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Advances in Thrombosis and Haemostasis
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Advances in Thrombosis and Haemostasis

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Hematology".

Deadline for manuscript submissions: 20 October 2025 | Viewed by 3482

Special Issue Editor

Prof. Dr. José A. Páramo

E-Mail Website
Guest Editor
Servicio de Hematología y Hemoterapia, Clínica Universidad de Navarra, Pamplona, Spain
Interests: antithrombotic therapy; thrombosis and haemostasis; atherosclerosis; venous and arterial thrombosis

Special Issue Information

Dear Colleagues,

Excessive activation of the blood coagulation system can cause thrombosis. However, new medical knowledge has changed the classical paradigm, making it increasingly apparent that the type of thrombosis associated with inflammation (thromboinflammation or immunothrombosis) often occurs in a broad range of vascular diseases, such as venous thromboembolism (VTE), atherosclerosis, and stroke. Importantly, recent studies have identified factors that contribute to thrombosis but not necessarily to haemostasis. The recent experiences of the COVID-19 pandemic also highlight the pathologic interplay between coagulation and immunity. The phenomenon of immunothrombosis represents a double-edged sword: on one hand, it is likely an important defence mechanism against invading pathogens; on the other, when dysregulated, it can lead to macro- and microvascular thrombosis and organ damage. While platelets, leukocytes, and the endothelium play an important role in immunothrombosis, the precise mechanisms that regulate this process remain poorly defined, posing a challenge for clinical management.

From this perspective, this Special Issue wants to provide a comprehensive review of the current knowledge on immunothrombotic processes relevant to different clinical conditions, as the recent advances in our understanding of the drivers of immunothrombosis provide new opportunities for the development of safer anticoagulant drugs.

We are looking forward to receiving your contributions.

Prof. Dr. José A. Páramo
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • coagulation
  • immunothrombosis
  • inflammation
  • immune response
  • venous thrombosis
  • arterial thrombosis
  • endothelial dysfunction
  • neutrophil extracellular traps

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Published Papers (3 papers)

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Research

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13 pages, 1864 KiB  
Article
Fibrinolytic Dysregulation in Regional Hemostasis During Liver Transplantation: A Viscoelastometry-Based Pilot Study
by István Zátroch, Elek Dinya, Anikó Smudla and János Fazakas
J. Clin. Med. 2025, 14(9), 2925; https://doi.org/10.3390/jcm14092925 - 24 Apr 2025
Viewed by 204
Abstract
Background/Objectives: In chronic liver disease, a rebalanced coagulation state often results in an increased risk of thrombosis, particularly in the splanchnic region. While systemic coagulation abnormalities are well documented, alterations in regional (portal) hemostasis remain underexplored. This study aimed to compare systemic [...] Read more.
Background/Objectives: In chronic liver disease, a rebalanced coagulation state often results in an increased risk of thrombosis, particularly in the splanchnic region. While systemic coagulation abnormalities are well documented, alterations in regional (portal) hemostasis remain underexplored. This study aimed to compare systemic and portal hemostasis during liver transplantation and to determine whether systemic parameters can accurately predict regional coagulation status. Methods: Thirty-five liver transplant recipients were included in this study. Systemic blood samples (S1–S5) were collected from the external jugular vein at five surgical time points, while portal blood samples (R3) were obtained immediately before reperfusion simultaneously with S3. All samples were analyzed using ClotPro® viscoelastic assays, conventional coagulation tests, and blood gas analysis. Results: The EX-test comparison between S3 and R3 samples revealed a discrepancy between systemic and regional hemostasis in 45.7% of patients. Among these, eight regional samples exhibited hypocoagulation characterized by coagulation factor consumption and hyperfibrinolysis. Another eight samples demonstrated hypercoagulation with fibrinolytic shutdown, which was confirmed by a fibrin-rich thrombus identified via scanning electron microscopy. Systemic samples failed to predict these regional variations. Conclusions: Regional (portal) hemostasis significantly differs from systemic coagulation and cannot be accurately predicted using systemic assays alone. These findings suggest that fibrinolytic shutdown in the portal vein may contribute to intraoperative and long-term graft damage, highlighting a potential need for regional coagulation assessment during liver transplantation. Full article
(This article belongs to the Special Issue Advances in Thrombosis and Haemostasis)
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9 pages, 732 KiB  
Article
Real-World Data on Effectiveness and Safety of First-Line Use of Caplacizumab in Italian Centers for the Treatment of Thrombotic Thrombocytopenic Purpura: The Roscapli Study
by Luana Fianchi, Matteo Bonanni, Alessandra Borchiellini, Federica Valeri, Gaetano Giuffrida, Stephanie Grasso, Claudio Fozza, Michele Ponta, Giovanni L. Tiscia, Elvira Grandone, Nicola Vianelli, Alessandra Dedola, Teresa Pirozzi, Monica Sacco, Stefano Lancellotti and Raimondo De Cristofaro
J. Clin. Med. 2024, 13(21), 6561; https://doi.org/10.3390/jcm13216561 - 31 Oct 2024
Viewed by 1090
Abstract
Background/Objectives: Immune thrombotic thrombocytopenic purpura (iTTP) is a thrombotic microangiopathy caused by the formation of anti-ADAMTS13 antibodies. Caplacizumab is approved for the treatment of acute episodes of iTTP in conjunction with plasma exchange (PEX) and immunosuppression. Real-world data for the use of [...] Read more.
Background/Objectives: Immune thrombotic thrombocytopenic purpura (iTTP) is a thrombotic microangiopathy caused by the formation of anti-ADAMTS13 antibodies. Caplacizumab is approved for the treatment of acute episodes of iTTP in conjunction with plasma exchange (PEX) and immunosuppression. Real-world data for the use of caplacizumab in Italy have been recently published by a limited number of centers located in the northern and middle regions of the country only. Methods: A total of 38 patients with iTTP were enrolled in the study in six Italian centers spread over the entire territory of the country. The patients’ data were registered in eCRF. Results: All patients achieved normalization of platelet count (median 2.0 days, IQR: 2–4), within a time significantly shorter than in the absence of caplacizumab, as previously reported in other studies. As to the secondary aims, patients treated with caplacizumab had a few exacerbations (4/38 (10.5%)) and relapses (2/38, 5.3%). No deaths or refractoriness were observed in these patients. The total length of hospitalization was 12 days (IQR: 9–18) and only one patient required 2 days of stay in the intensive care unit. Interestingly, when caplacizumab was initiated within the first 3 days, the plasma exchange (PEX) duration was 9 days (IQR: 8–10), which was significantly lower than those reported in previous studies conducted in the absence of caplacizumab. No severe adverse event was described in the caplacizumab-treated patients. Conclusions: Caplacizumab reduced exacerbations and refractoriness compared with previously reported standard-of-care regimens. When administered in association with PEX and immunosuppressive therapy, caplacizumab provided rapid normalization of platelet count, which was responsible for lower overall hospitalization time, ICU stay, lower exacerbations and relapses compared to previously reported outcomes of studies carried out without caplacizumab. Full article
(This article belongs to the Special Issue Advances in Thrombosis and Haemostasis)
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Review

