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Abstract Introduction Idiopathic retroperitoneal fibrosis (IRPF) is a rare fibro‐inflammatory disease characterized by fibrous sclerosis of the retroperitoneal area and may be accompanied by other autoimmune diseases. Herein, we report an unusual case of IRPF with compression of retroperitoneal vessels, then diagnosed with antiphospholipid syndrome (APS), evidenced by multiple venous thrombosis and persistent positivity of antiphospholipid antibodies (aPLs). Along with literature reviews, we highlighted the importance of screening for all possible causes in case of thrombosis secondary to IRPF. Case Description A 46‐year‐old male patient was admitted in 2010 due to hypogastralgia and low back pain. The initial laboratory findings showed elevated inflammatory indicators, but negative results of immunology screening. Abdominal computed tomography (CT) revealed diffuse soft tissue in the retroperitoneal area. IRPF was first diagnosed and initially treated with glucocorticoids and immunosuppressants. Along the process of tapering the drugs, IRPF relapsed again. Reexamination of CT scan showed newly developed thrombus in the retroperitoneal vessels. APLs were evaluated and persistently positive with the interval of six months. The diagnosis of APS was confirmed. Glucocorticoids and immunosuppressants were prescribed again accompanied with warfarin. During 17‐month follow‐up periods, there was no relapse of symptoms again. Conclusion When IRPF is accompanied by venous thrombosis, in addition to blood flow stasis due to venous compression, other potential causes of thrombophilia should also be considered.

Abstract Aims We aim to assess the risk of thrombus‐associated events (TAE) in patients with heart failure (HF) without atrial fibrillation (AF) and develop an effective scoring system for a risk stratification model. Methods and results This retrospective study included 450 patients (median age 64.0 years, interquartile range [55.0, 75.0]; 31.6% women) hospitalized for HF without AF and atrial flutter, but with a left ventricular ejection fraction (LVEF) ≤ 55% and New York Heart Association (NYHA) functional class of III–IV. A median follow‐up of 47 months was conducted. In the present study, TAE during follow‐up was independently associated with both all‐cause death [hazard ratio (HR) 1.756, 95% confidence interval (CI) 1.324–2.328, P

Abstract Antiphospholipid syndrome (APS), cryoglobulinemia, and monoclonal gammopathies are variably accompanied by thrombotic complications. We describe a patient with recurrent skin microvascular thrombosis, APS, cryoglobulinemia, marginal zone lymphoma, and IgMκ monoclonal gammopathy, responsive to chemoimmunotherapy. The cryoglobulin fraction contained the IgMκ paraprotein, while antiphospholipid antibodies (aPL) were predominantly in the cryosupernatant. A retrospective analysis of aPL‐positive patients in our institution showed that 8.1% co‐expressed monoclonal gammopathy. These overlap patients had thrombotic complications and most had recurrences. Patients with multiple gammopathies of thrombotic significance may have several autoantibodies and constitute a high‐risk group.

Introduction Transplant renal vein thrombosis is a serious post‐transplant complication. We report a case in which a thrombus was found in the transplant renal vein and rescued the transplanted kidney utilizing interventional radiology. Case presentation A 56‐year‐old woman underwent ABO‐compatible living donor renal transplantation due to impaired renal function caused by IgA nephropathy. On postoperative Day 13, there was a finding on transplant renal echocardiography that appeared to be an interruption of peripheral renal blood flow in diastole. Contrast‐enhanced computed tomography revealed that the vein was occluded due to the hematoma, and thrombosis was observed within, and distal contrast showed regurgitation into the collateral vessels. The stenosis was breached and balloon dilation restored progressive blood flow through interventional radiology. Conclusion Although open surgical thrombectomy is mainly considered for treatment for transplant renal vein thrombosis, interventional radiology might be the alternative treatment option.

Abstract Atherosclerotic plaque rupture mainly contributes to acute coronary syndrome (ACS). Insufficient repair of these plaques leads to thrombosis and subsequent ACS. Central to this process is the modulation of vascular smooth muscle cells (VSMCs) phenotypes, emphasizing their pivotal role in atherosclerotic plaque stability and healing post‐disruption. Here, an expansion of FSP1+ cells in a tandem stenosis (TS) model of atherosclerotic mice is unveiled, predominantly originating from VSMCs through single‐cell RNA sequencing (scRNA‐seq) analyses and VSMC lineage tracing studies. Further investigation identified TEA domain transcription factor 1 (TEAD1) as the key transcription factor driving the trans‐differentiation of VSMCs into fibroblast‐like cells. In vivo experiments using a TS model of plaque rupture demonstrated that TEAD1 played a crucial role in promoting plaque stability and healing post‐rupture through pharmacological or TEAD1‐AAV treatments. Mechanistically, it is found that TEAD1 promoted the expression of fibroblast markers through the Wnt4/β‐Catenin pathway, facilitating the trans‐differentiation. Thus, this study illustrated that TEAD1 played a critical role in promoting the trans‐differentiation of VSMCs into fibroblast‐like cells and subsequent extracellular matrix production through the Wnt4/β‐Catenin pathway. Consequently, this process enhanced the healing mechanisms following plaque rupture, elucidating potential therapeutic avenues for managing atherosclerotic instability.

ABSTRACT Background Thromboembolic events are a common cause of morbidity and mortality in patients with cancer. While direct‐acting oral anticoagulants (DOACs) have been established as the preferred agents of anticoagulation in most patients with cancer, data in resource‐limited settings is limited. Aims The study aims to assess the comparative efficacy and safety of warfarin and rivaroxaban for cancer‐associated thrombosis (CAT) in a resource‐limited setting. Methods and results A single‐center retrospective cohort study was conducted on 201 patients who were on follow‐up from September 2021 to August 2023. The patients were categorized into two groups (1) warfarin and (2) rivaroxaban. They were then retrospectively followed for 12 months. The primary endpoint was a composite of recurrence of venous thromboembolism (VTE), major bleeding event, or all‐cause mortality. The Cox regression model was used to compare the outcome of the two groups. The baseline mean (standard deviation) age of the patients was 48.4 (15.0) and 140 (69.7%) of them were female. 41.3% of the participants had one or more comorbidities, and the most common types of cancer were gynecologic (28.9%), hematologic (21.4%), and intra‐abdominal (16.9%). The most common type of thrombosis was deep vein thrombosis (DVT) (77.1%). The primary composite outcome of VTE recurrence, major bleeding event, and all‐cause mortality occurred in 25 (24.3%) patients in the warfarin group and 11 (11.2%) in the rivaroxaban group (hazard ratio (HR), 0.48; 95% confidence interval (CI), 0.24–0.97; p = 0.041). Conclusion Rivaroxaban was found to be more efficacious and safer than warfarin for patients with CAT in a resource‐limited setting. This finding is congruent with reports from resource‐abundant countries and recommendations from major international societies.

