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Thromb Haemost 2026; 126(01): 107-111
DOI: 10.1055/a-2763-7391
Editors' Choice

Thrombosis and Haemostasis 2025 Editors' Choice

Authors

  • Christian Weber

    1   Institute for Cardiovascular Prevention (IPEK), LMU Munich, Munich, Germany
    2   German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
    3   Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands

  • Anne Rigby

    1   Institute for Cardiovascular Prevention (IPEK), LMU Munich, Munich, Germany

  • Gregory Y. H. Lip

    4   Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
    5   Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
    6   Department of Cardiology, Lipidology and Internal Medicine with Intensive Coronary Care Unit, Medical University of Bialystok, Bialystok, Poland
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This year's Editors' Choice highlights some of the most read and relayed 2025 publications in Thrombosis and Haemostasis. The selection reflects a growing emphasis on precision medicine, artificial intelligence (AI), and integrated care pathways in cardiovascular disease, along with continued insights into anticoagulation optimization, immune-thrombosis, platelet and neutrophil biology, as well as mechanisms behind thrombotic and bleeding disorders.

Precision Medicine in Clinical Thrombosis

A growing body of research published in TH in 2025 illustrated how artificial intelligence (AI)-driven phenotyping, advanced imaging, and individualized antithrombotic strategies are transforming precision medicine approaches to thrombosis management.

The ARISTOTELES project[1] proposes to harness AI to analyze real-world data, predict outcomes, and support personalized treatment strategies in atrial fibrillation (AF). By rigorously testing AI-driven interventions in large multinational cohorts, this work promises to advance precision care in AF, identifying patient phenotypes and correlations that would otherwise remain hidden.[2] [3] Similarly, the TARGET initiative[4] aims to develop virtual twins for AF and stroke, enabling in silico simulations of patients' clinical trajectories, interventions, and outcome, and paving the way for broader AI integration in cardiovascular medicine.

AF remains a complex condition with substantial morbidity and mortality, complicated by comorbidities, polypharmacy, and variable adherence to holistic or integrated care management pathways.[5] [6] [7] The latter is based on the Atrial fibrillation Better Care (ABC) which is supported by clinical trial and real-world evidence.[8] [9]

Phenotype-driven approaches were further exemplified by the COOL-AF registry study[10] where latent class analysis of 42 clinical variables identified three distinct AF phenotypes with markedly different risk trajectories. Building on previous findings on the benefits of adherence to the ABC holistic care pathway,[9] Krittayaphong et al further found that patients in higher-risk phenotypes benefited substantially from adherence to the ABC pathway, whereas lower-risk groups did not,[10] highlighting the need for individualized, phenotype-based management beyond conventional risk scoring.

Chang et al[11] provided a critical comparison of AF management pathways across Asian and non-Asian populations, revealing inconsistencies in guideline-directed holistic care[12] [13] and emphasizing the importance of culturally and regionally tailored risk assessment. This is especially relevant given the well-recognized differences in AF-related complications, such as stroke and bleeding, between Asian and non-Asian populations.[14] [15] [16] Disentangling the effects of race and geography on clinical outcomes can prove challenging. Drawing on a large international registry, the study from Tafur et al[17] revealed that the healthcare system context outweighs race in shaping recurrence and mortality. Despite the inherent limitations of this retrospective observational data, the study offered timely insights with clear implications for strengthening health-system capacity to improve VTE care globally.

Addressing high-risk AF patients with prior intracerebral hemorrhage, the PRESTIGE-AF trial presented by Korompoki et al[18] is aiming to tackle another clinically persistent dilemma: how to balance ischemic-stroke prevention against the risk of recurrent intracerebral hemorrhage (ICH). This large HORIZON 2020 supported randomized trial is expected to help in defining personalized antithrombotic strategies for a high-risk population not represented by current clinical guidelines.

In a retrospective analysis of 317 patients, Wu et al[19] demonstrated how advanced imaging could also play a critical role in individualized management. In what may be the largest to date cardiac magnetic resonance (CMR)-based evaluation of thrombus risk in ischemic left ventricular aneurysm, they found that ventricular aneurysm morphology and myocardial fibrosis critically determined thromboembolic risk. These insights underscore the growing role of advanced imaging in guiding prophylactic anticoagulation decisions, while highlighting the need for external validation and integrated risk scores to translate these imaging markers into personalized preventive strategies.[20]

Complementing these advances, a recent narrative review[21] provided a timely and comprehensive overview of antithrombotic therapy in people with hemophilia, emphasizing the delicate balance between thrombosis prevention and bleeding risk. The authors highlighted the value of a multidisciplinary, personalized approach and envisioned future integration of advanced computational tools to tailor therapy, reflecting the evolving landscape of precision medicine in thrombosis care.


Anticoagulation Optimization and Real-world Evidence

Optimizing anticoagulation remains a central challenge, particularly in complex or high-risk populations, and recent 2025 studies highlighted how real-world evidence may guide safer, more personalized therapy.

