{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T08:09:02Z","timestamp":1779091742994,"version":"3.51.4"},"reference-count":29,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100006606","name":"Natural Science Foundation of Tianjin Municipality","doi-asserted-by":"publisher","award":["22JCYBJC00530"],"award-info":[{"award-number":["22JCYBJC00530"]}],"id":[{"id":"10.13039\/501100006606","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Tianjin Key Medical Discipline (Specialty) Construction Project","award":["TJYXZDXK-007A"],"award-info":[{"award-number":["TJYXZDXK-007A"]}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82172120"],"award-info":[{"award-number":["82172120"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Clin Appl Thromb Hemost"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients with pulmonary embolism (PE) and chronic kidney disease (CKD) have a fragile hemostatic balance, yet evidence comparing bleeding risk between direct oral anticoagulants (DOACs) and warfarin in critically ill patients remains limited. We compared overall and major bleeding risks associated with DOACs versus warfarin in ICU patients with PE and CKD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a retrospective cohort study using the MIMIC-IV (v3.1) database. Adult ICU patients with PE and an estimated glomerular filtration rate (eGFR) &lt;60 mL\/min\/1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      treated with DOACs or warfarin were included. Propensity score matching (PSM) was used as the primary adjustment strategy, with stabilized inverse probability of treatment weighting (IPTW) as sensitivity analysis. Cox proportional hazards models were applied. The primary outcome was any bleeding, and the secondary outcome was major bleeding.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 1,363 patients, 832 received warfarin and 531 received DOACs. After PSM, 1,038 patients were well balanced. In IPTW-weighted analyses, DOAC use was associated with a higher risk of any bleeding compared with warfarin (HR 1.37, 95% CI 1.13\u20131.66; P = 0.001), while no significant difference was observed for major bleeding (HR 0.97, 95% CI 0.74\u20131.28; P = 0.84). Results were consistent in the PSM cohort. Renal function did not significantly modify the relative bleeding risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In critically ill patients with PE and CKD, DOACs were associated with increased overall bleeding but not major bleeding compared with warfarin. Differentiating non-major from major bleeding is essential when selecting anticoagulant therapy in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10760296261452851","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T14:42:14Z","timestamp":1778856134000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Direct Oral Anticoagulants Increase Overall but Not Major Bleeding in Critically Ill Chronic Kidney Disease Patients With Pulmonary Embolism"],"prefix":"10.1177","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-7331-3394","authenticated-orcid":false,"given":"Zi-Kang","family":"Zhou","sequence":"first","affiliation":[{"name":"Tianjin Medical University General Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qin-Yi","family":"Xu","sequence":"additional","affiliation":[{"name":"Graduate School, Tianjin Medical University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jia-Lu","family":"Ping","sequence":"additional","affiliation":[{"name":"Graduate School, Tianjin Medical University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hao-Nan","family":"Chen","sequence":"additional","affiliation":[{"name":"Tianjin Medical University General Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Song-Tao","family":"Shou","sequence":"additional","affiliation":[{"name":"Tianjin Medical University General Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan-Cun","family":"Liu","sequence":"additional","affiliation":[{"name":"Tianjin Medical University General Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,5,15]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2023.10.018"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.119.044059"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/jth.12046"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz405"},{"issue":"12","key":"e_1_3_5_6_2","first-page":"e977","article-title":"2026 AHA\/ACC\/ACCP\/ACEP\/CHEST\/SCAI\/SHM\/SIR\/SVM\/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"153","author":"Writing Committee M","year":"2026","unstructured":"Writing Committee M, Creager MA, Barnes GD, Giri J, et al. 2026 AHA\/ACC\/ACCP\/ACEP\/CHEST\/SCAI\/SHM\/SIR\/SVM\/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines. 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