Abstract Objectives To assess the impact of a positive history of venous thromboembolism (VTE) on perioperative outcomes, including length of in‐hospital stay, readmission rates, 90‐day postoperative complications, and healthcare costs in bladder cancer (BCa) patients undergoing transurethral resection of bladder tumour (TURBT) in the United States. Patients and Methods Patients aged ≥18 years with a BCa diagnosis undergoing TURBT were identified in the Merative® Marketscan® Research de‐identified databases between 2007 and 2021. Multivariable logistic regression adjusted by relevant perioperative confounders was used to investigate the association between diagnosis of VTE before TURBT and 90‐day complication rates, new postoperative VTE events, re‐hospitalization, and total hospital expenditures (2021 US dollars). Sensitivity analyses on VTE severity (pulmonary embolism [PE], deep venous thrombosis [DVT] or superficial thrombophlebitis/phlebitis [SVT]), as well as TURBT extent (minor vs. major) were additionally examined. Results In total, 139 800 patients were identified, with 5.3% having preoperative VTE, including DVT (n = 3112, 42.20%), PE (n = 2046, 27.74%) and SVT (n = 2217, 30.06%). A history of preoperative VTE predicted higher rates of any complication (adjusted odds ratio [aOR] 1.28, 95% CI 1.14–1.43) and also higher rates of infectious and haemorrhagic complications. Additionally, preoperative VTE increased the risk of novel VTE events following TURBT (aOR 17.30, 95% CI 16.05–18.65), hospital length of stay (aOR 2.23, 95% CI 1.90–2.62), readmissions (aOR 1.47, 95% CI 1.39–1.56), and hospital associated costs (aOR 1.17, 95% CI 1.12–1.23). DVT and non‐minor TURBT procedures did not increase the risk of any, infectious, or haemorrhagic complications, but other associations were maintained regardless of the severity of VTE (PE, DVT, SVT) or TURBT extent (minor/major). Conclusions A history of VTE before undergoing transurethral procedures for BCa is associated with significantly worse perioperative outcomes and higher healthcare costs. These findings may help us to counsel on the risks of the intervention and hopefully improve our ability to mitigate such risks.

ABSTRACT Many dietary supplements commonly used by bodybuilders and athletes carry thrombogenic risks, potentially leading to life‐threatening conditions like arterial and venous thrombosis by either elevating testosterone levels or directly interfering with homeostasis. Increased awareness and further research are crucial for consumer safety and supplement regulation.

ABSTRACT Cerebrovascular thrombosis is among the most critical medical conditions, making early diagnosis and management crucial. Although some symptoms of cerebrovascular thrombosis are typical and lead to early diagnosis, they can sometimes present with rare and unusual symptoms, complicating the diagnostic process. Given the morbidity and mortality associated with these events, it is important to be aware of unexpected symptoms to diagnose and manage these patients more accurately and rapidly. We report a 74‐year‐old female initially misdiagnosed with Alzheimer's because of cognitive decline and disorganized speech. Her symptoms did not improve with Alzheimer's treatment. She was reevaluated by a neurologist, and her cognitive test results were impaired. Her brain MRI revealed a previously undetected left transverse sinus cerebral venous thrombosis with subcortical white matter lesions. The patient was managed acutely with subcutaneous enoxaparin and transitioned to oral rivaroxaban, resulting in significant improvement. This case report aimed to draw attention to the pitfalls of diagnosing dementia‐like syndromes in the elderly, advocating for a systematic approach to differential diagnosis. It emphasizes that a collaborative effort between psychiatrists, neurologists, radiologists, and other healthcare members is essential for accurate diagnosis and timely intervention, which can significantly alter the management and outcome for the patient.

ABSTRACT This case demonstrates the complex dynamics of cavernous transformation of the portal vein and portal vein thrombus due to umbilical cord infection in a child and its consequences, namely portal hypertension. This abnormal process has to be understood for proper treatment and stresses the importance of a thorough assessment of such patients.

Arterial and venous thromboembolism are leading causes of morbidity and death worldwide. Despite significant advances in the diagnosis, prognostication, and treatment of thrombotic diseases over the past 3 decades, the adoption of findings stemming from translational biomarker research in clinical practice remains limited. Biomarkers provide an opportunity to enhance our understanding of pathophysiological processes and optimize treatment strategies. They hold the promise of revolutionizing patient care. Still, this potential remains untapped, and several factors impede their use for near‐patient applications. We sought to provide an overview of biomarker research in arterial and venous thromboembolic disease. We then aimed to discuss key barriers to the broader clinical implementation of biomarker research and highlight promising strategies to overcome them. We emphasize the merits of translational and implementation science to bridge the gaps from bench to bedside. Innovative trial design, data sharing, and collaborative efforts between academia and industry will be essential. Purposeful regression methodology using rational conceptual framework design, causal mediation analysis, and artificial intelligence might better leverage the use of observational data. Dedicated translational science training programs geared toward educating physicians on the appropriate measurement, interpretation, and integration of biomarker data in clinical practice should foster endorsement by frontline physicians. Finally, we make the case in support of a paradigm shift in cardiovascular medicine. Improved recognition of biomarker research and a greater emphasis on mechanistic evidence can better equip clinicians to deal with the uncertainty that defines the practice of thrombosis medicine.

