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Miele C, Mennitti C, Gentile A, Veneruso I, Scarano C, Vastola A, La Monica I, Uomo F, Iafusco F, Capasso F, Pero R, D’Argenio V, Lombardo B, Tinto N, Di Micco P, Scudiero O, Frisso G, Mazzaccara C. Thrombosis and Thrombotic Risk in Athletes. J Clin Med 2024; 13:4881. [PMID: 39201023 PMCID: PMC11355105 DOI: 10.3390/jcm13164881] [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: 07/31/2024] [Revised: 08/13/2024] [Accepted: 08/14/2024] [Indexed: 09/02/2024] Open
Abstract
The hemostatic system is characterized by a delicate balance between pro- and anticoagulant forces, and the smallest alteration can cause serious events such as hemorrhages or thrombosis. Although exercise has been shown to play a protective role in athletes, several factors may increase the risk of developing venous thromboembolism (VTE), including hemoconcentration induced by exertion, immobilization following sports injuries, frequent long-distance flights, dehydration, and the use of oral contraceptives in female athletes. Biomarkers such as D-dimer, Factor VIII, thrombin generation, inflammatory cytokines, and leukocyte count are involved in the diagnosis of deep vein thrombosis (DVT), although their interpretation is complex and may indicate the presence of other conditions such as infections, inflammation, and heart disease. Therefore, the identification of biomarkers with high sensitivity and specificity is needed for the screening and early diagnosis of thromboembolism. Recent evidence about the correlation between the intensity of physical activity and VTE is divergent, whereas the repeated gestures in sports such as baseball, hockey, volleyball, swimming, wrestling, or, on the other hand, soccer players, runners, and martial art training represent a risk factor predisposing to the onset of upper and lower DVT. Anticoagulant therapy is the gold standard, reducing the risk of serious complications such as pulmonary embolism. The aim of this review is to provide a general overview about the interplay between physical exercise and the risk of thromboembolism in athletes, focusing on the main causes of thrombosis in professional athletes and underlying the need to identify new markers and therapies that can represent a valid tool for safeguarding the athlete's health.
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Affiliation(s)
- Ciro Miele
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, Via Sergio Pansini 5, 80131 Napoli, Italy; (C.M.); (C.M.); (A.G.); (I.V.); (C.S.); (A.V.); (F.U.); (R.P.); (B.L.); (N.T.); (G.F.); (C.M.)
- UOC Laboratory Medicine, Haematology and Laboratory Haemostasis and Special Investigations, AOU Federico II University of Naples, 80131 Naples, Italy;
- CEINGE-Biotecnologie Avanzate Franco Salvatore, Via G. Salvatore 486, 80145 Napoli, Italy; (I.L.M.); (F.I.); (V.D.)
| | - Cristina Mennitti
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, Via Sergio Pansini 5, 80131 Napoli, Italy; (C.M.); (C.M.); (A.G.); (I.V.); (C.S.); (A.V.); (F.U.); (R.P.); (B.L.); (N.T.); (G.F.); (C.M.)
| | - Alessandro Gentile
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, Via Sergio Pansini 5, 80131 Napoli, Italy; (C.M.); (C.M.); (A.G.); (I.V.); (C.S.); (A.V.); (F.U.); (R.P.); (B.L.); (N.T.); (G.F.); (C.M.)
| | - Iolanda Veneruso
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, Via Sergio Pansini 5, 80131 Napoli, Italy; (C.M.); (C.M.); (A.G.); (I.V.); (C.S.); (A.V.); (F.U.); (R.P.); (B.L.); (N.T.); (G.F.); (C.M.)
- CEINGE-Biotecnologie Avanzate Franco Salvatore, Via G. Salvatore 486, 80145 Napoli, Italy; (I.L.M.); (F.I.); (V.D.)
| | - Carmela Scarano
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, Via Sergio Pansini 5, 80131 Napoli, Italy; (C.M.); (C.M.); (A.G.); (I.V.); (C.S.); (A.V.); (F.U.); (R.P.); (B.L.); (N.T.); (G.F.); (C.M.)
