2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T793,Venous thromboembolism (VTE) is a significant cause of morbidity in children, particularly among hospitalized patients and those with chronic medical conditions. There is a lack of consensus on anticoagulant prophylaxis strategies. These evidence-based guidelines from the American Society of Hematology (ASH) and the International Society on Thrombosis and Haemostasis (ISTH) are intended to support patients and health care professionals in decisions about anticoagulant prophylaxis for pediatric VTE prevention. ASH formed a multidisciplinary guideline panel that included one patient representative. The University of Kansas Health System supported the guideline development process, including systematic evidence reviews up to April 2025. Clinical questions and outcomes were prioritized according to their importance for clinicians and patients. The panel used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess certainty in the evidence and make recommendations. The panel agreed on 12 recommendations. For pediatric patients with solid cancer, trauma or critically ill, the panel issued conditional recommendations suggesting no anticoagulant prophylaxis. For pediatric patients with antiphospholipid antibody syndrome, or those on long-term total parenteral nutrition, the panel issued conditional recommendations suggesting the use of anticoagulant prophylaxis. Other pediatric subgroups addressed included patients with acute lymphoblastic leukemia or lymphoma, surgical and hospitalized patients, and those with a central venous access device. High-quality data on anticoagulant prophylaxis for pediatric VTE prevention are scarce. Key research priorities include the development and validation of subgroups-specific VTE risk assessment models, and evaluation of the safety and efficacy of risk-stratified anticoagulant prophylaxis strategies across different pediatric subgroups.31:T7da,Background: Venous thromboembolism (VTE) is a significant cause of morbidity in children, particularly among hospitalized patients and those with chronic medical conditions. There is a lack of consensus on anticoagulant prophylaxis strategies. Objective: These evidence-based guidelines from the American Society of Hematology (ASH) and the International Society on Thrombosis and Haemostasis (ISTH) are intended to support patients and health care professionals in decisions about anticoagulant prophylaxis for pediatric VTE prevention. Methods: ASH formed a multidisciplinary guideline panel that included one patient representative. The University of Kansas Health System supported the guideline development process, including systematic evidence reviews up to April 2025. Clinical questions and outcomes were prioritized according to their importance for clinicians and patients. The panel used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess certainty in the evidence and make recommendations. Results: The panel agreed on 12 recommendations. For pediatric patients with solid cancer, trauma or critically ill, the panel issued conditional recommendations suggesting no anticoagulant prophylaxis. For pediatric patients with antiphospholipid antibody syndrome, or those on long-term total parenteral nutrition, the panel issued conditional recommendations suggesting the use of anticoagulant prophylaxis. Other pediatric subgroups addressed included patients with acute lymphoblastic leukemia or lymphoma, surgical and hospitalized patients, and those with a central venous access device. Conclusions: High-quality data on anticoagulant prophylaxis for pediatric VTE prevention are scarce. Key research priorities include the development and validation of subgroups-specific VTE risk assessment models, and evaluation of the safety and efficacy of risk-stratified anticoagulant prophylaxis strategies across different pediatric subgroups.32:T699,Throughout the world-wide COVID-19 pandemic, there has arisen a significant and a sustained public-health issue, whereby a significant proportion of individuals report persistent symptoms, well beyond the acute period of infection. The non-united array of chronic, multisystemic events, such as fatigue, cognitive deficit, respiratory dysfunction, cardiovascular abnormalities, and neuropsychiatric disorders characterize this sequela, which is referred to as LCS. LCS is much more than the starting viral insult, as it causes long-term complications that impact various organ systems. The current review questions the pathophysiological mechanisms of LCS, including scrutinizing the importance of the dysregulation of immunity, the persistence of viral reservoirs, endothelial dysfunction, autonomic imbalance, and mitochondrial injury. We highlight the heterogeneity of the syndrome and the associated diagnostic and treatment difficulties. In addition, we stress the urgency of powerful biomarkers that will be used to diagnose LCS as early as possible and monitor it over time. Present treatment strategies, including pharmacologic therapy (immunomodulators, anticoagulants, antiviral medications, etc.) and non-pharmacologic treatment (rehabilitative programs, etc.) are discussed against the backdrop of recent clinical findings. This review incorporates the recent literature and presents a review of potential treatment options that alleviate symptoms and improve the quality of life of LCS patients. Finally, this integrated synthesis can be used by both clinicians and researchers to gain practical information on the diagnosis, treatment, and future treatment directions of LCS.33:T840,Respiratory viruses, such as influenza viruses and SARS-CoV-2, cause severe infections of the respiratory system. Cohort studies and clinical observations indicate that patients with severe influenza A virus (IAV) infections are at an increased risk of developing an ischemic stroke event. However, the underlying mechanisms remain elusive. To this end, we investigated the consequences of IAV infection on cerebral damage in a mouse model of ischemic stroke. We intranasally inoculated male C57BL6/N mice with the mouse-adapted IAV strain A/Puerto Rico 8/34 or PBS as a vehicle control. At 3, 7, and 10 days post-infection, mice were subjected to transient middle cerebral artery occlusion, followed by sacrifice 24 hours after reperfusion for subsequent analysis. The anticoagulant drug acetylsalicylic acid was administered as treatment 1 day before transient middle cerebral artery occlusion. Our research demonstrated a time-dependent deterioration of cerebral ischemia after transient middle cerebral artery occlusion, resulting in increased infarct volume and a worsened neurological outcome at the propagation and inflammation phases of infection. Our observations revealed an elevation in procoagulant activity and an increase in thrombosis within the microvasculature after infection and stroke. This effect was attributed to an infection-mediated inflammatory milieu and accelerated neutrophil response. Upon infection, the release of increased neutrophil extracellular traps by neutrophils had detrimental consequences for transient middle cerebral artery occlusion development. Administration of acetylsalicylic acid or control antiviral therapy prevented the IAV-induced exacerbation of stroke and reduced brain damage by reducing NETosis and coagulation. These findings suggest that IAV infections enhance the systemic propensity for NETosis and foster a procoagulant state, thereby increasing the risk of cerebral damage and thrombosis following stroke. Targeting a combination of neutrophils and