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DÜZ, Özge Arıcı, Oktay OLMUŞÇELİK, Ali İhsan GEMİCİ, and Özlem SAATÇİ SANCAKTEPE. "Evaluation of pai-1 polymorphisms in central and peripheral thromboembolies." Journal of Experimental and Clinical Medicine 38, no. 2 (March 14, 2021): 167–71. http://dx.doi.org/10.52142/omujecm.38.2.20.
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Thromboembolism is a clinical finding that occurs due to thrombus; formed in the vascular system and has various etiological factors. It can be classified as central and peripheral thromboembolism. Our objective in this study is to explore genetic risk factors in central and peripheral thromboembolism and reveal the differences. 342 thromboembolism patients were retrospectively included to the study between January 2016 and December 2019. Demographic characteristics, risk factors for thromboembolism and genetic mutations in central and peripheral thromboembolism groups were overviewed. The genetic mutations evaluated in patients were Factor V Leiden G1691A, Factor V HR1299R, Factor II (Prothrombin) G20210A, MTHFR (Methylenetetrahydrofolate reductase) C677T, MTHFR A1298C, PAI 4G/5G. Within the scope of the study, genetic analyzes of 106 patients were reached and included in the study. Seventy-two central thromboembolism (69.8%), 34 (31.2%) peripheral thromboembolisms were detected. Sixty-three of the central thromboembolisms were from arterial and nine were from venous origin. There was no significant difference between age, gender and risk factors of central thromboembolism and peripheral thromboembolism patients (p˃0.05), but smoking was more common in central thromboembolism patients (p: 0.041). 4G/5G polymorphism was observed more frequently in patients with central thromboembolism (p: 0.039). Thromboembolism is a multifactorial disease, PAI-1 4G/5G polymorphism is a medium risk factor for thromboembolism. We conclude that PAI-1 4G/5G polymorphism is more frequent in central thromboembolism than peripheral thromboembolism and its evaluation can give more information about the thromboembolic risk analyze.
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Thomas, Sarah, Diana Braswell, and Corinne Stephenson. "Massive Pulmonary and Coronary Artery Thromboembolism in the Setting of Undetected Patent Foramen Ovale." Blood 126, no. 23 (December 3, 2015): 4718. http://dx.doi.org/10.1182/blood.v126.23.4718.4718.
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Abstract Invasive surgery brings with it a unique set of post-surgical risks that are directly dependent on various factors including the specific surgical approach used, pre-existing comorbidities and features such as gender and age. Pulmonary thromboembolism is one of the most feared complications following surgery, and diagnosis and treatment of this entity is a challenging task for the clinician. Here we describe a case of massive pulmonary thromboembolism and associated coronary artery thromboemboli status post spinal fusion surgery in a 68 year-old man with an undetected patent foramen ovale (PFO). Although the decedent was managed clinically with proper deep venous thrombosis prophylaxis protocols and physical rehabilitation, he went into cardiorespiratory arrest after experiencing acute oxygen desaturation and newly detected right bundle branch block. PFO can be incidentally found in 25% of the adult population. Several clinical syndromes including stroke, migraine headaches and obstructive sleep apnea have been associated in patients with PFO, the last two from which the decedent suffered. The pathology of this unique case of massive pulmonary thromboembolism resulting in coronary artery thromboemboli in the setting of an undetected PFO is discussed. The discovery of PFO in patients prior to surgery, if detected early, may improve post-surgical outcomes. Figure 1. Massive pulmonary artery thromboembolism in situ, gross examination. Figure 1. Massive pulmonary artery thromboembolism in situ, gross examination. Figure 2. Histology, hematoxylin and eosin. A. Pulmonary thromboembolus at the bifurcation of the pulmonary arteries and pulmonary trunk. B. Hemorrhagic infarct and thromboemboli in varying stages of organization, right lower lobe, lung. C. Cross section of the proximal left anterior descending coronary artery with thromboembolus. D. Cross section of the posterior descending coronary artery with thromboembolus. Figure 2. Histology, hematoxylin and eosin. A. Pulmonary thromboembolus at the bifurcation of the pulmonary arteries and pulmonary trunk. B. Hemorrhagic infarct and thromboemboli in varying stages of organization, right lower lobe, lung. C. Cross section of the proximal left anterior descending coronary artery with thromboembolus. D. Cross section of the posterior descending coronary artery with thromboembolus. Figure 3. Patent foramen ovale, gross examination. Figure 3. Patent foramen ovale, gross examination. Disclosures No relevant conflicts of interest to declare.
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Kang, Hyun-Seung, Moon Hee Han, Bae Ju Kwon, Cheolkyu Jung, Jeong-Eun Kim, O.-Ki Kwon, and Chang Wan Oh. "Is Clopidogrel Premedication Useful to Reduce Thromboembolic Events During Coil Embolization for Unruptured Intracranial Aneurysms?" Neurosurgery 67, no. 5 (November 1, 2010): 1371–76. http://dx.doi.org/10.1227/neu.0b013e3181efe3ef.
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Abstract BACKGROUND: Thromboembolism is a common complication related to coil embolization of intracranial aneurysms. OBJECTIVE: To identify factors related to thromboembolic events during coil embolization for unruptured intracranial aneurysms and to evaluate the role of clopidogrel premedication to prevent thromboembolisms. METHODS: Since March 2006, clopidogrel has been administered to patients with unruptured aneurysms before coil embolization (the clopidogrel group) in our institution. The clopidogrel group (416 patients with 485 aneurysms) and the historical control group (140 patients with 159 aneurysms who received no antiplatelet premedication) were compared to find the efficacy of clopidogrel premedication. Various factors, including age, sex, body weight, and medical history of hypertension, diabetes mellitus, hyperlipidemia, smoking, previous stroke, and heart disease, as well as clopidogrel premedication, were analyzed in relationship to the development of a procedure-related thromboembolism. RESULTS: Procedure-related thromboembolic events tended to occur less frequently in the clopidogrel group compared with the control group (7.4% vs 12.6%; P = .05), and clopidogrel premedication could modify the risk in female patients from 11.1% to 5.2% (P = .04). The use of multiple logistic regression analysis identified clopidogrel premedication (P = .03), smoking (P = .002), and hyperlipidemia (P = .02) as significant factors related to the formation of thromboembolism. CONCLUSION: Clopidogrel premedication seems to have a beneficial effect in reducing the number of procedure-related thromboembolisms during coil embolization for unruptured intracranial aneurysms, especially in female patients. Smoking and hyperlipidemia were independent risk factors related to thromboembolism.
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Bilge, Ayşegül, İsmail Karasoy, Elif Neziroğlu, and Yeşim Güner. "Upper extremity arterial thromboembolism in a patient with severe COVID-19 pneumonia: A case report." Joint Diseases and Related Surgery 32, no. 2 (June 11, 2021): 551–55. http://dx.doi.org/10.52312/jdrs.2021.82766.
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Although novel coronavirus-2019 (COVID-19) primarily affects the respiratory system, it can affect multiple organ systems, leading to serious complications, such as acute respiratory distress syndrome (ARDS) and multiple organ failure. Nearly 20 to 55% of patients with COVID-19 experience coagulation disorders that cause high mortality in line with the severity of the clinical picture. Thromboembolism can be observed in both venous and arterial systems. The vast majority of thromboembolic events are associated with the venous system and are often observed as pulmonary embolism. Arterial thromboembolisms often involve the arteries in the lower extremities, followed by those in the upper extremities. Herein, we report a rare case of COVID-19 pneumonia whose left arm was amputated at the forearm level after arterial thromboembolism in the left upper extremity. This case report is valuable, as it is the first reported case of upper extremity arterial thromboembolism in Turkey, as well as the only case in the literature in which the patient underwent four surgical interventions and is still alive.
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Marinkovic, Jovana, and Olivera Tarabar. "Multiple myeloma and deep vein thrombosis/pulmonary thromboembolism - incidence and risk factors." Medical review 75, no. 7-8 (2022): 230–36. http://dx.doi.org/10.2298/mpns2208230m.
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Introduction. Deep vein thrombosis and pulmonary thromboembolism are among the most important causes of morbidity and mortality in cancer patients. They are common and serious complications that are affected by various risk factors. The aim of this study was to determine the incidence of thromboembolic complications and their association with risk factors in patients with newly diagnosed multiple myeloma. Material and Methods. A retrospective study included 32 patients and the following variables were collected: age, C-reactive protein, beta-2 microglobulin, hemoglobin, platelets, total proteins, nephrotic syndrome, fibrinogen, D-dimer, albumin, lactate dehydrogenase, creatinine, calcium, gender, performance status, type of multiple myeloma, clinical stage, and applied therapy. All variables were compared between two groups of patients: group with thromboembolic complications (deep venous thrombosis and pulmonary thromboembolism), and the group without these complications. Results. The study sample included 18 men and 14 women. The patients? age ranged from 36 to 73 years. Of the 32 patients, 6 had deep venous thrombosis of the lower extremities, and 2 patients had deep venous thrombosis and pulmonary thromboembolism. The only two biomarkers that showed an association with venous thromboembolism in our patients with myeloma were elevated levels of C-reactive protein and D-dimer. Conclusion. The incidence of thromboembolic complications in patients with newly diagnosed multiple myeloma was 25%. When making the diagnosis of myeloma, risk factors that were significantly associated with venous thromboembolism were elevated levels of C-reactive protein and D-dimer. The occurrence of venous thromboembolism in patients with multiple myeloma was not associated with significantly higher mortality compared to patients without venous thromboembolism.
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Dávid, Marianna, Hajna Losonczy, Miklós Udvardy, Zoltán Boda, György Blaskó, Attila Tar, and György Pfliegler. "Risk assessment model for venous thromboembolism in hospitalized surgical and non-surgical patients in the 4th Hungarian Antithrombotic Guidelines entitled “Diminution and Treatment of Venous Thromboembolism”." Orvosi Hetilap 151, no. 34 (August 1, 2010): 1365–74. http://dx.doi.org/10.1556/oh.2010.28944.