- CEINGE-Biotecnologie Avanzate Franco Salvatore, Via G. Salvatore 486, 80145 Napoli, Italy; (I.L.M.); (F.I.); (V.D.)
| | - Aniello Vastola
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, Via Sergio Pansini 5, 80131 Napoli, Italy; (C.M.); (C.M.); (A.G.); (I.V.); (C.S.); (A.V.); (F.U.); (R.P.); (B.L.); (N.T.); (G.F.); (C.M.)
| | - Ilaria La Monica
- CEINGE-Biotecnologie Avanzate Franco Salvatore, Via G. Salvatore 486, 80145 Napoli, Italy; (I.L.M.); (F.I.); (V.D.)
| | - Fabiana Uomo
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, Via Sergio Pansini 5, 80131 Napoli, Italy; (C.M.); (C.M.); (A.G.); (I.V.); (C.S.); (A.V.); (F.U.); (R.P.); (B.L.); (N.T.); (G.F.); (C.M.)
| | - Fernanda Iafusco
- CEINGE-Biotecnologie Avanzate Franco Salvatore, Via G. Salvatore 486, 80145 Napoli, Italy; (I.L.M.); (F.I.); (V.D.)
| | - Filomena Capasso
- UOC Laboratory Medicine, Haematology and Laboratory Haemostasis and Special Investigations, AOU Federico II University of Naples, 80131 Naples, Italy;
| | - Raffaela Pero
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, Via Sergio Pansini 5, 80131 Napoli, Italy; (C.M.); (C.M.); (A.G.); (I.V.); (C.S.); (A.V.); (F.U.); (R.P.); (B.L.); (N.T.); (G.F.); (C.M.)
- Task Force on Microbiome Studies, University of Naples Federico II, 80100 Naples, Italy
| | - Valeria D’Argenio
- CEINGE-Biotecnologie Avanzate Franco Salvatore, Via G. Salvatore 486, 80145 Napoli, Italy; (I.L.M.); (F.I.); (V.D.)
- Department of Human Sciences and Quality of Life Promotion, San Raffaele Open University, 00100 Rome, Italy
| | - Barbara Lombardo
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, Via Sergio Pansini 5, 80131 Napoli, Italy; (C.M.); (C.M.); (A.G.); (I.V.); (C.S.); (A.V.); (F.U.); (R.P.); (B.L.); (N.T.); (G.F.); (C.M.)
- CEINGE-Biotecnologie Avanzate Franco Salvatore, Via G. Salvatore 486, 80145 Napoli, Italy; (I.L.M.); (F.I.); (V.D.)
| | - Nadia Tinto
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, Via Sergio Pansini 5, 80131 Napoli, Italy; (C.M.); (C.M.); (A.G.); (I.V.); (C.S.); (A.V.); (F.U.); (R.P.); (B.L.); (N.T.); (G.F.); (C.M.)
- CEINGE-Biotecnologie Avanzate Franco Salvatore, Via G. Salvatore 486, 80145 Napoli, Italy; (I.L.M.); (F.I.); (V.D.)
| | - Pierpaolo Di Micco
- AFO Medicina, P.O. Santa Maria delle Grazie, Pozzuoli, ASL Napoli2 nord, 80076 Naples, Italy
| | - Olga Scudiero
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, Via Sergio Pansini 5, 80131 Napoli, Italy; (C.M.); (C.M.); (A.G.); (I.V.); (C.S.); (A.V.); (F.U.); (R.P.); (B.L.); (N.T.); (G.F.); (C.M.)
- CEINGE-Biotecnologie Avanzate Franco Salvatore, Via G. Salvatore 486, 80145 Napoli, Italy; (I.L.M.); (F.I.); (V.D.)
- Task Force on Microbiome Studies, University of Naples Federico II, 80100 Naples, Italy
| | - Giulia Frisso
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, Via Sergio Pansini 5, 80131 Napoli, Italy; (C.M.); (C.M.); (A.G.); (I.V.); (C.S.); (A.V.); (F.U.); (R.P.); (B.L.); (N.T.); (G.F.); (C.M.)
- CEINGE-Biotecnologie Avanzate Franco Salvatore, Via G. Salvatore 486, 80145 Napoli, Italy; (I.L.M.); (F.I.); (V.D.)
| | - Cristina Mazzaccara
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, Via Sergio Pansini 5, 80131 Napoli, Italy; (C.M.); (C.M.); (A.G.); (I.V.); (C.S.); (A.V.); (F.U.); (R.P.); (B.L.); (N.T.); (G.F.); (C.M.)
- CEINGE-Biotecnologie Avanzate Franco Salvatore, Via G. Salvatore 486, 80145 Napoli, Italy; (I.L.M.); (F.I.); (V.D.)
