Search Results (306)

Background/Objectives: Acute ischemic stroke (AIS) associated with cervical carotid artery pathology remains a therapeutic challenge due to uncertainty regarding emergent carotid artery stenting (eCAS) and the need for intensified antithrombotic therapy, which may increase the risk of hemorrhagic transformation (HT). This retrospective cohort study evaluated the functional and safety outcomes of eCAS within an extended treatment time window. Methods: We analyzed 139 consecutive patients with anterior circulation AIS and large vessel occlusion treated with mechanical thrombectomy between 2019 and 2024. Patients were eligible for MT within 24 h based on clinical–core mismatch (DAWN) or perfusion–core mismatch (DEFUSE 3) criteria. Outcomes were compared between patients treated with eCAS and those undergoing MT without stenting. Results: Twenty-five patients underwent eCAS, predominantly for tandem lesions (80%). Median age was 66 years, median baseline NIHSS was 14, and median infarct core volume on DWI/CTP was 15 mL. Baseline characteristics were comparable between groups, except for the site of occlusion (p < 0.001). A good functional outcome (modified Rankin Scale, mRS 0–2 at 90 days) was observed in 60% of patients in the eCAS group versus 43% in the non-stenting group, without statistical significance (p = 0.067). Rates of parenchymal hematoma (12% vs. 18.4%) and symptomatic intracerebral hemorrhage (8% vs. 3.5%) were similar between groups. Conclusions: In this single-center cohort, eCAS performed in an extended time window did not demonstrate a clear signal of increased hemorrhagic risk. However, residual confounding and imbalance between treatment groups persisted despite the application of inverse probability weighting (IPW), and the findings should be interpreted cautiously. Full article

Dragon’s Blood, from the Dracaena cochinchinensis plant, is known for enhancing blood circulation. Its main components are Dragon’s Blood phenolic extracts (DBE). To pinpoint the active DBE constituents that are effective against thrombosis and understand their mechanism of action, the PT-stroke model was employed to assess DBE’s antithrombotic effects on cerebral blood flow and platelet aggregation. This investigation demonstrates that DBE enhances cerebral blood flow and inhibits ADP-induced platelet aggregation in photothrombotic (PT) stroke models. An FeCl₃-induced carotid artery thrombosis model was developed to test the antithrombotic activity of four DBE fractions. Through screening with this model, the ethyl acetate (EA) and methanol fractions were identified as the principal active components that effectively reduced thrombus weight and improved hemodynamics. Furthermore, the EA fraction was found to preserve the integrity of the blood–brain barrier. Phytochemical isolation allowed for the identification of compounds in the EA fractions, and UHPLC-MS was performed to characterize DBE and its active components in the bloodstream. In vitro ADP-induced platelet aggregation assays highlighted the active compounds. Through phytochemical analysis, Loureirin D (compound 17) was identified as a predominant constituent present in plasma. In vitro assays revealed that compounds 1 and 17 possess strong antiplatelet activity, with Loureirin D being confirmed as a selective P2Y12 receptor antagonist via molecular docking and cellular thermal shift assays. These findings substantiate Loureirin D as a pivotal antithrombotic component in DBE and its potential as a P2Y12-targeting therapeutic agent for thrombosis treatment. Full article

Background: Acute coronary syndromes (ACSs) remain a leading cause of death and disability. Since the publication of the 2023 ESC ACS guidelines, multiple studies and an ESC/EAS dyslipidaemia update have refined how clinicians diagnose, revascularize, and treat ACS across the care continuum. Content: This state-of-the-art review synthesizes advances from 2023 to 2025 across five domains. Diagnosis: High-sensitivity troponin-based accelerated pathways remain foundational; GRACE 3.0 improves calibration for early vs. delayed angiography, while selective use of CCTA and routine use of intracoronary imaging/physiology help define the mechanism and optimize PCI. Revascularization: complete revascularization continues to underpin care in multivessel disease, with recent data favouring culprit-only PCI acutely and staged non-culprit treatment during the index stay in most STEMI presentations, particularly with heart-failure physiology. Antithrombotic therapy: Aspirin remains critical early after ACS-PCI; emerging evidence supports shorter DAPT and aspirin withdrawal after 1 month in carefully selected, low-ischaemic-risk patients, whereas day-0 aspirin-free strategies in unselected ACS are not non-inferior. Secondary prevention: A “strike early and strong” approach to LDL-cholesterol—often with combination therapy in hospital—is emphasized, alongside nuanced roles for SGLT2 inhibitors and GLP-1 receptor agonists. Special populations and implementation: Sex- and age-aware tailoring (including MINOCA/SCAD evaluation), pragmatic bleeding-risk mitigation, digitally enabled cardiac rehabilitation, and registry-driven quality improvement translate evidence into practice. Summary: Contemporary ACS care is moving from uniform protocols toward risk-stratified, mechanism-informed pathways. We offer practical algorithms and checklists to align interventional timing, antithrombotic intensity/duration, and secondary prevention with individual patient risk—bridging new evidence to bedside decisions. Full article