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A kórházban kezelt sebészeti és belgyógyászati betegekben jelentős a vénásthromboembolia-rizikó. Profilaxis nélkül, a műtét típusától függően, a sebészeti beavatkozások kapcsán a betegek 15–60%-ában alakul ki mélyvénás trombózis vagy tüdőembólia, és az utóbbi ma is vezető kórházi halálok. Bár a vénás thromboemboliát leggyakrabban a közelmúltban végzett műtéttel vagy traumával hozzák kapcsolatba, a szimptómás thromboemboliás események 50–70%-a és a fatális tüdőembóliák 70–80%-a nem a sebészeti betegekben alakul ki. Nemzetközi és hazai felmérések alapján a nagy kockázattal rendelkező sebészeti betegek többsége megkapja a szükséges trombózisprofilaxist. Azonban profilaxis nélkül marad a rizikóval rendelkező belgyógyászati betegek jelentős része, a konszenzuson alapuló nemzetközi és hazai irányelvi ajánlások ellenére. A belgyógyászati betegek körében növelni kell a profilaxisban részesülők arányát és el kell érni, hogy trombózisrizikó esetén a betegek megkapják a hatásos megelőzést. A beteg trombóziskockázatának felmérése fontos eszköze a vénás thromboembolia által veszélyeztetett betegek felderítésének, megkönnyíti a döntést a profilaxis elrendeléséről és javítja az irányelvi ajánlások betartását. A trombózisveszély megállapításakor, ha nem ellenjavallt, profilaxist kell alkalmazni. „A thromboemboliák kockázatának csökkentése és kezelése” című, 4. magyar antithromboticus irányelv felhívja a figyelmet a vénástrombózis-rizikó felmérésének szükségességére, és elsőként tartalmazza a kórházban fekvő belgyógyászati és sebészeti betegek kockázati kérdőívét. Ismertetjük a kockázatbecslő kérdőíveket és áttekintjük a kérdőívekben szereplő rizikófaktorokra vonatkozó bizonyítékokon alapuló adatokat.
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Pavelková, Eva. "Feline arterial thromboembolism." Companion Animal 24, no. 8 (September 2, 2019): 426–30. http://dx.doi.org/10.12968/coan.2019.0021.
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Arterial thromboembolism is a common complication of feline cardiomyopathy. In many cats, underlying cardiac disease can be clinically silent. Risk factors for development of arterial thromboembolism include a previous episode of arterial thromboembolism; spontaneous echocardiographic contrast; severe left atrial enlargement; reduced left atrial and left ventricular function; and low left auricular appendage blood flow velocities. Diagnosis can be based on clinical signs, but echocardiography is necessary to confirm the presence of cardiomyopathy. Antithrombotic treatment is often empirical, as prospective studies are lacking. Clopidogrel has been shown to be superior to aspirin in prevention of subsequent arterial thromboembolism events, and future studies might show efficacy of other antithrombotic drugs. Cats that survive the initial thromboembolic event might have a fairly favourable prognosis, with a survival of over 12 months.
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Petrushenko, V. V., V. I. Voistryk, D. I. Grebeniuk, and O. V. Levadnyi. "The problem of prevalence, thromboprophylaxis and diagnostic strategies of thromboembolism in patients with COVID-19." Reports of Vinnytsia National Medical University 26, no. 3 (September 29, 2022): 491–96. http://dx.doi.org/10.31393/reports-vnmedical-2022-26(3)-25.
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Annotation. Coronavirus infection is associated with a large number of complications, among which thromboembolisms of various localization are extremely serious. This article presents an overview of current literature data on the prevalence, need for thromboprophylaxis and strategic diagnostic goals in patients who have experienced thromboembolism of various vessels against the background of COVID-19. From the PubMed, ScienceDirect, UpToDate, Web of science, Scopus databases, 30 sources were selected and reviewed that met the query conditions: the most recent publications (over the last 5 years) or the latest publications on this issue (regardless of the age). Thromboembolic complications arising from COVID-19 correlate with increased disease severity and worsening of treatment outcomes. Patients with COVID-19 had a high risk of venous thromboembolic events (VTE) (a significant proportion is pulmonary embolism (PE) and deep vein thrombosis (DVT) of the lower extremities), in contrast to the heterogeneity of the development of arterial thromboembolic events (ATE) (low rates of development myocardial infarction and stroke). It is important to implement diagnostic and search strategies for early detection of thromboembolism in patients suffering from coronavirus infection. In addition, according to the opinion of most authors, the number of thromboembolic events decreases against the background of taking primary thromboprophylaxis, which is confirmed by a decrease in the percentage of thromboembolic complications in patients with a diagnosis of SARS-CoV-2 infection. Therefore, conducting a more skeptical assessment of the possibility of the development of VTE is important for the prevention of complications of the coronavirus infection. The study of these problems allows us to use the acquired knowledge on the development of thromboembolic events in patients against the background of the incidence of COVID-19 in a more detailed and justified manner and, accordingly, to improve the methods of diagnosis, treatment and prevention of these complications.
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Popov, S. V., R. G. Guseynov, I. N. Isakova-Sivak, K. V. Sivak, O. N. Skryabin, V. V. Perepelitsa, D. I. Sengirbaev, N. S. Bunenkov, P. G. Osipov, and T. A. Lelyavina. "Thromboembolic complications in urogenital cancers: incidence, risk factors and prevention." Cancer Urology 20, no. 1 (May 17, 2024): 164–73. http://dx.doi.org/10.17650/1726-9776-2024-20-1-164-173.
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Numerous studies indicate a decrease in overall survival among cancer patients who have developed thromboembolic complications. The article presents a review of literature on thromboembolic complications in patients with kidney, bladder, and prostate cancer. The analysis of publications indicates a variety of risk factors and heterogeneous frequency of thromboembolism in patients with malignant neoplasms of the genitourinary system. Prevention of thromboembolism is carried out at all stages of treatment: outpatient, after surgery, during chemotherapy, but is accompanied by a fairly high risk of hemorrhagic complications and recurrences. Direct oral anticoagulants are an alternative to low-molecular-weight heparin for prevention of cancer-associated thromboembolism due to their convenience, efficacy and safety for most patients. An important task is to select patients for primary thromboprophylaxis based on stratification of the risk of thromboembolic complications using prognostic scales.
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Gala, Dhir, Taylor Newsome, Nicole Roberson, Soo Min Lee, Marvel Thekkanal, Mili Shah, Vikash Kumar, Praneeth Bandaru, and Vijay Gayam. "Thromboembolic Events in Patients with Inflammatory Bowel Disease: A Comprehensive Overview." Diseases 10, no. 4 (September 30, 2022): 73. http://dx.doi.org/10.3390/diseases10040073.
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Inflammatory bowel disease (IBD), Crohn’s disease and ulcerative colitis are chronic inflammatory disorders of the intestines. The underlying inflammation activates the coagulation cascade leading to an increased risk of developing arterial and venous thromboembolic events such as deep vein thrombosis and pulmonary embolism. Patients with IBD are at a 2–3-fold increased risk of developing thromboembolism. This risk increases in patients with active IBD disease, flare-ups, surgery, steroid treatment, and hospitalization. These complications are associated with significant morbidity and mortality making them important in clinical practice. Clinicians should consider the increased risk of thromboembolic events in patients with IBD and manage them with appropriate prophylaxis based on the risk. In this review, we discuss the literature associated with the pathophysiology of thromboembolism in patients with IBD, summarize the studies describing the various thromboembolic events, and the management of thromboembolism in patients with IBD.
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Nitta, Satoshi, Koji Kawai, Tomokazu Kimura, Takashi Kawahara, Shuya Kandori, Akio Hoshi, Takahiro Kojima, and Hiroyuki Nishiyama. "Predictors of venous thromboembolism development before and during chemotherapy for advanced germ cell tumor." Japanese Journal of Clinical Oncology 50, no. 3 (February 9, 2020): 338–43. http://dx.doi.org/10.1093/jjco/hyz177.
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Abstract Objective We retrospectively analyzed the incidence and localization of venous thromboembolism in patients undergoing chemotherapy for advanced germ cell tumor and separately evaluated the risk factors for venous thromboembolism development before and during chemotherapy. Methods We included 121 patients treated with cisplatin-based chemotherapy between 2005 and 2018. Venous thromboembolism was defined as venous thrombosis diagnosed using radiological imaging with or without thromboembolic symptoms. We analyzed the clinical parameters for identifying the possible venous thromboembolism risk factors. Khorana score was used to calculate the venous thromboembolism risk. Results Thirteen patients showed prechemotherapy venous thromboembolism and 13 developed venous thromboembolism during chemotherapy. The most common venous thromboembolism was deep vein thrombosis (10 patients), followed by inferior vena cava thrombus (eight patients) and pulmonary thrombus (six patients). Compared to the group without venous thromboembolism, the group with prechemotherapy venous thromboembolism showed higher proportion of patients with tumors originating in the right testis (10 out of 13), significantly higher lactate dehydrogenase levels (828 IU/L versus 436 IU/L, P = 0.013), significantly higher proportion of patients with retroperitoneal lymph node (RPLN) metastases >5 cm in diameter (76.9% versus 33.7%, P = 0.003) and slightly higher proportion of patients with high-risk Khorana score (≥ 3; 30.8% versus 11.6%). No significant differences were observed between the clinical characteristics of patients with venous thromboembolism developed during chemotherapy and patients without venous thromboembolism. Conclusions We show that both RPLN mass > 5 cm and high lactate dehydrogenase levels are significant risk factors for prechemotherapy venous thromboembolism but not for venous thromboembolism development during chemotherapy.
