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Hussein MH, Alabdaljabar MS, Alfagyh N, Badran M, Alamiri K. Splanchnic venous thrombosis in a nephrotic patient following COVID-19 infection: a case report. BMC Nephrol 2021; 22:420. [PMID: 34965863 PMCID: PMC8715408 DOI: 10.1186/s12882-021-02643-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 12/18/2021] [Indexed: 01/22/2023] Open
Abstract
Background As the COVID-19 pandemic spread worldwide, case reports and small series identified its association with an increasing number of medical conditions including a propensity for thrombotic complications. And since the nephrotic syndrome is also a thrombophilic state, its co-occurrence with the SARS-CoV-2 infection is likely to be associated with an even higher risk of thrombosis, particularly in the presence of known or unknown additional risk factors. Lower extremity deep vein thrombosis (DVT) and pulmonary embolism (PE) are the most common manifestations of COVID-19-associated hypercoagulable state with other venous or arterial sites being much less frequently involved. Although splanchnic vein thrombosis (SVT) has been reported to be 25 times less common than usual site venous thromboembolism (VTE) and rarely occurs in nephrotic patients, it can have catastrophic consequences. A small number of SVT cases have been reported in COVID-19 infected patients in spite of their number exceeding 180 million worldwide. Case presentation An unvaccinated young adult male with steroid-dependent nephrotic syndrome (SDNS) who was in a complete nephrotic remission relapsed following contracting SARS-CoV-2 infection and developed abdominal pain and diarrhea. Abdominal US revealed portal vein thrombosis. The patient was anticoagulated, yet the SVT rapidly propagated to involve the spleno-mesenteric, intrahepatic and the right hepatic veins. In spite of mechanical thrombectomy, thrombolytics and anticoagulation, he developed mesenteric ischemia which progressed to gangrene leading to bowel resection and a complicated hospital course. Conclusion Our case highlights the potential for a catastrophic outcome when COVID-19 infection occurs in those with a concomitant hypercoagulable state and reminds us of the need for a careful assessment of abdominal symptoms in SARS-CoV-2 infected patients.
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Affiliation(s)
- Maged H Hussein
- Department of Medicine, King Faisal Specialist Hospital and Research Center, MBC-46, P.O.Box 3354, Riyadh, 11211, Saudi Arabia.
| | | | - Noorah Alfagyh
- Department of Medicine, King Faisal Specialist Hospital and Research Center, MBC-46, P.O.Box 3354, Riyadh, 11211, Saudi Arabia
| | - Mohammad Badran
- Department of Radiology, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Khalid Alamiri
- Department of Medicine, King Faisal Specialist Hospital and Research Center, MBC-46, P.O.Box 3354, Riyadh, 11211, Saudi Arabia
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2
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Tsitlakidis C, Al Ajmi KIS, Al Madhani AY, Ahmidat AH. Postpartum ovarian vein thrombosis manifesting as acute appendicitis: a case report. J Med Case Rep 2021; 15:521. [PMID: 34689824 PMCID: PMC8543884 DOI: 10.1186/s13256-021-03102-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 09/06/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Postpartum ovarian thrombosis is an uncommon condition. It appears with the nonspecific, predominantly right-sided abdominal symptoms and must be differentiated from other acute visceral conditions. If left untreated, postpartum ovarian thrombosis can have severe consequences, including sepsis, pulmonary embolism, and even death. Momentarily, there are no specific guidelines for postpartum ovarian thrombosis management. We present a case of postpartum ovarian thrombosis admitted to our hospital with symptoms of acute appendicitis. CASE PRESENTATION : A 39-year-old Omani obese multiparous woman of Afro-Arab origin was admitted with acute symptoms, mainly abdominal pain, fever, and vomiting 1 week postpartum. Clinical picture and biochemical profile did not exhibit a recognizable pattern. Ultrasonography excluded retained products of conception. Computerized scan for abdomen and pelvis with oral and intravenous contrast reported a dilated tubular structure in the right adnexa extending up to the right renal hilum level with surrounding inflammation. Those findings were consistent with the thrombophlebitis of the right ovarian vein. Blood cultures and sensitivity showed group A β-hemolytic streptococci sensitive to penicillin G and clindamycin. The patient was treated successfully with antibiotics and therapeutic anticoagulants and discharged home 3 days later; follow-up was arranged. CONCLUSION This pathology is an exceptional entity in Oman. Therefore, awareness of this unique condition is required so that clinicians will be vigilant, exploring similar cases with imaging and avoiding unnecessary surgical interventions.