Small-diameter vascular grafts (SDVGs, ≤6 mm) face significant barriers in vascular reconstruction due to poor long-term patency stemming from thrombosis, intimal hyperplasia, and mechanical mismatch. Increasing rates of cardiovascular disease and limited autologous vessel supply underscore the urgent need for functional SDVGs. This review discusses the critical failure mechanisms of SDVGs and recent material-based advances—hydrophilic modifications, charge control, micro- and nano-engineering, antimicrobial and anti-inflammatory treatments, and controlled bioactive release (e.g., heparin, nitric oxide, t-PA). It details progress in cellular and tissue engineering for rapid endothelialization, smooth muscle regeneration, and mechanical durability. The review also highlights emerging gene engineering, the use of bioactive peptides, and molecular pathway strategies for physiological antithrombotic restoration. Finally, it outlines future directions, including smart materials, accelerated endothelialization, advanced manufacturing (3D printing, multilayer electrospinning), multifunctional composites, and clinical translation. Overall, SDVG research is shifting toward active, regenerative vascular substitutes with improved clinical prospects. Full article

Feline cardiogenic arterial thromboembolism (ATE) is a severe complication of cardiac disease in cats, often causing severe clinical signs and poor prognosis. Despite its importance, standardized guidelines for prevention and treatment are lacking. This systematic review evaluated available evidence on preventive, acute, and chronic management strategies for feline cardiogenic ATE. A comprehensive search using PubMed, Scopus and Web of Science was performed, following PRISMA 2020 guidelines. Peer-reviewed studies investigating therapeutic interventions for ATE were included. Risk of bias was assessed using the SYRCLE tool. Nineteen studies involving 909 cats were included. Preventive therapy with clopidogrel and rivaroxaban improved survival. Acute multimodal treatment combining anticoagulant and antiplatelet drugs improved survival compared to monotherapy. Thrombolytic therapy showed some efficacy but had frequent severe complications. Long-term management with clopidogrel and rivaroxaban achieved the longest survival and lowest recurrence, while acetylsalicylic acid provided inconsistent benefits and more adverse effects. Eleven of the nineteen (58%) studies had high risk of bias due to small sample size and heterogeneous protocols. Current evidence supports dual therapy, particularly clopidogrel with rivaroxaban or enoxaparin, as the most effective and well-tolerated approach for prevention and treatment. Larger, standardized prospective trials are urgently needed to strengthen the evidence. Full article

Peripheral artery disease (PAD) leads to reduced blood flow, primarily affecting the vessels of lower extremities. Symptoms include pain, cramping and reduced functional capacity, and patients are also at increased risk of cardiovascular complications and mortality. Postoperative medical management in PAD patients includes the use of antiplatelet and antithrombotic medications, which help to prevent postoperative graft and stent thrombosis and associated adverse effects. Despite extensive research, there is little consensus on the best strategy or medication regimen for patients with PAD or on monitoring strategies for the antithrombotic therapies. Thromboelastography, with the adjunct of platelet function assessment, is well established for providing real-time assessment of coagulation and platelet function in patients undergoing cardiovascular surgery or cardiovascular procedures. TEG^® PlateletMapping^® assays can assess hypercoagulable changes in pre- and post-intervention in cardiovascular patients, including in patients with PAD and help physicians guide antithrombotic treatments after revascularization. The use of thromboelastography with platelet function analysis provides an opportunity to tailor antithrombotic therapy and personalize care in patients with PAD, which could be integral to improving limb salvage and preventing adverse events in these patients. Full article