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Park, Jisoo, Bo-Young Hong, Joon-Sung Kim, Jung-Geun Park, Jiyoon Jung, and Seong-Hoon Lim. "Could DOAC Be a Better Choice Than Warfarin in Low Compliance Patients with Fontan Procedure?" Medicina 57, no. 5 (May 10, 2021): 465. http://dx.doi.org/10.3390/medicina57050465.
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Background and Objectives: After the Fontan procedure, thromboembolic events need to be prevented. We present a young patient with a history of Fontan procedure and poor adherence to warfarin who developed systemic thromboembolism. He was changed to maintenance dabigatran, which is one of the available direct oral anticoagulants (DOACs). Case presentation: A 20-year-old man was diagnosed with cerebral infarct, pulmonary thromboembolism (PTE), and renal infarcts. He was prescribed warfarin to prevent thromboembolic events after the Fontan procedure. Based on his poor adherence to warfarin, we decided to change the anticoagulant therapy from warfarin to dabigatran 150 mg bid. One month later, his pulmonary thromboembolism regressed. Conclusion: Our case report showed a young adult with low compliance to warfarin who developed cerebral, pulmonary, and renal thromboembolic events. Thus, in our opinion, the change from warfarin to a DOAC was necessary for further prevention and treatment of PTE. A change from warfarin to a DOAC should be considered in patients with poor compliance who are at high risk of thromboembolic events, for example, after the Fontan procedure.
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Katı, O., O. K. Bakkaloglu, I. Hatemi, A. F. Celik, E. Seyahi, and Y. Erzin. "P1029 Prevalance and risk factors of thromboembolism in Inflammatory Bowel Disease." Journal of Crohn's and Colitis 18, Supplement_1 (January 1, 2024): i1857. http://dx.doi.org/10.1093/ecco-jcc/jjad212.1159.
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Abstract Background Inflammatory bowel disease (IBD), as a chronic inflammatory condition, can affect atherosclerotic process, arterial events, and increase the formation of venous thromboembolism. The aim of this study was to determine the frequency of thromboembolism and the risk factors associated with acute thromboembolism in our IBD cohort. Methods A total of 3133 patients with 1414 Crohn's Disease (CD), 1667 Ulcerative Colitis (UC) and 52 Indeterminate Colitis who were admitted between 1999 and 2021 were retrospectively analyzed. Patients with acute arterial events and venous thromboembolism (n=39) during the follow-up period were compared with a control group (n=78) of the same gender and same diagnosis. Patients with Behçet's syndrome (n=126),systemic vasculitis (n=16) and hereditary thrombophilia (n=5) were excluded. Results Among 3133 IBD patients, number of patients with arterial events or venous thromboembolism at any time was 124, and the frequency was 3,95%. A total of 132 thromboembolic events, 86 arterial (65,2%) and 46 venous (34,8%) were recorded.Coronary artery disease was significantly higher in the UC group (2,3% vs. 1,2%; p=0.028). During follow-up, 40 acute thromboembolic events, 25 arterial and 15 venous, were seen in 39 patients (frequency 1,24%). There was no significant difference between the CD and UC groups in terms of acute thromboembolism (p=0.871). The presence of exacerbation, the presence of hospitalization, the number of priot hospitalizations and clinical activity at the last visit were associated with both arterial and venous thromboembolism; smoking history, age at diagnosis, body-mass index, non-mucosal CD (Montreal B2-B3) and higher basal CRP were associated with arterial thromboembolism only; higher CRP at the last visit, annual exacerbation frequency, presence of an additional inflammatory disease, presence of complications (surgery, abcess), longer total steroid traetment duration and also recent steroid therapy were associated only with venous thromboembolism. In regression analysis, recent steroid therapy and additional inflammatory disease were considered as independent risk factors for venous thromboembolism whereas age at diagnosis of IBD was considered as an independent risk factor for arterial events. Conclusion In addition to risk factors such as age, smoking and obesity, parameters indicating disease activity, inflammatory comorbidities and recent steroid therapy appear to be associated with acute thromboembolism in IBD patients.
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Sutanto, Henry, and Gatot Soegiarto. "Risk of Thrombosis during and after a SARS-CoV-2 Infection: Pathogenesis, Diagnostic Approach, and Management." Hematology Reports 15, no. 2 (April 3, 2023): 225–43. http://dx.doi.org/10.3390/hematolrep15020024.
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Coronavirus disease 2019 (COVID-19) increases the risk of thromboembolic events, especially in patients with severe infections requiring intensive care and cardiorespiratory support. COVID-19 patients with thromboembolic complications have a higher risk of death, and if they survive, these complications are expected to negatively affect these patients’ quality of life. Moreover, recent data reported that the risk of thromboembolism remains high months after a COVID-19 infection. Therefore, understanding the pathogenesis of thrombosis in the setting of COVID-19 may facilitate the early prevention and treatment of COVID-19-associated thromboembolism to reduce concomitant morbidity, mortality, and disability. This review will first discuss the clinical characteristics of COVID-19 infections, particularly with regard to the underlying pathophysiology. Then, the pathogenesis of COVID-19-associated thrombosis at the molecular and cellular levels will be comprehensively reviewed. Next, the clinical manifestations of venous and arterial thromboembolism in COVID-19 as well as the potential benefits of several laboratory markers of thrombosis will be further discussed. Lastly, the preventive and therapeutic management of thromboembolism during and after COVID-19 will also be explained.
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Kurokami, Tsunehiko, Reiko Takasawa, Sayaka Takeda, Masashi Kurobe, Kei Takasawa, Masato Nishioka, and Masayuki Shimohira. "Venous thromboembolism in two adolescents with Down syndrome." Turkish Journal of Pediatrics 60, no. 4 (August 25, 2018): 429–32. http://dx.doi.org/10.24953/turkjpediatr.2018.879.
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Although venous thromboembolic events are relatively rare in children, they are an increasingly recognized clinical entity in pediatric tertiary care hospitals. Although vascular disorders are prevalent with Down syndrome, it remains unclear whether Down syndrome patients are at higher risk for venous thromboembolic events. We report two adolescent cases with Down syndrome who unexpectedly developed venous thromboembolism in a general care unit. Our cases had a few risk factors; laparoscopic radical surgery for Hirschsprung's disease with central venous catheterisation in Case 1, and bacterial hepatic abscess in Case 2. Despite preventive heparinization with catheterisation and minor surgery in Case 1 and non-sepsis in Case 2, bed rest for only a few days triggered sudden onset of deep vein thrombosis in lower limbs with pulmonary thromboembolism in both cases. We speculate that the characteristics of Down syndrome, including physical and behavioural problems, might cause venous thromboembolic events. Thus, we should pay more attention to the relationship specifically between venous thromboembolism and Down syndrome, especially in adolescents, and increase prevention, early detection and treatment efforts.
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Lebedeva, M. N., I. V. Vitkovskaya, E. Yu Ivanova, V. L. Lukinov, and V. V. Rerikh. "Venous thromboembolism in complicated cervical spine injury." Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika) 21, no. 1 (March 27, 2024): 14–26. http://dx.doi.org/10.14531/ss2024.1.14-26.
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Objective. To determine incidence rate and risk factors for the development of venous thromboembolism in complicated cervical spine injury.Material and Methods. The study included 34 patients with acute complicated cervical spine injury. Inclusion criteria were newly diagnosed venous thromboembolic complications, and application of low-frequency piezothromboelastography to study the hemostasis system. All patients received standard drug thromboprophylaxis. Patients were divided into two study groups: Group I included 21 patientswith venous thromboembolic complications, and Group II – 13 patients without thromboembolic complications.Results. The incidence of venous thromboembolism in the total sample was 61.8 %. Pulmonary artery embolism developed in 4.7 % of cases. In 91,0 % of cases, thrombosis was asymptomatic. The state of the hemostatic system in Group I before the start of thromboprophylaxis was characterized by chronometric hypocoagulation, and structural hypercoagulation with a 2.6-fold increase in the intensity of clot retraction and lysis. In Group II, there was chronometric and structural hypercoagulation with a 14.4-fold increase in the intensity of clot retraction and lysis. The main significant predictors of the development of venous thromboembolism were identified as intestinal paresis (p = 0.004), absence of changes in neurological status (p = 0.012), length of stay in the ICU (p = 0.025), and length of hospitalstay (p = 0.039). The building of a multivariate logistic regression model revealed multiplicative significant predictors of the development of thromboembolism. It has been shown that the presence of intestinal paresis is associated with a 25.07-fold increase in the chances of developing DVT of lower extremities.Conclusion. Considering the high incidence of venous thromboembolic complications in patients with complicated cervical spine injury, further research is required to study the effectiveness and safety of correction of drug thromboprophylaxis regimens in the form of increasing doses of anticoagulants or the frequency of their administration.
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Morshed, Ghada, and Nader Zaki. "Adequate timing of thromboembolic prophylaxis in colorectal cancer surgery." International Surgery Journal 5, no. 2 (January 25, 2018): 576. http://dx.doi.org/10.18203/2349-2902.isj20180355.
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Background: It has been found that patients with colorectal cancer are at increased risk for postoperative venous thromboembolism. The aim of this prospective study is to evaluate the incidence of venous thromboembolism and major bleeding complications in patients undergoing colorectal cancer who are treated with preoperative or postoperative venous thromboprophylaxis.Methods: This prospective study included 30 patients from September 2013 to November 2017. There were 22 males and 8 females; mean age was 66.7±5.5 years (range 44-78). Author divided the patients randomly into two groups (group A=15 cases with preoperative and group B = 15 cases with postoperative venous thromboprophylaxis).Results: There was no significant difference in preoperative versus postoperative thromboembolic prophylaxis regarding postoperative DVT 0/15(0%) vs 1/15 (6.6%), P=0.69, no bleeding complications and no pulmonary embolism.Conclusions: Preoperative and postoperative thromboembolic prophylaxis are equally safe in venous thromboembolism protection.