The objective is to describe a comprehensive analysis of patients with bacterial meningitis exacerbate by cerebrovascular complications. We reviewed the literature on cerebrovascular complications in adult patients with bacterial meningitis. Cerebrovascular complications occur in one fourth of patients with bacterial meningitis. The most common cerebrovascular disease complicating bacterial meningitis are cerebral infarctions (9%–25%), intracerebral hemorrhage (1%–7%), cerebral venous thrombosis (1%–10%), and subarachnoid hemorrhage (1%–5%). Streptococcus pneumoniae and Staphylococcus aureus are the primary causative pathogens leading to these complications. The pathophysiological mechanisms have not completely been elucidated but involve vasculitis, endothelial dysfunction, hypercoagulability, aggregation, and complement activation. Cerebrovascular complications are important predictors of unfavorable outcome and death, and the use of adjunctive dexamethasone has been described to reduce the incidence. In conclusion, cerebrovascular complications are common in bacterial meningitis and are strongly associated with unfavorable outcomes and death. Although our understanding of the pathophysiology is evolving, there remains a need for novel treatment strategies to address these complications.

Abstract Pulmonary vein thrombosis (PVT) is rarer than pulmonary artery thrombosis (PAT). PVT is potentially fatal but is often overlooked due to its nonspecific symptoms. We present a case with PVT accompanied by paroxysmal atrial fibrillation. The symptoms were limited to transient ischemic attacks. Contrast‐enhanced computed tomography (CT), which showed a thrombus in the right pulmonary vein trunk, was useful in diagnosing PVT. After switching the patient's anticoagulant from dabigatran etexilate to apixaban, the thrombus disappeared within 5 months. Contrast‐enhanced CT is a useful and common tool for diagnosis and follow‐up of PVT.

ABSTRACT The primary antiphospholipid syndrome and protein S deficiency are known hypercoagulable states predisposing to strokes. We present a 34‐year‐old woman presented to rheumatology clinic complaining of right side weakness and aphasia for 2 months before the visit. There was joint pain in the right elbow and shoulder joints, hyperpigmentation on her face and dry painful red eyes mainly the right eye in addition to dry mouth. She had a history of recurrent abortions. Neurological examination showed hypertonia on right lower and upper limb and normal on left one, while the power was grade 3 on right side and normal in left one. Upper motor neuron signs and facial palsy was noted. Hyperpigmentation in the face was observed. MRI brain showed that left temporoparietal hemorrhagic infraction involving the basal ganglia and MRV brain showed left transverse sinus thrombosis and attenuation of sigmoid and internal jugular vein. B2‐glycoprotein Ig AGM, lupus anticoagulant, anticardiolipin (IgG, IgM, and IgA), protein S were positive. ANA profile was borderline for PCNA. We report unusual venous sinus thrombosis with primary antiphospholipid syndrome and acquired protein S deficiency.

ABSTRACT Case report of a case of acute pancreatitis (AP) at a patient previously known with essential thrombocytosis (ET). The most redoubtable complications of AP in this case were: pancreatic necrosis and splahnic vein thrombosis (SVT). Patient was followed‐up for 3 months with complete resolution of SVT under anticoagulation. As far as we know this is the first case ever published suffering simultaneously from AP and ET, both conditions known for their increased risk of developing thrombi.

ABSTRACT Background Inflammation is one of the hallmarks of cancer and is associated with tumor growth. Tumor endothelial cells (TECs) demonstrate inflamed phenotypes. Endothelial inflammation initiates thrombus formation, which is the second cause of cancer‐related deaths. Epigallocatechin‐3‐O‐gallate (EGCG), a natural compound in green tea, has demonstrated an anti‐inflammatory effect. However, the tumor progression inhibition effect of EGCG by targeting TEC inflammation remains unclear. This study addresses the anti‐tumor effect of EGCG, especially its anti‐inflammatory role in TECs. Methods In vitro, the effect of EGCG on TECs were studied using real‐time quantitative PCR and immunofluoresence to analyza gene and protein expression. In vivo, a cyclic RGD liposome delivery system (MEND) was employed to efficiently deliver EGCG to TECs in tumor‐bearing mice. Results In vitro, EGCG significantly reduces inflammatory cytokine expression, including tumor necrosis factor‐α, interleukin‐6, IL‐8, and IL‐1β through NF‐κB signaling inhibition. Additionally, von Willebrand factor reduction in TECs, which is involved in platelet adhesion and thrombosis formation, was analyzed. Our results revealed that EGCG‐MEND significantly inhibited TEC inflammation and thrombus formation in tumors. Additionally, EGCG‐MEND improved tumor immunity by reducing programmed death‐ligand 1 expression and promoting high endothelial venule formation by recruiting CD8+ T cells. Conclusion Our results indicate the anti‐tumor potential of EGCG‐MEND in normalizing the inflammatory immune microenvironment and inhibiting thrombosis by targeting TEC.

Abstract Andexanet alfa is a recombinant, modified factor Xa (FXa) molecule that is used for the reversal of the anticoagulant effect of oral anti‐FXa anticoagulants in patients with major haemorrhage. Here, we present a case of an 85‐year‐old man taking rivaroxaban for atrial fibrillation, who presented with an acute, upper gastrointestinal bleed. He was stabilised with red cell transfusion and then received a 400 mg bolus of andexanet alfa. Within minutes of this, he developed chest tightness, shortness of breath, ischaemic electrocardiographic changes and then cardiac arrest from which he could not be resuscitated. The onset of symptoms was clearly temporally related to andexanet alfa administration and the differential diagnosis includes anaphylaxis with Kounis syndrome, or myocardial infarction. Although infusion site reactions have been reported and are relatively common, this is to date the first case of a fatal drug reaction andexanet alfa. This knowledge can be factored into physicians’ risk–benefit decisions when treating patients with oral anti‐FXa anticoagulant‐associated major haemorrhage.

Abstract Background Thromboelastography (TEG) is a widely utilized clinical testing method for real‐time monitoring of platelet function and the thrombosis process. Lipid metabolism disorders are crucial risk factors for thrombosis. The lipid metabolism characteristics of hamsters resemble those of humans more closely than mice and rats, and their relatively large blood volume makes them suitable for studying the mechanisms of thrombosis related to plasma lipid mechanisms. Whole blood samples from golden Syrian hamsters and healthy humans were obtained following standard clinical procedures. TEG was employed to evaluate coagulation factor function, fibrinogen (Fib) function, platelet function, and the fibrinolytic system. Methods The whole blood from hamster or healthy human was isolated following the clinical procedure, and TEG was employed to evaluate the coagulation factor function, Fib function, platelet function, and fibrinolytic system. Coagulation analysis used ACLTOP750 automatic coagulation analysis pipeline. Blood routine testing used XN‐2000 automatic blood analyzer. Results TEG parameters revealed that hamsters exhibited stronger coagulation factor function than humans (reaction time [R], p = 0.0117), with stronger Fib function (alpha angle, p

