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Bertoletti L, Girard P, Élias A, Espitia O, Schmidt J, Couturaud F, Mahé I, Sanchez O. [Translation into French and republication of: "Recurrent venous thromboembolism in anticoagulated cancer patients: diagnosis and treatment"]. Rev Med Interne 2024; 45:289-299. [PMID: 38806295 DOI: 10.1016/j.revmed.2024.05.017] [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: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 05/30/2024]
Abstract
Patients with cancer are at significantly increased risk of venous thromboembolism (VTE), due both to the impact of malignant disease itself and to the impact of certain anticancer drugs on haemostasis. This is true both for first episode venous thromboembolism and recurrence. The diagnosis and management of VTE recurrence in patients with cancer poses particular challenges, and these are reviewed in the present article, based on a systematic review of the relevant scientific literature published over the last decade. Furthermore, it is uncertain whether diagnostic algorithms for venous thromboembolism, validated principally in untreated non-cancer patients, are also valid in anticoagulated cancer patients: the available data suggests that clinical decision rules and D-dimer testing perform less well in this clinical setting. In patients with cancer, computed tomography pulmonary angiography and venous ultrasound appear to be the most reliable diagnostic tools for diagnosis of pulmonary embolism and deep vein thrombosis respectively. Options for treatment of venous thromboembolism include low molecular weight heparins (at a therapeutic dose or an increased dose), fondaparinux or oral direct factor Xa inhibitors. The choice of treatment should take into account the nature (pulmonary embolism or VTE) and severity of the recurrent event, the associated bleeding risk, the current anticoagulant treatment (type, dose, adherence and possible drug-drug interactions) and cancer progression.
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Affiliation(s)
- L Bertoletti
- Service de médecine vasculaire et thérapeutique, CHU de Saint-Étienne, Inserm, UMR1059, équipe Dysfonction vasculaire et hémostase, université Jean-Monnet, CIC-1408, 42000 Saint-Étienne, France; F-CRIN INNOVTE network, Saint-Étienne, France.
| | - P Girard
- F-CRIN INNOVTE network, Saint-Étienne, France; Institut du thorax Curie-Montsouris, institut mutualiste Montsouris, Paris, France
| | - A Élias
- F-CRIN INNOVTE network, Saint-Étienne, France; Service de cardiologie et de médecine vasculaire, délégation recherche clinique et innovation, centre hospitalier intercommunal Toulon La Seyne-sur-Mer, Toulon, France
| | - O Espitia
- Service de médecine interne et vasculaire, Institut du thorax, Nantes université, CHU de Nantes, Inserm UMR 1087-CNRS UMR 6291, Team III Vascular & Pulmonary diseases, Nantes, France
| | - J Schmidt
- F-CRIN INNOVTE network, Saint-Étienne, France; Service d'urgence, CHU de Clermont-Ferrand, Lapsco-UMR UBP-CNRS 6024, université Clermont Auvergne, Clermont-Ferrand, France
| | - F Couturaud
- F-CRIN INNOVTE network, Saint-Étienne, France; Département de médecine interne, médecine vasculaire et pneumologie, CHU de Brest, Inserm U1304-GETBO, université de Brest, Brest, France
| | - I Mahé
- F-CRIN INNOVTE network, Saint-Étienne, France; Service de médecine interne, hôpital Louis-Mourier, AP-HP, Colombes, France; Université Paris Cité, Inserm UMR S1140, Innovations thérapeutiques en hémostase, Paris, France
| | - O Sanchez
- F-CRIN INNOVTE network, Saint-Étienne, France; Université Paris Cité, Inserm UMR S1140, Innovations thérapeutiques en hémostase, Paris, France; Service de pneumologie et de soins intensifs, hôpital européen Georges-Pompidou, AP-HP, Paris, France
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Bertoletti L, Girard P, Elias A, Espitia O, Schmidt J, Couturaud F, Mahé I, Sanchez O. Recurrent venous thromboembolism in anticoagulated cancer patients: Diagnosis and treatment. Arch Cardiovasc Dis 2024; 117:84-93. [PMID: 38065753 DOI: 10.1016/j.acvd.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 12/27/2023]
Abstract
Patients with cancer are at significantly increased risk of venous thromboembolism (VTE), due both to the impact of malignant disease itself and to the impact of certain anticancer drugs on haemostasis. This is true both for first episode venous thromboembolism and recurrence. The diagnosis and management of VTE recurrence in patients with cancer poses particular challenges, and these are reviewed in the present article, based on a systematic review of the relevant scientific literature published over the last decade. Furthermore, it is uncertain whether diagnostic algorithms for venous thromboembolism, validated principally in untreated non-cancer patients, are also valid in anticoagulated cancer patients: the available data suggests that clinical decision rules and D-dimer testing perform less well in this clinical setting. In patients with cancer, computed tomography pulmonary angiography and venous ultrasound appear to be the most reliable diagnostic tools for diagnosis of pulmonary embolism and deep vein thrombosis respectively. Options for treatment of venous thromboembolism include low molecular weight heparins (at a therapeutic dose or an increased dose), fondaparinux or oral direct factor Xa inhibitors. The choice of treatment should take into account the nature (pulmonary embolism or VTE) and severity of the recurrent event, the associated bleeding risk, the current anticoagulant treatment (type, dose, adherence and possible drug-drug interactions) and cancer progression.
