Epidemiology and biomarkers in transplant associated thrombotic microangiopathy
A Prospective Validation Cohort Study: The goals are to prospectively assess the incidence of TA-TMA in a large pediatric cohort and to test a dynamic risk prediction tool that incorporates validated clinical and laboratory biomarkers in immune, endothelial, and complement activation pathways.
Funding: NIH/NHLBI - K23HL159271, April 1, 2022 - March 31, 2027
Ma S, Bhar S, Guffey D, Kim RB, Jamil M, Amos CI, Lee SJ, Hingorani SR, Sartain SE#, Li A#. Prospective clinical and biomarker validation of the ASTCT consensus definition for transplant-associated thrombotic microangiopathy (TA-TMA). Transplant Cell Ther 2023 Aug 17;S2666-6367(23)01472-0. doi: 10.1016/j.jtct.2023.08.015. PMID: 37597686 [#co-senior authors, original work]
Zhang Z, Hong W, Wu Q, Tsavachidis S, Li JR, Amos CI, Cheng C, Sartain SE, Afshar-Kharghan V, Dong JF, Bhatraju P, Martin PJ, Makar RS, Bendapudi PK, Li A. Pathway-driven rare germline variants associated with transplant-associated thrombotic microangiopathy (TA-TMA). Thromb Res 2023;225:39-46. PMID: 36948020. PMCID: PMC10147584 [original work]
Van Benschoten V, Roy C, Gupta R, Ouellette L, Hingorani S, Li A. Incidence and Risk Factors of Transplantation-Associated Thrombotic Microangiopathy: A Systematic Review and Meta- Analysis. Transplant Cell Ther. 2022 05; 28(5):266.e1-266.e8. PMID: 35042011.
Li A, Wu Q, Davis C, Kirtane KS, Pham PD, Sorror ML, Lee SJ, Gopal AK, Dong JF, Garcia DA, Weiss NS, R Hingorani S. Transplant-Associated Thrombotic Microangiopathy Is a Multifactorial Disease Unresponsive to Immunosuppressant Withdrawal. Biol Blood Marrow Transplant. 2019 03; 25(3):570-576. PMID: 30940363 c.
Epperla N, Li A, Logan B, Fretham C, Chhabra S, Aljurf M, Chee L, Copelan E, Freytes CO, Hematti P, Lazarus HM, Litzow M, Nishihori T, Olsson RF, Prestidge T, Saber W, Wirk B, Yared JA, Loren A, Pasquini M. Incidence, Risk Factors for and Outcomes of Transplant-Associated Thrombotic Microangiopathy. Br J Haematol. 2020 06; 189(6):1171-1181. PMID: 32124435.
Li A, Bhatraju PK, Chen J, Chung DW, Hilton T, Houck K, Pao E, Weiss NS, Lee SJ, Davis C, Schmidt MJ, Lopez JA, Liles WC, Dong JF, Hingorani SR. Prognostic Biomarkers for Thrombotic Microangiopathy after Acute Graft-versus-Host Disease: A Nested Case-Control Study. Transplant Cell Ther. 2021 04; 27(4):308.e1-308.e8. PMID: 33836868
Li A, Gupta R, Amos CI, Davis C, Pao E, Lee SJ, Hingorani SR. Thrombotic Microangiopathy Increases the Risk of Chronic Kidney Disease but Not Overall Mortality in Long-term Transplant Survivors. Transplant Cell Ther. 2021 10; 27(10):864.e1-864.e5. PMID: 34217847.
Epidemiology, health disparity, and risk stratification for cancer associated thrombosis
The goal of this project is to study the epidemiology and prevention of cancer-associated thrombosis and to determine the patient and societal impact of a thromboprophylaxis program.
