1
|
Harjen HJ, Hellum M, Rørtveit R, Oscarson M, Anfinsen KP, Moldal ER, Solbak S, Kanse SM, Henriksson CE. Persistent hypercoagulability in dogs envenomated by the European adder (Vipera berus berus). PLoS One 2022; 17:e0263238. [PMID: 35180240 PMCID: PMC8856559 DOI: 10.1371/journal.pone.0263238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 01/14/2022] [Indexed: 11/23/2022] Open
Abstract
Background Envenomation by the European adder, Vipera berus berus (Vbb), is a medical emergency. The overall in vivo haemostatic effects of pro- and anticoagulant components in Vbb venom, and the downstream effects of cellular injury and systemic inflammation, are unclear. Objectives To longitudinally describe the global coagulation status of dogs after Vbb envenomation and compare to healthy controls. A secondary aim was to investigate differences between dogs treated with and without antivenom. Methods Citrated plasma was collected at presentation, 12 hours (h), 24 h, 36 h and 15 days after bite from 28 dogs envenomated by Vbb, and from 28 healthy controls at a single timepoint. Thrombin generation (initiated with and without exogenous phospholipids and tissue factor), thrombin-antithrombin (TAT)-complexes and the procoagulant activity of phosphatidylserine (PS)-expressing extracellular vesicles (EVs), expressed as PS-equivalents, were measured. Results At presentation the envenomated dogs were hypercoagulable compared to controls, measured as increased thrombin generation, TAT-complexes and PS-equivalents. The hypercoagulability decreased gradually but compared to controls thrombin generation and PS-equivalents were still increased at day 15. The discrepancy in peak thrombin between envenomated dogs and controls was greater when the measurement was phospholipid-dependent, indicating that PS-positive EVs contribute to hypercoagulability. Lag time was shorter in non-antivenom treated dogs, compared to antivenom treated dogs <24 h after envenomation. Conclusions Hypercoagulability was measured in dogs up to 15 days after Vbb envenomation. Dogs treated with antivenom may be less hypercoagulable than their non-antivenom treated counterparts. Thrombin generation is a promising diagnostic and monitoring tool for Vbb envenomation.
Collapse
Affiliation(s)
- Hannah J. Harjen
- Faculty of Veterinary Medicine, Department of Companion Animal Clinical Sciences, Norwegian University of Life Sciences, Oslo, Norway
- * E-mail:
| | - Marit Hellum
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- The Blood Cell Research Group, Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Runa Rørtveit
- Faculty of Veterinary Medicine, Department of Preclinical Sciences and Pathology, Norwegian University of Life Sciences, Oslo, Norway
| | | | - Kristin P. Anfinsen
- Faculty of Veterinary Medicine, Department of Companion Animal Clinical Sciences, Norwegian University of Life Sciences, Oslo, Norway
| | - Elena R. Moldal
- Faculty of Veterinary Medicine, Department of Companion Animal Clinical Sciences, Norwegian University of Life Sciences, Oslo, Norway
| | - Susanna Solbak
- Anicura Dyresykehus Oslo, Oslo, Norway
- Anicura Jeløy Dyresykehus, Moss, Norway
| | - Sandip M. Kanse
- Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Carola E. Henriksson
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- The Blood Cell Research Group, Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
2
|
Nemmar A, Al-Salam S, Beegam S, Zaaba NE, Elzaki O, Yasin J, Ali BH. Waterpipe smoke-induced hypercoagulability and cardiac injury in mice: Influence of cessation of exposure. Biomed Pharmacother 2022; 146:112493. [PMID: 35062048 DOI: 10.1016/j.biopha.2021.112493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/21/2021] [Accepted: 11/30/2021] [Indexed: 11/19/2022] Open
Abstract
Waterpipe tobacco smoking has gained worldwide popularity, particularly among youths. Several clinical and experimental studies have reported that waterpipe smoking (WPS) injures the cardiovascular system. However, the impact of smoking cessation (CS) on the cardiovascular toxicity induced by WPS received scant attention. Hence, we assessed, in C57BL/6 mice, the cardiovascular effects of WPS exposure for 3 months followed by 3 months of SC, as compared with mice exposed for either 3 months to WPS or air (control). WPS exposure induced hypertension, prothrombotic events both in vivo and in vitro and increased the plasma concentrations of tissue factor, fibrinogen and plasminogen activator inhibitor-1. These effects were significantly alleviated by SC. In heart tissue, the levels of troponin I, creatine kinase, lipid peroxidation, 8-isoprostane, tumor necrosis factor α, inteleukin 6, DNA damage and cleaved caspase-3 were significantly increased by WPS exposure. These actions were significantly reduced in the group of mice exposed to WPS followed by SC. Similarly, the increase in the level of nuclear factor κ-β induced by WPS exposure was significantly mitigated by SC. Immunohistochemical analysis of the hearts showed that WPS exposure increased the expression of nuclear factor erythroid-derived 2-like 2 by cardiomyocytes. The latter effect was significantly reduced by SC. Taken together, our data show that SC is associated with amelioration of WPS induced hypertension, prothrombotic events and cardiac oxidative stress, inflammation, DNA damage and apoptosis.
Collapse
Affiliation(s)
- Abderrahim Nemmar
- Department of Physiology, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, United Arab Emirates; Zayed Center for Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
| | - Suhail Al-Salam
- Department of Pathology, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, United Arab Emirates
| | - Sumaya Beegam
- Department of Physiology, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, United Arab Emirates
| | - Nur Elena Zaaba
- Department of Physiology, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, United Arab Emirates
| | - Ozaz Elzaki
- Department of Physiology, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, United Arab Emirates
| | - Javed Yasin
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, United Arab Emirates
| | - Badreldin H Ali
- Department of Pharmacology and Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, P O Box 35, Muscat 123, Al-Khod, Sultanate of Oman
| |
Collapse
|
3
|
Abstract
COVID-19 is frequently associated with abnormalities on coagulation testing and a coagulopathy driven by inflammation, intravascular coagulation activation, and microvascular thrombosis. Elevated D-dimer is the most common finding and is a predictor of adverse outcomes including thrombosis, critical illness, and death. Although COVID-19-associated coagulopathy has some similarities to disseminated intravascular coagulation, the platelet count is usually preserved, coagulation times are usually normal or minimally prolonged, and thrombosis is more common than bleeding, at least in noncritically ill patients. Bleeding is uncommon but may be a significant problem in critically ill patients, including those who may develop a consumptive coagulopathy with frank disseminated intravascular coagulation and those on extracorporeal membrane oxygenation. Blood product support to correct coagulopathy is reserved for bleeding patients or those requiring invasive procedures. Current recommendations suggest that all hospitalized patients should receive at least a prophylactic dose of anticoagulation. Results from a multiplatform randomized clinical trial suggest that therapeutically dosed anticoagulation may improve outcomes, including the need for organ support and mortality in moderately ill patients but not in those requiring critical care. The results of ongoing trials evaluating the impact of different antithrombotic strategies (therapeutic agents and intensity) on COVID-19 outcomes are eagerly awaited and are expected to have important implications for patient management. We also discuss COVID-19 vaccine-associated cytopenias and bleeding as well as vaccine-induced thrombotic thrombocytopenia, in which thrombosis is associated with thrombocytopenia, elevated D-dimer, and, frequently, hypofibrinogenemia.
Collapse
Affiliation(s)
- Gloria F Gerber
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shruti Chaturvedi
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
4
|
Abstract
BACKGROUND Recurrent implantation failure (RIF) can be defined as a failure to achieve a clinical pregnancy after transfer of at least four embryos of good quality in a minimum of three fresh or frozen cycles in women under the age of 40. RIF is often a complex problem with a wide variety of etiologies and mechanisms as well as treatment options. SUMMARY Anatomical conditions of the uterus, thrombophilia, genetic abnormalities, or immunological factors are only a few examples which could be responsible for RIF. The recommendations for women with RIF vary depending on the source of their problem. There is not just one treatment option, but many depending on the etiology and the severity of the problem. KEY MESSAGE However, it would help to establish a set of standardized examinations and tests to use, in order to do a preliminary evaluation on each patient, which would then hopefully direct the approach of treatment for each individual couple.
