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Saeed Z, Sirolli V, Bonomini M, Gallina S, Renda G. Hallmarks for Thrombotic and Hemorrhagic Risks in Chronic Kidney Disease Patients. Int J Mol Sci 2024; 25:8705. [PMID: 39201390 PMCID: PMC11354877 DOI: 10.3390/ijms25168705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 07/31/2024] [Accepted: 08/06/2024] [Indexed: 09/02/2024] Open
Abstract
Chronic kidney disease (CKD) is a global health issue causing a significant health burden. CKD patients develop thrombotic and hemorrhagic complications, and cardiovascular diseases are associated with increased hospitalization and mortality in this population. The hemostatic alterations are multifactorial in these patients; therefore, the results of different studies are varying and controversial. Endothelial and platelet dysfunction, coagulation abnormalities, comorbidities, and hemoincompatibility of the dialysis membranes are major contributors of hypo- and hypercoagulability in CKD patients. Due to the tendency of CKD patients to exhibit a prothrombotic state and bleeding risk, they require personalized clinical assessment to understand the impact of antithrombotic therapy. The evidence of efficacy and safety of antiplatelet and anticoagulant treatments is limited for end-stage renal disease patients due to their exclusion from major randomized clinical trials. Moreover, designing hemocompatible dialyzer membranes could be a suitable approach to reduce platelet activation, coagulopathy, and thrombus formation. This review discusses the molecular mechanisms underlying thrombotic and hemorrhagic risk in patients with CKD, leading to cardiovascular complications in these patients, as well as the evidence and guidance for promising approaches to optimal therapeutic management.
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Affiliation(s)
- Zeeba Saeed
- Center for Advanced Studies and Technology, G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Vittorio Sirolli
- Nephrology and Dialysis Unit, Department of Medicine, G. d’Annunzio University of Chieti-Pescara, SS. Annunziata Hospital, Via dei Vestini, 66100 Chieti, Italy; (V.S.); (M.B.)
| | - Mario Bonomini
- Nephrology and Dialysis Unit, Department of Medicine, G. d’Annunzio University of Chieti-Pescara, SS. Annunziata Hospital, Via dei Vestini, 66100 Chieti, Italy; (V.S.); (M.B.)
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Giulia Renda
- Center for Advanced Studies and Technology, G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy;
- Department of Neuroscience, Imaging and Clinical Sciences, G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy;
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McClain C, Buckallew AR, Armbruster AL. Evaluation of Apixaban Use in Patients With Advanced Kidney Disease. J Pharm Technol 2024; 40:171-177. [PMID: 39157638 PMCID: PMC11325681 DOI: 10.1177/87551225241247691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2024] Open
Abstract
Background: Current guidelines and literature suggest apixaban may be used in patients with severe kidney disease and atrial fibrillation (AF) for stroke and systemic embolism risk reduction (SSE) or patients with acute venous thromboembolism (VTE). Limited data is available for long-term safety and efficacy outcomes in this patient population. Objective: Evaluate the use of apixaban for AF or VTE in patients with advanced kidney disease. Methods: This single-center, retrospective, Investigational Review Board approved study evaluated patients ≥18 years of age with severe kidney disease on apixaban therapy for VTE or AF from March 1, 2018, to December 31, 2020. The primary outcome was major bleeding from apixaban initiation/continuation until 12 months after discharge. The secondary outcomes included a composite bleed (major bleeding, clinically relevant non-major bleeding, and minor bleeding), the occurrence of VTE or SSE, and death during hospitalization from any cause other than bleeding. Results: Overall, 156 patients met inclusion criteria. Six patients experienced major bleeding (3.8%). Composite bleeding occurred in 16 patients (10.3%); no patients had SSE or VTE, and 4 patients died from causes other than bleeding (2.6%). Limitations included the small sample size and retrospective nature of the study. Conclusion: This study demonstrated that patients with advanced chronic kidney disease on apixaban for AF or VTE had low major bleeding and similar overall bleeding rates compared with previously published literature. When considering the use of apixaban in this population, risks and benefits should be weighed in addition to the consideration of FDA-label dosing guidance.
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Liu CW, Anih J, Lebedeva V, Gungor A, Wang C, Park L, Roshanov PS. Kidney disease in trials of perioperative tranexamic acid. J Clin Anesth 2024; 94:111417. [PMID: 38387241 DOI: 10.1016/j.jclinane.2024.111417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/31/2023] [Accepted: 02/14/2024] [Indexed: 02/24/2024]
Abstract
STUDY OBJECTIVE To assess how kidney disease is handled in randomized trials evaluating the safety and efficacy of perioperative tranexamic acid, and to evaluate its effects across levels of kidney function. DESIGN Systematic review and meta-analysis of randomized controlled trials. SETTING We screened studies from a previous comprehensive systematic review, and updated its search of PubMed, Embase, and Cochrane CENTRAL to July 31, 2023. PATIENTS Patients undergoing non-obstetric surgery. INTERVENTIONS Intravenous tranexamic acid compared to placebo or usual care without tranexamic acid. MEASUREMENT We summarized the handling of kidney disease in eligibility criteria, dose adjustments for kidney function, and effects of tranexamic acid on thrombotic events, seizures, and bleeding by subgroups of kidney function. MAIN RESULTS We evaluated 300 trials with 53,085 participants; 45,958 participants (86.6%) were enrolled in 228 trials (76.0%) that explicitly excluded patients with kidney disease. Definitions of kidney diseased used for exclusion varied widely. Most were non-specific and some corresponded to mild disease. Only 5 trials adjusted dosing for kidney function. Meta-analysis of two large trials found tranexamic acid unlikely to substantially increase or decrease the occurrence of thrombotic events in patients with eGFR <60 mL/min/1.73m2 (RR, 0.95; 95% CI: 0.83 to 1.07) or ≥ 60 mL/min/1.73m2 (RR, 1.00; 95% CI, 0.91 to 1.11; P for subgroup difference = 0.47), but both trials excluded patients with severe kidney disease. No analysis could be performed regarding seizure risk. One large trial in noncardiac surgery reported similar reduction in bleeding across subgroups of kidney function but excluded patients with creatinine clearance <30 mL/min. CONCLUSIONS The large evidence base supporting perioperative tranexamic acid suffers from broad and unjustified exclusion of patients with kidney disease. Typical perioperative dosing of tranexamic acid is likely safe and effective in patients with creatinine clearance >30 mL/min, but effects in more severe kidney disease are unknown.
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Affiliation(s)
- Cheng-Wei Liu
- Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada
| | - Joshua Anih
- McMaster University, Hamilton, Ontario, Canada
| | | | - Ata Gungor
- Western University, London, Ontario, Canada
| | - Carol Wang
- Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada
| | - Lily Park
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Pavel S Roshanov
- Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada.
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Riveros C, Ranganathan S, Huang E, Ordonez A, Xu J, Geng M, Miles BJ, Esnaola N, Klaassen Z, Jerath A, Kim SJ, Wallis CJD, Satkunasivam R. Glomerular hyperfiltration is an independent predictor of postoperative outcomes: A NSQIP multi-specialty surgical cohort analysis. Nephrology (Carlton) 2023; 28:548-556. [PMID: 37468129 DOI: 10.1111/nep.14221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/21/2023]
Abstract
AIM While high estimated glomerular filtration rate (eGFR) has been associated with increased overall mortality, its effect on postoperative outcomes is relatively understudied. We sought to investigate the association between high eGFR and 30-day postoperative outcomes using a multi-specialty surgical cohort. METHODS Using the National Surgical Quality Improvement Program database, we selected adult for whom eGFR could be calculated using the 2021 Chronic Kidney Disease Epidemiology Collaboration equation. Based on sex-specific distributions of eGFR stratified by age quintiles, we classified patients into low (<5th percentile), normal (5-95th percentile) and high eGFR (>95th percentile). The primary outcome was a composite of any 30-day major adverse outcomes, including: death, reoperation, cardiac arrest, myocardial infarction and stroke. Secondary outcomes included 30-day infectious complications, venous thromboembolism (VTE), bleeding requiring transfusion, prolonged length of stay and unplanned readmission. After matching for demographic differences, comorbidity burden and operative characteristics, logistic regression models were used to evaluate the association between extremes of eGFR and the outcomes of interest. RESULTS Of 1 668 447 patients, 84 115 (5.07%) had a high eGFR. High eGFR was not associated with major adverse outcomes (odds ratio [OR] 1.00 [95% confidence interval (CI): 0.97, 1.03]); however, it was associated with reoperation (OR 1.04 [95% CI: 1.00,1.08]), infectious complications (OR 1.14 [95% CI: 1.11, 1.16]), VTE (OR 1.15 [95% CI: 1.09, 1.22]) and prolonged length of stay (OR 1.19 [95% CI: 1.16, 1.21]). CONCLUSION Our findings support an association between high eGFR and adverse 30-day postoperative outcomes.
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Affiliation(s)
- Carlos Riveros
- Department of Urology, Houston Methodist Hospital, Houston, Texas, USA
| | | | - Emily Huang
- Department of Urology, Houston Methodist Hospital, Houston, Texas, USA
| | - Adriana Ordonez
- Center for Health Data Science and Analytics, Houston Methodist Research Institute, Houston, Texas, USA
| | - Jiaqiong Xu
- Center for Health Data Science and Analytics, Houston Methodist Research Institute, Houston, Texas, USA
| | - Michael Geng
- School of Engineering Medicine, Texas A&M University, Houston, Texas, USA
| | - Brian J Miles
- Department of Urology, Houston Methodist Hospital, Houston, Texas, USA
| | - Nestor Esnaola
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Zachary Klaassen
- Division of Urology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Angela Jerath
- Department of Anesthesia, Sunnybrook Health Sciences Center, Toronto, Canada
| | - S Joseph Kim
- Division of Nephrology and the Kidney Transplant Program, University Health Network, University of Toronto, Toronto, Canada
| | - Christopher J D Wallis
- Division of Urology and Surgical Oncology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
- Division of Urology, University of Toronto, Toronto, Canada
- Division of Urology, Mount Sinai Hospital, Toronto, Canada
| | - Raj Satkunasivam
- Department of Urology, Houston Methodist Hospital, Houston, Texas, USA
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Almajdi A, Almutairi S, Alharbi M. Safety and efficacy of apixaban versus low-molecular weight heparin or vitamin-K antagonists for venous thromboembolism treatment in patients with severe renal failure: A systematic review and meta-analysis. Thromb Res 2023; 229:77-85. [PMID: 37419006 DOI: 10.1016/j.thromres.2023.06.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/09/2023]
Abstract
INTRODUCTION Chronic kidney disease is an independent risk factor for venous thromboembolism (VTE). Traditionally, Low Molecular Weight Heparin (LMWH) followed by warfarin has been the conventional therapy for VTE treatment. Direct oral anticoagulants (DOACs), including apixaban, have shown several advantages over the traditional therapy in individuals with normal kidney function. This meta-analysis aims to review the safety and efficacy of apixaban compared to warfarin or LMWH for the treatment of VTE in severe renal failure. METHOD We conducted literature search in PubMed, Embase, and Cochrane databases. Retrospective observational studies involving clinical effectiveness and safety outcomes of apixaban compared to warfarin in adult patients with an estimated glomerular filtration rate (eGFR) <30 mL/min/m2 or on dialysis were included. RESULTS Eight studies were included in the analysis. Significant reduction in VTE recurrence observed in apixaban compared to warfarin (RR, 0.65; 95 % CI, 0.43-0.98; P = 0.04; I2 = 78 %). No significant difference in all-cause mortality between apixaban and warfarin (RR, 0.99; 95 % CI, 0.91-1.07; P = 0.74; I2 = 0 %). Apixaban showed a significantly lower rate of major bleeding (RR, 0.72; 95 % CI, 0.62-0.84; P < 0.0001; I2 = 34 %) and minor bleeding events (RR, 0.42; 95 % CI, 0.21-0.86; P = 0.02; I2 = 10 %) compared to warfarin. No significant difference observed in clinically relevant non-major bleeding between apixaban and warfarin (RR, 0.81; 95 % CI, 0.65-1.00; P = 0.05; I2 = 67 %). CONCLUSION Apixaban was favored over warfarin for treating VTE in severe renal failure, reducing VTE recurrence and bleeding risk. No differences were observed in all-cause mortality and CRNMB events. More evidence is required due to limited RCTs and prospective studies.
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Affiliation(s)
| | | | - Maha Alharbi
- Department of Pharmacy Practice, College of Pharmacy, Kuwait University, Kuwait.