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Gao L, Wang Y, Fu S, Cai S, Li J, Yang X. Pitfalls of ultrasound for deep vein thrombosis of the lower extremities. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:773-777. [PMID: 38597807 DOI: 10.1002/jcu.23689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/19/2024] [Accepted: 03/29/2024] [Indexed: 04/11/2024]
Abstract
Venous ultrasound is the primary, widely accepted diagnostic tool to assess deep vein thrombosis (DVT) in the lower extremities. However, other focal lesions in the lower extremities can be identified on ultrasound. The sonographic appearance of these abnormalities may overlap the thrombosis, which included vascular tumors, Baker's cyst, hematoma, cancer thrombosis, and peripheral nerve tumors. This essay derives from cases diagnosed in our centers and published literature, with images available for illustrations, which may help to improve the clinical management of these findings.
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Affiliation(s)
- Luying Gao
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yahong Wang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuai Fu
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Sheng Cai
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianchu Li
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao Yang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Wells A, Rigby J, Castel C, Castel D. Pulsed Red and Blue Photobiomodulation for the Treatment of Thigh Contusions and Soft Tissue Injury: A Randomized Controlled Trial. J Sport Rehabil 2024; 33:20-26. [PMID: 37917978 DOI: 10.1123/jsr.2022-0334] [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: 09/07/2022] [Revised: 05/09/2023] [Accepted: 08/19/2023] [Indexed: 11/04/2023]
Abstract
CONTEXT Contusion and soft tissue injuries are common in sports. Photobiomodultion, light and laser therapy, is an effective aid to increase healing rates and improve function after various injury mechanisms. However, it is unclear how well photobiomodulation improves function after a contusion soft tissue injury. This study aimed to determine the effects of a pulsed red and blue photobiomodulation light patch on muscle function following a human thigh contusion injury. DESIGN Single-blinded randomized control trial design. METHODS We enrolled 46 healthy participants. Participants completed 5 visits on consecutive days. On the first visit, participants completed a baseline isokinetic quadriceps strength testing protocol at 60°/s and 180°/s. On the second visit, participants were struck in the rectus femoris of the anterior thigh with a tennis ball from a serving machine. Immediately following, participants were treated for 30 minutes with an active or placebo photobiomodulation patch (CareWear light patch system, CareWear Corp). Following the treatment, participants completed the same isokinetic quadriceps strength testing protocol. Participants completed the treatment and isokinetic quadriceps strength test during the following daily visits. We normalized the data by calculating the percent change from baseline. We used a mixed model analysis of covariance, with sex as a covariate, to determine the difference between treatment groups throughout the acute recovery process. RESULTS We found the active photobiomodulation treatment significantly increased over the placebo group, quadriceps peak torque during the 180°/s test (P = .030), and average power during both the 60°/s (P = .041) and 180°/s (P ≤ .001) assessments. The mean peak torque and average power of 180°/s, at day 4, exceeded the baseline levels by 8.9% and 16.8%, respectively. CONCLUSIONS The red and blue photobiomodulation light patch improved muscle strength and power during the acute healing phase of a human thigh contusion injury model.
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Affiliation(s)
- Aaron Wells
- Department of Exercise Sciences, Brigham Young University, Provo, UT, USA
| | - Justin Rigby
- Department of Physical Therapy and Athletic Training, University of Utah Health, Salt Lake City, UT, USA
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Kawasaki R, Sakata A, Hosoda C, Harada S, Soeda T, Nishida Y, Matsumoto N, Tatsumi K, Nogami K, Yoshimura Y, Shima M. The use of infrared thermography for non-invasive detection of bleeding and musculoskeletal abnormalities in patients with hemophilia: an observational study. Thromb J 2023; 21:70. [PMID: 37381012 DOI: 10.1186/s12959-023-00511-5] [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: 04/06/2023] [Accepted: 06/05/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND In patients with hemophilia (PwH), bleeding often occurs in joints and muscles, and early detection of hemorrhage is important to prevent the onset and progression of mobility impairment. Complex-Image analysis such as ultrasonography, computed tomography, and magnetic resonance imaging are used to detect bleeding. On the other hand, no simple and rapid method to detect the active bleeding has been reported. Local inflammatory responses occur when blood leaks from damaged vessels, and the temperature at the site of active bleeding could be expected to increase in these circumstances, leading to an increase in surrounding skin temperature. Therefore, the purpose of this study was to investigate whether the measurement of skin temperature using infrared thermography (IRT) can be used as a diagnostic aid to detect active bleeding. METHODS Fifteen PwH (from 6 to 82 years old) complaining of discomfort such as pain were examined. Thermal images were obtained simultaneously at the affected sides and comparable unaffected sides. The average skin temperature of the affected side and of the unaffected side were measured. The temperature differences were calculated by subtracting the average skin temperature at the unaffected side from the affected side. RESULTS In eleven cases with active bleeding, the skin temperature at the affected side was more than 0.3 °C higher (0.3 °C to 1.4 °C) compared to the unaffected side. In two cases without active bleeding, there were no significant differences in skin temperature between the affected and unaffected sides. In two cases with previous rib or thumb bone fracture, the skin temperature at the affected side was 0.3 °C or 0.4 °C lower than that of the unaffected side, respectively. In two cases with active bleeding in which longitudinal evaluation was conducted, the difference in skin temperature decreased after hemostatic treatment. CONCLUSION The analysis of skin temperature deference using IRT was a useful supportive tool to readily assess musculoskeletal abnormalities and bleeding in PwH as well as to determine the success of the hemostatic treatment.