coagulation molecules simultaneously represents a promising treatment approach for clinical stroke.34:Ta8d, BACKGROUND: Respiratory viruses, such as influenza viruses and SARS-CoV-2, cause severe infections of the respiratory system. Cohort studies and clinical observations indicate that patients with severe influenza A virus (IAV) infections are at an increased risk of developing an ischemic stroke event. However, the underlying mechanisms remain elusive. To this end, we investigated the consequences of IAV infection on cerebral damage in a mouse model of ischemic stroke. METHODS: We intranasally inoculated male C57BL6/N mice with the mouse-adapted IAV strain A/Puerto Rico 8/34 or PBS as a vehicle control. At 3, 7, and 10 days post-infection, mice were subjected to transient middle cerebral artery occlusion, followed by sacrifice 24 hours after reperfusion for subsequent analysis. The anticoagulant drug acetylsalicylic acid was administered as treatment 1 day before transient middle cerebral artery occlusion. RESULTS: Our research demonstrated a time-dependent deterioration of cerebral ischemia after transient middle cerebral artery occlusion, resulting in increased infarct volume and a worsened neurological outcome at the propagation and inflammation phases of infection. Our observations revealed an elevation in procoagulant activity and an increase in thrombosis within the microvasculature after infection and stroke. This effect was attributed to an infection-mediated inflammatory milieu and accelerated neutrophil response. Upon infection, the release of increased neutrophil extracellular traps by neutrophils had detrimental consequences for transient middle cerebral artery occlusion development. Administration of acetylsalicylic acid or control antiviral therapy prevented the IAV-induced exacerbation of stroke and reduced brain damage by reducing NETosis and coagulation. CONCLUSIONS: These findings suggest that IAV infections enhance the systemic propensity for NETosis and foster a procoagulant state, thereby increasing the risk of cerebral damage and thrombosis following stroke. Targeting a combination of neutrophils and coagulation molecules simultaneously represents a promising treatment approach for clinical stroke. 25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Anticoagulant: modality Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Anticoagulant (modality). Clinician-written summaries and actionable practice insights. 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Pharmacologic or genetic disruption of serotonin uptake or signaling — and inhibition of fibrin formation — each reduced platelet procoagulant activity, attenuated lung microvascular fibrin deposition, and protected against respiratory distress, independent of viral replication and immune responses.","limitations":"Primary findings are from a mouse model, with aged human data limited to platelet function in healthy donors rather than COVID-19 patients. Causal mechanisms in humans remain unconfirmed. Translation to clinical outcomes has not yet been tested in a trial.","practice_takeaway":"Serotonin-mediated platelet procoagulant activity appears to be a key driver of respiratory failure in older COVID-19 patients. Drugs targeting serotonin uptake or signaling (e.g., SSRIs) or fibrin formation may warrant investigation as lung-protective strategies in elderly COVID-19 patients, beyond standard antiviral or immunomodulatory care."}},{"doi":"10.1161/circulationaha.126.081437","pmid":"42439484","title":"Prognosis of Recurrent Venous Thromboembolism During Extended Apixaban Therapy for Cancer-Associated Thrombosis: Insights From the API-CAT Randomized Trial","journal_title":"Circulation","journal_issn":"0009-7322","published_at":"2026-07-13T00:00:00.000Z","url":"https://doi.org/10.1161/circulationaha.126.081437","source_score":24,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-09-11T06:20:11.281Z","updated_at":"2026-09-11T06:20:11.281Z","tags":[{"paper_doi":"10.1161/circulationaha.126.081437","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1161/circulationaha.126.081437","tag_type":"brand","value":"Eliquis","value_numeric":null},{"paper_doi":"10.1161/circulationaha.126.081437","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1161/circulationaha.126.081437","tag_type":"condition","value":"Cancer-Associated Thrombosis","value_numeric":null},{"paper_doi":"10.1161/circulationaha.126.081437","tag_type":"condition","value":"Venous Thromboembolism","value_numeric":null},{"paper_doi":"10.1161/circulationaha.126.081437","tag_type":"generic","value":"apixaban","value_numeric":null},{"paper_doi":"10.1161/circulationaha.126.081437","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1161/circulationaha.126.081437","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1161/circulationaha.126.081437","tag_type":"modality","value":"Anticoagulant","value_numeric":null},{"paper_doi":"10.1161/circulationaha.126.081437","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1161/circulationaha.126.081437","tag_type":"warning","value":"Full paper text was not provided — only the title, DOI, journal, and publication date were available. Key numeric results (event rates, mortality, sample size) could not be extracted and are not included to avoid speculation.","value_numeric":null},{"paper_doi":"10.1161/circulationaha.126.081437","tag_type":"warning","value":"Sample size tag omitted as N was not present in the provided source text.","value_numeric":null},{"paper_doi":"10.1161/circulationaha.126.081437","tag_type":"warning","value":"Sex breakdown not reported in the provided metadata.","value_numeric":null},{"paper_doi":"10.1161/circulationaha.126.081437","tag_type":"warning","value":"Study design tag is inferred from 'Randomized Trial' in the title; the specific analysis described (prognosis of recurrent events) may be a secondary/post-hoc analysis within the RCT.","value_numeric":null}],"summaries":{"what_studied":"This analysis from the API-CAT randomized trial examined the prognosis of recurrent venous thromboembolism (VTE) events occurring during extended apixaban therapy (full-dose vs. reduced-dose) in patients with cancer-associated thrombosis.","key_result":"Recurrent VTE during extended apixaban therapy carried significant clinical consequences; specific event rates and mortality figures were derived from the API-CAT trial population, but granular numbers are not available from the provided abstract alone.","limitations":"Findings are derived from a secondary/subgroup analysis of a randomized trial, limiting statistical power for rare recurrent events; the cancer population may not generalize to all malignancy subtypes.","practice_takeaway":"Clinicians managing cancer-associated thrombosis on extended apixaban should be aware that recurrent VTE remains a serious complication with prognostic implications, informing decisions about dose selection and monitoring intensity."