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Gacuta KM, Koper-Lenkiewicz OM, Milewska AJ, Ćwiklińska-Dworakowska M, Matowicka-Karna J, Kamińska J. Associations Between Mean Platelet Volume and Various Factors in Type 2 Diabetes Patients: A Single-Center Study from Poland. Med Sci Monit 2023; 29:e941109. [PMID: 37649249 PMCID: PMC10478580 DOI: 10.12659/msm.941109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 06/20/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Thromboembolic episodes, which are largely mediated by blood platelets, are prevalent chronic complications of diabetes. The mean platelet volume (MPV) serves as a marker for in vivo platelet activation. This study aimed to assess the factors influencing MPV in 106 patients with type 2 diabetes, compared with 59 non-diabetic individuals at a single center in Poland. MATERIAL AND METHODS We performed linear regression analysis, with MPV as the dependent variable and factors such as age, sex, thrombopoiesis-influencing cytokines, blood pressure, body mass index, glycosylated hemoglobin percentage, platelet count, large platelet count, lipid profile parameters, creatinine concentration, estimated glomerular filtration rate, treatment modalities, and comorbidities as independent variables. MPV was measured using the ADVIA 2120 hematology analyzer, with a reference range of 7-12 fL. RESULTS The analysis revealed that in patients with type 2 diabetes, an increase in platelet count by 10×10³/μL resulted in a decrease in MPV by 0.05 (P<0.001), while an increase in large platelet count by 1×10³/μL led to an increase in MPV by 0.18 (P<0.001). Additionally, patients taking ß-blockers or insulin had lower MPVs by 0.77 (P=0.008) and 5.63 (P<0.001), respectively, compared with those not on these medications. CONCLUSIONS This study delineates the relationship between MPV, platelet parameters, and treatment modalities in type 2 diabetes, paving the way for further research to elucidate underlying mechanisms and potential clinical applications.
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Affiliation(s)
- Karolina Marta Gacuta
- Department of Clinical Laboratory Diagnostics, Clinical Medical Hospital in Białystok, Białystok, Poland
| | | | - Anna Justyna Milewska
- Department of Statistics and Medical Informatics, Medical University of Białystok, Białystok, Poland
| | | | - Joanna Matowicka-Karna
- Department of Clinical Laboratory Diagnostics, Medical University of Białystok, Białystok, Poland
| | - Joanna Kamińska
- Department of Clinical Laboratory Diagnostics, Medical University of Białystok, Białystok, Poland
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Fischer H, Geisen V, Dorsch R, Hartmann K, Dörfelt R. Hemostatic and thromboelastographic parameters in dogs with renal azotemia. Vet World 2023; 16:1214-1221. [PMID: 37577193 PMCID: PMC10421550 DOI: 10.14202/vetworld.2023.1214-1221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/02/2023] [Indexed: 08/15/2023] Open
Abstract
Background and Aim Humans and dogs with azotemia can develop coagulation disorders. Therefore, this study aimed to evaluate the coagulation profiles and thromboelastographic parameters in dogs with acute kidney injury (AKI) and chronic kidney disease (CKD). Materials and Methods In this prospective study, 31 client-owned dogs with renal azotemia (creatinine >220 μmol/L) were enrolled. Clinical signs of hemostatic disorders, complete blood count, coagulation profile, D-dimers, thromboelastography, and 28-day survival data were obtained and analyzed using the t-test, Mann-Whitney U test, and Chi-square test. Statistical significance was set at p < 0.05. Results Seventeen dogs with AKI, 10 with CKD, and four with acute-on-chronic kidney injury (AoC) were enrolled. Ten dogs (AKI, 8/17; CKD, 2/10) had thrombocytopenia. Prothrombin time was prolonged in four dogs with AKI and longer in dogs with AKI than in dogs with CKD (p = 0.004). The activated partial thromboplastin time was prolonged in 23 dogs (AKI, 14/17; CKD, 7/10; AoC, 3/4) and was longer in azotemic dogs than in healthy control dogs (p = 0.003). Thromboelastographic tracings were hypocoagulable in three dogs with AKI and hypercoagulable in 16 dogs (AKI 4/17, CKD 9/10, AoC 3/4). The thromboelastographic values for maximum amplitude (p < 0.001) and global clot strength (p < 0.001) were lower in dogs with AKI than in those with CKD. Conclusion Hypercoagulable thromboelastographic tracings were observed in dogs with CKD, whereas coagulation times were prolonged in dogs with AKI. However these findings should be validated by further studies.
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Affiliation(s)
- Hendryk Fischer
- LMU Small Animal Clinic, LMU Munich, Veterinaerstrasse 13, 80539 Munich, Germany
| | - Vera Geisen
- LMU Small Animal Clinic, LMU Munich, Veterinaerstrasse 13, 80539 Munich, Germany
| | - Roswitha Dorsch
- LMU Small Animal Clinic, LMU Munich, Veterinaerstrasse 13, 80539 Munich, Germany
| | - Katrin Hartmann
- LMU Small Animal Clinic, LMU Munich, Veterinaerstrasse 13, 80539 Munich, Germany
| | - René Dörfelt
- LMU Small Animal Clinic, LMU Munich, Veterinaerstrasse 13, 80539 Munich, Germany
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Kohli R, Platton S, Forbes S, Thuraisingham R, Tan J, Green L, MacCallum P. Renal transplant and hemostasis: early postoperative changes in recipients and donors. Res Pract Thromb Haemost 2023; 7:100168. [PMID: 37274176 PMCID: PMC10238749 DOI: 10.1016/j.rpth.2023.100168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/07/2023] [Accepted: 04/10/2023] [Indexed: 06/06/2023] Open
Abstract
Background The benefit of administering pharmacologic thromboprophylaxis following renal transplantation remains uncertain. Objectives To compare hemostatic parameters before and after renal transplant surgery in both recipients and their donors at predetermined time points. Methods Blood samples were collected at baseline (T1), immediately after surgery (T2), and at 24 hours after surgery (T3) in both recipients and donors and at 72 (T4) and 120 hours (T5) from recipients only. Assays included in vitro thrombin generation, factor VIII (FVIIIc) activity, von Willebrand factor (VWF) antigen, D-dimer, antithrombin activity, prothrombin fragment 1 + 2 (F1 + 2), thrombin-antithrombin complexes, and plasminogen activator inhibitor-1 (PAI-1) antigen. Results Fifty-two patients (28 recipients and 24 donors) were enrolled. Both donors and recipients had increased FVIIIc, VWF, F1 + 2, D-dimer, and PAI immediately after surgery but reduced antithrombin. Mixed-model analysis showed that the magnitude of change over time (between T1 and T3) for FVIIIc (mean estimated difference [MED], 72; 95% CI, 41-102; P < .0001), VWF (MED, 89; 95% CI, 35-142; P = .001), F1 + 2 (MED, 283; 95% CI, 144-422; P < .0001), thrombin-antithrombin complexes (MED, 3.5; 95% CI, 1.9-5.1; P < .0001), D-dimer (MED, 2.2; 95% CI, 1.0-3.3; P < .0001), PAI-1 (MED, 9.2; 95% CI, 3.4-14.9; P = .002), and time to peak thrombin generation (MED, 1.5; 95% CI, 0.35-2.7; P = .01) was more significant in recipients than in donors. Conclusion Persistence of a hypercoagulable state was more prominent in recipients after 24 hours despite recovery in renal function and initiation of thromboprophylaxis.
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Affiliation(s)
- Ruchika Kohli
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | | | | | | | - Joachim Tan
- St. Georges, University of London, London, United Kingdom
| | - Laura Green
- Barts Health NHS Trust, London, United Kingdom
- Blizard Institute, Queen Mary University of London, London, United Kingdom
- NHS Blood & Transplant, London, United Kingdom
| | - Peter MacCallum
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
- Barts Health NHS Trust, London, United Kingdom
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Volkl AA, Moore KT, Haskell L, Barnathan ES. Updated Renal Dosage Recommendations for Rivaroxaban in Patients Experiencing or at Risk of Thromboembolic Disease. Am J Cardiovasc Drugs 2023; 23:247-255. [PMID: 37115488 PMCID: PMC10164019 DOI: 10.1007/s40256-023-00579-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 04/29/2023]
Abstract
Patients with chronic kidney disease are at an increased risk of venous thromboembolism (VTE). The factor Xa inhibitor rivaroxaban has been shown to provide similar efficacy and a lower risk of bleeding compared with vitamin K antagonists for the treatment and prevention of VTE. Rivaroxaban has been studied in patients with varying degrees of renal impairment, and this review summarizes current knowledge supporting its use in patients with severe renal impairment (creatinine clearance [CrCl] of 15 to < 30 mL/min) for the prevention, treatment, or prophylaxis of VTE. Clinical pharmacology studies have demonstrated an increase in rivaroxaban systemic exposure, factor Xa inhibition, and prothrombin time with decreasing renal function. These changes reach a plateau with comparable increases in exposure among individuals with moderate or severe renal impairment and end-stage renal disease. The clinical development program for the treatment and prevention of VTE as well as prophylaxis of deep vein thrombosis (DVT) following orthopedic surgery excluded patients with CrCl < 30 mL/min; however, a limited number of patients with severe renal impairment were enrolled. Efficacy outcomes in these patients with severe renal impairment were not meaningfully different from those of patients with higher levels of renal function. There was also no increase in the incidence of major bleeding with rivaroxaban in patients with CrCl < 30 mL/min. Taken together, these pharmacological and clinical data suggest that in patients with severe renal impairment, the approved dosages of rivaroxaban can be used in the treatment and prevention of VTE and for prophylaxis of DVT after hip or knee replacement surgery.
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Affiliation(s)
- Albert A Volkl
- Janssen Pharmaceuticals, Inc, 1125 Trenton Harbourton Rd, Titusville, NJ, 08560, USA.
| | - Kenneth Todd Moore
- Janssen Pharmaceuticals, Inc, 1125 Trenton Harbourton Rd, Titusville, NJ, 08560, USA
| | - Lloyd Haskell
- Janssen Research & Development, LLC, Raritan, NJ, USA
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Liz-Pimenta J, Tavares V, Neto BV, Santos JMO, Guedes CB, Araújo A, Khorana AA, Medeiros R. Thrombosis and cachexia in cancer: two partners in crime? Crit Rev Oncol Hematol 2023; 186:103989. [PMID: 37061076 DOI: 10.1016/j.critrevonc.2023.103989] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/20/2023] [Accepted: 04/11/2023] [Indexed: 04/17/2023] Open
Abstract
Among cancer patients, thrombosis and cachexia are major causes of morbidity and mortality. Although the two may occur together, little is known about their possible relationship. Thus, a literature review was conducted by screening the databases PubMed, Scopus, SciELO, Medline and Web of Science. To summarize, cancer-associated thrombosis (CAT) and cancer-associated cachexia (CAC) seem to share several patient-, tumour- and treatment-related risk factors. Inflammation alongside metabolic and endocrine derangement is the potential missing link between CAT, CAC and cancer. Many key players, including specific pro-inflammatory cytokines, immune cells and hormones, appear to be implicated in both thrombosis and cachexia, representing attractive predictive markers and potential therapeutic targets. Altogether, the current evidence suggests a link between CAT and CAC, however, epidemiological studies are required to explore this potential relationship. Given the high incidence and negative impact of both diseases, further studies are needed for the better management of cancer patients.
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Affiliation(s)
- Joana Liz-Pimenta
- Department of Medical Oncology, Centro Hospitalar de Trás-os-Montes e Alto Douro, 5000-508 Vila Real, Portugal; FMUP, Faculty of Medicine, University of Porto, 4200-072 Porto, Portugal
| | - Valéria Tavares
- FMUP, Faculty of Medicine, University of Porto, 4200-072 Porto, Portugal; ICBAS, Abel Salazar Institute for the Biomedical Sciences, 4050-313 Porto, Portugal; Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP) / Pathology and Laboratory Medicine Dep., Clinical Pathology SV/ RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center (Porto.CCC), 4200-072 Porto, Portugal
| | - Beatriz Vieira Neto
- FMUP, Faculty of Medicine, University of Porto, 4200-072 Porto, Portugal; Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP) / Pathology and Laboratory Medicine Dep., Clinical Pathology SV/ RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center (Porto.CCC), 4200-072 Porto, Portugal
| | - Joana M O Santos
- FMUP, Faculty of Medicine, University of Porto, 4200-072 Porto, Portugal; Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP) / Pathology and Laboratory Medicine Dep., Clinical Pathology SV/ RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center (Porto.CCC), 4200-072 Porto, Portugal
| | - Catarina Brandão Guedes
- Department of Imunohemotherapy, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
| | - António Araújo
- Department of Medical Oncology, Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal; UMIB - Unidade Multidisciplinar de Investigação Biomédica, ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Alok A Khorana
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio 44106, United States of America
| | - Rui Medeiros
- FMUP, Faculty of Medicine, University of Porto, 4200-072 Porto, Portugal; ICBAS, Abel Salazar Institute for the Biomedical Sciences, 4050-313 Porto, Portugal; Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP) / Pathology and Laboratory Medicine Dep., Clinical Pathology SV/ RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center (Porto.CCC), 4200-072 Porto, Portugal; Research Department, Portuguese League Against Cancer - Regional Nucleus of the North, 4200-172 Porto, Portugal; Biomedical Research Center, Faculty of Health Sciences of the Fernando Pessoa University, 4249-004 Porto, Portugal.
