Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis最新文献

{"title":"Subclinical Cardiac Diseases and the Role of Extracellular Vesicles in Patients with Hemophilia A Treated on-Demand.","authors":"Yanan Zong, Maren Maanja, Todd T Schlegel, Martin Ugander, Jovan Antovic, Apostolos Taxiarchis, Roza Chaireti, Xiangdong Kong","doi":"10.1177/10760296261432444","DOIUrl":"10.1177/10760296261432444","url":null,"abstract":"<p><p>IntroductionPatients with hemophilia A (HA) can reach normal life expectancy and suffer from coronary artery disease (CAD). The study evaluates the likelihood of subclinical CAD evaluated by advanced electrocardiography (A-ECG), global hemostasis and extracellular vesicles (EVs) in Chinese patients with HA treated on-demand.Materials and MethodsPatients with HA (n = 42) and age-matched male controls (n = 37) were included. The likelihood of having CAD was evaluated by A-ECG. Fibrin formation and fibrinolysis were assessed by the overall hemostatic potential (OHP) assay. EVs derived from platelets (PEVs), endothelial cells (EEVs) and leukocytes (LEVs), and expressing phosphatidylserine (PS + EVs), tissue factor (TF + EVs) or P-selectin (CD62P + EVs) were measured by flow cytometry.ResultsThe likelihood of CAD evaluated by A-ECG did not differ between patients and controls. Fibrin formation and clot stability were significantly impaired in patients. Patients had higher PEVs and CD62P + EVs. CD62P + EVs counts were inversely correlated with OHP, velocity and clot lysis time. Subclinical CAD did not correlate with OHP or EVs.ConclusionControls and patients with HA treated on-demand exhibited no differences in A-ECG, but varied in fibrin formation and clot stability. Larger studies are required to explore the significance of this finding in the context of CAD risk in this population.</p>","PeriodicalId":520590,"journal":{"name":"Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis","volume":"32 ","pages":"10760296261432444"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12972547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147380448","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":"Research Trends and Hotspots of Collateral Circulation in Acute Ischemic Stroke: A Bibliometric Analysis.","authors":"Pian Wang, Yangmei Chen","doi":"10.1177/10760296251414425","DOIUrl":"10.1177/10760296251414425","url":null,"abstract":"<p><p>IntroductionCollateral circulation is a critical determinant of outcomes in acute ischemic stroke (AIS). This bibliometric analysis evaluates research trends and future directions on this topic.MethodsA systematic search was conducted in the Web of Science Core Collection to identify publications on AIS and collateral circulation between 1981 and 2025. Bibliometric analysis and visualization were performed using VOSviewer, CiteSpace, and the R package \"bibliometric.\"ResultsThe analysis included 482 publications. China was the most productive countries, leading in publication volume (642). The University of California System emerged as top contributing institutions. <i>Stroke</i> was the most influential journals in terms of H-index (33), TP (53), and TC (3796). David S. Liebeskind and Gregory W. Albers were identified as leading authors. Keyword co-occurrence and cluster analysis revealed four main thematic areas: imaging and diagnostic assessment, treatment strategies, prognosis and outcome prediction, and pathophysiological mechanisms and hemodynamics. In addition, burst keyword analysis showed that terms like \"large vessel occlusion\", \"score\", \"management\", and \"endovascular thrombectomy\" remained active through 2025.ConclusionResearch on collateral circulation in AIS has evolved from exploring basic mechanisms to focusing on clinical applications. The current landscape integrates imaging-based collateral assessment with treatment decisions and prognosis to guide precise endovascular therapy. Future research will likely concentrate on collateral-guided precision treatment, imaging scores, and strategies for extending the therapeutic window. This study provides a comprehensive overview and valuable insights for researchers.