Thrombosis articles from across Nature Portfolio

Vascular protein disulfide isomerase (PDI) regulates thrombosis and targeting extracellular PDI remains a promising antithrombotic approach. Here, the authors show that PDI cleaves allosteric disulfides on histidine-rich glycoprotein to influence its functions during coagulation and thus fine-tune the kinetics of thrombus formation.

In ST-segment elevation myocardial infarction, the role of interventional modification of thrombi in the coronary arteries before stenting is controversial. However, innovations in stroke intervention have sparked renewed interest in thrombus modification approaches. We discuss current and emerging techniques to extract or disperse thrombi, aiming to reduce downstream embolization, microvascular obstruction and myocardial injury.

The risk of stroke in patients with atrial high-rate episodes (AHREs) depends on age, comorbidities and AHRE burden. Two randomized clinical trials on the use of oral anticoagulant therapy for stroke prevention in older patients with short and rare AHREs have reported conflicting findings on the efficacy of oral anticoagulation in this patient population, although both trials report a significantly increased risk of major bleeding with oral anticoagulation.

Preserving hemostasis while preventing pathological thrombosis has been a central goal in drug development. A new way to restore hemostasis is suggested by the finding that glycoprotein V is cleaved by thrombin on activated platelets, negatively regulating clotting at sites of vascular injury.

In patients with atrial fibrillation, treatment with asundexian, a novel, oral, small-molecule inhibitor of coagulation factor XIa, reduces the incidence of bleeding compared with standard dosing with the factor Xa inhibitor apixaban.

Aortic-intima-resident macrophages (MAC^AIRs) share the vessel luminal lining with endothelial cells in areas of turbulent flow and protrude into the arterial blood stream to clean the inner arterial surface via phagocytosis, shield nearby endothelial cells from activation by thrombin and prevent microthrombus formation.

In the phase II AXIOMATIC-TKR trial, the oral, selective factor XIa inhibitor milvexian provided dose-dependent protection against venous thromboembolism in patients undergoing knee arthroplasty.