Abstract Background Hypercoagulability has been documented in cats with cardiac disease. However, hemostatic parameters, including viscoelastic coagulation monitoring (VCM) have not been reported in cats with arterial thromboembolism (ATE). Hypothesis/Objectives Compare VCM parameters in cats with acute cardiogenic ATE and in control cats. Animals Sixteen cats with ATE and 30 control cats. Methods Multicenter university‐based prospective study. Cardiogenic ATE was diagnosed based on physical examination and by ultrasonographically‐diagnosed left atrial enlargement. Viscoelastic coagulation monitor analysis, CBC, serum biochemistry profile and coagulation profile were performed at admission in cats with ATE. Analysis from healthy control cats was performed using blood collected by direct venipuncture. Our objective was comparison of VCM parameters clot time (CT), clot formation time (CFT), alpha angle (Angle), maximum clot formation (MCF), amplitude at 10 and 20 minutes (A10 and A20, respectively) and clot lysis index at 30 and 45 minutes (LI30 and LI45, respectively) between ATE and control cats. Results Cats with ATE had a decreased angle compared to control cats, with a median (range) of 43° (30‐48°) compared to 47° (14‐59°; P = .01). The parameters A10, A20 and MCF were decreased in ATE cats compared to control cats with a median (range) of 19 units (8–32) compared to 22 units (6–38), 24.5 units (11‐40) compared to 29 units (10‐47) and 29.5 units (13‐44) compared to 33.5 units (14‐53), respectively (P = .01, .01 and .01, respectively). The parameters CT, CFT, LI30 and LI45 were similar between groups (P = .22, .09, .62 and .34, respectively). Conclusions and Clinical Importance Cats with cardiogenic ATE cats have VCM parameters consistent with hypocoagulability compared with healthy cats.

Abstract Background Pulmonary hypertension (PH) in dogs with myxomatous mitral valve disease (MMVD) is caused by increased pulmonary venous pressure. Thrombosis, vascular remodeling, and vasoconstriction mediated by platelets could exacerbate PH. Hypothesis Dogs with PH will exhibit a hypercoagulable state, characterized by increased platelet activation, platelet‐leukocyte, and platelet‐neutrophil aggregate formation. Animals Eleven dogs (≥3.5 kg) diagnosed with MMVD and PH and 10 dogs with MMVD lacking PH. Methods Prospective cohort ex vivo study. All dogs underwent echocardiographic examination, CBC, 3‐view thoracic radiographs, and heartworm antigen testing. Severity of PH and MMVD were assessed by echocardiography. Viscoelastic monitoring of coagulation was assessed using thromboelastography (TEG). Platelet activation and platelet‐leukocyte/platelet‐neutrophil interactions were assessed using flow cytometry. Plasma serotonin concentrations were measured by ELISA. Results Unstimulated platelets from dogs with MMVD and PH expressed more surface P‐selectin than MMVD controls (P = .03). Platelets from dogs with MMVD and PH had persistent activation in response to agonists. The number of platelet‐leukocyte aggregates was higher in dogs with MMVD and PH compared with MMVD controls (P = .01). Ex vivo stimulation of whole blood resulted in higher numbers of platelet‐neutrophil aggregates in dogs with MMVD and PH (P = .01). Assessment of hypercoagulability based on TEG or plasma serotonin concentrations did not differ between groups. Conclusion and Clinical Importance Platelet hyperresponsiveness and increased platelet‐neutrophil interaction occur in dogs with MMVD and PH, suggesting that platelets play a role of in the pathogenesis of PH. Clinical benefits of antiplatelet drugs in dogs with MMVD and PH require further investigation.

Abstract Background Acute thrombotic events play a major role in various cardiovascular diseases. Therefore, direct thrombus imaging can be proved beneficial for early diagnosis and prompt therapy of thrombosis. Our study investigated targeted dual‐modality cyclic arginine‐glycine‐aspartic micro bubbles (cRGD‐MBs) for direct imaging of thrombi by fluorescence and ultrasound. Methods cRGD‐MBs were prepared by mechanical vibration and chemical chelation methods. Results Coulter counter analysis demonstrated that the cRGD‐MBs were well dispersed, with diameters ranging from 1 to 3 μm. They emitted bright red fluorescence under an excitation wavelength of 660 nm. In vivo fluorescence and ultrasound imaging revealed that cRGD‐MBs accumulated at the site of thrombus in the carotid artery with significant fluorescence and ultrasonic signal. Conclusions This study showed that novel microbubble cRGD‐MBs were successfully synthesized, and that these could potentially be used as contrast agents for immediate diagnosis of acute thrombus in vivo.

Abstract Bleeding and thrombosis are common complications during immune thrombocytopenic purpura (ITP) treatment. There is a strong need to predict bleeding and thrombosis risks before ITP treatment to optimize therapy and appropriately manage these complications. We performed a retrospective cohort study of 120 patients with primary ITP to identify a biomarker to predict bleeding and thrombosis. We compared blood test results at diagnosis between patients with and without bleeding or thrombosis episodes. The standard deviation of red blood cell distribution width (RDW‐SD) differed significantly between those with and without bleeding and between those with and without thrombosis, leading us to identify it as a variable representative of risk. RDW‐SD was significantly associated with patient age and with histories of several vascular diseases. Multivariate regression analyses showed that RDW integrated several variables associated with vascular risks. RDW‐SD was significantly associated with difficulty with corticosteroid discontinuation (hazard ratio [HR], 2.22, p = 0.01), incidence of bleeding (HR, 2.75, p< 0.01), incidence of thrombosis (HR, 2.67, p< 0.01) and incidence of infection (HR, 1.78, p = 0.04). The RDW‐SD value at the time of ITP diagnosis is a useful biomarker to predict the risks of bleeding, thrombosis, and other complications.

Key Clinical Message Although systemic lupus erythematosus may present with broad and variable symptoms, the rare and atypical combined presentation of central retinal vein occlusion, myocarditis, and deep vein thrombosis poses a diagnostic challenge and highlights the need for a comprehensive diagnostic approach. Early diagnosis and prompt treatment help mitigate disease morbidity and mortality, and emphasize the importance of heightened clinical suspicion in complex presentations.

