1
|
Chooklin S, Chuklin S. PATHOPHYSIOLOGICAL MECHANISMS OF DEEP VEIN THROMBOSIS. FIZIOLOHICHNYĬ ZHURNAL 2023; 69:133-144. [DOI: 10.15407/fz69.06.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Deep venous thrombosis is a frequent multifactorial disease and most of the time is triggered by the interaction between acquired risk factors, particularly immobility, and hereditary risk factors such as thrombophilias. The mechanisms underlying deep venous thrombosis are not fully elucidated; however, in recent years the role of venous flow, endothelium, platelets, leukocytes, and the interaction between inflammation and hemostasis has been determined. Alteration of venous blood flow produces endothelial activation, favoring the adhesion of platelets and leukocytes, which, through tissue factor expression and neutrophil extracellular traps formation, contribute to the activation of coagulation, trapping more cells, such as red blood cells, monocytes, eosinophils, lymphocytes. The coagulation factor XI-driven propagation phase of blood coagulation plays a major role in venous thrombus growth, but a minor role in hemostasis. In this work, the main mechanisms involved in the pathophysiology of deep vein thrombosis are described.
Collapse
|
2
|
Ye X, Mi X, Sun J, ShenTu Y, Fei Y, Tang D, Ye X, Ma X, Shi J, Chen G, Gong L. PROS1 variant c.1574C>T p.Ala525Val causes portal vein thrombosis with Protein S Deficiency. Clin Res Hepatol Gastroenterol 2023; 47:102141. [PMID: 37207893 DOI: 10.1016/j.clinre.2023.102141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Protein S (PS) is a vitamin K-dependent plasma glycoprotein, and the deficiency of PS increases the risk of venous thromboembolism (VTE). PS deficiency has been found in 1.5-7% of selected groups of thrombophilic patients. However, the reported PS deficiency patients with portal vein thrombosis are scarce. CASE REPORT AND RESULTS Our case described a 60-year-old male patient presented portal vein thrombosis with protein S deficiency. Imaging findings of the patient revealed extensive thrombosis involving the portal vein and superior mesenteric vein. His medical history revealed lower extremity venous thrombosis 10 years ago. The level of PS activity was greatly reduced (14%, reference: 55-130%). Acquired thrombophilia caused by antiphospholipid syndrome, hyperhomocysteinemia, or malignancy were excluded. Whole exome sequencing revealed a heterozygous missense variation c.1574C>T, p.Ala525Val in the PROS1 gene. The in-silico analysis of the variant was performed by SIFT and PolyPhen-2. The results showed that the variant is a pathogenic and likely pathogenic variation respectively (SIFT, -3.404; PolyPhen-2, 0.892), the amino acid substitution A525V is presumed to result in unstable PS protein which is degraded intracellularly. Mutation site of the proband and his family members was validated by Sanger sequencing. CONCLUSION According to the clinical manifestation, imaging findings, protein S level, and the genetic results, a diagnosis of portal vein thrombosis with PS deficiency was made. To the best of our knowledge, our case is the second reported PS deficiency patient caused by PROS1 c.1574C>T, p.Ala525Val variant in Asia, and the case is also the only reported case with PROS1 c.1574C>T, p.Ala525Val variant presents portal vein thrombosis.
Collapse
Affiliation(s)
- Xiaoying Ye
- Hangzhou Normal University, Zhejiang, China.
| | - Xiaoxiao Mi
- Institute of Translational Medicine, Hangzhou Normal University Affiliated Hospital, Zhejiang, China.
| | - Jiawei Sun
- Hangzhou Normal University, Zhejiang, China.
| | - Yiling ShenTu
- Department of Respiratory Medicine, Fuyang First People's Hospital, Hangzhou, China.
| | - Yingming Fei
- Department of Infectious Disease (Liver Diseases), Shaoxing University Affiliated Hospital, Zhejiang, China.
| | - Dong Tang
- Department of Medical Imaging (Radiology), Hangzhou Normal University Affiliated Hospital, Zhejiang, China.