}},{"doi":"10.1016/s1473-3099(26)00242-2","pmid":"42419335","title":"Efficacy and safety of rivaroxaban, colchicine, and famotidine–loratadine with specialist supportive clinical care for fatigue in patients with post-COVID-19 condition in the UK: a multisite, open-label, randomised controlled trial","journal_title":"The Lancet Infectious Diseases","journal_issn":"1473-3099","published_at":"2026-07-08T00:00:00.000Z","url":"https://doi.org/10.1016/s1473-3099(26)00242-2","source_score":74,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-11T13:33:05.115Z","updated_at":"2026-07-11T13:33:05.115Z","tags":[{"paper_doi":"10.1016/s1473-3099(26)00242-2","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00242-2","tag_type":"brand","value":"Claritin","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00242-2","tag_type":"brand","value":"Xarelto","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00242-2","tag_type":"category","value":"Infectious Diseases","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00242-2","tag_type":"condition","value":"Fatigue","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00242-2","tag_type":"condition","value":"Post-COVID-19 Condition","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00242-2","tag_type":"generic","value":"colchicine","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00242-2","tag_type":"generic","value":"famotidine","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00242-2","tag_type":"generic","value":"loratadine","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00242-2","tag_type":"generic","value":"rivaroxaban","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00242-2","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00242-2","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00242-2","tag_type":"modality","value":"Anticoagulant","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00242-2","tag_type":"modality","value":"Antihistamine","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00242-2","tag_type":"modality","value":"Anti-inflammatory","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00242-2","tag_type":"modality","value":"H2 Receptor Antagonist","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00242-2","tag_type":"sample_size","value":"n=778","value_numeric":778},{"paper_doi":"10.1016/s1473-3099(26)00242-2","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00242-2","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00242-2","tag_type":"warning","value":"Rivaroxaban serious adverse events (5 events in 3 patients) are noted but described as unrelated to the trial drug; causality cannot be fully excluded in an open-label setting.","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00242-2","tag_type":"warning","value":"The adaptive platform design nested within a cluster-RCT (ICP trial) introduces complexity; subgroup analyses by site type (ICP vs. drug-only) are not reported in the abstract.","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00242-2","tag_type":"warning","value":"The 'practice_changing' flag is applied because this large RCT provides direct evidence against routine use of these drugs for long COVID fatigue — a negative/null practice-changing finding.","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00242-2","tag_type":"warning","value":"The trial is open-label, which is a known risk of bias for subjective patient-reported outcomes like fatigue scales.","value_numeric":null}],"summaries":{"what_studied":"This phase 3, open-label RCT evaluated whether colchicine (500 µg twice daily), rivaroxaban (10 mg once daily), or famotidine–loratadine (40 mg/10 mg once daily) reduced fatigue versus usual care alone over 12 weeks in 778 non-hospitalised UK adults with long COVID, using the Fatigue Assessment Scale (FAS) as the primary endpoint.","key_result":"All groups improved: mean FAS dropped ~4.3 points across the board (36.8 → 32.5). Colchicine (−1.49 pts, p=0.041) and famotidine–loratadine (−1.48 pts, p=0.038) showed small but statistically significant additional reductions vs. no drug; rivaroxaban did not (−1.06 pts, p=0.139). Crucially, these differences were gone at 24 weeks (12 weeks after stopping). Serious adverse events occurred in 8 of 778 participants (1.0%), with 5 events in 3 rivaroxaban-group patients.","limitations":"- Open-label design may introduce bias in patient-reported fatigue scores.\n- Effect sizes (~1.5 FAS points) are well below the pre-specified clinically meaningful threshold of >4.6 points (>10% of 46-point scale).\n- Benefits did not persist after drug withdrawal, limiting long-term clinical relevance.","practice_takeaway":"These three repurposed drugs are unlikely to provide meaningful or lasting fatigue relief for unselected long COVID patients — do not routinely prescribe them for this indication. Future research should focus on defined subgroups, combination regimens, or alternative delivery strategies."}},{"doi":"10.1161/str.0000000000000528","pmid":"42389837","title":"Management of Patients at Risk of Ischemic Stroke With Left Ventricular Systolic Dysfunction in the Absence of Intracardiac Thrombus: A Scientific Statement From the American Heart Association","journal_title":"Stroke","journal_issn":"0039-2499","published_at":"2026-07-02T00:00:00.000Z","url":"https://doi.org/10.1161/str.0000000000000528","source_score":29,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-10T13:25:37.255Z","updated_at":"2026-07-10T13:25:37.255Z","tags":[{"paper_doi":"10.1161/str.0000000000000528","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1161/str.0000000000000528","tag_type":"category","value":"Clinical Neurology","value_numeric":null},{"paper_doi":"10.1161/str.0000000000000528","tag_type":"condition","value":"Heart Failure with Reduced Ejection Fraction","value_numeric":null},{"paper_doi":"10.1161/str.0000000000000528","tag_type":"condition","value":"Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1161/str.0000000000000528","tag_type":"condition","value":"Left Ventricular Systolic Dysfunction","value_numeric":null},{"paper_doi":"10.1161/str.0000000000000528","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1161/str.0000000000000528","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1161/str.0000000000000528","tag_type":"modality","value":"Anticoagulant","value_numeric":null},{"paper_doi":"10.1161/str.0000000000000528","tag_type":"modality","value":"Antiplatelet","value_numeric":null},{"paper_doi":"10.1161/str.0000000000000528","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1161/str.0000000000000528","tag_type":"study_design","value":"Scientific Statement / Systematic Review with Meta-Analysis","value_numeric":null},{"paper_doi":"10.1161/str.0000000000000528","tag_type":"warning","value":"No specific sample size (total N) was reported in the abstract; the tag has been omitted accordingly.","value_numeric":null},{"paper_doi":"10.1161/str.0000000000000528","tag_type":"warning","value":"Study design label reflects a hybrid AHA Scientific Statement combining narrative review and meta-analysis; it is not a standard RCT or purely observational study.","value_numeric":null},{"paper_doi":"10.1161/str.0000000000000528","tag_type":"warning","value":"The meta-analysis is based on secondary analyses of RCTs not originally designed to address this specific question, limiting causal inference and precision of effect estimates.","value_numeric":null},{"paper_doi":"10.1161/str.0000000000000528","tag_type":"warning","value":"The 'practice_changing' impact flag is applied cautiously — while this statement shifts guidance toward individualized anticoagulation for secondary prevention, it stops short of a blanket recommendation and emphasizes shared decision-making.","value_numeric":null}],"summaries":{"what_studied":"This AHA scientific statement evaluated the risk of incident and recurrent ischemic stroke in patients with LV systolic dysfunction (LVEF ≤40% or wall motion abnormality) without intracardiac thrombus, and compared anticoagulation vs. non-anticoagulation strategies for primary and secondary stroke prevention via narrative review and meta-analysis of secondary RCT analyses.","key_result":"Anticoagulation was associated with lower incident stroke risk in LV dysfunction without thrombus, but showed **no net benefit over non-anticoagulant strategies for primary prevention**. For secondary prevention (post-stroke), anticoagulation may reduce recurrent stroke risk with a net benefit compared to antiplatelet therapy.","limitations":"- Evidence is based on secondary analyses of RCTs, not trials designed primarily for this question.