Dabigatran is widely used for stroke prevention in atrial fibrillation (AF), but concerns remain regarding its effectiveness in patients with Class III obesity ( BMI ≥40 kg/m2.) We evaluated the association between dabigatran use in patients with AF and ischaemic stroke (IS) or transient ischaemic attack (TIA) across body mass index (BMI) categories in a multiethnic New Zealand population. In this retrospective nested case–control study, cases with incident IS/TIA were identified from the fifth Auckland Regional Community Stroke Study (1st September 2020-31st August 2021), and event-free controls were randomly selected from the National Minimum Dataset. Multivariable logistic regression was used to estimate adjusted odds ratios (aORs) for IS/TIA, and effect modification by BMI catergory (< 30, 30–39.9, ≥40 kg/m2) was assessed using an interaction term. Among 1,854 patients with AF (295 cases, 1,559 controls), dabigatran use was associated with lower odds of IS/TIA (adjusted odds ratio [aOR] 0.50, 95
Evidence for rivaroxaban during the early postoperative period after surgical bioprosthetic valve replacement remains limited, particularly in Asian patients receiving low-dose rivaroxaban. We compared the effectiveness and safety of low-dose rivaroxaban versus dose-adjusted warfarin within the initial 3 months after surgery. In this single-center retrospective cohort study, we included consecutive adults who underwent surgical bioprosthetic valve replacement between August 2021 and December 2023 and received postoperative oral anticoagulation with low-dose rivaroxaban (15 or 10 mg once daily) or warfarin. Propensity score matching was used as the primary analysis, and inverse probability of treatment weighting was performed as a sensitivity analysis. The primary effectiveness outcome was thromboembolic events; the primary safety outcome was clinically relevant bleeding. Time-to-event outcomes were analyzed using Cox proportional hazards models, and absolute risk differences were reported descriptively. A total of 367 patients were included (178 rivaroxaban, 189 warfarin). After 1:1 PSM, 125 pairs were analyzed. During the 3-month follow-up, thromboembolic events occurred in 1/125 patients (0.8
Hip hemiarthroplasty for femoral neck fractures is often associated with substantial perioperative blood loss and transfusion requirements. Tranexamic acid (TXA) may reduce bleeding, but concerns remain regarding thromboembolic safety. This systematic review and meta-analysis evaluated the efficacy and safety of TXA in hip hemiarthroplasty. PubMed, Embase, and Cochrane were searched from inception to February 2026. Randomized controlled trials and cohort studies comparing TXA with no TXA or no TXA in patients undergoing hip hemiarthroplasty were included. Random-effects meta-analyses were performed to pool risk ratios (RRs) and mean differences (MDs), with subgroup and sensitivity analyses conducted to assess the robustness of the findings. The primary outcome was total blood loss. Secondary outcomes included postoperative haemoglobin, transfusion requirement, mortality, thromboembolic events, surgical site infection, stroke MI and length of hospital stay. Although total blood loss was the pre-specified primary outcome, transfusion requirement was also evaluated as an important secondary outcome because of its direct clinical relevance. Fourteen studies comprising 7,660 patients (3,271 TXA and 4,389 controls) were included. TXA significantly reduced allogeneic transfusion requirements (RR 0.48, 95
Venous thromboembolism (VTE) remains a leading preventable cause of death among cancer patients in the United States. Despite advances in thromboprophylaxis and clinical guideline development, nationally representative longitudinal data on VTE-related mortality trends in this population remain limited. Using CDC WONDER multiple-cause-of-death records (1999–2024), we identified VTE-related deaths (ICD-10: I26, I80–I82) among US adults aged ≥ 25 years with a concurrent cancer diagnosis (C00–C97). Age-adjusted mortality rates (AAMRs) per 100,000 persons and average annual percent changes (AAPCs) with 95
Left ventricular thrombus (LVT) can occur in patients after acute myocardial infarction (AMI) and carries significant embolic risk. Leveraging imaging tools that can guide the early and accurate diagnosis of LVT and appropriate use of anti-thrombotic therapy can mitigate the risk of embolic events. This study aims to evaluate the utility of common imaging modalities for the diagnosis of LVT in post-AMI patients. Several databases (Medline, Embase and Cochrane Library) were searched until May 2025 for studies reporting on the comparative diagnostic performance of imaging modalities for LVT in post-AMI patients. Fourteen studies were identified for inclusion. Compared to delayed enhancement cardiac magnetic resonance imaging (DE-CMRI), transthoracic echocardiography (TTE) with or without contrast and cine-CMRI all had high specificity and contrast TTE had the highest sensitivity for LVT detection. A strategy to identify high-risk patients who would benefit from further imaging with CMRI to identify LVT should be considered for patients whose TTE is inconclusive. Graphical abstract of the study, detailing the study background, methods and key findings. This graphic was created in https://BioRender.com. Abbreviations: LVT – left ventricular thrombus; AMI – acute myocardial infarction; DE-CMRI – delayed enhancement-cardiac magnetic resonance imaging; TTE – transthoracic echocardiography.
