Antonella Tufano
@unina.it
Scopus Publications
- Acquired Hemostasis Disorders
Antonella Tufano, Massimo Franchini, Antonio Coppola
Seminars in Thrombosis and Hemostasis, 2026 - Heparin-induced thrombocytopenia: a challenging diagnosis in haemodialysis—state of art and review of the literature
Ivana Capuano, Eleonora Riccio, Pasquale Buonanno, Antonella Tufano, Antonio Pisani
Clinical Kidney Journal, 2026
Heparin-induced thrombocytopenia (HIT) is a life-threatening disorder caused by exposure to heparin and characterized by high morbidity and mortality. It is largely underestimated because of its heterogeneous presentation, ranging from a decrease in platelet count antibody positivity to serious thrombotic complications. Haemodialysis (HD) patients represent a high-risk population due to anticoagulation use during extracorporeal treatments. It usually occurs in the first weeks after the start of HD, although it has been reported in chronic HD patients after surgery procedures. When the diagnosis of HIT is formulated, heparin must be promptly stopped and an alternative anticoagulant has to be started. The aim of this review is to provide a comprehensive overview on the pathogenesis, diagnosis and treatment of HIT in HD in order to increase the awareness of physicians of this important clinical syndrome to promptly start the specific treatment. - Acquired Hemophilia A in a Case of Relapsed Immune Thrombotic Thrombocytopenic Purpura
Antonella Tufano, Ciro Miele, Paolo Conca, Ilenia Calcaterra, Cristina Mazzaccara, et al.
Seminars in Thrombosis and Hemostasis, 2026
Hemostasis is a highly regulated physiological process governed by a series of enzymatic pathways that maintains a delicate balance between procoagulant and anticoagulant mechanisms. Both congenital and acquired alterations in coagulation can result in thrombotic events when procoagulant forces dominate, or hemorrhagic events when clotting mechanisms are impaired/absent. While hereditary coagulation de fi ciencies have a signi fi cant impact due to their wide-ranging clinical consequences, acquired coagulopa-thies pose equally complex diagnostic and therapeutic challenges. These conditions can develop in individuals with no prior personal/familial history of hemorrhagic or thrombotic disorders, often because of underlying diseases that affect coagulation factor synthesis and function. 1 Acquired hemophilia A (AHA) and immune-mediated thrombotic thrombocytopenic purpura (iTTP) are both individually rare autoimmune disorders that disrupt hemostasis, though they have distinct pathogenetic mechanisms and clinical manifestations, with an incidence of 1.5 to 6 and 1.5 cases per million - Emicizumab in Acquired Hemophilia A: A Real-World Case Series with Patient-Level Outcome Analysis
Ilenia Calcaterra, Carmine De Luca, Guido D'Errico, Ciro Miele, Chiara Caputo, et al.
Seminars in Thrombosis and Hemostasis, 2026
Acquired Hemophilia A (AHA) is a rare bleeding disorder caused by factor VIII inhibitors. Standard therapies are limited by thrombotic risk and prolonged hospitalization. Emicizumab, approved for congenital Hemophilia A, has emerged as a potential alternative in AHA based on case reports and early clinical trial data. To evaluate the efficacy and safety of Emicizumab in AHA through a retrospective real-world case series and a systematic literature review with patient-level data analysis. We retrospectively analyzed five AHA cases treated with Emicizumab at two Italian centers and performed a PRISMA-compliant systematic review of published reports, extracting and analyzing patient-level data using Joanna Briggs Institute tools. In the real-world cohort, early Emicizumab use in five patients with high-titer inhibitors and severe bleeding led to rapid hemorrhagic control, early withdrawal of bypassing agents, and no thrombotic or adverse events. All five patients received immunosuppression, and inhibitor eradication was achieved in 60% of patients, but for 40% follow up is still ongoing. The literature review identified 24 patients from 18 publications. Early Emicizumab administration (at admission) was associated with reduced bleeding recurrence (0% vs. 56.3%), shorter in-hospital stay (median 23.5 days vs. 39 days), and lower bleeding-related mortality (0% vs. 12.5%) compared with delayed administration. Early Emicizumab initiation appears to be a safe and effective strategy for AHA management, particularly in fragile or high-risk populations. Its subcutaneous route, favorable safety profile, and ability to reduce hospitalization support its integration into first-line therapeutic algorithms. Further prospective studies are warranted to define. - Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT): An Immunopathogenic Model of Dysregulated Vaccine-Triggered Immunity