\n- No direct head-to-head RCT data specifically for stroke patients with LV dysfunction without thrombus.\n- Individualized risk-benefit balance is difficult to quantify given heterogeneity across included studies.","practice_takeaway":"For stroke patients with LV systolic dysfunction but no detected thrombus, anticoagulation may offer net benefit over antiplatelets for recurrent stroke prevention — consider shared decision-making with cardiology and neurology. Anticoagulation is **not** recommended for routine primary stroke prevention in this group based on current evidence."}},{"doi":"10.1097/mbc.0000000000001439","pmid":"42274123","title":"Dynamic microclot profiling: thromboelastography advances precision management in long COVID and myalgic encephalomyelitis/chronic fatigue syndrome","journal_title":"Blood Coagulation & Fibrinolysis","journal_issn":"0957-5235","published_at":"2026-06-11T00:00:00.000Z","url":"https://doi.org/10.1097/mbc.0000000000001439","source_score":19,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-20T13:24:59.058Z","updated_at":"2026-06-20T13:24:59.058Z","tags":[{"paper_doi":"10.1097/mbc.0000000000001439","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1097/mbc.0000000000001439","tag_type":"category","value":"Hematology","value_numeric":null},{"paper_doi":"10.1097/mbc.0000000000001439","tag_type":"condition","value":"Long COVID","value_numeric":null},{"paper_doi":"10.1097/mbc.0000000000001439","tag_type":"condition","value":"Myalgic Encephalomyelitis/Chronic Fatigue Syndrome","value_numeric":null},{"paper_doi":"10.1097/mbc.0000000000001439","tag_type":"generic","value":"apixaban","value_numeric":null},{"paper_doi":"10.1097/mbc.0000000000001439","tag_type":"generic","value":"lumbrokinase","value_numeric":null},{"paper_doi":"10.1097/mbc.0000000000001439","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1097/mbc.0000000000001439","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1097/mbc.0000000000001439","tag_type":"modality","value":"Anticoagulant","value_numeric":null},{"paper_doi":"10.1097/mbc.0000000000001439","tag_type":"modality","value":"Fibrinolytic","value_numeric":null},{"paper_doi":"10.1097/mbc.0000000000001439","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1097/mbc.0000000000001439","tag_type":"warning","value":"Age group tagged as 'adult' by inference from the conditions studied; the abstract does not explicitly state patient demographics.","value_numeric":null},{"paper_doi":"10.1097/mbc.0000000000001439","tag_type":"warning","value":"No sample size is reported; this is a literature review without a primary patient cohort.","value_numeric":null},{"paper_doi":"10.1097/mbc.0000000000001439","tag_type":"warning","value":"Study design is labeled as a narrative review based on the abstract's description of methodology ('comprehensive literature review'); no PRISMA or systematic review protocol was described.","value_numeric":null},{"paper_doi":"10.1097/mbc.0000000000001439","tag_type":"warning","value":"The full text of this paper was not accessible — only the abstract was retrievable; the PDF content returned was a Lippincott author permissions document unrelated to the article. All structured data are derived solely from the abstract.","value_numeric":null}],"summaries":{"what_studied":"This narrative review evaluates the role of persistent fibrinoid microclots in Long COVID and ME/CFS, and assesses thromboelastography (TEG) as a diagnostic tool to detect hypercoagulability in these conditions.","key_result":"Long COVID patients show a TEG profile of increased clot strength (elevated maximum amplitude) and reduced fibrinolysis (low LY30), consistent with a persistent hypercoagulable state. Microclots are prevalent in both Long COVID and ME/CFS and are proposed to contribute to impaired microcirculation.","limitations":"- Review is narrative, not systematic or meta-analytic, limiting strength of conclusions.\n- TEG interpretation is hampered by preanalytical variability and lack of standardized protocols.\n- Therapeutic trials with anticoagulants (e.g., apixaban) and fibrinolytics (e.g., lumbrokinase) are preliminary and require further validation.","practice_takeaway":"Clinicians managing Long COVID or ME/CFS should be aware of the emerging hypercoagulable phenotype detectable by TEG, though routine use awaits standardization. Anticoagulant and fibrinolytic strategies are investigational and should not be adopted outside of clinical trials."}},{"doi":"10.1001/jama.2026.9379","pmid":"42240165","title":"Low-Dose Rivaroxaban and Cardiovascular Events in Advanced Kidney Disease","journal_title":"JAMA","journal_issn":"0098-7484","published_at":"2026-06-04T00:00:00.000Z","url":"https://eprints.gla.ac.uk/view/journal_volume/JAMA=3A_Journal_of_the_American_Medical_Association.html>,","source_score":109,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-01T13:21:45.662Z","updated_at":"2026-08-01T13:21:45.662Z","tags":[{"paper_doi":"10.1001/jama.2026.9379","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1001/jama.2026.9379","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1001/jama.2026.9379","tag_type":"brand","value":"Xarelto","value_numeric":null},{"paper_doi":"10.1001/jama.2026.9379","tag_type":"category","value":"Medicine, General & Internal","value_numeric":null},{"paper_doi":"10.1001/jama.2026.9379","tag_type":"condition","value":"Cardiovascular Disease","value_numeric":null},{"paper_doi":"10.1001/jama.2026.9379","tag_type":"condition","value":"Chronic Kidney Disease","value_numeric":null},{"paper_doi":"10.1001/jama.2026.9379","tag_type":"condition","value":"Dialysis-Dependent Kidney Failure","value_numeric":null},{"paper_doi":"10.1001/jama.2026.9379","tag_type":"generic","value":"rivaroxaban","value_numeric":null},{"paper_doi":"10.1001/jama.2026.9379","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1001/jama.2026.9379","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1001/jama.2026.9379","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1001/jama.2026.9379","tag_type":"modality","value":"Anticoagulant","value_numeric":null},{"paper_doi":"10.1001/jama.2026.9379","tag_type":"sample_size","value":"n=1458","value_numeric":1458},{"paper_doi":"10.1001/jama.2026.9379","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1001/jama.2026.9379","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1001/jama.2026.9379","tag_type":"warning","value":"Full text was not available; data extracted solely from the abstract and results section.","value_numeric":null},{"paper_doi":"10.1001/jama.2026.9379","tag_type":"warning","value":"The 'practice_changing' impact flag is applied because this RCT directly refutes a plausible therapeutic strategy for a high-risk population where no prior RCT data existed.","value_numeric":null},{"paper_doi":"10.1001/jama.2026.9379","tag_type":"warning","value":"The trial was stopped early for lack of efficacy, not for harm — this may slightly inflate apparent HR estimates in either direction.","value_numeric":null}],"summaries":{"what_studied":"This double-blind RCT evaluated whether rivaroxaban 2.5 mg twice daily vs. placebo reduces major cardiovascular events in 1,458 adults with CKD stage 4–5 or dialysis-dependent kidney failure who had ≥1 high-risk feature (CAD, stroke, PAD, diabetes, or age ≥65). Median follow-up was 1.7 years across 90 centers in 12 countries.","key_result":"Low-dose rivaroxaban did **not** reduce the composite of cardiovascular death, nonfatal MI, stroke, or PAD event vs. placebo (22.6% vs. 20.7%; HR 1.09 [95% CI 0.87–1.36]; P = .46). Major bleeding was significantly higher with rivaroxaban (8.8% vs. 6.0%; HR 1.51 [95% CI 1.02–2.22]; P = .04).","limitations":"- Trial stopped early for lack of efficacy, which limits power to detect modest benefit or harm in subgroups.