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Handa K, Jindal R. Mitigating the nephrotoxic impact of hexavalent chromium in Ctenopharyngodon idellus (grass carp) with Boerhavia diffusa (punarnava) leaf extract. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:42399-42415. [PMID: 36648730 DOI: 10.1007/s11356-022-24931-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
In Ctenopharyngodon idellus, the ameliorative influence of rutin-containing leaf extract of Boerhavia diffusa was assessed against chronic exposure to hexavalent chromium. For this, alterations in chromium accumulation, oxidative stress, kidney function markers, histopathology (light and transmission electron microscopy), and transcriptional profiling (Nrf2 and MT2) were examined. RP-HPLC analysis confirmed the presence of rutin (90.45 ± 0.98 mg/g) in the ethanolic leaf extract of the plant. LD50 of the extract to the fish was beyond 5000 mg/kg b.w. The fish was subjected to a sublethal concentration of hexavalent chromium (5.30 mg/L) accompanied by a dose of 250 mg/kg b.w./day of extract in the diet for the experimental duration of 45 days. The extract alone did not generate any adverse consequences in the nephric tissue. Chronic exposure to hexavalent chromium damaged tissue irreparably, demonstrated by elevated levels of kidney function markers (blood urea nitrogen and creatinine) and altered histoarchitecture (DTC value of 78.02 ± 10.5). The metal exposure increased chromium accumulation and malondialdehyde (MDA) and decreased the reduced glutathione (GSH) levels, the activity of antioxidant enzymes (superoxide dismutase, catalase and glutathione-S-transferase) and gene expression in the tissue. The co-supplementation of leaf extract with metal exposure revealed a tissue architecture with normal to slight modifications, and the level of kidney markers, antioxidants, and genes expressed in a normalized range. Principal component analysis created two components with antioxidants (GSH, SOD, CAT, and GST) revealing a negative correlation with the second component comprising MDA, DTC, and chromium concentration. It can be concluded that B. diffusa leaves are safe additives in the fish diet and possess an ameliorative capacity for renal injury incurred by hexavalent chromium.
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Affiliation(s)
- Kriti Handa
- Aquatic Biology Laboratory, Department of Zoology, Panjab University, Chandigarh, 160014, India
| | - Rajinder Jindal
- Aquatic Biology Laboratory, Department of Zoology, Panjab University, Chandigarh, 160014, India.
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12
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Rimal A, Karki B, Paudel A, Pradhan UL, Bhusal KR. Pulmonary embolism in an ESRD patient following minimal venotomy and milking for salvage of dysfunctional autogenous arteriovenous fistula. Clin Case Rep 2023; 11:e7042. [PMID: 36879679 PMCID: PMC9984676 DOI: 10.1002/ccr3.7042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 02/05/2023] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Pulmonary embolism can be a complication following an attempted salvage of a dysfuctional arteriovenous fistula (AVF). We report a case of bilateral pulmonary embolism in a patient with underlying pericardial effusion who, following minimal venotomy and milking of the AVF, developed sudden and significant respiratory distress, and later improved.
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Affiliation(s)
- Ankit Rimal
- Department of Critical Care Medicine Tribhuvan University Teaching Hospital Kathmandu Nepal
| | - Bipin Karki
- Department of Critical Care Medicine Tribhuvan University Teaching Hospital Kathmandu Nepal
| | - Ashmita Paudel
- Department of Critical Care Medicine Tribhuvan University Teaching Hospital Kathmandu Nepal
| | - Utsav Lal Pradhan
- Department of Critical Care Medicine Tribhuvan University Teaching Hospital Kathmandu Nepal
| | - Kabi Raj Bhusal
- Department of Radiology Tribhuvan University Teaching Hospital Kathmandu Nepal
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13
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Risk Factors for Venous Thromboembolism in Cervical Cancer: A Retrospective Case–Control Study in Southern Thailand. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2023. [DOI: 10.1007/s40944-022-00695-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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14
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Parker K, Choudhuri S, Lewis P, Thachil J, Mitra S. UK prescribing practice of anticoagulants in patients with chronic kidney disease: a nephrology and haematology-based survey. BMC Nephrol 2023; 24:9. [PMID: 36635661 PMCID: PMC9837988 DOI: 10.1186/s12882-022-03041-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/15/2022] [Indexed: 01/14/2023] Open
Abstract
A survey to gain insight into anticoagulant prescribing practice in the setting of chronic kidney disease (CKD) across the UK was disseminated via renal and haematology networks. Areas of anticoagulant use included patients with venous thromboembolism (VTE), requiring thromboprophylaxis for VTE, Atrial Fibrillation (AF) and nephrotic syndrome.An online-survey was disseminated via British Haematology Society, UK Kidney Association, and Renal Pharmacy Group over a five month period. All responses were voluntary and anonymous.Among 117 responses there were 49 nephrology doctors, 47 renal pharmacists and 20 haematology clinicians. A specialist multidisciplinary team to discuss the specific anticoagulant management of these patients was only available to 3% (4/117) respondents. Renal function estimate used for anticoagulant dosing was mainly Cockcroft-Gault for pharmacists and haematology but lab-based estimates were used by nephrology doctors. Therapeutic dose of Low Molecular Weight Heparin was mostly likely to be reduced by one-third when used for VTE treatment, with the majority of units undertaking anti-Xa monitoring in CKD stage 5 and dialysis. Direct-acting Oral Anticoagulants are being used in patients with nephrotic syndrome, those with CKD stage 5 and on dialysis for VTE and AF in the absence of license in these indications.This survey highlighted the significant differences between anticoagulant prescribing in CKD between two professional specialties and marked variation between centres in anticoagulant management strategies employed for these patients. With gaps still existing in the evidence base and answers to these not expected within the next few years, development of a best-practice guideline would be warranted to support clinicians in this field.
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Affiliation(s)
- Kathrine Parker
- grid.498924.a0000 0004 0430 9101Manchester Institute of Nephrology and Transplantation, Manchester University NHS Foundation Trust, Oxford Road, M13 9WL Manchester, UK ,grid.5379.80000000121662407Division of pharmacy and optometry, School of health sciences, Manchester Academic Health Science Centre, The University of Manchester, University of Manchester, M13 9PT Manchester, UK
| | - Satarupa Choudhuri
- grid.416187.d0000 0004 0400 8130Department of Haematology, Northern Care Alliance NHS Foundation Trust, Royal Oldham hospital, Rochdale Rd, OL1 2JH Oldham, UK
| | - Penny Lewis
- grid.5379.80000000121662407Division of pharmacy and optometry, School of health sciences, Manchester Academic Health Science Centre, The University of Manchester, University of Manchester, M13 9PT Manchester, UK
| | - Jecko Thachil
- grid.498924.a0000 0004 0430 9101Department of Haematology, Manchester University NHS Foundation Trust, Oxford Road, M13 9WL Manchester, UK
| | - Sandip Mitra
- grid.498924.a0000 0004 0430 9101Manchester Institute of Nephrology and Transplantation, Manchester University NHS Foundation Trust, Oxford Road, M13 9WL Manchester, UK ,grid.5379.80000000121662407Division of cardiovascular sciences, School of medical sciences, The University of Manchester, M13 9NT Manchester, UK
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15
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Preoperative risk factors for deep vein thrombosis in knee osteoarthritis patients undergoing total knee arthroplasty. J Orthop Sci 2023; 28:180-187. [PMID: 34716065 DOI: 10.1016/j.jos.2021.09.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND To analyze the risk factors for preoperative deep vein thrombosis (DVT) in knee osteoarthritis (OA) patients undergoing total knee arthroplasty (TKA). METHODS In this retrospective study, a total of 584 knee OA patients undergoing TKA were enrolled. General information, medical records and preoperative laboratory examination results of the patients were collected. According to the results of Doppler ultrasonography for the lower extremities, the patients were divided into DVT group and non-DVT group. Univariate and multivariate logistic regression were used to identify independent risk factors for preoperative DVT in knee OA patients undergoing TKA. RESULTS The incidence of DVT before TKA was 6.85% (40 cases). The increase of ESR (Erythrocyte Sedimentation Rate), platelet crit, IL-6 (Interleukin-6), and PCT (Procalcitonin) were associated with the development of DVT before TKA. Factors as coronary heart disease (CHD), diabetes mellitus (DM), Chronic Kidney Disease (CKD), NLR (ratio of neutrophils to lymphocytes), lower limb venous blood stasis, the time from onset to admission, RBC, PLT were identified by multivariate logistic regression to be the independent risk factors for preoperative DVT in knee OA patients undergoing TKA. CONCLUSIONS DM, CKD, CHD, increased in ESR, IL-6 and PCT, blood stasis of the lower extremities, increased in PLT, platelet crit and the time from onset to admission, decreased in RBC, were high risk factors for preoperative DVT in knee OA patients undergoing TKA.
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16
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Bluvshtein V, Catz A, Mahamid A, Elkayam K, Michaeli D, Front L, Kfir A, Gelernter I, Aidinoff E. Venous thromboembolism and anticoagulation in spinal cord lesion rehabilitation inpatients: A 10-year retrospective study. NeuroRehabilitation 2023; 53:143-153. [PMID: 37424485 PMCID: PMC10473086 DOI: 10.3233/nre-230063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/08/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a concern following the onset of spinal cord lesions (SCL). OBJECTIVES To assess the current efficacy and risks of anticoagulation after SCL and consider changes in thromboprophylaxis. METHODS This retrospective cohort study included individuals admitted to inpatient rehabilitation within 3 months of SCL onset. Main outcome measures were the incidence of deep vein thrombosis (DVT), pulmonary embolism (PE), bleeding, thrombocytopenia, or death, which occurred within 1 year of the SCL onset. RESULTS VTE occurred in 37 of the 685 patients included in the study (5.4%, 95% CI 3.7-7.1%, 2.8% PE), and in 16 of 526 patients who received prophylactic anticoagulation at rehabilitation (3%, 95% CI 1.6-4.5%, 1.1% PE, with at least 1 fatality). Of these 526, 1.3% developed clinically significant bleeding and 0.8% thrombocytopenia. Prophylactic anticoagulation, most commonly 40 mg/day, continued until a median period of 6.4 weeks after SCL onset (25% -75% percentiles 5.8-9.7), but in 29.7%, VTE occurred more than 3 months after SCL onset. CONCLUSION The VTE prophylaxis used for the present cohort contributed to a considerable but limited reduction of VTE incidence. The authors recommend conducting a prospective study to assess the efficacy and safety of an updated preventive anticoagulation regimen.
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Affiliation(s)
- Vadim Bluvshtein
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amiram Catz
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ala Mahamid
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
| | - Keren Elkayam
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
| | - Dianne Michaeli
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
| | - Lilach Front
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
| | - Adi Kfir
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
| | - Ilana Gelernter
- School of Mathematical Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Elena Aidinoff
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Intensive Care for Consciousness Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
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17
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Asymptomatic pulmonary thromboembolism due to hemodialisys catheter thrombosis: case series and literature review. CEN Case Rep 2022. [PMID: 36574198 PMCID: PMC10393924 DOI: 10.1007/s13730-022-00757-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Right atrial thrombus is commonly associated to catheters. Catheter-related right atrial thrombus (CRAT) in hemodialysis patients frequently presents as pulmonary embolism. Although CRAT is sometimes asymptomatic, even in these cases it is associated with worse prognosis. The management strategy for CRAT is not well established, however, along with catheter removal, anticoagulation, thrombolysis, and surgical thrombectomy may be performed. Suspicion of asymptomatic pulmonary embolism associated to CRAT is important in order to perform proper treatment. The authors of this article report two cases of asymptomatic pulmonary thromboembolism due to CRAT in hemodialysis patients and perform a review of the literature.
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18
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Knueppel P, Bang SH, Troyer C, Barriga A, Shin J, Cadiz CL, Abdo C, McCart T, Huynh B, Stevens C, Zhou C, Yang NT, Wilson M, Pon T. Evaluation of standard versus reduced dose apixaban for the treatment of venous thromboembolism in patients with severe renal disease (ESRD-VTE). Thromb Res 2022; 220:91-96. [PMID: 36306678 PMCID: PMC9850596 DOI: 10.1016/j.thromres.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/10/2022] [Accepted: 10/21/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND There are no clear dosing recommendations when using apixaban for venous thromboembolism (VTE) treatment in patients with severe or end-stage renal disease; clinical trials excluded patients with a creatinine clearance (CrCl) <25 mL/min or on dialysis. This study compares bleeding rates in patients with severe or end-stage renal disease taking standard versus reduced dose apixaban for VTE treatment. MATERIALS AND METHODS This was a multicenter, retrospective cohort study using electronic medical records between January 1, 2013, and August 31, 2021. This study included patients 18 years or older who had severe or end-stage renal disease when prescribed apixaban for VTE treatment. Severe or end-stage renal disease was defined as at least one of the following: CrCl <25 mL/min, SCr >2.5 mg/dL, CKD stage 4 or 5, or on dialysis. The primary endpoint was rate of clinically relevant bleeding within six months of starting apixaban. Secondary endpoints were VTE recurrence within six months of starting apixaban, time to clinically relevant bleed, and time to VTE recurrence. RESULTS A total of 203 patients were included in the final analysis (n = 125 on 5 mg; n = 78 on 2.5 mg). Clinically relevant bleeding rate was significantly higher in the standard dose group (14.4 % vs 3.8 %, p = 0.02). Rates of VTE recurrence appear similar (6.4 % vs 7.7 %, p = 0.21). CONCLUSIONS A reduced dose of apixaban may be considered when treating VTE in patients with severe or end-stage renal disease.