Although COVID-19 is associated with significant thrombo-inflammatory complications, reliable biomarkers to guide antithrombotic therapy remain limited. Immature platelet fraction (IPF) reflects platelet turnover and may indicate heightened thrombotic risk. We retrospectively analyzed 133 hospitalized COVID-19 patients (median age 68 years) at a single center. IPF and inflammatory markers (WBC, ANC, D-dimer, LDH, CRP) were measured on admission. Correlations between IPF and these biomarkers were assessed overall and in clinical subgroups (age, sex, disease severity, comorbidities, and treatment). We found that IPF was positively correlated with WBC and ANC in patients less than 70 years old (r = 0.36 and 0.33, respectively; p < 0.05), males, and those with moderate-to-severe disease. Among patients with congestive heart failure, IPF correlated strongly with D-dimer (r = 0.78, p = 0.013). Similar associations were observed in patients requiring enoxaparin or antiplatelet therapy. No significant correlations were found in patients age 70 or older. Based on these findings, we conclude that elevated IPF is associated with increased inflammatory and thrombotic activity in hospitalized COVID-19 patients, especially in younger, male, and more severe cases. These findings suggest IPF may serve as a dynamic marker for thrombo-inflammation and help identify patients who might benefit from more intensive antithrombotic therapy. Larger studies are warranted to validate IPF as a biomarker for personalized management of COVID-19. Full article

Prosthechea karwinskii is an orchid endemic to Mexico used for medicinal purposes. The objective of this study was to determine the anticoagulant potential ex vivo of the extract isolated using green solvents. Coagulometric assays were performed to evaluate the anticoagulant activity: activated partial thromboplastin time (APTT), prothrombin time (PT), and thrombin time (TT). For each assay, different concentrations of the extract were evaluated (0.5, 1.0, 1.5, 2.5, 3.5, 4.5, 5.5, 7.5, and 8.5 mg/mL) using platelet-poor plasma from healthy donors. The P. karwinskii leaves extract showed an anticoagulant effect by significantly prolonging (p < 0.05) the APTT and TT from a concentration of 3.5 and 2.5 mg/mL, respectively, compared to basal. The anticoagulant activity was concentration dependent. In addition, the hydroethanolic extract of P. karwinskii leaves inhibited factor XI activity by 86.10 ± 2.3%. The compounds in the extract were identified by ultra-high-performance liquid chromatography coupled with electrospray ionization and quadrupole time-of-flight mass spectrometry (UPLC-ESI-qTOF-MS/MS). The compounds identified were quinic acid, malic acid, succinic acid, L (-)-phenylalanine, guanosine, neochlorogenic acid, chlorogenic acid, rutin, kaempferol-3-O-rutinoside, azelaic acid, sebacic acid, pinellic acid, and embelin. Full article

Background: Cardiovascular diseases, driven by platelet hyperactivation and thrombosis, remain the leading global cause of death. Excessive platelet activation contributes to atherosclerosis and thrombo-inflammatory disorders, underscoring the urgent need for safer and more effective antiplatelet agents. Objectives:Xanthium strumarium L. (X. strumarium) has been reported to exhibit a wide range of pharmacological effects, including anti-inflammatory and antioxidant activities. However, its antiplatelet and antithrombotic effects remain unexplored. Therefore, the present study aimed to comprehensively evaluate the antiplatelet and antithrombotic effects of X. strumarium through integrated in vitro and in vivo experiments. Methods: The principal bioactive compounds present in the X. strumarium extract were identified through GC–MS analysis. In vitro antiplatelet effects were evaluated via light transmission aggregometry, scanning electron microscopy (SEM), ATP and calcium mobilization assays, αIIbβ3 binding assay, clot retraction assay, and Western blotting. In vivo ferric chloride-induced (FeCl₃) murine thrombus model was established to evaluate thrombogenesis. Results: Our results demonstrated that X. strumarium at 25, 50, or 100 μg/mL significantly inhibited collagen, ADP, U46619, and thrombin-induced platelet aggregation. SEM revealed that X. strumarium pretreatment markedly preserved the resting platelet morphology and inhibited collagen-induced activation and shape changes. Further, the granule secretion, integrin-αIIbβ3 signaling, and the MAPK and PI3K/Akt pathways were also concentration-dependently inhibited. The in vivo blood flow rate and mice survival were improved, and H&E staining further revealed a concentration-dependent prevention of arterial occlusion following X. strumarium treatment. Conclusions: Collectively, X. strumarium demonstrated potent antiplatelet and antithrombotic effects, improving blood flow and survival while preventing arterial occlusion. Full article