Shaw et al[22] showed that even low residual apixaban or rivaroxaban levels measurably impaired thrombin generation and were associated with postoperative bleeding, challenging the notion of a “safe” DOAC threshold. Although the findings largely confirm the expected continuous relationship between anticoagulant effect and bleeding risk, they reinforce the effectiveness of existing perioperative strategies such as the PAUSE trial strategy, which is associated with low absolute rates of adverse outcomes.

In a nationwide self-controlled case series, Choi et al[23] further identified heightened bleeding risk during concomitant use of amiodarone, diltiazem, or verapamil with factor Xa inhibitors, particularly in the first month of co-administration, while dronedarone appeared safer. These findings underscore the need for heightened vigilance and careful monitoring during early co-administration in patients at risk.

Real-world data also inform decision-making in life-limiting illnesses. Kempers et al[24] demonstrated that patients on vitamin K antagonists (VKAs) continued therapy until shortly before death, with similar event rates during and after discontinuation, supporting nuanced, patient-centered decisions regarding anticoagulation at the end of life.

Population-specific risk assessment was further highlighted by Tao et al,[25] who validated the RIETE bleeding risk score in the large East Asian CURES registry cohort, highlighting its superior, albeit modest, performance for predicting 90-day major bleeding among anticoagulated pulmonary embolism patients in China. The study highlighted the need for population-specific risk assessment and showed that low-risk patients identified by RIETE may particularly benefit from early DOAC therapy.

Cancer-associated VTE management has evolved in the DOAC era. Although cancer patients remain at markedly higher risk of VTE recurrence and major bleeding, complication rates have dropped substantially compared with the historical vitamin K antagonist era, underscoring the impact of modern anticoagulation strategies. The large guideline-driven and patient-centric prospective registry of acute VTE management presented by Cassianni et al[26] offered valuable insights into contemporary VTE management in cancer patients taking into account the latest systemic treatment of cancer.

Rare high-risk populations, such as pregnant women with inherited antithrombin deficiency, benefit from multidisciplinary guidance on anticoagulation. A thorough review by the French Society of Thrombosis and Haemostasis[27] addressed the challenging management of venous thromboembolism (VTE) risk in this population synthesizing scarce evidence to provide practical guidance on anticoagulation, antithrombin supplementation, and peripartum management. Although primarily reflecting French practice, this multidisciplinary collaboration presented a wide range of recommendations and recently published data that should help guide clinical decision-making in this high-risk, but infrequent, condition.


Guideline Updates, Standardization, and Clinical Practice

Several papers published last year have highlighted variations in international clinical guidelines, underscoring the need for harmonization and standardized diagnostic strategies across conditions such as AF, peripheral artery disease (PAD), VTE, chronic obstructive pulmonary disease (COPD), and sepsis.

Potpara et al provided a practicing clinician's perspective (and critique) of the 2024 European AF guidelines, in comparison with other published guidelines.[13] Zarghami and colleagues[28] highlighted important differences between the ACC/AHA and ESC PAD guidelines, focusing on non-statin lipid-lowering therapies and low-dose rivaroxaban, underscoring the need for consistent, evidence-aligned clinical guidance. Other studies emphasized the need for standardized approaches in complex domains. Rosson et al[29] provided a critical review of international guidelines with key consistencies and discrepancies for venous catheter-associated thrombosis, advocating for harmonized, multidisciplinary management to reduce variability and optimize patient care. The TERA case-control study[30] assessed VTE risks associated with different SARS-CoV-2 vaccines, showing no excess risk with mRNA vaccines but a modest association with vector-based platforms, balanced by a clear net population-level benefit. Despite limitations such as a low response rate and small subgroups, the study's detailed risk-factor collection and net-effect analyses provided important evidence supporting continued vaccination while transparently characterizing differential VTE risks.

Drawing on data from two multicenter trials in patients with Chronic Obstructive Pulmonary Disease (COPD), Mai et al[31] developed and validated a tailored pulmonary embolism diagnostic strategy, addressing a notoriously challenging clinical scenario. Although constrained by few outcome events and exclusions inherent to the source datasets, the proposed diagnostic strategy substantially reduced the need for imaging and takes an important step toward tailored PE diagnostics in COPD.

Finally, in a multicenter retrospective study of 1,438 patients with sepsis, Gando et al[32] found that the sepsis-induced coagulopathy (SIC) scoring system offered little value over the existing Japanese Association for Acute Medicine (JAAM) disseminated intravascular coagulation (DIC) criteria supporting the adequacy of current DIC scoring systems.


Mechanistic Insights, Emerging Therapies, and Translational Opportunities

2025 research further advanced our understanding of thromboinflammation, metabolic and hematologic dysregulation, and emerging therapeutic targets, bridging mechanistic insights with translational opportunities.