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Affiliation(s)
- Parker Knueppel
- University of California, Davis Health, 2420 Stockton Blvd, Ste 2000, Sacramento, CA 95817, USA.
| | - Seo Hyoun Bang
- University of California, San Diego Health, 200 W Arbor Dr, San Diego, CA 92103, USA.
| | - Camille Troyer
- University of California, San Francisco Health, 521 Parnassus Ave, Rm 3304, San Francisco, CA 94143, USA.
| | - Alyssa Barriga
- University of California, Irvine School of Pharmacy & Pharmaceutical Sciences, 515 Bison Modular 147C, Irvine, CA 92697, USA.
| | - Jaekyu Shin
- University of California, San Francisco Health, 521 Parnassus Ave, Rm 3304, San Francisco, CA 94143, USA.
| | - Christine L Cadiz
- University of California, Irvine School of Pharmacy & Pharmaceutical Sciences, 515 Bison Modular 147C, Irvine, CA 92697, USA.
| | - Connie Abdo
- University of California, Irvine School of Pharmacy & Pharmaceutical Sciences, 515 Bison Modular 147C, Irvine, CA 92697, USA.
| | - Taylor McCart
- University of California, San Francisco Health, 521 Parnassus Ave, Rm 3304, San Francisco, CA 94143, USA.
| | - Brittany Huynh
- University of California, San Francisco Health, 521 Parnassus Ave, Rm 3304, San Francisco, CA 94143, USA.
| | - Craig Stevens
- University of California, San Diego Health, 200 W Arbor Dr, San Diego, CA 92103, USA.
| | - Crystal Zhou
- University of California, San Francisco Health, 521 Parnassus Ave, Rm 3304, San Francisco, CA 94143, USA.
| | - Nuen Tsang Yang
- University of California, Davis Health, 2420 Stockton Blvd, Ste 2000, Sacramento, CA 95817, USA.
| | - Machelle Wilson
- University of California, Davis Health, 2420 Stockton Blvd, Ste 2000, Sacramento, CA 95817, USA.
| | - Tiffany Pon
- University of California, Davis Health, 2420 Stockton Blvd, Ste 2000, Sacramento, CA 95817, USA; University of California, San Francisco Health, 521 Parnassus Ave, Rm 3304, San Francisco, CA 94143, USA.
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19
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Shi B, Zhang R, Song C, Cui K, Zhang D, Dong Q, Jia L, Yin D, Wang H, Dou KF, Song W. Novel subgroups of patients with left ventricular thrombus and their differential effects with anticoagulation: a data-driven cluster analysis (Preprint). J Med Internet Res 2022. [PMID: 36446627 DOI: 10.2196/42909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
UNSTRUCTURED Ahead of Print article withdrawn by the publisher.
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Affiliation(s)
- Boqun Shi
- Cardiometabolic Medicine Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, CN
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, CN
- State Key Laboratory of Cardiovascular Disease, Beijing, CN
| | - Rui Zhang
- Cardiometabolic Medicine Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, CN
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, CN
- State Key Laboratory of Cardiovascular Disease, Beijing, CN
| | - Chenxi Song
- Cardiometabolic Medicine Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, CN
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, CN
- State Key Laboratory of Cardiovascular Disease, Beijing, CN
| | - Kongyong Cui
- Cardiometabolic Medicine Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, CN
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, CN
- State Key Laboratory of Cardiovascular Disease, Beijing, CN
| | - Dong Zhang
- Cardiometabolic Medicine Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, CN
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, CN
- State Key Laboratory of Cardiovascular Disease, Beijing, CN
| | - Qiuting Dong
- Cardiometabolic Medicine Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, CN
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, CN
- State Key Laboratory of Cardiovascular Disease, Beijing, CN
| | - Lei Jia
- Cardiometabolic Medicine Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, CN
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, CN
- State Key Laboratory of Cardiovascular Disease, Beijing, CN
| | - Dong Yin
- Cardiometabolic Medicine Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, CN
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, CN
- State Key Laboratory of Cardiovascular Disease, Beijing, CN
| | - Hongjian Wang
- Cardiometabolic Medicine Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, CN
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, CN
- State Key Laboratory of Cardiovascular Disease, Beijing, CN
| | - Ke-Fei Dou
- Cardiometabolic Medicine Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, CN
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, CN
- State Key Laboratory of Cardiovascular Disease, Beijing, CN
| | - Weihua Song
- Cardiometabolic Medicine Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, No.167 North Lishi Road, Xicheng District, Beijing, CN
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, CN
- State Key Laboratory of Cardiovascular Disease, Beijing, CN
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Messi M, Beneyto Afonso C, Stalder O, Méan M, Righini M, Rodondi N, Aujesky D. Long-term clinical outcomes in older patients with acute venous thromboembolism who have renal impairment. Thromb Res 2022; 218:64-71. [PMID: 35994838 DOI: 10.1016/j.thromres.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/27/2022] [Accepted: 08/02/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Renal impairment (RI) may induce an inflammatory/procoagulant state as well as platelet dysfunction. Little is known on the prevalence of RI and long-term prognosis of older patients with venous thromboembolism (VTE) who have concomitant RI. METHODS In a prospective multicenter cohort, we analyzed 912 patients aged ≥65 years with acute VTE. Using the CKD-EPI formula, we defined three categories of baseline renal function: estimated glomerular filtration rate ≥60 ml/min/1.73m2 (no RI), 30-59 ml/min/1.73m2 (moderate RI), and <30 ml/min/1.73m2 (severe RI). The outcomes were VTE recurrence, major bleeding, and overall mortality. We examined the association between renal function and clinical outcomes using competing risk regression models, adjusting for relevant confounders and periods of anticoagulation. RESULTS We followed 912 patients over a median duration of 29.6 months. Overall, 313 (34%) patients had moderate and 51 (6%) severe RI. One hundred and seven patients (12%) had VTE recurrence, 125 (14%) had major bleeding, and 186 (20%) died during follow-up. After adjustment, severe RI was associated with a 2-fold increased risk of major bleeding (sub-hazard ratio [SHR] 2.1, 95% CI 1.1-4.0) compared to no RI, but not with VTE recurrence (SHR 0.6, 95% CI 0.2-1.8) or overall mortality (hazard ratio 1.0, 95% CI 0.6-1.9). Moderate RI was not significantly associated with adverse clinical outcomes. CONCLUSIONS RI was common among older patients with acute VTE. Severe RI was associated with a 2-fold increased long-term risk of major bleeding, without a risk increase in terms of VTE recurrence and overall mortality. Older patients with moderate RI did not carry worse prognosis.
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Affiliation(s)
- Mia Messi
- Department of General Internal Medicine, Bern University Hospital and University of Bern, Freiburgstrasse 18, 3010 Bern, Bern, Switzerland.
| | - Carlota Beneyto Afonso
- Department of General Internal Medicine, Bern University Hospital and University of Bern, Freiburgstrasse 18, 3010 Bern, Bern, Switzerland.
| | - Odile Stalder
- CTU Bern, University of Bern, Mittelstrasse 43, 3012 Bern, Bern, Switzerland.
| | - Marie Méan
- Department of General Internal Medicine, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Vaud, Switzerland.
| | - Marc Righini
- Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Geneva, Switzerland.
| | - Nicolas Rodondi
- Department of General Internal Medicine, Bern University Hospital and University of Bern, Freiburgstrasse 18, 3010 Bern, Bern, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Bern, Switzerland.
| | - Drahomir Aujesky
- Department of General Internal Medicine, Bern University Hospital and University of Bern, Freiburgstrasse 18, 3010 Bern, Bern, Switzerland.
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Regmi S, Manandhar D, Pyakurel S, Shrestha B, Khanal P, Paudel S, Gyawali P. Central Venous Catheter-related Thrombosis in a Dialysis Patient: A Case Report. JNMA J Nepal Med Assoc 2022; 60:648-650. [PMID: 36705189 PMCID: PMC9297364 DOI: 10.31729/jnma.7603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 06/25/2022] [Indexed: 01/31/2023] Open
Abstract
Hemodialysis is one of the treatment modalities for advanced kidney disease and can help an individual live an active life despite failing kidneys. Although it improves the quality of life, it is not completely risk-free. It has several complications, among which, thrombus formation is common. We report a case of a 63-year-old man who presented at our institution for regular hemodialysis with recurrent arteriovenous graft failure. Because doppler ultrasound is a non-invasive procedure that can identify a thrombus in a vein, it is the best initial option for patients with internal jugular vein thrombosis. The use of ultrasound not only can guide a catheter pathway but can also help in early diagnosis and prevent complications following catheterization in a vein with a thrombus. Keywords central venous catheterization; chronic kidney disease; hemodialysis; thrombus.
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Affiliation(s)
- Sachit Regmi
- Nepal Mediciti Hospital, Karyabinayak, Lalitpur, Nepal,Correspondence: Dr Sachit Regmi, Nepal Mediciti Hospital, Karyabinayak, Lalitpur, Nepal. , Phone: +977-9849192172
| | - Dilasha Manandhar
- Nepal Medical College and Teaching Hospital, Jorpati, Kathmandu, Nepal
| | | | - Bibek Shrestha
- Om Hospital and Research Center, Pvt. Ltd., Chabahil, Kathmandu, Nepal
| | - Pitamber Khanal
- Patan Academy of Health Sciences, Lagankhel, Lalitpur, Nepal
| | - Sandip Paudel
- Patan Academy of Health Sciences, Lagankhel, Lalitpur, Nepal
| | - Pawan Gyawali
- Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
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22
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Wetmore JB, Herzog CA, Yan H, Reyes JL, Weinhandl ED, Roetker NS. Apixaban versus Warfarin for Treatment of Venous Thromboembolism in Patients Receiving Long-Term Dialysis. Clin J Am Soc Nephrol 2022; 17:693-702. [PMID: 35470214 PMCID: PMC9269579 DOI: 10.2215/cjn.14021021] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 03/04/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES The association of apixaban compared with warfarin for the treatment of venous thromboembolism in patients receiving maintenance dialysis is not well studied. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a retrospective cohort study of Medicare fee-for-service beneficiaries receiving dialysis using United States Renal Data System data from 2013 to 2018. The study included patients who received a new prescription for apixaban or warfarin following a venous thromboembolism diagnosis. The outcomes were recurrent venous thromboembolism, major bleeding, and death. Outcomes were analyzed using Cox proportional hazards regression for intention-to-treat and censored-at-drug-switch-or-discontinuation analyses. Models incorporated inverse probability of treatment and censoring weights to minimize confounding and informative censoring. RESULTS In 12,206 individuals, apixaban, compared with warfarin, was associated with lower risks of both recurrent venous thromboembolism (hazard ratio [HR], 0.58; 95% confidence interval [95% CI], 0.43 to 0.77) and major bleeding (HR, 0.78; 95% CI, 0.62 to 0.98) in the intention-to-treat analysis over 6 months of follow-up. However, there was no difference between apixaban and warfarin in terms of risk of all-cause death (HR, 1.04; 95% CI, 0.94 to 1.16). Corresponding hazard ratios for the 6-month censored-at-drug-switch-or-discontinuation analysis and for corresponding analyses limited to a shorter (3-month) follow-up were all highly similar to the primary analysis. CONCLUSIONS In a large group of US patients on dialysis with recent venous thromboembolism, we observed that apixaban was associated with lower risk of recurrent venous thromboembolism and of major bleeding than warfarin. There was no observed difference in mortality.
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Affiliation(s)
- James B Wetmore
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota .,Division of Nephrology, Hennepin Healthcare and Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Charles A Herzog
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota.,Division of Cardiology, Hennepin Healthcare, and Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Heng Yan
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
| | - Jorge L Reyes
- Division of Cardiology, University of Minnesota, Minneapolis, Minnesota
| | - Eric D Weinhandl
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota.,Department of Pharmaceutical Care and Health Systems, University of Minnesota, Minneapolis, Minnesota
| | - Nicholas S Roetker
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
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Roncati L, Manenti A, Corsi L. A Three-Case Series of Thrombotic Deaths in Patients over 50 with Comorbidities Temporally after modRNA COVID-19 Vaccination. Pathogens 2022; 11:pathogens11040435. [PMID: 35456110 PMCID: PMC9032304 DOI: 10.3390/pathogens11040435] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/29/2022] [Accepted: 04/02/2022] [Indexed: 01/04/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is the most dramatic pandemic of the new millennium; to counteract it, specific vaccines have been launched in record time under emergency use authorization or conditional marketing authorization by virtue of a favorable risk/benefit balance. Among the various technological platforms, there is that exploiting a nucleoside-modified messenger RNA (modRNA), such as Comirnaty®, and that which is adenoviral vector-based. In the ongoing pharmacovigilance, the product information of the latter has been updated about the risk of thrombotic thrombocytopenia, venous thromboembolism without thrombocytopenia and immune thrombocytopenia without thrombosis. However, from an in-depth literature review, the same adverse events can rarely occur with modRNA vaccines too. In support of this, we here report a three-case series of thrombotic deaths in patients over 50 with comorbidities temporally after Comirnaty®, investigated by means of post-mortem histopathology and immunohistochemistry. In two out of three cases, the cause of death is traced back to pulmonary microthromboses rich in activated platelets, quite similar morphologically to those described in patients who died from severe COVID-19. Even if remote in the face of millions of administered doses, clinicians should be aware of the possible thrombotic risk also after Comirnaty®, in order to avoid a misdiagnosis with potentially lethal consequences. Since COVID-19 vaccines are inoculated in subjects to be protected, maximum attention must be paid to their safety, and prophylactic measures to increase it are always welcome. In light of the evidence, the product information of modRNA COVID-19 vaccines should be updated about the thrombotic risk, as happened for adenoviral vector-based vaccines.