| | - Xiaoping Ye
- Department of Infectious Disease (Liver Diseases), Hangzhou Normal University Affiliated Hospital, Zhejiang, China.
| | - Xiaojie Ma
- Department of Infectious Disease (Liver Diseases), Hangzhou Normal University Affiliated Hospital, Zhejiang, China.
| | - Junping Shi
- Department of Infectious Disease (Liver Diseases), Hangzhou Normal University Affiliated Hospital, Zhejiang, China.
| | - Gongying Chen
- Department of Infectious Disease (Liver Diseases), Hangzhou Normal University Affiliated Hospital, Zhejiang, China.
| | - Ling Gong
- Department of Infectious Disease (Liver Diseases), Hangzhou Normal University Affiliated Hospital, Zhejiang, China.
| |
Collapse
|
3
|
Abstract
The association between inflammation, infection, and venous thrombosis has long been recognized; yet, only in the last decades have we begun to understand the mechanisms through which the immune and coagulation systems interact and reciprocally regulate one another. These interconnected networks mount an effective response to injury and pathogen invasion, but if unregulated can result in pathological thrombosis and organ damage. Neutrophils, monocytes, and platelets interact with each other and the endothelium in host defense and also play critical roles in the formation of venous thromboembolism. This knowledge has advanced our understanding of both human physiology and pathophysiology, as well as identified mechanisms of anticoagulant resistance and novel therapeutic targets for the prevention and treatment of thrombosis. In this review, we discuss the contributions of inflammation and infection to venous thromboembolism.
Collapse
Affiliation(s)
- Meaghan E. Colling
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Benjamin E. Tourdot
- Experimental Hematology and Cancer Biology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Yogendra Kanthi
- Laboratory of Vascular Thrombosis and Inflammation, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
4
|
Mauger C, Gouin I, Guéret P, Gac FN, Baillerie A, Lefeuvre C, Boutruche B, Bayard S, Jaquinandi V, Jégo P, Mahé G. Impact of multidisciplinary team meetings on the management of venous thromboembolism. A clinical study of 142 cases. JOURNAL DE MEDECINE VASCULAIRE 2020; 45:192-197. [PMID: 32571559 DOI: 10.1016/j.jdmv.2020.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 04/06/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Numerous guidelines have been published on the management of venous thromboembolism (VTE). However, therapeutic decision-making may prove challenging in routine clinical practice. With this in mind, multidisciplinary team (MDT) meetings have been set up in Rennes University Hospital, France. This study sought to describe the situations discussed during MDT meetings and to assess whether the meetings bring about changes in the management of these patients. MATERIALS AND METHODS A retrospective single-center study conducted at the Rennes University Hospital included cases presented from the beginning of the MDT meetings (February 2015) up to May 2017. RESULTS In total, 142 cases were presented in 15 MDT meetings, corresponding to a mean of 10±4 cases per meeting. Of these, 129 related to VTE patients: 33 provoked VTEs, 22 unprovoked VTEs, 49 cancer-related VTEs, and 25 unspecified VTEs. MDT meetings led to significant changes in the anticoagulation type (therapeutic, prophylactic, or discontinuation) and duration, but not in the anticoagulant choice (direct oral anticoagulants, vitamin K antagonists, heparins, etc.). CONCLUSION Requests for MDT meetings are made for all VTE types, and these meetings have an impact on VTE management.
Collapse
Affiliation(s)
- C Mauger
- Cardiology Department, Saint Malo Hospital, Saint Malo, France; Vascular Medicine unit, Rennes University Hospital, Rennes, France.
| | - I Gouin
- Cellular Hematology Laboratory - Bioclinical Hemostasis, Rennes, France; Rennes 1 University, Rennes, France
| | - P Guéret
- Cellular Hematology Laboratory - Bioclinical Hemostasis, Rennes, France
| | - F Nedelec Gac
- Cellular Hematology Laboratory - Bioclinical Hemostasis, Rennes, France
| | - A Baillerie
- Departement of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
| | - C Lefeuvre
- Oncology Department, Saint-Grégoire private hospital, Saint-Grégoire, France
| | - B Boutruche
- Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - S Bayard
- Cellular Hematology Laboratory - Bioclinical Hemostasis, Rennes, France; Pediatric Department, University Hospital, Rennes, France
| | - V Jaquinandi
- Vascular Medicine unit, Rennes University Hospital, Rennes, France
| | - P Jégo
- UMR INSERM U1085, Institut de Recherche sur la Santé, l'Environnement et le Travail (IRSET), Rennes, France
| | - G Mahé
- Vascular Medicine unit, Rennes University Hospital, Rennes, France; INSERM CIC 14 14, Rennes, France.