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Affiliation(s)
- Laurent Bertoletti
- Service de médecine vasculaire et thérapeutique, CHU de Saint-Étienne, INSERM, UMR1059, Équipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, INSERM, CIC-1408, CHU Saint-Etienne, Saint-Etienne, France; F-CRIN INNOVTE network, Saint-Etienne, France.
| | - Philippe Girard
- Institut du thorax Curie-Montsouris, institut mutualiste Montsouris, Paris, France; F-CRIN INNOVTE network, Saint-Etienne, France
| | - Antoine Elias
- Service de cardiologie et de médecine vasculaire, délégation recherche clinique et innovation, centre hospitalier intercommunal Toulon La Seyne-sur-Mer, Toulon, France; F-CRIN INNOVTE network, Saint-Etienne, France
| | - Olivier Espitia
- Service de médecine interne et vasculaire, institut du thorax, Nantes université, CHU de Nantes, Inserm UMR 1087-CNRS UMR 6291, Team III Vascular & Pulmonary diseases, Nantes, France
| | - Jeannot Schmidt
- Service d'urgence, CHU de Clermont-Ferrand, LAPSCO-UMR UBP-CNRS 6024, Université Clermont Auvergne, Clermont-Ferrand, France; F-CRIN INNOVTE network, Saint-Etienne, France
| | - Francis Couturaud
- Département de médecine interne, médecine vasculaire et pneumologie, CHU de Brest, Inserm U1304-GETBO, université de Brest, Brest, France; F-CRIN INNOVTE network, Saint-Etienne, France
| | - Isabelle Mahé
- Service de médecine interne, hôpital Louis-Mourier, AP-HP, Colombes, France; Université Paris Cité, Inserm UMR S1140, innovations thérapeutiques en hémostase, Paris, France; F-CRIN INNOVTE network, Saint-Etienne, France
| | - Olivier Sanchez
- Université Paris Cité, Inserm UMR S1140, innovations thérapeutiques en hémostase, Paris, France; Service de pneumologie et de soins intensifs, Hôpital européen Georges-Pompidou, AP-HP, Paris, France; F-CRIN INNOVTE network, Saint-Etienne, France
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Albricker ACL, Freire CMV, Santos SND, Alcantara MLD, Saleh MH, Cantisano AL, Teodoro JAR, Porto CLL, Amaral SID, Veloso OCG, Petisco ACGP, Barros FS, Barros MVLD, Souza AJD, Sobreira ML, Miranda RBD, Moraes DD, Verrastro CGY, Mançano AD, Lima RDSL, Muglia VF, Matushita CS, Lopes RW, Coutinho AMN, Pianta DB, Santos AASMDD, Naves BDL, Vieira MLC, Rochitte CE. Diretriz Conjunta sobre Tromboembolismo Venoso – 2022. Arq Bras Cardiol 2022; 118:797-857. [PMID: 35508060 PMCID: PMC9007000 DOI: 10.36660/abc.20220213] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Di Vilio A, Vergara A, Desiderio A, Iodice F, Serio A, Palermi S, Gambardella F, Sperlongano S, Gioia R, Acitorio M, D'Andrea A. Incremental value of compression ultrasound sonography in the emergency department. World J Crit Care Med 2021; 10:194-203. [PMID: 34616656 PMCID: PMC8462022 DOI: 10.5492/wjccm.v10.i5.194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/13/2021] [Accepted: 07/05/2021] [Indexed: 02/06/2023] Open
Abstract
The quick evaluation of venous thromboembolism is a key point of modern medicine since the delayed diagnosis is associated with a worse prognosis. Venous ultrasound (VU) is a sensitive and rapidly performed test in cases of suspected deep venous thrombosis. Various protocols have been proposed for its execution, such as the study of the whole deep venous circulation of the lower limb or the analysis of the femoral-popliteal area. The aim is to detect a vessel thrombus and the most sensitive element is the non-compressibility with the probe. Initially, the thrombus is hypoechogenic and adherent to the vessel; later, it tends to organize and recanalize. Usually, in the early stages, the risk of embolism is higher. The role of studying the iliac axis and calf veins is still uncertain. VU is not useful for assessing response to anticoagulation therapy and it is unclear whether the persistence of thrombotic abnormalities can guide on a possible prolongation of therapy.
