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Franchini M, Focosi D, Pezzo MP, Mannucci PM. Catastrophic Thrombosis: A Narrative Review. Semin Thromb Hemost 2024. [PMID: 39151904 DOI: 10.1055/s-0044-1788790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2024]
Abstract
Catastrophic thrombosis is a severe condition characterized by a hypercoagulable tendency, leading to multiple thromboembolic events in different blood vessels, usually within a short timeframe. Several conditions have been associated with the development of catastrophic thrombosis, including the catastrophic antiphospholipid syndrome, thrombotic anti-platelet factor 4 immune disorders, thrombotic microangiopathies, cancers, the hyper-eosinophilic syndrome, pregnancy, infections, trauma, and drugs. Thrombotic storm represents a medical emergency whose management represents a serious challenge for physicians. Besides the prompt start of anticoagulation, a patient's prognosis depends on early recognition and possible treatment of the underlying condition. In this narrative review, we summarize the main characteristics of catastrophic thrombosis, analyzing the various conditions triggering such life-threatening complication. Finally, an algorithm with the diagnostic workup and the initial management of patients with catastrophic thrombosis is presented.
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Affiliation(s)
- Massimo Franchini
- Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, Mantova, Italy
| | - Daniele Focosi
- North-Western Tuscany Blood Bank, Pisa University Hospital, Italy
| | | | - Pier Mannuccio Mannucci
- Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico and University of Milan, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
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2
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Buka RJ, Pavord S. Anti-platelet factor 4 immunothrombotic syndromes. Br J Haematol 2024. [PMID: 39058578 DOI: 10.1111/bjh.19663] [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: 03/30/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024]
Abstract
Anti-platelet factor 4 immunothrombotic syndromes comprise a group of disorders that include heparin-induced thrombocytopenia and vaccine-induced immune thrombocytopenia and thrombosis. These are highly prothrombotic, immunological disorders characterised by specific clinical and pathological criteria which include thrombocytopenia and thrombosis. While they are predominantly triggered by heparin and the adenoviral vector vaccines, respectively, other provoking factors have been described, as well as spontaneous forms. The unexplained co-occurrence of thrombocytopenia with thrombosis should raise suspicion and prompt testing. This nutshell review discusses the pathophysiology, presenting features and diagnostic criteria for these conditions.
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Affiliation(s)
- Richard J Buka
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Sue Pavord
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Sørvoll IH, Lægreid IJ, Sollid T, Ahlen MT, Johansen S, Reikvam H. Low Incidence of Anti-PF4/Heparin Antibodies in Patients with Acute Myelogenous Leukemia. Mediterr J Hematol Infect Dis 2024; 16:e2024057. [PMID: 38984091 PMCID: PMC11232681 DOI: 10.4084/mjhid.2024.057] [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: 05/15/2024] [Accepted: 06/14/2024] [Indexed: 07/11/2024] Open
Abstract
Not relevant
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Affiliation(s)
- Ingvild Hausberg Sørvoll
- The Norwegian National Unit for Platelet Immunology, Division of Diagnostics, University Hospital of North Norway, N-9037 Tromsø, Norway
| | - Ingvild Jenssen Lægreid
- The Norwegian National Unit for Platelet Immunology, Division of Diagnostics, University Hospital of North Norway, N-9037 Tromsø, Norway
| | - Tom Sollid
- The Norwegian National Unit for Platelet Immunology, Division of Diagnostics, University Hospital of North Norway, N-9037 Tromsø, Norway
| | - Maria Therese Ahlen
- The Norwegian National Unit for Platelet Immunology, Division of Diagnostics, University Hospital of North Norway, N-9037 Tromsø, Norway
| | - Silje Johansen
- K.G. Jebsen Center for Myeloid Blood Cancer, Department of Clinical Science, University of Bergen, N-5021 Bergen, Norway
- Section of Haematology, Department of Medicine, Haraldsplass Deaconess Hospital, N-5021 Bergen, Norway
| | - Håkon Reikvam
- K.G. Jebsen Center for Myeloid Blood Cancer, Department of Clinical Science, University of Bergen, N-5021 Bergen, Norway
- Section of Haematology, Department of Medicine, Haukeland University Hospital, N-5021 Bergen, Norway
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4
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Ordieres-Ortega L, Moragón-Ledesma S, Demelo-Rodríguez P. Cerebral venous thrombosis. Rev Clin Esp 2024; 224:237-244. [PMID: 38428733 DOI: 10.1016/j.rceng.2024.02.015] [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] [Indexed: 03/03/2024]
Abstract
Cerebral venous thrombosis is part of the so-called thrombosis in unusual sites. It is defined as an occlusion in the cerebral venous territory. Its incidence is progressively increasing, especially in developing countries. It is more frequently observed in young women, with hormonal factors such as pregnancy or hormonal contraception being significant risk factors in the development of this condition. The clinical presentation will depend fundamentally on the topography of the thrombosis, with a confirmatory diagnosis based mainly on imaging tests. The treatment generally consists of anticoagulation, and other options may be considered depending on the severity of the case. Overall, the prognosis is better than that of other intracranial vascular disorders. This review describes the current evidence available regarding cerebral venous thrombosis.