Background This study aimed to investigate the hemodynamic and anatomic factors associated with sinus thrombosis following transcatheter aortic valve replacement (TAVR), integrating in vivo patient data analysis and in vitro experiments. Methods and Results Postprocedural, 4‐dimensional, multiphase computed tomography data from 211 patients enrolled in the ADAPT‐TAVR (Anticoagulation Versus Dual Antiplatelet Therapy for Prevention of Leaflet Thrombosis and Cerebral Embolization After Transcatheter Aortic Valve Replacement) study were analyzed. The prevalence of native sinus thrombosis was examined in relation to valve type, implant depth, and anatomic features. In vitro experiments used particle image velocimetry to observe changes in sinus flow based on the transcatheter heart valves (23‐mm SAPIEN3, Edwards Lifesciences; and 29‐mm CoreValve, Medtronic) height and coronary artery flow. Native sinus thrombosis was more common in self‐expanding valves (39.1% versus 14.9%, P=0.004). In per‐cusp analysis of in vivo patient data, adjusted transcatheter heart valve implant depth (odds ratio, 1.2 [95% CI, 1.1–1.3]; P

Abstract The hollow fiber membrane bundle is the functional component of artificial lungs, transferring oxygen to and carbon dioxide from the blood. It is also the primary location of blood clot formation and propagation in these devices. The geometric design of fiber bundles is defined by a narrow set of parameters that determine gas exchange efficiency and blood flow resistance, principally: fiber packing density, path length, and frontal area. These same parameters also affect thrombosis. This study investigated the effect of these parameters on clot formation using 3D printed flow chambers that mimic the geometry and blood flow patterns of fiber bundles. Hollow fibers were represented by an array of vertical micro‐rods (380 μm diameter) arranged with three packing densities (40%, 50%, and 60%) and two path lengths (2 and 4 cm). Blood was pumped through these devices corresponding to three mean blood flow velocities (16, 20, and 25 cm/min). Results showed that (1) clot formation decreases dramatically with decreasing packing density and increasing blood flow velocity, (2) clot formation at the outlet of the fiber bundle enhances deposition upstream, and consequently (3) greater path length provides greater clot‐free fiber surface area for gas exchange than a shorter path length. These results can help guide the design of less thrombogenic, more efficient artificial lung designs.

Abstract This research aims to investigate the impact of Didang decoction (DD) on the formation of neutrophil extracellular traps (NETs) and cancer‐associated thrombosis in lung cancer. BALB/c nude mice were used to establish xenograft models for inducing deep vein thrombosis. Tumor growth and thrombus length were assessed. The impact of DD on NET generation was analyzed using enzyme‐linked immunosorbent assay, immunofluorescence staining, quantitative real‐time PCR, and western blot analysis, both in vivo and in vitro. CI‐amidine, a PAD4 inhibitor, was employed to evaluate the role of PAD4 in the generation of NETs. In vivo studies demonstrated that treatment with DD reduced tumor growth, inhibited thrombus formation, and decreased the levels of NET markers in the serum, tumor tissues, neutrophils, and thrombus tissues of mice. Additional data indicated that DD could suppress neutrophil counts, the release of tissue factor (TF), and the activation of thrombin‐activated platelets, all of which contributed to increased formation of NETs in mouse models. In vitro, following incubation with conditioned medium (CM) derived from Lewis lung carcinoma cells, the expression of NET markers in neutrophils was significantly elevated, and an extracellular fibrous network structure was observed. Nevertheless, these NET‐associated changes were partially counteracted by DD. Additionally, CI‐amidine reduced the expression of NET markers in CM‐treated neutrophils, consistent with the effects of DD. Collectively, DD inhibits cancer‐associated thrombosis in lung cancer by decreasing PAD4‐dependent NET formation through the regulation of TF‐mediated thrombin‐platelet activation. This presents a promising therapeutic strategy for preventing and treating venous thromboembolism in lung cancer.

Background G6PD (glucose‐6‐phosphate‐dehydrogenase) is a key enzyme in the glycolytic pathway and has been implicated in the pathogenesis of cancer and pulmonary hypertension‐associated vascular remodeling. Here, we investigated the role of an X‐linked G6pd mutation (N126D polymorphism), which is known to increase the risk of cardiovascular disease in individuals from sub‐Saharan Africa and many others with African ancestry, in the pathogenesis of pulmonary hypertension induced by a vascular endothelial cell growth factor receptor blocker used for treating cancer. Methods and Results CRISPR‐Cas9 genome editing was used to generate the G6pd variant (N126D; G6pdN126D) in rats. A single dose of the vascular endothelial cell growth factor receptor blocker sugen‐5416 (SU; 20 mg/kg in DMSO), which is currently in a Phase 2/3 clinical trial for cancer treatment, was subcutaneously injected into G6pdN126D rats and their wild‐type littermates. After 8 weeks of normoxic conditions, right ventricular pressure and hypertrophy, pulmonary artery remodeling, the metabolic profile, and cytokine expression were assessed. Right ventricular pressure and pulmonary arterial wall thickness were increased in G6PDN126D+SU/normoxic rats. Simultaneously, levels of oxidized glutathione, inositol triphosphate, and intracellular Ca2+ were increased in the lungs of G6PDN126D+SU/normoxic rats, whereas nitric oxide was decreased. Also increased in G6PDN126D+SU/normoxic rats were pulmonary levels of plasminogen activator inhibitor‐1, thrombin‐antithrombin complex, and expression of proinflammatory cytokines CCL3 (chemokine [C‐C motif] ligand), CCL5, and CCL7. Conclusions Our results suggest G6PDN126D increases inositol triphosphate‐Ca2+ signaling, inflammation, thrombosis, and hypertrophic pulmonary artery remodeling in SU‐treated rats. This suggests an increased risk of vascular endothelial cell growth factor receptor blocker‐induced pulmonary hypertension in those carrying this G6PD variant.

