{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T17:09:01Z","timestamp":1785431341839,"version":"3.56.0"},"reference-count":62,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009045","name":"Jagiellonian University Medical College","doi-asserted-by":"publisher","award":["N41\/DBS\/001454"],"award-info":[{"award-number":["N41\/DBS\/001454"]}],"id":[{"id":"10.13039\/100009045","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009045","name":"Jagiellonian University Medical College","doi-asserted-by":"publisher","award":["2024\/08\/X\/NZ7\/00030"],"award-info":[{"award-number":["2024\/08\/X\/NZ7\/00030"]}],"id":[{"id":"10.13039\/100009045","id-type":"DOI","asserted-by":"publisher"}]},{"award":["N41\/DBS\/001454"],"award-info":[{"award-number":["N41\/DBS\/001454"]}],"id":[{"id":"https:\/\/ror.org\/03bqmcz70","id-type":"ROR","asserted-by":"publisher"}]},{"award":["2024\/08\/X\/NZ7\/00030"],"award-info":[{"award-number":["2024\/08\/X\/NZ7\/00030"]}],"id":[{"id":"https:\/\/ror.org\/03bqmcz70","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Strategic Programme Excellence Initiative at Jagiellonian University"},{"id":[{"id":"https:\/\/ror.org\/03bqmcz70","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Perfluorooctanesulfonic acid (PFOS) is a persistent organic pollutant linked in epidemiological studies to increased coronary artery disease (CAD) risk, higher LDL-cholesterol, hypertension, and other adverse outcomes. However, the mechanisms by which PFOS affects cardiovascular physiology, particularly coagulation, remain insufficiently understood. We evaluated the ex vivo effects of PFOS on fibrin clot structure and thrombin generation in platelet-poor plasma (PPP) and citrated whole blood from ten healthy volunteers (five women, aged 27\u201332 years; mean serum PFOS: 2.63 \u00b1 0.85 \u03bcg\/L). PPP samples were incubated with PFOS at 50, 200, and 400 \u03bcg\/L. Assays included calibrated automated thrombogram, clot permeability (Ks), clot lysis time (CLT), thromboelastography (400 \u03bcg\/L), and scanning electron microscopy (SEM). PFOS did not significantly modify endogenous thrombin potential or peak thrombin. In contrast, it reduced Ks and prolonged CLT at 200 and 400 \u03bcg\/L, indicating impaired fibrinolysis. SEM images confirmed the formation of thinner, tightly packed fibrin fibers with reduced pore size at higher PFOS concentrations. These findings were consistent across dilution models, with only minimal changes observed in low-dilution protocols. Overall, PFOS appears to disrupt fibrin polymerization, generating denser and more fibrinolysis-resistant clots without major effects on thrombin generation. Such alterations may promote a prothrombotic state and predispose exposed individuals to clinically relevant thrombotic events, including myocardial infarction and stroke. Further studies are required to define the clinical consequences of PFOS-related coagulation abnormalities in exposed populations.<\/jats:p>","DOI":"10.3390\/jcdd13050209","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T16:26:37Z","timestamp":1778689597000},"page":"209","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of Perfluorooctanesulfonic Acid on Fibrin Clot Properties and Thrombin Generation: Linking Environmental Pollution with Cardiovascular Diseases"],"prefix":"10.3390","volume":"13","author":[{"given":"Jakub","family":"Kuci\u0144ski","sequence":"first","affiliation":[{"name":"Department of Coronary Disease and Heart Failure, The St. John Paul II Hospital, 31-202 Krakow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krzysztof","family":"Krawczyk","sequence":"additional","affiliation":[{"name":"Department of Coronary Disease and Heart Failure, The St. John Paul II Hospital, 31-202 Krakow, Poland"},{"name":"Faculty of Medicine and Health Sciences, Medical College, Jagiellonian University, 30-060 Krakow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konrad","family":"Kieca","sequence":"additional","affiliation":[{"name":"Faculty of Chemistry, Jagiellonian University, 30-060 Krakow, Poland"},{"name":"Doctoral School of Exact and Natural Sciences, Jagiellonian University, 30-060 Krakow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7493-3626","authenticated-orcid":false,"given":"Aleksander","family":"Siniarski","sequence":"additional","affiliation":[{"name":"Department of Coronary Disease and Heart Failure, The St. John Paul II Hospital, 31-202 Krakow, Poland"},{"name":"Faculty of Medicine and Health Sciences, Medical College, Jagiellonian University, 30-060 Krakow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1762-308X","authenticated-orcid":false,"given":"Micha\u0142","family":"Z\u0105bczyk","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Sciences, Medical College, Jagiellonian University, 30-060 Krakow, Poland"},{"name":"Krakow Centre for Medical Research and Technologies, The St. John Paul II Hospital, 31-202 Krakow, Poland"},{"name":"Department of Thromboembolic