Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis最新文献

{"title":"Heavy menstrual bleeding with direct oral anticoagulants and vitamin K antagonists: a systematic review and meta-analysis.","authors":"Stephanie Quon, Lok In Josephine Ma, Peter Tsang","doi":"10.1097/MBC.0000000000001463","DOIUrl":"https://doi.org/10.1097/MBC.0000000000001463","url":null,"abstract":"<p><p>Heavy menstrual bleeding (HMB) is a clinically important but underrecognized complication of oral anticoagulation that can impair quality of life, cause of iron deficiency or anaemia, and lead to treatment interruption. We conducted a systematic review and meta-analysis to compare menstrual bleeding outcomes among direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs). MEDLINE, Embase, Scopus, and Cochrane CENTRAL were searched from inception through February 2026. Random-effects meta-analyses pooled odds ratios (ORs) with 95% confidence intervals (CIs) for HMB, anticoagulant modification, treatment for menstrual bleeding, and hospitalization, transfusion, or procedural intervention. Twenty-five studies published from 2015 to 2025 were included; most were observational. Compared with apixaban, rivaroxaban was associated with higher odds of HMB [odds ratio (OR) 2.83, 95% confidence interval (CI) 2.11-3.81; I2 = 0%] and anticoagulant modification because of menstrual bleeding (OR 6.05, 95% CI 1.91-19.19; I2 = 0%). Hospitalization, transfusion, or procedural intervention did not differ significantly (OR 1.04, 95% CI 0.10-11.13). Compared with VKAs, rivaroxaban was associated with greater odds of requiring treatment for menstrual bleeding (OR 4.01, 95% CI 1.88-8.54), whereas estimates for HMB and anticoagulant modification were imprecise and nonsignificant. Pooled DOAC-VKA comparisons for HMB were inconclusive. Menstrual bleeding risk appears to vary by individual anticoagulant rather than uniformly across the DOAC class. Proactive assessment of menstrual symptoms and iron deficiency, and patient-centred anticoagulant selection, are warranted, particularly for patients with preexisting HMB or anaemia.</p>","PeriodicalId":520571,"journal":{"name":"Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149221223","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":"Correlation of clinico-hematological and biochemical features with quality of life in hemophilia patients.","authors":"May AlMoshary, Ebtisam Bakhsh, Nahid Abdulhamid Qushmaq, Ekremah A Alzarea, Ezeldine K Abdalhabib, Saeed H Halawani","doi":"10.1097/MBC.0000000000001454","DOIUrl":"10.1097/MBC.0000000000001454","url":null,"abstract":"<p><p>Hemophilia is an inherited bleeding disorder associated with substantial physical, emotional, and social challenges. This study evaluated the association of disease severity, bleeding frequency, and laboratory parameters with quality of life (QoL) among patients with hemophilia. A cross-sectional study was conducted among patients with hemophilia attending Cluster 2 Hospitals, Jeddah, Saudi Arabia. Clinical, haematological, and biochemical data were collected, and QoL was assessed using the 36-Item Short Form Health Survey (SF-36). Pearson's correlation, one-way analysis of variance, and multivariable logistic regression were performed. Patients with severe hemophilia demonstrated significantly lower physical functioning (35.58 vs. 55.92; P  = 0.039) and emotional well being scores (48.59 vs. 61.32; P  = 0.031) than those with mild disease. Recurrent joint bleeding (≥2 episodes within 6 months) independently predicted impaired QoL (AOR = 5.2; P  < 0.001), while severe disease was also a significant predictor (AOR = 4.1; P  = 0.001). Age was negatively correlated with QoL ( r  = -0.48; P  < 0.001). Serum ferritin showed a weak negative association ( r  = -0.27; P  = 0.003), whereas INR correlated positively with QoL ( r  = 0.44; P  < 0.001). Disease severity, recurrent bleeding, and advancing age are major determinants of reduced QoL in hemophilia. These findings support individualized prophylactic and multidisciplinary management strategies to improve patient outcomes.</p>","PeriodicalId":520571,"journal":{"name":"Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis","volume":" ","pages":"323-328"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148709427","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":"Acquired hemophilia: insights from a multicenter real-life study in a middle-income country.","authors":"Fernando Chuliber, Analía Sánchez-Luceros, María Lucila Romero, Cristina Duboscq, Marta Martinuzzo, Luis Beligoy, Manuela Clavijo, Augusto Pintos Marquez, Susana Garbiero, Mirta Arias, María Del Carmen Gallo, Mariana Del Castillo, Amalia Bonacina, Daniel Villalba, Ana Juarez Avignone, Jorge Jerez, Dolores Puente, Virginia Castoldi, Andrea Lo Turco, Juan Maradei, Haydee Bernard, Alejandra Baques, Diana Penchasky","doi":"10.1097/MBC.0000000000001459","DOIUrl":"10.1097/MBC.0000000000001459","url":null,"abstract":"<p><strong>Background: </strong>Acquired hemophilia A (AHA) is a rare hemorrhagic disease with scarce published information from developing countries.