Funding:
- Cancer Prevention & Research Institute of Texas (CPRIT) RR190104, Aug. 31, 2019 - Aug. 30, 2024
- NIH AIM-AHEAD, 3OT2OD032581-01S1, Sept. 17, 2022 - Sept. 16, 2023
Li A, Jafari O, Lam BD, Jiang JY, Kim RB, Ma S, Zhou E, Tiong JW, Chiang EC, Ryu J, Amos CI, La J, Fillmore NR. Validation of a risk score for cancer-associated thrombosis using nationwide EHR data. JAMA Netw Open 2025;8(11):e2544428. PMID: 41288979. PMCID: PMC12648341 [original work]
Chan A, Chrysafi P, Angelini D, Schaefer J, Li A, Chaturvedi S, Mahajan A, Leben T, May J, Lake L, Patell R, Gutierrez A, Parks A. An International Survey of Clinician Recommendations for Physical Activity after Venous Thromboembolism. Thromb Res 2025;255:109478. PMID: 41005025 [original work]
Jafari O, Ma S, Lam BD, Jiang JY, Zhou E, Ranjan M, Ryu J, Bandyo R, Maghsoudi A, Peng B, Amos CI, Oluyomi AO, Fillmore NR, La J#, Li A#. Development and Validation of VTE-BERT Natural Language Processing Model for Venous Thromboembolism. J Thromb Haemost 2025: S1538-7836(25)00484-2. PMID: 40754035. PMCID: PMC12360494 [original work]
Li A, De Las Pozas G, Andersen CR, Nze CC, Toale KM, Milner EM, Fillmore NR, Chiao EY, Rojas Hernandez CM, Kroll MH, Merriman KW#, Flowers CR#. External validation of a novel electronic risk score for cancer associated thrombosis in a comprehensive cancer center. Am J Hematol 2023, Apr 17. doi: 10.1002/ajh.26928. PMID: 37067102. PMCID: PMC10330124 [#co-senior authors, original work]
Thomas RM, Wilkinson K, Koh I, Li A, Warren JSA, Roetker NS, Smith NL, Holmes CE, Plante TB, Repp AB, Cushman M, Zakai NA. Development of a computable phenotype using electronic health records for venous thromboembolism in medical inpatients: the Medical Inpatient Thrombosis and Hemostasis study. Res Pract Thromb Haemost 2023;7(4):100162. PMID: 37342252; PMCID: PMC10277582 [original work]
Shang H, Jiang JY, Guffey D, Novoa F, Bandyo R, Ma S, Li A. Natural History of Cancer-Associated Splanchnic Vein Thrombosis. J Thromb Haemost. 2024:S1538-7836(24)00060-6. doi: 10.1016/j.jtha.2024.01.019. PMID: 38309433. [original work]
Kim R#, Li A#, Park K, et al. Low-Dose Aspirin for Primary Prevention of Cardiovascular Events Comparing East Asians with Westerners. JACC: Asia, 2023, ISSN 2772-3747. https://doi.org/10.1016/j.jacasi.2023.07.008 [#co-first authors, original work]
Zakai NA, Wilkinson K, Sparks AD, Packer RT, Koh I, Roetker NS, Repp AB, Thomas R, Holmes CE, Cushman M, Plante TB, Al-Samkari H, Pishko AM, Wood WA, Masias C, Gangaraju R, Li A, Garcia D, Wiggins KL, Schaefer JK, Hooper C, Smith NL, McClure LA. Development and validation of a risk model for hospital-acquired venous thrombosis: the Medical Inpatients Thrombosis and Hemostasis study. J Thromb Haemost 2023:S1538-7836(23)00784-5. PMID: 37918635 [original work]
Avery J, Guffey D, Ma S, Basom R, Lee SJ, Garcia DA, Rojas Hernandez CM, Li A#, Martens KL#. Risks factors and outcomes for isolated catheter-related deep venous thrombosis in patients undergoing allogeneic hematopoietic stem cell transplantation. Thromb Res 2023;229:1-6. PMID: 37356171. PMCID: PMC10527315 [#co-senior authors, original work]