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Di Stasio, Fabiana, Angela Amoroso, Naire Sansotta, Valeria Casotti, and Lorenzo D'Antiga. "Cefalea e rettocolite ulcerosa: trombosi cerebrale alle porte?" Medico e Bambino pagine elettroniche 24, no. 2 (February 28, 2021): 39–41. http://dx.doi.org/10.53126/mebxxiv039.
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Venous thromboembolism (VTE) is a serious extraintestinal complication of inflammatory bowel disease (IBD). Patients with IBD have a VTE risk 3 times greater than those without IBD. IBD children are exposed to that risk as well but with lower incidence compared to adults, 9 events per 10,000 patients per years in children. The acute IBD flare is a predisposing factor to VTE. The management of thromboembolism in IBD patients includes treatment of a thromboembolic complication and secondary prophylaxis of the recurrence of a thromboembolic event. The paper reports a case of a boy with ulcerative colitis who developed cerebrovascular VTE during IBD flare.
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Paradis, Khazal, Mark L. Bernstein, and Joel W. Adelson. "Thrombosis as a Complication of Inflammatory Bowel Disease in Children." Journal of Pediatric Gastroenterology and Nutrition 4, no. 4 (August 1985): 659–62. http://dx.doi.org/10.1002/j.1536-4801.1985.tb08926.x.
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SummaryThrombosis and thromboembolism have rarely been reported in inflammatory bowel disease (IBD) in children. Four cases of thrombosis, two with apparently serious thromboembolism, are reported in three patients with ulcerative colitis and one with Crohn's disease. Two patients were on steroid treatment at the time of the initial thromboembolic event. Thrombosis may result from a “hypercoagulable state“ that occurs in IBD, brought about by a combination of altered clotting factors and the presence of a thrombogenic gastrointestinal mucosa, the risk of which is increased by steroid medications. Children and adolescents with IBD are at risk for serious thromboembolic complications.
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Guillaumin, Julien. "Why could thrombolysis be an option for cats with acute aortic thromboembolism?" Companion Animal 28, no. 11 (November 2, 2023): 2–6. http://dx.doi.org/10.12968/coan.2023.0028.
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Feline aortic thromboembolism, or ‘saddle thrombus’, is a common syndrome initiated by the sudden migration of a left atrial thrombus into the systemic arteries. It is usually caused by cardiomyopathy of varying types and severity. It is easily diagnosed clinically using the ‘5P rule’ (pulselessness, pallor, polar, pain and paralysis). Although the prognosis for feline aortic thromboembolism has historically been considered poor, this is not validated by retrospective or prospective studies. Indeed, a prospective study on cats with aortic thromboembolism and bilateral pelvic limb paralysis showed a 37.5% discharge rate, with a calculated 95% confidence interval of 22.5% to 52.5%, and with some cats surviving for more than a year. Treatment includes supportive care, treatment of cardiac disease if applicable and nursing care. Thrombolysis is recommended in many thromboembolic diseases in humans, including pulmonary thromboembolism, acute myocardial infarction and acute ischemic stroke, and has been recently suggested in cats suffering from acute (within 6 hours) aortic thromboembolism. Most clinicians will use the tissue plasminogen activator alteplase. Complications of treatment of feline aortic thromboembolism, with or without thrombolysis, include acute kidney injury (20%) as well as reperfusion injuries (25%). Thromboprophylaxis with clopidogrel or clopidogrel and rivaroxaban is recommended for long-term management of cats with aortic thromboembolism.
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Espírito Santo, Joana, Inês Coutinho, Ana Pimentel, Rui Garcia, and Rui Marques dos Santos. "Superior Vena Cava Syndrome and Colon Carcinoma: A Report of a Multifactorial Association." Case Reports in Oncological Medicine 2015 (2015): 1–5. http://dx.doi.org/10.1155/2015/345804.
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Introduction. Superior vena cava (SVC) syndrome results from the obstruction of blood flow through the SVC, having distinct pathophysiological underlying mechanisms. Cancer is associated with an increased risk of thromboembolism that varies according to patient-, tumor-, and treatment-related factors. An individualized clinical approach is important to pursue the accurate diagnosis of the underlying pathology causing thromboembolism in cancer patients.Case Presentation. The authors present a case of a 58-year-old male with an infrequent presentation of an unknown colon carcinoma, who has never had any symptom until he was hospitalized with the diagnosis of superior vena cava syndrome and pulmonary thromboembolism. The patient had an advanced disease by the time of diagnosis and molecular alterations contributing to abnormal hemostasis. He presented venous and arterial thromboembolism and developed disseminated intravascular coagulopathy after surgery, anticoagulant and transfusion therapy, dying 40 days after the hospitalization.Conclusion. The authors discuss thromboembolic disease and tumor metastasis roles in a cancer patient with SVC syndrome. Thromboembolism in a malignancy context is a challenging clinical entity. A multifactorial perspective of the thrombotic disease is warranted to approach thromboembolism risk and stratify patients suitable to receive adequate anticoagulant prophylaxis and targeted therapies, aiming to improve clinical prognosis.
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Jacinto, Ana M. L., Alison E. Ridyard, Itamar Aroch, Penny J. Watson, Linda R. Morrison, Marge L. Chandler, and Sharon Kuzi. "Thromboembolism in Dogs with Protein-Losing Enteropathy with Non-Neoplastic Chronic Small Intestinal Disease." Journal of the American Animal Hospital Association 53, no. 3 (May 1, 2017): 185–92. http://dx.doi.org/10.5326/jaaha-ms-6328.
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ABSTRACT Dogs with protein-losing enteropathy (PLE) are suggested to be at increased risk of developing thromboembolic events. However, with some exceptions, there are very few reports of thromboembolism in such dogs. This multicentre retrospective observational study describes a case series of thromboembolism (TE) in eight dogs with PLE secondary to non-neoplastic, chronic small intestinal disease. Seven dogs had poorly controlled PLE when the thromboembolic event occurred. Pulmonary thromboembolism (PTE) occurred in six dogs, while one dog developed splenic vein thrombosis and another had concurrent splenic vein and aortic TE. Six dogs died, all with PTE. Antithrombin activity was decreased in one of two dogs in which it was measured. Serum cobalamin and folate concentrations were measured in three dogs and cobalamin was subnormal in all three. Serum magnesium, measured in two dogs, was low in both. Dogs with uncontrolled chronic small intestinal disease and PLE are at risk for developing serious life-threatening TE, mostly PTE.
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Pesavento, Raffaele, Lucia Filippi, Antonio Palla, Adriana Visonà, Carlo Bova, Marco Marzolo, Fernando Porro, et al. "Impact of residual pulmonary obstruction on the long-term outcome of patients with pulmonary embolism." European Respiratory Journal 49, no. 5 (May 2017): 1601980. http://dx.doi.org/10.1183/13993003.01980-2016.
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The impact of residual pulmonary obstruction on the outcome of patients with pulmonary embolism is uncertain.We recruited 647 consecutive symptomatic patients with a first episode of pulmonary embolism, with or without concomitant deep venous thrombosis. They received conventional anticoagulation, were assessed for residual pulmonary obstruction through perfusion lung scanning after 6 months and then were followed up for up to 3 years. Recurrent venous thromboembolism and chronic thromboembolic pulmonary hypertension were assessed according to widely accepted criteria.Residual pulmonary obstruction was detected in 324 patients (50.1%, 95% CI 46.2–54.0%). Patients with residual pulmonary obstruction were more likely to be older and to have an unprovoked episode. After a 3-year follow-up, recurrent venous thromboembolism and/or chronic thromboembolic pulmonary hypertension developed in 34 out of the 324 patients (10.5%) with residual pulmonary obstruction and in 15 out of the 323 patients (4.6%) without residual pulmonary obstruction, leading to an adjusted hazard ratio of 2.26 (95% CI 1.23–4.16).Residual pulmonary obstruction, as detected with perfusion lung scanning at 6 months after a first episode of pulmonary embolism, is an independent predictor of recurrent venous thromboembolism and/or chronic thromboembolic pulmonary hypertension.
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Kızıltan, Feryaz, Emre Demir Benli, Seyhan Yılmaz, Mehmet Kalender, and Serdar Gunaydin. "Association of arterial thromboembolism location with presence of nonvalvular atrial fibrillation." Vascular 28, no. 3 (February 9, 2020): 325–28. http://dx.doi.org/10.1177/1708538119881077.
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Objectives Since nonvalvular atrial fibrillation is persistent in nature, patients with chronic nonvalvular atrial fibrillation are at life-time risk for development of thromboembolic events. Several novel oral anticoagulants have entered the market and there has been a growing body of evidence regarding their efficacy in prevention of ischemic stroke and arterial thromboembolism. The present study sought to compare the baseline characteristics between patients presenting with upper and lower extremity arterial thromboembolism developed secondary to nonvalvular atrial fibrillation. Methods This retrospective study was made up of patients presenting with acute upper or lower extremity arterial thromboembolism as the first presentation of atrial fibrillation. Patients were included if they had acute upper or lower critical limb ischemia symptoms lasting for less than one week. Patients in whom chronic peripheral artery disease was diagnosed were also excluded to prevent potential confounding. Results Overall, 46.9% of patients presented with upper extremity arterial thromboembolism and 53.1% of patients presented with lower extremity arterial thromboembolism. None of the baseline characteristics showed significant difference between patients with upper and lower extremity arterial thrombosis. Conclusion It was observed that there was no significant difference in the incidence of extremity involvement of acute arterial thromboembolism occurring in patients with nonvalvular atrial fibrillation in our study, and we think that acute arterial thromboembolism must be taken into consideration as one of the first signs and symptoms of atrial fibrillation.