Background The optimal strategy in prosthetic heart valve thrombosis (PVT) remains controversial, with no randomized trials and conflicting observational data. We performed a systematic review and meta‐analysis of evidence comparing systemic thrombolysis and cardiac surgery in PVT. Methods and Results We searched PubMed, the Cochrane Library, and Embase for studies on treatment strategies in patients with left‐sided PVT since 2000. The primary outcome was death, and the secondary outcomes were major bleeding and thromboembolism during follow‐up (International Prospective Register of Systematic Reviews No. CRD42022384092). We identified 2298 studies, of which 16 were included, comprising 1389 patients with PVT (mean age, 50.4±9.3 years; 60.0% women). Among them, 67.2% were New York Heart Association stage III/IV at admission. Overall, 48.1% were treated with systemic thrombolysis and 51.9% with cardiac surgery. The mortality rate was 10.8% in the thrombolysis group and 15.3% in the surgery group. The pooled risk difference for death with systemic thrombolysis was 1.13 (exact CI, 0.74–1.79; ζ2=0.89; P

ABSTRACT Background Venous thromboembolism (VTE) may jeopardise excellent treatment results of germ cell tumours (GCT). We previously constructed a VTE risk score for GCT patients qualified for first‐line chemotherapy (CTH), including vein compression, clinical stage (CS) and haemoglobin concentration. Aim Validating our score in a separate cohort and establishing the cut‐off point for the score. Re‐assessing the numerical score in the training cohort. Materials and Methods We retrospectively analysed a new cohort of GCT patients staged IS–IIIC. Area under the curve of receiver‐operating characteristic (AUC‐ROC) was calculated for the developed score, Khorana Risk Score (KRS) and Padua Prediction Score (PPS). AUC‐ROC of the integer score was calculated for the training cohort. Cut‐off point was established by Youden's and Liu's indices. Results Among 336 eligible patients in the validation cohort, VTE occurred in 41 (12.2%). AUC‐ROC for our score, KRS and PPS were 0.818 (95% confidence interval (CI): 0.746–0.891), 0.608 (0.529–0.688) and 0.634 (0.547–0.720), respectively, p

Key Clinical Message Percutaneous precutaneous mechanical thrombectomy has been used for clot dissolution and removal in selected cases of iliofemoral deep vein thrombosis. Intravascular Hemolysis and hemoglobinuria caused by pharmachomechanical chather directed thrombolysis (PCDT) devices like the Angiojet is associated with an increased risk of acute kidney injury (AKI). Acute tubular necrosis that is severe enough to require hemodialysis can occur. Clinicians should be aware of this potential risk to ensure early recognition and timely referral to the nephrologist, and a clear explanation of the risk of AKI should be given to the patients undergoing this procedure. Abstract Lower extremity deep vein thrombosis (DVT) is a frequently encountered medical condition, and one that can lead to death or major disability if not promptly treated. Anticoagulation alone may not always be enough for complete treatment. It has been reported that early thrombus removal can rapidly relieve symptoms and prevent disease progression in some selected cases. Percutaneous pharmacomechanical thrombectomy has been used for clot dissolution and removal in such cases. AngioJet is an increasingly used method of percutaneous mechanical thrombectomy for DVT that can cause intravascular hemolysis and potentially acute kidney injury (AKI). We report here a case of a 39 years old lady who developed severe AKI (illustrated by creatinine level of 664 μmol/L (7.5 mg/dL), bicarb of 13 mmol/L and being anuric), requiring hemodialysis secondary to intravascular hemolysis and hemoglobinuria that occurred immediately after the use of AngioJet pharmacomechanical catheter‐directed technique to treat an extensive iliofemoral DVT.

Population studies have suggested that viral infections may be contributing to risk of ischemic stroke, although the mechanisms for this are unclear. In this review, we examine the epidemiological evidence supporting the involvement of viral diseases, including influenza, COVID‐19, chronic herpesvirus infections, and hepatitis C in current trends of stroke incidence. To support these associations, we highlight the virus–host interactions that are critical in the context of stroke, including direct effects of acute and persistent viral infections on vascular function, inflammation, and thrombosis. Additionally, we evaluate the systemic changes that occur during viral infection that can predispose individuals to ischemic stroke, including alterations in blood pressure regulation, coagulation, and lipid metabolism. Our review emphasizes the need to further elucidate precise mechanisms involved in viral infections and stroke risk. Future research will inform the development of targeted interventions for stroke prevention in the context of viral diseases.

Objective Many studies reported that tranexamic acid (TXA) was effective in reducing surgical blood loss in the perioperative period of medial open wedge high tibial osteotomy (MOWHTO). However, few studies focused on the simple topical use of TXA in MOWHTO, and the modality and dosage of topical use of TXA varied. The purpose of this study was to observe the effect of topical use of low‐dose TXA on drainage volume after MOWHTO, and to analyze the related influencing factors. Methods Data of patients who underwent MOWHTO combined with arthroscopic knee surgery in our department from January 2019 to September 2021 were retrospectively analyzed. A total of 105 patients (38 males and 67 females, aged 57.7 ± 7.5 years) were included in this study who received topical TXA or no TXA. The patients were divided into three groups: control group (39 cases), 0.5 g TXA group (40 cases), 1 g TXA group (26 cases). Postoperative drainage volume, wound healing, incidence of hematoma and deep venous thrombosis (DVT) were observed and analyzed in the three groups. The effects of gender, hypertension and diabetes on postoperative drainage volume were analyzed using a t‐test. The correlation between age, body mass index (BMI), osteotomy gap and postoperative drainage volume were analyzed using the Pearson correlation coefficient. Results The average postoperative drainage volume of the control group was 259.54 ± 226.33 mL, that of the 0.5 g TXA group was 277.18 ± 177.68 mL, and that of the 1 g TXA group was 229.15 ± 219.93 mL. There was no statistically significant difference in postoperative drainage volume among the three groups (F = 0.423, p = 0.656). There was no local hematoma and wound infection in the three groups. The wound fat liquefaction was found in one patient of the control group. The incidence of DVT was 38.9% (7/18) and 57.1% (8/14) in the control group and 0.5 TXA group, respectively. There was no significant difference in the incidence of DVT between the above two groups (p = 0.476). The average postoperative drainage volume of male patients in the three groups was higher than that of female patients, and the differences were statistically significant (p 0.05). Conclusion Topical use of low‐dose TXA has no significant effect on drainage volume after MOWHTO. The drainage volume after MOWHTO in male patients was more than that in female patients. Topical administration of low‐dose TXA does not increase postoperative complications, such as DVT and hematoma.