Collapse
Affiliation(s)
- Veronika Günther
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Kiel, Germany
- Ambulanzzentrum des UKSH gGmbH, University Fertility Center, Kiel, Germany
| | - Sören V Otte
- Ambulanzzentrum des UKSH gGmbH, University Fertility Center, Kiel, Germany
| | - Damaris Freytag
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Kiel, Germany
| | - Nicolai Maass
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Kiel, Germany
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Kiel, Germany
| |
Collapse
|
5
|
Mazzeffi MA, Chow JH, Tanaka K. COVID-19 Associated Hypercoagulability: Manifestations, Mechanisms, and Management. Shock 2021; 55:465-471. [PMID: 32890309 PMCID: PMC7959868 DOI: 10.1097/shk.0000000000001660] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/17/2020] [Accepted: 08/24/2020] [Indexed: 12/15/2022]
Abstract
ABSTRACT Patients with severe coronavirus disease-2019 (COVID-19) frequently have hypercoagulability caused by the immune response to the severe acute respiratory syndrome coronavirus-2 infection. The pathophysiology of COVID-19 associated hypercoagulability is not fully understood, but characteristic changes include: increased fibrinogen concentration, increased Factor VIII activity, increased circulating von Willebrand factor, and exhausted fibrinolysis. Anticoagulant therapy improves outcomes in mechanically ventilated patients with COVID-19 and viscoelastic coagulation testing offers an opportunity to tailor anticoagulant therapy based on an individual patient's coagulation status. In this narrative review, we summarize clinical manifestations of COVID-19, mechanisms, monitoring considerations, and anticoagulant therapy. We also review unique considerations for COVID-19 patients who are on extracorporeal membrane oxygenation.
Collapse
Affiliation(s)
- Michael A Mazzeffi
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland
| | | | | |
Collapse
|
6
|
Freeman-Beman L, Ratner S, Kabani N, Neculiseanu E, Ginzler E. COVID-19 Coagulopathy in a Patient With Systemic Lupus Erythematosus and Antiphospholipid Antibodies. J Clin Rheumatol 2021; 27:e60-e61. [PMID: 32947435 DOI: 10.1097/rhu.0000000000001599] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
7
|
Siag K, Mazzawi S, Koren A, Colodner R, Masalha M, Biener R, Moed N, Ghanayim R, Levin C. Pediatric Otogenic Cerebral Sinus Vein Thrombosis and Thrombophilia. Isr Med Assoc J 2021; 23:99-106. [PMID: 33595215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Otogenic cerebral sinus vein thrombosis (CSVT) is a rare but severe complication of otitis media in children. To date, the role of prothrombotic evaluation is still controversial. OBJECTIVES To report the clinical manifestations, prothrombotic evaluation, and current management of CSVT. METHODS We performed a retrospective study of nine pediatric patients with otogenic CSVT who underwent prothrombotic evaluation between 2008 and 2018. RESULTS Prominent clinical features included persistent otorrhea (88.8%), signs of mastoiditis (88.8%), high fever ≥ 38.3°C (100%), a classic spiking fever pattern (55.5%), and neurological signs (55.5%). A subperiosteal abscess (66.6%) was the most common otitis media complication associated with mastoiditis and CSVT. No microorganism was identified in 55.5% of patients. Cultures collected from ear secretions had a low yield (6.25%). However, PCR assays had a high detection rate (100%; n=3). The prothrombotic evaluation demonstrated an abnormal LAC-dRVVT ratio (6/9), elevated Factor VIII (5/8) (and a combination of both in four patients), antiphospholipid antibodies (2/8), and high homocysteine levels (1/5).The surgical intervention of choice included one-sided mastoidectomy with myringotomy and ventilation-tube placement on the affected side (77.7%). There were no mortalities and no long-term sequela except chronic otitis media (22.2%). CONCLUSIONS Our findings demonstrate good outcomes for otogenic CSVT treatment with intravenous antibiotics, anticoagulation, and conservative surgical intervention, which supports the current trend in management. The prothrombotic evaluation revealed transient inflammation-related risk factors but did not alter management. Further prospective multicenter studies are needed to determine its relevance.
Collapse
Affiliation(s)
- Kfir Siag
- Department of Otolaryngology-Head and Neck Surgery, Emek Medical Center, Afula, Israel
| | - Salim Mazzawi
- Department of Otolaryngology-Head and Neck Surgery, Emek Medical Center, Afula, Israel
| | - Ariel Koren
- Pediatric Hematology Unit, Emek Medical Center, Afula, Israel
| | - Raul Colodner
- Microbiology Laboratory, Emek Medical Center, Afula, Israel
| | - Muhamed Masalha
- Department of Otolaryngology-Head and Neck Surgery, Emek Medical Center, Afula, Israel
| | - Roy Biener
- Department of Otolaryngology-Head and Neck Surgery, Emek Medical Center, Afula, Israel
| | - Nidal Moed
- Department of Otolaryngology-Head and Neck Surgery, Emek Medical Center, Afula, Israel
| | - Rami Ghanayim
- Department of Otolaryngology-Head and Neck Surgery, Emek Medical Center, Afula, Israel
| | - Carina Levin
- Pediatric Hematology Unit, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
8
|
Feldmeier JJ, Kirby JP, Buckey JC, Denham DW, Evangelista JS, Gelly HB, Harlan NP, Mirza ZK, Ray KL, Robins M, Savaser DJ, Wainwright S, Bird N, Huang ET, Moon RE, Thom SR, Weaver LK. Physiologic and biochemical rationale for treating COVID-19 patients with hyperbaric oxygen. Undersea Hyperb Med 2021; 48:1-12. [PMID: 33648028 DOI: 10.22462/01.03.2021.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The SARS-Cov-2 (COVID-19) pandemic remains a major worldwide public health issue. Initially, improved supportive and anti-inflammatory intervention, often employing known drugs or technologies, provided measurable improvement in management. We have recently seen advances in specific therapeutic interventions and in vaccines. Nevertheless, it will be months before most of the world's population can be vaccinated to achieve herd immunity. In the interim, hyperbaric oxygen (HBO2) treatment offers several potentially beneficial therapeutic effects. Three small published series, one with a propensity-score-matched control group, have demonstrated safety and initial efficacy. Additional anecdotal reports are consistent with these publications. HBO2 delivers oxygen in extreme conditions of hypoxemia and tissue hypoxia, even in the presence of lung pathology. It provides anti-inflammatory and anti-proinflammatory effects likely to ameliorate the overexuberant immune response common to COVID-19. Unlike steroids, it exerts these effects without immune suppression. One study suggests HBO2 may reduce the hypercoagulability seen in COVID patients. Also, hyperbaric oxygen offers a likely successful intervention to address the oxygen debt expected to arise from a prolonged period of hypoxemia and tissue hypoxia. To date, 11 studies designed to investigate the impact of HBO2 on patients infected with SARS-Cov-2 have been posted on clinicaltrials.gov. This paper describes the promising physiologic and biochemical effects of hyperbaric oxygen in COVID-19 and potentially in other disorders with similar pathologic mechanisms.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Kristy L Ray
- Louisiana State University Undersea and Hyperbaric Medicine
| | | | - Davut J Savaser
- Hyperbaric Medicine / Wound Healing, Legacy Emanuel Medical Center
| | | | | | - Enoch T Huang
- Hyperbaric Medicine / Wound Healing, Legacy Emanuel Medical Center
| | - Richard E Moon
- Center for Hyperbaric Medicine and Environmental Physiology, Duke University Medical Center
| | | | - Lindell K Weaver
- LDS Hospital, Salt Lake City, and Intermountain Medical Center, Murray, Utah
| |
Collapse
|
9
|
Abstract
Viscoelastic assays (VEAs) that include thromboelastography and rotational thromboelastometry add value to the investigation of coagulopathies and goal-directed management of bleeding by providing a complete picture of clot formation, strength, and lysis in whole blood that includes the contribution of platelets, fibrinogen, and coagulation factors. Conventional coagulation assays have several limitations, such as their lack of correlation with bleeding and hypercoagulability; their inability to reflect the contribution of platelets, factor XIII, and plasmin during clot formation and lysis; and their slow turnaround times. VEA-guided transfusion algorithms may reduce allogeneic blood exposure during and after cardiac surgery and in the emergency management of trauma-induced coagulopathy and hemorrhage. However, the popularity of VEAs for other indications is driven largely by extrapolation of evidence from cardiac surgery, by the drawbacks of conventional coagulation assays, and by institution-specific preferences. Robust diagnostic studies validating and standardizing diagnostic cutoffs for VEA parameters and randomized trials comparing VEA-guided algorithms with standard care on clinical outcomes are urgently needed. Lack of such studies represents the biggest barrier to defining the role and impact of VEA in clinical care.