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Ong, Chea Tze, Edmund Leung, and Adarsh P. Shah. "Improving prescribing of extended prophylaxis for venous thromboembolism at discharge in patients who underwent surgery for colorectal cancer." British Journal of Hospital Medicine 81, no. 11 (November 2, 2020): 1–7. http://dx.doi.org/10.12968/hmed.2020.0405.
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Aims/Background Prophylaxis at discharge is important in mitigating venous thromboembolism events from colorectal cancer and major abdominopelvic surgery, both of which are risk factors for venous thromboembolism. Foundation doctors frequently rotate between departments, and so rely on departmental induction and/or handing down of knowledge to prescribe extended venous thromboembolism prophylaxis upon discharge. Methods A retrospective audit of all patients who underwent surgery for colorectal cancer at The County Hospital, Hereford, between 1 August 2018 and 31 August 2019, was undertaken to assess departmental compliance with guidance from the National Institute for Health and Care Excellence. Results A total of 181 patients underwent elective surgery and 29 patients had emergency surgery. The initial audit revealed a cyclical 4-monthly decline that coincided with foundation doctors' rotations. Six multidisciplinary interventions were implemented. Reaudit demonstrated 100% compliance with prescribing of extended venous thromboembolism prophylaxis at discharge. No venous thromboembolism events 30 days post operation were noted. Conclusions A multidisciplinary approach involving educating health professionals about the importance of extended venous thromboembolis prophylaxis in patients who have undergone surgery for colorectal cancer can be effective in improving compliance with prescribing practices at discharge.
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Madeeva, Daria V., Kelly Borges, Marcus Shallow, Prerak V. Juthani, Stephen Y. Wang, Akash Gupta, Hyung J. Chun, Alfred Ian Lee, and Alexander B. Pine. "Proteomic Profiles in Patients with Thrombosis Due to COVID-19 Are Distinct from Non-COVID-19 Thrombosis." Blood 138, Supplement 1 (November 5, 2021): 777. http://dx.doi.org/10.1182/blood-2021-153959.
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Abstract BACKGROUND. COVID-19 is a prothrombotic disease, characterized by endotheliopathy, hypercoagulability, and thromboembolic complications. We hypothesized that the pathogenesis of thromboembolism associated with COVID-19 might differ from thromboembolism in patients without COVID-19. In this study, we sought to evaluate the proteomic signatures of plasma from patients with venous thromboembolism with and without COVID-19. METHODS. Between December 17, 2020 and February 25, 2021 blood was collected from 48 hospitalized patients. Of these 24 had a confirmed diagnosis of COVID-19 infection (COVID+) and radiologic confirmation of arterial or venous thromboembolism (TE+); 17 had COVID-19 infection with absence of arterial thrombosis clinically and absence of venous thromboembolism on lower extremity Doppler ultrasound or chest CT angiography (COVID+/TE-), while 7 were arterial or venous thromboembolism in the absence of COVID-19 (COVID-/TE+). Blood was collected in sodium citrate tubes and centrifuged at 4000 rpm for 20 minutes, with resulting plasma supernatant used for protein profiling performed at Eve Technologies (Calgary, Alberta, Canada). Institutional Review Board approval was obtained for this study. Statistical analysis was performed using GraphPad Prism (v9.1, GraphPad Software, San Diego, CA) and R (v4, R Core Team). P values <0.05 were considered statistically significant. A heatmap was generated using Heatmapper (heatmapper.ca) to represent the concentrations of proteins. RESULTS. The median age was 63 years; overall 25 (52%) were men (13 [54%] among COVID+/TE+, 11 [65%] among COVID+/TE-, and 1 [14%] among COVID-/TE+). In COVID-19 patients who developed thromboembolic events, several proteins associated with inflammation, complement activation, and hemostasis were present at higher levels than in non-COVID-19 patients who developed thromboembolic events (Fig. 1). These included complement factors C2 and C5a, pentraxin-3 (PTX-3), lipocalin-2 (LCN2), resistin (RETN), platelet endothelial cell adhesion molecule-1 (Pecam1), serum amyloid A (SAA), and tissue factor (TF). The heatmap indicates relative protein levels detected in each subject (columns) for proteins (rows) that had statistically significant differences between groups (Fig. 2). Heatmap revealed relatively lower levels of all proteins in patients with thromboembolism without COVID-19 and relatively higher levels of proteins in patients with COVID-19, and especially in ICU patients with COVID-19 and thromboembolism. CONCLUSIONS. Thromboembolic complications in patients with COVID-19 are associated with increased levels of various proteins involved in complement activation and immunothrombotic cascades, compared to thrombotic events in the absence of COVID-19. Activation of the classical complement pathway as evidenced by a relative increase in complement factor C2 may lead to increased TF activation, reflecting more substantial endothelial damage in COVID-19 patients. Higher levels of Pecam1, SAA, LCN2, and RETN all point to increased endotheliopathy, inflammation, and tissue damage in COVID-19 compared to non-COVID-19 thrombosis. These findings may offer insights into novel therapeutic strategies to treat immunothrombotic complications of COVID-19. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.
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Pritchard, K. I., A. H. Paterson, N. A. Paul, B. Zee, S. Fine, and J. Pater. "Increased thromboembolic complications with concurrent tamoxifen and chemotherapy in a randomized trial of adjuvant therapy for women with breast cancer. National Cancer Institute of Canada Clinical Trials Group Breast Cancer Site Group." Journal of Clinical Oncology 14, no. 10 (October 1996): 2731–37. http://dx.doi.org/10.1200/jco.1996.14.10.2731.
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PURPOSE AND METHODS Associations between thromboembolism and malignancy, usually widespread, and between thromboembolism and hormonal and/or chemotherapy have been previously reported. We performed a randomized trial of tamoxifen 30 mg/d for 2 years (T) versus T plus 6 months of intravenous chemotherapy with cyclophosphamide, methotrexate, and fluorouracil (CMF) for postmenopausal women with involved axillary nodes and positive estrogen receptor (ER) or progesterone receptor (PgR) status following primary therapy for breast cancer. RESULTS We observed one or more thromboembolic events in 48 of 353 women (13.6%) allocated to receive T plus CMF in comparison to five of 352 women (2.6%) randomized to receive T alone (P < .0001). Six women in the T plus CMF arm, but none randomized to receive T alone, suffered two thromboembolic events while an study therapy. There were also significantly more women who developed severe (grade 3 to 5) thromboembolic events in the T plus CMF arm than in the T arm (34 v five; P < .0001). Most thromboembolic events (39 of 54) occurred while women were actually receiving chemotherapy (P < .0001). Thromboembolic complications resulted in more days in hospital and more deaths than any other complication of therapy, including infection, in this trial. CONCLUSION Thromboembolism related to the addition of CMF chemotherapy to tamoxifen as adjuvant therapy in this group of women represents a relatively common and serious complication that may outweigh any benefits offered by this additional therapy.
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Tsimberidou, Apostolia-Maria, Sushma Vemulapalli, Lakshmi Chintala, Navjot Dhillon, Xiudong Lei, David Hong, and Razelle Kurzrock. "Clinical Outcomes and Factors Predicting Development of Venous Thromboembolic Complications in Patients with Advanced Refractory Cancer in a Phase I Clinic: The M. D. Anderson Cancer Center Experience." Blood 112, no. 11 (November 16, 2008): 3828. http://dx.doi.org/10.1182/blood.v112.11.3828.3828.
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Abstract Venous thromboembolism (VTE) is common in patients with advanced cancer and may influence patient eligibility for clinical studies, quality of life, and survival. We reviewed the records of 220 consecutive patients seen in the Phase I Program at M. D. Anderson Cancer Center to determine the frequency of VTE, associated characteristics and clinical outcomes. Of 220 patients, 23 (10.5%) presented to the Phase I clinic with a history of VTE. Twenty-six patients (11.8%) subsequently developed a venous thromboembolic event, with a median follow-up of 8.4 months. These included 9 of 23 patients (39%) with and 17 of 197 (8.6%) without a history of VTE (p < 0.0001). The median time from the first visit to the Phase I clinic to a new thromboembolic episode in the 26 patients was 5.1 months (range, 0 to 27 months). The respective times to development of new thromboembolic events for patients with and without a history of thromboembolism were 3.1 months (n = 9) and 5.3 months (n = 17). Four (15%) of the 26 patients developed venous thromboembolism within one month after their first visit to the Phase I clinic. Among the remaining 22 patients, 18 (69%) developed venous thromboembolism within the first year following their initial visit to the Phase I clinic, and 4 patients developed it after 2.5 years. Fifteen patients developed DVT, seven pulmonary embolism (PE), and one patient each developed one of the following thromboembolic episodes: concurrent DVT and PE; right atrial thrombus; thrombus in the abdominal aorta and DVT; and isolated thrombus in an abdominal aortic aneurysm. The median survival in patients with and without a history of VTE were 4.7 and 10.9 months, respectively (p = 0.0002). Multivariate analysis demonstrated that a history of VTE (hazard ratio 6.2; 95% C.I. 2.6–14.7; p < 0.0001), diagnosis of pancreatic cancer (hazard ratio 4.0; 95% C.I. 1.5–11.2; p=0.007) and platelet count >440 × 109/L (hazard ratio 3.1; 95% C.I. 1.1–8.2; p = 0.026) predicted the development of new venous thromboembolic episodes. These three parameters were used to design a predictive model. Based on the relative risks of the independent covariates, the relative risk of a new thromboembolic episode could be characterized by summing the weighted number of risk factors present at first visit to the Phase I clinic. History of venous thromboembolism was given a score of 2 because the hazard ratio was 6.3, whereas the diagnosis of pancreatic cancer and elevated platelet counts had hazard ratios of 4.7 and 3.0, respectively, and were each given a score of 1. Therefore, patients could have a score ranging from 0 to 4 (no patients had a score of 4). Patients were assigned to one of three risk groups on the basis of their weighted number of presenting risk factors: 0, low risk; 1, medium risk; 2–3, high risk. At 6 months, the rates of a new thromboembolic episode were 3.5%, 12.5%, and 28% for patients with scores 0, 1, or 2–3, respectively (p<0.0001). The median time to a new thromboembolic episode was not reached for patients with a score 0 or 1, and it was 9.1 months for patients with a score of 2–3. In conclusion, a history of VTE or new development of VTE was noted in 40 (18%) of 220 patients seen in our Phase 1 clinic. Our study suggests the need to closely monitor individuals with advanced cancer for the development of venous thromboembolic events. The high risk of recurrent venous thromboembolism in patients with a prior history of venous thromboembolism, whose anticoagulation therapy was discontinued before clinic referral, supports long-term continued prophylaxis in these patients. A prognostic score to predict for time to and frequency of venous thromboembolic events is thereby proposed.
