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Lim, Sunghee, Ji Yoon Lee, Seok Jin Kim e Won Seog Kim. "The International Prognostic Index Is a Better Predictor of Thrombotic Complications Than the Khorana Score for Patients with Diffuse Large B-Cell Lymphoma Treated with R-CHOP: Results of a Single Center Prospective Cohort Study". Blood 120, n. 21 (16 novembre 2012): 5095. http://dx.doi.org/10.1182/blood.v120.21.5095.5095.
Abstract (sommario):
Abstract Abstract 5095 Background Thrombotic complication is a major life threatening condition in lymphoma patients because chemotherapy as well as lymphoma cell itself can result in thrombosis. Although high rates of thrombotic complication have been reported in patients with lymphoma, the majority of data were from retrospective studies with heterogeneous group of patients. Furthermore, the frequency of thrombotic complications varied depending o the nature of studies and subtypes of lymphoma included. Thus, it is still not determined about the risk factors for thrombotic complications in lymphoma patients. As a predictive model for cancer-associated thrombosis, Khorana risk score has been proposed including cancer type, body mass index (BMI), prechemotherapy white blood cell, hemoglobin, and platelet count. However, there is few data prospectively validating the role of this risk model in Asian lymphoma patients. Therefore, we explored risk factors influencing the occurrence of venous and arterial thrombotic complications in diffuse large B-cell lymphoma (DLBCL) patients who were uniformly treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). Methods We analyzed the incidence of venous and arterial thrombotic complications from DLBCL patients enrolled in our prospective cohort study (NCT00822731). Patients were pathologically confirmed and treated with R-CHOP. Thrombotic complications defined as venous thrombosis including pulmonary thromboembolism (PTE) and deep vein thrombosis (DVT), and arterial thrombosis including stroke and infarction occurred after diagnosis. The thrombotic complications were diagnosed with radiologic imaging studies including CT scan and ultrasound imaging. Results 352 patients were enrolled between 2008 and 2011, and they were prospectively monitored regarding the occurrence of thrombotic complications with the median follow-up duration of 22. 6 months. The median age was 56 years old (range 16–86) and male to female ratio was 1. 3:1. Thrombotic complications occurred in 48 patients (crude incidence: 13. 6%) including venous thrombosis (n = 37, 10. 5%) and arterial thrombosis (n = 11, 3. 1%). Venous thrombosis including DVT and PE occurred within 6 months after diagnosis (32/37, 86. 5%), so the actuarial incidence of venous thrombosis at one year was 10. 1%. However, arterial thrombosis mainly occurred around 12 months after diagnosis. Among 37 cases of venous thrombosis, anticoagulation therapy was used for 22 patients with symptomatic DVT or PE. Incidental cases of DVT or PE which were found during imaging follow-up for evaluation of tumor response did not require therapy. There were two deaths-related with venous thrombosis including refractory hypoxemia due to PE and bleeding due to anticoagulation while no death was found in arterial thrombosis. Age older 60 years and poor performance status (≥ ECOG grade 2) were significantly associated with thrombotic complications. However, other host factors including co-morbidity, body mass index (BMI), and gender were not related (P > 0. 05). Disease-related factors representing high tumor burden such as elevated serum LDH, two or more than two extranodal involvements, and Ann Arbor stage III/IV were significantly associated with increased risk of thrombotic complications (P < 0. 05). However, a particular extranodal site including stomach, pancreas, intestine, and mediastinum did not influence the thrombotic complications. Khorana score-based risk model failed to predict the occurrence of thrombotic complications in our study population. Furthermore, each parameter such as the level of hemoglobin, white blood cell and platlet count before chemotherapy, and BMI did not show a significant association with venous and arterial thrombotic complications. In fact, the number of patient more than 35 kg/m2 BMI was extremely small in our population. As a result, the International Prognostic Index was predictive for the occurrence of thrombotic complications in diffuse large B-cell lymphoma patients treated with R-CHOP. Conclusions The incidence of venous and arterial thrombotic complications in our study population was significantly associated with the IPI rather than Khorana score model. These results may help better defining lymphoma patients at high risk of thrombotic complications in Asian lymphoma patients. Disclosures: No relevant conflicts of interest to declare.
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Makatsaria, Alexander Davidovich, Svetlana Vladimirovna Akinshina, Viktoriya Omarovna Bitsadze e Margarita Darchievna Andreeva. "Severe obstetric complications as a manifestation of thrombotic microangiopathy". Journal of obstetrics and women's diseases 64, n. 5 (15 dicembre 2015): 6–15. http://dx.doi.org/10.17816/jowd6456-15.
Abstract (sommario):
Thrombotic microangiopathy is one of the most serious thrombotic complications characterized by microvascular thrombosis in various organs and accompanied by thrombocytopenia and hemolytic anemia. The term thrombotic microangiopathy has incorporated several nosology, which are characterized by different mechanisms of microvascular thrombosis. Currently thrombotic microangiopathy include thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), heparin-induced thrombocytopenia, HELLP-syndrome. Pregnancy presents one of the key triggers to the development of thrombotic microangiopathy. This fact gives us a significant opportunity to study the pathogenesis of thrombotic microangiopathy in the context of the physiological changes of hemostasis during pregnancy. At the same time the discovery of molecular mechanisms of thrombotic microangiopathy allows for a new research on the field of pathogenesis of thrombotic complications associated with pregnancy, as well as the pathogenesis of so-called placental obstetric complications, including severe preeclampsia, premature detachment of normally situated placenta, septic shock.
3
Ogurkova, O. N., M. A. Dragunova, T. E. Suslova, Yu G. Lugacheva e R. E. Batalov. "Evaluation of the CD40 receptor-ligand system in the patients with atrial fibrillation of non-valvular genesis". Medical Immunology (Russia) 24, n. 6 (8 dicembre 2022): 1255–64. http://dx.doi.org/10.15789/1563-0625-eot-2532.
Abstract (sommario):
Thromboembolic syndrome is the most dangerous complication of atrial fibrillation which develops in about 8-15% of cases, thus presuming the role of persisting left-heart thrombosis in presence of anticoagulant therapy in some patients. When activated, the blood platelets express multiple copies of CD40L on their membrane. Hence, the soluble form of CD40 ligand is considered a marker of platelet activation and pathogenic processes associated with increased activity of the thrombotic system. Our aim was to study the content of CD40, soluble CD40 ligand and thrombomodulin in the patients with atrial fibrillation of non-valvular genesis receiving anticoagulant therapy, discerning those with a history of thrombotic complications, and the cases with atrial fibrillation, however, free of thrombotic complications. The study group included 22 healthy volunteers and 60 patients diagnosed with atrial fibrillation who received anticoagulant therapy, of whom 21 patients have developed thrombotic complications in the course of adequate anticoagulant therapy. Quantitative assays of CD40, soluble CD40 ligand and soluble thrombomodulin were performed by enzyme immunoassay using Core Facility “Medical Genomics”, Tomsk National Research Medical Center. Concentration of soluble CD40 ligand in both groups of the patients with atrial fibrillation significantly exceeded appropriate values in the group of healthy volunteers. CD40L content was increased in the group of patients with thrombotic complications against the group of patients without thrombotic complications. Thrombomodulin content in blood serum was decreased in the patients with thrombotic complications, as compared to both thrombosis-free patients, and to practically healthy volunteers. The study of CD40/CD40L system and thrombomodulin showed that the patients with thrombotic complications exhibited higher serum level of soluble CD40L, with a simultaneous decrease of thrombomodulin, a physiological anticoagulant. A comparative analysis of the CD40/sCD40L system showed increased concentrations of the biomarkers in females, when compared to males.
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Haman, Luděk, Petr Pařízek, Radovan Malý, Jiří Duda e Jaroslav Malý. "Analysis of Thrombotic Complications After Catheter Ablation". Acta Medica (Hradec Kralove, Czech Republic) 49, n. 1 (2006): 47–50. http://dx.doi.org/10.14712/18059694.2017.109.
Abstract (sommario):
Introduction: Thromboembolic complications are described in about 1% of the patients undergoing radiofrequency catheter ablation (RFA). The aim of this study was to analyze thrombotic complications after RFA and to determine prothrombotic states in patients with thrombotic complications. Methods: We analyzed data from 400 patients (212 females) who underwent 453 RFA procedures for supraventricular tachycardias. Transthoracic echocardiography was performed one day before and after RFA in all patients. We evaluated the clinical and laboratory (in patients with thrombotic complications after RFA) risk factors of thromboembolism. Results: We observed thrombotic complication in 7 (1.75%) patients (6 females), thrice flail thrombus in the right atrium, flail thrombus in the inferior vena cava, femoral vein thrombosis with massive pulmonary embolism, femoral vein mural thrombus and upper extremity digital arteries embolization; four of them were asymptomatic. As a prothrombotic state we identified factor V Leiden mutation in one case and the use of oral contraceptives in two cases. Two other patients had a positive history of thromboembolic events. In a subgroup of females the use of oral contraceptives (p=0.13) or a positive history of thromboembolism (p=0.21) were not identified as important risk factors. Conclusion: Echocardiographic detection of asymptomatic thrombotic complications contributed to the higher percentage of these complications in our study. Although we can identify the risk factor (laboratory or clinical) in a majority of patients with a thromboembolic complication, occurrence of these complications is unpredictable.
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Jenner, William J., Rahim Kanji, Saeed Mirsadraee, Ying X. Gue, Susanna Price, Sanjay Prasad e Diana A. Gorog. "Thrombotic complications in 2928 patients with COVID-19 treated in intensive care: a systematic review". Journal of Thrombosis and Thrombolysis 51, n. 3 (14 febbraio 2021): 595–607. http://dx.doi.org/10.1007/s11239-021-02394-7.
Abstract (sommario):
AbstractA prothrombotic state is reported with severe COVID-19 infection, which can manifest in venous and arterial thrombotic events. Coagulopathy is reflective of more severe disease and anticoagulant thromboprophylaxis is recommended in hospitalized patients. However, the prevalence of thrombosis on the intensive care unit (ICU) remains unclear, including whether this is sufficiently addressed by conventional anticoagulant thromboprophylaxis. We aimed to identify the rate of thrombotic complications in ICU-treated patients with COVID-19, to inform recommendations for diagnosis and management. A systematic review was conducted to assess the incidence of thrombotic complications in ICU-treated patients with COVID-19. Observational studies and registries reporting thrombotic complications in ICU-treated patients were included. Information extracted included patient demographics, use of thromboprophylaxis or anticoagulation, method of identifying thrombotic complications, and reported patient outcomes. In 28 studies including 2928 patients, thrombotic complications occurred in 34% of ICU-managed patients, with deep venous thrombosis reported in 16.1% and pulmonary embolism in 12.6% of patients, despite anticoagulant thromboprophylaxis, and were associated with high mortality. Studies adopting systematic screening for venous thrombosis with Duplex ultrasound reported a significantly higher incidence of venous thrombosis compared to those relying on clinical suspicion (56.3% vs. 11.0%, p < 0.001). Despite thromboprophylaxis, there is a very high incidence of thrombotic complications in patients with COVID-19 on the ICU. Systematic screening identifies many thrombotic complications that would be missed by relying on clinical suspicion and should be employed, with consideration given to increased dose anticoagulant thromboprophylaxis, whilst awaiting results of prospective trials of anticoagulation in this cohort.