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Affiliation(s)
- Alessandro Di Vilio
- Unit of Cardiology and Intensive Coronary Care, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples 80131, Italy
| | - Andrea Vergara
- Unit of Cardiology and Intensive Coronary Care, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples 80131, Italy
| | - Alfonso Desiderio
- Unit of Cardiology and Intensive Coronary Care, Umberto I Hospital, Nocera Inferiore 84014, Italy
| | - Franco Iodice
- Unit of Cardiology and Intensive Coronary Care, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples 80131, Italy
| | - Alessandro Serio
- Human Anatomy and Sport Medicine Division, Department of Public Health, University of Naples “Federico II”, Naples 80131, Italy
| | - Stefano Palermi
- Human Anatomy and Sport Medicine Division, Department of Public Health, University of Naples “Federico II”, Naples 80131, Italy
| | - Francesco Gambardella
- Human Anatomy and Sport Medicine Division, Department of Public Health, University of Naples “Federico II”, Naples 80131, Italy
| | - Simona Sperlongano
- Unit of Cardiology and Intensive Coronary Care, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples 80131, Italy
| | - Renato Gioia
- Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno 84084, Italy
| | - Maria Acitorio
- Unit of Cardiology and Intensive Coronary Care, Umberto I Hospital, Nocera Inferiore 84014, Italy
| | - Antonello D'Andrea
- Unit of Cardiology and Intensive Coronary Care, Umberto I Hospital, Nocera Inferiore 84014, Italy
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AIUM Practice Parameter for the Performance of a Peripheral Venous Ultrasound Examination. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:E49-E56. [PMID: 32162338 DOI: 10.1002/jum.15263] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Needleman L, Cronan JJ, Lilly MP, Merli GJ, Adhikari S, Hertzberg BS, DeJong MR, Streiff MB, Meissner MH. Ultrasound for Lower Extremity Deep Venous Thrombosis. Circulation 2018; 137:1505-1515. [DOI: 10.1161/circulationaha.117.030687] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Venous ultrasound is the standard imaging test for patients suspected of having acute deep venous thrombosis (DVT). There is variability and disagreement among authoritative groups regarding the necessary components of the test. Some protocols include scanning the entire lower extremity, whereas others recommend scans limited to the thigh and knee supplemented with serial testing. Some protocols use gray-scale ultrasound alone, whereas others include Doppler interrogation. Point-of-care ultrasound is recommended in some settings, and there is heterogeneity of these protocols as well. Heterogeneity of recommendations can lead to errors including incorrect application of guidelines, confusion among requesting physicians, and incorrect follow-up. In October 2016, the Society of Radiologists in Ultrasound convened a multidisciplinary panel of experts to evaluate the current evidence to develop recommendations regarding ultrasound protocols for DVT and the terminology used to communicate results to clinicians. Recommendations were made after open discussion and by unanimous consensus.
The panel recommends a comprehensive duplex ultrasound protocol from thigh to ankle with Doppler at selected sites rather than a limited or complete compression-only examination. This protocol is currently performed in many facilities and is achievable with standard ultrasound equipment and personnel. The use of these recommendations will increase the diagnosis of calf DVT and provide better data to explain the presenting symptoms. The panel recommends a single point-of-care protocol that minimizes underdiagnoses of proximal DVT.
The panel recommends the term chronic postthrombotic change to describe the residual material that persists after the acute presentation of DVT to avoid potential overtreatment of prior thrombus.
Adoption of a single standardized comprehensive duplex ultrasound and a single point-of-care examination will enhance patient safety and clinicians’ confidence.