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18 pages, 617 KiB  
Review
Anticoagulation Management: Current Landscape and Future Trends
by Andaleb Kholmukhamedov, David Subbotin, Anna Gorin and Ruslan Ilyassov
J. Clin. Med. 2025, 14(5), 1647; https://doi.org/10.3390/jcm14051647 - 28 Feb 2025
Viewed by 1762
Abstract
Blood transports nutrients and oxygen to the cells while removing the waste. It also possesses a hemostasis function to prevent excessive bleeding. However, abnormal clot formation (thrombosis) within healthy blood vessels can lead to life-threatening conditions like heart attacks, strokes, and pulmonary embolism. [...] Read more.
Blood transports nutrients and oxygen to the cells while removing the waste. It also possesses a hemostasis function to prevent excessive bleeding. However, abnormal clot formation (thrombosis) within healthy blood vessels can lead to life-threatening conditions like heart attacks, strokes, and pulmonary embolism. This review explores anticoagulants, their historical aspects, current clinical applications, and future trends. Anticoagulants play a critical role in preventing and treating thrombosis by interfering with different stages of blood clotting. The journey began with heparin, a rapidly acting injectable medication discovered in 1916. The introduction of warfarin in the 1950s revolutionized anticoagulation by offering long-term oral regimens. Today, anticoagulants are crucial for managing conditions like deep vein thrombosis and pulmonary embolism, especially in an aging population with a rising prevalence of thrombotic complications. Three main types of anticoagulants are used today: vitamin K antagonists (VKAs), injectable heparins, and direct oral anticoagulants (DOACs). Despite advancements, managing anticoagulant therapy remains complex due to individual patient variability, the need for regular monitoring, and the delicate balance between preventing thrombosis and bleeding risks. Emerging trends include the development of factor XIa inhibitors, which promise more targeted thrombosis prevention with potentially lower bleeding risks. This review highlights the ongoing innovation in anticoagulant development, the need for precise management, and potential future avenues like factor XIa inhibitors. Additionally, artificial intelligence holds promise for improving patient outcomes and addressing the complexities of thrombotic disease management by personalizing therapy and reducing bleeding risks. Full article
(This article belongs to the Special Issue Advances in Thrombosis and Haemostasis)
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