BACKGROUND:Urine albumin-to-creatinine ratio (UACR) provides a reliable method for chronic kidney disease screening in patients with type 2 diabetes, yet its use remains underutilized. METHODS:The CKD-DETECT randomized clinical trial included outpatients ≥18 years with type 2 diabetes without UACR testing in the prior 12 months and no chronic kidney disease. Physicians were randomized to receive either an alert prompting UACR testing or no alert (control). The primary outcome was the proportion of UACR orders within 90 days. The secondary outcome was new chronic kidney disease stage 3-5 diagnoses. Tertiary outcomes were referral to a nephrologist and prescription of chronic kidney disease-related medications, and post-hoc outcomes were UACR ≥10 mg/g and ≥30 mg/g. RESULTS:Overall, 400 patients (mean age 64.7 years; 51.5% female) were included. UACR was ordered in 72 (36.0%) patients in the alert group vs. 23 (11.5%) in the control group (odds ratio [OR] 5.71; 95% confidence interval [CI] 2.58-12.64; P < 0.001). New diagnoses of chronic kidney disease occurred in 1 (0.5%) patient in the alert and 2 (1.0%) in the control group (OR 0.50, 95%CI 0.04-5.53; P = 0.570). There were no referrals to nephrologists or new prescriptions of chronic kidney disease-related medications. The alert group was associated with increased identification of UACR ≥10 mg/g (21.0% vs. 8.5%; OR 3.41; 95%CI 1.37-8.48; P = 0.008) and ≥30 mg/g (9.5% vs. 4.0%; OR 3.71; 95%CI 1.36-10.12; P = 0.011). CONCLUSION:The alert-based CDS program was associated with increased UACR testing and early detection of elevated albuminuria in patients with diabetes. CLINICAL TRIAL REGISTRATION:ClinicalTrials.gov identifier, NCT05342545 (prospectively registered on April 18, 2022) FUNDING: This work was supported by a research grant from Bayer.

This post hoc analysis of the Extended-Duration Low-Intensity Apixaban to Prevent Recurrence in High-Risk Patients With Provoked Venous Thromboembolism ( HI-PRO) randomized clinical trial investigates the impact of extended low-dose apixaban on symptomatic superficial vein thrombosis events in patients with provoked venous thromboembolism and enduring risk factors.

BACKGROUND:Antiphospholipid antibodies (aPL) are associated with an increased risk of thrombosis. However, individual studies have reported conflicting findings regarding the prevalence of aPL in patients with ischemic stroke and their association with first or recurrent events. METHODS:Systematic searches of PubMed and Embase through May 13, 2025 were conducted to identify case-control, cohort, or cross-sectional studies investigating 3 questions related to aPL seropositivity (defined as positivity for either immunoglobulin G/immunoglobulin M anticardiolipin antibody, immunoglobulin G/immunoglobulin M anti-β2 glycoprotein I antibody, or a lupus anticoagulant): (1) the prevalence of aPL seropositivity among individuals with ischemic stroke; (2) the association between aPL seropositivity and the risk of first ischemic stroke; and (3) the association between aPL seropositivity and the risk of recurrent ischemic stroke. Random-effects models with inverse weighting were used to calculate pooled prevalences and odds ratios (OR) with 95% CIs. Risk of bias was assessed using the ROBINS-I tool. RESULTS:A total of 52 studies were included (40 case-control, 12 cohort). The pooled prevalence of seropositivity for any aPL among patients with ischemic stroke (51 studies, 9438 patients) was 19.1% (95% CI, 15.4%-23.0%; I2=95.8%). aPL seropositivity was associated with higher odds of first ischemic stroke (43 studies, 19 097 patients; OR, 2.93 [95% CI, 2.31-3.73]; I2=68.7%). The strongest associations were for lupus anticoagulant (OR, 6.69 [95% CI, 2.94-15.2]; I2=92.6%) and immunoglobulin G anticardiolipin antibody (OR, 2.56 [95% CI, 1.96-3.35]; I2=92.5%). The odds of recurrent ischemic stroke among patients with versus without any aPL seropositivity were not significantly different (OR, 1.20 [95% CI, 0.87-1.67]; 9 studies, 2873 patients, I2=11.4%). CONCLUSIONS:Seropositivity for any aPL was present in nearly 1-in-5 patients with ischemic stroke and was associated with increased odds of ischemic stroke at presentation.