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Sousa Nanji, Liliana, André Torres Cardoso, João Costa e António Vaz-Carneiro. "Analysis of the Cochrane Review: Thrombolysis for Acute Deep Vein Thrombosis. Cochrane Database Syst Rev. 2014,1: CD002783." Acta Médica Portuguesa 28, n. 1 (27 febbraio 2015): 12. http://dx.doi.org/10.20344/amp.6286.
Abstract (sommario):
<p>The standard treatment for acute deep vein thrombosis (DVT) targets to reduce immediate complications, however thrombolysis could reduce the long-term complications of post-thrombotic syndrome in the affected limb. This systematic review aimed to assess the effects of thrombolytic therapy and anticoagulation <em>versus </em>anticoagulation in people with deep vein thrombosis of the lower limb through the effects on pulmonary embolism, recurrent deep vein thrombosis, major bleeding, post-thrombotic complications, venous patency and venous function. The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last search in April 2013) and CENTRAL (2013, Issue 4). A total of 17 randomised controlled trials (RCTs) and 1103 participants were included. In the experimental group receiving thrombolysis, complete clot lysis occurred more frequently and there was greater improvement in venous patency. The incidence of post-thrombotic syndrome decreased by a 1/3 and venous ulcers were less frequent. There were more bleeding complications and 3 strokes occurred in less recent studies, yet there seemed to be no significant effect on mortality. Data on the occurrence of pulmonary embolism and recurrent deep vein thrombosis were inconclusive. There are advantages to thrombolysis, yet the application of rigorous criteria is warranted to reduce bleeding complications. Catheter-directed thrombolysis is the current preferred method, as opposed to systemic thrombolysis in the past, and other studies comparing these procedures show that results are similar.</p><p><strong>Keywords:</strong> Randomized Controlled Trials as Topic; Thrombolytic Therapy; Venous Thrombosis.</p>
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Capecchi, Marco, Alessandro Ciavarella, Andrea Artoni, Maria Abbattista e Ida Martinelli. "Thrombotic Complications in Patients with Immune-Mediated Hemolysis". Journal of Clinical Medicine 10, n. 8 (18 aprile 2021): 1764. http://dx.doi.org/10.3390/jcm10081764.
Abstract (sommario):
Autoimmune hemolytic anemias are rare and heterogeneous disorders characterized by hemolysis, which is a well-recognized risk factor for thrombosis. The most common immune-mediated anemias are represented by autoimmune hemolytic anemia and paroxysmal nocturnal hemoglobinuria, both associated with a high rate of thrombosis. Multiple pathophysiological mechanisms for thrombosis have been proposed, involving hemolysis itself and additional effects of the immune system. Despite the increasing awareness of the thrombotic risk in these conditions, evidence-based guidance on prevention and management of thrombotic events is lacking. We herein report available evidence on epidemiological data on thrombosis and thrombophilia in immune-mediated hemolysis, together with possible underlying pathophysiological mechanisms. In addition, we summarize current recommendations for treatment of thrombosis in immune-mediated hemolysis. In particular, we address the issue of thrombotic complications treatment and prophylaxis by proposing a therapeutic algorithm, focusing on specific situations such as splenectomy and pregnancy.
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McFadyen, James D., Hannah Stevens e Karlheinz Peter. "The Emerging Threat of (Micro)Thrombosis in COVID-19 and Its Therapeutic Implications". Circulation Research 127, n. 4 (31 luglio 2020): 571–87. http://dx.doi.org/10.1161/circresaha.120.317447.
Abstract (sommario):
The recent emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the ensuing global pandemic has presented a health emergency of unprecedented magnitude. Recent clinical data has highlighted that coronavirus disease 2019 (COVID-19) is associated with a significant risk of thrombotic complications ranging from microvascular thrombosis, venous thromboembolic disease, and stroke. Importantly, thrombotic complications are markers of severe COVID-19 and are associated with multiorgan failure and increased mortality. The evidence to date supports the concept that the thrombotic manifestations of severe COVID-19 are due to the ability of SARS-CoV-2 to invade endothelial cells via ACE-2 (angiotensin-converting enzyme 2), which is expressed on the endothelial cell surface. However, in patients with COVID-19 the subsequent endothelial inflammation, complement activation, thrombin generation, platelet, and leukocyte recruitment, and the initiation of innate and adaptive immune responses culminate in immunothrombosis, ultimately causing (micro)thrombotic complications, such as deep vein thrombosis, pulmonary embolism, and stroke. Accordingly, the activation of coagulation (eg, as measured with plasma D-dimer) and thrombocytopenia have emerged as prognostic markers in COVID-19. Given thrombotic complications are central determinants of the high mortality rate in COVID-19, strategies to prevent thrombosis are of critical importance. Several antithrombotic drugs have been proposed as potential therapies to prevent COVID-19-associated thrombosis, including heparin, FXII inhibitors, fibrinolytic drugs, nafamostat, and dipyridamole, many of which also possess pleiotropic anti-inflammatory or antiviral effects. The growing awareness and mechanistic understanding of the prothrombotic state of COVID-19 patients are driving efforts to more stringent diagnostic screening for thrombotic complications and to the early institution of antithrombotic drugs, for both the prevention and therapy of thrombotic complications. The shifting paradigm of diagnostic and treatment strategies holds significant promise to reduce the burden of thrombotic complications and ultimately improve the prognosis for patients with COVID-19.
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Routledge, David JM, Joanna Tomlins, Adrian Bloor, Kaz Mamat, Michael Dennis, Jim Cavet, Tim Somervaille, Sven Armin Sommerfeld e Samar Kulkarni. "Incidence of Thrombotic Complications with Use of Peg-Asparginase in Treatment for Acute Lymphoblastic Leukemia (ALL) in Adults and Young Adolescent Patients". Blood 126, n. 23 (3 dicembre 2015): 4864. http://dx.doi.org/10.1182/blood.v126.23.4864.4864.
Abstract (sommario):
Abstract Introduction: Peg-Asparginase is routinely used in the chemotherapy regimens used for treatment of ALL. Incidence of thrombotic complications is well established in children but there is limited data in adult and young adolescent patients. This is retrospective analysis to assess the risk of thrombotic complications with use of Peg-Asparginase. Methods and Results: 100 patients with Acute Lymphoblastic Leukaemia treated between 2007-2015 who received Peg-Asparginase containing chemotherapy regimen were evaluated for development of thrombotic complications and pancreatitis. There were 69 male patients and 31 female patients. Median age was 29 yr. (range: 16-68 yr). Route of administration for Peg-Asparginase was intravenous in 51 cases and intramuscular in 49 cases. Peg-Aspraginase was administered during induction phase and consolidation cycles according to the relevant chemotherapy protocols. The adverse events included deep vein thrombosis (DVT) in 15 (15%), cerebral venous thrombosis in 7 (7%), Pancreatitis in 2 (2%), DVT and pancreatitis in 1 (1%) and 1 patient had clinically suspected DVT (1%). Complication rate was similar with IV or IM route of administration. 10 patients in IM group (20.4%) and 17 patients in IV group (33.3%) had at least one complication with Peg-Asparginase (P=0.31). Risk of individual complications was similar in both groups (DVT: 14.3% vs. 21.6%, p=0.34; Pancreatitis 2% vs. 3.9%, p=0.57; Cerebral venous thrombosis 4%% vs. 9.8%, p=0.25). There was no difference in the incidence of thrombotic complications with gender, age at diagnosis and use of central venous lines. Conclusions: There is a significant risk of thrombotic events including PE (18% risk of thrombotic events excluding CNS). Risk of CNS events is 7% in this population. Risk appears to be higher with IV administration but this is not statistically significant due to small sample size. Incidence of CNS events is similar to that reported in adolescents participating in UKALL2003 study. The analysis will be extended to evaluate other toxicities especially hepatic toxicity and identify if there are any high risk patients for CNS or thrombotic events including blood counts, clotting, and cytogenetics. Use of LMWH prophylaxis seems reasonable in view of high incidence of thrombotic events even if CNS events are excluded. Disclosures Cavet: Celgene: Consultancy, Research Funding, Speakers Bureau; Janssen: Consultancy, Research Funding, Speakers Bureau. Somervaille:Novartis Pharmaceuticals Corporation: Consultancy, Membership on an entity's Board of Directors or advisory committees.
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Borota, A. V., A. A. Borota e E. V. Onishchenko. "Thrombotic Complications in Inflammatory Bowel Disease". Russian Journal of Gastroenterology, Hepatology, Coloproctology 29, n. 2 (16 maggio 2019): 23–26. http://dx.doi.org/10.22416/1382-4376-2019-29-2-23-26.
Abstract (sommario):
The risk of thrombotic complications is known to be 3 times higher in patients with inflammatory bowel disease (IBD) than in healthy individuals, with the relative risk being 15 times higher during the periods of relapses. Aim. To study and generalize literature data available on the prevention and treatment of IBD thrombotic complications.Key findings. In the сonditions under study, the presence of chronic inflammation and increased bleeding of the intestinal wall is shown to activate the coagulation system, impair the fibrinolysis system and reduce the activity of natural anticoagulation mechanisms. The concentration of fibrinogen — a protein of the acute inflammation phase — increases significantly. This results in an imbalance of the blood coagulation system with a tendency to hypercoagulation, which significantly increases the risk of thrombotic complications and the disseminated intravascular coagulation syndrome. In turn, the activation of the coagulation cascade may trigger the inflammatory response, which eventually leads to the formation of a vicious circle between chronic inflammation and thrombosis. The pathogenesis of thrombosis in inflammatory colon diseases is a multifactor process, which remains to be understood.Conclusion.The management of patients with IBD in combination with thromboembolic complications requires an individual multidisciplinary approach. Taking into account the pathogenetic factors, the following options are possible in the prevention and treatment of thrombotic complications in IBD: strengthening the basic therapy of the primary disease; administration of prophylactic doses of anticoagulants under dynamic continuous laboratory control in the acute period using the methods of conservative therapy of thrombotic complications (elastic compression of the lower extremities) in the period of exacerbation of the primary disease.
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Lim, Cheryl XQ, Chuen Wen Tan, Bingwen Eugene Fan, Winnie Teo, Moon Ley Tung, Humaira Shafi, Dheepa Christopher et al. "Thrombotic Complications in COVID-19 Patients: Low Incidence of Thrombotic Complications Among Critically Ill COVID-19 Patients in Singapore". Blood 136, Supplement 1 (5 novembre 2020): 37–38. http://dx.doi.org/10.1182/blood-2020-138610.
Abstract (sommario):
Objective Arterial and venous thrombosis are reported to be common in critically ill COVID-19 patients. This study aims to describe the thrombotic and bleeding rates in COVID-19 patients admitted to intensive care units (ICU) in Singapore. Design Retrospective observational study involving all consecutive adult COVID-19 patients who required ICU admission between 23 January 2020 and 30 April 2020. Setting National multicenter study involving all eight public hospitals in Singapore. Patients 111 consecutive COVID-19 patients who required ICU admission were included. Measurements and Main Results Primary outcome was any venous or arterial thrombotic events occurred in ICU. Other measures included (1) the overall, venous and arterial thrombotic events throughout the hospitalisation, (2) major and minor bleeding events. The overall thrombotic rate in ICU was 11.7% (n=13), with 1.8% (n=2) venous and 9.9% (n=11) arterial events. The overall thrombotic rates throughout hospitalisation, censored at 30 April 2020, increased to 18.0% (n=20) with 6.3% (n=7) venous and 11.7% (n=13) arterial events. Major and minor bleeding rates were 14.8% (n=16) and 3.7% (n=4), respectively. Two-third of the patients received pharmacological thromboprophylaxis in ICU. Conclusions Critically ill COVID-19 patients in Singapore have lower VTE but higher arterial thrombosis rates with higher bleeding manifestations than other reported cohorts. Standard thromboprophylaxis may be sufficient to prevent thrombotic complications in patients with similar demographics. Disclosures No relevant conflicts of interest to declare.