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3
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Alsharif S, Subahi A, Shirah B, Alshamrani KM, Alhazmi TA, Mesurolle B. Incidental Gonadal Vein Thrombosis Diagnosed Using Computed Tomography Imaging: A Single-Center, Retrospective, Cohort Study. Cureus 2021; 13:e15741. [PMID: 34285850 PMCID: PMC8286637 DOI: 10.7759/cureus.15741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives Gonadal vein thrombosis is an uncommon but serious condition that can be fatal if it goes unnoticed. Up to 80% of cases occur in patients after delivery, hysterectomy, or lymphadenectomy for gynecological neoplasms. The objective of this study was to determine the incidence of gonadal vein thrombosis using computed tomography (CT) imaging at our center and to describe associated risk factors. Methods A retrospective, single-center, observational study was conducted at King Abdulaziz Medical City in Jeddah, Saudi Arabia. Data were collected for all patients diagnosed with incidental gonadal-vein-thrombosis using contrast-enhanced computed tomography imaging of the abdomen and pelvis between January 2005 and December 2017. We included all patients with incidental findings of gonadal vein thrombosis and excluded those with incomplete data. Results In total, 58/68,268 (0.08%) patients were included. Fifty-seven patients were females, and only one was male. The mean age (years) of the patients was 50.0±15.0 (range 4-87). Thirty-four patients (59%) had right gonadal vein thrombosis, 20 (34%) had thrombosis on the left side, and four (7%) had bilateral thrombosis. Nineteen patients (33%) had undergone pelvic surgery previously. Forty-four patients (76%) had a malignancy at the time of diagnosis. Forty-two patients (72%) were treated with anticoagulants after the diagnosis. Conclusion Gonadal vein thrombosis is a rare clinical entity with vague clinical presentation. The incidence in the oncology population is similar to the reported incidence in the obstetric population. Initiation of anticoagulation therapy is important to treat this condition and limit complications.
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Affiliation(s)
- Shaza Alsharif
- Medical Imaging, King Abdullah International Medical Research Center, Jeddah, SAU.,Medical Imaging, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU.,Medical Imaging, Ministry of the National Guard - Health Affairs, Jeddah, SAU
| | - Ahmed Subahi
- College of Science and Health Professions, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Bader Shirah
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Khalid M Alshamrani
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU.,Medical Imaging, Ministry of the National Guard - Health Affairs, Jeddah, SAU.,College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Turki A Alhazmi
- Medical Imaging, Ministry of the National Guard - Health Affairs, Jeddah, SAU.,Research Office, King Abdullah International Medical Research Center, Jeddah, SAU.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU.,College of Medicine, Umm Alqura University, Makkah, SAU
| | - Benoit Mesurolle
- Department of Radiology, Pôle Santé République, Clermont-Ferrand, FRA
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4
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Riva N, Ageno W. Direct oral anticoagulants for unusual-site venous thromboembolism. Res Pract Thromb Haemost 2021; 5:265-277. [PMID: 33733025 PMCID: PMC7938617 DOI: 10.1002/rth2.12480] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 12/25/2022] Open
Abstract
Direct oral anticoagulants (DOACs) are currently the preferred oral anticoagulant treatment for most of the patients with deep vein thrombosis of the lower extremities and/or pulmonary embolism. DOACs have several advantages over vitamin K antagonists, such as availability of fixed dosages, fewer drug interactions, faster onset of action, shorter half-life, and lower risk of major and intracranial bleeding. Although the evidence on the use of DOACs in patients with unusual-site venous thromboembolism (VTE) is limited to a few, small randomized controlled trials, these drugs are increasingly used in clinical practice, and several observational cohort studies have been published recently. This narrative review will describe the latest evidence for the use of the DOACs in patients with thrombosis in atypical locations (splanchnic, cerebral, upper extremity, ovarian, and renal vein thrombosis) and will provide some practical advice for their use in patients with unusual-site VTE.