Carmine Siniscalchi, Manuela Basaglia, Antonella Tufano, Egidio Imbalzano, Pierpaolo Di Micco
Vaccines, 2026
Background/Objectives: Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare but severe immune-mediated adverse event associated with adenoviral vector-based SARS-CoV-2 vaccines. Beyond its clinical relevance, VITT provides a unique human model of vaccine-triggered autoimmunity and immune-thrombosis. This review critically reassesses the immunopathogenic framework of VITT in light of recent evidence. Methods: We conducted a structured narrative review of studies published between 2021 and 2025, focusing on clinical, epidemiological, and mechanistic data relevant to PF4 immunogenicity, platelet activation, and long-term outcomes. Results: Current evidence supports a multistep model in which adenoviral vector components form immunogenic PF4–polyanion complexes that induce high-affinity anti-PF4 IgG antibodies. These antibodies activate platelets via FcγRIIa, amplify complement signaling, promote neutrophil extracellular trap formation, and drive endothelial perturbation, establishing a self-sustaining thrombo-inflammatory loop. Recent longitudinal studies refine earlier interpretations by distinguishing persistent anti-PF4 seropositivity from sustained platelet-activating capacity. Epidemiological data support platform-enriched risk rather than absolute platform exclusivity, with a proposed mechanistic “border zone” for incomplete phenotypes. Conclusions: VITT represents a tractable human model of vaccine-induced autoimmunity in which innate immune activation and multivalent antigen presentation converge to break tolerance. Updated evidence clarifies antibody persistence, platform enrichment, and translational implications, while highlighting unresolved questions regarding host susceptibility and long-term immune regulation. - Hemostatic Aspects of Interactions between Anticancer Drugs and Oral Anticoagulants in Patients with Cancer-Associated Venous Thromboembolism
Antonella Tufano, Alberto Corsini, Nicola Ferri, Mario Mandalà, Anna Guida, et al.
Seminars in Thrombosis and Hemostasis, 2026
Cancer-associated thrombosis (CAT) remains a major cause of morbidity and mortality in patients with malignancy. Direct oral anticoagulants (DOACs) have expanded the therapeutic armamentarium for CAT and are now widely used as alternatives to low molecular weight heparins (LMWHs). However, the increasing complexity of contemporary oncologic care has heightened concerns regarding clinically relevant drug–drug interactions (DDIs). All DOACs are substrates of P-glycoprotein, and some undergo partial metabolism via cytochrome P4503A4, rendering them more susceptible to pharmacokinetic (PK) modulation by anticancer agents. Moreover, several antineoplastic drugs exert intrinsic prothrombotic or hemorrhagic effects, thereby introducing pharmacodynamic interactions that may further destabilize the already dysregulated hemostatic system in cancer. Despite these theoretical concerns, evidence from randomized trials and real-world studies remains limited and largely derived from subgroup analyses, PK investigations in healthy volunteers, or retrospective registries. Consequently, the true clinical magnitude of DDIs in CAT remains incompletely defined. This review critically appraises the pharmacological basis, clinical evidence, and translational implications of DDIs between DOACs and anticancer therapies. We propose that DDIs in CAT should not be viewed solely as PK phenomena, but also as potential biological amplifiers of cancer-associated coagulopathy. Until prospective, dedicated studies become available, a structured/individualized approach—integrating thrombotic/bleeding risk, interacting medications, and patient-specific factors—is warranted. - Use of Plasma-Derived FVII Concentrate in Surgical Patients with Factor VII Deficiency: A Case Series
Paolo Conca, Ernesto Cimino, Anna Guida, Rosa Albisinni, Tommaso Marrazzo, et al.