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De Wet, Charl J., e Ronald G. Pearl. "POSTOPERATIVE THROMBOTIC COMPLICATIONS". Anesthesiology Clinics of North America 17, n. 4 (dicembre 1999): 895–922. http://dx.doi.org/10.1016/s0889-8537(05)70139-5.
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Broucek, Joseph R., Amanda B. Francescatti, Garth R. Swanson, Ali Keshavarzian, Marc I. Brand e Theodore J. Saclarides. "Unusual Thrombotic Complications". American Surgeon 78, n. 6 (giugno 2012): 728–29. http://dx.doi.org/10.1177/000313481207800631.
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Peres, E. M., M. Abidi, R. Ibrahim e S. Mellon-Reppen. "213: Thrombotic complications". Biology of Blood and Marrow Transplantation 13, n. 2 (febbraio 2007): 78. http://dx.doi.org/10.1016/j.bbmt.2006.12.217.
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Borst, Alexandra J., Debra L. Sudan, Laura A. Wang, Michael J. Neuss, Tracy G. Spears e Thomas L. Ortel. "Bleeding and Thrombotic Complications of Pediatric Liver Transplant". Blood 128, n. 22 (2 dicembre 2016): 1005. http://dx.doi.org/10.1182/blood.v128.22.1005.1005.
Abstract (sommario):
Abstract Background: Due to underlying liver disease and the transplant process itself, pediatric abdominal transplant patients are at significant risk for bleeding and thrombotic complications. Hemostasis in these patients is nuanced, reflecting a balance of pro- and anti-coagulant factors not accurately captured by routine coagulation lab testing. Previous studies of pediatric liver transplant estimate thrombotic complications in up to 19% of patients and bleeding in 5-9%. These hematologic complications increase risk for graft failure, re-transplantation, or death. Methods: We retrospectively reviewed electronic medical records of consecutive pediatric liver andmultivisceraltransplants at Duke University Medical Center between January 2010 and December 2015 (one exclusion due to inability to access chart). We extracted data from 30 days pre-transplant to 90 days post-transplant. Thrombotic events were defined as any documented thrombus by imaging or direct observation during a surgical procedure. Major bleeding events included surgical bleeding requiring re-operation, CNS bleed, bleeding into an enclosed anatomic space, or blood loss resulting in > 3g/dl drop in hemoglobin. Data was entered into aRedCapDatabase and analyzed usingunivariablelogistic regression. Results: There were 84 transplants at Duke from 2010-2015 (Table 1). There were 103 major bleeding events in 65 patients (incidence 77.4%) and 27 thrombotic events in 21 patients (incidence 25%). Excluding events that were only a > 3g/dl drop in hemoglobin, there were 21 bleeding events in 17 patients (incidence 20.2%). Patients on prophylactic aspirin were less likely to have a thrombosis and were not more likely to have bleeding (Table 2). Patients who received prophylactic heparin (initiated prior to any event) did not have a decreased risk of thrombosis nor increased bleeding (Table 2). There was a higher rate of thrombosis and bleeding in patients who had prior GI surgery (Table 2). Use of an arterial conduit was associated with increased bleeding but not thrombosis (Table 2). Patients with a post-op fibrinogen nadir < 75mg/dl had increased bleeding whereas fibrinogen > 75mg/dl was associated with increased thrombosis (Table 2). Patient age, weight, donor to recipient weight ratio, and transplant type were not associated with bleeding or thrombosis. Maximum INR (pre, intra or post-operatively) or minimum antithrombin(<70%, measured in 43% of patients) werealso not associated with bleeding or thrombosis. Fifty-four patients (64%) required repeat operation within 90 days post-transplant, 9 for bleeding and 10 for thrombotic complications. Nine patients required re-transplant for thrombotic complications. No bleeding events necessitated re-transplantation. Seven patients were deceased at time of review. Two deaths were attributed to transplant, one from graft failure due to vascular thrombosis (portal vein and hepatic artery) that occurred 2 days after transplant. In response to an increase in thrombotic events around 2013, clinical practices changed to utilize increased heparin prophylaxis and antithrombinsupplementation. There has been an increase in total number of bleeding events since those practice changes were implemented (Figure 1), however the event rate per number of transplants remains similar. Discussion: We found that bleeding events were more frequent than reported in previous cohorts, but notably less severe than thrombotic complications. In our cohort, many thrombotic complications were severe and potentiallylife-threatening. Practice changes aimed to decrease thrombosis may have led to an increase in recent bleeding events, but these events generally did not result in significant morbidity. Bleeding often required intervention, but did not contribute to re-transplantation or mortality during this period. Laboratory parameters predicted adverse events poorly, apparently failing to capture the nuanced and dynamic interplay between pro- and anti-coagulant factors in the post-transplant patient. A standard approach to coagulation testing combined with a protocol for use of anti-thrombotic therapies may be useful for prospective study. Regular review of outcomes can demonstrate changes that may impact future practice. Further study aimed at delineating parameters associated with adverse outcomes-possibly other than standard coagulation assays-is warranted. Disclosures No relevant conflicts of interest to declare.
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Franchini, Massimo. "Thrombotic complications in patients with hereditary bleeding disorders". Thrombosis and Haemostasis 92, n. 08 (2004): 298–304. http://dx.doi.org/10.1160/th04-03-0148.
Abstract (sommario):
SummaryThromboses in patients with hereditary bleeding disorders are uncommon. However, in some cases, the co-existence of prothrombotic risk factors may increase the likelihood of developing thrombotic complications in such patients. This review summarizes the cases of thrombosis reported in the literature and analyzes the most important risk factors for thrombosis in patients with a congenital bleeding tendency. In particular we focus on central venous catheter (CVC)-associated thrombosis, on the thrombotic complications of coagulation factor concentrate therapy and on the presence of prothrom-botic gene mutations. Data were identified by searches of the published literature, including PubMed, references from reviews and abstracts from the most important meetings on this topic. In conclusion, there is increasing evidence that thrombotic complications in patients with hereditary bleeding disorders have a multifactorial pathogenesis, depending on exogenous (coagulation factor replacement therapy, CVC, HIV infection) and/or endogenous (prothrombotic gene mutations) risk factors.
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Chebotareva, N. V., A. S. Berns, M. V. Lebedeva e S. V. Moiseev. "Clinical impact of plasma haemostasis disorders and their correction in chronic glomerulonephritis with nephrotic syndrome". Russian journal of hematology and transfusiology 65, n. 4 (10 dicembre 2020): 473–82. http://dx.doi.org/10.35754/0234-5730-2020-65-4-473-482.
Abstract (sommario):
Introduction. Thrombosis and thromboembolism are frequent complications in chronic glomerulonephritis (CGN) with nephrotic syndrome (NS), despite the use of anticoagulant therapy. Therefore, the questions of thrombosis risk assessment and thrombotic complication prevention in NS are still relevant.Aim. Description of the frequency and localisation of thromboembolic complications in CGN-NS patients and a review of approaches to their risk assessment and prevention.Main findings. The main risk predictors of venous thrombosis in NS are considered, including low serum albumin, high plasma D-dimer, age over 60 and hypovolemic conditions. The risk of arterial thrombosis is determined by general population factors: age, gender, smoking, diabetes mellitus and arterial hypertension. Venous thrombosis may be asymptomatic and mainly occurs in deep lower limb veins, renal veins and branches of pulmonary artery. Among the NS-associated CGN morphotypes of high risk are membranous nephropathy and membranoproliferative CGN. Issues in the thrombotic complication risk assessment, prevention and treatment are highlighted.
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Cavezzi, A., e K. Parsi. "Complications of Foam Sclerotherapy". Phlebology: The Journal of Venous Disease 27, n. 1_suppl (marzo 2012): 46–51. http://dx.doi.org/10.1258/phleb.2012.012s09.
Abstract (sommario):
Foam sclerotherapy may result in drug and/or gas-related complications of a generalized or localized nature. Significant complications include anaphylactic/anaphylactoid reactions (very rare), deep vein thrombosis (1–3%), stroke (0.01%), superficial venous thrombosis (4.4%), tissue necrosis (variable frequency), oedema (0.5%) and nerve damage (0.2%). Cosmetic complications include telangiectatic matting (15–24%) and pigmentation (10–30%). Patent foramen ovale and other cardiopulmonary right-to-left shunts seem to play a role in the systemic gas-related complications. In conclusion, foam sclerotherapy is characterized by an overall high degree of safety, though special attention should be given to the embolic and thrombotic complications. Good technique, adequate imaging, general precautions and compliance with post-treatment instructions may help avoid some of the adverse events and an appropriate early intervention may minimize possible sequelae. Higher volumes of sclerosant foam have been attributed to local and distant thrombotic complications and should be avoided.
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Ghinea, Mihaela Maria, Zizi Niculescu, C. Niculescu e M. Grigorian. "Essential thrombocythemia – Incidence of thrombotic complications". ARS Medica Tomitana 22, n. 2 (1 maggio 2016): 108–12. http://dx.doi.org/10.1515/arsm-2016-0019.
Abstract (sommario):
Abstract Essential thrombocytemia is a classic negative chronic myeloproliferative disease BCR-ABL characterized by global myeloid proliferation but mainly on the megacariocitary series. Most symptomatic patients show manifestations due to the vascular thromboses or haemorrhages. The objective of the paper is to evaluate the incidence of thrombotic complications. The study was carried out in the Haematology Compartment of Constanta County Clinical Hospital on a lot of 60 cases with essential thrombocytemia. The diagnosis criteria were OMS 2008 criteria. On the studied lot, on the diagnosis, 45 patients (75%) were symptomatic. Among the symptomatic ones 27 patients (60%) showed thromboembolic manifestations in the moment of the diagnosis or after diagnosis. The thrombotic manifestations present at the patients with essential thrombocytemia taken for the study were: cerebral micro thromboses - 10 cases; peripheral micro thromboses - 3 cases; erythromelalgia - 6 cases; acrocyanosis - 2 cases; coronary thrombosis - 1 case; portal vein thrombosis - 2 cases; pulmonary thromboembolism - 1 case; thrombosis of placenta vessels- 2 cases. The thrombocytosis degree is not the only important risk factor for thrombosis. The age over 60 years, arterial hypertension, dyslipidemia, smoking, atherosclerosis, are associated risk factors (independent from thrombocytosis) for the frequency and severity of the thromboses. In this framework, on the one hand the increase of accessibility to the background therapy proven efficient (interferon, anagrelide) and on the other hand the mentioning in the cardiovascular pathology guides of primary and secondary thromboses as risk factors along with hypertension, diabetes, dyslipidemias, etc is required.
20
Mancini, Mariangela, Gianmarco Randazzo, Gregory Piazza e Fabrizio Dal Moro. "Arterial Thrombotic Complications in COVID-19: A Case of Renal Infarction". Biomedicines 10, n. 10 (21 settembre 2022): 2354. http://dx.doi.org/10.3390/biomedicines10102354.
