{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:39:49Z","timestamp":1792787989204,"version":"4.5.0"},"reference-count":7,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T00:00:00Z","timestamp":1792713600000},"content-version":"vor","delay-in-days":87,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Cardiothorac Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Heart transplant recipients often face the clinical dilemma of coexisting bleeding and thrombotic risks postoperatively. Conventional anticoagulation monitoring parameters (e.g., platelet count, fibrinogen, D\u2011dimer, and anti\u2011Xa activity) frequently exhibit limitations in evaluating complex postoperative patients, including delayed response, poor sensitivity, and lack of clear target ranges. This case report describes the use of thrombin\u2013antithrombin complex (TAT) to guide anticoagulation management for complex thrombotic events after heart transplantation and explores its potential value as a supplementary monitoring tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 50\u2011year\u2011old male heart transplant recipient developed multiple venous thrombi in the extremities and cerebral venous sinuses during the early postoperative period. Conventional monitoring parameters (platelets, fibrinogen, D\u2011dimer, and anti\u2011Xa activity) failed to effectively warn of thrombus progression or guide dose adjustments. Thrombosis continued to progress despite increasing anticoagulant intensity. Introduction of TAT monitoring revealed that its dynamic changes closely paralleled thrombotic events. Persistently elevated TAT levels (&gt;\u20098 ng\/mL) indicated inadequate anticoagulation. After adjusting anticoagulant intensity based on TAT levels to maintain them within a safe range (&lt;\u20098 ng\/mL), thrombosis was controlled. Later, when anti\u2011Xa activity decreased due to infection, stable TAT levels provided evidence to maintain the original anticoagulation regimen, avoiding overtreatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This case suggests that TAT may serve as a useful adjunctive monitoring tool for hypercoagulable states after heart transplantation. Its dynamic changes may more sensitively reflect thrombotic risk and assist in clinical decision\u2011making, particularly when conventional parameters are contradictory or lack clear targets, thereby facilitating more individualized and precise anticoagulation management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13019-026-04500-3","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T19:23:49Z","timestamp":1785266629000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Navigating anticoagulation in heart transplantation with thrombin\u2013antithrombin complex: when conventional monitoring fails"],"prefix":"10.1186","volume":"21","author":[{"given":"Chaonan","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liqin","family":"Ling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xunbei","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiyu","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuang","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"key":"4500_CR1","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1016\/j.healun.2022.10.015","volume":"42","author":"A Velleca","year":"2023","unstructured":"Velleca A, Shullo MA, Dhital K, et al. The International Society for Heart and Lung Transplantation (ISHLT) guidelines for the care of heart transplant recipients. J Heart Lung Transplant. 2023;42:e1\u2013141","journal-title":"J Heart Lung Transpl Off Publ Int Soc Heart Transpl"},{"key":"4500_CR2","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1002\/ajh.21010","volume":"83","author":"T Gursoy","year":"2008","unstructured":"Gursoy T, Tekinalp G, Yurdakok M, et al. Thrombin activatable fibrinolysis inhibitor activity, thrombin-antithrombin complex and D-dimer levels in preterm neonates with early respiratory distress syndrome. Am J Hematol. 2008;83:50\u20133.","journal-title":"Am J Hematol"},{"key":"4500_CR3","doi-asserted-by":"publisher","first-page":"e157","DOI":"10.1016\/S2352-3026(17)30026-1","volume":"4","author":"PK Bendapudi","year":"2017","unstructured":"Bendapudi PK, Hurwitz S, Fry A, et al. Derivation and external validation of the PLASMIC score for rapid assessment of adults with thrombotic microangiopathies: a cohort study. Lancet Haematol. 2017;4:e157\u201364.","journal-title":"Lancet Haematol"},{"key":"4500_CR4","doi-asserted-by":"crossref","unstructured":"Garcia DA, Baglin TP, Weitz JI, Samama MM. (2012) Parenteral anticoagulants: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 141:e24S-e43S.","DOI":"10.1378\/chest.11-2291"},{"key":"4500_CR5","doi-asserted-by":"publisher","first-page":"e11","DOI":"10.5858\/arpa.2023-0496-OA","volume":"149","author":"L Ling","year":"2025","unstructured":"Ling L, Liu C, Huang X, et al. Anti-Xa activity test is needed but is not enough for monitoring fondaparinux therapy a mong critically ill patients. Arch Pathol Lab Med. 2025;149:e11\u20138.","journal-title":"Arch Pathol Lab Med"},{"key":"4500_CR6","doi-asserted-by":"publisher","first-page":"108470","DOI":"10.1016\/j.rmed.2025.108470","volume":"249","author":"V Vasanthan","year":"2025","unstructured":"Vasanthan V, Jayaraj BS, Chaya SK, et al. Serum heparin binding protein as a prognostic biomarker in community acquired pneumonia: A prospective observational study. Respir Med. 2025;249:108470.","journal-title":"Respir Med"},{"key":"4500_CR7","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1002\/j.1875-9114.2011.01049.x","volume":"32","author":"JW Vandiver","year":"2012","unstructured":"Vandiver JW, Vondracek TG. Antifactor Xa levels versus activated partial thromboplastin time for monitoring unfractionated heparin. Pharmacotherapy. 2012;32:546\u201358.","journal-title":"Pharmacotherapy"}],"container-title":["Journal of Cardiothoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13019-026-04500-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13019-026-04500-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13019-026-04500-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:01:59Z","timestamp":1792785719000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13019-026-04500-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,28]]},"references-count":7,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4500"],"URL":"https:\/\/doi.org\/10.1186\/s13019-026-04500-3","relation":{},"ISSN":["1749-8090"],"issn-type":[{"value":"1749-8090","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,28]]},"assertion":[{"value":"6 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was approved by the Ethics Committees of West China Hospital of Sichuan University. Informed consent was obtained from patient for this study.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"840"}}