Collapse
Affiliation(s)
- Rita Selby
- Department of Laboratory Medicine and Pathobiology and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
10
|
Abstract
Three leading infectious disease experts in China were invited to share their bedside observations in the management of COVID-19 patients. Professor Taisheng Li was sent to Wuhan to provide frontline medical care. He depicts the clinical course of SARS-CoV-2 infection. Furthermore, he observes the significant abnormality of coagulation function and proposes that the early intravenous immunoglobulin and low molecular weight heparin anticoagulation therapy are very important. Professor Hongzhou Lu, a leader in China to try various anti-viral drugs, expresses concern on the quality of the ongoing clinical trials as most trials are small in scale and repetitive in nature, and emphasizes the importance of the quick publication of clinical trial results. Regarding the traditional Chinese medicine, Professor Lu suggests to develop a creative evaluation system because of the complicated chemical compositions. Professor Wenhong Zhang is responsible for Shanghai's overall clinical management of the COVID-19 cases. He introduces the team approach to manage COVID-19 patients. For severe or critically ill patients, in addition to the respiratory supportive treatment, timely multiorgan evaluation and treatment is very crucial. The medical decisions and interventions are carefully tailored to the unique characteristics of each patient.
Collapse
Affiliation(s)
- Taisheng Li
- Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Hongzhou Lu
- Shanghai Public Health Clinical Center, Shanghai, People’s Republic of China
| | - Wenhong Zhang
- Department of Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| |
Collapse
|
11
|
Charvier A, Laroche JP, Schved JF, Quéré I. Thrombophilia assessment in presence of a venous thromboembolic disease and therapeutic consequences: Evaluation of practices in general medicine (Languedoc-Roussillon Region). J Med Vasc 2020; 45:275-283. [PMID: 32862985 DOI: 10.1016/j.jdmv.2020.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 06/01/2020] [Indexed: 06/11/2023]
Affiliation(s)
- A Charvier
- Vascular Doctors, Department of Vascular Medicine, Saint Eloi Hospital, CHRU Montpellier, 80 avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
| | - J P Laroche
- Vascular Doctors, Department of Vascular Medicine, Saint Eloi Hospital, CHRU Montpellier, 80 avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
| | - J F Schved
- Department of Biological Hematology, Saint-Éloi Hospital, Montpellier University Hospital, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
| | - I Quéré
- Vascular Doctors, Department of Vascular Medicine, Saint Eloi Hospital, CHRU Montpellier, 80 avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
| |
Collapse
|
12
|
Violi F, Pastori D, Cangemi R, Pignatelli P, Loffredo L. Hypercoagulation and Antithrombotic Treatment in Coronavirus 2019: A New Challenge. Thromb Haemost 2020; 120:949-956. [PMID: 32349133 PMCID: PMC7295290 DOI: 10.1055/s-0040-1710317] [Citation(s) in RCA: 152] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/13/2020] [Indexed: 02/07/2023]
Abstract
The novel coronavirus 2019 (COVID-19) is clinically characterized by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is responsible for a high number of patients needing mechanical ventilation or intensive care units treatment and for the elevated mortality risk. A link between COVID-19 and multiorgan failure may be dependent on the fact that most COVID-19 patients are complicated by pneumonia, which is known to be associated with early changes of clotting and platelet activation and artery dysfunction; these changes may implicate in thrombotic-related events such as myocardial infarction and ischemic stroke. Recent data showed that myocardial injury compatible with coronary ischemia may be detectable in SARS-CoV-2 patients and laboratory data exploring clotting system suggest the presence of a hypercoagulation state. Thus, we performed a systematic review of COVID-19 literature reporting measures of clotting activation to assess if changes are detectable in this setting and their relationship with clinical severity. Furthermore, we discussed the biologic plausibility of the thrombotic risk in SARS-CoV-2 and the potential use of an antithrombotic treatment.
Collapse
Affiliation(s)
- Francesco Violi
- Department of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - Daniele Pastori
- Department of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - Roberto Cangemi
- Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Pasquale Pignatelli
- Department of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - Lorenzo Loffredo
- Department of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Italy
| |
Collapse
|
13
|
Abstract
Mechanical circulatory support (MCS) is the overarching term that encompasses the temporary and durable devices used in patients with severe heart failure. MCS disturbs the hematologic and coagulation system, leading to platelet activation, activation of the contact pathway of coagulation, and acquired von Willebrand syndrome. Ischemic stroke and major hemorrhage occur in up to 30% of patients. Hematologists are an essential part of the MCS team because they understand the delicate balance between bleeding and clotting and alteration of hemostasis with antithrombotic therapy. However, prior to this important collaborative role, learning the terminology used in the field and types of MCS devices allows improved communication with the MCS team and best patient care. Understanding which antithromobotic therapies are used at baseline is also required to provide recommendations if hemorrhage or thrombosis occurs. Additional challenging consultations in MCS patients include the influence of thrombophilia on the risk for thrombosis and management of heparin-induced thrombocytopenia. This narrative review will provide a foundation to understand MCS devices how to prevent, diagnose, and manage MCS thrombosis for the practicing hematologist.
Collapse
Affiliation(s)
- Lisa Baumann Kreuziger
- Division of Hematology, Department of Medicine, BloodCenter of Wisconsin, Medical College of Wisconsin, Milwaukee, WI; and
| | | |
Collapse
|
14
|
Bal Dit Sollier C, Drouet L. [Involvement of thrombophilia in coronary thrombosis]. Ann Cardiol Angeiol (Paris) 2017; 66:365-372. [PMID: 29096905 DOI: 10.1016/j.ancard.2017.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This review of thrombophilia and coronary thrombosis takes into account the "classical" thrombophilia commonly found in venous pathology and the conditions under which their research may be useful in certain forms of arterial thrombosis especially coronary thrombosis. In addition to the classical thrombophilia, exceptional thrombophilia are evoked, which are both factors of venous thrombosis but also arterial thrombosis. There are also thrombophilia that are more specific to the arterial system such as - homocystein which is potentially both a thrombosis factor but also an agent of arterial parietal lesion or - serotonin which is a factor of arterial spasm and especially coronary spasm. Finally, under the term thrombophilia, it is possible to include thrombophilic conditions, in particular cancers and inflammatory conditions.
Collapse
Affiliation(s)
- C Bal Dit Sollier
- CREATIF (centre de référence et d'éducation aux antithrombotiques d'Île-de-France), service de cardiologie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - L Drouet
- CREATIF (centre de référence et d'éducation aux antithrombotiques d'Île-de-France), service de cardiologie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France.
| |
Collapse
|
15
|
Bratseth V, Byrkjeland R, Njerve IU, Solheim S, Arnesen H, Seljeflot I. Procoagulant activity in patients with combined type 2 diabetes and coronary artery disease: No effects of long-term exercise training. Diab Vasc Dis Res 2017; 14:144-151. [PMID: 28111966 DOI: 10.1177/1479164116679080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We investigated the effects of 12-month exercise training on hypercoagulability in patients with combined type 2 diabetes mellitus and coronary artery disease. Associations with severity of disease were further explored. Patients ( n = 131) were randomized to exercise training or a control group. Blood was collected at inclusion and after 12 months. Tissue factor, free and total tissue factor pathway inhibitor, prothrombin fragment 1 + 2 (F1 + 2) and D-dimer were determined by enzyme-linked immunosorbent assay and ex vivo thrombin generation by the calibrated automated thrombogram assay. Tissue factor and ex vivo thrombin generation increased from baseline to 12 months ( p < 0.01, all), with no significant differences in changes between groups. At baseline, free and total tissue factor pathway inhibitor significantly correlated to fasting glucose ( p < 0.01, both) and HbA1c ( p < 0.05, both). In patients with albuminuria ( n = 34), these correlations were strengthened, and elevated levels of D-dimer, free and total tissue factor pathway inhibitor ( p < 0.01, all) and decreased ex vivo thrombin generation ( p < 0.05, all) were observed. These results show no effects of exercise training on markers of hypercoagulability in our population with combined type 2 diabetes mellitus and coronary artery disease. The association between poor glycaemic control and tissue factor pathway inhibitor might indicate increased endothelial activation. More pronounced hypercoagulability and increased tissue factor pathway inhibitor were demonstrated in patients with albuminuria.