Abstract Use of extracorporeal membrane oxygenation (ECMO) for cardiorespiratory failure remains complicated by blood clot formation (thrombosis), triggered by biomaterial surfaces and flow conditions. Thrombosis may result in ECMO circuit changes, cause red blood cell hemolysis, and thromboembolic events. Medical device thrombosis is potentiated by the interplay between biomaterial properties, hemodynamic flow conditions and patient pathology, however, the contribution and importance of these factors are poorly understood because many in vitro models lack the capability to customize material and flow conditions to investigate thrombosis under clinically relevant medical device conditions. Therefore, an ECMO thrombosis‐on‐a‐chip model is developed that enables highly customizable biomaterial and flow combinations to evaluate ECMO thrombosis in real‐time with low blood volume. It is observed that low flow rates, decelerating conditions, and flow stasis significantly increased platelet adhesion, correlating with clinical thrombus formation. For the first time, it is found that tubing material, polyvinyl chloride, caused increased platelet P‐selectin activation compared to connector material, polycarbonate. This ECMO thrombosis‐on‐a‐chip model can be used to guide ECMO operation, inform medical device design, investigate embolism, occlusion and platelet activation mechanisms, and develop anti‐thrombotic biomaterials to ultimately reduce medical device thrombosis, anti‐thrombotic drug use and therefore bleeding complications, leading to safer blood‐contacting medical devices.

Key Clinical Message We describe an acute lower‐extremity arterial occlusion in a 30‐year‐old woman with immune thrombocytopenia and polycystic ovary syndrome. Thrombosis may be a complication of immune thrombocytopenia requiring careful management.

Key Clinical Message Antiphospholipid syndrome is an immunopathologic disorder that should be considered in all patients with recurrent and/or unexplained thromboembolic events. Antiphospholipid antibodies are diagnostic markers, and anticoagulation therapy is the therapeutic and preventive strategy. Long‐term anticoagulation therapy is necessary, with careful attention to potential bleeding complications.

Key Clinical Message Accidental foreign body ingestion is the most common hidden cause of abdominal pain. A high index of suspicion should be implemented in patients with unresolved abdominal pain. Here we reported a 54‐year‐old patient with vague abdominal pain who had a successful laparoscopic removal of a toothpick. Abstract Toothpicks and fish bones are considered one of the most common accidentally ingested foreign bodies. Fortunately, most patients are asymptomatic. About 80%–90% of ingested foreign bodies pass through the gut spontaneously within a week. We present a case of a 54‐year‐old female with chronic epigastric pain and fever found to have a foreign body (toothpick) that penetrated the stomach and migrated to the liver causing liver abscess with portal vein thrombosis. The patient was managed with laparoscopic removal of the foreign body with an uneventful postoperative course.

Abstract Platelets play a key role in physiological hemostasis and pathological thrombosis. Based on the limitations of current antiplatelet drugs, it's important to elucidate the mechanisms of regulating platelet activation. In addition to dissolving lipid nutrients, bile acids (BAs) can regulate platelet function. However, the specific mechanisms underlying BAs‐mediated effects on platelet activation and thrombotic diseases remain unknown. Therefore, the effects of BAs on platelets and intracellular regulatory mechanisms are explored. It is showed that the inhibitory effect of secondary BAs is more significant than that of primary BAs; lithocholic acid (LCA) shows the highest inhibitory effect. In the process of platelet activation, BAs suppress platelet activation via the spleen tyrosine kinase (SYK), protein kinase B (Akt), and extracellular signal‐regulated kinase1/2 (Erk1/2) pathways. Nck adaptor proteins (NCK1) deficiency significantly suppress the activity of platelets and arterial thrombosis. Phosphorylated proteomics reveal that LCA inhibited phosphorylation of syntaxin‐11 at S80/81 in platelets. Additional LCA supplementation attenuated atherosclerotic plaque development and reduced the inflammation in mice. In conclusion, BAs play key roles in platelet activation via Syk, Akt, ERK1/2, and syntaxin‐11 pathways, which are associated with NCK1. The anti‐platelet effects of BAs provide a theoretical basis for the prevention and therapy of thrombotic diseases.

Key Clinical Message Portal vein thrombosis (PVT) is a rare condition, particularly in non‐cirrhotic patients. Anticoagulation remains the mainstay of the treatment. Extensive PVT can lead to variceal bleeding, ascites, bowel ischemia, and hypersplenism. The role of thrombolysis and thrombectomy in these patients remains unclear. However, there is evidence that local thrombolysis and thrombectomy should be considered in those who remain symptomatic on anticoagulation and are at risk of complications with acute PVT.

Abstract Recent studies elucidate that coronavirus disease 2019 (COVID‐19) patients may face a higher risk of cardiovascular complications. This study aimed to evaluate association of COVID‐19 with the risk of pulmonary embolism (PE) or deep vein thrombosis (DVT). This nationwide population‐based retrospective cohort study included Korean adult citizens between January 2021 and March 2022 from the Korea Disease Control and Prevention Agency COVID‐19 National Health Insurance Service cohort. The Fine and Gray's regression with all‐cause death as a competing event was adopted to evaluate PE and DVT risks after COVID‐19. This study included a total of 1,601,835 COVID‐19 patients and 14,011,285 matched individuals without COVID‐19. The risk of PE (adjusted hazard ratio [aHR], 6.25; 95% confidence interval [CI], 3.67–10.66; p

Abstract Objective To quantify postoperative venous thromboembolism (VTE) incidence in head and neck cancer (HNC) patients, and assess the economic implications of chemoprophylaxis. Study Design Retrospective cost‐effective analysis. Setting Fifty‐three health care organizations. Methods The TriNetX Research Network was queried to identify the 1‐month VTE rate in HNC patients undergoing neck dissection from 2012 to 2022. A literature search provided additional postsurgical VTE rates in HNC patients. Costs of prophylactic heparin and enoxaparin were obtained from a drug wholesaler, and VTE‐associated medical costs were sourced from the literature. A break‐even analysis determined the absolute risk reduction (ARR) in the VTE rate necessary for a medication to break‐even on cost. Results In TriNetX, 8193 HNC surgical patients underwent neck dissection, and an additional 1640 patients underwent neck dissection plus free flap reconstruction without chemoprophylaxis. Respective 1‐month VTE rates were 1.3% (n = 103) and 2.5% (n = 41). Four additional studies of 1546 postoperative HNC patients not prescribed chemoprophylaxis reported a mean VTE rate of 3.8% (n = 59), ranging from 1.9% to 13.0%. At $8.40 per week, heparin resulted in cost savings if it decreased the VTE rate by an ARR of at least 0.05%, while enoxaparin, at $23.66 per week, needed to achieve a 0.14% ARR. Considering potential added costs from bleeding complications, heparin, and enoxaparin remained cost‐effective if chemoprophylaxis did not increase bleeding complications by an absolute risk of more than 2.86% and 2.79%, respectively. Conclusion Postoperative VTE rates varied in HNC patients. Despite this, achievable ARRs suggested the potential cost‐effectiveness of routine chemoprophylaxis with heparin and enoxaparin.