</p>","PeriodicalId":520590,"journal":{"name":"Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis","volume":"32 ","pages":"10760296251414425"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13187395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147978589","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":"Derivation and Validation of a Genotype- Guided Warfarin Dosing Model in a Mixed Arab Population.","authors":"Amr M Fahmi, Ahmed El Bardissy, Mohamed Omar Saad, Islam Eljilany, Loulia Bader, Hazem Elewa","doi":"10.1177/10760296261439536","DOIUrl":"10.1177/10760296261439536","url":null,"abstract":"<p><p>BackgroundPrevious studies demonstrated the superiority of a genotype-guided warfarin dosing (GWD) method for warfarin initiation. International GWD models such as Gage et al model were validated in diverse populations but Arab patients were not well represented in these studies.ObjectiveTo derive and validate a GWD model in an Arab population and compare the outcomes to Gage et al model.MethodsIn this cross-sectional study, DNA was collected through saliva kits from a cohort of recruited Arab patients on warfarin<i>.</i> Clinical factors and demographics were recorded and genotyping for <i>VKORC1 (-1639G</i> <i>></i> <i>A)</i>, <i>CYP2C9*2</i>, <i>CYP2C9*3</i> and <i>CYP4F2*3</i> was performed. Subjects were randomly divided to derivation and validation cohorts. Simple and Multiple linear regression analyses were used to identify factors associated with warfarin dose and derive a warfarin dosing model. The warfarin dose was also calculated using Gage et al model. Accuracy of the 2 models were compared through the mean absolute error (MAE) and percentage of predicted warfarin doses within 20% of the actual warfarin doseResultsThe Arab cohort included 405 patients. In the derivation cohort (n = 270), multiple regression analysis showed a dosing model consisting of <i>VKORC1 (-1639G</i> <i>></i> <i>A)</i>, <i>CYP2C9*2</i> & <i>CYP2C9*3</i> genotypes, along with other clinical factors (R² = 51.6%) (P < 0.05). When compared to Gage et al model, the Arab model had a significantly lower MAE of weekly warfarin dose (9.3 ± 7.6 mg/week vs 12.4 ± 10.4 mg/week, <i>p</i> = 0.03)ConclusionA model derived and validated in an Arab population had better prediction accuracy compared to an internationally validated one.</p>","PeriodicalId":520590,"journal":{"name":"Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis","volume":"32 ","pages":"10760296261439536"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13250413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148207559","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":"Standard Modifiable Cardiovascular Risk Factors and Prognostic Outcomes in Non-Valvular Atrial Fibrillation Patients on Oral Anticoagulants.","authors":"Linhao Liu, Hangkuan Liu, Pengfei Sun, Geru Aa, Yuanyuan Liu, Zhiqiang Zhang, Qing Yang, Xin Zhou","doi":"10.1177/10760296261442055","DOIUrl":"10.1177/10760296261442055","url":null,"abstract":"<p><p>BackgroundStandard Modifiable Cardiovascular Risk Factors (SMurfs) influence Atrial fibrillation (AF). However, data on their cumulative prognostic effect in Asian non-valvular AF (NVAF) patients receiving oral anticoagulants (OACs) remain limited. This study investigated the association between the cumulative burden of SMurfs and the prognosis of these NVAF patients on oral anticoagulation (OAC) therapy.MethodsThis retrospective cohort study used Tianjin Health and Medical Data Platform (THMDP) data on 20 782 NVAF patients on OACs between 2015 and 2020. Patients were categorized into groups by the number of baseline SMurfs (0, 1-2, or 3-4: hypertension, diabetes, hyperlipidemia, smoking). Cox proportional hazards models assessed the association between SMurf burden group and the primary outcome (all-cause mortality) and secondary outcomes. Subgroup and sensitivity analyses were performed to evaluate the consistency and robustness of the findings.ResultsAfter adjusting for confounders, compared to the SMurf-less group, the hazard ratios (HRs) for all-cause mortality were 1.20 (95% confidence interval [CI]: 1.01-1.44) for the SMurf (1-2) group and 1.67 (95% CI: 1.33-2.08) for the SMurf (3-4) group. For ischemic stroke, the hazard ratio (HR) was 1.44 (95% CI: 1.03-1.99) for the SMurf (3-4) group, while the association was not significant for the SMurf (1-2) group. A more pronounced association between SMurfs and all-cause mortality was observed in patients with an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m².ConclusionIn Asian NVAF patients receiving OACs, a higher SMurf burden is significantly associated with an increased risk of all-cause mortality and ischemic stroke.