Collapse
Affiliation(s)
- Vibeke Bratseth
- 1 Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital - Ullevål, Oslo, Norway
- 2 Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
| | - Rune Byrkjeland
- 1 Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital - Ullevål, Oslo, Norway
- 2 Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
- 3 Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ida U Njerve
- 1 Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital - Ullevål, Oslo, Norway
- 2 Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
- 3 Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Svein Solheim
- 1 Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital - Ullevål, Oslo, Norway
- 2 Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
| | - Harald Arnesen
- 1 Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital - Ullevål, Oslo, Norway
- 2 Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
- 3 Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ingebjørg Seljeflot
- 1 Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital - Ullevål, Oslo, Norway
- 2 Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
- 3 Faculty of Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
16
|
Sturlese E, Triolo O, Grasso R, Laganà AS, Retto A, Rossetti D, Vitale SG, Sarpietro G, De Dominici R. Thromboembolism prophylaxis in laparoscopic surgery for gynecologic benign diseases. Results of a single center experience in 922 procedures. Ann Ital Chir 2017; 88:342-347. [PMID: 28590256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM The aim of this study is to assess the role of preoperative evaluation risk for venous tromboembolism (VTE) in patients submitted to laparoscopic surgery for gynecologic benign diseases. METHODS Date from nine hundred twenty-two women affected by adnexal benign diseases treated with laparoscopic procedures were collected and included in this study. VTE risk was assessed by "on line Caprini score calculator". Patients with one or more negative risk factors for Caprini's score underwent to venous thromboembolism prophylaxis (VTP). The remainign of the patients did not recived any VTP. A survey was conducted after three months from the discharge in order to collect the follow up date. RESULTS In our study 160 patients had a Caprini's score major than 2 and they have been subjected to VTP. A total of 762 patients were considered at low risk for VTE and they did not receive any VTP. In these patients was not registered any event of VTE. DISCUSSION The results of this study suggest that laparoscopic approach, when carried out in non-oncological patients and without any previous thromboembolic risk factor, is associated with a very low risk of VTE. This study also confirm what was reported by Ageno et al. 6, Nick et al. 7 and ACCP guidelines in 2012 8 in which routine thromboprophylaxis is recommended for patients with additional risk factors. CONCLUSIONS Laparoscopic surgery in women for gynecologic benign diseases is associated with a very low risk of thromboembolism and therefore it does not require any mechanical or pharmacological thromboprophylaxis in the absence of risk factors. The systematic evaluation of VTE risk with the help of a standard calculator is highly recommended. KEY WORDS Gynaecology, Laparoscopic surgery, Thromboprophylaxis.
Collapse
|
17
|
Morishita E. [Diagnosis and treatment of inherited thrombophilia]. Rinsho Ketsueki 2017; 58:866-874. [PMID: 28781286 DOI: 10.11406/rinketsu.58.866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Inherited thrombophilia is a thrombotic diathesis caused by a variety of genetic abnormalities in anticoagulant factors such as antithrombin (AT), protein C (PC), and protein S (PS), or coagulation factors such as prothrombin and factor V. Patients with inherited thrombophilia often present with unusual clinical episodes of venous thromboembolism (VTE), which manifests as deep vein thrombosis or pulmonary thromboembolism in young persons (younger than 40 years), often with a positive family history of thrombosis. Moreover, the thrombosis sometimes recurs, despite anticoagulant therapy. The genetic background is known to differ between Caucasians and East Asians. Starting this April, inherited thrombophilia, AT, PC, or PS deficiency, are officially designated as intractable diseases, and the treatment of these diseases is subsidized as public expense.
Collapse
Affiliation(s)
- Eriko Morishita
- Department of Clinical Laboratory Medicine, Kanazawa University School of Medicine
| |
Collapse
|
18
|
Bonar RA, Lippi G, Favaloro EJ. Overview of Hemostasis and Thrombosis and Contribution of Laboratory Testing to Diagnosis and Management of Hemostasis and Thrombosis Disorders. Methods Mol Biol 2017; 1646:3-27. [PMID: 28804815 DOI: 10.1007/978-1-4939-7196-1_1] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Hemostasis is a complex and tightly regulated process whereby the body attempts to maintain a homeostatic balance to permit normal blood flow, without bleeding or thrombosis. When this balance is disrupted, due to trauma or underlying congenital bleeding or thrombotic disorders, clinical intervention may be required. To assist clinicians in diagnosing and managing affected patients, hemostasis laboratories offer an arsenal of tests, both routine (screening) and more specialized (diagnostic). In general, screening assays are used to screen for hemostasis-related disease or to monitor or measure the effect of anticoagulant therapy, which may be applied to treat patients with recent thrombosis or at risk of thrombosis. Diagnostic assays are used to diagnose or exclude specific hemostasis-related diseases, and in some cases, to monitor or measure the effect of anticoagulant therapy, or alternatively procoagulant therapy that may be applied to those at risk of bleeding. This chapter provides an overview of hemostasis and thrombosis with respect to laboratory tests that may be applied to affected patients.
Collapse
Affiliation(s)
- Roslyn A Bonar
- Royal College of Pathologists of Australasia Quality Assurance Program (RCPAQAP) Haematology, Suite 201, Level 2, 8 Herbert Street, St Leonards, NSW, Australia.
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Emmanuel J Favaloro
- Haematology Department, Sydney Centres for Thrombosis and Haemostasis, Institute of Clinical Pathology and Medical Research (ICPMR), Westmead Hospital, NSW Health Pathology, Westmead, NSW, 2145, Australia
| |
Collapse
|
19
|
Abstract
Inherited thrombophilia is a blood coagulation disorder that increases the risk for venous thromboembolism (VTE). During the last decades, the practice of testing has evolved from testing selected populations, leading to high perceived risks, to broad testing for various conditions that included VTE, arterial thrombosis, and pregnancy complications. Because results of such tests usually do not guide treatment decisions, not testing patients with VTE for inherited thrombophilia is on the "Choosing Wisely" list endorsed by multiple specialty societies, including ASH. Inherited thrombophilia can be regarded a double-edged sword, as despite the rationale not to test, it is still being performed frequently. Another way of seeing inherited thrombophilia as a double-edged sword lies in its 2-sided association with reproduction, both in men and in women. Current areas of research are whether women with inherited thrombophilia and pregnancy complications benefit from anticoagulant therapy with regard to improving the chance of a successful pregnancy. Potential effects of inherited thrombophilia, most notably factor V Leiden, on improved embryo implantation in women and sperm counts in men are intriguing, but are currently poorly understood.
Collapse
Affiliation(s)
- Saskia Middeldorp
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
20
|
Abstract
Thrombophilias are hereditary and/or acquired conditions that predispose patients to thrombosis. Testing for thrombophilia is commonly performed in patients with venous thrombosis and their relatives; however such testing usually does not provide information that impacts management and may result in harm. This manuscript, initiated by the Anticoagulation Forum, provides clinical guidance for thrombophilia testing in five clinical situations: following 1) provoked venous thromboembolism, 2) unprovoked venous thromboembolism; 3) in relatives of patients with thrombosis, 4) in female relatives of patients with thrombosis considering estrogen use; and 5) in female relatives of patients with thrombosis who are considering pregnancy. Additionally, guidance is provided regarding the timing of thrombophilia testing. The role of thrombophilia testing in arterial thrombosis and for evaluation of recurrent pregnancy loss is not addressed. Statements are based on existing guidelines and consensus expert opinion where guidelines are lacking. We recommend that thrombophilia testing not be performed in most situations. When performed, it should be used in a highly selective manner, and only in circumstances where the information obtained will influence a decision important to the patient, and outweigh the potential risks of testing. Testing should not be performed during acute thrombosis or during the initial (3-month) period of anticoagulation.
Collapse
Affiliation(s)
- Scott M Stevens
- Department of Medicine, Intermountain Medical Center, 5121 Cottonwood Street, Murray, UT, 84157-7000, USA.
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.
| | - Scott C Woller
- Department of Medicine, Intermountain Medical Center, 5121 Cottonwood Street, Murray, UT, 84157-7000, USA
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Kenneth A Bauer
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Raj Kasthuri
- Johns Hopkins Comprehensive Hemophilia Treatment Center, Baltimore, MD, USA
| | - Mary Cushman
- Department of Medicine, Cardiovascular Research Institute of Vermont, University of Vermont, Burlington, VT, USA
| | - Michael Streiff
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Wendy Lim
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - James D Douketis
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
21
|
Affiliation(s)
- Mike Greaves
- School of Medicine, College of Life Sciences and Medicine, University of Aberdeen, UK.