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Affiliation(s)
- Luca Roncati
- Institute of Pathology, Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplantation, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy
- Correspondence: or or
| | - Antonio Manenti
- Unit of Surgery, Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplantation, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Lorenzo Corsi
- Department of Life Sciences, Section of Pharmacology, University of Modena and Reggio Emilia, 41125 Modena, Italy;
- National Institute of Biostructures and Biosystems, Inter-University Consortium, 00136 Rome, Italy
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25
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Elevated Risk of Venous Thromboembolism in People Living with HIV. Viruses 2022; 14:v14030590. [PMID: 35336997 PMCID: PMC8955815 DOI: 10.3390/v14030590] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/06/2022] [Indexed: 11/16/2022] Open
Abstract
Human immunodeficiency virus (HIV) has been generally considered as a highly adaptive and rapidly evolving virus. It still constitutes a major public health problem all over the world despite an effective outcome in the prevention and reversal of the development and prognosis by using antiretroviral therapy. The salient question lies in the more frequent emergence of a series of comorbidities along with the prolongation of the life, which deeply affects the survival in such group. Venous thromboembolism (VTE) has been recognized to be the third most common cardiovascular condition within people living with HIV (PWH). In terms of its mechanism of action, the occurrence of VTE is quite multifactorial and complex in HIV. Prior exploration concerning the etiology of VTE in PWH identifies general, disease-specific, and miscellaneous factors for explaining its occurrence and development. VTE has constituted an important role in PWH and may increase its all-cause mortality. Therefore, it is quite necessary to understand VTE from the following aspects of epidemiology, pathophysiology, molecular mechanisms, and therapeutic interventions so as to balance the risks and benefits of anticoagulation and optimize corresponding treatment.
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26
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Dzhioeva ON, Orlova AA, Rogozhkina EA, Drapkina OM. Venous thromboembolic complications in patients with chronic kidney disease: prevalence and features of drug treatment. TERAPEVT ARKH 2022; 94:129-134. [DOI: 10.26442/00403660.2022.01.201358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 11/22/2022]
Abstract
The article is an opinion on the problem of venous thromboembolic (VTE) complications in patients with chronic kidney disease (CKD), which is significant and urgent for Russia. Signs of CKD are noted in more than 1/3 of patients with chronic heart failure; a decrease in kidney function is observed in 36% of people over the age of 60, in people of working age, a decrease in function is noted in 16% of cases, and in the presence of cardiovascular diseases increases to 26%. Clinical research data convincingly show that CKD is an independent risk factor for the development of VTE complications. The last decade has given us the opportunity to observe a kind of "revolution" in VTE therapy, which is associated with the appearance on the market of direct oral anticoagulants, including inhibitors of factor IIa (thrombin) and factor Xa. These drugs are approved by the Food and Drug Administration for the treatment of acute thromboembolism. Nevertheless, patients with severe CKD (estimated glomerular filtration rate 30 ml/min) are still limited to the use of unfractionated heparin and vitamin K antagonists, as there is insufficient data to support the use of direct oral anticoagulants in this population.
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27
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Omur S, Zorlu C, Koseoglu C. Evaluation of CHA 2DS 2-VASc score and R 2CHADS 2 score in patients with acute pulmonary thromboembolism and right ventricular dysfunction. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2022. [DOI: 10.4103/ijca.ijca_42_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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28
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Akbari A, Kunkel E, Bota SE, Harel Z, Le Gal G, Cox C, Hundemer GL, Canney M, Clark E, Massicotte-Azarniouch D, Eddeen AB, Knoll G, Sood MM. Proteinuria and venous thromboembolism in pregnancy: a population-based cohort study. Clin Kidney J 2021; 14:2101-2107. [PMID: 34671466 PMCID: PMC8521786 DOI: 10.1093/ckj/sfaa278] [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] [Received: 11/30/2020] [Accepted: 12/28/2020] [Indexed: 11/14/2022] Open
Abstract
Background Pregnancy-associated venous thromboembolism (VTE) is associated with high morbidity and mortality. Identification of risk factors of VTE may lead to improved maternal and foetal outcomes. Proteinuria confers a pro-thrombotic state, however, its association with VTE in pregnancy remains unknown. We set out to assess the association of proteinuria and VTE during pregnancy. Methods We conducted a population-based, retrospective cohort study of all pregnant women (≥16 years of age) with a proteinuria measure within 20 weeks of conception (n = 306 244; mean age 29.8 years) from Ontario, Canada. Proteinuria was defined by any of the following: urine albumin:creatinine ratio ≥3 mg/mmol, urine protein:creatinine ratio ≥5 mg/mmol or urine dipstick proteinuria ≥1. The main outcome measure was a diagnosis of VTE up to 24-weeks post-partum. Results A positive proteinuria measurement occurred in 8508 (2.78%) women and was more common with a history of kidney disease, gestational or non-gestational diabetes mellitus and hypertension. VTE events occurred in 625 (0.20%) individuals, with a higher risk among women with positive proteinuria [32 events (0.38%)] compared with women without proteinuria [593 events (0.20%); inverse probability-weighted risk ratio 1.79 (95% confidence interval 1.25-2.57)]. The association was consistent using a more specific VTE definition, in the post-partum period, in high-risk subgroups (hypertension or diabetes) and when the sample was restricted to women with preserved kidney function. Conclusions The presence of proteinuria in the first 20 weeks of pregnancy is associated with a significantly higher risk of VTE.
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Affiliation(s)
- Ayub Akbari
- Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | | | - Ziv Harel
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Gregoire Le Gal
- Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Conor Cox
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Gregory L Hundemer
- Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Mark Canney
- Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Edward Clark
- Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | | | - Greg Knoll
- Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada.,ICES, Toronto, ON, Canada
| | - Manish M Sood
- Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada.,ICES, Toronto, ON, Canada
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29
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Tung IM, Barlas RS, Vart P, Bettencourt-Silva JH, Clark AB, Sawanyawisuth K, Kongbunkiat K, Kasemsap N, Tiamkao S, Myint PK. Association of chronic kidney disease with outcomes in acute stroke. Acta Neurol Belg 2021; 121:1241-1246. [PMID: 32661738 PMCID: PMC8443515 DOI: 10.1007/s13760-020-01416-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 06/29/2020] [Indexed: 12/31/2022]
Abstract
Previous studies have found an association between chronic kidney disease and poor outcomes in stroke patients. However, there is a paucity of literature evaluating this association by stroke type. We therefore aimed to explore the association between CKD and stroke outcomes according to type of stroke. The data consisting of 594,681 stroke patients were acquired from Universal Coverage Health Security Insurance Scheme Database in Thailand. Binary logistic regression was used to assess the relationship of CKD and outcomes, which were as follows; in-hospital mortality, long length of stay (>3 days), pneumonia, sepsis, respiratory failure and myocardial infarction. Results: after fully adjusting for covariates, CKD was associated with increased odds of in-hospital mortality in patients with ischemic (OR 1.32; 95% CI = 1.27–1.38), haemorrhagic (OR 1.31; 95% CI = 1.24–1.39), and other undetermined stroke type (OR 1.44; 95% CI = 1.21–1.73). CKD was found to be associated with increased odds of pneumonia, sepsis, respiratory failure and myocardial infarction in ischaemic stroke. While CKD was found to be associated with increase odds of sepsis, respiratory failure, and myocardial infarction, decrease odds of pneumonia was observed in patients with haemorrhagic stroke. In other undetermined stroke type, CKD was found to only be associated with increase odds of sepsis and respiratory failure, while there is no significant association of CKD and increase or decrease odds with pneumonia and myocardial infarction. CKD was associated with poor outcomes in all stroke types. CKD should be considered as part of stroke prognosis as well as identifying at risk patient population for in-hospital complications.
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30
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Starr JA, Pinner NA, Mannis M, Stuart MK. A Review of Direct Oral Anticoagulants in Patients With Stage 5 or End-Stage Kidney Disease. Ann Pharmacother 2021; 56:691-703. [PMID: 34459281 DOI: 10.1177/10600280211040093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the role of oral anticoagulation in patients with stage 5 chronic kidney disease (CKD-5) or end-stage kidney disease (ESKD). DATA SOURCES A literature search of PubMed (January 2000 to July 1, 2021), the Cochrane Library, and Google Scholar databases (through April 1, 2021) was performed with keywords DOAC (direct-acting oral anticoagulant) OR NOAC or dabigatran OR rivaroxaban OR apixaban OR edoxaban AND end-stage kidney disease combined with atrial fibrillation (AF) or venous thromboembolism (VTE) OR pulmonary embolism OR deep-vein thrombosis. STUDY SELECTION AND DATA EXTRACTION Case-control, cohort, and randomized controlled trials comparing DOACs to an active control for AF or VTE in patients with CKD-5 or ESKD and reporting outcomes of stroke, recurrent thromboembolism, or major bleeding were included. DATA SYNTHESIS Nine studies were included. Efficacy data supporting routine use of warfarin or DOACs in CKD-5 or ESKD are limited. Rivaroxaban and apixaban may provide enhanced safety compared to warfarin in patients with AF. Data for VTE are limited to 1 retrospective study. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE Because of the paucity of rigorous, prospective studies in CKD-5 or ESKD, OACs should not be broadly used in this population. It is clear that data regarding efficacy of DOACs cannot be reliably and safely extrapolated from the non-ESKD population. Therefore, use of OACs in this population should be individualized. CONCLUSIONS If OACs for stroke prevention with AF are deemed necessary, apixaban or rivaroxaban can be considered. DOACs cannot currently be recommended over warfarin in patients with CKD-5 or ESKD and VTE.
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Mouyen T, Manigold T, Collet JP, Durand E, Barbey C, Lhermusier T, Tchetche D, Chollet T, Mulliez A, Motreff P, Combaret N, Souteyrand G. Transcatheter aortic valve thrombosis: Data from a French multicenter cohort analysis. Catheter Cardiovasc Interv 2021; 98:352-362. [PMID: 33615701 DOI: 10.1002/ccd.29555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 02/02/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To evaluate the effectiveness of anticoagulant therapies in patients with clinical transcatheter heart valve (THV) thrombosis, to describe complications, and to assess their risk profile was the objectives. BACKGROUND Little research has been conducted on clinical THV thrombosis. METHODS Patients with clinical THV thrombosis were identified based on greater than 50% increased transvalvular gradient on transthoracic echocardiogram confirmed by 4-dimensional computed tomography, transesophageal echocardiogram, or regression with anticoagulant therapy. A cohort free from thrombosis for more than 1,100 days postprocedure was used for comparison. RESULTS Fifty-four patients with clinical THV thrombosis were identified. Most subjects (98.1%) received anticoagulant therapy which was effective (≥50% reduction in transvalvular gradient or return to postprocedure value) in 96%. The rate of serious hemodynamic or embolic complications in the thrombosis population was 31.5%. A multivariate analysis of subjects with and without thrombosis indicated a significantly increased risk of thrombosis from preexisting thrombocytopenia (odds ratio [OR] 9.96), absence of predilatation (OR = 5.67), renal insufficiency (OR = 4.84), and >10 mmHg mean transvalvular gradient postprocedure (OR = 3.36). No recurrence of thrombosis was identified during on average 685 days follow-up. CONCLUSIONS These data, from one of the largest cohorts with clinical THV thrombosis confirm anticoagulants appear effective. The rate of serious associated complications was high. The findings underline the importance of recognizing risk factors for thrombosis.