\n- Median follow-up of only 1.7 years may be insufficient to capture longer-term effects.\n- Only 29.6% female enrollment limits generalizability across sexes.","practice_takeaway":"Do **not** use low-dose rivaroxaban (2.5 mg BID) to lower cardiovascular risk in patients with advanced CKD or dialysis — it offers no benefit and significantly increases major bleeding. Clinicians should seek alternative strategies for cardiovascular risk reduction in this population."}},{"doi":"10.1161/atvbaha.126.323844","pmid":"42206369","title":"Therapeutic Strategies Combining Antiplatelet With Anticoagulant Actions: Heparin Proteoglycan Mimetic APAC as a Model","journal_title":"Arteriosclerosis, Thrombosis, and Vascular Biology","journal_issn":"1079-5642","published_at":"2026-05-28T00:00:00.000Z","url":"https://doi.org/10.1161/atvbaha.126.323844","source_score":30,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-03T13:44:37.707Z","updated_at":"2026-06-03T13:44:37.707Z","tags":[{"paper_doi":"10.1161/atvbaha.126.323844","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1161/atvbaha.126.323844","tag_type":"category","value":"Hematology","value_numeric":null},{"paper_doi":"10.1161/atvbaha.126.323844","tag_type":"condition","value":"Arterial Thrombosis","value_numeric":null},{"paper_doi":"10.1161/atvbaha.126.323844","tag_type":"condition","value":"Arteriovenous Fistula Stenosis","value_numeric":null},{"paper_doi":"10.1161/atvbaha.126.323844","tag_type":"condition","value":"Atherosclerosis","value_numeric":null},{"paper_doi":"10.1161/atvbaha.126.323844","tag_type":"condition","value":"Ischemia-Reperfusion Injury","value_numeric":null},{"paper_doi":"10.1161/atvbaha.126.323844","tag_type":"condition","value":"Peripheral Arterial Disease","value_numeric":null},{"paper_doi":"10.1161/atvbaha.126.323844","tag_type":"condition","value":"Thrombophilia","value_numeric":null},{"paper_doi":"10.1161/atvbaha.126.323844","tag_type":"generic","value":"APAC","value_numeric":null},{"paper_doi":"10.1161/atvbaha.126.323844","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1161/atvbaha.126.323844","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1161/atvbaha.126.323844","tag_type":"modality","value":"Anticoagulant","value_numeric":null},{"paper_doi":"10.1161/atvbaha.126.323844","tag_type":"modality","value":"Antiplatelet Agent","value_numeric":null},{"paper_doi":"10.1161/atvbaha.126.323844","tag_type":"modality","value":"Heparin Proteoglycan Mimetic","value_numeric":null},{"paper_doi":"10.1161/atvbaha.126.323844","tag_type":"study_design","value":"Review Article","value_numeric":null},{"paper_doi":"10.1161/atvbaha.126.323844","tag_type":"warning","value":"APAC is an investigational agent; no Phase 2 efficacy data are yet available as of this publication.","value_numeric":null},{"paper_doi":"10.1161/atvbaha.126.323844","tag_type":"warning","value":"Sample size tag omitted as no specific enrolled patient number is reported for the clinical trials described.","value_numeric":null},{"paper_doi":"10.1161/atvbaha.126.323844","tag_type":"warning","value":"The paper is a narrative review with preclinical and early-phase clinical data — no randomized controlled trial results are reported.","value_numeric":null}],"summaries":{"what_studied":"This review evaluates APAC (antiplatelet and anticoagulant), a heparin proteoglycan mimetic with dual VWF- and thrombin-targeting actions, as an alternative antithrombotic strategy across diverse patient populations including high-risk cardiovascular, pediatric cardiac, and severe thrombophilia cases.","key_result":"Preclinical models show APAC reduces atherosclerotic/stenotic lesions, inflammation, and ischemia-reperfusion injury without increased bleeding; early clinical trials confirmed safety under both systemic and local administration, with a Phase 2 trial in peripheral arterial disease ongoing and another planned for AV fistula patency.","limitations":"Evidence is largely preclinical; Phase 2 trials are still underway with no efficacy outcomes yet reported. No head-to-head comparisons with standard antithrombotic regimens (aspirin + P2Y12 + anticoagulant) in humans are available.","practice_takeaway":"APAC is not yet ready for clinical use, but its dual antiplatelet/anticoagulant mechanism with a preclinical safety profile makes it a candidate to watch — especially for patients where bleeding risk limits standard triple therapy. Monitor Phase 2 results in peripheral arterial disease and AV fistula populations."}},{"doi":"10.1182/bloodadvances.2025019415","pmid":"41949461","title":"ASH ISTH 2026 guidelines for Anticoagulant Prophylaxis of Pediatric Patients at Risk of Venous Thromboembolism","journal_title":"Blood Advances","journal_issn":"2473-9529","published_at":"2026-04-08T00:00:00.000Z","url":"https://doi.org/10.1182/bloodadvances.2025019415","source_score":71,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2026-04-14","doi":"10.1182/bloodadvances.2025019415","days":"30","issn":"2473-9529","rank":"4","field":"Clinical Medicine","score":"71","category":"Hematology","categories":["Hematology"],"_categories":["Hematology"]},"pubmed":{"doi":"10.1182/bloodadvances.2025019415","title":"ASH ISTH 2026 guidelines for Anticoagulant Prophylaxis of Pediatric Patients at Risk of Venous Thromboembolism.","journal":"Blood advances","methods":"","results":"The panel agreed on 12 recommendations. For pediatric patients with solid cancer, trauma or critically ill, the panel issued conditional recommendations suggesting no anticoagulant prophylaxis. For pediatric patients with antiphospholipid antibody syndrome, or those on long-term total parenteral nutrition, the panel issued conditional recommendations suggesting the use of anticoagulant prophylaxis. Other pediatric subgroups addressed included patients with acute lymphoblastic leukemia or lymphoma, surgical and hospitalized patients, and those with a central venous access device.","abstract":"$30","keywords":[],"pubmed_id":"41949461","conclusions":"","publication_date":"2026-04-08T00:00:00"},"crossref":{"DOI":"10.1182/bloodadvances.2025019415","URL":"https://doi.org/10.1182/bloodadvances.2025019415","ISSN":["2473-9529","2473-9537"],"link":[{"URL":"https://ashpublications.org/bloodadvances/article-pdf/doi/10.1182/bloodadvances.2025019415/2512980/bloodadvances.2025019415.pdf","content-type":"application/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https://ashpublications.org/bloodadvances/article-pdf/doi/10.1182/bloodadvances.2025019415/2512980/bloodadvances.2025019415.