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Affiliation(s)
- Nicoletta Riva
- Department of Pathology, Faculty of Medicine and SurgeryUniversity of MaltaMsidaMalta
| | - Walter Ageno
- Department of Medicine and SurgeryUniversity of InsubriaVareseItaly
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5
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Kovac M, Mitic G, Djilas I, Kuzmanovic M, Serbic O, Lekovic D, Tomic B, Bereczky Z. Genotype phenotype correlation in a pediatric population with antithrombin deficiency. Eur J Pediatr 2019; 178:1471-1478. [PMID: 31359133 DOI: 10.1007/s00431-019-03433-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 07/12/2019] [Accepted: 07/16/2019] [Indexed: 11/25/2022]
Abstract
Inherited antithrombin (AT) deficiency is a rare autosomal dominant disorder, caused by mutations in the AT gene (SERPINC1). Considering that the genotype phenotype relationship in AT deficiency patients remains unclear, especially in pediatric patients, the aim of our study was to evaluate genotype phenotype correlation in a Serbian pediatric population. A retrospective cohort study included 19 children younger than 18 years, from 15 Serbian families, with newly diagnosed AT deficiency. In 21% of the recruited families, mutations affecting exon 4, 5, and 6 of the SERPINC1 gene that causes type I AT deficiency were detected. In the remaining families, the mutation in exon 2 causing type II HBS (AT Budapest 3) was found. Thrombosis events were observed in 1 (33%) of those with type I, 11 (85%) of those with AT Budapest 3 in the homozygous respectively, and 1(33%) in the heterozygous form. Recurrent thrombosis was observed only in AT Budapest 3 in the homozygous form, in 27% during initial treatment of the first thrombotic event. Abdominal venous thrombosis and arterial ischemic stroke, observed in almost half of the children from the group with AT Budapest 3 in the homozygous form, were unprovoked in all cases.Conclusion: Type II HBS (AT Budapest 3) in the homozygous form is a strong risk factor for arterial and venous thrombosis in pediatric patients. What is Known: • Inherited AT deficiency is a rare autosomal dominant disorder, caused by mutations in the SERPINC1gene. • The genotype phenotype correlation in AT deficiency patients remains unclear, especially in pediatric patients. What is New: • The genetic results for our paediatric population predominantly showed the presence of a single specific mutation in exon 2, that causes type II HBS deficiency (AT Budapest 3). • In this group thrombosis mostly occurred as unprovoked, in almost half of them as abdominal thrombosis or stroke with high incidence of recurrent thrombosis, in 27% during initial treatment.
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Affiliation(s)
- Mirjana Kovac
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia. .,Blood Transfusion Institute of Serbia, Hemostasis Department, Sv. Save 39, Belgrade, 11000, Serbia.
| | - Gorana Mitic
- Institute of Laboratory Medicine, Clinical Center of Vojvodina, Faculty of Medicine Novi Sad, University of Novi Sad, Novi Sad, Serbia
| | - Iva Djilas
- Blood Transfusion Institute of Serbia, Hemostasis Department, Sv. Save 39, Belgrade, 11000, Serbia
| | - Milos Kuzmanovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Institute for Health Care of Mother and Child of Serbia Dr Vukan Cupic, Belgrade, Serbia
| | - Olivera Serbic
- Institute for Health Care of Mother and Child of Serbia Dr Vukan Cupic, Belgrade, Serbia
| | - Danijela Lekovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic of Hematology, Clinical Center of Serbia, Belgrade, Serbia
| | - Branko Tomic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Zsuzsanna Bereczky
- Division of Clinical Laboratory Research, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Qureshi M, Alabi F, Christian F, Romero C. The forgotten urinalysis: an integral part of unmasking thrombophilia. J Community Hosp Intern Med Perspect 2019; 9:40-44. [PMID: 30788075 PMCID: PMC6374955 DOI: 10.1080/20009666.2018.1562854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 12/18/2018] [Indexed: 10/27/2022] Open
Abstract
A 43-year-old female presented with flank pain of two days duration. She had been admitted previously for bilateral lower extremity edema which had not improved with diuresis. Abdominal Imaging showed left ovarian vein thrombosis and left renal vein thrombosis extending into the IVC. Chest imaging revealed right lower lobe segmental pulmonary emboli. Careful review of serial urinalysis during previous admissions revealed significant proteinuria. Confirmatory urine tests followed by a renal biopsy led to a diagnosis of membranous nephropathy. We report a case of acute diffuse thromboembolism due to membranous nephropathy, unmasked by serial abnormal urinalysis.