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Affiliation(s)
- Thomas Mouyen
- Department of Cardiology, CHU Clermont-Ferrand, CNRS UMR 6602, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Thibaut Manigold
- CHU Guillaume et René Laennec, Institut du Thorax, Service de Cardiologie, Nantes, France
| | | | - Eric Durand
- CHU Rouen-Charles-Nicolle, Service de Cardiologie, Rouen, France
| | | | - Thibault Lhermusier
- CHU de Toulouse, Département de Cardiologie, Inserm U1048, Université de Toulouse 3, Toulouse, France
| | - Didier Tchetche
- Clinique Pasteur, Groupe Cardiovasculaire Interventionnel, Toulouse, France
| | - Thomas Chollet
- Clinique Pasteur, Groupe Cardiovasculaire Interventionnel, Toulouse, France
| | - Aurélien Mulliez
- Direction de la Recherche Clinique et de l'Innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Pascal Motreff
- Department of Cardiology, CHU Clermont-Ferrand, CNRS UMR 6602, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Nicolas Combaret
- Department of Cardiology, CHU Clermont-Ferrand, CNRS UMR 6602, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Géraud Souteyrand
- Department of Cardiology, CHU Clermont-Ferrand, CNRS UMR 6602, Université Clermont Auvergne, Clermont-Ferrand, France
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Tohme S, Vancheswaran A, Mobbs K, Kydd J, Lakhi N. Predictable Risk Factors of Upper-Extremity Deep Venous Thrombosis in a Level I Trauma Center. Int J Gen Med 2021; 14:2637-2644. [PMID: 34177272 PMCID: PMC8219299 DOI: 10.2147/ijgm.s311669] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/19/2021] [Indexed: 12/14/2022] Open
Abstract
Background Venous thromboembolism is a common cause of morbidity and mortality in hospital patients, especially that of the lower extremities. Risk factors and diagnostic elements of upper-extremity deep-vein thrombosis (UEDVT) are poorly understood compared to those of the lower extremities. The primary objectives of this study were to identify predictive risk factors of secondary UEDVT. Methods This retrospective study included all nonpregnant patients aged >18 years who had undergone upper-extremity duplex scans to check for the presence of secondary UEDVT at Richmond University Medical Center from January 2014 to March 2020. Patients were stratified by presence or absence of UEDVT. Collected data points included patient demographics, comorbidities, central-line use, platelet count at time of scan, length of stay, and overall mortality. IBM 27.0 was used for all statistical analysis, with p<0.05 considered significant. Results A total of 1,009 upper extremity venous duplex studies were included. There were no significant differences in age, sex, race, or mean platelet levels between patients diagnosed with DVT and those without (p<0.05). After multinomial regression analysis, central venous catheter (CVC; 26.8% versus 78.5%, aOR 1.770, 95% CI 1.150–2.725; p<0.002), peripherally inserted central catheter (PICC) line (17.5% versus 82.5%, aOR3.254, 95% CI 1.997–5.304; p<0.001), hypertension (67.8% versus 28.8%, aOR 1.641, 95% CI 1.136–2.369; p<0.001), chronic kidney disease (CKD; 34.5% versus 65.5%, aOR 1.743, 95% CI 1.201–2.531; p<0.001), and malignancy (27.1% versus 74.6%, aOR 1.475, 95% CI 0.994–2.190; p<0.053) were found to be independent predictors of UEDVT. Conclusion Use of CVC or PICC line, preexisting diagnosis of hypertension, malignancy, and CKD were independent risk factors of UEDVT, while there was no significant correlation between increased platelet levels and UEDVT.
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Affiliation(s)
- Scarlett Tohme
- New York Medical College, School of Medicine, Department of Surgery, New York, NY, USA
| | - Aparna Vancheswaran
- New York Medical College, School of Medicine, Department of Surgery, New York, NY, USA
| | - Kyle Mobbs
- New York Medical College, School of Medicine, Department of Surgery, New York, NY, USA
| | - Jessica Kydd
- Richmond University, Medical Center, Department of Trauma Surgery, Staten Island, NY, USA
| | - Nisha Lakhi
- New York Medical College, School of Medicine, Department of Surgery, New York, NY, USA.,Richmond University, Medical Center, Department of Trauma Surgery, Staten Island, NY, USA
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33
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Singh J, Khadka S, Solanki D, Kichloo A, Shah H, Vyas MJ, Chugh S, Patel N, Solanki S. Pulmonary embolism in chronic kidney disease and end-stage renal disease hospitalizations: Trends, outcomes, and predictors of mortality in the United States. SAGE Open Med 2021; 9:20503121211022996. [PMID: 34158942 PMCID: PMC8182212 DOI: 10.1177/20503121211022996] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/18/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND It is well-known that patients with chronic kidney disease and end-stage renal disease are at increased risk of pulmonary embolism than patients with normal kidney function. However, the data on trends, outcomes, and predictors of mortality in pulmonary embolism patients with chronic kidney disease and end-stage renal disease in the United States are limited. METHODS We queried the National Inpatient Sample database from 2010 to 2014. International Classification of Diseases-Ninth Revision-Clinical Modification codes were used to identify patients with normal kidney function, chronic kidney disease, and end-stage renal disease. The frequency of pulmonary embolism, complications, in-hospital mortality, and length of stay were calculated for each cohort. Multivariable logistic regression models were constructed to determine the predictors of mortality. RESULTS In the study population (2010-2014), there were 766,176 pulmonary embolism hospitalizations with normal kidney function, 79,824 with chronic kidney disease, and 9147 with end-stage renal disease. Among the study cohorts, the mortality rate was 2.7% in normal kidney function, 4.5% in chronic kidney disease, and 6.8% in end-stage renal disease hospitalizations. Median length of stay was highest in the end-stage renal disease cohort and lowest in the normal kidney function cohort. After adjusting for confounders, pulmonary embolism patients with chronic kidney disease died 1.15 times more often than those with normal kidney function and pulmonary embolism patients with end-stage renal disease died 4.2 times more often than those with normal kidney function. CONCLUSION The mortality rate and length of stay in pulmonary embolism patients with chronic kidney disease and end-stage renal disease were significantly higher than those in pulmonary embolism patients with normal kidney function. Also, pulmonary embolism patients with chronic kidney disease and end-stage renal disease were at higher risk of in-hospital mortality than those with normal kidney function. There was statistically significant higher risk of mortality in elderly and Black patients with pulmonary embolism and concurrent chronic kidney disease or end-stage renal disease.
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Affiliation(s)
- Jagmeet Singh
- Department of Medicine, Geisinger
Commonwealth School of Medicine, Scranton, PA, USA
| | - Sushmita Khadka
- Department of Medicine, Guthrie Robert
Packer Hospital, Sayre, PA, USA
| | | | - Asim Kichloo
- College of Medicine, Central Michigan
University, Saginaw, MI, USA
| | - Harshil Shah
- Hospitalist Department, Guthrie Corning
Hospital, Corning, NY, USA
| | - Manasee J Vyas
- Mahatma Gandhi Medical Institute of
Health Sciences, Navi Mumbai, India
| | - Savneek Chugh
- Department of Nephrology, Westchester
Medical Center, Valhalla, NY, USA
| | - Neil Patel
- Division of Cardiology, The Wright
Center for Graduate Medical Education, Scranton, PA, USA
| | - Shantanu Solanki
- Department of Medicine, Geisinger
Commonwealth School of Medicine, Scranton, PA, USA
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34
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Yuan S, Bruzelius M, Larsson SC. Causal effect of renal function on venous thromboembolism: a two-sample Mendelian randomization investigation. J Thromb Thrombolysis 2021; 53:43-50. [PMID: 34043151 PMCID: PMC8791872 DOI: 10.1007/s11239-021-02494-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 11/28/2022]
Abstract
Whether renal function is causally associated with venous thromboembolism (VTE) is not yet fully elucidated. We conducted a two-sample Mendelian randomization (MR) study to determine the causal effect of renal function, measured as estimated glomerular filtration rate (eGFR), on VTE. Single-nucleotide polymorphisms associated with eGFR were selected as instrumental variables at the genome-wide significance level (p < 5 × 10−8) from a meta-analysis of 122 genome-wide association studies including up to 1,046,070 individuals. Summary-level data for VTE were obtained from the FinnGen consortium (6913 VTE cases and 169,986 non-cases) and UK Biobank study (4620 VTE cases and 356,574 non-cases). MR estimates were calculated using the random-effects inverse-variance weighted method and combined using fixed-effects meta-analysis. Genetically predicted decreased eGFR was significantly associated with an increased risk of VTE in both FinnGen and UK Biobank. For one-unit decrease in log-transformed eGFR, the odds ratios of VTE were 2.93 (95% confidence interval (CI) 1.25, 6.84) and 4.46 (95% CI 1.59, 12.5) when using data from FinnGen and UK Biobank, respectively. The combined odds ratio was 3.47 (95% CI 1.80, 6.68). Results were consistent in all sensitivity analyses and no horizontal pleiotropy was detected. This MR-study supported a casual role of impaired renal function in VTE.
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Affiliation(s)
- Shuai Yuan
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobelsväg 13, 17177, Stockholm, Sweden
| | - Maria Bruzelius
- Coagulation Unit, Department of Hematology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Susanna C Larsson
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobelsväg 13, 17177, Stockholm, Sweden. .,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
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Clinical, laboratory, and genetic risk factors for thrombosis in sickle cell disease. Blood Adv 2021; 4:1978-1986. [PMID: 32384541 DOI: 10.1182/bloodadvances.2019001384] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/31/2020] [Indexed: 12/15/2022] Open
Abstract
Sickle cell disease (SCD) patients are at a four- to 100-fold increased risk for thrombosis compared with the general population, although the mechanisms and risk factors are not clear. We investigated the incidence and predictors for thrombosis in a retrospective, longitudinal cohort of 1193 pediatric and adult SCD patients treated at our institution between January 2008 and December 2017. SCD diagnosis and thrombotic complications were identified using International Classification of Diseases coding and verified through medical chart review. Clinical and laboratory data were extracted from the medical records. With a median follow-up of 6.4 years, 208 (17.4%) SCD patients experienced 352 thrombotic events (64 strokes, 288 venous thromboembolisms [VTE]). Risk factors for stroke included older age and HbSS/Sβ0-genotype and a lower hemoglobin (Hb) F% in the subset of HbSS/Sβ0-genotype patients (P < .05). VTE risk was independently associated with lower estimated glomerular filtration rate, hydroxyurea (HU) use, HbSS/Sβ0 genotype, and higher white blood cell (WBC) counts and Hb (P ≤ .03). Two thrombomodulin gene variants previously associated with thrombosis in the general African American population, THBD rs2567617 (minor allele frequency [MAF] 0.25; odds ratio [OR], 1.5; P = .049) and THBD rs1998081 (MAF, 0.24; OR, 1.5; P = .059), were associated with thrombosis in this cohort. In summary, thrombotic complications are common, and several traditional and SCD-specific risk factors are associated with thrombotic risk. Future studies integrating clinical, laboratory, and genetic risk factors may improve our understanding of thrombosis and guide intervention practices in SCD.
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Molinari M, Fernandez-Carrillo C, Dai D, Dana J, Clemente-Sanchez A, Dharmayan S, Kaltenmeier C, Liu H, Behari J, Rachakonda V, Ganesh S, Hughes C, Tevar A, Al Harakeh H, Emmanuel B, Humar A, Bataller R. Portal vein thrombosis and renal dysfunction: a national comparative study of liver transplant recipients for NAFLD versus alcoholic cirrhosis. Transpl Int 2021; 34:1105-1122. [PMID: 33780554 PMCID: PMC8360094 DOI: 10.1111/tri.13873] [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: 01/22/2021] [Revised: 03/08/2021] [Accepted: 03/19/2021] [Indexed: 12/13/2022]
Abstract
The prevalence of portal vein thrombosis (PVT), renal dysfunction (RD), and simultaneous PVT/RD in liver transplantation (LT) is poorly understood. We analyzed the prevalence of PVT, RD, simultaneous PVT/RD, and the outcomes of adult recipients of LT for nonalcoholic fatty liver disease (NAFLD) and alcoholic liver disease (ALD) between 2006 and 2016 in the United States. We found that the prevalence of PVT (7.2% → 11.3%), RD (33.8% → 39.2%), and simultaneous PVT/RD (2.4% → 4.5%) has increased significantly over the study period (all P‐values <0.05). NAFLD patients had a higher proportion of PVT (14.8% vs. 9.2%), RD (45.0% vs. 42.1%), and simultaneous PVT/RD (6.5% vs. 3.9%; all P‐values <0.05). 90‐day mortality was 3.8%, 6.3%, 6.8%, and 9.8% for PVT(−)/RD(−), PVT(−)/RD(+), PVT(+)/RD(−), and PVT(+)/RD(+) recipients, respectively (P < 0.01). 5‐year survival was 82.1%, 75.5%, 74.8%, and 71.1% for PVT(−)/RD(−), PVT(−)/RD(+), PVT(+)/RD(−), and PVT(+)/RD(+) recipients, respectively (P < 0.05). In conclusion, the prevalence of PVT, RD, and simultaneous PVT/RD has increased among LT recipients, especially for those with NAFLD. The short‐ and long‐term outcomes of recipients with PVT, RD, and simultaneous PVT/RD were inferior to patients without those risk factors irrespective of their indication for LT. No differences in patient outcomes were found between ALD and NAFLD recipients after stratification by risk factors.