</p>","PeriodicalId":520590,"journal":{"name":"Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis","volume":"32 ","pages":"10760296261442055"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13058181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147629748","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":"D-Dimer Variability Predicts Venous Thromboembolism in Postoperative Fracture Patients: A Single-Center Retrospective Cohort Study.","authors":"Xin-Miao Chen, Hui Huang, Fen-Hua Jin, Hui-Ying Li, Sheng-Qiao Shi, Xiao-Dong Xia","doi":"10.1177/10760296261468952","DOIUrl":"10.1177/10760296261468952","url":null,"abstract":"<p><p>BackgroundVenous thromboembolism (VTE) is a potentially life-threatening complication following traumatic fractures. Although plasma D-dimer is widely used as a biomarker of coagulation and fibrinolysis, its utility as a standalone predictor of postoperative VTE remains limited due to poor specificity. This study aimed to investigate whether D-dimer variability is a more accurate predictor of VTE compared to D-dimer alone.MethodsDemographic data, fracture classification, and D-dimer levels were collected. D-dimer variability was defined as the ratio of postoperative D-dimer to preoperative D-dimer. Duplex ultrasonography was used to evaluate DVT in the lower extremities, while computed tomography pulmonary angiography was conducted for patients suspected of having pulmonary thromboembolism (PTE).ResultsA total of 77,609 traumatic fracture patients without VTE [median age: 53.00 (44.00, 61.00) years] and 2,813 patients with VTE [median age: 66.00 (58.00, 75.00) years] were included. Among VTE cases, 36 sustained upper limb or craniofacial fractures, 522 spinal fractures, 269 pelvic fractures, 1265 lower limb fractures, and 721 compound or other fractures. Specifically, 2743 patients developed lower extremity VTE, and 70 suffered from PTE. Postoperative D-dimer variability was significantly higher in patients with VTE (2.30 [1.57, 3.43]) than in those without VTE (1.33 [0.77, 2.15]). At a D-dimer variability cutoff of 2.0, the sensitivity and specificity were 83.44% and 88.60%, respectively. Multivariate analysis identified age > 60 years, female sex, and lower extremity fractures as independent VTE risk factors.ConclusionsThe D-dimer variability is strongly correlated with VTE in postoperative traumatic fracture patients. D-dimer variability ≥2.0 may identify a subgroup of postoperative fracture patients at elevated VTE risk. It serves as a useful predictor of VTE, particularly in elderly patients, females, and those with lower extremity fractures.</p>","PeriodicalId":520590,"journal":{"name":"Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis","volume":"32 ","pages":"10760296261468952"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13385585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521731","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":"Direct Oral Anticoagulants for Portal Vein Thrombosis in Cirrhosis: From Pharmacology to Clinical Practice.","authors":"Khalid M Al Naamani, Sundus Rizwan, Siham Al Sinani, Bader Al Rawahi, Sheikha AlMa'mari, Mohamed El-Kassas","doi":"10.1177/10760296261420229","DOIUrl":"10.1177/10760296261420229","url":null,"abstract":"<p><p>BackgroundHemostasis in cirrhosis is a dynamic, \"rebalanced\" state rather than a simple bleeding diathesis. Portal vein thrombosis (PVT) is a frequent complication linked to variceal bleeding, hepatic decompensation, and mortality. Anticoagulation can prevent thrombus progression, promote recanalization, and improve survival without a major increase in bleeding risk.ObjectivesTo summarize the safety, efficacy, and pharmacologic considerations of direct oral anticoagulants (DOACs) for PVT in cirrhosis.MethodsThis narrative review is informed by a systematic literature search (Ovid Medline, Ovid EMBASE, Cochrane Central, Cochrane Database of Systematic Reviews, and Scopus) from 2010 to 17 July 2025. We included cohort, interventional, and meta-analytic studies evaluating DOACs in adults with cirrhosis and PVT, and synthesized these with pharmacokinetic data and international guidance.ResultsFixed-dose oral DOACs, with generally favorable safety profiles, are promising alternatives to vitamin K antagonists (VKAs) and low-molecular-weight heparins. Regulatory guidance supports DOAC use in Child-Turcotte-Pugh (CTP) class A, recommends cautious use in selected CTP class B patients, and generally discourages use in CTP class C. Apixaban and edoxaban show relatively stable pharmacokinetics in compensated cirrhosis. Observational cohorts and network meta-analyses suggest that DOACs achieve at least comparable, and often higher, rates of portal vein recanalization than VKAs, with similar risks of major and variceal bleeding.ConclusionsOverall, DOACs represent an effective and convenient anticoagulation option for carefully selected cirrhotic patients with PVT. Treatment should be individualized according to liver and renal function, variceal status, and transplant candidacy. High-quality prospective studies are still needed, particularly in CTP classes B/C cirrhosis.