Abstract (sommario):
COVID-19 infection has been associated with thrombotic complications, especially venous thromboembolism. Although arterial thrombotic complications are rarely seen in these patients, we report the case of a 43-year-old patient who developed thrombosis of the main branch of the left renal artery, causing partial infarction of the left kidney associated with severe pain. He had no risk factors for thrombosis except for COVID-19 infection. We excluded any possible condition usually associated with renal artery thrombosis/embolism (i.e., cardiovascular, oncological, hematological, or rheumatic). The thrombosis resolved after a combination of anticoagulant and anti-platelet therapy. This case highlights the importance of the risk of recurrence of thrombosis in patients with a recent history of COVID-19, even after hospital discharge, improvement of the initial thrombotic event, and clearance of SARS-CoV-2 infection.
21
Kumar, Vinay, Chhavi Rai, Swati Srivastava, Bhuvensh Kumar e Iti Garg. "High altitude Provoked Thrombotic Complications". Defence Life Science Journal 5, n. 3 (22 luglio 2020): 224–29. http://dx.doi.org/10.14429/dlsj.5.15490.
Abstract (sommario):
On rapid ascending to high-altitude particularly very high-altitude or extreme high-altitude, there is a risk of developing high-altitude illness and most people may experience acute mountain sickness which may further lead to potentially life-threatening pathologies like high-altitude pulmonary edema, high-altitude cerebral edema, high-altitude-induced thrombosis etc. if not treated on time. Hypercoagulability state associated with high-altitude which lead to the formation of a clot in the blood vessels, a condition called deep vein thrombosis, which may further complicate and lead to pulmonary embolism. Lack of epidemiological data poses a constraint in evaluating the actual incident rate of thromboembolic disorders at high-altitude. In the present scenario, the most commonly used diagnostic marker for thrombosis is the D-dimer test which has low specificity. Various anticoagulants are also available for anticoagulation therapy but they have their own limitation. Under this review, worldwide reported incidents and management strategies related to thrombotic complications are consolidated and presented. It also summarizes diagnostic and anticoagulation therapy regimes against thrombosis existing at present. Accurate diagnosis and therapeutics are a thrust area of further exploration and there is an urgent need to develop quick and advanced methods to reduce the mortality associated with this disorder especially with respect to high-altitude.
22
Han, Yue, Wu Depei, Luping Hu, Yongya Ren, Aining Sun, Huiying Qiu, Xiaohui Hu et al. "Risk Factors and Clinical Outcome of Thrombotic and Bleeding Complications in 527 Patients Following Hematopoietic Stem-Cell Transplantation (HSCT)". Blood 118, n. 21 (18 novembre 2011): 3076. http://dx.doi.org/10.1182/blood.v118.21.3076.3076.
Abstract (sommario):
Abstract Abstract 3076 Background: Hemostatic disorders are common and potentially fatal complications in patients undergoing hematopoietic stem-cell transplantation (HSCT). Limited data exist on early diagnosis and prevention of these complications. In this study, we retrospectively investigated the outcome and risk factors associated with thrombotic and bleeding complications in HSCT recipients. Methods: From April 2004 to December 2010, 527 hematologic patients receiving HSCT (126 Auto-HSCT and 401 Allo-HSCT) were enrolled in the study, and their clinical manifestation and laboratory parameters were analyzed for evaluating the outcome of hemostatic complications and related risk factors. All analyses were carried out using the SAS program (version 8.1). Results: Overall incidence of thrombotic complication, which included 9 veno-occlusive diseases (VOD), 1 transplantation related thrombotic microangiopathy (TA-TMA), 1 pulmonary embolism (PE) and 1 deep vein thrombosis (DVT), was 2.3% (12 cases), and occurred in 11 patients who received allogeneic HSCT, and 1 patient who received autologous HSCT. The overall mortality after thrombotic events was 75% (9 cases) in all HSCT recipients with thrombotic complications. A total of 382 HSCT recipients (72.5%) developed bleeding events, including minor bleeding of 67.1% (210 cases), moderate bleeding of 28.4% (89 cases), and severe bleeding of 4.5% (14 cases) of all bleeding patients. By bleeding sites, 183 patients developed hemorrhagic cystitis (34.7% of all HSCT recipients). Other organs of hemorrhage involved skin or mucosa (46.5% of all HSCT recipients), gastrointestinal tract (21.1%), vagina (9.3%), and respiratory tract (1.3%). By risk factors analysis, CD33 mAb use and preparative regimen containing total body irradiation were significantly associated with the occurrence of thrombotic disorders (P<0.05). Thrombocytopenia, grade 2–4 acute graft-versus-host disease (aGVHD), allogeneic transplantation and infection were independent risk factors for bleeding complication (P<0.05). Polyomavirus and grade 2–4 aGVHD were risk factors for hemorrhagic cystitis (P<0.05). The number of hemorrhagic sites was significantly correlated with bleeding severity (P<0.05). Neither thrombotic nor bleeding disorders was correlated with age, disease category, gender, transplantation types, routine hemostatic parameters, or biochemical indicators (P>0.05). Survival rate was correlated with the bleeding site and intensity of bleeding disorders (P<0.01). Respiratory and gastrointestinal bleeding independently increased the mortality of HSCT recipients, while overal cumulative survival was decreased in patients with thrombotic complications. In addition, PAI-1 level in the HSCT recipients with thrombotic complications were significantly higher than other complications, including GVHD, infections, and preparative regimen-related toxicity (P<0.01). Conclusions: Our study suggested that HSCT patients with thrombotic complications experienced high mortality while the HSCT recipients with bleeding disorders had high morbidity. Hence, early diagnosis and therapy of hemostatic complications are crucial to improve the prognosis of HSCT recipients. Disclosures: No relevant conflicts of interest to declare.
23
White, Michael H., Kavita Patel, Lazaros Kochilas e Robert F. Sidonio. "2205 Thrombotic complications in single ventricle reconstructions for single ventricle physiology congenital heart disease". Journal of Clinical and Translational Science 2, S1 (giugno 2018): 88–89. http://dx.doi.org/10.1017/cts.2018.307.
Abstract (sommario):
OBJECTIVES/SPECIFIC AIMS: Infants with single ventricle congenital heart disease (CHD) who undergo staged surgical reconstruction are among the pediatric patients at highest risk for thrombotic complications. Despite improvements in survival due to medical and surgical advancements, thrombotic complications are common and lead to increased morbidity and mortality, especially during the first two stages of surgical reconstruction. The burden of disease caused by thrombosis is not fully known, and the risk factors associated with thrombosis are not clear. Due to this knowledge gap, prevention of thrombosis with medication, a strategy called thromboprophylaxis, has not been standardized, leading to inadequate prevention of thrombosis. In order to understand the burden of thrombosis and then provide targeted thromboprophylaxis for thrombosis prevention, better characterization of thrombotic complications and the associated factors is needed. Hypothesis: I hypothesize that in infants with single ventricle CHD, the incidence of thrombosis will be more frequent after stage I Versus stage II reconstruction, despite the type of shunt used. Specific demographic, clinical, and surgical variables will be associated with an increased risk for thrombotic complications, and a model to predict which subset of infants is at increased risk will be developed. Specific Aim 1: Characterize the incidence of thrombotic complications at different time points from stage I through stage II of the single ventricle reconstruction (SVR) pathway and determine the demographic, clinical, and surgical factors associated with thrombosis in infants with single ventricle CHD. (1) Determine the incidence of thrombosis in infants with single ventricle CHD. (2) Compare the rate of thrombotic complications between the 2 most commonly used approaches for stage I reconstruction for the group of patients with hypoplastic left heart type of anatomy [modified Blalock-Taussig shunt (MBTS) vs. right ventricle to pulmonary artery shunt (RVPAS)]. (3) Determine the factors (demographic, clinical, and surgical) associated with thrombosis in infants with single ventricle CHD. Specific Aim 2: Determine which subset of infants with single ventricle CHD is at increased risk of developing thrombotic complications across the first 2 stages of surgical reconstruction. (1) Test the identified demographic, clinical, and surgical variables including, but not limited to, gestational age, sex, CHD diagnosis, baseline oxygen saturation, stage of reconstruction, shunt type, and other clinical data available in a univariable and multivariable analysis and study their potential interactions to construct a novel risk predictive model specific for single ventricle CHD. METHODS/STUDY POPULATION: To address the specific aims, I will utilize data from the SVR clinical trial public use data set. This data set includes a prospective cohort of infants, 0–14 months of age, enrolled from any of the 15 participating clinical centers from the years 2005 to 2009. Inclusion criteria for enrollment were diagnosis of hypoplastic left heart syndrome or related single, morphologic right systemic ventricle anomaly, planned Norwood procedure, and informed consent of parent or legal guardian. No additional subjects outside of this data set will be included. Exclusion criteria were a diagnosis of single, morphologic left ventricle anomaly, preoperative identification of anatomy rendering the MBTS or RVPAS technically impossible, and any other major abnormality or acquired extra-cardiac disorder that could independently affect the likelihood of the subject meeting the primary endpoint. The complication of stroke will be excluded from the analyses of factors associated with thrombosis. The complication of thrombosis as defined in this dataset is a composite of events that include arterial or venous thrombosis, thromboembolism, and pulmonary embolism. The data was collected in such a way that it will not be possible to separate these sub-types of thrombosis. Additional thrombotic events of interest are superior vena cava occlusion and inferior vena cava occlusion. Specific Aim 1: Patient data will be extracted from the SVR clinical trial public use dataset to characterize the incidence of thrombotic complications at different time points from stage I through stage II of the SVR pathway and determine the demographic, clinical, and surgical factors associated with thrombosis in infants with single ventricle CHD. In addition, I will compare the rates of thrombotic complications between the 2 most commonly used approaches for stage I palliation for the group of patients with hypoplastic left heart type of anatomy (MBTS vs. RVPAS) and will test the hypothesis that the risk of thrombotic complications is associated with the stage of palliative surgery (stage I vs. stage II). Specific Aim 2: We will test identified demographic, clinical, surgical, and newly identified variables in a univariable and multivariable analysis and study their potential interactions to construct a novel risk predictive model specific for single ventricle CHD. RESULTS/ANTICIPATED RESULTS: To determine feasibility for adequate numbers to be able to address the research aims, a preliminary analysis dataset was performed using a dataset from the Pediatric Heart Network. The PHN is a collaborative group of hospitals that participates in clinical research studies in children with CHD. For the SVR clinical trial, the PHN conducted a randomized clinical trial at 15 centers in North America between 2005 and 2009, prospectively enrolling infants with HLHS or single right ventricle anomalies who were to undergo the Stage I Norwood procedure. A total of 920 newborns were screened; 664 were medically eligible and 549 patients were randomized. The primary aim of the trial was to compare survival of infants randomized to receive either the Norwood procedure with the MBTS or the RVPAS. These patients were followed at specific time points, including from baseline (pre-Norwood), at the time of the Norwood procedure, between stage I and II, following stage II reconstruction, and at 14 months of age. At these time points, data were collected that includes demographic, radiologic, clinical, and surgical outcomes. Included in the clinical outcomes are complications, such a thrombosis. There was no screening process to assess for asymptomatic thromboses, suggesting that most, if not all, discovered thromboses were due to clinically relevant effects. A newer iteration of this study (SVRIII) expands the monitoring of this cohort until the Fontan stage at 2–6 years of age, but these data have not yet been released in the public use data set. A descriptive analysis of the frequency of thrombotic complications was assessed at each time point, as well as in aggregate. Data were extracted from the specific time periods of interest, identified as Pre-Norwood, during Norwood Hospitalization, in-between visits, and during Stage II Hospitalization. There were 549 infants who were randomized with available data to analyze. During the Norwood hospitalization, 37 infants had a thrombotic complication. Between Stage I and Stage II outpatient visits, 8 infants had a thrombotic complication. During Stage II hospitalization, 16 infants had a thrombus. Overall, 61 individual patients (11%) had a thrombotic complication. DISCUSSION/SIGNIFICANCE OF IMPACT: This study utilizing data from the Pediatric Heart will be the largest cohort ever utilized for characterizing thrombotic complications and determining the factors associated with thrombosis across the first and second stages of surgical reconstruction. More than 500 (n=549) subject’s data will be analyzed through the first two stages of reconstruction, while the largest analysis before this proposed analysis only included a total of 195 children. Notably, these prior studies did not include a comparison between the 2 shunt types in stage I reconstruction, leaving a gap in knowledge regarding the incidence of thrombosis comparing these groups. The analysis will be the first to address this gap and update the current literature. Preliminary data show that the overall incidence of thrombosis across the first 2 stages of surgical reconstruction was 11%, which is lower than the previously reported overall rates of 40%–50%. Despite the continued lack of evidence-based guidelines for thromboprophylaxis methods, the decreased overall rate is most likely due to more widespread practice of anticoagulation in general. Determining the factors associated with thrombosis across the first and second stages of surgical reconstruction will help identify those at risk. An innovative aspect of this analysis will be the use of disease-specific factors to develop a model to predict thrombosis. Unique factors include cardiac variables like ejection fraction, baseline oxygen saturation, shunt type (MBTS vs. RVPAS), and other echocardiographic parameters. While the use of thromboprophylaxis has been associated with decreased risk of thrombosis, there is no general consensus to guide thromboprophylaxis in this population, which can be burdensome and costly. Determining which subset of infants with single ventricle CHD are at increased risk of developing thrombotic complications will allow for the development of a prediction model to predict those at highest risk of developing a thrombotic complication. Developing a predictive model will be a novel way to identify patients at risk for thrombosis and will set the stage for targeted prevention of thrombosis.