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Affiliation(s)
- Ryohei Kawasaki
- Medicinal Biology of Thrombosis and Hemostasis, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
- Product Research Department, Medical Affairs Division, Chugai Pharmaceutical Co., Ltd., Yokohama, Japan
- Advanced Medical Science of Thrombosis and Hemostasis, Nara Medical University, Kashihara, Japan
| | - Asuka Sakata
- Medicinal Biology of Thrombosis and Hemostasis, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Chihiro Hosoda
- Advanced Medical Science of Thrombosis and Hemostasis, Nara Medical University, Kashihara, Japan
| | - Suguru Harada
- Medicinal Biology of Thrombosis and Hemostasis, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
- Product Research Department, Medical Affairs Division, Chugai Pharmaceutical Co., Ltd., Yokohama, Japan
| | - Tetsuhiro Soeda
- Medicinal Biology of Thrombosis and Hemostasis, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
- Product Research Department, Medical Affairs Division, Chugai Pharmaceutical Co., Ltd., Yokohama, Japan
| | - Yukiko Nishida
- Medicinal Biology of Thrombosis and Hemostasis, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
- Project Planning and Coordination Department, Translational Research Division, Chugai Pharmaceutical Co., Ltd., Chuo-ku, Japan
| | - Naoki Matsumoto
- Medicinal Biology of Thrombosis and Hemostasis, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
- Product Research Department, Medical Affairs Division, Chugai Pharmaceutical Co., Ltd., Yokohama, Japan
| | - Kohei Tatsumi
- Medicinal Biology of Thrombosis and Hemostasis, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
- Advanced Medical Science of Thrombosis and Hemostasis, Nara Medical University, Kashihara, Japan
| | - Keiji Nogami
- Department of Pediatrics, Nara Medical University, Kashihara, Japan
| | - Yasushi Yoshimura
- Product Research Department, Medical Affairs Division, Chugai Pharmaceutical Co., Ltd., Yokohama, Japan
| | - Midori Shima
- Medicinal Biology of Thrombosis and Hemostasis, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan.
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Guo EQ, Yang XD, Lu HR. Tumor-like disorder of the brachial plexus region in a patient with hemophilia: A case report. World J Clin Cases 2022; 10:5910-5915. [PMID: 35979120 PMCID: PMC9258380 DOI: 10.12998/wjcc.v10.i17.5910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/25/2022] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Various tumors and tumor-like disorders, originating from the neural sheath, as well as other types, may affect the brachial plexus region. Due to the infrequent presentation, brachial plexus palsy caused by spontaneous hematoma in patients with hemophilia might miss the treatment by early surgical decompression and progress to permanent nerve damage.
CASE SUMMARY The case reported here was a 30-year-old man with hemophilia, as well as both sensory and motor dysfunction of the left upper extremity. A presumptive diagnosis of brachial plexus tumor was initially made, which was subsequently confirmed to be an organized chronic hematoma rather than a neoplasm. The hemophilia-induced expanding hematoma compressing the brachial plexus was considered to be the main reason for the patient’s complaints. The clinical symptoms were alleviated and the involved nerves partially recovered at a follow-up of 1 year.
CONCLUSION Early surgical intervention is crucial and it seems to be an essential precondition for recovery of nerve function in brachial plexus lesions.