Disorders, Institute of Cardiology, Faculty of Medicine and Health Sciences, Medical College, Jagiellonian University, 30-060 Krakow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0993-3953","authenticated-orcid":false,"given":"Ewa","family":"Konduracka","sequence":"additional","affiliation":[{"name":"Department of Coronary Disease and Heart Failure, The St. John Paul II Hospital, 31-202 Krakow, Poland"},{"name":"Faculty of Medicine and Health Sciences, Medical College, Jagiellonian University, 30-060 Krakow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"ref_1","unstructured":"Organisation for Economic Co-Operation and Development (2018). Toward a New Comprehensive Global Database of Per- and Polyfluoroalkyl Substances (PFASs): Summary Report on Updating the OECD 2007 List of per and Polyfluoroalkyl Substances (PFASs), Organisation for Economic Co-Operation and Development. Available online: http:\/\/www.oecd.org\/chemicalsafety\/portal-perfluorinated-chemicals\/."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"115663","DOI":"10.1016\/j.ecoenv.2023.115663","article-title":"Environmental impacts, exposure pathways, and health effects of PFOA and PFOS","volume":"267","author":"Wee","year":"2023","journal-title":"Ecotoxicol. Environ. Saf."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1289\/ehp.0901827","article-title":"Epidemiologic evidence on the health effects of perfluorooctanoic acid (PFOA)","volume":"118","author":"Steenland","year":"2010","journal-title":"Environ. Health Perspect."},{"key":"ref_4","unstructured":"U.S. Environmental Protection Agency (2026, May 05). Final Human Health Toxicity Assessment for Perfluorooctane Sulfonic Acid (PFOS) and Related Salts, Available online: https:\/\/www.epa.gov\/sdwa\/human-health-toxicity-assessment-perfluorooctane-sulfonic-acid-pfos."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Meneguzzi, A., Fava, C., Castelli, M., and Minuz, P. (2021). Exposure to Perfluoroalkyl Chemicals and Cardiovascular Disease: Experimental and Epidemiological Evidence. Front. Endocrinol., 12.","DOI":"10.3389\/fendo.2021.706352"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"106963","DOI":"10.1016\/j.envint.2021.106963","article-title":"Exposure to perfluoroalkyl substances in waste recycling workers: Distributions in paired human serum and urine","volume":"158","author":"Peng","year":"2022","journal-title":"Environ. Int."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1016\/j.envint.2013.06.004","article-title":"Accumulation of perfluoroalkyl substances in human tissues","volume":"59","author":"Nadal","year":"2013","journal-title":"Environ. Int."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.envint.2014.11.013","article-title":"Hazard assessment of fluorinated alternatives to long-chain perfluoroalkyl acids (PFAAs) and their precursors: Status quo, ongoing challenges and possible solutions","volume":"75","author":"Wang","year":"2015","journal-title":"Environ. Int."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1038\/s41370-018-0094-1","article-title":"A review of the pathways of human exposure to poly- and perfluoroalkyl substances (PFASs) and present understanding of health effects","volume":"29","author":"Sunderland","year":"2019","journal-title":"J. Expo. Sci. Environ. Epidemiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1289\/ehp.1306615","article-title":"Perfluorooctanoic acid (PFOA) exposures and incident cancers among adults living near a chemical plant","volume":"121","author":"Barry","year":"2013","journal-title":"Environ. Health Perspect."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"154198","DOI":"10.1016\/j.tox.2025.154198","article-title":"Perfluoroalkyl substance pollutants disrupt microglia function and trigger transcriptional and epigenomic changes","volume":"517","author":"Cheng","year":"2025","journal-title":"Toxicology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"154218","DOI":"10.1016\/j.tox.2025.154218","article-title":"Impact of per- and polyfluoroalkyl substances structure on oxidative stress and lipid metabolism disruption in HepG2 cells","volume":"517","author":"Li","year":"2025","journal-title":"Toxicology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"154167","DOI":"10.1016\/j.tox.2025.154167","article-title":"Per- and polyfluoroalkyl substances as potentiators of hepatotoxicity in an exposome framework: Current challenges of environmental toxicology","volume":"515","author":"Choi","year":"2025","journal-title":"Toxicology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1617","DOI":"10.1016\/j.chemosphere.2008.08.011","article-title":"Estimating the contribution of precursor compounds in consumer exposure to PFOS and PFOA","volume":"73","author":"Vestergren","year":"2008","journal-title":"Chemosphere"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"152565","DOI":"10.1016\/j.tox.2020.152565","article-title":"Early life exposure to per- and polyfluoroalkyl substances (PFAS) and latent health outcomes: A review including the placenta as a target tissue and possible driver of peri- and postnatal effects","volume":"443","author":"Blake","year":"2020","journal-title":"Toxicology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1161\/CIRCRESAHA.124.323697","article-title":"Perfluoroalkyl\/Polyfluoroalkyl Substances: Links to Cardiovascular Disease Risk","volume":"134","author":"Schlezinger","year":"2024","journal-title":"Circ. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1596","DOI":"10.1289\/ehp.10598","article-title":"Polyfluoroalkyl chemicals in the U.S. population: Data from the National Health and Nutrition Examination Survey (NHANES) 2003\u20132004 and comparisons with NHANES 1999\u20132000","volume":"115","author":"Calafat","year":"2007","journal-title":"Environ. Health Perspect."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1873","DOI":"10.1289\/ehp.0800379","article-title":"The C8 health project: Design, methods, and participants","volume":"117","author":"Frisbee","year":"2009","journal-title":"Environ. Health Perspect."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"106117","DOI":"10.1016\/j.envint.2020.106117","article-title":"Associations Between Perfluoroalkyl Substances and Lipid Profile in a Highly Exposed Young Adult Population in the Veneto Region","volume":"145","author":"Canova","year":"2020","journal-title":"Environ. Int."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Jeddi, M.Z., Zuanna, T.D., Barbieri, G., Fabricio, A.S.C., Dapr\u00e0, F., Fletcher, T., Russo, F., Pitter, G., and Canova, C. (2021). Associations of Perfluoroalkyl Substances with Prevalence of Metabolic Syndrome in Highly Exposed Young Adult Community Residents\u2014A Cross-Sectional Study in Veneto Region, Italy. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18031194"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s12940-020-00588-9","article-title":"Associations Between Perfluoroalkyl Substances and Serum Lipids in a Swedish Adult Population with Contaminated Drinking Water","volume":"19","author":"Li","year":"2020","journal-title":"Environ. Health"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"112971","DOI":"10.1016\/j.envpol.2019.112971","article-title":"Association Between Perfluoroalkyl Substance Concentrations and Blood Pressure in Adolescents","volume":"254","author":"Ma","year":"2019","journal-title":"Environ. Pollut."},{"key":"ref_23","first-page":"500802","article-title":"Environmental pollution and cardiovascular health. Challenges and new perspectives","volume":"8","year":"2025","journal-title":"Clin. Investig. Arterioscler."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Menotti, A., and Puddu, P.E. (2025). From a Few Cardiovascular Risk Factors to the Prediction of Age at Death: The Shifting Interests of Cardiovascular Epidemiologists. J. Cardiovasc. Dev. Dis., 12.","DOI":"10.3390\/jcdd12020035"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"D\u2019Elia, S., Morello, M., Titolo, G., Caso, V.M., Solimene, A., Luisi, E., Serpico, C., Morello, A., La Mura, L., and Loffredo, F.S. (2025). Homocysteine in the Cardiovascular Setting: What to Know, What to Do, and What Not to Do. J. Cardiovasc. Dev. Dis., 12.","DOI":"10.3390\/jcdd12100383"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Gaubert, M., Bardin, T., Cohen-Solal, A., Di\u00e9vart, F., Fauvel, J.P., Guieu, R., Sadrin, S., Maixent, J.M., Galinier, M., and Paganelli, F. (2020). Hyperuricemia and hypertension, coronary artery disease, kidney disease: From concept to practice. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21114066"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1289\/ehp.0901165","article-title":"Exposure to polyfluoroalkyl chemicals and cholesterol, body weight, and insulin resistance in the general U.S. population","volume":"118","author":"Nelson","year":"2010","journal-title":"Environ. Health Perspect."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"112903","DOI":"10.1016\/j.envres.2022.112903","article-title":"Changes in plasma levels of per- and polyfluoroalkyl substances (PFAS) are associated with changes in plasma lipids\u2014A longitudinal study over 10 years","volume":"211","author":"Dunder","year":"2022","journal-title":"Environ. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"106446","DOI":"10.1016\/j.envint.2021.106446","article-title":"Per- and polyfluoroalkyl substances and calcifications of the coronary and aortic arteries in adults with prediabetes: Results from the Diabetes Prevention Program Outcomes Study","volume":"151","author":"Cardenas","year":"2021","journal-title":"Environ. Int."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"110589","DOI":"10.1016\/j.ecoenv.2020.110589","article-title":"Association between perfluoroalkyl acids and the prevalence of hypertension among US adults","volume":"196","author":"Liao","year":"2020","journal-title":"Ecotoxicol. Environ. Saf."