</p>","PeriodicalId":520590,"journal":{"name":"Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis","volume":"32 ","pages":"10760296261420229"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12868593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146115403","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":"Should <i>JAK2</i> V617F Mutation Testing be Inducted into Routine Thrombophilia Screening?","authors":"Stephen E Langabeer","doi":"10.1177/10760296261422766","DOIUrl":"10.1177/10760296261422766","url":null,"abstract":"","PeriodicalId":520590,"journal":{"name":"Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis","volume":"32 ","pages":"10760296261422766"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12873071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121780","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":"Early Prophylactic-Dose Thromboprophylaxis and 30-Day Mortality in Solid Tumor Patients Hospitalized for COVID-19: A Multicenter Retrospective Cohort Study.","authors":"Linlin Yang, Jie Chen, Yanfang Zhang, Xiaoting Wang, Ziqi Ye","doi":"10.1177/10760296261488613","DOIUrl":"10.1177/10760296261488613","url":null,"abstract":"<p><p>ObjectivePatients with solid tumors are at increased risk of venous thromboembolism (VTE), and COVID-19 infection may further enhance thrombotic risk. Although prophylactic-dose thromboprophylaxis is recommended for hospitalized patients with COVID-19 when bleeding risk is acceptable, its clinical impact among patients with solid tumors remains uncertain.MethodsWe conducted a multicenter retrospective cohort study across three tertiary hospitals in China from December 2022 to January 2023. Adult patients with solid tumors hospitalized for laboratory-confirmed COVID-19 were included. Patients receiving prophylactic-dose thromboprophylaxis within 24 hours of admission were classified as the early cohort, whereas those initiating prophylaxis after 24 hours or receiving no prophylaxis were classified as the non-early cohort. The primary outcome was 30-day mortality. Secondary outcomes included thrombotic events, bleeding events, and 60-day mortality. Multivariable Cox regression, inverse probability of treatment weighting (IPTW) analyses, multiple imputation, and sensitivity analyses were performed.ResultsAmong 431 patients, 86 were classified into the early cohort and 345 into the non-early cohort. Early prophylactic-dose thromboprophylaxis was not significantly associated with 30-day mortality (adjusted HR=1.468, 95% CI 0.840-2.567, P=0.173) or 60-day mortality (adjusted HR=1.386, 95% CI 0.798-2.408, P=0.241). IPTW-adjusted analyses and sensitivity analyses yielded consistent results. No significant associations were observed between early thromboprophylaxis and thrombotic or bleeding events.ConclusionsIn this multicenter cohort of patients with solid tumors hospitalized for COVID-19, early prophylactic-dose thromboprophylaxis was not clearly associated with improved 30-day or 60-day mortality. Further prospective studies are needed to identify patients who may benefit from optimized thromboprophylaxis strategies.</p>","PeriodicalId":520590,"journal":{"name":"Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis","volume":"32 ","pages":"10760296261488613"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922532","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":"Genetically Predicted Muscle Mass and Function in Relation to Deep Vein Thrombosis: A Two-step Mendelian Randomization Study Highlighting the Mediating Role of BMI.","authors":"Qixiang Sun, Yiming Hu, Zhenyong Yang, Shutao Tan, Jamol Uzokov, Azad Hussain, Chen Chen, Yun Li, Jian Zhang, Yanshuo Han","doi":"10.1177/10760296261488557","DOIUrl":"10.1177/10760296261488557","url":null,"abstract":"<p><p>BackgroundSarcopenia is observationally