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Affiliation(s)
- Marvi Qureshi
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Fortune Alabi
- Florida Lung Asthma and Sleep Specialists, Florida Hospital, FL, USA
| | - Francis Christian
- Department of Pulmonary and Critical Medicine, University of Oklahoma, Oklahoma, FL, USA
| | - Claudia Romero
- Florida Lung Asthma and Sleep Specialists, Florida Hospital, FL, USA
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7
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Björck M, Koelemay M, Acosta S, Bastos Goncalves F, Kölbel T, Kolkman JJ, Lees T, Lefevre JH, Menyhei G, Oderich G, Kolh P, de Borst GJ, Chakfe N, Debus S, Hinchliffe R, Kakkos S, Koncar I, Sanddal Lindholt J, Vega de Ceniga M, Vermassen F, Verzini F, Geelkerken B, Gloviczki P, Huber T, Naylor R. Editor's Choice - Management of the Diseases of Mesenteric Arteries and Veins: Clinical Practice Guidelines of the European Society of Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2018; 53:460-510. [PMID: 28359440 DOI: 10.1016/j.ejvs.2017.01.010] [Citation(s) in RCA: 348] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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8
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Tufano A, Modesti PA. The "very rare" unusual sites venous thromboses. Intern Emerg Med 2017. [PMID: 28643210 DOI: 10.1007/s11739-017-1701-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Antonella Tufano
- Regional Reference Centre for Coagulation Disorders, Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy.
| | - Pietro Amedeo Modesti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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9
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Early onset of abdominal venous thrombosis in a newborn with homozygous type II heparin-binding site antithrombin deficiency. Blood Coagul Fibrinolysis 2017; 28:264-266. [PMID: 27214036 DOI: 10.1097/mbc.0000000000000570] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: The overall incidence of thromboembolic events in the neonatal period is 5 per 100 000 births, wherein more than 40% of all such manifestations are symptomatic renal vein thromboses. We describe the case of a newborn female who developed extensive thrombosis, which filled the inferior vena cava and renal vein and was diagnosed in the first weeks of life. A homozygous type II heparin-binding site antithrombin deficiency (c. 391C>T, p. Leu131Phe) was detected in the background. Despite the timely diagnosis and appropriate treatment, clinical signs of renal insufficiency, because of left kidney atrophy and arterial hypertension, were observed. Our case demonstrates the seriousness of the consequences arising after early onset of venous thrombosis caused by homozygous type II heparin-binding site antithrombin deficiency. In addition to prompt diagnosis, of huge importance is the determination of inherited thrombophilia, as it significantly affects therapeutic treatment and indicates that long-term follow-up is mandatory.
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10
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Zarrouk M, Salim S, Elf J, Gottsäter A, Acosta S. Testing for thrombophilia in mesenteric venous thrombosis - Retrospective original study and systematic review. Best Pract Res Clin Gastroenterol 2017; 31:39-48. [PMID: 28395787 DOI: 10.1016/j.bpg.2016.11.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 11/02/2016] [Accepted: 11/07/2016] [Indexed: 01/31/2023]
Abstract
The aim was to perform a local study of risk factors and thrombophilia in mesenteric venous thrombosis (MVT), and to review the literature concerning thrombophilia testing in MVT. Patients hospitalized for surgical or medical treatment of MVT at our center 2000-2015. A systematic review of observational studies was performed. In the local study, the most frequently identified risk factor was Factor V Leiden mutation. The systematic review included 14 original studies. The highest pooled percentage of any inherited thrombophilic factor were: Factor V Leiden mutation 9% (CI 2.9-16.1), prothrombin gene mutation 7% (CI 2.7-11.8). The highest pooled percentage of acquired thrombophilic factors were JAK2 V617F mutation 14% (CI -1.9-28.1). The wide range of frequency of inherited and acquired thrombophilic factors in different populations indicates the necessity to relate these factors to background population based data in order to estimate their overrepresentation in MVT. There is a need to develop guidelines for when and how thrombophilia testing should be performed in MVT.