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1136\/oemed-2011-100288","article-title":"Perfluorooctanoic acid exposure is associated with elevated homocysteine and hypertension in US adults","volume":"69","author":"Min","year":"2012","journal-title":"Occup. Environ. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"87004","DOI":"10.1289\/EHP12351","article-title":"Per- and polyfluoroalkyl substances (PFAS) and lipid trajectories in women 45\u201356 years of age: The Study of Women\u2019s Health Across the Nation","volume":"131","author":"Kang","year":"2023","journal-title":"Environ. Health Perspect."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Batzella, E., Zare Jeddi, M., Pitter, G., Russo, F., Fletcher, T., and Canova, C. (2022). Associations between mixture of perfluoroalkyl substances and lipid profile in a highly exposed adult community in the Veneto Region. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph191912421"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1289\/ehp.1307943","article-title":"Modeled PFOA exposure and coronary artery disease, hypertension, and high cholesterol in community and worker cohorts","volume":"122","author":"Winquist","year":"2015","journal-title":"Environ. Health Perspect."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1038\/s41370-022-00464-3","article-title":"Association between per- and polyfluoroalkyl substances exposure and risk of diabetes: A systematic review and meta-analysis","volume":"33","author":"Gui","year":"2023","journal-title":"J. Expo. Sci. Environ. Epidemiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"114370","DOI":"10.1016\/j.envres.2022.114370","article-title":"Associations between serum perfluoroalkyl acid (PFAA) concentrations and health related biomarkers in firefighters","volume":"215","author":"Nilsson","year":"2022","journal-title":"Environ. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"115188","DOI":"10.1016\/j.envres.2022.115188","article-title":"A systematic evidence map of chronic inflammation and immunosuppression related to per- and polyfluoroalkyl substance (PFAS) exposure","volume":"220","author":"Zhang","year":"2023","journal-title":"Environ. Res."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Byoun, J.T., Yun, K.H., Jo, S., Joo, D., and Cho, J.Y. (2025). Prognostic Role of Pan-Immune-Inflammatory Value in Patients with Non-ST-Segment Elevation Acute Coronary Syndrome. J. Cardiovasc. Dev. Dis., 12.","DOI":"10.3390\/jcdd12020079"},{"key":"ref_39","first-page":"17946","article-title":"Exposure to poly- and perfluoroalkyl substances and its association with the coagulation system: A mini-review","volume":"77","author":"Konduracka","year":"2025","journal-title":"Prz. Lek. Jagiellonian Med. Rev."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"De Toni, L., Radu, C.M., Sabovic, I., Di Nisio, A., Dall\u2019acqua, S., Guidolin, D., Spampinato, S., Campello, E., Simioni, P., and Foresta, C. (2020). Increased cardiovascular risk associated with chemical sensitivity to perfluoro\u2013octanoic acid: Role of impaired platelet aggregation. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21020399"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"113457","DOI":"10.1016\/j.ecoenv.2022.113457","article-title":"Association between serum per- and polyfluoroalkyl substances and thrombograms in young and middle-aged Taiwanese populations","volume":"236","author":"Lin","year":"2022","journal-title":"Ecotoxicol. Environ. Saf."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"106584","DOI":"10.1016\/j.envint.2021.106584","article-title":"Interference of C6O4 on platelet aggregation pathways: Cues on the new-generation of perfluoro-alkyl substance","volume":"154","author":"Minuz","year":"2021","journal-title":"Environ. Int."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1093\/cvr\/cvad017","article-title":"Fibrin clot properties in cardiovascular disease: From basic mechanisms to clinical practice","volume":"119","author":"Undas","year":"2023","journal-title":"Cardiovasc. Res."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"873","DOI":"10.20452\/pamw.4165","article-title":"Plasma fibrin clot structure and thromboembolism: Clinical implications","volume":"127","author":"Undas","year":"2017","journal-title":"Pol. Arch. Intern. Med."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Z\u0105bczyk, M., Natorska, J., and Undas, A. (2021). Fibrin clot properties in atherosclerotic vascular disease: From pathophysiology to clinical outcomes. J. Clin. Med., 10.","DOI":"10.3390\/jcm10132999"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2196","DOI":"10.3324\/haematol.2020.253047","article-title":"Thrombin generation: A global coagulation procedure to investigate hypo- and hyper-coagulability","volume":"105","author":"Tripodi","year":"2020","journal-title":"Haematologica"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1016\/S0006-3495(96)79596-6","article-title":"Fibrinogen Dusart: Electron microscopy of molecules, fibers and clots, and viscoelastic properties of clots","volume":"70","author":"Collet","year":"1996","journal-title":"Biophys. J."