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Nowak-Göttl, Ulrike, Elvira Ahlke, Gudrun Fleischhack, Dirk Schwabe, Rosmarie Schobess, Christiane Schumann, and Ralf Junker. "Thromboembolic events in children with acute lymphoblastic leukemia (BFM protocols): prednisone versus dexamethasone administration." Blood 101, no. 7 (April 1, 2003): 2529–33. http://dx.doi.org/10.1182/blood-2002-06-1901.
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Alterations in hemostasis leading to symptomatic thromboembolism have been observed in patients with acute lymphoblastic leukemia (ALL) receiving Escherichia coli asparaginase (CASP) combined with steroids. Moreover, hereditary prothrombotic risk factors are associated with an increased risk for venous thromboembolism in pediatric ALL patients treated according to the BFM 90/95 protocols (including CASP combined with prednisone during induction therapy). To assess whether the thromboembolic risk associated with established prothrombotic risk factors is modified by treatment modalities (prednisone or dexamethasone), the present analysis was performed. Three hundred thirty-six consecutively recruited leukemic children treated according to different BFM protocols (PRED group, n = 280, 60 mg/m2 prednisone; DEXA group, n = 56, 10 mg/m2 dexamethasone during induction therapy) were studied. Study end point was the onset of symptomatic vascular accidents during induction therapy. Cumulative thromboembolism-free survival was significantly reduced in children in the PRED group (thrombosis frequency, 10.4%) compared with children in the DEXA group (thrombosis frequency, 1.8%; P = .028). Although no significant difference was found in the overall prevalence of prothrombotic risk factors, 46.5% of patients in the PRED group who experienced thromboembolic events were carriers of a prothrombotic risk factor, whereas no carrier in the DEXA group had a thromboembolism. At the time of maximum CASP activity, fibrinogen and activities of antithrombin, plasminogen, and protein S were significantly reduced in the PRED group. No significant correlation could be found between CASP activity and levels of coagulation factors. In conclusion, the use of dexamethasone instead of prednisone, administered with CASP, significantly reduced the onset of venous thromboembolism.
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Hsu, Charlie Chia-Tsong, Trevor Watkins, Kosuke Kato, Igor Fomin, Sachintha Hapugoda, Jeffery Cheng, and Timo Krings. "Iodine-stained fragmented thromboembolism." Neuroradiology Journal 32, no. 6 (September 11, 2019): 445–51. http://dx.doi.org/10.1177/1971400919874508.
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Aim Iodine-stained fragmented thromboembolism (ISFT) is a rare phenomenon encountered in the immediate aftermath of mechanical thrombectomy or rarely as a complication of post–carotid stenting. The aim was to describe the imaging appearance and discuss its pathophysiology. Method This is a retrospective review of patients who underwent mechanical thrombectomy for acute stroke at a single institution over the period of one year. All patients underwent the standard acute stroke imaging protocol (CT head, CT angiogram (CTA) and CT brain perfusion) and when clinically appropriate followed by catheter angiogram and mechanical thrombectomy. ISFT was defined as an arterial luminal filling defect with Hounsfield density equal to or greater than iodine seen on the biplanar CT or conventional CT. The presence and location of ISFT were documented. Standard CT angiogram (CTA) or magnetic resonance angiogram (MRA) was performed 24–48 hours after the neurointerventional procedure to assess for recanalization, volume of infarction and the fate of the ISFT. Results ISFTs were identified in eight (five males and three females, age range 18–80 years) out of 49 patients in the following locations: distal M1 ( n = 1), M2 ( n = 4), M3 ( n = 1), A1 ( n = 1), distal A2 ( n = 1). ISFT and vessel recanalization occurred in five patients on follow-up. ISFT and vessel occlusion persisted in two patients. Conclusion ISFT is likely the result of mechanical disruption of a thromboembolus, and porosity of the thromboembolus fragment may transiently retain iodinated contrast. Recognition of this entity may be important to aid detection of residual thromboembolism and avoid misinterpretation as calcified thromboembolism.
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Benfor, B., R. Hajji, A. Bouarhroum, Y. Lagdrori, Brahim Boukatta, Abderrahim Elbouazzaoui, and Nabil Kanjaa. "Intracardiac Thrombosis and Multiple Arterial Thromboembolism with Acute Limb Ischemia: A Rare Complication of Carbon Monoxide Intoxication." International Journal of Angiology 28, no. 02 (August 2, 2017): 147–50. http://dx.doi.org/10.1055/s-0037-1604452.
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AbstractCarbon monoxide (CO) poisoning is a very common reason for emergency ward admission, with symptoms varying from a simple headache and dizziness to severe neurological and cardiac impairment. We report here a rare clinical presentation of CO intoxication manifested by a severe cardiac impairment with intracardiac thrombus formation, acute limb ischemia, renal infarction, and carotid artery thrombosis. There have been initial reports of thromboembolic events in acute CO poisoning with intracardiac thrombosis being sparsely reported. Contrary to venous thromboembolism, arterial thromboembolism in CO poisoning seems to be extremely rare. To the best of our knowledge, this is the first report in recent literature of a combined intracardiac thrombosis and multiple arterial thromboembolism induced by CO poisoning.
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Hacobian, Melkon, Ranjith Shetty, Clyde Matthew Niles, Marie Gerhard-Herman, Neelima Vallurupalli, Steven Baroletti, Sylvia C. McKean, et al. "Once Daily Enoxaparin for Outpatient Treatment of Acute Venous Thromboembolism: A Case-control Study." Clinical and Applied Thrombosis/Hemostasis 16, no. 1 (January 14, 2009): 21–25. http://dx.doi.org/10.1177/1076029608330009.
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We studied the efficacy and safety of an investigational enoxaparin regimen, 1.5 mg/kg once daily, as a bridge to warfarin for the outpatient treatment of acute venous thromboembolism. We undertook a case-control design. We enrolled 40 acute venous thromboembolism cases prospectively and matched them by age, gender, and location of venous thromboembolism to 80 previously treated controls. All controls had received enoxaparin 1 mg/kg twice daily. The primary end point was recurrent venous thromboembolism. We followed the cases for 30 days. We discontinued enoxaparin after we achieved the target international normalized ratio between 2.0 and 3.0. One case (2.9%) and three controls (3.8%) had recurrent venous thromboembolic events (P = 1.00). There were no major bleeding complications in the case group, compared to 3 (3.8%) in the control group (P = .55). Once daily enoxaparin, 1.5 mg/kg, as a bridge to warfarin was as effective with a similar safety profile as twice daily enoxaparin, 1mg/kg, for initial treatment of acute venous thromboembolism in the outpatient setting. This case-control study provides the rationale for undertaking a randomized controlled trial comparing enoxaparin 1.5 mg/kg once daily versus enoxaparin 1.0 mg/kg twice daily as a bridge to warfarin in outpatients with acute venous thromboembolism.
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Durmuşoğlu, Jülide, Henri J. L. M. Timmers, Pepijn van Houten, Hans F. Langenhuijsen, Ad R. M. M. Hermus, and Annenienke C. van de Ven. "Venous thromboembolism in patients with adrenocortical carcinoma after surgery." Endocrine Connections 9, no. 9 (September 2020): 874–81. http://dx.doi.org/10.1530/ec-20-0299.
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Background: Adrenocortical carcinoma is a rare malignancy with a poor prognosis. We hypothesized that patients with adrenocortical carcinoma are at high risk for venous thromboembolism, given the numerous risk factors such as malignancy, abdominal surgery, immobility and hormonal excess. The aim of this study was to determine retrospectively the incidence of venous thromboembolisms after surgical treatment in patients with adrenocortical carcinoma. Materials and methods: A retrospective study was performed, collecting data from all patients diagnosed with adrenocortical carcinoma from 2003 to 2018 at the Radboud University Medical Centre, The Netherlands. Results: In 34 patients, eight postoperative venous thromboembolisms, all pulmonary embolisms, were diagnosed in the first 6 months after adrenalectomy (23.5%). In addition, one patient developed pulmonary embolism just prior to surgery and one patient 7 years after surgery. Five of the eight patients with postoperative venous thromboembolisms presented with symptomatic pulmonary embolism whereas the other three pulmonary embolisms were incidentally found on regular follow up CT scans. Seven of the eight venous thromboembolisms occurred within 10 weeks after surgery. Seven of the eight patients had advanced stage adrenocortical carcinoma and four patients already received low-molecular weight heparin during the development of the venous thromboembolism. There was one case of fatal pulmonary embolism in a patient with a cortisol producing tumor with pulmonary metastases, despite the use of a therapeutic dose thromboprophylaxis. Conclusion: Patients with adrenocortical carcinoma are at high risk of developing postoperative venous thromboembolisms. Prolonged postoperative thromboprophylaxis could be considered in these patients.
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Abbas, Amna, Mazhar ur Rehman, Hina Aftab, Muhammad Athif Akram, and Ghulam Kibriya. "Pulmonary Thromboendarterectomy for Chronic Pulmonary Thromboembolism." Pakistan Journal of Medical and Health Sciences 17, no. 3 (March 24, 2023): 204–6. http://dx.doi.org/10.53350/pjmhs2023173204.