Anti-amyloid monoclonal antibodies such as lecanemab are increasingly used to treat Alzheimer’s disease (AD) and are associated with amyloid-related imaging abnormalities (ARIA), including hemorrhagic findings (ARIA-H). Whether anti-amyloid therapy is associated with systemic alterations in coagulation function is unknown. We sought to evaluate systemic coagulation function in patients receiving lecanemab compared with untreated AD controls. We prospectively collected blood samples from 20 lecanemab-treated participants with AD at baseline and after 8–10 weeks of therapy, and from 48 untreated AD controls. We assessed thrombin generation in platelet-poor plasma initiated with tissue factor and measured lag time, time to peak, peak thrombin, velocity, and area under the curve. We also evaluated fibrin formation by turbidity assays, yielding maximum rate of clot formation and time to Vmax. Comparisons were performed between groups and within treated participants over time. Mean age was 72.8 years (SD 8.1); 51.5
Patients with multiple myeloma receiving immunomodulatory drugs have an increased risk of venous thromboembolism (VTE), but the comparative effectiveness and safety of available prophylactic strategies remain uncertain. A systematic review and meta-analysis of randomized and prospective studies was conducted in accordance with PRISMA 2020. Studies evaluating aspirin, low-molecular-weight heparin (LMWH), warfarin, direct oral anticoagulants (DOACs), or no prophylaxis in patients receiving immunomodulatory therapy were included. Primary outcomes were symptomatic VTE and major bleeding. Twelve studies (n=2,435; 25 arm-level observations) were included. Descriptive pooled VTE incidence was 2.2
Accurate anatomical assessment of coronary lesions is fundamental to effective percutaneous coronary intervention (PCI). Conventional two-dimensional quantitative coronary angiography (2D-QCA) is limited by projection dependency, vessel overlap, and foreshortening, leading to imprecise estimation of lesion severity. Three-dimensional quantitative coronary angiography (3D-QCA), based on 3D reconstruction, provides more accurate vessel assessment than 2D analysis; however, its reported advantages remain inconsistent across studies. We conducted a systematic review and meta-analysis in accordance with PRISMA and Cochrane guidelines. PubMed, Embase, Scopus, and Cochrane Central were searched from inception to October 2025 for studies comparing 3D-QCA with 2D-QCA using validated software. Random-effects models pooled standardized mean differences (SMDs) with 95
Sarcopenia, the age-related loss of muscle mass and quality, is an indicator of frailty that can be objectively measured using computed tomography (CT) images acquired for other routine indications. CT-based muscle mass has been shown to predict adverse outcomes in many diseases, although evidence in acute pulmonary embolism (PE) is scant. A retrospective cohort study included patients ≥ 70 years diagnosed with acute PE between 2015 and 2019. Axial CT images at the carina and mid-thigh were used to measure chest muscle area (CMA), thigh muscle area (TMA), and thigh intramuscular fat area (TFMA) using semi-automated segmentation tools. Outcomes included 30-day mortality or unplanned emergency department (ED) revisit, hospital length of stay, disposition, and mortality at last follow-up. Logistic and Cox regression models were adjusted for the Pulmonary Embolism Severity Index (PESI). The cohort consisted of 205 patients (mean age 80 years; 63
Aneurysmal subarachnoid hemorrhage (aSAH) represents one of the acute neurological conditions associated with the highest morbidity and mortality, often complicated by early rebleeding in the hyperacute phase. Tranexamic acid (TXA), an antifibrinolytic agent, has been proposed to reduce the risk of rebleeding; however, its impact on outcomes in patients admitted early (≤ 72 h) remains unclear. The authors searched PubMed, Embase, Web of Science, and Cochrane for randomized controlled trials evaluating TXA use among aSAH patients admitted early to the hospital (≤ 72 h). The authors performed a traditional frequentist and Bayesian meta-analyses with informative priors for heterogeneity. Additionally, studies were stratified by whether they used a long-term or short-term TXA protocol. After a comprehensive search, 6 randomized trials were included in this review. Bayesian meta-analysis showed a significant reduction of rebleeding events (RR 0.59; 95
Intracranial atherosclerotic stenosis (ICAS) and cerebral small vessel disease (CSVD) frequently co-exist and contribute to poor stroke outcomes. Whether distinct pathophysiological mechanisms mediate large-vessel versus small-vessel disease effects on stroke outcomes, and whether these are modifiable by thrombolysis, remains unknown. In this prospective cohort study, acute ischemic stroke patients with ICAS and/or CSVD were enrolled. ICAS was defined as ≥ 50