linked to venous thromboembolism, but the causal architecture and underlying biological pathways remain largely unclear. This study investigated the causal effects of sarcopenia-related traits on lower extremity deep vein thrombosis (DVT) and quantified potential mediating mechanisms.MethodsWe performed two-sample bidirectional Mendelian randomization (MR) and two-step mediation MR using large-scale GWAS data from UK Biobank, EMBL-EBI, and FinnGen. Exposures included appendicular lean mass (ALM), leg fat-free mass (LFM), hand grip strength, and walking pace. Eighteen candidate mediators were screened for indirect pathways.ResultsGenetically predicted higher ALM was significantly associated with increased DVT risk (FinnGen: OR = 1.288, 95% CI: 1.215-1.365, P < 0.001). Similar positive associations were observed for LFM (OR = 1.920-1.954, P < 0.001). By contrast, muscle functional traits - grip strength and walking pace - demonstrated no consistent causal effects. Reverse MR confirmed a unidirectional relationship. Body mass index (BMI) emerged as a pivotal mediator, accounting for 7.58% - 10.50% of the ALM-DVT effect and 52.74% - 62.73% of the LFM-DVT effect. Notably, the independent effect of ALM was largely attenuated after adjusting for metabolic confounders in multivariable MR.ConclusionGenetic predisposition to high muscle mass, rather than functional strength, increases DVT risk. This relationship appears to be significantly driven by metabolic adiposity, suggesting that the \"muscle-vascular-coagulation\" interaction is partly explained by body-size-related metabolic burden. Risk stratification should integrate muscle mass evaluation with comprehensive metabolic health assessments.</p>","PeriodicalId":520590,"journal":{"name":"Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis","volume":"32 ","pages":"10760296261488557"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148932432","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":"Clinical Significance of Time in Therapeutic Range (TTR) During Unfractionated Heparin Therapy in Non-ST-Segment Elevation Myocardial Infarction.","authors":"Tal Golani, Louay Taha, Mohammad Karmi, Abed Qadan, Akiva Brin, Noam Fink, Pierre Sabouret, Mamas A Mamas, Amjad Abu-Salman, Eyal Ben-Zvi, Ari Naimark, Motaz Amro, Mony Shuvy, Asher Schnur, Michael Glikson, Elad Asher","doi":"10.1177/10760296261493181","DOIUrl":"https://doi.org/10.1177/10760296261493181","url":null,"abstract":"<p><p>BackgroundUnfractionated heparin (UFH) is widely used in non-ST-segment elevation myocardial infarction (NSTEMI), but its narrow therapeutic window requires frequent activated partial thromboplastin time (aPTT) monitoring. Data on time in therapeutic range (TTR) in this setting are scarce.MethodsWe analyzed 1,553 consecutive patients with NSTEMI treated with UFH in a tertiary care intensive cardiovascular care unit between July 2019 and December 2025. TTR was calculated by linear interpolation over 72 hours. Associations with complications and 30-day and 1-year mortality were assessed.ResultsAmong them (mean age 67.1 ± 13.8 years, 73.9% male), only 325 (20.9%) reached the therapeutic range. Mean TTR was 12.5 ± 20.2%. An early invasive strategy predominated: 85.5% underwent coronary angiography, approximately 89% of them within 24 hours (mean time to angiography 14.4 ± 10.1 hours). Therapeutic-range attainment was not associated with mortality at 30 days (4.6% vs 4.0%, p=0.614) or 1 year (8.6% vs 9.3%, p=0.710), even after multivariable adjustment (adjusted OR 1.30, 95% CI 0.70-2.40 and 0.98, 95% CI 0.62-1.55, respectively). It was also not associated with in-hospital complications, including re-infarction, stroke, stent thrombosis, or bleeding.ConclusionsTherapeutic aPTT was achieved infrequently, and neither therapeutic-range attainment nor TTR was associated with clinical outcomes. These findings suggest that, using a contemporary approach to NSTEMI with a short time to angiography in the great majority of cases, TTR does not represent an optimal marker of anticoagulation quality, warranting evaluation of alternative strategies. Given the low event rate, confirmation in larger, adequately powered studies is required.</p>","PeriodicalId":520590,"journal":{"name":"Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis","volume":"32 ","pages":"10760296261493181"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070925","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}