Martens KL#, Li A#, La J, May SB, Swinnerton KN, Tosi H, Elbers DC, Do NV, Brophy MT, Gaziano JM, Lotfollahzadeh S, Chitalia V, Ravid K, Fillmore NR. Epidemiology of venous thromboembolism in patients with solid and hematologic malignancies in the United States. JAMA Netw Open 2023;6(6):e2317945. PMID: 37306999. PMCID: PMC10261992 [#co-first authors, original work]
Li A, May SB, La J, Martens KL, Amos CI, Flowers CR, Do NV, Brophy MT, Chitalia V, Ravid K, Gaziano JM, Fillmore NR. Venous thromboembolism risk in cancer patients receiving first-line immune checkpoint inhibitor versus chemotherapy. Am J Hematol 2023;98(8):1214-1222. PMID: 37161855 PMCID: PMC10569448 [original work]
Li A, La J, May SB, Guffey D, da Costa WL, Amos CI, Bandyo R, Milner EM, Kurian KM, Chen DC, Do NV, Granada C, Riaz N, Brophy MT, Chitalia V, Gaziano JM, Garcia DA, Carrier M, Flowers CR, Zakai NA, Fillmore NR. Derivation and validation of clinical risk assessment model for cancer associated thrombosis in two unique U.S. healthcare systems. J Clin Oncol 2022. doi: 10.1200/JCO.22.01542. PMID: 36626707 [original work]
Projects link: https://dynamicapp.shinyapps.io/EHR-CAT/
Dima D#, Li A#, Granat LM, Dhillon P, Chamseddine F, Wei W, Samaras CJ, ValentJ, Anwer F and Khouri J. External Validation of the SAVED Score for Venous Thromboembolism Risk Stratification in Patients with Multiple Myeloma Receiving Immunomodulatory Drugs. Br J Haematol 2022. doi.org/10.1111/bjh.18630. PMID: 36604838 [#co-first authors, original work]
da Costa WL, Guffey D, Oluyomi A, Bandyo R, Rosales O, Wallace CD, Granada C, Riaz N, Fitzgerald M, Garcia DA, Carrier M, Amos CI, Flowers CR, Li A. Patterns of venous thromboembolism risk, treatment, and outcomes among patients with cancer from uninsured and vulnerable populations. Am J Hematol. 2022 Aug; 97(8):1044-1054. PMID: 35638475.
Li A, da Costa WL, Guffey D, Milner EM, Allam AK, Kurian KM, Novoa FJ, Poche MD, Bandyo R, Granada C, Wallace CD, Zakai NA, Amos CI. Developing and optimizing a computable phenotype for incident venous thromboembolism in a longitudinal cohort of patients with cancer. Res Pract Thromb Haemost. 2022 May; 6(4):e12733. PMID: 35647478.
Li A, Wu Q, Warnick G, Li S, Libby EN, Garcia DA, Lyman GH. The incidence of thromboembolism for lenalidomide versus thalidomide in older patients with newly diagnosed multiple myeloma. Ann Hematol. 2020 Jan; 99(1):121-126. PMID: 31773215.
Li A, Wu Q, Luo S, Warnick GS, Zakai NA, Libby EN, Gage BF, Garcia DA, Lyman GH, Sanfilippo KM. Derivation and Validation of a Risk Assessment Model for Immunomodulatory Drug-Associated Thrombosis Among Patients With Multiple Myeloma. J Natl Compr Canc Netw. 2019 07 01; 17(7):840-847. PMID: 31319391.
Wang TF, Li A, Garcia D. Managing thrombosis in cancer patients. Res Pract Thromb Haemost. 2018 Jul; 2(3):429-438. PMID: 30046747. f. Li A, Lopes RD, Garcia DA. Use of Direct Oral Anticoagulants in Special Populations. Hematol Oncol Clin North Am. 2016 10; 30(5):1053-71. PMID: 27637307.
Risk factors and burden of COVID-19 related thrombosis and bleeding complication:
The goals are to determine the incidence of thrombosis and bleeding and to assess benefit/harm of therapeutic anticoagulation among hospitalized patients with COVID-19 across different hospital systems. There was a specific focus on people with cancer and thrombosis.