| |
Collapse
|
22
|
de la Morena-Barrio ME, Martínez-Martínez I, de Cos C, Wypasek E, Roldán V, Undas A, van Scherpenzeel M, Lefeber DJ, Toderici M, Sevivas T, España F, Jaeken J, Corral J, Vicente V. Hypoglycosylation is a common finding in antithrombin deficiency in the absence of a SERPINC1 gene defect. J Thromb Haemost 2016; 14:1549-60. [PMID: 27214821 DOI: 10.1111/jth.13372] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Indexed: 12/24/2022]
Abstract
UNLABELLED Essentials We investigated the molecular base of antithrombin deficiency in cases without SERPINC1 defects. 27% of cases presented hypoglycosylation, transient in 62% and not restricted to antithrombin. Variations in genes involved in N-glycosylation underline this phenotype. These results support a new form of thrombophilia. Click here to listen to Dr Huntington's perspective on thrombin inhibition by the serpins SUMMARY Background Since the discovery of antithrombin deficiency, 50 years ago, few new thrombophilic defects have been identified, all with weaker risk of thrombosis than antithrombin deficiency. Objective To identify new thrombophilic mechanisms. Patients/methods We studied 30 patients with antithrombin deficiency but no defects in the gene encoding this key anticoagulant (SERPINC1). Results A high proportion of these patients (8/30: 27%) had increased hypoglycosylated forms of antithrombin. All N-glycoproteins tested in these patients (α1-antitrypsin, FXI and transferrin) had electrophoretic, HPLC and Q-TOF patterns indistinguishable from those of the congenital disorders of glycosylation (rare recessive multisystem disorders). However, all except one had no mental disability. Moreover, intermittent antithrombin deficiency and hypoglycosylation was recorded in five out of these eight patients, all associated with moderate alcohol intake. Genetic analysis, including whole exome sequencing, revealed mutations in different genes involved in the N-glycosylation pathway. Conclusions Our study provides substantial and novel mechanistic insights into two disease processes, with potential implications for diagnosis and clinical care. An aberrant N-glycosylation causing a recessive or transient antithrombin deficiency is a new form of thrombophilia. Our data suggest that congenital disorders of glycosylation are probably underestimated, especially in cases with thrombosis as the main or only clinical manifestation.
Collapse
Affiliation(s)
- M E de la Morena-Barrio
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain
- Grupo de investigación CB15/00055 del Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - I Martínez-Martínez
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain
- Grupo de investigación CB15/00055 del Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - C de Cos
- Hospital Puerta del Mar, Cádiz, Spain
| | - E Wypasek
- The John Paul II Hospital, Kraków, Poland
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - V Roldán
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain
| | - A Undas
- The John Paul II Hospital, Kraków, Poland
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - M van Scherpenzeel
- Department of Neurology, Laboratory for Genetic, Endocrine and Metabolic Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - D J Lefeber
- Department of Neurology, Laboratory for Genetic, Endocrine and Metabolic Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M Toderici
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain
| | - T Sevivas
- Serviço de Hematologia do Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - F España
- Grupo de Hemostasiam Trombosis, Arteriosclerosis y Biología Vascular, Centro de Investigación, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - J Jaeken
- Center for Metabolic Diseases, Universitair Ziekenhuis Gasthuisberg, Leuven, Belgium
| | - J Corral
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain
- Grupo de investigación CB15/00055 del Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - V Vicente
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain
- Grupo de investigación CB15/00055 del Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| |
Collapse
|
23
|
Kwon AJ, Roshal M, DeSancho MT. Clinical adherence to thrombophilia screening guidelines at a major tertiary care hospital. J Thromb Haemost 2016; 14:982-6. [PMID: 26857657 DOI: 10.1111/jth.13284] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Indexed: 08/31/2023]
Abstract
UNLABELLED Essentials Thrombophilia screening has significantly increased but has limited clinical utility. We evaluated the positive rate of thrombophilia screening and adherence to published guidelines. Both the positive rate for thrombophilia screening and the adherence to guidelines were low. Guidance implementation is essential to improve current thrombophilia screening practice. SUMMARY Background Thrombophilia screening is widely performed but provides limited clinical utility in managing patients predisposed to venous thromboembolism. Although guidelines to limit testing have been published, adherence to those guidelines in the outpatient clinical setting has not been assessed. Objective To evaluate outpatient thrombophilia screening practices at a tertiary academic medical center. Methods We performed a retrospective review of the electronic medical records and a computational analysis of thrombophilia tests collected during a 3-year period (August 2010 to June 2013) at a large teaching hospital. Our primary outcome measures were positive diagnostic yield for thrombophilia and clinician adherence to published thrombophilia screening guidelines in the outpatient setting. Results and Conclusions We found a positive diagnostic yield of 13.8% (95% confidence interval 12.3% to 15.3%) for outpatient thrombophilia screening at our institution. Of the screening tests requiring a second confirmatory assay for definitive diagnosis, only 12% (95% confidence interval 10.3% to 13.7%) were appropriately obtained. We also observed that 73% of patients in our electronic medical record review were inappropriately tested based on existing screening guideline criteria. When parsed by specialty, we identified that hematologists had a higher adherence rate to guideline criteria than do physicians from other specialties. Our study confirms low adherence to thrombophilia screening guidelines across disciplines and indicates the need for continued clinician education.
Collapse
Affiliation(s)
- A J Kwon
- Weill Cornell Medical College, New York, NY, USA
| | - M Roshal
- Departments of Pathology and Laboratory Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - M T DeSancho
- Division of Hematology-Oncology, Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
24
|
Kohmann A, Graczyk M. [Management of patients with nephrotic syndrome]. Wiad Lek 2016; 69:703-706. [PMID: 28033589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Nephrotic syndrome is a group of clinical symptoms and laboratory findings, caused by heavy proteinuria, which may be caused by many glomerular diseases. In the approach to a patient with nephrotic syndrome is important to establish an aetiology of the disease, with excluding its secondary causes and in most cases with renal biopsy. The treatment aims to prevent or slow further kidney damage. It involves addressing the underlying medical condition and the treatment of symptoms such as edema, proteinuria, hyperlipidemia, as well as preventing complications like thromboembolic disease, infections or undernutrition.
Collapse
Affiliation(s)
- Anna Kohmann
- Katedra i Klinika Nefrologii, Dializoterapii i Chorób Wewnętrznych WUM, Warszawa, Polska, e-mail:
| | - Maciej Graczyk
- Katedra i Klinika Nefrologii, Dializoterapii i Chorób Wewnętrznych WUM, Warszawa, Polska
| |
Collapse
|
25
|
Shklyaev AE, Malakhova IG, Bessonov AG, Utkin IY. [Thrombosis of the portal, upper mesenteric, and splenic veins in a patient with thrombophilia (a clinical case report)]. Angiol Sosud Khir 2016; 22:164-168. [PMID: 27935897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Currently there are several dozens of hereditarily associated thrombophilias and acquired states known to condition the development of a thrombus. Thrombosis of visceral veins appears to be a considerably less often encountered event than thrombosis in the system of visceral arteries. Presented herein in the article is a clinical case report concerning subacute thrombosis of the portal, upper mesenteric and splenic veins, having developed on the background of mutations of 7 genes of the system of haemostasis in a young adult patient. Timely comprehensive examination with determining polymorphism of the haemostasis system genes made it possible to verify the aetiology of the disease in the patient, while multispiral computed tomography contributed favourably to specifying the extension of thrombosis. Due to the developed segmental necrosis of the small intestine the patient was subjected to resection of the necrotised portion of the small intestine followed by establishing an entero-enteric anastomosis. In the postoperative period adequate anticoagulant therapy was adjusted in order to prevent relapse of thrombogenesis.
Collapse
Affiliation(s)
- A E Shklyaev
- Chair of Faculty Therapy with Courses of Endocrinology and Haematology, Izhevsk State Medical Academy of the RF Public Health Ministry, Izhevsk, Russia
| | - I G Malakhova
- Chair of Faculty Therapy with Courses of Endocrinology and Haematology, Izhevsk State Medical Academy of the RF Public Health Ministry, Izhevsk, Russia
| | - A G Bessonov
- Chair of Faculty Therapy with Courses of Endocrinology and Haematology, Izhevsk State Medical Academy of the RF Public Health Ministry, Izhevsk, Russia
| | - I Yu Utkin
- Chair of Faculty Therapy with Courses of Endocrinology and Haematology, Izhevsk State Medical Academy of the RF Public Health Ministry, Izhevsk, Russia
| |
Collapse
|
26
|
Čingerová L, Kučeráková M. [Thrombophilia]. Vnitr Lek 2016; 62:985-989. [PMID: 28139127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Thrombophilia is a risk factor for thrombosis. The hematologists have come under pressure to initiate thrombophilia testing on an increasing number of patients. This article summarized practical aspects, with focus on whom to test, why to test, what to test, what not to test and clinical management consequences for individuals having been identified with a thrombophilia.Key words: thrombophilia - thrombosis.