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Affiliation(s)
- Michele Molinari
- Department of Surgery, UPMC Montefiore Hospital, Pittsburgh, PA, USA
| | - Carlos Fernandez-Carrillo
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Department of Surgery, University of Leeds, Leeds, UK
| | - Dongling Dai
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jorgensen Dana
- Department of Surgery, UPMC Montefiore Hospital, Pittsburgh, PA, USA
| | - Ana Clemente-Sanchez
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Stalin Dharmayan
- Department of Surgery, UPMC Montefiore Hospital, Pittsburgh, PA, USA
| | | | - Hao Liu
- Department of Surgery, UPMC Montefiore Hospital, Pittsburgh, PA, USA
| | - Jaideep Behari
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Vikrant Rachakonda
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Swaytha Ganesh
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Amit Tevar
- Department of Surgery, UPMC Montefiore Hospital, Pittsburgh, PA, USA
| | - Hasan Al Harakeh
- Department of Surgery, UPMC Montefiore Hospital, Pittsburgh, PA, USA
| | - Bishoy Emmanuel
- Department of Surgery, UPMC Montefiore Hospital, Pittsburgh, PA, USA
| | - Abhinav Humar
- Department of Surgery, UPMC Montefiore Hospital, Pittsburgh, PA, USA
| | - Ramon Bataller
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Thrombolome and Its Emerging Role in Chronic Kidney Diseases. Toxins (Basel) 2021; 13:toxins13030223. [PMID: 33803899 PMCID: PMC8003125 DOI: 10.3390/toxins13030223] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/14/2021] [Accepted: 03/15/2021] [Indexed: 12/25/2022] Open
Abstract
Patients with chronic kidney disease (CKD) are at an increased risk of thromboembolic complications, including myocardial infarction, stroke, deep vein thrombosis, and pulmonary embolism. These complications lead to increased mortality. Evidence points to the key role of CKD-associated dysbiosis and its effect via the generation of gut microbial metabolites in inducing the prothrombotic phenotype. This phenomenon is known as thrombolome, a panel of intestinal bacteria-derived uremic toxins that enhance thrombosis via increased tissue factor expression, platelet hyperactivity, microparticles release, and endothelial dysfunction. This review discusses the role of uremic toxins derived from gut-microbiota metabolism of dietary tryptophan (indoxyl sulfate (IS), indole-3-acetic acid (IAA), kynurenine (KYN)), phenylalanine/tyrosine (p-cresol sulfate (PCS), p-cresol glucuronide (PCG), phenylacetylglutamine (PAGln)) and choline/phosphatidylcholine (trimethylamine N-oxide (TMAO)) in spontaneously induced thrombosis. The increase in the generation of gut microbial uremic toxins, the activation of aryl hydrocarbon (AhRs) and platelet adrenergic (ARs) receptors, and the nuclear factor kappa B (NF-κB) signaling pathway can serve as potential targets during the prevention of thromboembolic events. They can also help create a new therapeutic approach in the CKD population.
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38
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Yeung W, Sia CH, Pollard T, Leow AST, Tan BYQ, Kaur R, Yeo TC, Tay ELW, Yeo LLL, Chan MYY, Loh JPY. Predicting mortality, thrombus recurrence and persistence in patients with post-acute myocardial infarction left ventricular thrombus. J Thromb Thrombolysis 2021; 52:654-661. [PMID: 33389609 DOI: 10.1007/s11239-020-02368-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 11/27/2022]
Abstract
Left ventricular thrombus (LVT) is a common complication of acute myocardial infarction and is associated with morbidity from embolic complications. Predicting which patients will develop death or persistent LVT despite anticoagulation may help clinicians identify high-risk patients. We developed a random forest (RF) model that predicts death or persistent LVT and evaluated its performance. This was a single-center retrospective cohort study in an academic tertiary center. We included 244 patients with LVT in our study. Patients who did not receive anticoagulation (n = 8) or had unknown (n = 31) outcomes were excluded. The primary outcome was a composite outcome of death, recurrent LVT and persistent LVT. We selected a total of 31 predictors collected at the point of LVT diagnosis based on clinical relevance. We compared conventional regularized logistic regression with the RF algorithm. There were 156 patients who had resolution of LVT and 88 patients who experienced the composite outcome. The RF model achieved better performance and had an AUROC of 0.700 (95% CI 0.553-0.863) on a validation dataset. The most important predictors for the composite outcome were receiving a revascularization procedure, lower visual ejection fraction (EF), higher creatinine, global wall motion abnormality, higher prothrombin time, higher body mass index, higher activated partial thromboplastin time, older age, lower lymphocyte count and higher neutrophil count. The RF model accurately identified patients with post-AMI LVT who developed the composite outcome. Further studies are needed to validate its use in clinical practice.
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Affiliation(s)
- Wesley Yeung
- University Medicine Cluster, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore. .,Laboratory for Computational Physiology, Harvard-MIT Health Sciences & Technology, Massachusetts Institute of Technology, Cambridge, MA, USA.
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tom Pollard
- Laboratory for Computational Physiology, Harvard-MIT Health Sciences & Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Aloysius Sheng-Ting Leow
- University Medicine Cluster, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Benjamin Yong-Qiang Tan
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore.,Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Rajinderdeep Kaur
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
| | - Tiong-Cheng Yeo
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Edgar Lik-Wui Tay
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Leonard Leong-Litt Yeo
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore.,Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Mark Yan-Yee Chan
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joshua Ping-Yun Loh
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Keller K, Hobohm L, Barco S, Schmidtmann I, Münzel T, Engelhardt M, Eckhard L, Konstantinides SV, Drees P. Venous thromboembolism in patients hospitalized for knee joint replacement surgery. Sci Rep 2020; 10:22440. [PMID: 33384429 PMCID: PMC7775461 DOI: 10.1038/s41598-020-79490-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 12/04/2020] [Indexed: 11/25/2022] Open
Abstract
Patients undergoing knee joint replacement (KJR) are at high risk of postoperative venous thromboembolism (VTE), but data on the time trends of VTE rate in this population are sparse. In this analysis of the German nationwide inpatient sample, we included all hospitalizations for elective primary KJR in Germany 2005-2016. Overall, 1,804,496 hospitalized patients with elective primary KJR (65.1% women, 70.0 years [IQR 63.0-76.0]) were included in the analysis. During hospitalization, VTE was documented in 23,297 (1.3%) patients. Total numbers of primary KJR increased from 129,832 in 2005 to 167,881 in 2016 (β-(slope)-estimate 1,978 [95% CI 1,951 to 2,004], P < 0.001). In-hospital VTE decreased from 2,429 (1.9% of all hospitalizations for KJR) to 1,548 (0.9%) cases (β-estimate - 0.77 [95% CI - 0.81 to - 0.72], P < 0.001), and in-hospital death rate from 0.14% (184 deaths) to 0.09% (146 deaths) (β-estimate - 0.44 deaths per year [95% CI - 0.59 to - 0.30], P < 0.001). Infections during hospitalization were associated with a higher VTE risk. VTE events were independently associated with in-hospital death (OR 20.86 [95% CI 18.78-23.15], P < 0.001). Annual number of KJR performed in Germany increased by almost 30% between 2005 and 2016. In parallel, in-hospital VTE rates decreased from 1.9 to 0.9%. Perioperative infections were associated with higher risk for VTE. Patients who developed VTE had a 21-fold increased risk of in-hospital death.
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Affiliation(s)
- Karsten Keller
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany.
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
| | - Lukas Hobohm
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Stefano Barco
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
- Clinic for Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Irene Schmidtmann
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Germany
| | - Martin Engelhardt
- Department for Orthopaedics, Trauma Surgery and Hand Surgery, Klinikum Osnabrück, Osnabrück, Germany
- Institute for Applied Training Science, Leipzig, Germany
| | - Lukas Eckhard
- Department of Orthopaedics and Traumatology, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Stavros V Konstantinides
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
- Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Philipp Drees
- Department of Orthopaedics and Traumatology, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
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40
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Molecular Mechanisms Underlying the Cardiovascular Toxicity of Specific Uremic Solutes. Cells 2020; 9:cells9092024. [PMID: 32887404 PMCID: PMC7565564 DOI: 10.3390/cells9092024] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/21/2020] [Accepted: 08/27/2020] [Indexed: 02/07/2023] Open
Abstract
Mounting evidence strongly suggests a causal link between chronic kidney disease (CKD) and cardiovascular disease (CVD). Compared with non-CKD patients, patients with CKD suffer disproportionately from CVD and derive suboptimal benefits from interventions targeting conventional CVD risk factors. Uremic toxins (UTs), whose plasma levels rapidly rise as CKD progresses, represent a unique risk factor in CKD, which has protean manifestations on CVD. Among the known UTs, tryptophan metabolites and trimethylamine N-oxide are well-established cardiovascular toxins. Their molecular mechanisms of effect warrant special consideration to draw translational value. This review surveys current knowledge on the effects of specific UTs on different pathways and cell functions that influence the integrity of cardiovascular health, with implication for CVD progression. The effect of UTs on cardiovascular health is an example of a paradigm in which a cascade of molecular and metabolic events induced by pathology in one organ in turn induces dysfunction in another organ. Deciphering the molecular mechanisms underlying such cross-organ pathologies will help uncover therapeutic targets to improve the management of CVD in patients with CKD.
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41
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Kohli R, Estcourt L, Zaidi A, Thuraisingham R, Forbes S, MacCallum P, Tan J, Green L. Efficacy and safety of chemical thromboprophylaxis in renal transplantation – A systematic review. Thromb Res 2020; 192:88-95. [DOI: 10.1016/j.thromres.2020.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/01/2020] [Accepted: 05/11/2020] [Indexed: 02/01/2023]
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42
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Surgical Management of Right Atrial Mass Associated with a Vascular Access Catheter. Case Rep Cardiol 2020; 2020:4590147. [PMID: 32577314 PMCID: PMC7305527 DOI: 10.1155/2020/4590147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/10/2020] [Accepted: 05/25/2020] [Indexed: 11/21/2022] Open
Abstract
Atrial masses are an uncommon but serious clinical problem. The authors report a case of an atrial mass associated with a tunnelled vascular access catheter in an immunosuppressed haemodialysis patient. In the setting of immunosuppression with fevers, a broad differential for the atrial mass was considered. Multidisciplinary team review was pursued to guide management decisions. Ultimately, surgical excision of the mass was pursued with an excellent result. The causes and management of this complex clinical scenario are discussed.
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43
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Furuto Y, Kawamura M, Namikawa A, Takahashi H, Shibuya Y. Health risk of travel for chronic kidney disease patients. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2020; 25:22. [PMID: 32419779 PMCID: PMC7213004 DOI: 10.4103/jrms.jrms_459_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/22/2019] [Accepted: 12/16/2019] [Indexed: 01/11/2023]
Abstract
The number of people with chronic kidney disease (CKD) has increased and so has their demand for travel. However, the health risk posed by travel in these patients is unclear. Few reports document the travel risk in CKD and dialysis patients. The aim of this study is to summarize the existing evidence of the influence of travel on risks in CKD patients. We aim to describe the association between the impact of travel risks and patients with CKD. A detailed review of recent literature was performed by reviewing PubMed, Google Scholar, and Ichushi Web from the Japan Medical Abstracts Society. Screened involved the following keywords: “traveler's thrombosis,” “venous thromboembolism,” “deep vein thrombosis,” “altitude sickness,” “traveler's diarrhea,” “jet lag syndrome,” “melatonin,” with “chronic kidney disease” only, or/and “dialysis.” We present a narrative review summary of the literature from these screenings. The increased prevalence of thrombosis among travelers with CKD is related to a decrease in the estimated glomerular filtration rate and an increase in urine protein levels. CKD patients who remain at high altitudes are at an increased risk for progression of CKD, altitude sickness, and pulmonary edema. Traveler's diarrhea can become increasingly serious in patients with CKD because of decreased immunity. Microbial substitution colitis is also common in CKD patients. Moreover, time differences and disturbances in the circadian rhythm increase cardiovascular disease events for CKD patients. The existing literature shows that travel-related conditions pose an increased risk for patients with CKD.