Funding: CDC - 6NU38OT000280-03-02, Sept. 1, 2020 - Jul 31, 2022
Li A, Kuderer NM, Hsu CY, Shyr Y, Warner JL, Shah DP, Kumar V, Shah S, Kulkarni AA, Fu J, Gulati S, Zon RL, Li M, Desai A, Egan PC, Bakouny Z, Kc D, Hwang C, Akpan IJ, McKay RR, Girard J, Schmidt AL, Halmos B, Thompson MA, Patel JM, Pennell NA, Peters S, Elshoury A, de Lima Lopes G, Stover DG, Grivas P, Rini BI, Painter CA, Mishra S, Connors JM, Lyman GH,
Rosovsky RP. The CoVID-TE risk assessment model for venous thromboembolism in hospitalized patients with cancer and COVID-19. J Thromb Haemost. 2021 10; 19(10):2522-2532. PMID: 34260813.
Chen N, Jotwani A, Li A. Care Delivery in Cancer Patients With Asymptomatic COVID-19 Infection in a Tertiary, Safety-Net Hospital in Houston, Texas. Am J Clin Oncol. 2021 08 01; 44(8):409-412. PMID: 34107500.
Desai A, Gupta R, Advani S, Ouellette L, Kuderer NM, Lyman GH, Li A. Mortality in hospitalized patients with cancer and coronavirus disease 2019: A systematic review and meta-analysis of cohort studies. Cancer. 2021 05 01; 127(9):1459-1468. PMID: 33378122.
Razjouyan J, Helmer DA, Li A, Naik AD, Amos CI, Bandi V, Sharafkhaneh A. Differences in COVID-19-Related Testing and Healthcare Utilization by Race and Ethnicity in the Veterans Health Administration. J Racial Ethn Health Disparities. 2022 Apr; 9(2):519-526. PMID: 33694124
Management of thrombosis and bleeding in hematopoietic cell transplant patients:
The goals are to assess the incidence of and risk factors for thrombosis and bleeding in people undergoing hematopoietic cell transplantation. A novel risk prediction model was derived and externally validated.
Li A, Martens KL, Nguyen D, Basom R, Rondon G, Jin S, Young E, Amos CI, Lee SJ, Davis C, Garcia DA, Champlin R, Shpall E, Kebriaei P, Rojas Hernandez C. External validation of the HIGH-2-LOW model: A predictive score for venous thromboembolism after allogeneic transplant. Am J Hematol. 2022 06 01; 97(6):740-748. PMID: 35266218.
Martens KL, Amos CI, Hernandez CR, Kebriaei P, da Costa WL, Basom R, Davis C, Kesten M, Carrier M, Garcia DA, Lee SJ, Li A. Impact of anticoagulation on recurrent thrombosis and bleeding after hematopoietic cell transplantation. Am J Hematol. 2021 09 01; 96(9):1137-1146. PMID: 34097772.
Martens KL, da Costa WL, Amos CI, Davis C, Kesten M, Lee SJ, Zakai NA, Garcia DA, Li A. HIGH-2-LOW risk model to predict venous thromboembolism in allogeneic transplant patients after platelet engraftment. Blood Adv. 2021 01 12; 5(1):167-175. PMID: 33570631.
Li A, Davis C, Wu Q, Li S, Kesten MF, Holmberg LA, Gopal AK, Garcia DA. Management of venous thromboembolism during thrombocytopenia after autologous hematopoietic cell transplantation. Blood Adv. 2017 May 09; 1(12):707-714. PMID: 29296714.
Rapid diagnosis of immune thrombotic thrombocytopenic purpura
The goals are to characterize patients with high pre-test probability for iTTP. Specifically, a risk prediction model was derived and externally validated for iTTP.
Javed B, Brown J, Meade J, Nambi V, Li A, Chaturvedi S, Sukumar S. Standard Cardiovascular Risk Prediction Scores Underestimate Risk in Immune-Mediated Thrombotic Thrombocytopenic Purpura Survivors. Res Pract Thromb Haemost 2025;9(6):103005. PMID: 40994890. PMCID: PMC12454890 [original work]
Pishko AM, Li A, Cuker A. Immune Thrombotic Thrombocytopenic Purpura: A Review. JAMA 2025; 334(6):517-529. PMID: 40388146 [review]
Li A, Kremer Hovinga JA. Laboratory surveillance of immune-mediated thrombotic thrombocytopenic purpura. Hematology Am Soc Hematol Educ Program. 2020 12 04; 2020(1):82-84. PMID: 33275690.