24
Babkina, Anastasiya S., Mikhail Y. Yadgarov, Alexey V. Volkov, Artem N. Kuzovlev, Andrey V. Grechko e Arkady M. Golubev. "Spectrum of Thrombotic Complications in Fatal Cases of COVID-19: Focus on Pulmonary Artery Thrombosis In Situ". Viruses 15, n. 8 (2 agosto 2023): 1681. http://dx.doi.org/10.3390/v15081681.
Abstract (sommario):
COVID-19-related thrombosis affects the venous and arterial systems. Data from 156 autopsies of COVID-19 patients were retrospectively analyzed to investigate the pattern of thrombotic complications and factors associated with pulmonary artery thrombosis and thromboembolism. Thrombotic complications were observed in a significant proportion (n = 68, 44%), with pulmonary artery thrombosis the most frequently identified thrombotic event (42, 27%). Multivariate analysis revealed that the length of hospital stay (OR 1.1, p = 0.004), neutrophil infiltration in the alveolar spaces (OR 3.6, p = 0.002), and the absence of hyaline membranes (OR 0.1, p = 0.01) were associated with thrombotic complications. Neutrophil infiltration in the alveolar spaces (OR 8, p < 0.001) and the absence of hyaline membranes (OR 0.1, p = 0.003) were also independent predictors of pulmonary artery thrombosis. The association of pulmonary artery thrombosis with an absence of hyaline membranes suggests it occurs later in the course of COVID-19 infection. As neutrophil infiltration in the alveolar spaces may indicate bacterial infection, our studies suggest the consideration of bacterial infections in these critically ill patients.
25
Nair, Velu, Ajay Sharma, Satya R. Das, D. K. Mishra, J. Kotwal e Mohan B. Agarwal. "Thrombotic Complications in Young Adults at High Altitude Areas: An Indian Experience." Blood 108, n. 11 (16 novembre 2006): 4108. http://dx.doi.org/10.1182/blood.v108.11.4108.4108.
Abstract (sommario):
Abstract High altitudes(HA) have been a source of great adventures to sea land natives during short visits. But they also result in life threatening situations. There is no definite protocol to predict these likely complications. Certain thrombotic tendencies have been identified as possible risks for these complications but there have been some times such complications can occur in the individuals otherwise not known to have any known abnormalities of thrombosis. Also the duration of exposure to high altitude required to trigger this complication is uncertain. We present 24 cases of high altitude associated thrombotic complications. All patients were incidentally males in an age group of 22–38 years (median age 28 years). They were all otherwise healthy individuals having undergone a basic medical examination before moving to HA (defined as an altitude above 9000 ft.). They all moved to HA by air and underwent standard acclimatization program before they were allowed to move out there. The duration of stay ranged between 2 weeks to 4 months. The complications encountered included deep vein thrombosis (DVT) of lower limbs (n- 18) pulmonary embolism(PE; n- 9), cortical venous thrombosis (CVT) in 5 cases and splenic infarctions in 5 cases. 25 of these also developed features of pulmonary hypertension as confirmed by echocardiography in these patients and pulmonary angiography in 3 cases who had developed pulmonary embolism. They all were treated with heparin followed by oral anticoagulation. These all patients were told to move out of HA at earliest possible opportunity. They were all investigated for possible thrombotic abnormalities. These tests included assays for Protein C,S,AT, APC resistance and mutation analysis for MTHFR and Factor V leiden. Two of the Five patients, who had developed splenic infarction were detected to have sickle cell trait. These patients underwent splenectomy besides anticoagulation. The anticoagulation was stopped 6 months later. They all later moved out of HA and were advised to avoid re-exposure to HA. These individuals arte on regular follow up and are free of any subsequent recurrence of thrombotic complications. We conclude that HA itself may be a risk for various thrombotic complications especially in individuals exposed to HA for a longer duration.
26
Sugraliyev, A. B. "Heparin-Induced Thrombocytopenia". Kardiologiia 64, n. 5 (31 maggio 2024): 18–25. http://dx.doi.org/10.18087/cardio.2024.5.n2186.
Abstract (sommario):
The extensive use of therapeutic doses of heparin to prevent thrombosis in critically ill patients with COVID-19 during the pandemic has led to an increased incidence of bleeding and heparin-induced thrombocytopenia (HIT). In addition, the introduction of the AstraZeneca and Johnson&Johnson vaccines against COVID-19 into clinical practice was associated with the development of a rare but very severe, adverse thrombotic complication, vaccine-induced immune thrombotic thrombocytopenia (VITT). Thrombotic complications of VITT turned out to be similar to HIT both clinically and pathophysiologically. HIT is a potentially fatal immune-mediated adverse drug response that results in emergence of antibodies that activate platelets in the presence of heparin. HIT is characterized by a high incidence of venous and arterial thromboses, often with fatal outcomes. Currently, there are clearly defined international guidelines for the diagnosis, treatment and prevention of HIT. In case of thrombotic complications, non-heparin anticoagulants should be used.
27
Dragunova, Marina Alexandrovna, Ekaterina Sergeevna Sitkova, Oksana Nikolaevna Ogurkova, Roman Efimovich Batalov e Tatiana Evgenievna Suslova. "ANALYSIS OF MARKERS OF THE HEMOSTASIS SYSTEM IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION WITH THROMBOEMBOLIC COMPLICATIONS". Baikal Medical Journal 2, n. 3 (10 settembre 2023): 54–55. http://dx.doi.org/10.57256/2949-0715-2023-3-54-55.
Abstract (sommario):
Introduction. Atrial fibrillation (AF) is one of the most common heart rhythm disorders. The risk of developing thromboembolic complications, including ischemic stroke, in patients with AF is 5 times higher than that in patients with sinus rhythm; therefore, one of the main directions in the treatment of patients with this rhythm disorder is the prevention of thromboembolic complications. Objective: to study the markers of monitoring the blood coagulation system in the blood serum of patients with non-valvular AF receiving anticoagulant therapy and having a history of thrombotic and thromboembolic complications. Materials and methods. The study included 31 healthy volunteers (without a history of AF, thrombosis) and 31 patients over 18 years of age with a diagnosis of AF (mean age 66.2±8.1), receiving anticoagulant therapy and having a history of thrombotic and thromboembolic events. complications. Therapy taken by patients at the time of inclusion in the study was in line with current recommendations and included standard conventional antiarrhythmic and anticoagulant therapy, as well as therapy for the underlying cardiovascular disease. Biomarkers of thrombus formation and pro-inflammatory activation (L-selectin, thrombomodulin) were determined by enzyme immunoassay using diagnostic kits from BiomedicaGmbH, Austria. Results. During the screening of 2820 patients treated in the Department of CHLSRS&EX for the nosology of AF in the period 01.2020-01.2023, 31 patients were included in the study, who were diagnosed with thrombotic and thromboembolic complications (0.01% of the total number of screened patients) against the background of regular anticoagulant therapy . Among all patients included in the study, thrombotic complications in AF were as follows: thrombosis of the left atrial appendage was noted in 17 patients (54%), spontaneous echo contrast of grade II or more in 5 patients (16%), cardioembolic stroke - in 3 patients (10%) , thrombosis of peripheral arteries (2 (6%)), thrombosis on EKS electrodes (2 (6%)). The concentration of soluble thrombomodulin in the blood serum of patients with thrombotic and thromboembolic complications was reduced compared with the group of healthy volunteers (2073.0±548.6 vs. 2845.3±726.4 pg/ml; p=0.004). Serum levels of L-selectin in patients with thrombotic and thromboembolic complications were reduced compared to healthy volunteers (1.5±0.6 vs. 2.4±1.3 µg/mL; p=0.04). Conclusion. In patients with thrombotic and thromboembolic complications that occurred against the background of adequate anticoagulant therapy, there was a decrease in serum soluble thrombomodulin and L-selectin, which may indicate damage to the endothelium, activation of thrombus formation and inflammation.
28
Popovich, Yaroslav M., Vyacheslav V. Korsak, Patricia O. Boldizhar e Orest P. Laver. "Surgical Prevention of Thromboembolic Complications in Transfascial Thrombosis". Ukrainian Journal of Cardiovascular Surgery 31, n. 1 (27 marzo 2023): 66–73. http://dx.doi.org/10.30702/ujcvs/23.31(01)/pk002-6673.
Abstract (sommario):
The aim. To evaluate the effectiveness of surgical methods of prevention of venous thromboembolic complications in transfascial thrombosis of the lower extremities.
Materials and methods. The paper analyzes the results of examination and surgical or conservative treatment of 417 patients with transfascial thrombosis treated at the Vascular Surgery Department of the Zakarpattia Regional Clinical Hospital named after A. Novak from 1995 to March 2020 and at the Surgical Department of the Central City Clinical Hospital of Uzhhorod from September 2020 to September 2022. The main (I) group consisted of 349 (83.7%) patients who were operated for transfascial thrombosis. The control (II) group consisted of 68 (16.3%) patients with transfascial thrombosis who received conservative treatment.
Results. In case of acute varicothrombophlebitis complicated by transfascial thrombosis, the scope of surgery should be expanded in order to surgically prevent thromboembolism of the pulmonary artery. All the patients with transfascial thrombosis were treated as for deep vein thrombosis. The approach to the removal of the small saphenous vein should be differentiated depending on the extent of thrombotic occlusion and the confluence of the sural veins. Surgical treatment of patients with transfascial thrombosis made it possible to prevent recurrence of the thrombotic process in the superficial and deep veins of the lower extremities, thromboembolism of the pulmonary artery, while with conservative treatment their frequency was 5.1%, 3.4% and 3.4%, respectively. Active surgical tactics in patients of the I group made it possible to reduce the frequency of manifestations of decompensated chronic venous insufficiency from 27.1% to 7.0%, and manifestations of postthrombotic syndrome in the deep veins of the lower extremities from 100% to 3.7%.