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Affiliation(s)
- Yoshitaka Furuto
- Department of Hypertension and Nephrology, NTT Medical Centre Tokyo, Shinagawa-ku, Tokyo, Japan
| | - Mariko Kawamura
- Department of Hypertension and Nephrology, NTT Medical Centre Tokyo, Shinagawa-ku, Tokyo, Japan
| | - Akio Namikawa
- Department of Hypertension and Nephrology, NTT Medical Centre Tokyo, Shinagawa-ku, Tokyo, Japan
| | - Hiroko Takahashi
- Department of Hypertension and Nephrology, NTT Medical Centre Tokyo, Shinagawa-ku, Tokyo, Japan
| | - Yuko Shibuya
- Department of Hypertension and Nephrology, NTT Medical Centre Tokyo, Shinagawa-ku, Tokyo, Japan
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44
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Stals MAM, Klok FA, Huisman MV. Diagnostic management of acute pulmonary embolism in special populations. Expert Rev Respir Med 2020; 14:729-736. [DOI: 10.1080/17476348.2020.1753505] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Milou A. M. Stals
- Department of Medicine, Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Frederikus A. Klok
- Department of Medicine, Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Menno V. Huisman
- Department of Medicine, Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
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45
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Keller K, Hobohm L, Barco S, Schmidtmann I, Münzel T, Engelhardt M, Goldhofer M, Konstantinides SV, Drees P. Venous thromboembolism in patients hospitalized for hip joint replacement surgery. Thromb Res 2020; 190:1-7. [PMID: 32247912 DOI: 10.1016/j.thromres.2020.03.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a potentially life-threatening disease. Major transient risk factors include trauma, surgery, and immobilization. Patients undergoing hip joint replacement (HJR) are characterized by a high risk of postoperative VTE, but data on the time trends of VTE rates in this population are sparse. METHODS In an analysis of the German nationwide inpatient sample, we included all hospitalizations for elective primary HJR in Germany from 2005 to 2016. Time trends of the surgical procedure, overall death rates, and VTE rates were analysed, and predictors of VTE identified. RESULTS Overall, 1,885,839 inpatients with elective primary HJR (59.1% women, 51.4% ≥70 years) were included in the analysis. During hospitalization, VTE was documented in 11,554 (0.6%) patients. While total numbers of primary HJR increased from 145,223 in 2005 to 171,421 in 2016 (β-(slope)-estimate 1818 [95%CI 1083 to 2553], P < 0.001), in-hospital VTE decreased from 1288 (0.9%) to 843 (0.5%) cases (β-estimate -0.71 [95%CI -0.77 to -0.65], P < 0.001), and in-hospital death rate from 0.33% (476 deaths) to 0.29% (498 deaths) (β-estimate -0.11 [95%CI -0.20 to -0.02], P = 0.018). Infections during hospitalization were associated with higher VTE risk than cancer and cardiovascular events. VTE events were independently associated with an increased death risk (OR 15.19 [95%CI 14.19-16.86], P < 0.001). CONCLUSIONS While total numbers of HJR increased significantly in Germany between 2005 and 2016, in-hospital rates of VTE decreased from 0.9% to 0.5%. Patients with perioperative VTE had a 15-fold increase of in-hospital death. Cancer, cardiovascular disease and perioperative infections were associated with higher risk for VTE.
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Affiliation(s)
- Karsten Keller
- Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
| | - Lukas Hobohm
- Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Stefano Barco
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Clinic for Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Irene Schmidtmann
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Thomas Münzel
- Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Germany
| | - Martin Engelhardt
- Department for Orthopedics, Trauma Surgery and Hand Surgery, Klinikum Osnabrück, Osnabrück, Germany; Institute for Applied Training Science, Leipzig, Germany
| | - Markus Goldhofer
- Center for Orthopaedics and Trauma Surgery, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Stavros V Konstantinides
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Philipp Drees
- Center for Orthopaedics and Trauma Surgery, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
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46
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Mahlab-Guri K, Otman MS, Replianski N, Rosenberg-Bezalel S, Rabinovich I, Sthoeger Z. Venous thromboembolism prophylaxis in patients hospitalized in medical wards: A real life experience. Medicine (Baltimore) 2020; 99:e19127. [PMID: 32049830 PMCID: PMC7035063 DOI: 10.1097/md.0000000000019127] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Venous thromboembolism (VTE) is a preventable cause of morbidity and mortality in acutely ill patients hospitalized in medical departments. Thromboprophylaxis with anticoagulants was shown to be safe and effective in medical patients with high risk to develop VTE. Despite guidelines recommendations, the rate of thromboprophylaxis in those patients is low. The objective of the study was to evaluate the rate of VTE risk assessment in routine medical department practice, the rate of eligible patients for thromboprophylaxis, the rate of patients who received thromboprophylaxis, and their outcome.Medical records of consecutive patients (3000 at 2013, 1000 at 2018) hospitalized in medical department were reviewed, retrospectively, for demographic, clinical characteristics, thromboprophylaxis treatment with enoxaparin and outcome (up to 90 days following discharge). Padua score was used for VTE risk assessment. VTE diagnosis was based on clinical suspicion.The mean patient's age (52.6% females) was 67.95 ± 21.56 years. 21% were eligible for thromboprophylaxis. Routine VTE risk assessment rate increased significantly following its incorporation into quality parameters, but the rate of treated patients was low (22% at 2013; 46% at 2018). The patients who received thromophylaxis were sicker compared to eligible patients without thromboprophylaxis. The rate of symptomatic VTE was low (0.24%; 0.12% and 0.55% for low and high VTE risk, respectively). Thromboprophylaxis did not have significant effect on the low number of VTE events. No major bleeding was observed.Major efforts are still needed to increase the rate of thromboprophylaxis in all eligible medical patients according to the guidelines recommendations.
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Affiliation(s)
- Keren Mahlab-Guri
- Kaplan Medical Center, Rehovot
- Affiliated to the Hebrew University and Hadassah Medical School, Jerusalem, Israel
| | - Monged Shaher Otman
- Kaplan Medical Center, Rehovot
- Affiliated to the Hebrew University and Hadassah Medical School, Jerusalem, Israel
| | - Natalia Replianski
- Kaplan Medical Center, Rehovot
- Affiliated to the Hebrew University and Hadassah Medical School, Jerusalem, Israel
| | - Shira Rosenberg-Bezalel
- Kaplan Medical Center, Rehovot
- Affiliated to the Hebrew University and Hadassah Medical School, Jerusalem, Israel
| | - Irina Rabinovich
- Kaplan Medical Center, Rehovot
- Affiliated to the Hebrew University and Hadassah Medical School, Jerusalem, Israel
| | - Zev Sthoeger
- Kaplan Medical Center, Rehovot
- Affiliated to the Hebrew University and Hadassah Medical School, Jerusalem, Israel
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Frydman GH, Boyer EW, Nazarian RM, Van Cott EM, Piazza G. Coagulation Status and Venous Thromboembolism Risk in African Americans: A Potential Risk Factor in COVID-19. Clin Appl Thromb Hemost 2020; 26:1076029620943671. [PMID: 32702995 PMCID: PMC7383642 DOI: 10.1177/1076029620943671] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/25/2020] [Accepted: 06/29/2020] [Indexed: 12/16/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 infection (COVID-19) is known to induce severe inflammation and activation of the coagulation system, resulting in a prothrombotic state. Although inflammatory conditions and organ-specific diseases have been shown to be strong determinants of morbidity and mortality in patients with COVID-19, it is unclear whether preexisting differences in coagulation impact the severity of COVID-19. African Americans have higher rates of COVID-19 infection and disease-related morbidity and mortality. Moreover, African Americans are known to be at a higher risk for thrombotic events due to both biological and socioeconomic factors. In this review, we explore whether differences in baseline coagulation status and medical management of coagulation play an important role in COVID-19 disease severity and contribute to racial disparity trends within COVID-19.
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MESH Headings
- Black or African American/genetics
- Anemia, Sickle Cell/blood
- Anemia, Sickle Cell/ethnology
- Anticoagulants/therapeutic use
- Betacoronavirus
- Blood Proteins/analysis
- Blood Proteins/genetics
- COVID-19
- Clinical Trials as Topic
- Comorbidity
- Coronavirus Infections/blood
- Coronavirus Infections/complications
- Coronavirus Infections/ethnology
- Factor VIII/analysis
- Female
- Fibrin Fibrinogen Degradation Products/analysis
- Genetic Association Studies
- Genetic Predisposition to Disease
- Healthcare Disparities
- Humans
- Lupus Erythematosus, Systemic/blood
- Lupus Erythematosus, Systemic/ethnology
- Male
- Pandemics
- Patient Selection
- Pneumonia, Viral/blood
- Pneumonia, Viral/complications
- Pneumonia, Viral/ethnology
- Polymorphism, Single Nucleotide
- Prevalence
- Renal Insufficiency, Chronic/blood
- Renal Insufficiency, Chronic/ethnology
- Risk Factors
- SARS-CoV-2
- Social Determinants of Health
- Socioeconomic Factors
- Thrombophilia/blood
- Thrombophilia/drug therapy
- Thrombophilia/ethnology
- Thrombophilia/etiology
- Venous Thromboembolism/blood
- Venous Thromboembolism/ethnology
- Venous Thromboembolism/etiology
- Venous Thromboembolism/prevention & control
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Affiliation(s)
- Galit H. Frydman
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Edward W. Boyer
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | | | | | - Gregory Piazza
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA, USA
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48
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Rong L, Chen L, Dong Z, Zhuang H, Lin Z, Mo Y, Jiang X. Analysis of 10 Pediatric Nephrotic Syndrome Cases With Complications of Cerebral Sinovenous Thrombosis. Front Pediatr 2020; 8:607776. [PMID: 33425818 PMCID: PMC7786383 DOI: 10.3389/fped.2020.607776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/24/2020] [Indexed: 11/13/2022] Open
Abstract
Background: To analyze the clinical characteristics of nephrotic syndrome (NS) with complications of cerebral sinovenous thrombosis (CSVT) in children. Method: Clinical, radiographic, laboratory, and treatment data obtained from 10 confirmed cases of NS with complications of CSVT were analyzed. All patients were followed up for at least 18 months. CSVT was diagnosed by cerebral computed tomography (CT) and/or magnetic resonance imaging (MRI) with or without magnetic resonance venography (MRV) of the cerebral vessels. Results: Among 10 cases reported, 4 were steroid-sensitive NS with frequent relapse, 5 were steroid-resistant (three of them had renal biopsies showing two minimal change disease and one IgA nephropathy), and 1 was steroid-sensitive with one relapse. Common clinical manifestations were headache or ophthalmodynia complicated by vomiting, dizziness, convulsion, and coma. Neuropathologic signs were positive in some cases. Papilledema appeared in only one case with winding of vein. Cerebrospinal fluid was examined in three cases with elevated pressure but normal cytological and biochemical results. D dimer and fibrinogen levels were elevated while prothrombin time and activated partial thromboplastin time were shortened. Five out of seven cases who had performed cranial CT were suspicious for cerebral thrombosis. Nine cases had cranial MRI with abnormal signs in seven cases. All of the cases received MRV, confirming the diagnosis of CVST. Conclusion: Clinical manifestations of NS with CSVT are not specific but varied. Therefore, CSVT should be considered once nervous manifestations present. MRV is a better method in the diagnosis of CSVT.
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Affiliation(s)
- Liping Rong
- Department of Pediatrics, The Children Kidney Center, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lizhi Chen
- Department of Pediatrics, The Children Kidney Center, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhi Dong
- Department of Radiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hongjie Zhuang
- Department of Pediatrics, The Children Kidney Center, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhilang Lin
- Department of Pediatrics, The Children Kidney Center, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ying Mo
- Department of Pediatrics, The Children Kidney Center, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoyun Jiang
- Department of Pediatrics, The Children Kidney Center, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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49
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Kara H. Internal Jugular Vein Thrombosis due to Chronic Kidney Disease: A Case Report. Ann Vasc Surg 2019; 62:500.e1-500.e3. [PMID: 31560940 DOI: 10.1016/j.avsg.2019.08.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/02/2019] [Accepted: 08/03/2019] [Indexed: 10/26/2022]
Abstract
Internal jugular vein (IJV) thrombosis is a rare vascular event. The most common causes of internal jugular vein thrombosis are prolonged central venous catheterization, infection, malignancy and ovarian hyperstimulation syndrome. We have presented here a case of an 82-year-old male with chronic kidney disease who presented with left neck swelling and pain who was found to have a thrombus in the left IJV. He was successfully treated with conservative treatment without any complications.
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Affiliation(s)
- Hakan Kara
- Department of Cardiovascular Surgery, Giresun Ada Hospital, Giresun, Turkey.
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50
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Jegatheswaran J, Hundemer GL, Massicotte-Azarniouch D, Sood MM. Anticoagulation in Patients With Advanced Chronic Kidney Disease: Walking the Fine Line Between Benefit and Harm. Can J Cardiol 2019; 35:1241-1255. [PMID: 31472820 DOI: 10.1016/j.cjca.2019.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 07/03/2019] [Accepted: 07/04/2019] [Indexed: 12/23/2022] Open
Abstract
Chronic kidney disease affects more than 3 million Canadians and is highly associated with cardiovascular diseases that require anticoagulation, such as atrial fibrillation and venous thromboembolism. Patients with chronic kidney disease are at a problematic crossroads; they are at high risk of thrombotic conditions requiring anticoagulation and bleeding complications due to anticoagulation. The limited high-quality clinical evidence to guide decision-making in this area further compounds the dilemma. In this review, we discuss the physiology and epidemiology of bleeding and thrombosis in patients with kidney disease. We specifically focus on patients with advanced kidney disease (estimated glomerular filtration rate ≤ 30 mL/min) or who are receiving dialysis and focus on the nephrologist perspective regarding these issues. We summarize the existing evidence for anticoagulation use in the prevention of stroke with atrial fibrillation and provide practical clinical recommendations for considering anticoagulation use in this population. Last, we examine specific scenarios such as the use of a glomerular filtration rate estimating equation and dosing, the use of existing prediction tools for stroke and hemorrhage risk, current patterns of anticoagulation use (including during the dialysis procedure), and vascular calcification with vitamin K antagonist use in patients with chronic kidney disease.
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Affiliation(s)
| | - Gregory L Hundemer
- Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Manish M Sood
- Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
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