Seminars in Thrombosis and Hemostasis, 2026
Congenital factor VII (FVII) deficiency is the most common rare hemorrhagic disorder. Acquired FVII deficiency can be isolated or associated with other low coagulation factor levels. FVII levels do not accurately predict a patient's bleeding risk. In the case of surgery, the perioperative management needs to be evaluated on a case-by-case basis, considering the patient's bleeding history and the type of surgery. We present 12 patients with congenital or acquired FVII deficiency and describe the perioperative management with plasma-derived nonactivated FVII (pd-FVII) concentrate. Patients with factor VII deficiency treated with pd-FVII for perioperative hemostasis, between April 2022 and May 2025. We report thirteen procedures in 12 patients (11 males and 1 female; age range: 15–78 years). Two patients were affected by acquired deficiency, and 10 patients presented congenital deficiency. Perioperative prophylaxis with pd-FVII was performed at doses ranging from 20 to 40 IU/kg/dose. Total pd-FVII consumption ranged between 20 and 320 IU/kg. During and after surgery, there were no major bleeding or thrombotic events. In the postoperative period, only one patient presented with hematuria. - A Rare Case of Acquired Non-neutralizing Factor II Inhibitor in a Patient with B-Cell Lymphoproliferative Disorder
Ciro Miele, Chiara Caputo, Ilenia Lorenza Calcaterra, Paolo Conca, Ernesto Cimino, et al.
Seminars in Thrombosis and Hemostasis, 2026 - Preferences Among Expert Physicians in Areas of Uncertainty in Venous Thromboembolism Management: Results from a Multiple-Choice Questionnaire
Alessandro Di Minno, Gaia Spadarella, Ilenia Lorenza Calcaterra, Antonella Tufano, Alessandro Monaco, et al.
Journal of Clinical Medicine, 2025
Background/Objectives: Prevention and treatment of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major clinical issue in hospitalized patients. Some aspects of VTE management lack clarity due to differing physicians’ opinions and behaviors. Methods: A multidisciplinary steering committee identified two main areas of uncertainty: VTE prophylaxis and PE management in special settings. A multiple-choice questionnaire including 10 statements was circulated to 183 doctors trained in VTE management. The expected benefit-to-harm ratio was represented on a nine-point Likert scale, with consensus (≥75% agreement) on scores of 1–3 indicating inappropriate and 7–9 indicating appropriate care measures. Results: In online voting, a consensus was reached for 9/10 statements. Respondents considered the following to be appropriate: risk assessment of VTE (93.44%) and bleeding (91.6%) in hospitalized medical patients; low-molecular weight heparin (LMWH) prophylaxis for inpatients with pneumonia and malignancy (82.78%); therapeutic doses of LMWH/fondaparinux in patients with intermediate/high risk of PE with (80.9%) or without (77.97%) instability criteria; and echocardiography to manage patients with a post-PE syndrome (93.99%). Respondents considered the following to be inappropriate: use of 4000 IU LMWH in chronic renal failure (80.46%); use of 2000 IU LMWH in persons on dual antiplatelet therapy (77.01%); and use of low-dose apixaban (2.5 mg) in pregnancy (88.57%) or in subsegmental PE with hypoxemia (82.46%). No consensus was reached on the identification of PE cases eligible for outpatient treatment. Conclusions: Our findings show persistent gaps between guideline recommendations and clinical implementation despite improved awareness among physicians. Uncertainty persists regarding criteria for outpatient PE eligibility and/or for validation of bleeding-risk models. - A machine learning approach to identify patients at risk for long-term consequences after pulmonary embolism
Stephan Nopp, Clemens Spielvogel, Behnood Bikdeli, Ana Alberich-Conesa, Luis Hernández-Blasco, et al.
Scientific Reports, 2025 - Acute pulmonary embolism: A multimarker calculator to predict short-term outcomes
David Jiménez, Álvaro Dubois-Silva, Pablo Demelo-Rodríguez, Pedro Ruiz-Artacho, Juan José López-Núñez, et al.
European Heart Journal, 2025 - Thrombotic events after vaccination for covid-19 in Italy: a report from the Italian society on thrombosis and haemostasis registry
Marco Paolo Donadini, Elisa Tarasconi, Lorenza Bertù, Emilia Antonucci, Laura Contino, et al.