Rule-based natural language processing (NLP) tools can identify pulmonary embolism (PE) via radiology reports. However, their external validity remains uncertain.In this cross-sectional study, 1,712 hospitalized patients (with and without PE) at Mass General Brigham (MGB) hospitals (2016-2021) were analyzed. Two previously published NLP algorithms were applied to radiology reports to identify PE. Chart review by two physicians was the reference standard. We tested three approaches: (A) NLP applied to all patients; (B) NLP limited to radiology reports of patients with principal or secondary International Classification of Diseases 10th revision (ICD-10) PE discharge codes; and (C) NLP applied to patients with PE discharge codes or a Present-on-Admission (POA) indicator ("Y") for PE. All others were assumed PE-negative in Approaches B and C to minimize NLP false positives. Weighted estimates were derived from the MGB hospitalized cohort (n = 381,642) to calculate F1 scores (as the harmonic mean of sensitivity and positive predictive value [PPV]).In Approach A, both NLP tools showed high sensitivity (82.5%, 93.0%) and specificity (98.9%, 98.7%) but low PPV (60.3%, 59.6%). Approach B improved PPV (95.2%, 94.9%) but reduced sensitivity (74.1%, 76.2%), while Approach C preserved both high sensitivity (82.5%, 93.0%) and PPV (95.6%, 95.8%). Approach C demonstrated the best performance, yielding significantly higher F1 scores for both NLP tools (88.6%, 94.4%) compared with Approach A (69.7%, 72.6%) and Approach B (83.3%, 84.5%) (P < 0.001).The accuracy of PE detection improves when rule-based NLP algorithms are operationalized using administrative claims data in addition to radiology reports.

Despite a significant number of innovations for management of acute pulmonary embolism (PE) over the past decade, PE-related mortality has not decreased as expected. Significant heterogeneity in PE presentations and limitations in contemporary risk stratification approaches are hypothesized to be important drivers of poorer than expected outcomes. Recently, artificial intelligence (AI) has gained attention in cardiovascular medicine, notably in wearable technology, electrocardiography, and cardiovascular imaging. The utility of AI has been studied in PE diagnosis and risk stratification, especially in hospitalized patients and has the potential to predict presence of PE based on electrocardiography and clinical risk factors, decrease time to diagnosis, and improve characterization of PE as acute versus chronic. However, AI systems do not appear to have better accuracy in identification of PE compared with radiologists. Additionally, whether utilization of AI in diagnosis and management of PE will improve clinician workflow and patient outcomes remains unknown. In this review, we critically appraise the literature on AI-based strategies to diagnose and refine risk stratification of acute PE and discuss how integration of AI may move the field of PE forward with the universal goal of improving short- and long-term PE-related outcomes.

Background: Rule-based natural language processing (NLP) tools are easy to implement and can identify pulmonary embolism (PE) via radiology reports, but their accuracy is limited when used in isolation, and their external validity remains uncertain. Methods: In this cross-sectional study, we analyzed data from a prespecified sample of 1,712 hospitalized patients (with and without PE) at Mass General Brigham (MGB) hospitals (2016–2021) and applied two previously published NLP algorithms (Verma et al. and Johnson et al) to radiology reports to identify PE. Chart review by two independent physicians using pre-specified criteria was the reference standard. We tested three approaches: (A) NLP applied to all patients; (B) NLP limited to patients with primary or secondary International Classification of Diseases (ICD)-10 PE discharge codes; and (C) NLP applied to patients with PE discharge codes or a Present-on-Admission (POA) indicator (“Y” or “N”) for PE. All others were assumed PE-negative in Approaches B and C to minimize false positives with NLP. Weighted estimates were derived from the full MGB hospitalized cohort (n=381,642) to calculate F1 scores that summarize model performance by combining sensitivity and positive predictive value (PPV) [F1 = 2 x (PPV x sensitivity)/ (PPV + sensitivity)]. Results: In total, 7,708 (2.0%) patients had PE. In Approach A, both NLP models showed high sensitivity (82.5%, 93.0%) and specificity (98.9%, 98.7%) but low PPV (60.3%, 59.6%) (Figure). Approach B improved PPV (95.2%, 94.9%) at the cost of reduced sensitivity (74.1%, 76.2%), while Approach C preserved both high sensitivity (82.5%, 93.0%) and PPV (95.6%, 95.8%). Approach C demonstrated the best performance, yielding significantly higher F1 scores for both NLP models (88.6%, 94.4%) compared with Approach A (69.7%, 72.6%) and Approach B (83.3%, 84.5%) (P<0.001). Conclusions: The accuracy of PE detection improves when rule-based NLP models are operationalized within a screening framework using administrative claims data in addition to radiology reports.