</p><p><strong>Objectives: </strong>The main objective was to describe the clinical manifestation and treatment, as well as laboratory characteristics of patients with AHA.</p><p><strong>Patients/methods: </strong>We conducted a multicenter retrospective cohort study that included consecutive adult patients with AHA between 1999 and 2020 from Argentine hospitals. A comparison was made between the group achieving complete remission and the nonremission group. Logistic regression analysis was conducted to assess factors associated with death.</p><p><strong>Results: </strong>The study included 68 patients. Nineteen hospitals from 11 cities were involved. The median follow-up was 12.5 months [interquartile range (IQR) 4-36]. Sixty-six patients (97%) had spontaneous bleeding at diagnosis (66% major bleeding). The median inhibitor titer was 27 (IQR 13-98) Bethesda units/ml (BU/ml). Hemostatic therapy was employed in 52 cases (67% utilized bypassing agents). The most used therapy was corticosteroids plus cyclophosphamide (40%). Complete remission was achieved in 45 patients (66%), with a median of 6 weeks (IQR 3-12). No differences were found in achieving complete remission with FVIII or inhibitor titer, nor in therapies. Nineteen patients died (28%). Eleven of the deaths were related to AHA or their treatments. The main cause of death was bleeding ( n  = 8). Seven out of eight deaths due to bleeding occurred within 72 h.</p><p><strong>Conclusion: </strong>We present the most extensive AHA study in Latin America. Unlike studies from other regions, we found a high rate of bleeding-related deaths. It may be necessary to improve early suspicion and diagnosis and enhance therapeutic management in our area.</p>","PeriodicalId":520571,"journal":{"name":"Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis","volume":" ","pages":"341-348"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148877239","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":"BCR::ABL1 analysis is not indicated in the thrombophilia work-up of patients with splanchnic vein thrombosis.","authors":"Stephen E Langabeer","doi":"10.1097/MBC.0000000000001448","DOIUrl":"https://doi.org/10.1097/MBC.0000000000001448","url":null,"abstract":"","PeriodicalId":520571,"journal":{"name":"Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis","volume":"37 7","pages":"382"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140304","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":"Upregulation of coagulation pathway and enhanced platelet activity in hypoxia-exposed rat blood.","authors":"Wenqi Zhao, Lan Feng, Erlong Zhang, Zhiqi Gao, Jian Chen","doi":"10.1097/MBC.0000000000001449","DOIUrl":"10.1097/MBC.0000000000001449","url":null,"abstract":"<p><p>To investigate the effects of chronic hypoxia on platelet characteristics and overall coagulation function, and to elucidate the mechanisms underlying high-altitude-induced blood system disorders. Rats were exposed to chronic hypoxic conditions. Platelet counts were measured using routine blood analysis. Plasma levels of platelet activation markers (P-selectin and sCD40L) were quantified by ELISA. A label-free quantitative proteomic approach was employed to identify alterations in the platelet coagulation cascade proteome, with key findings validated by western blotting. Coagulation function was assessed via prothrombin time (PT) and thromboelastography (TEG). Chronic hypoxia resulted in a significant decrease in platelet count compared with controls. This was accompanied by a significant increase in plasma markers of platelet activation, P-selectin, and sCD40L ( P  < 0.05). Proteomic analysis revealed substantial alterations in the expression of coagulation-related proteins in platelets. These changes were confirmed by western blot, which showed significant upregulation of key coagulation factors, including F2, F9, F10, and F12. Consistent with these molecular changes, functional assays demonstrated a significant prolongation of PT and a marked reduction in overall coagulation function as measured by TEG, evidenced by a prolonged R-time and decreased α-angle and maximum amplitude values. Chronic hypoxia induces a state of platelet activation and thrombocytopenia but, paradoxically, leads to an overall net reduction in coagulation function. This dysfunction is linked to significant alterations in the expression of multiple coagulation factors within platelets, suggesting a complex regulatory mechanism beyond simple platelet counts that may contribute to the bleeding diathesis observed in high-altitude environments.