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Affiliation(s)
- M Zarrouk
- Lund University, Department of Vascular Diseases, Skåne University Hospital, S-205 02 Malmö, Sweden.
| | - S Salim
- Lund University, Department of Vascular Diseases, Skåne University Hospital, S-205 02 Malmö, Sweden.
| | - J Elf
- Lund University, Department of Vascular Diseases, Skåne University Hospital, S-205 02 Malmö, Sweden.
| | - A Gottsäter
- Lund University, Department of Vascular Diseases, Skåne University Hospital, S-205 02 Malmö, Sweden.
| | - S Acosta
- Lund University, Department of Vascular Diseases, Skåne University Hospital, S-205 02 Malmö, Sweden.
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11
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Leclerc A, Lapébie FX, Thuillier F, Lacroix P. [Calcified bullet thrombus of the inferior vena cava and left renal vein in an adult]. ACTA ACUST UNITED AC 2016; 41:294-7. [PMID: 27344300 DOI: 10.1016/j.jmv.2016.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/08/2016] [Indexed: 12/28/2022]
Abstract
Calcifications are rarely located within the inferior vena cava and the renal veins. The etiology is poorly understood and the prognosis is uncertain. We report a case in a 55-year-old man.
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Affiliation(s)
- A Leclerc
- Service de cardiologie et maladies vasculaires, centre hospitalier Roland-Mazoin, 12, rue Châteaubriand, 87200 Saint-Junien, France.
| | - F-X Lapébie
- Service de médecine vasculaire, hôpital universitaire Rangueil, 31059 Toulouse cedex 9, France
| | - F Thuillier
- Service de médecine interne, hôpital Roland-Mazoin, 87200 Saint-Junien, France
| | - P Lacroix
- Inserm UMR 1094, institut de neuroépidémiologie et neurologie tropicale, 87042 Limoges, France; Institut de neuroépidémiologie et neurologie tropicale, faculté de médicine, université de Limoges, 87042 Limoges, France; Service de chirurgie thoracique et cardiovasculaire et angiologie, hôpital universitaire Dupuytren, 87042 Limoges, France
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12
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Sticchi E, Magi A, Kamstrup PR, Marcucci R, Prisco D, Martinelli I, Mannucci PM, Abbate R, Giusti B. Apolipoprotein(a) Kringle-IV Type 2 Copy Number Variation Is Associated with Venous Thromboembolism. PLoS One 2016; 11:e0149427. [PMID: 26900838 PMCID: PMC4762703 DOI: 10.1371/journal.pone.0149427] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 01/02/2016] [Indexed: 11/18/2022] Open
Abstract
In addition to the established association between high lipoprotein(a) [Lp(a)] concentrations and coronary artery disease, an association between Lp(a) and venous thromboembolism (VTE) has also been described. Lp(a) is controlled by genetic variants in LPA gene, coding for apolipoprotein(a), including the kringle-IV type 2 (KIV-2) size polymorphism. Aim of the study was to investigate the role of LPA gene KIV-2 size polymorphism and single nucleotide polymorphisms (SNPs) (rs1853021, rs1800769, rs3798220, rs10455872) in modulating VTE susceptibility. Five hundred and sixteen patients with VTE without hereditary and acquired thrombophilia and 1117 healthy control subjects, comparable for age and sex, were investigated. LPA KIV-2 polymorphism, rs3798220 and rs10455872 SNPs were genotyped by TaqMan technology. Concerning rs1853021 and rs1800769 SNPs, PCR-RFLP assay was used. LPA KIV-2 repeat number was significantly lower in patients than in controls [median (interquartile range) 11(6–17) vs 15(9–25), p<0.0001]. A significantly higher prevalence of KIV-2 repeat number ≤7 was observed in patients than in controls (33.5% vs 15.5%, p<0.0001). KIV-2 repeat number was independently associated with VTE (p = 4.36 x10-9), as evidenced by the general linear model analysis adjusted for transient risk factors. No significant difference in allele frequency for all SNPs investigated was observed. Haplotype analysis showed that LPA haplotypes rather than individual SNPs influenced disease susceptibility. Receiver operating characteristic curves analysis showed that a combined risk prediction model, including KIV-2 size polymorphism and clinical variables, had a higher performance in identifying subjects at VTE risk than a clinical-only model, also separately in men and women.