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Affiliation(s)
- L Ordieres-Ortega
- Unidad de Enfermedad Tromboembólica Venosa, Medicina Interna, Hospital General Universitario Gregorio Marañón, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Spain
| | - S Moragón-Ledesma
- Unidad de Enfermedad Tromboembólica Venosa, Medicina Interna, Hospital General Universitario Gregorio Marañón, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Spain
| | - P Demelo-Rodríguez
- Unidad de Enfermedad Tromboembólica Venosa, Medicina Interna, Hospital General Universitario Gregorio Marañón, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Spain; Facultad de Medicina, Universidad CEU San Pablo, Spain.
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Khan Z, Patel I, Gardner T, Wei X, Cheng M, Vesely MR, Benitez RM, Zimrin AB, Wang L, Finn AV. Recurrent Stent Thrombosis Following Myocardial Infarction Associated With VITT-Like Antibodies. JACC Case Rep 2024; 29:102234. [PMID: 38464793 PMCID: PMC10920136 DOI: 10.1016/j.jaccas.2024.102234] [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: 11/17/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 03/12/2024]
Abstract
Early stent thrombosis is a rare complication of percutaneous intervention and is associated with significant 30-day mortality. We present a novel case of multiple recurrent early stent thrombosis consistent with spontaneous vaccine-induced thrombotic thrombocytopenia. We were successfully able to manage this unusual condition through an interdisciplinary collaboration.
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Affiliation(s)
- Zulqarnain Khan
- University of Maryland School of Medicine, Department of Internal Medicine, Cardiovascular Division, Baltimore, Maryland, USA
| | - Imari Patel
- University of Maryland School of Medicine, Department of Internal Medicine, Hematology/Oncology Division, Baltimore, Maryland, USA
| | - Tiffany Gardner
- University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Xin Wei
- University of Maryland School of Medicine, Department of Internal Medicine, Cardiovascular Division, Baltimore, Maryland, USA
| | - Michael Cheng
- University of Maryland School of Medicine, Department of Internal Medicine, Cardiovascular Division, Baltimore, Maryland, USA
| | - Mark R Vesely
- University of Maryland School of Medicine, Department of Internal Medicine, Cardiovascular Division, Baltimore, Maryland, USA
| | - Roberto M Benitez
- University of Maryland School of Medicine, Department of Internal Medicine, Cardiovascular Division, Baltimore, Maryland, USA
| | - Ann B Zimrin
- University of Maryland School of Medicine, Department of Internal Medicine, Hematology/Oncology Division, Baltimore, Maryland, USA
| | - Libin Wang
- University of Maryland School of Medicine, Department of Internal Medicine, Cardiovascular Division, Baltimore, Maryland, USA
| | - Aloke V Finn
- University of Maryland School of Medicine, Department of Internal Medicine, Cardiovascular Division, Baltimore, Maryland, USA
- CVPath Institute Inc, Gaithersburg, Maryland, USA
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Kudo Y, Suzuki K, Maezawa S, Seo R, Irinoda T. High-Dose Immunoglobulin Therapy for Multiple Thromboembolism in Persisting Heparin-Induced Thrombocytopenia. Cureus 2024; 16:e55747. [PMID: 38586733 PMCID: PMC10998767 DOI: 10.7759/cureus.55747] [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] [Accepted: 03/07/2024] [Indexed: 04/09/2024] Open
Abstract