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Affiliation(s)
- En-Qi Guo
- Center for Plastic and Reconstructive Surgery, Department of Hand and Reconstructive Surgery, Zhejiang Provincial People’s Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Xiao-Dong Yang
- Center for Plastic and Reconstructive Surgery, Department of Hand and Reconstructive Surgery, Zhejiang Provincial People’s Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Hong-Rui Lu
- Center for Plastic and Reconstructive Surgery, Department of Hand and Reconstructive Surgery, Zhejiang Provincial People’s Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
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Walter SS, Fritz J. MRI of Muscular Neoplasms and Tumor-Like Lesions: A 2020 World Health Organization Classification-based Systematic Review. Semin Roentgenol 2022; 57:252-274. [DOI: 10.1053/j.ro.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/03/2022] [Accepted: 01/08/2022] [Indexed: 11/11/2022]
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Ultrasound of Musculoskeletal Hematomas: Relationship of Sonographic Appearance to Age and Ease of Aspiration. AJR Am J Roentgenol 2020; 216:125-130. [PMID: 32603221 DOI: 10.2214/ajr.19.22752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the safety and efficacy of ultrasound-guided aspiration of musculoskeletal hematomas, evaluate the associations between the sonographic appearance of hematomas and their age with ease of aspiration, and determine if there is an optimal time frame for aspiration. MATERIALS AND METHODS A retrospective search of our radiology database was conducted using the keywords "hematoma" and "aspiration" for procedures performed from January 1, 2008, through September 28, 2017, by three fellowship-trained musculoskeletal radiologists. Associations between the ease of aspiration and echotexture of the hematoma and between the ease of aspiration and age of the hematoma were assessed with a marginal ordinal logistic regression model to account for patient-level clusters. Pairwise comparisons of the ease of aspiration between the different echotextures were adjusted for multiple comparisons with the Tukey-Kramer method. This same method was also used to calculate the odds ratio (OR) for the age of the hematoma and ease of aspiration and decompression. Clinical follow-up was assessed for infection and symptomatic relief. RESULTS The cohort was composed of 148 patients (77 male and 71 female patients) with a mean age of 48 years (age range, 16-80 years). One hundred patients underwent clinical follow-up: There were no instances of infection and all patients reported symptomatic relief. Marginal proportional odds model showed an OR of 3.77 when comparing the ease of aspiration between hypoechoic hematomas and hematomas showing the other echotextures combined (i.e., complex, heterogeneous, echo-genic), which was statistically significant (p = 0.010). The OR of the ease of aspiration in relation to the age of a hematoma for each additional week was 1.03 with a p value of 0.547, which shows that there is no correlation between the age of the hematoma and ease of aspiration. CONCLUSION Ultrasound-guided aspiration of hematomas is a safe and effective procedure. The sonographic appearance of a hematoma is unrelated to its age. Although a hematoma with a hypoechoic appearance is easier to aspirate than hematomas with other echotextures, the appearance and age of a hematoma should not dissuade one from trying to aspirate it.
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Lambing A, Witkop M, Humphries TJ. Complementary and alternative therapy (CAM) in haemophilia pain management: a review of published literature. ACTA ACUST UNITED AC 2019. [DOI: 10.17225/jhp00122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Angela Lambing
- Clinical Support Specialist, Bayer HealthCare , United States
| | - Michelle Witkop
- Head of Research, National Hemophilia Foundation , United States
| | - Thomas J. Humphries
- Formerly Senior Medical Director, US Medical Affairs, Bayer HealthCare , United States
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Strike K, Uy M, Lawson W, Squire S, Iorio A, Stein N, Jackson S, Chan A. Point-of-care ultrasonography in haemophilia care: Training and competency for muscular haematomas. Haemophilia 2018. [PMID: 29537118 DOI: 10.1111/hae.13417] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- K Strike
- Hamilton Niagara Regional Hemophilia Program, Hamilton Health Sciences, Hamilton, ON, Canada
| | - M Uy
- Institute of Applied Health Sciences, McMaster University/Mohawk College, Hamilton, ON, Canada
| | - W Lawson
- Department of Allied Health, Mohawk College, Hamilton, ON, Canada
| | - S Squire
- Hemophilia Program - Adult Division, St. Paul's Hospital, Vancouver, BC, Canada
| | - A Iorio
- Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - N Stein
- Pediatric Radiology, McMaster Children's Hospital, Hamilton, ON, Canada
| | - S Jackson
- Hemophilia Program - Adult Division, St. Paul's Hospital, Vancouver, BC, Canada
| | - A Chan
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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Haws BE, Luo TD, Al'Khafaji IM, Rogers JP, Botros DB, Freehill MT. Definitive management of thigh contusions in athletes: but how definitive? A systematic review. J ISAKOS 2017. [DOI: 10.1136/jisakos-2016-000107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