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Affiliation(s)
- Elena Sticchi
- Department of Experimental and Clinical Medicine, University of Florence—Atherothrombotic Disease Center, Careggi Hospital, Florence, Italy
| | - Alberto Magi
- Department of Experimental and Clinical Medicine, University of Florence—Atherothrombotic Disease Center, Careggi Hospital, Florence, Italy
| | - Pia R. Kamstrup
- Department of Clinical Biochemistry, Copenhagen University Hospital—Herlev, Herlev, Denmark
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence—Atherothrombotic Disease Center, Careggi Hospital, Florence, Italy
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Florence—SOD Patologia Medica, Center for Autoimmune Systemic Diseases, Behçet Center and Lupus Clinic, Careggi Hospital, Florence, Italy
| | - Ida Martinelli
- A. Bianchi Bonomi Hemophilia and Thrombosis Center—Ospedale Maggiore Policlinico, Milan, Italy
| | - Pier Mannuccio Mannucci
- A. Bianchi Bonomi Hemophilia and Thrombosis Center—Ospedale Maggiore Policlinico, Milan, Italy
- Scientific Direction, Fondazione Ca’ Granda–Ospedale Maggiore Policlinico, Milan, Italy
| | - Rosanna Abbate
- Department of Experimental and Clinical Medicine, University of Florence—Atherothrombotic Disease Center, Careggi Hospital, Florence, Italy
| | - Betti Giusti
- Department of Experimental and Clinical Medicine, University of Florence—Atherothrombotic Disease Center, Careggi Hospital, Florence, Italy
- * E-mail:
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13
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Ovarian Vein Thrombosis as a Complication of Laparoscopic Surgery. Case Rep Obstet Gynecol 2015; 2015:682941. [PMID: 26788386 PMCID: PMC4691616 DOI: 10.1155/2015/682941] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/25/2015] [Indexed: 11/22/2022] Open
Abstract
Ovarian vein thrombosis (OVT) is an extremely rare but life-threatening complication of the postpartum period. It has never been reported as a complication of laparoscopic surgery. We report a case of right ovarian vein thrombosis that occurred in the postoperative period after patient underwent laparoscopic salpingectomy for a right side ectopic pregnancy. She presented with 1-week history of abdominal pain and fever. A complete workup for fever was performed and was found negative. Computed tomography of the abdomen and pelvis revealed right ovarian vein thrombosis. The patient was treated with anticoagulant therapy and responded well.
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14
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Moncayo León K, Domínguez Bahamonde J, Hernández-Lahoz Ortiz I, García Casas R, Vidal-Insua J. Trombo flotante de aorta torácica y trombosis venosa esplácnica: a propósito de 2 casos. ANGIOLOGIA 2015. [DOI: 10.1016/j.angio.2014.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Mantha S, Sarasohn D, Ma W, Devlin SM, Chi DS, Roche KL, Suidan RS, Woo K, Soff GA. Ovarian vein thrombosis after debulking surgery for ovarian cancer: epidemiology and clinical significance. Am J Obstet Gynecol 2015; 213:208.e1-4. [PMID: 25743130 DOI: 10.1016/j.ajog.2015.02.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/05/2015] [Accepted: 02/27/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Ovarian vein thrombosis is associated with pregnancy and pelvic surgery. Postpartum ovarian vein thrombosis is associated with infection and a high morbidity rate and is treated with anticoagulant and intravenous antibiotic therapy. The natural history of such thrombotic events after debulking surgery for ovarian cancer has not been well described. Our objective was to characterize the presentation and outcomes for patients with this condition at our institution. STUDY DESIGN We conducted a retrospective study of patients who underwent surgical debulking for ovarian cancer at Memorial Sloan Kettering Cancer Center between the years 2001 and 2010. Patients were included if contrast computed tomography scans of both the abdomen and pelvis were performed within 12 weeks before and 12 weeks after the surgery. The images were reviewed to assess for the presence and extent of a new postoperative ovarian vein thrombosis. When available, subsequent studies were assessed for thrombus progression. Medical records were reviewed to determine whether anticoagulation was used for treatment of the thrombotic episode and to record the occurrence of any new significant venous thromboembolic event in the next year. RESULTS One hundred fifty-nine patients had satisfactory imaging. New ovarian vein thrombosis was a common complication of debulking surgery, as found in 41 of patients (25.8%). Only 5 women with ovarian vein thrombosis were started on anticoagulation, of which 2 individuals had an independent venous thromboembolic event as indication for treatment. Only 2 of the ovarian vein thromboses (4.9%) progressed to the inferior vena cava or left renal vein on subsequent scan. The estimated cumulative incidence of venous thromboembolism 1 year after the first postoperative scan was 17.1% for patients in the new ovarian vein thrombosis group vs 15.3% of individuals for the group without a postoperative ovarian vein thrombosis (P = .78). CONCLUSION Ovarian vein thrombosis is commonly encountered after debulking surgery for ovarian cancer. Anticoagulation is usually not indicated, and clinically meaningful thrombus progression rarely occurs.