Left atrial appendage closure (LAAC) is increasingly used in patients with non-valvular atrial fibrillation (NVAF) who are at high risk of bleeding. However, the optimal post-procedural antithrombotic strategy remains uncertain. This meta-analysis compares the efficacy and safety of direct oral anticoagulants (DOACs) versus dual antiplatelet therapy (DAPT) following LAAC. A systematic review and meta-analysis were conducted according to PRISMA and Cochrane guidelines. PubMed, Embase, and Cochrane were searched from inception to November 2025 for randomized controlled trials and cohort studies comparing DOACs with DAPT after LAAC in NVAF patients. Outcomes included all-cause mortality, cardiac mortality, stroke, major bleeding, device-related thrombosis (DRT), and thromboembolic events. Pooled risk ratios (RRs) with 95
Splanchnic vein thrombosis (SVT) is an uncommon but clinically significant complication of myeloproliferative neoplasms (MPNs), contributing to morbidity and management complexity. Evidence regarding prognostic factors and optimal anticoagulation strategies remains limited. We aimed to evaluate the clinical characteristics, risk factors, treatment strategies, and survival outcomes in patients with SVT associated with MPNs. In this multicenter retrospective cohort study, 289 adult patients with SVT associated with MPNs were analyzed. The median age at SVT diagnosis was 49 years, with 74
Hypercoagulability and platelet activation are central components of COVID-19 pathophysiology. However, despite growing evidence that sex-related biological differences may influence thromboinflammatory responses, studies focusing on sex-based genetic variations in coagulation and platelet indices remain limited. This study includes 324 COVID-19 patients, investigated the sex-specific effects of FGB − 455 G > A (rs1800790) and ITGB3 T1565C (rs5918) polymorphisms. Genotypes were determined using TaqMan-based real-time PCR, and patients were stratified by sex; demographic, hematological, and biochemical data were retrieved and analyzed statistically. The GA genotype of FGB rs1800790 was more frequent in females than males, whereas the TC genotype of ITGB3 (rs5918) was less frequent in females (OR = 1.71, 95
Transcatheter aortic valve replacement (TAVR) has extended its use to low-surgical-risk populations, yet long-term comparative data against surgical aortic valve replacement (SAVR) are still limited, particularly concerning durability and the need for reintervention. We conducted a search of PubMed/MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov through March 2026 for randomized trials comparing TAVR with SAVR in patients with low surgical risk and severe aortic stenosis, specifically those with at least three years of follow-up. Outcomes were pooled as risk ratios (RR) using Mantel-Haenszel random-effects models, and durability and mortality outcomes were analyzed as time-to-event hazard ratios (HR) to accommodate different follow-up durations. Prespecified subgroup analyses by valve platform were performed. Four trials involving 3,014 patients (follow-up ranging from 3 to 10 years) were included. Cardiovascular mortality (HR 1.11, 95
The optimal timing of oral anticoagulation (OAC) initiation after transcatheter aortic valve replacement (TAVR) in patients with atrial fibrillation remains uncertain. This study compared early (within 2 days) versus delayed (5–7 days) OAC initiation on clinical outcomes in this population. In this retrospective cohort study using the TriNetX US Collaborative Network (data through 2024), we identified patients aged ≥ 18 years with atrial fibrillation or flutter undergoing TAVR via percutaneous femoral approach. Patients were categorized by OAC initiation timing post-TAVR. The index date was the TAVR procedure day; outcomes were assessed at 30 days, 90 days, and 1 year. Analyses used risk ratios (RRs), hazard ratios (HRs), Kaplan–Meier curves, and log-rank tests. After 1:1 propensity score matching, 3,372 patients remained in each cohort. Early OAC was associated with lower net adverse clinical events (NACE; all-cause mortality, stroke, arterial embolism or thrombosis, or major hemorrhage including transfusion) at 30 days (RR 0.754, 95
Severe sepsis-associated thrombocytopenia creates a difficult clinical trade-off between thrombosis prevention and bleeding risk, yet evidence to guide pharmacological prophylaxis when platelet counts are 30,000–50,000/µL remains limited. We conducted a target trial emulation using the MIMIC-IV database, classifying eligible adults with sepsis upon first intensive care unit admission based on whether a predominantly unfractionated heparin (UFH)-based prophylaxis strategy was administered within a 24-hour grace period after platelet counts initially entered this range. Among 938 eligible patients (189 prophylaxis strategy, 749 control strategy), venous thromboembolism (VTE) occurred in 14 and 86 patients, respectively. In the inverse probability-weighted Cox analysis, early administration of this UFH-based prophylaxis was associated with a lower 28-day VTE hazard (adjusted hazard ratio 0.51, 95