</p>","PeriodicalId":520571,"journal":{"name":"Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis","volume":" ","pages":"308-313"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148724450","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":"Clinical outcomes of peripartum fibrinogen replacement plus tranexamic acid in congenital hypofibrinogenemia: a single-centre case series of eight pregnancies.","authors":"Jing Tian, Tianying Zhu, Terence T Lao, Min Xie, Yunping Wu, Runmei Ma","doi":"10.1097/MBC.0000000000001458","DOIUrl":"10.1097/MBC.0000000000001458","url":null,"abstract":"<p><p>Pregnancy in congenital hypofibrinogenemia is rare and hemorrhage-prone, with no reported use of tranexamic acid (TXA). We retrospectively reviewed eight pregnancies in six women (2015-2025). One intrauterine fetal death occurred. Seven live births were complicated by preterm membrane rupture, placental abruption, and postpartum hemorrhage (PPH; 4/8). All received peripartum fibrinogen replacement; seven also received intravenous TXA (1-3 g). Despite predelivery fibrinogen <0.8-1.89 g/l, no major maternal bleeding occurred. All neonates had low fibrinogen but remained asymptomatic and healthy at discharge. Despite prior asymptomatic status, pregnancies are frequently complicated, yet neonatal outcomes remain favorable. In this small single-center observational cohort, combined peripartum fibrinogen substitution plus intravenous TXA (1-3 g) was well tolerated without maternal venous thromboembolism, even among patients with predelivery fibrinogen levels <1.0 g/l. This descriptive case series provides preliminary safety data for this rare obstetric population in TXA.</p>","PeriodicalId":520571,"journal":{"name":"Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis","volume":" ","pages":"359-365"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835895","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":"Glycoprotein 1bM assay and von Willebrand disease: a change in diagnosis.","authors":"David Lazris, Craig Seaman","doi":"10.1097/MBC.0000000000001457","DOIUrl":"10.1097/MBC.0000000000001457","url":null,"abstract":"<p><p>The diagnosis of von Willebrand disease (VWD) is complicated by limitations of traditional laboratory tests, such as the VWF ristocetin cofactor (VWF:RCo) assay. Newer assays, such as the VWF glycoprotein 1bM (VWF:GP1bM) assay, are more reliable and not affected by the D1472H polymorphism; thus, current hematology societal guidelines recommend these newer assays for diagnosing VWD. This study aims to perform a descriptive analysis of the impact of the VWF:GP1bM assay on the diagnosis of VWD among previously diagnosed patients at the Hemophilia Center of Western Pennsylvania. This retrospective chart review included patients with a historical diagnosis of VWD, in part based on VWF:RCo activity, VWF:GP1bM activity performed separate from and subsequent to the historical diagnosis of VWD, and 18 years of age at the time of data abstraction. The primary outcome was a change in historical VWF:RCo assay-based diagnosis to an alternative current VWF:GP1bM assay-based diagnosis. This study analyzed 138 patients with a mean age of 36.7 years. The mean VWF:RCo activity, 0.56 IU/ml, was lower than the mean VWF:GP1bM activity, 0.73 IU/ml, P  < 0.001. The VWF:GP1bM assay led to a change in diagnosis in 42.8% of patients, including 26.1% of patients with no bleeding disorder. The presence of the D1472H polymorphism was associated with 10.6 greater odds, P  < 0.01, of a change in diagnosis. The use of the VWF:GP1bM assay may improve the ability to accurately diagnose VWD, prompting a change in diagnosis and emphasizing the assay's critical role in optimizing patient care.</p>","PeriodicalId":520571,"journal":{"name":"Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis","volume":" ","pages":"336-340"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835857","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":"Describing the clinical outcomes and treatment landscape for male haemophilia A and B patients in a real-world setting across Europe and the United States.","authors":"Sheena Thakkar, Lisa J Wilcox, Valeria Merla, Anna Kane, Rabiyah Sahar, Chris Blazos, Sophie Lai, Ella Morton, Kieran Wynne-Cattanach, Nathan Ball","doi":"10.1097/MBC.0000000000001447","DOIUrl":"10.1097/MBC.0000000000001447","url":null,"abstract":"<p><p>Haemophilia A and haemophilia B are rare bleeding disorders characterized by prolonged bleeding episodes, bruising, and spontaneous bleeds. As the treatment landscape evolves, real-world data are essential to assess disease management practices. This study aimed to describe clinical outcomes for haemophilia A and haemophilia B patients in a real-world setting. Data were drawn from the Adelphi Haemophilia Disease Specific Programme (DSP), a cross-sectional survey of physicians and their patients conducted in France, Germany, Italy, Spain, the United Kingdom, and the United States between February 2020 and May 2021. Physicians provided data on patient demographics, clinical characteristics, bleed history, and treatment patterns. Analyses were descriptive. Overall, 75 physicians reported data for 739 patients with haemophilia