BACKGROUND Haemophilia is a bleeding disorder associated with haemorrhaging into joints and muscles. Exercise is often used to aid recovery after bleeds, and to improve joint function in the presence of arthropathy. OBJECTIVES Our objective was to systematically review the available evidence on the safety and effectiveness of exercise for people with haemophilia. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Coagulopathies Trials Register and electronic databases PubMed, OVID-Embase, and CINAHL. We hand searched abstracts from congresses of the World Federation of Hemophilia and the European Hematology Association, trial registries and the reference lists of relevant articles.Date of the last search of the Cochrane Cystic Fibrosis and Genetic Disorders Group's Coagulopathies Trials Register: 14 December 2016. SELECTION CRITERIA Randomized or quasi-randomized controlled studies comparing any exercise intervention considered relevant in haemophilia management including supervised, unsupervised, aquatic, strengthening, aerobic or cardiovascular, stretching, proprioceptive and balance training exercise programs in males of any age with haemophilia A or B of any severity (those with co-morbidities were not excluded). DATA COLLECTION AND ANALYSIS Two authors reviewed the identified abstracts to determine their eligibility. For studies meeting the inclusion criteria, full articles were obtained. The two authors extracted data and assessed the risk of bias. Any disagreements were resolved by discussion. The authors contacted study investigators to obtain any missing data. MAIN RESULTS Eight studies were included, which represented 233 males with all severities of haemophilia A and B, ranging in age from eight years to 49 years. Study duration ranged from four to 12 weeks. Exercise interventions varied greatly and included resistance exercises, isometric exercises, bicycle ergometry, treadmill walking and hydrotherapy; therefore, comparison between studies was difficult.None of the studies measured or reported adverse effects from the interventions. None of the studies reported outcomes regarding bleed frequency, quality of life or aerobic activity. Overall risk of bias across all studies was assessed as unclear.Very few studies provided sufficient information for comparison. None of the studies reported data that favoured the control group. One study reported that six weeks of resistance training improved joint health status (Colorado score) compared to controls. The addition of pulsed electromagnetic fields also improved ankle scores compared to exercises alone, but this was not seen in the elbows or knees.Two studies reported statistically significant improvements in pain intensity after exercise interventions compared to controls. Hydrotherapy exercises produced significant decreases in pain compared to controls and land-based exercise groups.Two studies found improvement in joint motion in the exercise group compared to controls. One study compared land- and water-based exercises; there was no difference in the range of motion between the two groups; however, the water-based exercise group did show improvement over the control group.One study, comparing joint traction and proprioceptive neuromuscular facilitation for the elbow to a control group, showed no differences in biceps girth or strength after 12 weeks of intervention.Some studies reported comparisons between interventions. In one study, treadmill training significantly improved balance in children compared to bicycle ergometry. Another study added partial weight bearing exercises to quadriceps exercises and showed improved walking tolerance.Four studies evaluated quadriceps or hamstring strength (or both). The addition of bicycle ergometry and exercises with weights was more effective than static exercises and treadmill walking for strengthening knee flexors and extensors. Partial weight-bearing exercises through range were more effective than static and short arc exercises for improving knee extensor strength. The addition of treadmill walking to ultrasound, stretching and strengthening exercises showed increased peak torque of knee flexors and extensors and decrease in knee effusion.The results should be interpreted with caution due to the quality of evidence (GRADE) as outlined in the summary of findings tables, which demonstrates that all but one of the outcomes assessed were rated as low or very low due to the small sample sizes and potential bias. AUTHORS' CONCLUSIONS These results must be considered with caution. There is a lack of confidence in the results due to the small number of included studies and the inability to pool the results due to the heterogeneity of outcome measures. Most exercise interventions produced improvement in one or more of the measured outcomes including pain, range of motion, strength and walking tolerance. Hydrotherapy may be more effective than land exercises for pain relief in adults. Functional exercises such as treadmill walking and partial weight bearing exercises seem to be more effective than static or short arc exercises for improving muscle strength. These findings are consistent with the many non-controlled intervention reports in the haemophilia literature. No adverse effects were reported as a result of any of the interventions. However, some groups used prophylactic factor prior to exercise and other groups studied only subjects with moderate haemophilia. Therefore, the safety of these techniques for persons with severe haemophilia remains unclear.