Conclusions. Implementation of operative treatment of acute varicothrombophlebitis complicated by transfascial thrombosis allows to effectively prevent venous thromboembolic complications, eliminate manifestations of chronic venous insufficiency and prevent the development of post-thrombotic changes in superficial and deep veins.
29
Zafren, Ken. "Thrombotic Complications at Altitude". Wilderness & Environmental Medicine 15, n. 2 (giugno 2004): 155. http://dx.doi.org/10.1580/1080-6032(2004)015[0157:tcaa]2.0.co;2.
30
Willerson, James T. "Serotonin and Thrombotic Complications". Journal of Cardiovascular Pharmacology 17, Supplement 5 (1991): S21. http://dx.doi.org/10.1097/00005344-199100175-00004.
31
Czap, Alexandra L., Ashley Becker e Patrick Y. Wen. "Thrombotic Complications in Gliomas". Seminars in Thrombosis and Hemostasis 45, n. 04 (30 aprile 2019): 326–33. http://dx.doi.org/10.1055/s-0039-1687892.
Abstract (sommario):
AbstractArterial and venous thromboses are common in glioma patients, both in the perioperative period and throughout the course of the disease. High-grade glioma patients harbor underlying hypercoagulability, which predisposes these high-risk patients with prolonged immobility and neurologic deficits to thrombotic events. Despite the high incidence and recurrent nature of these complications, there is no standardized approach to the management of glioma patients, and many challenges remain. Historically, the perceived risk of intracranial and intratumoral hemorrhage limited the use of anticoagulation, favoring nonpharmacological prophylaxis and treatment. Multiple studies have demonstrated the safety and efficacy of anticoagulation when indicated, with low molecular weight heparin as the preferred short- or long-term treatment. This review will discuss the epidemiology, risk factors, and therapeutic management of both venous and arterial thrombotic complications in glioma.
32
Inoue, Susumu, e Christina Anagonye. "Frequency of Thrombotic Events in Hospitalized Patients with Sickle Cell Disease". Blood 136, Supplement 1 (5 novembre 2020): 13. http://dx.doi.org/10.1182/blood-2020-143444.
Abstract (sommario):
Background Thrombosis is one of the most common complications described in patients with sickle cell disease. However, little is known about the prevalence, variety and severity of thrombus particularly in sickle cell patients hospitalized with vaso-occlusive crisis. Methods We made a retrospective chart review of patients (age 21 years or older) admitted with sickle cell disease at Hurley Medical Center (Flint, Michigan) and was diagnosed with a thrombotic event between April 2012 and April 2020. To obtain a logistic model, we identified all patients with the the final discharge diagnosis of thrombosis (ICD-9 or ICD-10 code indicating any thrombosis, such as DVT, arterial thrombosis, catheter-related thrombus, pulmonary embolism, and stroke), combined with the diagnosis of sickle cell disease. Findings 37/137 (27%) sickle cell patients were found to have had at least one thrombotic event during their hospitalization. As predicted, patients with sickle cell disease appeared to have very high frequency of thrombotic complications, though we lack a control group to compare with. Genotypes of sickle cell disease was also measured in this study. Patients with the Hb-SS disease had a much higher rate of this complication(25/68=37%) compared with those with Hb SC disease patients (12/49=24%). There were no thrombotic events reported in patients with Hb S/beta thalassemia+, or 0 patients or in patients with Hb SS with HPFH. Interpretation The risk of a thromboembolic event in patients with SCD is high, Sickle cell anemia is a procoagulant condition, which is a risk factor for thrombosis. More research is required to determine if preventive modalities could reduce thrombotic risk. Disclosures No relevant conflicts of interest to declare.
33
Ouchicha, I., H. Abid, S. Bahja, A. Lamine, M. Lahlali, N. Lahmidani, M. Elyousfi, Da Benajah, A. Ibrahimi e M. Elabkari. "THROMBOEMBOLIC COMPLICATIONS IN CHRONIC INFLAMMATORY BOWEL DISEASE". International Journal of Advanced Research 10, n. 04 (30 aprile 2022): 01–06. http://dx.doi.org/10.21474/ijar01/14509.
Abstract (sommario):
Patients with chronic inflammatory bowel disease (IBD) represented by Crohn disease (CD) and ulcerative colitis (UC) are at higher risk for thromboembolic complications (CTE) which are a major cause of morbidity. They are attributed to a pre-thrombotic state induced by the inflammatory activity of this disease. The thrombotic risk inpatients with IBD is underestimated and thromboprophylaxisis not widely implemented in the clinical practice. Many studies on thromboembolism in the IBD populationhave already been carried out, however the precisepathogenesis is still poorly understood. The aim of our study is to determine the prevalence, risk factors and clinical aspects of thrombosis during IBD.
34
Ouchicha, I., H. Abid, S. Bahja, A. Lamine, M. Lahlali, N. Lahmidani, M. Elyousfi, Da Benajah, A. Ibrahimi e M. Elabkari. "THROMBOEMBOLIC COMPLICATIONS IN CHRONIC INFLAMMATORY BOWEL DISEASE". International Journal of Advanced Research 10, n. 04 (30 aprile 2022): 01–06. http://dx.doi.org/10.21474/ijar01/14509.
Abstract (sommario):
Patients with chronic inflammatory bowel disease (IBD) represented by Crohn disease (CD) and ulcerative colitis (UC) are at higher risk for thromboembolic complications (CTE) which are a major cause of morbidity. They are attributed to a pre-thrombotic state induced by the inflammatory activity of this disease. The thrombotic risk inpatients with IBD is underestimated and thromboprophylaxisis not widely implemented in the clinical practice. Many studies on thromboembolism in the IBD populationhave already been carried out, however the precisepathogenesis is still poorly understood. The aim of our study is to determine the prevalence, risk factors and clinical aspects of thrombosis during IBD.
35
Ouchicha, I., H. Abid, S. Bahja, A. Lamine, M. Lahlali, N. Lahmidani, M. Elyousfi, Da Benajah, A. Ibrahimi e M. Elabkari. "THROMBOEMBOLIC COMPLICATIONS IN CHRONIC INFLAMMATORY BOWEL DISEASE". International Journal of Advanced Research 10, n. 04 (30 aprile 2022): 01–06. http://dx.doi.org/10.21474/ijar01/14509.
Abstract (sommario):
Patients with chronic inflammatory bowel disease (IBD) represented by Crohn disease (CD) and ulcerative colitis (UC) are at higher risk for thromboembolic complications (CTE) which are a major cause of morbidity. They are attributed to a pre-thrombotic state induced by the inflammatory activity of this disease. The thrombotic risk inpatients with IBD is underestimated and thromboprophylaxisis not widely implemented in the clinical practice. Many studies on thromboembolism in the IBD populationhave already been carried out, however the precisepathogenesis is still poorly understood. The aim of our study is to determine the prevalence, risk factors and clinical aspects of thrombosis during IBD.
36
Ameri, Afshin, Courtney M. Anderson, Joetta H. Smith e Julisa Patel. "Thromboembolic Complications in a Pediatric Patient Population: Treatment with Direct Oral Anticoagulants. Monitoring of Treatment Efficiency with D-Dimer Levels and Safety Profile By Thromboelastogram". Blood 138, Supplement 1 (5 novembre 2021): 4270. http://dx.doi.org/10.1182/blood-2021-146948.
Abstract (sommario):
Abstract Direct oral anticoagulants (DOAC) such as the thrombin inhibitor Dabigatran and the coagulation factor Xa inhibitors Apixaban and Rivaroxaban have been in clinical use for the past 5-6 years. Familiarity with their use in the general pediatric population with thrombosis secondary to inflammatory disorders and rheumatologic disease is currently not as prevalent due to the widespread more conventional anticoagulation practice with the fractionated heparins in particular Lovenox. In this report we would like to summarize our experience in a pediatric patient population ranging from 3- 17 years with thrombotic disease. Of 55 patients with various thrombotic events 16 patients were treated with DOAC. There were 5 patients who had underlying inflammatory disease including COVID. Thrombotic complications included arterial as well as venous thrombotic events. All patients had elevated D-Dimer levels ranging from 360-4000 mcg/ml on diagnosis and normalized with successful anticoagulation. All patients had resolution of thrombosis. Thrombelastogram (TEG) were obtained on isolated patients during therapy and were useful to balance anticoagulation to prevent hemorrhagic complications. In conclusion, DOAC are a safe and effective alternative to LMW Heparin in pediatric patients with arterial or venous thrombosis. Monitoring should include determination of D-Dimer levels for efficacy of treatment and TEG in cases with arterial disease where bleeding may be a secondary complication of therapy. Disclosures No relevant conflicts of interest to declare.
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Linnemann e Lindhoff-Last. "Risk factors, management and primary prevention of thrombotic complications related to the use of central venous catheters". Vasa 41, n. 5 (1 agosto 2012): 319–32. http://dx.doi.org/10.1024/0301-1526/a000217.
Abstract (sommario):
An adequate vascular access is of importance for the treatment of patients with cancer and complex illnesses in the intensive, perioperative or palliative care setting. Deep vein thrombosis and thrombotic occlusion are the most common complications attributed to central venous catheters in short-term and, especially, in long-term use. In this review we will focus on the risk factors, management and prevention strategies of catheter-related thrombosis and occlusion. Due to the lack of randomised controlled trials, there is still controversy about the optimal treatment of catheter-related thrombotic complications, and therapy has been widely adopted using the evidence concerning lower extremity deep vein thrombosis. Given the increasing use of central venous catheters in patients that require long-term intravenous therapy, the problem of upper extremity deep venous thrombosis can be expected to increase in the future. We provide data for establishing a more uniform strategy for preventing, diagnosing and treating catheter-related thrombotic complications.
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Bereziuk, Olha M., Julia V. Mazur, Galyna K. Berko, Larysa S. Perebetiuk, Maryna M. Velychkovych, Olena V. Temna e Halyna O. Movchan. "PRIMARY AND SECONDARY THROMBOPHILIА: PATHOGENESIS, CLINICAL PRESENTATION, APPROACHES TO THROMBOTIC COMPLICATIONS PREVENTION AND TREATMENT". Wiadomości Lekarskie 72, n. 5 (2019): 908–13. http://dx.doi.org/10.36740/wlek201905133.
Abstract (sommario):
Introduction: Thrombophiliа is a predisposition to arterial or venous thrombotic complications as a result of congenital or acquired hemostatic system defects. Thrombophilia increases risk of fatal complications, disability of patients. The assessment of the risk of thrombotic complications makes it possible to prescribe adequate primary or secondary prophylaxis. However, there is no systematic information about estimation risk of thrombosis in various types of thrombophilia and conduction primary and secondary prophylaxis of thrombotic complications, choosing treatment. The aim: Analysis and arrangement information regarding pathogenesis, clinical features, approaches to diagnosis, risk assessment, primary and secondary prevention and peculiarities of thrombotic complications treatment in patients with thrombophilia. Materials and methods: There were used methods: content analysis, method of systemic approach. An analysis of the results of clinical trials, the review of articles in the field of hemostasis was conducted. Conclusions: Patients with deficiency of Pt C, S, antithrombin III deficiency and homozygous factor V Leiden mutation, malignancy, antiphospholipid syndrome, surgical interventions, pregnancy, usage of oral contraceptive pills (OCP s) and hormone replacement therapy (HRT) have the highest risk of thrombotic complications. The type of thrombophilia determinates the choice of anticoagulants, necessity for primary prophylaxis and the duration of secondary prophylaxis.