Internal and Emergency Medicine, 2025 - Venous and arterial thromboembolism in out-patients with inflammatory bowel disease: a single center study
Antonella Tufano, Anna Testa, Marta Patturelli, Antonio Rispo, Vincenzo Fotticchia, et al.
Thrombosis Update, 2025 - Neutrophil–lymphocyte ratio is associated with worse outcomes in patients with cirrhosis: insights from the PRO-LIVER Registry
Tania D’Amico, Marzia Miglionico, Roberto Cangemi, Giulio Francesco Romiti, Benedetta De Fabrizio, et al.
Internal and Emergency Medicine, 2025 - Baseline Hemoglobin Values and Clinical Outcomes in Acute Venous Thromboembolism: Insights From the RIETE Registry
Carmine Siniscalchi, Pierpaolo Di Micco, Antonella Tufano, Maria Luisa Peris, Patricia López‐Miguel, et al.
American Journal of Hematology, 2025 - Long-term left ventricular thrombosis resolution in patients receiving vitamin k antagonists: a multicenter observational study
Emanuele Valeriani, Giulia Astorri, Arianna Pannunzio, Daniele Pastori, Ilaria Maria Palumbo, et al.
Internal and Emergency Medicine, 2025 - Impact of the 2023 ACR/EULAR Classification Criteria on START2 Antiphospholipid Registry
Anna Aiello, Luca Sarti, Gilda Sandri, Daniela Poli, Piera Sivera, et al.
International Journal of Laboratory Hematology, 2025 - Use of Oral Anti-Xa Inhibitor in Prosthetic Mechanical Aortic Valve with Warfarin Hypersensitivity Due to the FIX p(Ala37Thr) Propeptide Variant: Case Report and Literature Review
Antonella Tufano, Carmine Fierarossa, Ferdinando Cirillo, Ciro Miele, Filomena Capasso, et al.
Seminars in Thrombosis and Hemostasis, 2025 - Pharmacokinetic Studies, Assessing the Efficiency of FVIII/VWF Concentrates and Intravenous Human Immunoglobulin, Revealed the Etiopathogenesis of Acquired von Willebrand Disease in Patient With MGUS
Ciro Miele, Francesca D'Auria, Luca Manfredi, Paolo Conca, Ernesto Cimino, et al.
Haemophilia, 2025 - Extended pharmacological thromboprophylaxis and clinically relevant venous thromboembolism after major abdominal and pelvic surgery: International, prospective, propensity score-weighted cohort study
A Sgrò, R Blanco-Colino, N Brindl, D Chaudhry, K Gressmann, et al.
British Journal of Surgery, 2025 - Fright of Long-Haul Flights: Focus on Travel-Associated Thrombosis
Emmanuel Papadakis, Eleni Gavriilaki, Nikolaos Kotsiou, Antonella Tufano, Benjamin Brenner
Seminars in Thrombosis and Hemostasis, 2025 - Can LDL-C be too low? Time to rethink the “lower is better” paradigm
Carmine SINISCALCHI, Antonella TUFANO, Tiziana MESCHI, Egidio IMBALZANO, Pierpaolo Di MICCO
Internal and Emergency Medicine, 2025 - Rate of recurrence after discontinuing anticoagulation in patients with venous thromboembolism within 30 days after COVID-19 vaccine
Luis Jara‐Palomares, Behnood Bikdeli, David Jiménez, Alfonso Muriel, Pablo Demelo‐Rodríguez, et al.
European Journal of Clinical Investigation, 2024 - Rate and predictors of thromboprophylaxis in internal medicine wards: Results from the AURELIO study
Arianna Magna, Enrico Maggio, Gianpaolo Vidili, Angela Sciacqua, Chiara Cogliati, et al.
Thrombosis Research, 2024 - Assessment of bleeding events in patients receiving DOACs with or without statins to treat venous thromboembolism: insights from the RIETE registry
Rosaria Del Giorno, Lucia Mazzolai, Sanjiv Keller, Carmine Siniscalchi, Luciano Lopez-Jimenez, et al.
BMJ Open, 2024