Li A, Khalighi PR, Wu Q, Garcia DA. External validation of the PLASMIC score: a clinical prediction tool for thrombotic thrombocytopenic purpura diagnosis and treatment. J Thromb Haemost. 2018 01; 16(1):164-169. PMID: 29064619.
Sun L, Mack J, Li A, Ryu J, Upadhyay VA, Uhl L, Kaufman RM, Stowell CP, Dzik WS, Makar RS, Bendapudi PK. Predictors of relapse and efficacy of rituximab in immune thrombotic thrombocytopenic purpura. Blood Adv. 2019 05 14; 3(9):1512-1518. PMID: 31076407.
Li A, Khalighi PR, Wu Q, Garcia DA. External validation of the PLASMIC score: a clinical prediction tool for thrombotic thrombocytopenic purpura diagnosis and treatment. J Thromb Haemost. 2018 01; 16(1):164-169. PMID: 29064619.
Bendapudi PK, Hurwitz S, Fry A, Marques MB, Waldo SW, Li A, Sun L, Upadhyay V, Hamdan A, Brunner AM, Gansner JM, Viswanathan S, Kaufman RM, Uhl L, Stowell CP, Dzik WH, Makar RS. Derivation and external validation of the PLASMIC score for rapid assessment of adults with thrombotic microangiopathies: a cohort study. Lancet Haematol. 2017 Apr;
4(4):e157-e164. PMID: 28259520. f. Li A, Bendapudi PK, Uhl L, Hamdan A, Kaufman RM, Makar RS. Clinical features and outcomes in patients with thrombotic microangiopathy not associated with severe ADAMTS13 deficiency. Transfusion. 2017 09; 57(9):2151-2158. PMID: 28635017.
Li A, Makar RS, Hurwitz S, Uhl L, Kaufman RM, Stowell CP, Dzik WS, Bendapudi PK. Treatment with or without plasma exchange for patients with acquired thrombotic microangiopathy not associated with severe ADAMTS13 deficiency: a propensity score-matched study. Transfusion. 2016 08; 56(8):2069-77. PMID: 27232383.
Bendapudi PK, Li A, Hamdan A, Uhl L, Kaufman R, Stowell C, Dzik W, Makar RS. Impact of severe ADAMTS13 deficiency on clinical presentation and outcomes in patients with thrombotic microangiopathies: the experience of the Harvard TMA Research Collaborative. Br J Haematol. 2015 Dec; 171(5):836-44. PMID: 26314936.
Comparative and cost effectiveness research in hematology
The gaosl are to better understand the societal implications of novel treatment approaches in anticoagulation through systematic review, meta-analysis, and cost effectiveness analysis.
Li A, Carlson JJ, Kuderer NM, Schaefer JK, Li S, Garcia DA, Khorana AA, Carrier M, Lyman GH. Cost-effectiveness analysis of low-dose direct oral anticoagulant (DOAC) for the prevention of cancer-associated thrombosis in the United States. Cancer. 2020 04 15; 126(8):1736-1748. PMID: 31999844.
Li A, Manohar PM, Garcia DA, Lyman GH, Steuten LM. Cost effectiveness analysis of direct oral anticoagulant (DOAC) versus dalteparin for the treatment of cancer associated thrombosis (CAT) in the United States. Thromb Res. 2019 Aug; 180:37-42. PMID: 31200341.
Li A, Kuderer NM, Garcia DA, Khorana AA, Wells PS, Carrier M, Lyman GH. Direct oral anticoagulant for the prevention of thrombosis in ambulatory patients with cancer: A systematic review and meta-analysis. J Thromb Haemost. 2019 12; 17(12):2141-2151. PMID: 31420937.
Li A, Garcia DA, Lyman GH, Carrier M. Direct oral anticoagulant (DOAC) versus low-molecular-weight heparin (LMWH) for treatment of cancer associated thrombosis (CAT): A systematic review and meta-analysis. Thromb Res. 2019 01; 173:158-163. PMID: 29506866.