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["ASH ISTH 2026 guidelines for Anticoagulant Prophylaxis of Pediatric Patients at Risk of Venous Thromboembolism"],"author":[{"given":"Marisol","family":"Betensky","sequence":"first","affiliation":[{"name":"Johns Hopkins All Children's Hospital, St Petersburg, Florida, United States"}]},{"given":"Muayad","family":"Azzam","sequence":"additional","affiliation":[{"name":"University of Kansas Medical Center, Kansas City, Kansas, United States"}]},{"given":"Rachel Sara","family":"Bercovitz","sequence":"additional","affiliation":[{"name":"Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States"}]},{"given":"Rukhmi","family":"Bhat","sequence":"additional","affiliation":[{"name":"Ann and Robert H. Lurie Childrens Hospital of Chicago, Chicago, Illinois, United States"}]},{"given":"Tina T","family":"Biss","sequence":"additional","affiliation":[{"name":"The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom"}]},{"given":"Brian Re","family":"Branchford","sequence":"additional","affiliation":[{"name":"Versiti Blood Center Wisconsin, Wauwatosa, Wisconsin, United States"}]},{"given":"Leonardo R","family":"Brandão","sequence":"additional","affiliation":[{"name":"The Hospital for Sick Children, Toronto, Ontario, Canada"}]},{"given":"Anthony KC","family":"Chan","sequence":"additional","affiliation":[{"name":"McMaster University, Hamilton, Canada"}]},{"given":"E. Vincent S.","family":"Faustino","sequence":"additional","affiliation":[{"name":"Yale School of Medicine, New Haven, Connecticut, United States"}]},{"given":"Qais","family":"Hamarsha","sequence":"additional","affiliation":[{"name":"The University of Kansas Medical Center, Kansas City, Kansas, United States"}]},{"given":"Julie","family":"Jaffray","sequence":"additional","affiliation":[{"name":"Rady Children's Hospital, University of California, San Diego, San Diego, California, United States"}]},{"given":"Sophie E","family":"Jones","sequence":"additional","affiliation":[{"name":"The University of Melbourne, Melbourne, Australia"}]},{"given":"Hassan","family":"Kawtharany","sequence":"additional","affiliation":[{"name":"University of Kansas Medical Center, Kansas City, Kansas, United States"}]},{"given":"Bryce A","family":"Kerlin","sequence":"additional","affiliation":[{"name":"Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, United States"}]},{"given":"Jana","family":"Khawandi","sequence":"additional","affiliation":[{"name":"The University of Kansas Medical Center, Kansas City, Kansas, United States"}]},{"given":"Grace","family":"Krider","sequence":"additional","affiliation":[{"name":"Ascension St. Vincent Indianapolis, Indianapolis, Indiana, United States"}]},{"given":"Nicole","family":"Kucine","sequence":"additional","affiliation":[{"name":"Weill Cornell Medicine, New York, New York, United States"}]},{"given":"Riten","family":"Kumar","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, Massachusetts, United States"}]},{"given":"Christoph","family":"Male","sequence":"additional","affiliation":[{"name":"Medical University of Vienna, Vienna, Austria"}]},{"given":"Paul","family":"Monagle","sequence":"additional","affiliation":[{"name":"department of Paediatrics, University of Melbourne , Australia , Australia, Parkville, Australia"}]},{"given":"Marie-Claude","family":"Pelland-Marcotte","sequence":"additional","affiliation":[{"name":"Centre Hospitalier Universitaire de Québec, Quebec City, Quebec, Canada"}]},{"given":"Leslie","family":"Raffini","sequence":"additional","affiliation":[{"name":"Children's Hospital of Philadelphia, Swarthmore, Pennsylvania, United States"}]},{"given":"Chittalsinh M","family":"Raulji","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center / Children's Nebraska, Omaha, Nebraska, United States"}]},{"given":"Sarah E","family":"Sartain","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Hematology/Oncology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, United States"}]},{"given":"Clifford M.","family":"Takemoto","sequence":"additional","affiliation":[{"name":"St. Jude Children's Hospital, Memphis, Tennessee, United States"}]},{"given":"Cristina","family":"Tarango","sequence":"additional","affiliation":[{"name":"Cincinnati Children's Hospital Medical Center Cancer and Blood Diseases Institute and the University of Cincinnati College of Medicine, Cincinnati, Ohio, United States"}]},{"given":"C. Heleen","family":"van Ommen","sequence":"additional","affiliation":[{"name":"Erasmus MC/Sophia Children's Hospital, Rotterdam, Netherlands"}]},{"given":"Maria C","family":"Velez","sequence":"additional","affiliation":[{"name":"LSU Health Sciences Center/Manning Family Children's, New Orleans, Louisiana, United States"}]},{"given":"Sara K","family":"Vesely","sequence":"additional","affiliation":[{"name":"University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States"}]},{"given":"John T","family":"Wiernikowski","sequence":"additional","affiliation":[{"name":"McMaster University, Hamilton, Canada"}]},{"given":"Suzan","family":"Williams","sequence":"additional","affiliation":[{"name":"Hospital for Sick Children, Toronto, Canada"}]},{"given":"Hope P","family":"Wilson","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham Heersink School of Medicine, Children's of Alabama, Birmingham, District of Columbia, United States"}]},{"given":"Gary","family":"Woods","sequence":"additional","affiliation":[{"name":"Children's Healthcare of Atlanta, Atlanta, Georgia, United States"}]},{"given":"Reem A.","family":"Mustafa","sequence":"additional","affiliation":[{"name":"University of Kansas Medical Center, Kansas City, Kansas, United States"}]}],"issued":{"date-parts":[[2026,4,8]]},"member":"234","prefix":"10.1182","source":"Crossref","volume":null,"created":{"date-time":"2026-04-08T14:01:48Z","timestamp":1775656908000,"date-parts":[[2026,4,8]]},"indexed":{"date-time":"2026-05-07T20:20:23Z","timestamp":1778185223747,"date-parts":[[2026,5,7]]},"license":[{"URL":"https://creativecommons.org/licenses/by-nc-nd/4.0/","start":{"date-time":"2026-04-08T00:00:00Z","timestamp":1775606400000,"date-parts":[[2026,4,8]]},"delay-in-days":0,"content-version":"vor"}],"subject":[],"abstract":"$31","language":"en","relation":{},"resource":{"primary":{"URL":"https://ashpublications.org/bloodadvances/article/doi/10.1182/bloodadvances.2025019415/567385/ASH-ISTH-2026-guidelines-for-Anticoagulant"}},"subtitle":[],"deposited":{"date-time":"2026-04-08T14:01:48Z","timestamp":1775656908000,"date-parts":[[2026,4,8]]},"issn-type":[{"type":"print","value":"2473-9529"},{"type":"electronic","value":"2473-9537"}],"published":{"date-parts":[[2026,4,8]]},"publisher":"American Society of Hematology","reference":null,"short-title":[],"update-policy":"https://doi.org/10.1182/blood.2019cm0000","article-number":"bloodadvances.2025019415","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"original-title":[],"container-title":["Blood Advances"],"reference-count":0,"published-online":{"date-time":null,"timestamp":null,"date-parts":[[2026,4,8]]},"references-count":0,"short-container-title":[],"is-referenced-by-count":1},"unpaywall":{"doi":"10.1182/bloodadvances.2025019415","is_oa":true,"title":"ASH ISTH 2026 guidelines for Anticoagulant Prophylaxis of Pediatric Patients at Risk of Venous Thromboembolism","updated":"2026-04-09T13:00:59+00:00","published_date":"2026-04-08","best_oa_location":{"url":"https://doi.org/10.1182/bloodadvances.2025019415","pmh_id":null,"url_for_pdf":null,"url_for_landing_page":"https://doi.org/10.1182/bloodadvances.2025019415"}}},"created_at":"2026-05-07T22:51:16.182Z","updated_at":"2026-05-14T15:13:26.918Z","tags":[{"paper_doi":"10.1182/bloodadvances.2025019415","tag_type":"age_group","value":"pediatric","value_numeric":null},{"paper_doi":"10.1182/bloodadvances.2025019415","tag_type":"category","value":"Hematology","value_numeric":null},{"paper_doi":"10.1182/bloodadvances.2025019415","tag_type":"condition","value":"Acute Lymphoblastic Leukemia","value_numeric":null},{"paper_doi":"10.1182/bloodadvances.2025019415","tag_type":"condition","value":"Antiphospholipid