A and 131 patients with haemophilia B, with a mean [standard deviation (SD)] age of 27 (14.9) and 25.5 (15.8) years. At data collection, the most common treatment received by haemophilia A patients was emicizumab (40%), while for haemophilia B, this was extended half-life factor (55%). Since switching to their current prophylactic treatment, 48% of haemophilia A patients and 54% of haemophilia B patients had experienced one or more episodes of breakthrough bleeding. Of these patients, the most common bleed type experienced in the 12 months prior to data collection was joint bleeds (53% of haemophilia A patients and 57% of haemophilia B patients). These findings highlight that despite prophylactic treatment, breakthrough bleeding, particularly within the joints, remains common, emphasizing the need for more effective therapeutic strategies.</p>","PeriodicalId":520571,"journal":{"name":"Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis","volume":" ","pages":"297-307"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148709444","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":"Indwelling inferior vena cava filter as a persistent thrombotic risk factor: recurrent venous thromboembolism after anticoagulation withdrawal.","authors":"Eva Szabóová, Jan Matĕjka, Lucia Dekanová, Marek Hudák, Tomáš Molnár","doi":"10.1097/MBC.0000000000001451","DOIUrl":"10.1097/MBC.0000000000001451","url":null,"abstract":"<p><p>The use of inferior vena cava (IVC) filter is associated with long-term complications, including recurrent venous thromboembolism (VTE), particularly when filters remain indwelling. Current guidelines recommend the use of retrievable filters with removal whenever feasible. However, there is limited guidance regarding long-term anticoagulation management in patients with indwelling filters. We report the case of a 68-year-old man with an indwelling IVC filter, who developed a pulmonary embolism (PE) 3 months after completing 6 years anticoagulation for femoropopliteal deep vein thrombosis (DVT). During treatment for DVT, he had a prophylactic placement of retrievable IVC filter for a femur fracture with a high perioperative risk for VTE. Filter removal was unsuccessful. Three months after switching to extended thromboprophylaxis with sulodexide, and following a prolonged journey, he developed recurrent DVT and PE. Anticoagulation was restarted. This case highlights the potential prothrombotic role of indwelling IVC filters and the uncertainty regarding optimal anticoagulation strategies.</p>","PeriodicalId":520571,"journal":{"name":"Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis","volume":" ","pages":"352-355"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148709411","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":"Effect of heparin on immunological heparin-induced thrombocytopenia-IgG chemiluminescence testing.","authors":"Ronny Vong, Leonardo Pasalic, Dea Donikian, Timothy Brighton, Emmanuel J Favaloro","doi":"10.1097/MBC.0000000000001456","DOIUrl":"10.1097/MBC.0000000000001456","url":null,"abstract":"<p><p>Heparin-induced thrombocytopenia (HIT) requires clinical evaluation and laboratory testing using immunological assays with confirmation by functional assays such as serotonin release assay (SRA). The HIT-IgG chemiluminescence immunoassay (CLIA) is a rapid immunological assay; we aimed to assess the effect of heparin on this assay. The effect of low-dose (0.1 U/ml) and high-dose (100 U/ml) heparin on the CLIA HIT-IgG assay was evaluated, these concentrations aligning to those used for SRA. A cohort of available pretested patient material (plasma or serum) comprised samples negative for HIT-IgG (i.e., <1.0 U/ml) (n = 22), or positive for HIT-IgG (i.e., ≥1.0 U/ml) ( n  = 25), with the latter split into 'low positive' (1.0-<10 U/ml; n  = 16) and 'high positive' (≥10 U/ml; n  = 9). Low-dose heparin, used for initiating serotonin release in SRA, had no appreciable effect on the CLIA HIT-IgG assay for any HIT-IgG group. High-dose heparin, used for inhibiting serotonin release in SRA, had a variable effect on HIT-IgG testing, generally reducing detected HIT-IgG levels in high positive samples, and mostly reducing detected HIT-IgG levels in low positive samples. However, some samples from negative and low positive groups showed counterintuitive increases in HIT-IgG signal. Heparin levels may influence HIT-IgG test values in various ways. Although high positive samples showed an expected decrease in signal with high-dose heparin, some low positive and negative samples showed unexpected increases in signal. Whether these findings improve identification of pathological HIT, or of variable HIT subtypes, requires further investigation.</p>","PeriodicalId":520571,"journal":{"name":"Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis","volume":" ","pages":"329-335"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805073","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}