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Park, D. J., S. E. Choi, H. Xu, J. H. Kang e S. S. Lee. "AB0442 RISK FACTORS ASSOCIATED WITH THROMBOTIC EVENTS IN KOREAN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS". Annals of the Rheumatic Diseases 79, Suppl 1 (giugno 2020): 1519.3–1520. http://dx.doi.org/10.1136/annrheumdis-2020-eular.1674.
Abstract (sommario):
Background:Objectives:Up to 30~40% of all patients with systemic lupus erythematosus (SLE) experience thrombosis, presenting as stroke and myocardial infarction, and these thrombotic events cause substantial morbidity and mortality in SLE. We explored the risk factors associated with the occurrence of thrombotic events in SLE patients.Methods:This study enrolled 259 SLE patients (mean age, 34.0 ± 13.7; 239 females) with available clinical data at the time of SLE onset from the lupus cohort at Chonnam National University Hospital. Sociodemographic, clinical, and laboratory data, and history of concomitant diseases were obtained. Thrombotic events were defined as the presence of arterial or venous thrombosis. The multivariable Cox’s model was performed to investigate the possible risk factors for thrombotic events.Results:During a mean follow-up of 103.3 months (SD, 53.4), 27 patients (10.4%) developed thrombotic events: stroke in 15 patients, venous thrombosis in five patients, myocardial infarction in four patients, and angina in three patients. In the multivariable Cox’s regression analysis, hypertension (hazard ratio [HR], 16.946; P=0.031), antiphospholipid syndrome (APS) (HR, 18.348; P=0.001), cumulative prednisolone >5 mg/day (HR, 14.374; P<0.001), use of ACE inhibitors (ACEi) or angiotensin receptor blockers (ARB) (HR, 0.110; P=0.004), and Systemic Lupus International Collaborating Clinics Group (SLICC) damage index (HR, 1.972; P=0.004) were significant predictors of the development of thrombotic events in patients with SLE.Conclusion:Patients with SLE showed significant thrombotic events during the course of their disease. Risk factors associated with thrombotic complications were higher cumulative dose of prednisolone, diagnosis of APS, and higher SLICC damage index. On the other hand, the use of ACEi or ARBs was associated with a reduced risk of thrombotic complications in patients with SLE. Our results support the need for increased monitoring of thrombotic complications in SLE patients.Disclosure of Interests: :None declared
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Baygozina, E. А. "Combination of arterial and venous thrombosis in a patient with the novel coronavirus infection (a clinical case)". Tuberculosis and Lung Diseases 100, n. 4 (14 maggio 2022): 22–25. http://dx.doi.org/10.21292/2075-1230-2022-100-4-22-25.
Abstract (sommario):
The presented clinical case demonstrates a rare combination of arterial and venous thrombosis in a patient with severe COVID-19 coronavirus infection and a fatal outcome. The clinical manifestations of thrombosis were acute irreversible ischemia of the lower extremities, acute impairment of cerebral circulation, and venous thrombosis of the left lower extremity. These thrombotic complications were caused by virus-induced coagulopathy deteriorated by such risk factors as an old age, comorbidities and delayed prescription of anticoagulants. The mechanisms of thrombotic complications in patients with COVID-19 are complex and require further investigation.
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Drapkina, O. M., I. I. Almazova, A. V. Smirnova, S. A. Berns e R. N. Shepel. "Cerebrovascular Accident in a Patient with Polycythemia: a Case Report". Rational Pharmacotherapy in Cardiology 18, n. 1 (5 marzo 2022): 79–84. http://dx.doi.org/10.20996/1819-6446-2022-02-10.
Abstract (sommario):
Polycythemia vera is not only a clonal disease that causes hematopoietic stem cells, but also a pathology that often leads to thrombotic complications. Thrombosis can have different localization and is clinically manifested by stroke, myocardial infarction, deep vein thrombosis of the lower extremities, pulmonary embolism, thrombosis of the veins of internal organs and other conditions. One of the most formidable thrombotic complications is acute cerebrovascular accident. The heterogeneity of the possible causes of acute cerebrovascular accident requires a careful approach to differential diagnosis for timely diagnosis and individual, pathogenetically grounded selection of means of long-term antithrombotic therapy. The presented clinical case of the development of cerebrovascular accident in a patient with polycythemia vera demonstrates the importance of an informal approach to diagnosis, as well as interdisciplinary interaction for finding the true cause of the development of acute cerebrovascular accident and the appointment of pathogenetically based treatment, aimed, among other things, at the prevention of repeated episodes of acute cerebrovascular accident and others. thrombotic complications.
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Ogurkova, O. N., Yu G. Lugacheva, M. A. Dragunova e E. S. Sitkova. "Gender differences in serum markers of inflammation and platelet activation in patients with non-valvular atrial fibrillation". Medical Immunology (Russia) 25, n. 4 (1 giugno 2023): 947–54. http://dx.doi.org/10.15789/1563-0625-gdi-2695.
Abstract (sommario):
The prevalence of atrial fibrillation is high and comparable in both sexes. Such factors as differently expressed blood biomarkers in women and men may play a role in the occurrence of atrial fibrillation and the development of thrombotic complications. To study markers of inflammation and platelet activation in patients with atrial fibrillation of non-valvular origin, receiving anticoagulant therapy and having a history of thrombotic complications and patients with atrial fibrillation without thrombotic complications, depending on the gender of the patients. The study included 22 healthy volunteers and 60 patients diagnosed with atrial fibrillation receiving anticoagulant therapy, of which 21 patients developed thrombotic complications. Serum levels of α2- macroglobulin, hsC-reactive protein, fetuin A, α-1-acid glycoprotein, L-selectin, serum amyloid P, adipsin, and platelet factor 4 were studied on FLEXMAP 3D using Acute Phase diagnostic test systems Panel 3. A comparative study of the content of biomarkers demonstrated an increased concentration of C-reactive protein in men and women in both groups of patients with atrial fibrillation; decrease in fetuin A and L-selectin in the group of women with thrombosis compared with women without thrombotic complications and compared with healthy women. There were no gender differences in the concentration of fetuin A and L-selectin in the group of patients with atrial fibrillation without thrombotic complications and in healthy volunteers. The level of adipsin had no gender differences in the group of patients with atrial fibrillation with thrombosis and in healthy volunteers, however, it was significantly increased in women without thrombosis. The content of platelet factor 4 in women in both groups of patients exceeded the value of this indicator in healthy women; no gender differences were found in the groups of patients with atrial fibrillation. Low levels of fetuin A and L-selectin, with a simultaneous increase in C-reactive protein and platelet factor 4, lead to an increase of prothrombogenic potential and to a change in the balance of pro- and antiinflammatory mediators towards increased inflammation in female patients with atrial fibrillation.
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Werner, Maureen J. M., Ruben H. J. de Kleine, Marieke T. de Boer, Vincent E. de Meijer, René Scheenstra, Henkjan J. Verkade, Frank A. J. A. Bodewes et al. "Routine Postoperative Antithrombotic Therapy in Pediatric Liver Transplantation: Impact on Bleeding and Thrombotic Complications". Thrombosis and Haemostasis 120, n. 04 (29 gennaio 2020): 627–37. http://dx.doi.org/10.1055/s-0039-1701010.
Abstract (sommario):
Abstract Background Hepatic artery thrombosis (HAT) and portal vein thrombosis (PVT) are serious causes of morbidity and mortality after pediatric liver transplantation. To reduce thrombotic complications, routine antithrombotic therapy consisting of 1 week heparin followed by 3 months acetylsalicylic acid, was implemented in our pediatric liver transplant program in 2003. This study aimed to evaluate incidences of bleeding and thrombotic complications since the implementation of routine antithrombotic therapy and to identify risk factors for these complications. Methods This retrospective cohort study includes 200 consecutive pediatric primary liver transplantations performed between 2003 and 2016. Uni- and multivariate logistic regression analysis, Kaplan–Meier method, and Cox regression analysis were used to evaluate recipient outcome. Results HAT occurred in 15 (7.5%), PVT in 4 (2.0%), and venous outflow tract thrombosis in 2 (1.0%) recipients. Intraoperative vascular interventions (odds ratio [OR] 14.45 [95% confidence interval [CI] 3.75–55.67]), low recipient age (OR 0.81 [0.69–0.95]), and donor age (OR 0.96 [0.93–0.99]) were associated with posttransplant thrombosis. Clinically relevant bleeding occurred in 37%. Risk factors were high recipient age (OR 1.08 [1.02–1.15]), high Child–Pugh scores (OR 1.14 [1.02–1.28]), and intraoperative blood loss in mL/kg (OR 1.003 [1.001–1.006]). Both posttransplant thrombotic (hazard ratio [HR] 3.38 [1.36–8.45]; p = 0.009) and bleeding complications (HR 2.50 [1.19–5.24]; p = 0.015) significantly increased mortality. Conclusion In 200 consecutive pediatric liver transplant recipients receiving routine postoperative antithrombotic therapy, we report low incidences of posttransplant vascular complications. Posttransplant antithrombotic therapy seems to be a valuable strategy in pediatric liver transplantation. Identified risk factors for bleeding and thrombotic complications might facilitate a more personalized approach in antithrombotic therapy.
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Berz, David, Gerald A. Colvin, Priya Mital e Peter J. Quesenbery. "Argatroban Associated Bleeding Complications." Blood 110, n. 11 (16 novembre 2007): 1867. http://dx.doi.org/10.1182/blood.v110.11.1867.1867.
Abstract (sommario):
Abstract Background: Heparin induced thrombocytopenia (HIT) is a frequently observed side effect observed with heparin administration. Treatment for this condition includes direct thrombin inhibitor (DTI) therapy. Major hemorrhagic complications are considered rare events in this setting. Methods: This is a case series of patients diagnosed with HIT in a tertiary medical referral center. The diagnosis of HIT was established on the base of clinical criteria. All included patients had positive HIT ELISA based antibody testing during the time interval from July 2006 to July 2007 and all patients were treated with argatroban. A systematic review for hemorrhagic and thrombotic complications of argatroban therapy was performed. Major hemorrhage was defined as clinically identified bleeding with the demand for transfusion therapy. Thrombotic complications were defined as thrombosis evidenced by imaging studies developing during argatorban therapy. We performed bivariate and multivariate logistic regression analysis to identify demographic and clinical factors that influence the development of complications of argatroban therapy as treatment for HIT. Examined covariates were gender, age, type of service the patient was admitted under (surgical versus medical), amount of comorbidities, preexisting history of gastrointestinal bleeding, documented thrombotic or thrombembolic event at the time point of HIT diagnosis and coexisting coexisting coagulopathy other than HIT. Results: We identified 102 patients with the diagnosis of HIT. The median optical density (OD) of the ELISA HIT immunoassay was 1.23 (95% CI 0.93–1.43). We identified 11 (10.7%) major hemorrhagic events in patients on argatroban. Four patients (3.9%) died as a consequence of major hemorrhagic complications. No thrombotic events were identified in our study cohort. As statistically significant; predictors for clinically relevant hemorrhagic complications in our model remained male gender, preexisting GI bleeding history and being patient on a surgical service. Conclusion: The incidence of major hemorrhagic episodes with agatroban therapy is significantly higher then generally reported and the mortality rate is very disturbing. These data suggest that alternatives to standard direct thrombin inhibitor therapy should be aggressively pursued.