Antibody Syndrome","value_numeric":null},{"paper_doi":"10.1182/bloodadvances.2025019415","tag_type":"condition","value":"Solid Cancer","value_numeric":null},{"paper_doi":"10.1182/bloodadvances.2025019415","tag_type":"condition","value":"Venous Thromboembolism","value_numeric":null},{"paper_doi":"10.1182/bloodadvances.2025019415","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1182/bloodadvances.2025019415","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1182/bloodadvances.2025019415","tag_type":"modality","value":"Anticoagulant","value_numeric":null},{"paper_doi":"10.1182/bloodadvances.2025019415","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1182/bloodadvances.2025019415","tag_type":"study_design","value":"Clinical Practice Guideline","value_numeric":null},{"paper_doi":"10.1182/bloodadvances.2025019415","tag_type":"warning","value":"All 12 recommendations are conditional (not strong), based on low to very low certainty evidence; clinical applicability requires individualized assessment.","value_numeric":null},{"paper_doi":"10.1182/bloodadvances.2025019415","tag_type":"warning","value":"Level of evidence assigned as '7' (expert consensus/guideline) because the recommendations are GRADE-based but driven largely by very low certainty data rather than primary trial evidence.","value_numeric":null},{"paper_doi":"10.1182/bloodadvances.2025019415","tag_type":"warning","value":"No specific anticoagulant agents, doses, or durations are detailed in the abstract — clinicians should consult the full guideline document for agent-specific guidance.","value_numeric":null},{"paper_doi":"10.1182/bloodadvances.2025019415","tag_type":"warning","value":"The guideline publication date (2026-04-08) is in the future relative to most current databases but is within one month of today's date (May 7, 2026).","value_numeric":null}],"summaries":{"what_studied":"ASH and ISTH jointly developed evidence-based guidelines on anticoagulant prophylaxis for pediatric patients at risk of VTE, covering 12 clinical questions across subgroups including solid cancer, trauma, critical illness, antiphospholipid antibody syndrome (APS), total parenteral nutrition (TPN), ALL/lymphoma, surgical/hospitalized patients, and those with central venous access devices (CVADs); evidence reviewed through April 2025.","key_result":"The panel issued 12 conditional recommendations: anticoagulant prophylaxis is **suggested against** in pediatric patients with solid cancer, trauma, or critical illness; prophylaxis is **suggested for** those with APS or on long-term TPN. All recommendations are conditional, reflecting very low to low certainty evidence throughout.","limitations":"- High-quality data on pediatric VTE prophylaxis are scarce across all subgroups, limiting confidence in all 12 recommendations.\n- No validated, subgroup-specific VTE risk assessment models exist for children.\n- All recommendations are conditional, meaning individual patient values and clinical context must drive final decisions.","practice_takeaway":"Do not routinely give anticoagulant prophylaxis to critically ill, trauma, or solid-cancer pediatric patients; do consider it for children with APS or on long-term TPN. For all other pediatric subgroups (ALL/lymphoma, surgical, CVAD), shared decision-making is essential given the weak evidence base."}},{"doi":"10.1056/nejmoa2517213","pmid":"41910347","title":"Left Atrial Appendage Closure or Anticoagulation for Atrial Fibrillation","journal_title":"New England Journal of Medicine","journal_issn":"0028-4793","published_at":"2026-03-28T00:00:00.000Z","url":"https://doi.org/10.1056/nejmoa2517213","source_score":415,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-11T13:42:55.512Z","updated_at":"2026-06-11T13:42:55.512Z","tags":[{"paper_doi":"10.1056/nejmoa2517213","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1056/nejmoa2517213","tag_type":"brand","value":"Watchman","value_numeric":null},{"paper_doi":"10.1056/nejmoa2517213","tag_type":"category","value":"Medicine, General & Internal","value_numeric":null},{"paper_doi":"10.1056/nejmoa2517213","tag_type":"condition","value":"Atrial Fibrillation","value_numeric":null},{"paper_doi":"10.1056/nejmoa2517213","tag_type":"generic","value":"Non-Vitamin K Antagonist Oral Anticoagulant","value_numeric":null},{"paper_doi":"10.1056/nejmoa2517213","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1056/nejmoa2517213","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1056/nejmoa2517213","tag_type":"modality","value":"Anticoagulant","value_numeric":null},{"paper_doi":"10.1056/nejmoa2517213","tag_type":"modality","value":"Left Atrial Appendage Closure Device","value_numeric":null},{"paper_doi":"10.1056/nejmoa2517213","tag_type":"sample_size","value":"n=3000","value_numeric":3000},{"paper_doi":"10.1056/nejmoa2517213","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1056/nejmoa2517213","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1056/nejmoa2517213","tag_type":"warning","value":"Industry funding (Boston Scientific) should be noted when interpreting the magnitude of bleeding benefit.","value_numeric":null},{"paper_doi":"10.1056/nejmoa2517213","tag_type":"warning","value":"Mean CHA2DS2-VASc score was 3.5, indicating moderate-to-high stroke risk; findings may not generalize to lower-risk AF populations.","value_numeric":null},{"paper_doi":"10.1056/nejmoa2517213","tag_type":"warning","value":"The paper is described as 'ongoing' — longer-term follow-up data are not yet available.","value_numeric":null},{"paper_doi":"10.1056/nejmoa2517213","tag_type":"warning","value":"The specific NOAC(s) used in the anticoagulation arm are not named in the abstract; results may not apply equally to all NOACs.","value_numeric":null}],"summaries":{"what_studied":"In the CHAMPION-AF trial, 3,000 adults with atrial fibrillation who were suitable NOAC candidates were randomized 1:1 to left atrial appendage closure (LAAC) with the Watchman device vs. NOAC therapy, with 3 years of follow-up for cardiovascular death, stroke, systemic embolism, and non-procedure-related bleeding.","key_result":"LAAC was noninferior to NOACs for the composite of CV death, stroke, or systemic embolism (5.7% vs. 4.8%; difference 0.9 pp, 95% CI −0.8 to 2.6; P<0.001 for noninferiority) and superior for non-procedure-related bleeding (10.9% vs. 19.0%; HR 0.55, 95% CI 0.45–0.67; P<0.001).","limitations":"- Trial is ongoing; 3-year data may not capture long-term efficacy or late device-related complications.\n- Funded by Boston Scientific, introducing potential industry bias.\n- Only patients already suitable for anticoagulation were enrolled, limiting generalizability to true NOAC-ineligible populations.","practice_takeaway":"For AF patients eligible for anticoagulation, LAAC offers a comparable stroke-prevention option to NOACs while cutting non-procedure-related bleeding risk roughly in half — a meaningful trade-off worth discussing with patients who have high bleeding risk. Procedure-related risks of LAAC itself must still be factored into shared decision-making."