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Affiliation(s)
| | - John J. Cronan
- Department of Diagnostic Imaging, Brown University, Providence, RI (J.J.C.)
| | - Michael P. Lilly
- Department of Surgery, University of Maryland School of Medicine, Baltimore (M.P.L.)
| | - Geno J. Merli
- Department of Medicine (G.J.M.), Thomas Jefferson University, Philadelphia, PA
| | - Srikar Adhikari
- Department of Emergency Medicine, University of Arizona, Tucson (S.A.)
| | - Barbara S. Hertzberg
- Department of Radiology, Duke University School of Medicine, Durham, NC (B.S.H.)
| | | | - Michael B. Streiff
- Department of Medicine (M.B.S.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Mark H. Meissner
- Department of Surgery, University of Washington School of Medicine, Seattle (M.H.M.)
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Abstract
Abstract
Because the clinical diagnosis of deep-vein thrombosis and pulmonary embolism is nonspecific, integrated diagnostic approaches for patients with suspected venous thromboembolism have been developed over the years, involving both non-invasive bedside tools (clinical decision rules and D-dimer blood tests) for patients with low pretest probability and diagnostic techniques (compression ultrasound for deep-vein thrombosis and computed tomography pulmonary angiography for pulmonary embolism) for those with a high pretest probability. This combination has led to standardized diagnostic algorithms with proven safety for excluding venous thrombotic disease. At the same time, it has become apparent that, as a result of the natural history of venous thrombosis, there are special patient populations in which the current standard diagnostic algorithms are not sufficient. In this review, we present 3 evidence-based patient cases to underline recent developments in the imaging diagnosis of venous thromboembolism.
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Frank B, Ariza L, Lamparter H, Grossmann V, Prochaska JH, Ullmann A, Kindler F, Weisser G, Walter U, Lackner KJ, Espinola-Klein C, Münzel T, Konstantinides SV, Wild PS. Rationale and design of three observational, prospective cohort studies including biobanking to evaluate and improve diagnostics, management strategies and risk stratification in venous thromboembolism: the VTEval Project. BMJ Open 2015; 5:e008157. [PMID: 26133379 PMCID: PMC4499722 DOI: 10.1136/bmjopen-2015-008157] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Venous thromboembolism (VTE) with its two manifestations deep vein thrombosis (DVT) and pulmonary embolism (PE) is a major public health problem. The VTEval Project aims to investigate numerous research questions on diagnosis, clinical management, treatment and prognosis of VTE, which have remained uncertain to date. METHODS AND ANALYSIS The VTEval Project consists of three observational, prospective cohort studies on VTE comprising cohorts of individuals with a clinical suspicion of acute PE (with or without DVT), with a clinical suspicion of acute DVT (without symptomatic PE) and with an incidental diagnosis of VTE (PE or DVT). The VTEval Project expects to enrol a total of approximately 2000 individuals with subsequent active and passive follow-up investigations over a time period of 5 years per participant. Time points for active follow-up investigations are at months 3, 6, 12, 24 and 36 after diagnosis (depending on the disease cohort); passive follow-up investigations via registry offices and the cancer registry are performed 48 and 60 months after diagnosis for all participants. Primary short-term outcome is defined by overall mortality (PE-related death and all other causes of death), primary long-term outcome by symptomatic VTE (PE-related death, recurrence of non-fatal PE or DVT). The VTEval Project includes three 'all-comer' studies and involves the standardised acquisition of high-quality data, covering the systematic assessment of VTE including symptoms, risk profile, psychosocial, environmental and lifestyle factors as well as clinical and subclinical disease, and it builds up a large state-of-the-art biorepository containing various materials from serial blood samplings. ETHICS AND DISSEMINATION The VTEval Project has been approved by the local data safety commissioner and the responsible ethics committee (reference no. 837.320.12 (8421-F)). Trial results will be published in peer-reviewed journals and presented at national and international scientific meetings. TRIAL REGISTRATION NUMBER NCT02156401.