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Affiliation(s)
- Karen Strike
- Hamilton Health Sciences, McMaster Children's HospitalDepartment of Physiotherapy1200 Main Street WestHamiltonONCanadaL8N 3Z5
| | - Kathy Mulder
- Health Sciences CentrePhysiotherapy‐Child HealthCH246 ‐ 840 Sherbrook StreetWinnipegMBCanadaR3A 1S1
| | - Rojer Michael
- Manipal HospitalSchool of Allied Health SciencesOld Airport RoadBangaloreIndia560017
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Abstract
OBJECTIVE To describe a successful prophylactic protocol for managing an athlete with hemophilia playing at a high level of contact sports. BACKGROUND Published data show that team physicians are not comfortable either treating athletes with bleeding disorders or allowing them to participate in contact sports. Much of the literature historically has recommended against allowing athletes with bleeding disorders to play sports at all and certainly against playing contact sports. Hemophilia treatment can now include prophylactic injections of recombinant factor VIII to prevent bleeding episodes. Modern treatments hold the promise of allowing athletes with hemophilia to participate in contact sports. DIFFERENTIAL DIAGNOSIS Mild, moderate, or severe hemophilia; von Willebrand disease; other factor deficiencies. TREATMENT A treatment protocol was developed that included prophylactic factor VIII injections on a regular basis and when the athlete was injured. UNIQUENESS This is the first published case report of an athlete with known hemophilia being successfully treated and participating in National Collegiate Athletic Association collegiate basketball for 2 full seasons. CONCLUSIONS Sports medicine teams can successfully manage an athlete with hemophilia playing a contact sport.
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Affiliation(s)
- Mark Maffet
- Houston Methodist Orthopedics and Sports Medicine, TX
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13
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Tranholm M, Kristensen AT, Broberg ML, Groth MP. Novel, high incidence exercise-induced muscle bleeding model in hemophilia B mice: rationale, development and prophylactic intervention. J Thromb Haemost 2015; 13:82-91. [PMID: 25370152 PMCID: PMC4309488 DOI: 10.1111/jth.12775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Muscle hematomas are the second most common complication of hemophilia and insufficient treatment may result in serious and even life-threatening complications. Hemophilic dogs and rats do experience spontaneous muscle bleeding, but currently, no experimental animal model is available specifically investigating spontaneous muscle bleeds in a hemophilic setting. AIM The objective of this study was to develop a model of spontaneous muscle bleeds in hemophilia B mice. We hypothesized that treadmill exercise would induce muscle bleeds in hemophilia B mice but not in normal non-hemophilic mice and that treatment with recombinant factor IX (rFIX) before treadmill exercise could prevent the occurrence of pathology. METHODS A total of 203 mice (123 F9-KO and 80 C57BL/6NTac) were included in three separate studies: (i) the model implementation study investigating the bleeding pattern in hemophilia B mice after treadmill exercise; (ii) a study evaluating the pharmacokinetics of recombinant FIX (rFIX) in hemophilia B mice and based on these data; (iii) the treatment study, which tested therapeutic intervention with rFIX. At termination of the treadmill studies the presence of bleeds was evaluated. RESULTS Treadmill exercise resulted in a high incidence of muscle bleeds in F9-KO mice but not in C57BL/6NTac mice. Treating hemophilia B mice with rFIX before treadmill exercise prevented muscle bleeds. CONCLUSION A novel model of muscle bleeds in hemophilia B mice, responsive to rFIX, has been developed.