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Pulmonary embolism in terms of causes of mortality is the third most common cause, when talking about cardiovascular diseases, yet most undiagnosed or misdiagnosed one. Among causes of pulmonary thromboembolism protein C deficiency is a rare one and idiopathic most common entity. In general population the incidence of severe protein C deficiency is about 1 in 500,000-750,000 people. We present a case of chronic pulmonary thromboembolism in young female of 23 years. She presented with history of dyspnea, dry cough and bilateral DVT of legs. On pulmonary CT diagnosis of massive pulmonary thrombus was made and her pulmonary thromboendarterectomy was done in our center. Conclusion: All patients with chronic pulmonary thromboembolic hypertension should be assessed for operability by proper referral to an experienced CTEPH (chronic thromboembolic pulmonary hypertension) team to determine if they are viable candidate for PEA (pulmonary endarterectomy). PEA is standard and recommended operative technique for treatment of CTEPH. Keywords: pulmonary endarterectomy, pulmonary embolism, protein C deviciency
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Erstad, Brian L. "Venous Thromboembolism in Multiple Trauma Patients." Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy 18, no. 5 (September 10, 1998): 1011–23. http://dx.doi.org/10.1002/j.1875-9114.1998.tb03931.x.
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Thromboembolic complications are frequent in patients with multiple trauma. The efficacy of unfractionated heparin for venous thrombosis prophylaxis has not been established. Based on limited prospective data, low‐molecular‐weight heparin appears to be more effective than unfractionated heparin and at least as effective as compression devices for preventing thromboembolic complications in these patients. Vena cava filters should be considered in high‐risk patients who cannot receive anticoagulant therapy, but long‐term filter use without concomitant anticoagulant therapy is associated with a substantial risk of recurrent thromboembolism.
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Armstrong, Emily M., Jessica M. Bellone, Lori B. Hornsby, Sarah Treadway, and Haley M. Phillippe. "Pregnancy-Related Venous Thromboembolism." Journal of Pharmacy Practice 27, no. 3 (April 17, 2014): 243–52. http://dx.doi.org/10.1177/0897190014530425.
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Pregnancy is associated with an increased risk of venous thromboembolism (VTE), with a reported incidence ranging from 0.49 to 2 events per 1000 deliveries. Risk factors include advanced maternal age, obesity, smoking, and cesarian section. Women with a history of previous VTE are at a 4-fold higher risk of recurrent thromboembolic events during subsequent pregnancies. Additionally, the presence of concomitant thrombophilia, particularly factor V Leiden (homozygosity), prothrombin gene mutation (homozygosity), or antiphospholipid syndrome (APS), increases the risk of pregnancy-related VTE. Low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) are the drugs of choice for anticoagulation during pregnancy. LMWH is preferred due to ease of use and lower rates of adverse events. Women with high thromboembolic risk particularly those with a family history of VTE should receive antepartum thromboprophylaxis. Women with low thromboembolic risk or previous VTE caused by a transient risk factor (ie, provoked), who have no family history of VTE, may undergo antepartum surveillance. Postpartum anticoagulation can be considered in women with both high and low thromboembolic risk.
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Veljkovic, Milena, and Jasmina Popovic. "Venous thromboembolism and oral contraception." Medical review 63, no. 5-6 (2010): 376–79. http://dx.doi.org/10.2298/mpns1006376v.
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Introduction. Because of their safety and efficacy, oral contraceptives are available without prescription in many countries. Monophasic combined oral contraceptives are a combination of estrogen and progestin taken in constant amounts. Venous thromboembolism. Combined oral contraceptives slightly increase the risk of venous thromboemolism, but this event is very rare among non-pregnant women of reproductive age. The absolute risk rises with age, obesity, recent surgery and certain forms of thrombophilia. The estrogen component of combined oral contraceptives increases the synthesis of several coagulation factors in a dose-dependent manner. Changes of most of these parameters are very small and there is no evidence that they have any effect upon the clinical risk of developing venous thrombosis. If a woman has an inherited coagulation disorder that increases her risk of developing thrombosis, the risk is increased several fold if she ingests estrogen containing oral contraception. Conclusion. The increased risk of venous thromboembolism associated with combined oral contraceptives should have little impact on healthy women, but may have substantial impact on women with a history of thromboembolism. Combined oral contraceptive use increases the risk of venous thromboembolosm in a dose-dependent manner. The absolute risk of venous thromboembolism rises with age, obesity, recent surgery and certain forms of thrombophilia, as well.
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Reiffel, James A. "Optimum Risk Assessment for Stroke in Atrial Fibrillation: Should We Hold the Status Quo or Consider Magnitude Synergism and Left Atrial Appendage Anatomy?" Arrhythmia & Electrophysiology Review 6, no. 4 (2017): 161. http://dx.doi.org/10.15420/aer.2017.33.1.
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Thromboembolic stroke and systemic embolism are generally agreed to be the major morbidity/mortality concerns for patients with AF. However, the risk of thromboembolism is not the same for all AF patients. Both AF and comorbidities must interact synergistically to create the risk for thromboembolism. But, is the synergism dichotomous – AF present or absent, comorbid disorder present or absent – or does synergism have magnitude, depending on the number and severity of the associated disorders and the amount of time one is in AF? This review discusses the current risk-score contributors and options for assessing risk of thromboembolism in AF patients, and what their combined roles might be. Also covered is the consideration of left atrial appendage anatomy in this context.
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Ambrož, David, and Pavel Jansa. "From venous thromboembolism to chronic thromboembolic pulmonary disease." Intervenční a akutní kardiologie 22, no. 2 (May 9, 2023): 70–73. http://dx.doi.org/10.36290/kar.2023.018.
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Weir, Robin A. P., Nicola MacKenzie, and Colin J. Petrie. "Cheating the CHA2DS2-VASc Score: Thromboembolism in Apical Hypertrophic Cardiomyopathy." Case Reports in Cardiology 2014 (2014): 1–3. http://dx.doi.org/10.1155/2014/189895.
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Atrial fibrillation increases the risk of systemic thromboembolism in general and stroke in particular. Not all patients who develop atrial fibrillation are at significantly heightened risk of thromboembolic complications, however, with the development of risk scoring systems aiding clinicians in determining whether formal anticoagulation is mandated. The most commonly used contemporary scoring systems—CHADS2and CHA2DS2-VASc—provide a reliable means of assessing stroke risk, but certain cardiac conditions are associated with an increased incidence of thromboembolism without impacting on these risk scores. Hypertrophic cardiomyopathy, with its apical variant, is such a condition. We present a case of a patient with apical hypertrophic cardiomyopathy and atrial fibrillation who suffered dire thromboembolic consequences despite a reassuringly low CHA2DS2-VASc score and suggest that this scoring system is modified to incorporate the thromboembolic risk inherent to certain cardiomyopathies irrespective of impairment of left ventricular systolic dysfunction or clinical heart failure.
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Macklon, N. S., and I. A. Greer. "Venous Thromboembolic Disease in Obstetrics and Gynaecology: The Scottish Experience." Scottish Medical Journal 41, no. 3 (June 1996): 83–86. http://dx.doi.org/10.1177/003693309604100305.
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The incidence and pattern of thromboembolic complications in obstetric and gynaecological patients in Scotland between 1981 and 1992 was investigated by analysing ICD coded data retrieved from the SMR1 and SMR2 database. The effect of mode of delivery and maternal age over 35 on risk of thromboembolism in pregnancy was also assessed. 0.076% of gynaecological episodes were subsequently complicated by thromboembolic events. Nineteen percent of those suffering thromboembolic complications within two weeks of discharge were referred back to gynaecology. The incidence of deep venous thrombosis (DVT) in those under 35 years and over 35 years was 0.615/1000 maternities and 1.216/1000 maternities respectively. Respective figures for postnatal DVT were 0.304/1000 and O. 720/1000 and for pulmonary thromboembolism (PTE), 0.108/ 1000 and 0.405/1000. In both age groups, emergency caesarean section was associated with a higher incidence of DVT than elective caesarean section and vaginal delivery.
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Omčikus, Maja, and Ivan Milivojević. "Oral anticoagulation therapy in the treatment of pulmonary thromboembolism." Galenika Medical Journal 2, no. 5 (2023): 62–66. http://dx.doi.org/10.5937/galmed2305062o.
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Venous thromboembolic disease, which includes pulmonary thromboembolism and deep vein thrombosis, is one of the most common causes of morbidity and mortality. Management of patients with acute pulmonary thromboembolism is challenging, due to the wide spectrum of clinical presentation and possible outcomes. Certainly, anticoagulant therapy is the basis of treatment for these patients. Until recently, parenteral anticoagulants and oral vitamin K antagonists were used to achieve an anticoagulant effect. These drugs still have their place in the treatment of venous thromboembolic disease, but new, i.e. direct oral anticoagulants have replaced oral vitamin K antagonists due to their more favorable pharmacological characteristics. In this paper, based on available literature, clinical trials and good clinical practice guidelines, we highlight critical errors and discuss potential advantages and disadvantages of oral anticoagulants.
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Zhang, Nan, Dong-Kun Sun, Xu Tian, Xin-Yu Zheng, and Tong Liu. "Protein C deficiency with venous and arterial thromboembolic events." World Journal of Clinical Cases 12, no. 12 (April 26, 2024): 2000–2003. http://dx.doi.org/10.12998/wjcc.v12.i12.2000.
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Protein C (PC) is a key component of the vitamin K-dependent coagulation pathway. It exerts anticoagulant effects by inactivating factors V and VIII. Acquired or inherited PC deficiency results in a prothrombotic state, with presentations varying from asymptomatic to venous thromboembolism. However, there has been an increasing number of reports linking PC deficiency to arterial thromboembolic events, such as myocardial infarction and ischemic stroke. This editorial focuses on the association between PC deficiency and thromboembolism, which may provide some insights for treatment strategy and scientific research.