Sodium bicarbonate has recently emerged as an alternative additive to purge flow in microaxial blood pumps, offering local antithrombotic effects. However, the systemic effects of additive bicarbonate on coagulation remain incompletely defined. Here, we examined the effect of sodium bicarbonate at varying concentrations (10− 2–10− 5M) on select coagulation parameters to define systemic versus local effects. Fresh human whole blood from healthy adults (N ≥ 4 per assay) was incubated with sodium bicarbonate over a range of concentrations (10− 5-10− 2M). Coagulation and thrombus formation was assessed via whole blood clotting time (WBCT), activated partial thromboplastin time (aPTT), prothrombin time (PT), rotational thromboelastometry (ROTEM) and total thrombus analysis (T-TAS). Sodium bicarbonate at concentrations 10− 3M or less, did not induce significant changes in WBCT, aPTT, PT, ROTEM clot stiffness, or thrombus formation. Notably, at higher bicarbonate concentrations (10− 2M) WBCT was delayed (2.5 ± 0.5 min; p = 0.02), aPTT showed a moderate delay (3.9 ± 2.2 s; p > 0.05), ROTEM revealed increased clot stiffness at 10 min (1.7 ± 0.3 mm; p = 0.004) with high concentrations (10− 2 M) and a moderate decrease in thrombus formation (33.5 ± 21.9Kpa∙min; p > 0.05). Sodium bicarbonate, at concentrations encountered during intravenous (IV) use or expected systemic dilution during Impella purge use, was not associated with statistically significant alterations in global coagulation or platelet thrombosis in this in vitro study. Supraphysiologic levels, consistent with via intra-device purge flow in the device microenvironment, produced measurable but mild changes to clotting time and stiffness. These findings underscore the safety and lack of confounding effect of low dose systemic bicarbonate on systemic coagulation, while supporting mechanisms of local device-based antithrombotic efficacy.
Thrombocytopenia is a defining and prognostically relevant feature of dengue virus infection, yet its mechanistic basis remains incompletely resolved. Classical models have emphasized immune-mediated platelet destruction or transient bone marrow suppression as independent causes of platelet loss. Increasing evidence, however, suggests that these explanations fail to capture the depth, persistence, and severity-dependent amplification of thrombocytopenia, which appears to arise from a coordinated failure of immune-haematopoietic homeostasis driven by viral perturbation of host immune and metabolic networks. To define this framework, a meta-analysis of two independent whole-blood transcriptomic datasets (GSE18090 and GSE51808), integrating patient-derived gene expression signatures with systematic synthesis of 37 mechanistic studies was performed. Across cohorts, dengue infection was characterized by robust activation of innate antiviral and interferon driven programs alongside reproducible repression of megakaryocyte and platelet biogenesis pathways. These transcriptional changes were not restricted to terminal platelet genes but extended to mitochondrial translation, ribosomal assembly, and cytoskeletal regulators essential for effective megakaryocyte maturation. Network integration revealed that dengue viral proteins, particularly non-structural protein 1 (NS1), act as upstream immune perturbators that couple innate immune sensing to endothelial disruption, metabolic reprogramming and accelerated platelet clearance. Together, these findings reposition dengue-associated thrombocytopenia as an emergent systems-level immunopathology rather than a singular consequence of platelet destruction. The integrated immune haematopoietic network framework explains severity dependent platelet loss through convergent defects in platelet production, functional integrity, and survival, and provides platelet homeostasis during dengue infection.
Rivaroxaban dosing for nonvalvular atrial fibrillation (NVAF) is based on Cockcroft–Gault creatinine clearance using actual body weight (CG-CrCl-ABW) per FDA labeling. Recent recommendations support utilizing the race-free CKD-EPI 2021 equation for estimating kidney function. However, it is unknown whether substituting estimated glomerular filtration rate (eGFR) for CG-CrCl-ABW would alter dosing recommendations. The purpose of this study was to evaluate differences in rivaroxaban dosing when renal function is estimated using CG-CrCl-ABW versus CKD-EPI 2021. This retrospective statewide cohort study included adults (≥ 18 years) with NVAF identified from the Michigan Anticoagulation Quality Improvement Initiative registry. The primary outcome was rivaroxaban dosing disagreements, defined as a difference in dose between CG-CrCl-ABW and CKD-EPI 2021 with body surface area (BSA) adjustment using the Du Bois formula. Agreement between methods was assessed using Cohen’s kappa. A total of 476 NVAF patients were included. The mean age was 69.7 years, weight was 95.6 kg and serum creatinine was 0.96 mg/dL. Dosing disagreement occurred in 4.8