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Affiliation(s)
| | - A T Kristensen
- Department of Veterinary Clinical and Animal Sciences, University of CopenhagenFrederiksberg, Denmark
| | | | - M P Groth
- Novo Nordisk A/SMåløv, Denmark
- Department of Veterinary Clinical and Animal Sciences, University of CopenhagenFrederiksberg, Denmark
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14
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Treatment of muscle haematomas in haemophiliacs with special emphasis on percutaneous drainage. Blood Coagul Fibrinolysis 2014; 25:787-94. [DOI: 10.1097/mbc.0000000000000159] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sørensen B, Benson GM, Bladen M, Classey S, Keeling DM, McLaughlin P, Yee TT, Makris M. Management of muscle haematomas in patients with severe haemophilia in an evidence-poor world. Haemophilia 2011; 18:598-606. [PMID: 22151135 DOI: 10.1111/j.1365-2516.2011.02720.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Treatment studies in haemophilia focus on joint bleeds; however, some 10-25% of bleeds occur in muscles. This review addresses management of muscle haematoma in severe haemophilia, defines gaps in the published evidence, and presents a combined clinician and physiotherapist perspective of treatment modalities. The following grade 2C recommendations were synthesized: (i) Sport and activity should be based on individual factor levels, bleeding history and physical characteristics, (ii) Musculoskeletal review aids the management of children and adults, (iii) 'Time to full recovery' should be realistic and based on known timelines from the healthy population, (iv) Diagnosis should be carried out by both a clinician and physiotherapist, (v) Severe muscle bleeds should be treated similarly to surgical patients: a 50% trough for 10-14 days followed by high-level prophylaxis, (vi) Protection, rest, ice, compression and elevation should be implemented in the acute stage, and (vii) Physiotherapy and rehabilitation should be divided into: control of haemorrhage (phase 1); restoration of Range of Movement (ROM) and strength (phase 2); functional rehabilitation and return to normal living (phase 3). Recommendations specifically for inhibitor patients include: (i) Minor to moderate bleeds should be managed by home-treatment within 1 h of bleed onset using either one injection of rFVIIa 270 μg kg(-1), or two to three injections of rFVIIa 90 μg kg(-1) (2-3 h intervals), or FEIBA 50-100 U kg(-1) (repeated at 12-hourly intervals, if necessary) and (ii) Severe muscle bleeds should be supervised by the treatment centre and include bypassing agents until clinical improvement is observed.
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Affiliation(s)
- B Sørensen
- Haemostasis Research Unit, Centre for Haemophilia and Thrombosis, Guy's and St Thomas Hospital & NHS Foundation Trust & King's College London School of Medicine, London, UK.
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Querol F, Rodriguez-Merchan EC. The role of ultrasonography in the diagnosis of the musculo-skeletal problems of haemophilia. Haemophilia 2011; 18:e215-26. [PMID: 22044728 DOI: 10.1111/j.1365-2516.2011.02680.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Recurrent haemarthrosis is the final cause of haemophilic arthrosic disease in haemophilia patients. Therefore, it is essential to diagnose it early, both clinically and by imaging. In addition, haemophilia patients experience chronic synovitis, joint degeneration, muscle haematoma and pseudotumours. The objective of this article is to highlight the value of ultrasounds in the diagnosis and control of the evolution of musculo-skeletal problems in haemophilia patients. To this end, we have performed a literature search in the PubMed, Web of Science(®) (WOS) and SciVerse bases, using the following keywords: hemophilia or haemophilia and ultrasonography (US), ultrasound, echography and sonography. The search was limited to studies published in English between the years 1991 and 2011, finding a total of 221 references. After reviewing the title or abstract for evidence of the use of US for the diagnosis of musculo-skeletal lesions in haemophilia, we selected 24 of these references. We added data collected from our experience to the most important data found in the references. Our main conclusion is that US is highly valuable for the diagnosis of musculo-skeletal diseases in haemophilia. It is a fast, effective, safe, available, comparative, real-time technique that can help us confirm the clinical examination. It is particularly important in acute haemarthrosis, as it can be used to objectively identify the presence of blood in the joints, measure its size, pinpoint its location, assess its evolution and confirm its complete disappearance.
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Affiliation(s)
- F Querol
- Department of Physiotherapy, Valencia University and La Fe Hospital, Valencia, Spain
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Sørensen B, Dargaud Y, Kenet G, Lusher J, Mumford A, Pipe S, Tiede A. On-demand treatment of bleeds in haemophilia patients with inhibitors: strategies for securing and maintaining predictable efficacy with recombinant activated factor VII. Haemophilia 2011; 18:255-62. [PMID: 21771206 DOI: 10.1111/j.1365-2516.2011.02612.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- B Sørensen
- Haemostasis Research Unit, Centre for Haemostasis & Thrombosis, Guy's & St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK.
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BEYER R, INGERSLEV J, SØRENSEN B. Current practice in the management of muscle haematomas in patients with severe haemophilia. Haemophilia 2010; 16:926-31. [DOI: 10.1111/j.1365-2516.2010.02275.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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