Collapse
|
27
|
Abstract
BACKGROUND The aim of the study was the reduction of adverse pregnancy outcomes in women with gestational and genetically determined changes in the hemostatic system. PATIENTS AND METHODS The study group comprised 98 patients with obstetric complications on the background of changes in the parameters of coagulation screening. In 63 pregnant women, hemostatic disorders were not corrected, in 35 patients medical tactic defined clinical situation and the results of laboratory and instrumental studies of the hemostatic system. RESULTS Hereditary thrombophilia detected in 85% of patients with obstetric complications. Carriage of the rare allele of MTHFR-677 2-fold increased risk of adverse pregnancy outcomes; heterozygous carriers of polymorphism PAI-1 - 1.5 times more. The prognostic parameters thrombelastographic (sensitivity 80%, specificity 82%) were higher than in laboratory tests. To determine the most predictive of adverse pregnancy outcome has a density of fibrin clot--the maximum amplitude. CONCLUSIONS In women with obstetric complications associated with disturbances in the hemostatic system, medical diagnostic tactics using c thrombelastographic evaluates all stages of coagulation and fibrinolysis, allows you to select a reasonable pathogenetic anticoagulant therapy and reduce the number of adverse pregnancy outcomes.
Collapse
|
28
|
Shchukin SP. [Modern methods of diagnosis of thrombophylic states and complex treatment of patients with thrombotic complications of severe forms of varicose disease]. Klin Khir 2014:38-41. [PMID: 25675742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Actual issues of surgical treatment of patients, suffering complications of severe forms of varicose disease of the lower extremities (VDLE) are discussed. The causes of unsatisfactory results of treatment in patients, suffering varicothrombophlebitis (VTHPH), the main of which--absence of the only one tactics for operative treatment and anticoagulant therapy, were analyzed. The results of patients examination, suffering thrombotic complications of severe forms of VDLE, while its recurrent course, in conjunction of VTHPH and thrombosis of deep veins of the lower extremities, using diagnostic complex "PLR genetics thrombophilia", are adduced. Differential tactics of treatment in patients, suffering severe forms of VDLE, while various localization of thrombotic process, concerning the presence of thrombophilic states, is proposed.
Collapse
|
29
|
Thom K, Male C, Mannhalter C, Quehenberger P, Mlczoch E, Luckner D, Marx M, Hanslik A. No impact of endogenous prothrombotic conditions on the risk of central venous line-related thrombotic events in children: results of the KIDCAT study (KIDs with Catheter Associated Thrombosis). J Thromb Haemost 2014; 12:1610-5. [PMID: 25131188 DOI: 10.1111/jth.12699] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 07/25/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Central venous lines (CVLs) are the major exogenous risk factor for deep venous thrombosis (DVT) in children. The study objective was to assess whether endogenous prothrombotic conditions contribute to the risk of CVL-related DVT in children. METHODS This was a cohort study of consecutive children with heart disease requiring CVLs for perioperative care. CVLs were inserted percutaneously in the upper venous system and patients received prophylaxis with continuous unfractionated heparin (50 u kg(-1) d(-1) ). Blood samples to test for prothrombotic conditions were collected prospectively and assayed in a blinded fashion. Outcome assessment was by screening for DVT by venography, venous ultrasound and echocardiography. RESULTS The study population consisted of 90 children, median age 2.7 years (0 months-18 years). Prevalence rates of antithrombin deficiency, protein C deficiency, protein S deficiency, heterozygous factor V Leiden, prothrombin G20210A mutation, methylentetrahydrofolate C677TT genotype, hyperhomocysteinemia, lupus anticoagulant, anticardiolipin antibodies and increased levels of lipoprotein (a) were within the range reported for the general population. At least one prothrombotic condition was present in 38% of children and combined abnormalities in 8%. The incidence of DVT was 28% (25/90), and most DVTs were asymptomatic. None of the prothrombotic conditions showed a significant association with DVT. The population attributable risk (i.e. the risk of DVT in the overall population attributable to a specific condition) did not exceed 2.2%. CONCLUSION Prothrombotic conditions did not have an important impact on the risk of DVT in children with short-term CVLs. The results of the study suggest that screening for prothrombotic conditions is not justified in this setting.
Collapse
Affiliation(s)
- K Thom
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Santulli G, Wronska A, Uryu K, Diacovo TG, Gao M, Marx SO, Kitajewski J, Chilton JM, Akat KM, Tuschl T, Marks AR, Totary-Jain H. A selective microRNA-based strategy inhibits restenosis while preserving endothelial function. J Clin Invest 2014; 124:4102-14. [PMID: 25133430 DOI: 10.1172/jci76069] [Citation(s) in RCA: 136] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 06/05/2014] [Indexed: 02/06/2023] Open
Abstract
Drugs currently approved to coat stents used in percutaneous coronary interventions do not discriminate between proliferating vascular smooth muscle cells (VSMCs) and endothelial cells (ECs). This lack of discrimination delays reendothelialization and vascular healing, increasing the risk of late thrombosis following angioplasty. We developed a microRNA-based (miRNA-based) approach to inhibit proliferative VSMCs, thus preventing restenosis, while selectively promoting reendothelialization and preserving EC function. We used an adenoviral (Ad) vector that encodes cyclin-dependent kinase inhibitor p27(Kip1) (p27) with target sequences for EC-specific miR-126-3p at the 3' end (Ad-p27-126TS). Exogenous p27 overexpression was evaluated in vitro and in a rat arterial balloon injury model following transduction with Ad-p27-126TS, Ad-p27 (without miR-126 target sequences), or Ad-GFP (control). In vitro, Ad-p27-126TS protected the ability of ECs to proliferate, migrate, and form networks. At 2 and 4 weeks after injury, Ad-p27-126TS-treated animals exhibited reduced restenosis, complete reendothelialization, reduced hypercoagulability, and restoration of the vasodilatory response to acetylcholine to levels comparable to those in uninjured vessels. By incorporating miR-126-3p target sequences to leverage endogenous EC-specific miR-126, we overexpressed exogenous p27 in VSMCs, while selectively inhibiting p27 overexpression in ECs. Our proof-of-principle study demonstrates the potential of using a miRNA-based strategy as a therapeutic approach to specifically inhibit vascular restenosis while preserving EC function.
Collapse
|
31
|
Galán Gutiérrez JC, García Rodríguez D, Ibañez Fernández C, Picatto Hernández P. [Rethrombosis after the insertion of an inferior vena cava filter after oncology surgery]. Rev Esp Anestesiol Reanim 2014; 61:58-59. [PMID: 23276375 DOI: 10.1016/j.redar.2012.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 10/24/2012] [Accepted: 11/02/2012] [Indexed: 06/01/2023]
Affiliation(s)
- J C Galán Gutiérrez
- Servicio de Anestesiología y Reanimación, Hospital Universitario Central de Asturias, Oviedo, España.
| | - D García Rodríguez
- Servicio de Anestesiología y Reanimación, Hospital Universitario Central de Asturias, Oviedo, España
| | - C Ibañez Fernández
- Servicio de Anestesiología y Reanimación, Hospital Universitario Central de Asturias, Oviedo, España
| | - P Picatto Hernández
- Servicio de Anestesiología y Reanimación, Hospital Universitario Central de Asturias, Oviedo, España
| |
Collapse
|
32
|
Kojima T. [New era of laboratory testing. Topics: II. Particulars; 6. Clinical laboratory tests for thrombophilia]. Nihon Naika Gakkai Zasshi 2013; 102:3147-3153. [PMID: 24605563 DOI: 10.2169/naika.102.3147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Tetsuhito Kojima
- Department of Pathophysiological Laboratory Sciences Nagoya University Graduate School of Medicine, Japan
| |
Collapse
|
33
|
Thachil J. A practical approach to thrombophilia testing. Br J Hosp Med (Lond) 2013; 74:C94-C96. [PMID: 24049827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Jecko Thachil
- Department of Haematology, Manchester Royal Infirmary, Manchester M13 9WL.
| |
Collapse
|
34
|
van der Pas R, Leebeek FWG, Hofland LJ, de Herder WW, Feelders RA. Hypercoagulability in Cushing's syndrome: prevalence, pathogenesis and treatment. Clin Endocrinol (Oxf) 2013; 78:481-8. [PMID: 23134530 DOI: 10.1111/cen.12094] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 10/23/2012] [Accepted: 10/31/2012] [Indexed: 12/27/2022]
Abstract
Cushing's syndrome is not only accompanied by an increased prevalence of cardiovascular disease but also by a hypercoagulable state that is reflected by an increased incidence of venous thromboembolism. Overall, patients with CS have been reported to have a more than 10-fold increased risk of developing venous thromboembolism. Moreover, the incidence of postoperative thrombosis has been shown to be comparable to the risk after major orthopaedic surgery. Hypercoagulability in CS is due to both increased production of procoagulant factors with activation of the coagulation cascade and an impaired fibrinolytic capacity, resulting in a shortened activated partial thromboplastin time and an increased clot lysis time respectively. Although these abnormalities seem to improve 1 year following successful surgery, they do not yet normalize. Therefore, sustained biochemical remission might be required to fully resolve the hypercoagulable state in CS. Considering the risk of venous thromboembolism in uncontrolled CS there may be a rationale to give patients with active CS thromboprophylaxis. So far this seems warranted following surgical interventions. However, further studies are needed to determine the optimal dosage and duration of thromboprophylaxis.