Background: Emerging evidence suggests that antiphospholipid antibodies (aPL) may be associated with an increased cardiovascular risk beyond the thrombotic antiphospholipid syndrome (APS). Among patients with ischemic stroke, the clinical significance of single positive aPL remains ill-defined. We aimed to assess the prevalence of aPL seropositivity in patients with stroke and the association between aPL seropositivity and stroke risk. Methods: This analysis is part of a larger project with PROSPERO ID CRD420251047305. We conducted a systematic search of PubMed and Embase on 5/13/2025 to identify cohort or case-control studies of unselected adult patients (without APS) investigating the association between aPL seropositivity and acute ischemic stroke compared with non-stroke controls. Positivity for aPL was defined as a single positive measurement for lupus anticoagulant in clot-based assays, IgM/IgG anti-β2-glycoprotein I antibody, or IgM/IgG anticardiolipin antibody at the time of stroke. Random-effects models with inverse weights were utilized to calculate pooled odds ratios (OR) with 95% confidence intervals (CIs). Results: Among 3,241 unique records, 43 studies (39 case-control and 4 cohort studies) were included representing a total of 6,374 patients (mean age 59.0 years, 51.1% men). The pooled prevalence of aPL seropositivity among patients with ischemic stroke was 18.1% (95% CI 17.2%-19.0%) (Figure, Panel A). Patients with ischemic stroke, compared with non-stroke controls, had a higher odds for seropositivity for aPL (OR: 2.94, 95% CI 2.31-3.74, I 2 =69%) (Figure, Panel B). In sensitivity analysis following removal of outlier studies, similar findings were demonstrated with overall improvement in model heterogeneity (OR: 2.58, 95% CI, 2.21-3.02, I 2 =20%). Conclusion: In this analysis, seropositivity for aPL were present in nearly one in five patients with ischemic stroke, significantly more than in the general population, and were associated with an increased odds of stroke. Whether seropositivity for aPL at a single time point is a causal risk factor for stroke warrants further investigation in future prospective studies.

Background Patients with COVID‐19 are at risk of thrombotic and cardiovascular complications. Existing risk estimates derive from early COVID‐19 experiences. More recent event rates, temporal trends, and the association between vaccination status and cardiovascular outcomes remain unclear. Methods The CORONA‐VTE Network (COVID‐19 Registry to Assess Frequency, Risk Factors, Management, and Outcomes of Arterial and Venous Thromboembolic Complications) multicenter registry included patients with COVID‐19 from March 2020 to February 2024. A composite of venous and arterial thrombotic events and a composite of adjudicated cardiovascular events were assessed at 90 days after COVID‐19 diagnosis. Time‐to‐first‐event analyses were stratified by inpatients and outpatients and adjusted for competing risks. Outcomes were adjudicated by independent physicians. Results Of 11 165 patients, 4451 were inpatients (mean age, 65 years; 47% women) and 462 of 4451 were admitted to the intensive care unit. Among inpatients, the 90‐day cumulative incidences of thrombotic and cardiovascular events were 8.9% (95% CI, 8.0%–9.8%) and 15.6% (95% CI, 14.5%–16.7%), respectively. Corresponding estimates for patients in the intensive care unit were 20.0% (95% CI, 16.6%–24.0%) and 30.7% (95% CI, 26.8%–35.3%), while event rates were low among outpatients. There was an initial decline in cardiovascular events (adjusted hazard ratio [HR], 0.84; P=0.001) after the first COVID‐19 wave, with a subsequent catch‐up, with no significant linear change in cardiovascular events (adjusted Ptrend=0.634). Vaccination was associated with a reduced risk of cardiovascular events (adjusted HR, 0.75 [95% CI, 0.62–0.92]; P=0.005). Conclusions Thrombotic and cardiovascular events are common in hospitalized patients with COVID‐19, especially those in the intensive care unit, without a persistent decline over time. COVID‐19 vaccination was associated with a reduced risk of cardiovascular events.