Background/Objectives: Complex aneurysms of the posterior inferior cerebellar artery (PICA) remain challenging because of their deep location, variable morphology, and proximity to critical neurovascular structures. Although endovascular therapy is preferred, its feasibility is limited in wide-necked, fusiform, or dissecting lesions. We describe our tertiary referral hospital single-center experience with tailored microsurgical and endovascular strategies—emphasizing occipital artery–PICA (OA-PICA) bypass, transcondylar fossa craniotomy, and cerebellomedullary fissure opening—and analyze perioperative factors that influence outcome. Methods: All consecutive patients treated for PICA origin or distal-PICA aneurysms between January 2021 and April 2025 were retrospectively reviewed. Demographics, aneurysm characteristics, procedure type, antithrombotic regimen, complications, diffusion-weighted MRI findings, and 3-month modified Rankin Scale scores were collected. Results: Twelve aneurysms (mean age 61.4 ± 15.2 years; 8 women) were treated: trapping + OA-PICA bypass in 5, direct clipping in 2, flow diverter in 1, endovascular parent artery occlusion in 2, coil embolization in 1, and a hybrid bypass-plus-coil strategy in 1. Two cases were ruptured aneurysms. Perioperative aspirin was used in 2/5 bypass cases; heparin was added in one hybrid case. Asymptomatic PICA-territory infarcts occurred in the three bypasses performed without antiplatelet therapy (one with intra-anastomotic thrombus). No leaks or subcutaneous collections of cerebrospinal fluid were encountered, and no graft occlusions were observed. At 3 months, 9/12 patients achieved a good outcome (mRS 0–2); among them, only one patient with subarachnoid hemorrhage (SAH) experienced postoperative worsening of the mRS. Two cranial nerve palsies (one permanent, one transient) and one wound site hematoma (heparin-associated) resolved without sequelae. Conclusions: Meticulous operative planning allows safe treatment of complex PICA aneurysms. Perioperative aspirin appears beneficial for OA-PICA bypass, whereas perioperative heparin increases bleeding risk. Individualized selection of endovascular, microsurgical, or combined strategies yields favorable early neurological outcomes in this demanding subset of cerebrovascular disease. Full article

The coronary no-reflow phenomenon remains a daunting and unresolved barrier during percutaneous coronary procedures, especially for acute coronary syndrome. Despite successful epicardial artery patency restoration, decreased microvascular perfusion leads to unfavorable outcomes such as ventricular remodeling, progression of heart failure, and increased mortality. This review provides a new, integrative informative perspective by combining multifactorial pathophysiology, which includes systemic inflammation, thrombogenicity, ischemia–reperfusion injury, and distal embolization, with advances in diagnostic imaging, such as cardiac magnetic resonance and computed tomography. Therapeutic options, including antithrombotic regimes, vasodilators, and mechanical adjuncts, are evaluated in the context of developing debates and unmet clinical needs. Importantly, we provide feasible future directions for artificial intelligence-based predictive modeling and targeted microvascular treatments. This comprehensive review fills a significant gap, aiming to inform personalized approaches and improve both short- and long-term outcomes in this high-risk patient population. Full article