Collapse
Affiliation(s)
- R van der Pas
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, Rotterdam, The Netherlands.
| | | | | | | | | |
Collapse
|
35
|
Vasil'ev SA, Vinogradov VL, Gemdzhian ÉG, Orel EB, Shevelev AA, Margolin OV. [Experience with outpatient treatment for thromboses and thrombophilias]. TERAPEVT ARKH 2013; 85:47-50. [PMID: 24640667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM To evaluate the efficiency of diagnosis and treatment of thromboses in patients with thrombophilia in an outpatient setting. SUBJECTS AND METHODS One hundred and seventy-two patients with different forms of thrombophilic states were examined. One hundred and thirty-two patients were found to have genetic mutations, of them 125 patients had multiple mutations. Thromboses were diagnosed in 130 patients with genetic disorders. RESULTS The most common laboratory markers of thrombophilias were hyperhomocysteinemia (55%), sticky platelet syndrome (41%), and laboratory findings of antiphospholipid syndrome. Thrombogenic mutations, such as plasminogen activator plasminogen inhibitor-1 (73%), methylene tetrahydrofolate reductase (60%), platelet glycoprotein 1a receptors (50%), and fibrinogen (42%), were most often diagnosed. The efficiency of treatment was shown to largely depend on the duration of an initial thrombotic process. CONCLUSION Outpatient treatment for thromboses is more economical and comfortable for patients. To avoid hospital admissions, it is necessary to time detect the disease and to start its treatment as soon as possible. The concurrent use of ultrasonography, genetic and laboratory diagnostic methods accelerates the identification and localization of the pathology, which facilitates its treatment and frequently rules out the need for patient hospitalization.
Collapse
|
36
|
Fonseca AG. [Hereditary thrombophilia and pregnancy: thrombotic risk and pregnancy outcome]. ACTA MEDICA PORT 2012; 25:433-441. [PMID: 23534596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Accepted: 12/02/2012] [Indexed: 06/02/2023]
Abstract
Thromboembolic disease and obstetric complications related to ischemia of the placenta are currently the major causes of maternal mortality and morbidity. Thrombophilia been implicated in their aetiology and the magnitude of the risk depends on the type of thrombophilia. As the evidence is still unclear and controversial, questions about the clinical management of pregnant women with thrombophilia are a daily issue. We aim to review, bearing in mind the consensus and controversies, the impact of inherited thrombophilia in the risk of thrombosis related to pregnancy and of obstetric complications. Moreover, the diagnostic, preventive and therapeutic approach during pregnancy and puerperium, including the role of antithrombotic pharmacopoeia available, will be discussed.
Collapse
Affiliation(s)
- Ana Glória Fonseca
- Serviço de Medicina, Hospital Garcia de Orta. Almada. & Departamento de Saúde Publica, Faculdade de Ciências Médicas, Lisboa, Portugal
| |
Collapse
|
37
|
Bura-Rivière A. [Thrombophilia and pregnancy]. Rev Prat 2012; 62:937-942. [PMID: 23236864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The risk of venous thromboembolic disease is increased in pregnancy and death from pulmonary embolism is the first cause of maternal mortality in western countries. Biological thrombophilia has been linked to venous thromboembolism during pregnancy in some cohort studies. The relative risk of thrombosis in pregnancy varies according to the type of thrombophilia and the absolute risk to develop a venous thromboembolic disease remains weak for the most frequent variants. The association between the presence of thrombophilia and pregnancy complications is less clear, apart from the link with antiphospholipid syndrome. In this article we give some advice concerning the managing of the most frequent situations, but the more complex situations necessitate a specialist counseling.
Collapse
|
38
|
Affiliation(s)
- Lee-Yee Chong
- National Clinical Guideline Centre, Royal College of Physicians, London NW1 4LE, UK
| | | | | | | |
Collapse
|
39
|
Abstract
Hypercoagulable states can be inherited or acquired. Inherited hypercoagulable states can be caused by a loss of function of natural anticoagulant pathways or a gain of function in procoagulant pathways. Acquired hypercoagulable risk factors include a prior history of thrombosis, obesity, pregnancy, cancer and its treatment, antiphospholipid antibody syndrome, heparin-induced thrombocytopenia, and myeloproliferative disorders. Inherited hypercoagulable states combine with acquired risk factors to establish the intrinsic risk of venous thromboembolism for each individual. Venous thromboembolism occurs when the risk exceeds a critical threshold. Often a triggering factor, such as surgery, pregnancy, or estrogen therapy, is required to increase the risk above this critical threshold.
Collapse
Affiliation(s)
- Julia A M Anderson
- Department of Clinical and Laboratory Hematology, Royal Infirmary of Edinburgh, Scotland EH16 4SA, UK
| | | |
Collapse
|
40
|
Aygun B, Wruck LM, Schultz WH, Mueller BU, Brown C, Luchtman-Jones L, Jackson S, Iyer R, Rogers ZR, Sarnaik S, Thompson AA, Gauger C, Helms RW, Ware RE. Chronic transfusion practices for prevention of primary stroke in children with sickle cell anemia and abnormal TCD velocities. Am J Hematol 2012; 87:428-30. [PMID: 22231377 DOI: 10.1002/ajh.23105] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 12/12/2011] [Indexed: 11/10/2022]
MESH Headings
- Anemia, Sickle Cell/blood
- Anemia, Sickle Cell/complications
- Anemia, Sickle Cell/drug therapy
- Anemia, Sickle Cell/therapy
- Autoantibodies/analysis
- Blood Flow Velocity
- Cerebrovascular Circulation
- Child
- Child, Preschool
- Erythrocyte Transfusion/methods
- Erythrocyte Transfusion/statistics & numerical data
- Exchange Transfusion, Whole Blood/statistics & numerical data
- Female
- Hemoglobin, Sickle/analysis
- Hemoglobin, Sickle/immunology
- Humans
- Hydroxyurea/therapeutic use
- Isoantibodies/analysis
- Male
- Stroke/etiology
- Stroke/prevention & control
- Thrombophilia/etiology
- Thrombophilia/therapy
- Time Factors
- Ultrasonography, Doppler, Transcranial
Collapse
|
41
|
Blagova OV, Dzemeshkevich SL, Kozlovskaia NL, Nedostup AV, Sarkisova ND, Frolova IV, Raskin VV, Dzemeshkevich AS, Abugov SA, Skipenko OG, Shilov EM, Sedov VP, Gagarina NV, Sinitsyn VE, Mershina EA, Volkova EI. [Successful treatment of massive thrombosis of the vena cava inferior with nephrotic syndrome and chronic bilateral pulmonary artery thromboembolism in a patient with genetic thrombophilia]. TERAPEVT ARKH 2012; 84:41-47. [PMID: 22616531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A case is reported of a 23-year-old male patient who developed, after severe blunt injury of the lumbar region, massive thrombosis of the vena cava inferior (VCI), both renal veins, bilateral pulmonary artery thromboembolism (PATE), nephrotic syndrome (NS). In spite of anticoagulant therapy, the condition of the patient progressively aggravated for 1.5 year: thrombosis involved the ileac and femoral arteries on the right, thrombus floated in the right atrium with PATE recurrent episodes, pulmonary hypertension reached 120 mm Hg with formation of decompensated cor pulmnonale, proteinuria and hypoalbuminemia deteriorated, anasarca edema developed Multigenic thrombophilia was diagnosed (1 homozygous and 5 heterozygous mutations). A radical one-stage operation was successful: thromboectomy from the VCI, right ileac and left renal veins, thrombendarterectomy from the pulmonary arteries, suture of the interatrial septum defect, installation of cava-filter After the operation pulmonary pressure lowered to 40-45 mm Hg, right heart volume normalized, immunosuppressive therapy with prednisolone and cyclosporine led to nephropathy remission. The discussion covers mechanisms and factors (including genetic) of thrombosis progression, correlations between intravascular thrombosis, NS and chronic glomerulonephritis (possible NS development due to bilateral thrombosis of the renal veins and nephropathy role in thrombosis progression), approaches to conservative and surgical treatment of such patients. Global experience in conduction of pulmonary thrombendarterectomy and thrombectomy from VCI is reviewed (one-stage operations were not described earlier).