}},{"doi":"10.1161/strokeaha.125.053755","pmid":"41766531","title":"Recurrent Stroke in Patients With Cryptogenic Stroke and Left Ventricular Injury: The Cardiac Abnormalities in Stroke Prevention and Recurrence (CASPR) Study","journal_title":"Stroke","journal_issn":"0039-2499","published_at":"2026-03-02T00:00:00.000Z","url":"https://doi.org/10.1161/strokeaha.125.053755","source_score":34,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-07T22:51:09.803Z","updated_at":"2026-05-07T22:51:09.803Z","tags":[{"paper_doi":"10.1161/strokeaha.125.053755","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.053755","tag_type":"category","value":"Clinical Neurology","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.053755","tag_type":"condition","value":"Cryptogenic Stroke","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.053755","tag_type":"condition","value":"Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.053755","tag_type":"condition","value":"Left Ventricular Dysfunction","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.053755","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.053755","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.053755","tag_type":"modality","value":"Anticoagulant","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.053755","tag_type":"modality","value":"Antiplatelet","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.053755","tag_type":"sample_size","value":"n=2328","value_numeric":2328},{"paper_doi":"10.1161/strokeaha.125.053755","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.053755","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.053755","tag_type":"warning","value":"The composite outcome combines recurrent stroke, major bleeding, and death — individual component rates should be considered separately when interpreting clinical benefit.","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.053755","tag_type":"warning","value":"The 'practice_changing' impact flag is used cautiously here — findings are observational and authors explicitly recommend RCT confirmation before clinical adoption.","value_numeric":null},{"paper_doi":"10.1161/strokeaha.125.053755","tag_type":"warning","value":"Treatment assignment was non-randomized; inverse probability weighting was used but residual confounding cannot be excluded.","value_numeric":null}],"summaries":{"what_studied":"This multicenter retrospective cohort study (27 US sites, n=2328) examined whether left ventricular (LV) injury — defined as EF 20–40% plus wall motion abnormality — increases recurrent stroke risk and modifies the effect of anticoagulation vs. antiplatelet therapy after cryptogenic stroke, over a median follow-up of 1.6 years.","key_result":"LV injury was present in 13.3% of patients. In those with LV injury, anticoagulation was associated with a markedly lower risk of the composite outcome (recurrent stroke, major bleeding, or death) vs. antiplatelet therapy (adjusted HR 0.24 [95% CI 0.10–0.59]), compared to no benefit in the non-LV injury group (adjusted HR 1.28 [95% CI 0.83–1.95]; interaction p=0.001).","limitations":"- Retrospective, observational design with potential for residual confounding despite inverse probability weighting.\n- Treatment assignment was not randomized, so results are hypothesis-generating only.\n- Authors explicitly call for confirmation in a dedicated RCT.","practice_takeaway":"In cryptogenic stroke patients with LV injury (EF 20–40% + wall motion abnormality), anticoagulation may substantially reduce recurrent stroke, major bleeding, and death compared to antiplatelet therapy — but this is observational data only. Consider these patients for enrollment in a future RCT before changing practice."}},{"doi":"10.1007/s10787-025-02062-9","pmid":"41318861","title":"Lingering echoes of SARS-CoV-2: mechanistic insights and management of long COVID syndrome","journal_title":"Inflammopharmacology","journal_issn":"0925-4692","published_at":"2025-11-30T00:00:00.000Z","url":"https://doi.org/10.1007/s10787-025-02062-9","source_score":26,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2025-11-30","doi":"10.1007/s10787-025-02062-9","days":"7","issn":"0925-4692","rank":"6","field":"Clinical Medicine","score":"26","category":"Immunology","categories":["Immunology"],"_categories":["Immunology"]},"pubmed":{"doi":"10.1007/s10787-025-02062-9","title":"Lingering echoes of SARS-CoV-2: mechanistic insights and management of long COVID syndrome.","journal":"Inflammopharmacology","methods":"","results":"","abstract":"$32","keywords":["Clinical management","Immune dysregulation","LCS","Pathophysiology","Persistent symptoms","SARS-CoV-2"],"pubmed_id":"41318861","conclusions":"","publication_date":"2025-11-30T00:00:00"},"crossref":{"DOI":"10.1007/s10787-025-02062-9","URL":"https://doi.org/10.1007/s10787-025-02062-9","ISSN":["0925-4692","1568-5608"],"link":[{"URL":"https://link.springer.com/content/pdf/10.1007/s10787-025-02062-9.pdf","content-type":"application/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https://link.springer.com/article/10.1007/s10787-025-02062-9/fulltext.html","content-type":"text/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https://link.springer.com/content/pdf/10.1007/s10787-025-02062-9.pdf","content-type":"application/pdf","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["Lingering echoes of SARS-CoV-2: mechanistic insights and management of long COVID syndrome"],"author":[{"given":"Jagat Pal","family":"Yadav","sequence":"first","affiliation":[]},{"given":"Seema","family":"Yadav","sequence":"additional","affiliation":[]},{"given":"Nimesh Kumar","family":"Dubey","sequence":"additional","affiliation":[]},{"given":"Indra Pal","family":"Yadav","sequence":"additional","affiliation":[]},{"given":"Prateek","family":"Pathak","sequence":"additional","affiliation":[]},{"given":"Amita","family":"Verma","sequence":"additional","affiliation":[]}],"issued":{"date-parts":[[2025,11,30]]},"member":"297","prefix":"10.1007","source":"Crossref","volume":null,"created":{"date-time":"2025-11-30T03:09:46Z","timestamp":1764472186000,"date-parts":[[2025,11,30]]},"indexed":{"date-time":"2025-11-30T04:16:12Z","timestamp":1764476172889,"date-parts":[[2025,11,30]]},"license":[{"URL":"https://www.springernature.com/gp/researchers/text-and-data-mining","start":{"date-time":"2025-11-30T00:00:00Z","timestamp":1764460800000,"date-parts":[[2025,11,30]]},"delay-in-days":0,"content-version":"tdm"},{"URL":"https://www.springernature.com/gp/researchers/text-and-data-mining","start":{"date-time":"2025-11-30T00:00:00Z","timestamp":1764460800000,"date-parts":[[2025,11,30]]},"delay-in-days":0,"content-version":"vor"}],"subject":[],"abstract":null,"language":"en","relation":{},"resource":{"primary":{"URL":"https://link.springer.com/10.1007/s10787-025-02062-9"}},"subtitle":[],"assertion":[{"name":"received","group":{"name":"ArticleHistory","label":"Article History"},"label":"Received","order":1,"value":"4 October 2025"},{"name":"accepted","group":{"name":"ArticleHistory","label":"Article History"},"label":"Accepted","order":2,"value":"17 November 2025"},{"name":"first_online","group":{"name":"ArticleHistory","label":"Article History"},"label":"First Online","order":3,"value":"30 November 2025"},{"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"},"order":1},{"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"},"order":2,"value":"The authors declare no conflict of interest related to the publication of this manuscript."}],"deposited":{"date-time":"2025-11-30T04:14:18Z","timestamp":1764476058000,"date-parts":[[2025,11,30]]},"issn-type":[{"type":"print","value":"0925-4692"},{"type":"electronic","value":"1568-5608"}],"published":{"date-parts":[[2025,11,30]]},"publisher":"Springer Science and Business Media LLC","reference":[{"DOI":"10.3390/v13101904","key":"2062_CR1","year":"2021","issue":null,"author":"D Acanfora","volume":"13","first-page":null,"unstructured":"Acanfora D, Acanfora C, Ciccone MM et al (2021) The cross-talk between thrombosis and inflammatory storm in acute and long-COVID-19: therapeutic targets and clinical cases. 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