruz ,&nbsp;Ernesto Calderón-Martínez","doi":"10.1016/j.tru.2025.100208","DOIUrl":"10.1016/j.tru.2025.100208","url":null,"abstract":"<div><h3>Introduction</h3><div>Infective endocarditis (IE) involves inflammation of the heart's inner lining and valves, leading to complications like embolic events. The role of aspirin in preventing these events is controversial, with concerns about bleeding risk, limiting its use. This meta-analysis evaluates the effectiveness of oral aspirin in preventing embolic events and its adverse outcomes in IE patients.</div></div><div><h3>Methods</h3><div>A systematic search was conducted on July 20, 2024, across PubMed/MEDLINE, Cochrane, Scopus, Web of Science, EMBASE, and CINAHL for studies comparing aspirin to placebo or no treatment. The protocol was registered in PROSPERO (CRD42024573274).</div></div><div><h3>Results</h3><div>Five studies involving 1174 participants were included, with three eligible for meta-analysis due to data limitations. Findings on embolic event incidence were inconsistent: one randomized clinical trial (RCT) excluding prior aspirin therapy (OR 1.62, [0.68–3.86], p = 0.29) and a reanalysis examining long-term use (OR 0.80, [0.36–1.78], p = 0.582) found no significant reduction, while another study reported a possible reduction (OR 0.65, [0.43–0.98], p = 0.04). Bleeding rates trended higher in aspirin groups across two studies, though not statistically significant. Mortality data also varied; one study found higher mortality in aspirin users, while another associated chronic antiplatelet therapy with lower mortality, particularly with early initiation after admission.</div></div><div><h3>Conclusion</h3><div>Aspirin may reduce embolic events in IE, but evidence remains inconclusive due to mixed findings. Aspirin showed a non-significant increase in bleeding risk and mortality, so routine use for embolic prevention in IE is not recommended, highlighting the need for further research to clarify its potential role.</div></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"19 ","pages":"Article 100208"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144088817","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":"Antithrombin supplementation to prevent venous thromboembolism: A case of hereditary antithrombin deficiency with increased antithrombin clearance during pregnancy and peripartum","authors":"Ayako Kaneda-Takeuchi ,&nbsp;Tomoaki Oda ,&nbsp;Mei Kitamoto ,&nbsp;Emiyu Fujiwara ,&nbsp;Kenta Kawai ,&nbsp;Megumi Narumi ,&nbsp;Yoshimasa Horikoshi ,&nbsp;Masako Matsumoto ,&nbsp;Yukiko Kohmura-Kobayashi ,&nbsp;Naomi Furuta-Isomura ,&nbsp;Toshiyuki Uchida ,&nbsp;Kazunao Suzuki ,&nbsp;Naohiro Kanayama ,&nbsp;Hiroaki Itoh ,&nbsp;Naoaki Tamura","doi":"10.1016/j.tru.2025.100211","DOIUrl":"10.1016/j.tru.2025.100211","url":null,"abstract":"<div><div>Hereditary antithrombin deficiency (HATD) is an autosomal dominant disorder that significantly increases the risk of venous thromboembolism (VTE) during pregnancy. Based on our experience with three previous cases and the Japanese clinical guidelines, we manage high-risk VTE in pregnant women with HATD using unfractionated heparin (UFH) and antithrombin (AT) supplementation from early pregnancy to the peripartum period. Herein, we report another case of HATD type 1 in pregnancy and evaluate changes in AT clearance. A 29-year-old woman had a history of pulmonary embolism (PE) at 14 years and a family history of HATD with AT activity of 47 % at baseline, which decreased to 31 % when she developed PE after an abortion. During her second pregnancy, she was treated with UFH and AT concentrate (ATC) with doses increasing from 50 to 100 IU/kg to achieve target AT activity levels of 50–60 % throughout pregnancy and 70 % during delivery. She delivered a healthy male infant at 39 weeks of gestation. She started to take warfarin on postpartum day 1, with an uneventful postpartum course. AT clearance, calculated using plasma AT antigen levels, showed notable increases in the first and late third trimesters, peaking around delivery and coinciding with elevated thrombin-antithrombin complex levels. These findings suggest increased AT consumption during these periods, which may contribute to unexpected decreases in AT activity. We propose close monitoring of AT activity and providing adequate ATC supplementation alongside anticoagulation throughout pregnancy, particularly during periods of elevated AT clearance, to minimize VTE risks in HATD patients.</div></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"19 ","pages":"Article 100211"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144166909","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}