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Lugacheva, Yu G., I. V. Kulagina, I. A. Kovalev, Ye V. Krivoschekov, O. S. Yanulevich e T. E. Suslova. "Risk factors of thrombotic complications in patients with single functional ventricle". Rossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics) 64, n. 2 (15 maggio 2019): 68–74. http://dx.doi.org/10.21508/1027-4065-2019-64-2-68-74.
Abstract (sommario):
Objective: to analyze the parameters of the hemostasis system and the results of molecular genetic testing in patients with a single functional ventricle. The study included 102 patients. All the patients underwent a staged surgical hemodynamic correction of a single functional ventricle. The authors performed a retrospective analysis of patient records in order to identify the episodes of thrombosis. The incidence of thrombotic complications at different stages of hemodynamic correction in the examined patients with a single functional ventricle was 12.7%. The indicators of plasma link hemostasis in the observed patients have been characterized by a balance of hemostatic reactions in the group of children with thrombosis and without. The results of a molecular genetic study demonstrated that the carrier of the heterozygous genotype of 20210GA factor II gene in patients with a single functional ventricle increased the risk of thrombotic complications 16 times (15.4% in patients with thrombosis versus 1.1% in the group without thrombosis; odds ratio 16.0; 95% confidence interval 1.34–191.24; p=0.028). All patients with thrombosis in the history revealed a homozygous condition according to variant 10976GG factor VII gene (p=0.017). Conclusion: molecular genetic analysis of polymorphic variants of the hemostatic system in patients with a single functional ventricle is required to predict the risk, timely prevention and correction of thrombotic complications during the surgical treatment of congenital heart disease.
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Melikyan, Anait L., Irina N. Subortseva, Elena A. Gilyazitdinova, Tamara I. Koloshejnova, Kristina S. Shashkina, Elena K. Egorova, Alla M. Kovrigina, Andrei B. Sudarikov e Lana A. Gorgidze. "Thrombosis in patients with myeloproliferative neoplasms. Case report". Terapevticheskii arkhiv 93, n. 7 (23 luglio 2021): 800–804. http://dx.doi.org/10.26442/00403660.2021.07.200925.
Abstract (sommario):
Thrombotic complications are the most significant factors determining the prognosis in myeloproliferative neoplasms. Markers for assessing the risk of thrombosis are the number of leukocytes, platelets, hemoglobin level, hematocrit, age, molecular status, history of thrombosis, obesity, arterial hypertension, hyperlipidemia, hereditary or acquired thrombophilia. The pathogenesis of thrombosis in patients with myeloproliferative neoplasms is complex and multifactorial. In most cases, the etiological factor remains unknown. Currently, antiplatelet and anticoagulant therapy is carried out on an individual basis. The algorithm for primary and secondary (after thrombosis) prevention requires development and testing. We present a clinical case of repeated arterial and venous thrombotic complications in a patient with primary myelofibrosis.
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Han, Yue, De Pei Wu, Xiaoxu Lu, Aining Sun, Wei Zhang, Zhaoyue Wang e Changgeng Ruan. "Clinical Significance of Hemostatic Parameters in the Patients with Transplantation-Related Complications during Hematopoietic Stem Cell Transplantation." Blood 110, n. 11 (16 novembre 2007): 3956. http://dx.doi.org/10.1182/blood.v110.11.3956.3956.
Abstract (sommario):
Abstract Introduction Hepatic veno-occlusive disease (VOD) and thrombotic microangiopathy (TMA) are important and serious thrombotic complications after hematopoietic stem cell transplantation (HSCT), but the early diagnosis remains difficult since their clinical manifestations are similar to those of other transplantation-related complications. Our aim in this study is to illustrate the early alteration of hemostatic parameters in recipients of hematopoietic stem cell transplantation and then determine its value in transplantation-related thrombotic complications and other post-HSCT clinical settings, such as acute graft-versus-host disease (aGVHD) and infection. Methods Plasma from 95 patients undergoing HSCT was collected prior to conditioning therapy and then weekly until five weeks after HSCT. Hemostatic parameters were evaluated prospectively in our institution. 1. Plasminogen activator inhibitor-1(PAI-1), tissue-plasminogen activator(t-PA), protein C(PC), von Willebrand factor(vWF)and thrombomodulin(TM)were investigated by enzymimmunoassay. Other hemostatic parameters such as activated partial thromboplastin time(APTT), prothrombin time(PT), fibrinogen (Fg), antithrombin III(AT III) and D-dimer(D-Di) were measured with hemagglutinin equipment in the same time. 2. According to the different settings after transplantation, three groups of transplant associated complications were classified as thrombus group (VOD n=5, TMA n=1), aGVHD group (n=29) and infection group (n=19). Systemic analyses were carried out for the hemostatic parameters and transplantation-related thrombotic complications or other clinical settings. Results Significant increase was observed in the levels of fibrinogen, t-PA and PAI-1 after transplant, while Protein C and ATIII decreased significantly(P<0.05). No significant change existed in PT, vWF and APTT levelsfollowing HSCT(P>0.05). All the patients with three different complications presented with significantly increased PAI-1 and lower level of Protein C compared with those who had no complication (P<0.05), other parameters didn’t change apparently in the same time(P>0.05). However, 6 patients with thrombotic complications (VOD5, TMA1) extremely showed elevated PAI-1 levels after the clinical onset of thrombotic complications by comparison with highest post-HSCT values in the aGVHD patients or infection patients (P<0.05). Significant decreased level of Protein C was simultaneously found in the 29 patients with aGVHD compared with the 19 patients with infection(P<0.01)and the 6 patients with thrombotic complications(P<0.05). Conclusion All the results demonstrated early hemostatic imbalance is one important manifestation during HSCT, reflecting prothrombotic states and endothelial damage, which may be caused by the conditioning regimen and/or transplantation-related complications. There is apparent correlation between the alteration of hemostasis related parameters and various transplantation-associated complications. The extreme elevation of PAI-1 can be considered as important value to distinguish the development of thrombotic complications from other transplantation-related complications, while Protein C diminution promotes the early diagnosis of aGVHD from thrombosis and infection.
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Somonova, O. V., A. L. Elizarova e T. V. Davydova. "Prevention and treatment of thrombosis in cancer and oncohematological patients". Oncohematology 16, n. 4 (11 novembre 2021): 40–49. http://dx.doi.org/10.17650/1818-8346-2021-16-4-40-49.
Abstract (sommario):
The purpose of the review is to highlight the current possibilities for the prevention and treatment of venous thrombotic complications in patients with cancer.The data of 52 scientific sources published in the Russian and foreign press in 1997–2020 are considered.Cancer patients are at high risk of thrombotic complications, which worsen the outcome of anticancer treatment and are one of the leading causes of death. Thrombosis in an oncological patient increases the risk of death by 30 times, which is associated with fatal thromboembolism and a more aggressive course of the disease. The leading role in the pathogenesis of thrombotic complications is played by disorders in the hemostasis system caused both by the tumor itself and by therapy. Low molecular weight heparins are considered the basis for specific prophylaxis of thromboembolic complications in cancer patients. The use of low molecular weight heparins after surgery and during chemotherapy effectively reduces the incidence of venous thrombosis. Direct oral anticoagulants are promising drugs for oral administration and are indicated as one of the treatment options for patients with tumor-associated thrombosis with a low risk of bleeding and no drug interactions with ongoing systemic chemotherapy.
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Bodnar, P. Ya. "Comparative analysis of the hemostasis system of cancer patients with thrombotic complications". Modern medical technology, n. 2(49) (20 luglio 2021): 63–67. http://dx.doi.org/10.34287/mmt.2(49).2021.11.
Abstract (sommario):
Surgical treatment of female genital cancer remains a rather difficult task in gynecological practice due to the possibility of thrombotic complications. It is important to study the features of hemostasis in such patients for the practical application of this knowledge. The aim of the study was to scientifically substantiate the features of hemostasis in patients with female genital cancer. Study materials: 103 patients with genital cancer who were treated.
The purpose of the study. Coagulogram, colorimetry, others. Results of the research. As a result of a blood test, it was found that the initial level of hemoglobin in patients with thrombotic complications after surgery decreased by 12%, in patients without thrombotic complications – by 14%. The average platelet count in patients with thrombotic complications decreased by 11,50%, in patients without thrombotic complications – 8,12%. The level of leukocytes in patients with thrombotic complications – increased by 21,05%, in patients without thrombotic complications – 30,30%. In the study of hemostasis, it has been found that surgery in patients with female genital cancer causes a pronounced activation of the hemostasis system, especially in patients with thrombotic complications. In patients with thrombotic complications there is a more pronounced activation of intravascular coagulation on the background of a significant decrease in the level of antigen III than in patients without thrombotic complications. The level of fibrinogen in patients with thrombotic complications in the preoperative period was significantly higher by 16,3% than in patients without thrombotic complications; there was a decrease in fibrinogen levels in the early postoperative period; from the third day after surgery, fibrinogen levels increased in patients without thrombotic complications. There was also a significant reduction in activated partial thromboplastin time in patients with thrombotic complications. The number of soluble complexes of fibrin monomers increased to higher values in patients with thrombotic complications. Conclusion. In the study of hemostasis, it has been found that surgery in patients with female genital cancer causes marked activation of the hemostasis system, especially in patients with thrombotic complications.
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Ullman, Amanda J., Deanne August, Tricia Kleidon, Rachel Walker, Nicole M. Marsh, Andrew Bulmer, Benjamin Pearch et al. "Peripherally Inserted Central catheter iNnovation to reduce Infections and Clots (the PICNIC trial): a randomised controlled trial protocol". BMJ Open 11, n. 4 (aprile 2021): e042475. http://dx.doi.org/10.1136/bmjopen-2020-042475.
Abstract (sommario):
IntroductionPeripherally inserted central catheters (PICCs) are vital for the delivery of medical therapies, but up to 30% of PICCs are associated with complications such as deep vein thrombosis or infection. The integration of antimicrobial and hydrophobic catheter materials, and pressure-activated valves, into polyurethane PICCs are innovations designed to prevent infective and/or thrombotic complications.Methods and analysisA multicentre, parallel group, superiority randomised controlled trial with two experimental arms ((1) hydrophobic PICC (with pressure-activated valve); (2) chlorhexidine gluconate-impregnated PICC (with external clamp)) and one control group ((3) conventional polyurethane PICC (with external clamp)). Recruitment of 1098 adult and paediatric patients will take place over 2 years at three tertiary-referral hospitals in Queensland, Australia. Patients are eligible for inclusion if their PICC is to be inserted for medical treatment, with a vascular size sufficient to support a 4-Fr PICC or larger, and with informed consent. The primary outcome is PICC failure, a composite of thrombotic (venous thrombosis, breakage and occlusion) and infective complications (PICC-associated bloodstream infection and local infection). Secondary outcomes include: all-cause PICC complication; thrombotic complications; infective complications; adverse events (local or systemic reaction); PICC dwell time; patient/parent satisfaction; and healthcare costs. Differences between both intervention groups and the control group will be compared using Cox proportional hazards regression. Effect estimates will be presented as HRs with corresponding 95% CI.Ethics and disseminationEthical approval from Queensland Health (HREC/QCHQ/48682) and Griffith University (Ref. No. 2019/094). Results will be published.Trial registration numberACTRN12619000022167.