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Gadó, Klára, and Gyula Domján. "Thromboembolic events in malignant disorders." Orvosi Hetilap 153, no. 24 (June 2012): 934–47. http://dx.doi.org/10.1556/oh.2012.29385.
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There is a bidirectional connection between tumors and thrombosis. On one hand, thromboembolic events are more frequent in cases of malignancies, on the other hand, proliferation of tumor cells, progression of the malignant process and metastasis formation are facilitated by the activation of the hemostatic system. Thromboembolic events are associated with a worse prognosis in case of patients with malignant diseases. Thromboembolism is the second most frequent cause of death in patients with malignant tumors. Mortality is twice as high in patients with thromboembolism compared to those without it. The incidence of thromboembolism shows an increasing tendency. There has been a 28% increase among hospitalized cancer patients between 1995 and 2003. One reason is that the new anti-tumor agents have more pronounced prothrombotic activity than those of traditional chemotherapeutic drugs. Assessment of the thrombotic risk of cancer patients becomes more important. Several guidelines have been published concerning the prevention and treatment of thromboembolism in patients with malignancy. The risk of thrombosis is influenced not only by the type of malignancy but there are also large individual differences. Furthermore, the risk of thrombosis changes during the disease process in the same patient. Perioperative thromboprophylaxis is a very important issue considering oncologic surgery. Thromboprophylaxis of oncologic patients has a high significance in respect of morbidity and mortality. However, thromboprophylaxis may also cause serious complications thus the correct risk assessment of cancer patients is very important. Orv. Hetil., 2012, 153, 934–947.
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Kakkar, Ajay K. "Prevention of Venous Thromboembolism in the Cancer Surgical Patient." Journal of Clinical Oncology 27, no. 29 (October 10, 2009): 4881–84. http://dx.doi.org/10.1200/jco.2009.23.2009.
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Venous thromboembolism is a common complication in patients with malignant disease. One of the environments in which patients can present with symptomatic thromboembolic disease is in the postoperative period. Operation in the patient with cancer increases the risk of thromboembolic complications some two to three fold. A variety of methods have been evaluated for the prevention of thromboembolic disease in cancer surgical patients. The most extensively investigated are the pharmacologic methods, including low-dose unfractionated heparin and low molecular weight heparin. These agents are recommended for the prevention of thromboembolic disease during hospital stay. For selected high-risk populations, extended thromboprophylaxis into the postdischarge period is also recommended.
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Yenidunya, Gulsah, Hande Turna, Mehmet Akif Ozturk, Deniz Tural, Fatih Selcukbiricik, Ozcan Yildiz, Mustafa Ozguroglu, Fuat Demirelli, Evin Buyukunal, and Suheyla Serdengecti. "Thromboembolic complications in cancer patients." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): e21143-e21143. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e21143.
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e21143 Background: Thromboembolic events are frequent and important complications causing mortality and morbidity in cancer patients.To determine the charecteristics of these events can help us to determine the patients who have higher risks for thromboembolism. Methods: Characteristics of clinically or radiologically determined thromboembolic events were retrospectively analayzed from files of cancer patients followed up in the outpatient oncology clinic of Cerrahpasa Medical Faculty of Istanbul University. Results: A total of 267 thromboembolic events were analyzed.Events were encountered mostly in the venous system, only 3% were in the form of arterial embolism.Venous events were in the form of deep vein thrombosis (67%), pulmonary embolism (16.5%), vena cava superior thrombosis (2.6%), superficial migratory thrombophlebitis (0.4%) or two different forms occuring concomitantly(10.5%). Thromboembolism was determined most frequently in patients with gastrointestinal tumors (41.9%), lung cancer (22.1%) and gynecological tumors (12.1%). The most frequent histopathology was adenocarcinoma (72.4%).Thromboembolic complications were mostly in the form of lower extremity deep venous thrombosis in patients with gastointestinal, gynecological and urogenital tumors where as in the form of pulmonary embolism and vena cava superior thrombosis in patients with lung cancer. Nearly half of the patients with pulmonary embolism (%48.%) were asymptomatic and were diagnosed incidentally with radiological imaging. Upper extremity thrombosis were frequently encountered in patients with venous port a-cath system Most of the patients (87.7%) had metastatic cancer and were receiving chemotherapy (65.5% ) when the event occured. Cisplatin, 5–FU and gemcitabine were the most frequently used chemotherapy agents.Thromboembolic events related to cancer surgery occured usually (59%) in the first month after surgery.Recurrent thromboembolic events were determined in 8.9% of patients mostly whom had gastrointestnal primary tumors (54%). Conclusions: Characteristics of thromboembolic events can help to determine the patients who have higher risk for thromboembolism and predict types and time of the event and provide anticoagulation without delay.
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Halbmayer, Walter-Michael, Christine Mannhalter, Christine Feichtinger, Karl Rubi, and Michael Fischer. "The Prevalence of Factor XII Deficiency in 103 Orally Anticoagulated Outpatients Suffering from Recurrent Venous and/or Arterial Thromboembolism." Thrombosis and Haemostasis 68, no. 03 (1992): 285–90. http://dx.doi.org/10.1055/s-0038-1656366.
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SummaryOne hundred and three patients suffering from recurrent venous thrombosis, recurrent arterial thromboembolism and/or recurrent myocardial infarction and 50 healthy subjects were tested for Hageman factor (FXII) coagulant activity and antigen. Among the 103 patients we identified 15 subjects with FXII deficiency (15%), 3 with protein C deficiency (3%) and 3 with protein S deficiency (3%). Combined FXII and protein C, protein S or antithrombin III deficiency was not observed. The 103 patients were devided into subgroups according to the type of thrombotic complication. Among patients with exclusively recurrent venous thromboembolism 8% (p = 0.153) were deficient in FXII. Among patients suffering from recurrent arterial thromboembolism and/or myocardial infarction, the incidence of FXII deficiency was significantly higher (20%, p < 0.003). In 67% of the patients with FXII deficiency a positive family history of thrombosis could be established. In contrast, only 32% of all venous and 28% of all arterial thrombosis patients had a positive family history. We believe that reduced levels of FXII should be considered as a risk factor in the development of thromboembolism. Consequently, more attention should be payed to the measurement of FXII when evaluating thromboembolic risk factors especially in cases of recurrent arterial thromboembolism and/or myocardial infarction.
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Theodorou, Jacqueline M., Yogini Patel, and Patricia Ford. "Recurrent Venous Thromboembolism in Two Patients With Cancer Taking Rivaroxaban." Journal of Pharmacy Practice 30, no. 3 (March 29, 2016): 381–84. http://dx.doi.org/10.1177/0897190016639805.
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Pharmacologic agents for the treatment and prevention of venous thromboembolism in the cancer patient population are limited. Currently, low-molecular-weight heparin is recommended by national consensus guidelines for this indication. Rivaroxaban, an oral factor Xa inhibitor, is Food and Drug Administration (FDA) approved for the treatment and prevention of venous thromboembolism and offers the convenience of oral fixed-dose regimens, no routine laboratory monitoring, and has few drug and dietary interactions; however, its use in patients with cancer has not been largely studied. We report 2 cases of recurrent venous thromboembolism in patients with active cancer on rivaroxaban therapy. The first case is a 64-year-old female admitted for recurrent pulmonary embolism, and the second case is a 70-year-old female admitted for recurrent deep vein thrombosis. Both patients were receiving rivaroxaban at the time of thromboembolic recurrence. These cases serve as a reminder to health-care providers that more safety and efficacy data in the cancer patient population are needed prior to using rivaroxaban for venous thromboembolism treatment.
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Al-Ayyubi, Rami N., Evgeny V. Merkulov, Andrey S. Tereschenko, Dmitry V. Pevzner, Natalia S. Zhukova, Anatoly N. Samko, and Ruslan V. Guchaev. "THE ENDOVASCULAR PREVENTION OF THROMBOEMBOLISM IN ATRIAL FIBRILLATION." Atherothrombosis Journal, no. 2 (December 27, 2018): 104–14. http://dx.doi.org/10.21518/2307-1109-2018-2-104-114.
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The article dwells upon the various strategies for prevention of thromboembolic events in patients with atrial fibrillation. The main focus is put on the endovascular strategies for prevention of tromboembolism. In recent years, the endovascular strategies for the prevention of thromboembolic events in patients with atrial fibrillation, who have contraindications to oral anticoagulant therapy, are increasingly gaining popularity and find evidence of its safety for the prevention of thromboembolism. The patients with AF with a high risk of bleeding is the most interesting category for studying. The large studies confirm the effectiveness of non-drug prevention of thromboembolic events as compared to the anticoagulant therapy in these patients.
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Zavadovsky, Konstantin V., Nikolay G. Krivonogov, and Yury B. Lishmanov. "Use of Technetium-99m-Labelled Sodium Diphosphate Decahydrate to Assess Right Ventricle Dysfunction in Patients with Pulmonary Embolism." Advanced Materials Research 1084 (January 2015): 536–39. http://dx.doi.org/10.4028/www.scientific.net/amr.1084.536.
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The objective of this study was to identify the signs of the right ventricular dysfunction in patients with non-massive pulmonary artery thromboembolism (PE) using radionuclide gated blood pool SPECT (GBPS). The study included 55 patients: 40 with PE, and 15 - control group. Radionuclide studies included perfusion-ventilation scintigraphy and GBPS. GBPS results suggest that the signs of right ventricular dysfunction in PE are: the reduction in its stroke volume, as well as reduction in the peak filling and ejection rate. GBPS results allow distinguishing acute thromboembolism and chronic post-thromboembolic pulmonary hypertension.