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Cook RM, Rondina MT, Horton DJ. Rivaroxaban for the Long-term Treatment of Spontaneous Ovarian Vein Thrombosis Caused by Factor V Leiden Homozygosity. Ann Pharmacother 2014; 48:1055-1060. [PMID: 24798316 DOI: 10.1177/1060028014533304] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To report a case where rivaroxaban was used in the management of an ovarian vein thrombosis and to briefly review the literature, pathophysiology, and clinical implications therein. CASE SUMMARY A 30-year-old previously healthy woman was diagnosed with acute, spontaneous, left-ovarian vein thrombosis (OVT) with proximal extension into the renal vein. After initial catheter-directed thrombolysis with tPA, angioplasty of the left renal vein, and heparinoid treatment, rivaroxaban was begun for long-term anticoagulation. Three months after her index event she was symptom free, with complete resolution of her thrombosis and no adverse effects or bleeding complications from rivaroxaban. To our knowledge, this is the first report of OVT successfully treated with rivaroxaban. DISCUSSION OVT is a rare but potentially fatal cause of abdominal pain that may pose diagnostic and therapeutic dilemmas. Factor V Leiden (FVL) homozygosity, an uncommon but severe inherited thrombophilia, increases the risk of thrombosis by approximately 50- to 80-fold. This case report and accompanying literature review highlight important clinical pearls related to the diagnosis and management of OVT and inherited thrombophilias. CONCLUSIONS This clinical vignette adds to the published literature suggesting that novel oral anticoagulants, such as rivaroxaban, may eventually emerge as an alternative to vitamin K antagonists for the treatment of extra-axial thromboses. Reporting these cases is important because their prevalence is low outside of specialized referral centers, and thus, dissemination of these experiences may help other providers in treating their patients.
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Affiliation(s)
- Rhett M Cook
- University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | | | - Devin J Horton
- University of Utah Health Sciences Center, Salt Lake City, UT, USA
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Reflex anuria: an old concept with new evidence. Int Urol Nephrol 2013; 46:323-8. [DOI: 10.1007/s11255-013-0541-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 08/14/2013] [Indexed: 10/26/2022]
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M’rabet Bensalah K, Uehlinger D, Kalicki R, Czerwinska J. Hemodynamic Modeling of the Intrarenal Circulation. Ann Biomed Eng 2013; 41:2630-44. [DOI: 10.1007/s10439-013-0865-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 07/06/2013] [Indexed: 10/26/2022]
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Holmsen Fairchild A, Beecham Chick JF, Dorton BJ. Identity crisis: the patient's abdominal discomfort stemmed from a treacherous event. Am J Obstet Gynecol 2013; 209:70.e1-2. [PMID: 23454252 DOI: 10.1016/j.ajog.2013.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 10/29/2012] [Accepted: 02/24/2013] [Indexed: 11/18/2022]
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Guler S, Kokoglu OF, Ucmak H, Ozkan F. Postpartum ovarian vein thrombosis and renal vein thrombosis in a woman with protein S and C deficiency. BMJ Case Rep 2013; 2013:bcr-2013-009164. [PMID: 23696144 DOI: 10.1136/bcr-2013-009164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Selma Guler
- Department of Infectious Disease, Faculty of Medicine, Kahramanmaras, Turkey.
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