Kaiser et al[33] provided a timely state-of-the-art review of immunothrombosis and thromboinflammation, integrating their own recent findings on immune complexes, complement, and cellular contributors such as neutrophils, monocytes, and platelets. The authors highlighted both the protective roles of immunothrombosis and the detrimental consequences of thromboinflammation across cardiovascular, septic, and autoimmune diseases while outlining questions to be addressed to translate these advances into clinical applications.

Neutrophil extracellular traps (NETs) have emerged as central mediators of hypercoagulability. Tong et al[34] demonstrated their role in non-small-cell lung cancer (NSCLC), with malignant neutrophils, platelets, and endothelial cells forming a prothrombotic network. Although the study's comprehensive in vitro and ex vivo assays demonstrated patient's stage-dependent NET procoagulant activity, its observational design limits causal inference and raises the need for clinical studies validating NET-targeted strategies. Nonetheless, the work importantly positions NETs as promising therapeutic targets for mitigating cancer-associated thrombosis in advanced NSCLC. Soltani et al added to the NETosis narrative[35] by identifying neutrophils as meaningful sources of FXIII-A transglutaminase, based on transcriptional and imaging evidence that the enzyme is externalized and functionally active during NET formation.

De Moner et al[36] provided mechanistic insights into JAK2V617F-mutated myeloproliferative neoplasms (MPNs), showing that circulating factors, particularly in patients presenting with splanchnic vein thrombosis, could induce endothelial inflammation, and a prothrombotic phenotype, and how MPN-directed therapy may mitigate this dysfunction. Similarly, a recent study explored fibrinogen variant profiles in obesity and metabolic dysfunction-associated steatotic liver disease (MASLD),[37] revealing subtle but meaningful shifts in variant composition across disease severity and following bariatric surgery. Despite potential confounding from comorbidities, medications, and postoperative physiological changes, these findings provide valuable insight into the interplay between fibrinogen alterations and metabolic dysfunction in humans.

COVID-19 also continues to impact thrombosis biology. Petito et al[38] revealed that severe infection disrupts the platelet NO/ROS balance, linking oxidative stress to thrombotic complications.

Zhang et al[39] delivered a comprehensive and timely review of the cellular and molecular pathways governing platelet production, highlighting how disruptions in megakaryopoiesis, platelet clearance, or distribution give rise to diverse quantitative platelet disorders. The authors synthesized current knowledge on thrombocytopenia and thrombocytosis and presented medication strategies for managing these conditions in different clinical settings.

Beyond mechanistic studies, our 2025 publications also highlighted emerging therapeutic targets. As factor XI (FXI)-targeted drugs are gaining popularity as the newest class of anticoagulants, assessing FXI pharmacokinetics is critical. Spagnolo et al[40] reported on a prospective study of 54 segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI), demonstrating a significant rise in FXI levels from admission to discharge, independent of conventional thrombotic risk indicators or identifiable clinical predictors. Although limited by sample size, the study has potential relevance for timing and personalization of emerging FXI-targeted anticoagulant strategies, adding up to current data from PACIFIC-AMI and the ongoing LIBREXIA-ACS trial.[41] Banaś et al[42] presented case-control study evidence linking elevated FXI to both the development and recurrence of left atrial appendage thrombus, as well as subsequent cerebrovascular events. Despite a small cohort size, inevitable given the rarity of the condition, the data opens the door to considering FXI as a potential tool for long-term management strategies in this patient population.

Lipoprotein-lowering therapies represent another promising avenue in development. Although a growing body of evidence has established a causal association between elevated lipoprotein(a) [Lp(a)] levels and both atherosclerotic cardiovascular disease and valvular aortic stenosis, the review by Pfeferman et al[43] shifted the focus to VTE. Their work synthesized the complex, and often inconsistent, evidence linking Lp(a) to VTE, providing a clear appraisal of mechanistic, epidemiologic, and genetic data, alongside an overview of emerging Lp(a)-lowering therapies.

In 2025, the field of thrombosis and hemostasis continued to evolve rapidly, driven by a combination of AI-driven precision medicine, real-world evidence, mechanistic insights, and emerging therapeutics. From phenotype-guided AF management and advanced imaging to NET-targeted therapies and FXI inhibitors, we were delighted to see how research published at TH is bridging laboratory discoveries with patient-centered care. We look forward to the innovations that 2026 will bring and the continued translation of scientific insight into tangible clinical benefit.



Conflict of Interest

None declared.


Address for correspondence

Anne Rigby, PhD
Institute for Cardiovascular Prevention (IPEK), LMU Munich
Munich
Germany   

Christian Weber, MD
Institute for Cardiovascular Prevention (IPEK), LMU Munich
Munich
Germany   

Gregory Y. H. Lip, MD
Liverpool Centre for Cardiovascular Science, University of Liverpool
William Henry Duncan Building, 6 West Derby Street, Liverpool L7 8TX
United Kingdom   

Publication History

Received: 03 December 2025

Accepted: 03 December 2025

Article published online:
02 January 2026

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