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Daraei, A., Pieters, M., Baker, S.R., de Lange-Loots, Z., Siniarski, A., Litvinov, R.I., Veen, C.S.B., de Maat, M.P.M., Weisel, J.W., and Ari\u00ebns, R.A.S. (2021). Automated fiber diameter and porosity measurements of plasma clots in scanning electron images. Biomolecules, 11.","DOI":"10.3390\/biom11101536"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"2567","DOI":"10.1161\/01.ATV.0000241589.52950.4c","article-title":"Altered fibrin architecture is associated with hypofibrinolysis and premature coronary atherothrombosis","volume":"26","author":"Collet","year":"2006","journal-title":"Arter. Thromb. Vasc. Biol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1093\/eurheartj\/ehy013","article-title":"Fibrin clot properties independently predict adverse clinical outcome following acute coronary syndrome: A PLATO substudy","volume":"39","author":"Sumaya","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1801677","DOI":"10.1183\/13993003.01677-2018","article-title":"Rate and duration of hospitalisation for acute pulmonary embolism in the real-world clinical practice of different countries: Analysis from the RIETE registry","volume":"53","author":"Mastroiacovo","year":"2019","journal-title":"Eur. Respir. J."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1182\/blood-2017-07-798306","article-title":"Altered plasma clot properties increase the risk of recurrent deep vein thrombosis: A cohort study","volume":"131","author":"Broniatowska","year":"2018","journal-title":"Blood"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1161\/ATVBAHA.116.308253","article-title":"Prothrombotic Fibrin Clot Phenotype Is Associated with Recurrent Pulmonary Embolism After Discontinuation of Anticoagulant Therapy","volume":"37","author":"Wojtowicz","year":"2017","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1016\/j.thromres.2009.11.013","article-title":"Fibrin clot properties in acute ischemic stroke: Relation to neurological deficit","volume":"125","author":"Undas","year":"2010","journal-title":"Thromb. Res."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.ejim.2019.07.028","article-title":"Statin and all cause mortality in patients receiving anticoagulant therapy for venous thromboembolism. Data from the RIETE registry","volume":"68","author":"Siniscalchi","year":"2019","journal-title":"Eur. J. Intern. Med."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Siniscalchi, C., Basaglia, M., Riva, M., Meschi, M., Meschi, T., Castaldo, G., and Di Micco, P. (2023). Statins Effects on Blood Clotting: A Review. Cells, 12.","DOI":"10.3390\/cells12232719"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1160\/TH11-12-0851","article-title":"Effects of atorvastatin on plasma fibrin clot properties in apparently healthy individuals and patients with previous venous thromboembolism","volume":"107","author":"Undas","year":"2012","journal-title":"Thromb. Haemost."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1007\/s00059-004-2607-z","article-title":"Fibrinogen and fibrin clot structure in diabetes","volume":"29","author":"Dunn","year":"2004","journal-title":"Herz"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"3989","DOI":"10.1182\/blood-2023-189881","article-title":"A short thrombin generation time-to-peak\/lag time ratio is an independent risk factor for mortality in the general population","volume":"142","author":"Costanzo","year":"2023","journal-title":"Blood"},{"key":"ref_60","unstructured":"Agency for Toxic Substances and Disease Registry (ATSDR) (2026, May 05). Human Exposure: PFAS Information for Clinicians, Available online: https:\/\/www.atsdr.cdc.gov\/pfas\/hcp\/clinical-overview\/human-exposure.html."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/j.envres.2006.06.008","article-title":"Comparison of human whole blood, plasma, and serum matrices for the determination of perfluorooctanesulfonate (PFOS), perfluorooctanoate (PFOA), and other fluorochemicals","volume":"103","author":"Ehresman","year":"2007","journal-title":"Environ. Res."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1097\/01.jom.0000052958.59271.10","article-title":"Epidemiologic assessment of worker serum perfluorooctanesulfonate (PFOS) and perfluorooctanoate (PFOA) concentrations and medical surveillance examinations","volume":"45","author":"Olsen","year":"2003","journal-title":"J. Occup. Environ. Med."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/5\/209\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T17:03:35Z","timestamp":1778691815000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/5\/209"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,13]]},"references-count":62,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcdd13050209"],"URL":"https:\/\/doi.org\/10.3390\/jcdd13050209","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,13]]}}}