COVID-19 is associated with an increased risk of venous thromboembolism (VTE) in hospitalized patients. Although prior studies have attempted to identify predictors of VTE, restricted sample size and use of administrative claims data have limited such analyses. We utilized data from hospitalized patients in the CORONA-VTE Network, a United States multicenter registry of adult patients with PCR-confirmed COVID-19 (N = 3,844). The primary outcome was time-to-first event for a composite of adjudicated pulmonary embolism or deep vein thrombosis during 90-day follow-up. The candidate variables were selected by a priori clinical consensus. We conducted cause-specific Cox regression analysis adjusted for the selected variables for each imputed dataset and pooled the estimated HRs for reporting (p < 0.05 for significance). VTE occurred in 206 patients, with a cumulative incidence of 5.3

Background: Although antiphospholipid antibodies (aPL) are classically associated with excess risk of thrombosis in antiphospholipid syndrome (APS), emerging data suggest that aPLs may confer a prognostic role in patients with cardiovascular conditions who do not fulfill traditional research criteria for APS. We aimed to investigate the prevalence of aPL seropositivity among patients with peripheral artery disease (PAD) and to assess outcomes among those with and without aPL. Methods: In this study, as part of a larger project (PROSPERO ID CRD420251047305), we systematically searched PubMed and Embase through 3/11/2025 to determine the pooled prevalence of aPL seropositivity among patients with PAD. Despite variation in PAD severity across studies, aPL testing occurred in unselected individuals (rather than by clinical suspicion). aPL positivity was defined as at least one single positive measurement for either anticardiolipin, anti-β2 glycoprotein, or lupus anticoagulant. For studies with longitudinal data available, we assessed a composite outcome of subsequent arterial thrombosis, revascularization failure, amputations, and death stratified by aPL seropositivity. Random-effects models with inverse weights were used to calculate pooled odds ratios (ORs). Results: Among 2,890 records, we identified 31 studies assessing aPL prevalence and 11 evaluating clinical outcomes (3,364 total patients, mean age 58.6 years, 62.3% men). Seropositivity for at least one aPL was observed in 21.1% of patients with PAD (95% CI, 19.7%-22.5%). aPL seropositivity was associated with a significantly higher odds of the primary outcome (OR: 2.49, 95% CI 1.48-4.18) (Figure). Among patients who underwent revascularization, aPL seropositivity was associated with a higher odds of a failed revascularization procedure (OR: 2.72, 95% CI 1.49-4.98). Conclusion: aPL seropositivity is present in approximately one-in-five patients with PAD and correlates with a subsequent risk of adverse clinical events. Whether early testing can help inform management strategies and improve outcomes requires further investigation.

BACKGROUND:The appropriate duration of anticoagulation for venous thromboembolism (VTE) in patients who have a transient provoking factor (e.g., surgery, trauma, or immobility) and concomitant enduring risk factors is uncertain. METHODS:In this single-center, double-blind, randomized trial, adults with VTE after the occurrence of a transient provoking factor who had at least one enduring risk factor and had completed at least 3 months of anticoagulation were assigned to receive oral apixaban (at a dose of 2.5 mg twice daily) or placebo for 12 months. The primary efficacy outcome was the first symptomatic recurrent VTE. The primary safety outcome was the first episode of major bleeding according to the criteria of the International Society on Thrombosis and Hemostasis. RESULTS:A total of 600 patients underwent randomization (mean age, 59.5 years; female sex, 57.0%; non-White race, 19.2%). The trial population had a broad range of provoking factors and enduring risk factors. Symptomatic recurrent VTE occurred in 4 of the 300 patients (1.3%) in the apixaban group and in 30 of the 300 patients (10.0%) in the placebo group (hazard ratio, 0.13; 95% confidence interval [CI], 0.04 to 0.36; P<0.001). Major bleeding occurred in 1 patient in the apixaban group and none in the placebo group. Clinically relevant nonmajor bleeding was observed in 14 of 294 patients (4.8%) in the apixaban group and in 5 of 294 patients (1.7%) in the placebo group (hazard ratio, 2.68; 95% CI, 0.96 to 7.43; P = 0.06). One patient in the apixaban group and 3 patients in the placebo group died, with no deaths attributed to cardiovascular or hemorrhagic causes. Nonhemorrhagic, nonfatal adverse events occurred in 6 patients (2.0%) in each group. CONCLUSIONS:Among patients with provoked VTE and enduring risk factors, low-intensity therapy with apixaban for 12 months resulted in a lower risk of symptomatic recurrent VTE than placebo, with a low risk of major bleeding. (Funded by Bristol-Myers Squibb-Pfizer Alliance; HI-PRO ClinicalTrials.gov number, NCT04168203.).