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Affiliation(s)
- Bernd Frank
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
| | - Liana Ariza
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
| | - Heidrun Lamparter
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
| | - Vera Grossmann
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
| | - Jürgen H Prochaska
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
- Department of Medicine 2, University Medical Center Mainz, Mainz, Germany
| | - Alexander Ullmann
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
| | - Florentina Kindler
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
| | - Gerhard Weisser
- Department of Medicine 2, University Medical Center Mainz, Mainz, Germany
| | - Ulrich Walter
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
| | - Karl J Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz, Mainz, Germany
| | | | - Thomas Münzel
- Department of Medicine 2, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), partner site RhineMain, Mainz, Germany
| | | | - Philipp S Wild
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
- Preventive Cardiology and Preventive Medicine, Department of Medicine 2, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), partner site RhineMain, Mainz, Germany
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Huisman MV, Klok FA. Current challenges in diagnostic imaging of venous thromboembolism. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2015; 2015:202-209. [PMID: 26637722 DOI: 10.1182/asheducation-2015.1.202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Because the clinical diagnosis of deep-vein thrombosis and pulmonary embolism is nonspecific, integrated diagnostic approaches for patients with suspected venous thromboembolism have been developed over the years, involving both non-invasive bedside tools (clinical decision rules and D-dimer blood tests) for patients with low pretest probability and diagnostic techniques (compression ultrasound for deep-vein thrombosis and computed tomography pulmonary angiography for pulmonary embolism) for those with a high pretest probability. This combination has led to standardized diagnostic algorithms with proven safety for excluding venous thrombotic disease. At the same time, it has become apparent that, as a result of the natural history of venous thrombosis, there are special patient populations in which the current standard diagnostic algorithms are not sufficient. In this review, we present 3 evidence-based patient cases to underline recent developments in the imaging diagnosis of venous thromboembolism.
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Affiliation(s)
- Menno V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Frederikus A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
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Hara T, Truelove J, Tawakol A, Wojtkiewicz GR, Hucker WJ, MacNabb MH, Brownell AL, Jokivarsi K, Kessinger CW, Jaff MR, Henke PK, Weissleder R, Jaffer FA. 18F-fluorodeoxyglucose positron emission tomography/computed tomography enables the detection of recurrent same-site deep vein thrombosis by illuminating recently formed, neutrophil-rich thrombus. Circulation 2014; 130:1044-52. [PMID: 25070665 DOI: 10.1161/circulationaha.114.008902] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Accurate detection of recurrent same-site deep vein thrombosis (DVT) is a challenging clinical problem. Because DVT formation and resolution are associated with a preponderance of inflammatory cells, we investigated whether noninvasive (18)F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) imaging could identify inflamed, recently formed thrombi and thereby improve the diagnosis of recurrent DVT. METHODS AND RESULTS We established a stasis-induced DVT model in murine jugular veins and also a novel model of recurrent stasis DVT in mice. C57BL/6 mice (n=35) underwent ligation of the jugular vein to induce stasis DVT. FDG-PET/computed tomography (CT) was performed at DVT time points of day 2, 4, 7, 14, or 2+16 (same-site recurrent DVT at day 2 overlying a primary DVT at day 16). Antibody-based neutrophil depletion was performed in a subset of mice before DVT formation and FDG-PET/CT. In a clinical study, 38 patients with lower extremity DVT or controls undergoing FDG-PET were analyzed. Stasis DVT demonstrated that the highest FDG signal occurred at day 2, followed by a time-dependent decrease (P<0.05). Histological analyses demonstrated that thrombus neutrophils (P<0.01), but not macrophages, correlated with thrombus PET signal intensity. Neutrophil depletion decreased FDG signals in day 2 DVT in comparison with controls (P=0.03). Recurrent DVT demonstrated significantly higher FDG uptake than organized day 14 DVT (P=0.03). The FDG DVT signal in patients also exhibited a time-dependent decrease (P<0.01). CONCLUSIONS Noninvasive FDG-PET/CT identifies neutrophil-dependent thrombus inflammation in murine DVT, and demonstrates a time-dependent signal decrease in both murine and clinical DVT. FDG-PET/CT may offer a molecular imaging strategy to accurately diagnose recurrent DVT.