This report presents a case of an 81-year-old male with acute respiratory distress syndrome secondary to aspiration pneumonia who developed heparin-induced thrombocytopenia (HIT). His platelet count remained persistently low despite discontinuing unfractionated heparin and initiating intravenous argatroban. Multiple thromboembolisms, including a new aortic mural thrombus in the descending aorta, were observed on contrast-enhanced computed tomography (CT), resulting in a diagnosis of autoimmune HIT (aHIT). Subsequent high-dose intravenous immunoglobulin (IVIG) therapy substantially improved the platelet count and resolved thromboembolisms. This case is notable owing to the improvement of aHIT complicated by multiple thromboembolisms, including an aortic mural thrombus, following high-dose IVIG therapy. In recent years, a growing number of reports have documented the effectiveness of high-dose IVIG therapy for aHIT. However, reports on whether high-dose IVIG therapy could improve an aortic mural thrombus complicating aHIT are lacking. The successful use of high-dose IVIG therapy in the current case highlights its potential efficacy in treating aHIT complicated by multiple thromboembolisms. Further studies are required to clarify the role of IVIG in the management of aHIT with thromboembolism.
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Affiliation(s)
- Yasushi Kudo
- Department of Emergency Medicine, Osaki Citizen Hospital, Miyagi, JPN
| | - Koki Suzuki
- Department of Emergency Medicine, Osaki Citizen Hospital, Miyagi, JPN
| | - Shota Maezawa
- Department of Emergency Medicine, Osaki Citizen Hospital, Miyagi, JPN
| | - Ryota Seo
- Department of Emergency Medicine, Osaki Citizen Hospital, Miyagi, JPN
| | - Takashi Irinoda
- Department of Emergency Medicine, Osaki Citizen Hospital, Miyagi, JPN
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Warkentin TE. Immunologic Effects of Heparin Associated With Hemodialysis: Focus on Heparin-Induced Thrombocytopenia. Semin Nephrol 2023; 43:151479. [PMID: 38195304 DOI: 10.1016/j.semnephrol.2023.151479] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Intermittent hemodialysis (HD) is almost invariably performed with heparin, and thus HD patients are at risk of developing the immune-mediated adverse effect heparin-induced thrombocytopenia (HIT), caused by anti-platelet factor 4/heparin IgG, which strongly activates platelets. HIT patients develop hypercoagulability with greatly increased risk of thrombosis, both venous and arterial. Certain HIT-associated complications are more likely to develop among HD patients, including hemofilter thrombosis despite heparin, intravascular catheter and/or arteriovenous fistula-associated thrombosis, post-heparin bolus anaphylactoid/anaphylactic reactions, and thrombotic stroke and acute limb artery thrombosis (reflecting the high frequency of underlying arteriopathy in many patients with renal failure). Management of HIT in HD usually requires use of an alternative (non-heparin) anticoagulant; for example, danaparoid sodium (outside the USA) or argatroban (USA and elsewhere). Whether heparin-grafted hemodialyzers (without systemic heparin) can be used safely in acute HIT is unknown. The HIT immune response is remarkably transient and usually not retriggered by subsequent heparin administration. Accordingly, since renal failure patients often require long-term HD, there may be the opportunity-following seroreversion (loss of platelet-activating HIT antibodies)-to restart heparin for HD, a practice that appears to have a low likelihood of retriggering HIT.
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Affiliation(s)
- Theodore E Warkentin
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada; Department of Medicine, McMaster University, Hamilton, Canada; Transfusion Medicine, Hamilton Regional Laboratory Medicine Program, Hamilton General Hospital, Hamilton Health Sciences, Hamilton, Canada; Service of Benign Hematology, Hamilton General Hospital, Hamilton Health Sciences, Hamilton, Canada.
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