Young women who have survived cancer may have lost their fertility due to cytotoxic treatments like chemotherapy or irradiation. So far, oocyte or ovarian tissue cryopreservation are well-known and well-used opportunities for fertility preservation prior cytotoxic therapies. However, these methods are not possible in certain cases, like those with a high risk of ovarian metastasis or prepubertal girls. Therefore, new medical and biotechnological options are also being sought to help this patient group to fulfill their desire to have their own biological children. The investigation described here focuses on the possibility of in vitro follicle maturing. To this point, a long-term temperature and pH-controlled bioreactor system is developed that can supply a whole ovary with oxygen and nutrients over several days and offers the possibility of hormone administration or the delivery of other drugs. This bioreactor was then tested with mature bovine ovaries. After appropriate cannulation, antithrombotic vascular perfusion, and antibiotic pretreatment, the ovaries were cultured for up to 9 days without any contamination or suffering major vital cell damage. The controlled application of oocyte stimulation hormones (human menopausal gonadotropin; hMG) also enabled successful in vitro follicle growth and maturation. From a technical point of view, there is still optimization potential for this bioreactor system, but in principle, it has been demonstrated that long-term ovary cultivation and in vitro maturation of follicles are possible, which opens up further potential for these and other applications. Full article

Chalcones, a class of flavonoid compounds, are recognized for their unique biological properties, and especially for their antithrombotic, anti-inflammatory, and antioxidant health-promoting properties against inflammation-related disorders. Chalcones are phytochemicals naturally found in plants, fruits, and vegetables, such as tomatoes, apples, and licorice. Their characteristic chemical structure, which includes two aromatic rings and an α,β-unsaturated carbonyl group, makes them particularly versatile for pharmaceutical use. At the same time, chalcones exhibit strong antioxidant activity by neutralizing free radicals and enhancing endogenous antioxidant defense systems, such as glutathione. Structural modifications have improved their biological activity, leading to important applications in the treatment of atherosclerosis and cardiovascular diseases, cancer, neurodegenerative diseases, and inflammatory disorders. In addition, they have been successfully used in agriculture as natural pesticides and in the food industry as antioxidant additives. This review demonstrates the interdisciplinary importance of chalcones, highlighting the need for further research into their molecular mechanisms of action. A deeper understanding of their properties may open new avenues for the development of innovative drugs and environmentally friendly applications. In this way, chalcones can be a decisive factor in improving human health and environmental sustainability. Full article

Novel antidiabetic drugs introduced in the last decade have not only revolutionized the treatment of type 2 diabetes mellitus but have also changed our cardiovascular risk reduction strategy. Glucagon-like peptide-1 (GLP-1) receptor agonists reduce the risk of atherosclerotic diseases primarily through their complex anti-atherosclerotic effect due to their endothelial function-improving, anti-inflammatory, anti-thrombotic, and plaque-stabilizing effects. Sodium–glucose cotransporter 2 (SGLT2) inhibitors, on the other hand, have a favorable cardiovascular effect, mainly by increasing sodium excretion, reducing plasma volume, enhancing the use of ketone bodies as metabolic substrates in heart and kidney tissues, and reducing oxidative stress and uric acid serum levels. However, when using these two groups of drugs, important questions arise. What criteria should be used to decide on the administration of one or the other class of drugs? Which group of agents can be used more effectively to reduce our patients’ cardiovascular risk? What are the possible adverse effects? What can be gained by combining the two drugs? Our objective was to provide a current literature-based and comparative summary on the mechanisms of action, cardiovascular-risk-reducing efficacy, and safety profiles of these two drug classes, with an emphasis on identifying key factors influencing everyday clinical decision-making. Full article

The number of elderly patients requiring antithrombotic therapy (for example, those with atrial fibrillation, ischemic heart disease, peripheral arterial disease, or venous thrombo-embolism) is increasing worldwide due to population aging. These patients are often frail and therefore at increased risk of both thromboembolic events and bleeding complications during antithrombotic treatment. Therapeutic decision-making is further complicated by the underrepresentation of older adults in large randomized trials and the resulting scarcity of age-specific, evidence-based data. As a result, their management is not guided by specific recommendations but rather relies on clinician evaluation in an individualized, patient-by-patient approach. The aim of this narrative review is to discuss the current optimal therapeutic strategies for the management of elderly patients in different clinical conditions requiring antithrombotic therapy. We analyze the efficacy and safety of the different anti-thrombotic drugs and guidelines indications by discussing the clinical data available from randomized as well as observational studies. At the same time, we focus into the future of antithrombotic therapy presenting new drugs and new strategies for the management of elderly patients requiring antithrombotic therapy. Full article