Collapse
|
42
|
Abstract
Although the use of central lines has many valuable applications in neonates and infants, they may cause serious mechanical, infectious and thrombotic complications. In fact, the use of central lines is the main cause for thrombosis in this age group. The frequency of central-line-related thrombosis in neonates and infants is reported to be as low as 1% when including only symptomatic cases, around 44% when systematically screened for thrombosis, and as high as 65% in autopsy studies. The risk factors for line-related thrombosis in neonates and infants include those associated with the underlying medical conditions, the duration of the line in situ, the placement of the umbilical artery catheter and the therapy used through the line. The contribution of inherited and acquired thrombophilia to central-line-related thrombosis is controversial, and the data are not sufficiently consistent to make a firm recommendation for thrombophilia screening for neonates and infants with central-line-related thrombosis. Most experts will recommend pursuing a thrombophilia work-up in the setting of a significant thrombosis event and will recommend avoiding thrombophilia work-up in subclinical and asymptomatic central-line-related thrombosis. The management of line-related thrombosis is based on expert opinion guidelines and is largely dependent on the type of the catheter and the further requirement of the catheter. Continuous heparin infusion through the central lines prevents catheter occlusion, but has no effect on occurrence of thrombosis. Currently no definitive recommendations exist for thromboprophylaxis in children, infants and neonates with central lines.
Collapse
Affiliation(s)
- Shoshana Revel-Vilk
- Pediatric Hematology/Oncology Department, Hadassah Hebrew-University Hospital, POB 12000, Jerusalem il-91120, Israel.
| | | |
Collapse
|
43
|
Abstract
Thrombophilic states are common in intensive care medicine. Generally, they are complications of serious underlying diseases or adverse effects of treatment measures. The attributive mortality rate for thrombophilic states is high. Early recognition and management are, thus, indispensable. In this review, important diagnostic and therapeutic aspects are briefly summarized. Leading symptoms and the context to the underlying disease or therapy, which result in a thrombophilic state, are the basics for a specific diagnostic workup. Almost all current treatment recommendations are based on expert opinion.
Collapse
Affiliation(s)
- L Engelmann
- Klinik für Innere Medizin III, Krankenhaus Köthen GmbH, Hallesche Strasse 29, Köthen, Germany.
| |
Collapse
|
44
|
Abstract
Much of the decline in stroke incidence and mortality for the past several decades in Western countries has been attributed to better treatment of risk factors. Many epidemiological studies and clinical trials confirmed the importance of managing hypertension. Comparative trials of anti-hypertensive drugs or drug classes have not yielded clear results, but blood pressure variability may play an important role beyond the absolute value of blood pressure. Diabetes therapy remains a conundrum. Although diabetes is clearly a risk factor for ischemic stroke, treatment trials targeting different glycemic goals have not indicated that glucose lowering results in stroke prevention. Trials focused on insulin resistance are ongoing and they may be able to help establish the management of diabetes/impaired glucose tolerance. Evidence for treatment of dyslipidemia has contrasted science to diabetes mellitus. Dyslipidemia has not been strongly or consistently linked to ischemic stroke but the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial showed the impact of statin treatment in stroke prevention. The results of clinical trials investigating dabigatran and rivaroxaban clearly indicate alternative strategies to vitamin K antagonists in stroke prevention for persons with atrial fibrillation. Evidence for stroke prevention by life style modification, treating metabolic syndrome, sleep disordered breathing, lipoprotein (a), hyperhomocysteinemia, and coagulation disorders are also discussed.
Collapse
Affiliation(s)
- Junya Aoki
- Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Okayama 701–0192 Japan
| | - Ken Uchino
- Cerebrovascular Center, Cleveland Clinic, Cleveland, OH 44195 USA
| |
Collapse
|
45
|
Levin C, Koren A. Healing of refractory leg ulcer in a patient with thalassemia intermedia and hypercoagulability after 14 years of unresponsive therapy. Isr Med Assoc J 2011; 13:316-318. [PMID: 21845977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Carina Levin
- Pediatric Hematology Unit, HaEmek Medical Center, Afula, affiliated with Rappaport Faculty of Medicine, Technion-lsrael Institute of Technology, Haifa, Israel.
| | | |
Collapse
|
46
|
Zeybek B, Terek MC, Guven C, Cinar C. Placement of a vena cava filter in term pregnancy: case report and review of the literature. CLIN EXP OBSTET GYN 2011; 38:96-98. [PMID: 21485739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
During pregnancy there are hemostatic changes that may result in a hypercoagulable state producing thrombotic consequences. This condition may be aggravated in women who are carriers of congenital thrombophilic factors. These factors may increase obstetric complications such as miscarriages, fetal growth restriction, placental abruption and preeclampsia. Trombophilic factors may also cause venous thromboembolism, which is the leading cause of maternal morbidity and mortality. We report a case of a 22-year-old woman with factor V Leiden mutation, whose pregnancy was complicated with deep venous thrombosis requiring placement of a vena cava filter.
Collapse
Affiliation(s)
- B Zeybek
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Bornova, Izmir, Turkey.
| | | | | | | |
Collapse
|
47
|
Furie KL, Kasner SE, Adams RJ, Albers GW, Bush RL, Fagan SC, Halperin JL, Johnston SC, Katzan I, Kernan WN, Mitchell PH, Ovbiagele B, Palesch YY, Sacco RL, Schwamm LH, Wassertheil-Smoller S, Turan TN, Wentworth D. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the american heart association/american stroke association. Stroke 2010; 42:227-76. [PMID: 20966421 DOI: 10.1161/str.0b013e3181f7d043] [Citation(s) in RCA: 1266] [Impact Index Per Article: 90.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of this updated statement is to provide comprehensive and timely evidence-based recommendations on the prevention of ischemic stroke among survivors of ischemic stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches for atherosclerotic disease, antithrombotic treatments for cardioembolism, and the use of antiplatelet agents for noncardioembolic stroke. Further recommendations are provided for the prevention of recurrent stroke in a variety of other specific circumstances, including arterial dissections; patent foramen ovale; hyperhomocysteinemia; hypercoagulable states; sickle cell disease; cerebral venous sinus thrombosis; stroke among women, particularly with regard to pregnancy and the use of postmenopausal hormones; the use of anticoagulation after cerebral hemorrhage; and special approaches to the implementation of guidelines and their use in high-risk populations.
Collapse
|
48
|
Castellanos JA, Edwards CM, Shaver A, Merchant NB, Parikh AA. Appendiceal adenocarcinoma presenting as venous thromboembolism: an unusual presentation of a rare carcinoma. Am Surg 2010; 76:543-544. [PMID: 20506889 PMCID: PMC4157457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
|
49
|
Abstract
Mr A, a previously healthy 37-year-old man, was diagnosed as having Prinzmetal angina and a hypercoagulable state 3 years ago after an ST-elevation myocardial infarction. Now, his cardiologist is moving and Mr A must select a new physician and health system. Geographic relocation, insurance changes, and other events force millions in the United States to change physicians and hospitals every year. Mr A should begin by choosing a primary care physician, since continuity and coordination of care improves outcomes. Evidence for evaluating specific physicians is less robust, though a variety of sources are available. A broad range of detailed quality information, such as Medicare's Hospital Compare (http://www.hospitalcompare.hhs.gov/), is available for selecting a hospital. However, the relationship of these metrics to patient outcomes is variable, and different Web sites provide meaningfully different rankings and data interpretations. For Mr A in particular, a warfarin management team, the hospital's location, and a cardiologist with whom he feels comfortable and who can communicate with his primary care physician are important factors. Nevertheless, hospital quality information and metrics are an important component of the strategy Mr A should take to solve this challenging problem.
Collapse
Affiliation(s)
- Michael D Howell
- Silverman Institute for Health Care Quality and Safety, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA.
| |
Collapse
|
50
|
Abstract
BACKGROUND AND OBJECTIVES Interruption of the Inferior Vena Cava (IVC) is recommended in certain cases to prevent Pulmonary Embolism (PE). Reported data on the efficacy and rate of complications vary considerably. PATIENTS AND METHODS We conducted a retrospective analysis of patients who had a temporary or permanent IVC filter inserted at our institution during the past 5 years. RESULTS Seventy-seven of 225 patients (34%) with Venous Thrombosis (VT) had an IVC filter inserted. Deep vein thrombosis and PE were the most common causes for anticoagulation. Bleeding was the reason for IVC filter insertion in 48 (62%). The only complication found was the breaking of a temporary filter during removal related to the procedure. However, 3 patients (out of 10) had a recurrence of VT after prolonged discontinuation of anticoagulation. CONCLUSIONS Our criteria for indication of IVC filter insertion are in line with current standard of care. The immediate and delayed complications caused by IVC filter insertion was low. Active bleeding was the most common indication for filter insertion, whereas inherited thrombophilia was relatively common.
Collapse
Affiliation(s)
- Jalal Saour
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
| | | | | | | | | |
Collapse
|