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Affiliation(s)
- Tetsuya Hara
- From the Cardiovascular Research Center (T.H., C.W.K., F.A.J.), Center for Systems Biology (J.T., G.R.W., R.W.), Cardiology Division (A.T., W.J.H., M.H.M., M.R.J., F.A.J.), and Martinos Biomedical Imaging Center (A.-.L.B., K.J.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; and Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI (P.K.H.)
| | - Jessica Truelove
- From the Cardiovascular Research Center (T.H., C.W.K., F.A.J.), Center for Systems Biology (J.T., G.R.W., R.W.), Cardiology Division (A.T., W.J.H., M.H.M., M.R.J., F.A.J.), and Martinos Biomedical Imaging Center (A.-.L.B., K.J.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; and Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI (P.K.H.)
| | - Ahmed Tawakol
- From the Cardiovascular Research Center (T.H., C.W.K., F.A.J.), Center for Systems Biology (J.T., G.R.W., R.W.), Cardiology Division (A.T., W.J.H., M.H.M., M.R.J., F.A.J.), and Martinos Biomedical Imaging Center (A.-.L.B., K.J.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; and Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI (P.K.H.)
| | - Gregory R Wojtkiewicz
- From the Cardiovascular Research Center (T.H., C.W.K., F.A.J.), Center for Systems Biology (J.T., G.R.W., R.W.), Cardiology Division (A.T., W.J.H., M.H.M., M.R.J., F.A.J.), and Martinos Biomedical Imaging Center (A.-.L.B., K.J.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; and Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI (P.K.H.)
| | - William J Hucker
- From the Cardiovascular Research Center (T.H., C.W.K., F.A.J.), Center for Systems Biology (J.T., G.R.W., R.W.), Cardiology Division (A.T., W.J.H., M.H.M., M.R.J., F.A.J.), and Martinos Biomedical Imaging Center (A.-.L.B., K.J.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; and Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI (P.K.H.)
| | - Megan H MacNabb
- From the Cardiovascular Research Center (T.H., C.W.K., F.A.J.), Center for Systems Biology (J.T., G.R.W., R.W.), Cardiology Division (A.T., W.J.H., M.H.M., M.R.J., F.A.J.), and Martinos Biomedical Imaging Center (A.-.L.B., K.J.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; and Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI (P.K.H.)
| | - Anna-Liisa Brownell
- From the Cardiovascular Research Center (T.H., C.W.K., F.A.J.), Center for Systems Biology (J.T., G.R.W., R.W.), Cardiology Division (A.T., W.J.H., M.H.M., M.R.J., F.A.J.), and Martinos Biomedical Imaging Center (A.-.L.B., K.J.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; and Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI (P.K.H.)
| | - Kimmo Jokivarsi
- From the Cardiovascular Research Center (T.H., C.W.K., F.A.J.), Center for Systems Biology (J.T., G.R.W., R.W.), Cardiology Division (A.T., W.J.H., M.H.M., M.R.J., F.A.J.), and Martinos Biomedical Imaging Center (A.-.L.B., K.J.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; and Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI (P.K.H.)
| | - Chase W Kessinger
- From the Cardiovascular Research Center (T.H., C.W.K., F.A.J.), Center for Systems Biology (J.T., G.R.W., R.W.), Cardiology Division (A.T., W.J.H., M.H.M., M.R.J., F.A.J.), and Martinos Biomedical Imaging Center (A.-.L.B., K.J.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; and Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI (P.K.H.)
| | - Michael R Jaff
- From the Cardiovascular Research Center (T.H., C.W.K., F.A.J.), Center for Systems Biology (J.T., G.R.W., R.W.), Cardiology Division (A.T., W.J.H., M.H.M., M.R.J., F.A.J.), and Martinos Biomedical Imaging Center (A.-.L.B., K.J.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; and Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI (P.K.H.)
| | - Peter K Henke
- From the Cardiovascular Research Center (T.H., C.W.K., F.A.J.), Center for Systems Biology (J.T., G.R.W., R.W.), Cardiology Division (A.T., W.J.H., M.H.M., M.R.J., F.A.J.), and Martinos Biomedical Imaging Center (A.-.L.B., K.J.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; and Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI (P.K.H.)
| | - Ralph Weissleder
- From the Cardiovascular Research Center (T.H., C.W.K., F.A.J.), Center for Systems Biology (J.T., G.R.W., R.W.), Cardiology Division (A.T., W.J.H., M.H.M., M.R.J., F.A.J.), and Martinos Biomedical Imaging Center (A.-.L.B., K.J.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; and Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI (P.K.H.)
| | - Farouc A Jaffer
- From the Cardiovascular Research Center (T.H., C.W.K., F.A.J.), Center for Systems Biology (J.T., G.R.W., R.W.), Cardiology Division (A.T., W.J.H., M.H.M., M.R.J., F.A.J.), and Martinos Biomedical Imaging Center (A.-.L.B., K.J.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; and Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI (P.K.H.).
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