| |
Collapse
|
5
|
Marín-Romero S, Elías-Hernández T, Asensio-Cruz MI, Ortega-Rivera R, Morillo-Guerrero R, Toral J, Montero E, Sánchez V, Arellano E, Sánchez-Díaz JM, Real-Domínguez M, Otero-Candelera R, Jara-Palomares L. Risk of Recurrence After Withdrawal of Anticoagulation in Patients With Unprovoked Venous Thromboembolism: External Validation of the Vienna Nomogram and the Dash Prediction Score. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.arbr.2019.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
6
|
Marín-Romero S, Elías-Hernández T, Asensio-Cruz MI, Ortega-Rivera R, Morillo-Guerrero R, Toral J, Montero E, Sánchez V, Arellano E, Sánchez-Díaz JM, Real-Domínguez M, Otero-Candelera R, Jara-Palomares L. Risk Of Recurrence After Withdrawal Of Anticoagulation In Patients With Unprovoked Venous Thromboembolism: External Validation Of The Vienna Nomogram And The Dash Prediction Score. Arch Bronconeumol 2019; 55:619-626. [PMID: 31130245 DOI: 10.1016/j.arbres.2019.03.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/17/2019] [Accepted: 03/18/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Scales for predicting venous thromboembolism (VTE) recurrence are useful for deciding the duration of the anticoagulant treatment. Although there are several scales, the most appropriate for our setting has not been identified. For this reason, we aimed to validate the DASH prediction score and the Vienna nomogram at 12 months. METHODS This was a retrospective study of unselected consecutive VTE patients seen between 2006 and 2014. We compared the ability of the DASH score and the Vienna nomogram to predict recurrences of VTE. The validation was performed by stratifying patients as low-risk or high-risk, according to each scale (discrimination) and comparing the observed recurrence with the expected rate (calibration). RESULTS Of 353 patients evaluated, 195 were analyzed, with an average age of 53.5 ± 19 years. There were 21 recurrences in 1 year (10.8%, 95% CI: 6.8%-16%). According to the DASH score, 42% were classified as low risk, and the rate of VTE recurrence in this group was 4.9% (95% CI: 1.3%-12%) vs. the high-risk group that was 15% (95% CI: 9%-23%) (p <.05). According to the Vienna nomogram, 30% were classified as low risk, and the rate of VTE recurrence in the low risk group vs. the high risk group was 4.2% (95% CI:0.5%-14%) vs. 16.2% (95% CI: 9.9%-24.4%) (p <.05). CONCLUSIONS Our study validates the DASH score and the Vienna nomogram in our population. The DASH prediction score may be the most advisable, both because of its simplicity and its ability to identify more low-risk patients than the Vienna nomogram (42% vs. 30%).
Collapse
Affiliation(s)
- Samira Marín-Romero
- Unidad Médico Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Teresa Elías-Hernández
- Unidad Médico Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - María Isabel Asensio-Cruz
- Unidad Médico Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Rocío Ortega-Rivera
- Unidad Médico Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Sevilla, España
| | | | - Javier Toral
- Unidad de Urgencias y Emergencias, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Emilio Montero
- Unidad de Urgencias y Emergencias, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Verónica Sánchez
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, España
| | - Elena Arellano
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, España
| | - José María Sánchez-Díaz
- Unidad Médico Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Sevilla, España
| | | | - Remedios Otero-Candelera
- Unidad Médico Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Luis Jara-Palomares
- Unidad Médico Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Sevilla, España; CIBERES, Instituto de Salud Carlos III, Madrid, España.
| |
Collapse
|