Evidence map›Paper›PMID 40318574›Full record

ArticleComputer methods and programs in biomedicine2025

Hemodynamics affects factor XI/XII anticoagulation efficacy in patient-derived left atrial models.

M Guerrero-Hurtado, M García-Villalba, A Gonzalo, E Durán, P Martinez-Legazpi, P Ávila, A M Kahn, M Y Chen, E McVeigh, J Bermejo and 2 more

Abstract read
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In one paragraph

Article in Computer methods and programs in biomedicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

M Guerrero-HurtadoDepartment of Aerospace Engineering, Universidad Carlos III de Madrid, Leganés, Spain.
M García-VillalbaInstitute of Fluid Mechanics and Heat Transfer, TU Wien, 1060 Vienna, Austria.
A GonzaloDepartment of Mechanical Engineering, University of Washington, Seattle, WA, USA.
E DuránDepartment of Mechanical, Thermal and Fluids Engineering, Universidad de Málaga, Málaga, Spain.
P Martinez-LegazpiDept. of Mathematical Physics and Fluids, Universidad Nacional de Educación a Distancia, Spain; CIBERCV, Madrid, Spain.
P ÁvilaCIBERCV, Madrid, Spain; Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
A M KahnDivision of Cardiovascular Medicine, University of California San Diego, La Jolla, CA, USA.
M Y ChenNational Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
E McVeighDivision of Cardiovascular Medicine, University of California San Diego, La Jolla, CA, USA; Department of Bioengineering, University of California San Diego, La Jolla, CA, USA; Department of Radiology, University of California San Diego, La Jolla, CA, USA.
J BermejoCIBERCV, Madrid, Spain; Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
J C Del ÁlamoDepartment of Mechanical Engineering, University of Washington, Seattle, WA, USA; Center for Cardiovascular Biology, University of Washington, Seattle, WA, USA; Division of Cardiology, University of Washington, Seattle, WA, USA.
O FloresDepartment of Aerospace Engineering, Universidad Carlos III de Madrid, Leganés, Spain. Electronic address: oflores@ing.uc3m.es.

Funding

Mechanistic Relationships Between Fibrosis, Fibrillation, and Stroke: Multi-Scale, Multi-Physics SimulationsR01HL158667 · NHLBI · UNIVERSITY OF WASHINGTON · PI Patrick M Boyle · 2022 to 2026
$3.1M
Patient-specific thrombosis risk in atrial fibrillation by 4D CT imaging of atrial kinetics combined with computational fluid dynamicsR01HL160024 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI DEL ALAMO, JUAN CARLOS, KAHN, ANDREW · 2021 to 2024
$2.7M
NHLBI NIH HHS R01 HL158667NHLBI NIH HHS R01 HL160024
6 · The paper itself

Abstract

BACKGROUND AND

objectiveAtrial fibrillation (AF) is a common arrhythmia that disrupts blood circulation in the left atrium (LA), causing stasis in the left atrial appendage (LAA) and increasing thromboembolic risk. In patients at sufficiently high risk, anticoagulation is indicated. This benefit may be counterbalanced by an increased risk of bleeding. Novel anticoagulants under development, such as factor XI/XII inhibitors, may be associated with a lower bleeding risk. However, their efficacy in preventing thrombosis is not fully understood. We hypothesized that patient-specific flow patterns in the LA and LAA not only influence the risk of thrombosis but also the effectiveness of anticoagulation agents.

methodsTo test our hypothesis, we simulated blood flow and the intrinsic coagulation pathway in patient-specific LA anatomies with and without factor XI/XII inhibition. We included a heterogeneous cohort of thirteen patients, some in sinus rhythm and others in AF, four of whom had an LAA thrombus or a history of transient ischemic attacks. We used computational fluid dynamics based on 4D CT imaging and a detailed 32-coagulation factor system to run 247 simulations. We analyzed baseline LA flow patterns and evaluated various factor XI/XII inhibition levels. Implementing a novel multi-fidelity coagulation modeling approach accelerated computations by two orders of magnitude, enabling many simulations to be performed.

resultsThe simulations provided spatiotemporally resolved maps of thrombin concentration throughout the LA, showing that it peaks inside the LAA. Coagulation metrics based on peak LAA thrombin dynamics suggested patients could be classified as having no, moderate or high thromboembolic risk. High-risk patients had slower flows and higher residence times in the LAA than those with moderate thromboembolic risk, and they required stronger factor XI/XII inhibition to prevent thrombin growth. These data suggest that the anticoagulation effect was also related to the LAA hemodynamics.

conclusionThe methodology outlined in this study has the potential to enable personalized assessments of coagulation risk and to tailor anticoagulation therapy by analyzing flow dynamics in patient-derived LA models, representing a significant step towards advancing the application of digital twins in cardiovascular medicine.

Indexed as

AnticoagulantsFactor XIHeart AtriaHemodynamicsAgedAtrial FibrillationBlood CoagulationComputer SimulationFemaleHumansMaleMiddle AgedThromboembolismThrombosisAnticoagulantsFactor XICoagulation cascadeComputational fluid dynamicsDigital twinsFactor XIFactor XII

Identifiers

PMID40318574
PMCPMC13191223

What Socratic holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.