Abstract The toxicity of inhaled particulate air pollution perseveres even at lower concentrations than those of the existing air quality limit. Therefore, the identification of safe and effective measures against pollutant particles‐induced vascular toxicity is warranted. Carnosol is a bioactive phenolic diterpene found in rosemary herb, with anti‐inflammatory and antioxidant actions. However, its possible protective effect on the thrombotic and vascular injury induced by diesel exhaust particles (DEP) has not been studied before. We assessed here the potential alleviating effect of carnosol (20 mg/kg) administered intraperitoneally 1 h before intratracheal (i.t.) instillation of DEP (20 μg/mouse). Twenty‐four hours after the administration of DEP, various parameters were assessed. Carnosol administration prevented the increase in the plasma concentrations of C‐reactive protein, fibrinogen, and tissue factor induced by DEP exposure. Carnosol inhibited DEP‐induced prothrombotic effects in pial microvessels in vivo and platelet aggregation in vitro. The shortening of activated partial thromboplastin time and prothrombin time induced by DEP was abated by carnosol administration. Carnosol inhibited the increase in pro‐inflammatory cytokines (interleukin‐6 and tumor necrosis factor α) and adhesion molecules (intercellular adhesion molecule‐1, vascular cell adhesion molecule‐1, E‐selectin, and P‐selectin) in aortic tissue. Moreover, it averted the effects of DEP‐induced increase of thiobarbituric acid reactive substances, depletion of antioxidants and DNA damage in the aortic tissue. Likewise, carnosol prevented the decrease in the expression of nuclear factor erythroid 2‐related factor 2 (Nrf2) and heme oxygenase‐1 (HO‐1) caused by DEP. We conclude that carnosol alleviates DEP‐induced thrombogenicity and vascular inflammation, oxidative damage, and DNA injury through Nrf2 and HO‐1 activation.

Abstract Antiphospholipid syndrome (APS) is characterized by thrombus formation, poor pregnancy outcomes, and a proinflammatory response. H3K4me3‐related monocytes activation are key regulators of APS pathogenesis. Therefore, H3K4me3 CUT&Tag and ATAC‐seq are performed to examine the epigenetic profiles. The results indicate that the H3K4me3 signal and chromatin accessibility at the FOXJ2 promoter are enhanced in an in vitro monocyte model by stimulation with β2GPI/anti‐β2GPI, which mimics APS, and decreases after OICR‐9429 administration. Furthermore, FOXJ2 is highly expressed in patients with primary APS (PAPS) and is the highest in patients with triple‐positive antiphospholipid antibodies (aPLs). Mechanistically, FOXJ2 directly binds to the SLAMF8 promoter and activates SLAMF8 transcription. SLAMF8 further interacts with TREM1 to stimulate TLR4/NF‐κB signaling and prohibit autophagy. Knockdown of FOXJ2, SLAMF8, or TREM1 blocks TLR4/NF‐κB and provokes autophagy, subsequently inhibiting the release of inflammatory and thrombotic indicators. A mouse model of vascular APS is established via β2GPI intraperitoneal injection, and the results suggest that OICR‐9429 administration attenuates the inflammatory response and thrombus formation by inactivating FOXJ2/SLAMF8/TREM1 signaling. These findings highlight the overexpression of H3K4me3‐mediated FOXJ2 in APS, which consequently accelerates APS pathogenesis by triggering inflammation and thrombosis via boosting the SLAMF8/TREM1 axis. Therefore, OICR‐9429 is a promising candidate drug for APS therapy.

Key Clinical Message Stent thrombosis is a serious complication with high morbidity and mortality rates resulting in cardiac death or nonfatal myocardial infarction that occurs following stent placement during percutaneous coronary intervention (PCI). Stent underexpansion or malapposition are avoidable risk factors for stent thrombosis. Sufficient postdilation should be considered to mitigate this risk, especially with the guidance of intravascular ultrasound (IVUS). We present the case of a 60‐year‐old man developing a thrombotic lesion inside a stent 2 weeks after PCI for Non‐ST‐Segment Elevation Myocardial Infarction (NSTEMI), which was strongly related to stent underexpansion and malapposition. This case highlights the importance of IVUS in evaluating procedural success, particularly in assessing stent expansion and apposition.

Key Clinical Message We present a case of Cronkhite–Canada syndrome in a patient with decompensated cirrhosis who had successful induction of remission with nutritional supplementation alone. We propose that early institution of high‐protein, high‐energy enteral supplementation should be offered to all patients, especially those with compelling contraindications to immunosuppression.

Key Clinical Message This case image describes the complex proposed etiologies of a case of superior vena cava syndrome. Hence, different diagnostic and therapeutic modalities are needed in a multidisciplinary team approach.

Key Clinical Message Cerebral venous sinus thrombosis in itself is rarely encountered clinical entity and its association with immune thrombocytopenic purpura (ITP) makes it more unusual presentation. No any as such standard guidelines exist that guides the prompt evidence based management in such concurrent cases but neuroendovascular modality can play a pivotal role.

Abstract Neutrophil released peptidyl arginine deiminase 4 (PAD4) converts arginine residues on plasma proteins into citrulline. Here, we developed an assay to quantify citrullinated fibrinogen. We employed a biotin‐conjugated phenylglyoxal (biotin‐phenylglyoxal (PG)) compound that selectively labels citrulline. Patient samples were derived from a multicenter prospective cohort study that aimed to identify cancer patients at high risk for venous thromboembolism (VTE). Our data show that cancer patients have higher (median 2‐fold increased) citrullinated fibrinogen levels when compared to normal human plasma and a cohort of healthy donors. Our results show that citrullination of fibrinogen is a common posttranslational modification in patients with cancer.