1
|
Heymann WR. Getting JAKed up about deep vein thrombosis risk. J Am Acad Dermatol 2024; 90:933-934. [PMID: 38403130 DOI: 10.1016/j.jaad.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 02/27/2024]
Affiliation(s)
- Warren R Heymann
- Division of Dermatology, Cooper Medical School of Rowan University, Marlton, New Jersey.
| |
Collapse
|
2
|
Shang H, Jiang JY, Guffey D, Novoa F, Bandyo R, Ma S, Li A. Natural history of cancer-associated splanchnic vein thrombosis. J Thromb Haemost 2024; 22:1421-1432. [PMID: 38309433 DOI: 10.1016/j.jtha.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND There is uncertainty in the management of cancer-associated isolated splanchnic vein thrombosis (SpVT). OBJECTIVES To describe the natural history of SpVT by cancer type and thrombus composition and to review anticoagulation (AC) practices and associated rates of usual-site venous thromboembolism (VTE), major and clinically relevant nonmajor bleeding (MB/CRNMB), recanalization/progression, and mortality. METHODS We performed a retrospective cohort study in patients with SpVT at 2 cancer care centers in Houston, Texas. We estimated the incidence of usual-site VTE and MB/CRNMB at 6 months using competing risk methods and examined venous patency in a subset of patients with repeat imaging. We assessed associations with mortality using Cox regression. RESULTS Among 15 342 patients with an incident cancer diagnosis from 2011 to 2020, we identified 298 with isolated SpVT. Patients with hepatocellular carcinoma (HCC) and SpVT (n = 146) had the highest disease prevalence (20%), lowest rate of AC treatment (2%), and similar rate of usual-site VTE (4.2%) vs those without SpVT (5.2%) at 6 months, though tumor thrombus vs bland was associated with worse overall survival. In patients with non-HCC bland SpVT (n = 114), AC (n = 37) was more common in those with non-upper gastrointestinal cancers and fewer comorbidities. AC was associated with more recanalization (44% vs 15%, P = .041) but no differences in usual-site VTE, MB/CRNMB, or mortality at 6 months. CONCLUSION Cancer-associated isolated SpVT is a common but heterogeneous thrombotic disease that is treated differently from usual-site VTE. Tumor thrombus is a negative prognostic factor. Initiation of AC in bland thrombi requires judicious consideration of thrombotic and bleeding risk.
Collapse
Affiliation(s)
- Hanqing Shang
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Jun Y Jiang
- Section of Hematology and Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Danielle Guffey
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas, USA
| | - Francisco Novoa
- Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | | | - Shengling Ma
- Section of Hematology and Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Ang Li
- Section of Hematology and Oncology, Baylor College of Medicine, Houston, Texas, USA.
| |
Collapse
|
3
|
Van Bruggen S, Sheehy CE, Kraisin S, Frederix L, Wagner DD, Martinod K. Neutrophil peptidylarginine deiminase 4 plays a systemic role in obesity-induced chronic inflammation in mice. J Thromb Haemost 2024; 22:1496-1509. [PMID: 38325598 DOI: 10.1016/j.jtha.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 12/29/2023] [Accepted: 01/16/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Obesity is an increasing problem in our current society and is expected to keep rising in incidence. With its multiorigin, complex pathophysiology, it is difficult to treat and easy to acquire unnoticeably. During obesity, it has been established that the body is in a constant state of low-grade inflammation, thereby causing changes in immune cell physiology. OBJECTIVES Here, we investigated the influence of neutrophils, more specifically as a result of peptidylarginine deiminase 4 (PAD4) activity and the release of neutrophil extracellular traps (NETs), during obesity-induced chronic inflammation. METHODS Wild-type mice were placed on a high-fat diet (HFD) and investigated over a period of 10 weeks for NET formation and its impact on the heart. Neutrophil-selective PAD4 knockout (Ne-PAD4-/-) mice were studied in parallel. RESULTS As a result of high fat intake, we observed clear alteration in the priming status of isolated neutrophils toward NET release, including early stages of speck formation and histone citrullination of apoptosis-associated speck-like protein containing a CARD. Ne-PAD4-/- mice deficient in NET formation did not increase bodyweight to the same extent as their littermate controls, with Ne-PAD4-/- mice being leaner after 10 weeks of HFD feeding. Interestingly, obesity progression led to cardiac remodeling and diastolic dysfunction in wild-type mice after 10 weeks, while this remodeling and subsequent decrease in function were absent in Ne-PAD4-/- mice. Surprisingly, HFD did not alter NET content or thrombus formation in the inferior vena cava stenosis model. CONCLUSION Detrimental physiological effects, the result of obesity progression, can in part be attributed to neutrophil PAD4 and NETs in response to chronic inflammation.
Collapse
Affiliation(s)
- Stijn Van Bruggen
- Center for Vascular and Molecular Biology, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium; Program in Cellular and Molecular Medicine, Boston Children's Hospital, Boston, Massachusetts, USA. http://www.twitter.com/Cardio_KULeuven
| | - Casey E Sheehy
- Program in Cellular and Molecular Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sirima Kraisin
- Center for Vascular and Molecular Biology, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium. http://www.twitter.com/Cardio_KULeuven
| | - Liesbeth Frederix
- Center for Vascular and Molecular Biology, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium. http://www.twitter.com/Cardio_KULeuven
| | - Denisa D Wagner
- Program in Cellular and Molecular Medicine, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA; Division of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA.
| | - Kimberly Martinod
- Center for Vascular and Molecular Biology, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.
| |
Collapse
|
4
|
Lan X, Dong FY, Duan JJ. Successful Treatment Strategy for Duplicate Inferior Vena Cava and Deep Venous Thrombosis: Filter Placement and Thrombolysis Approach. Am J Case Rep 2024; 25:e942578. [PMID: 38630648 PMCID: PMC11034388 DOI: 10.12659/ajcr.942578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 03/05/2024] [Accepted: 02/26/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Duplicate inferior vena cava (IVC) accompanied by deep venous thrombosis is rare. The optimal treatment plan is determined according to the results of imaging, including venography. In this report, we present a case of successful treatment of a patient with duplicate IVC and deep venous thrombosis (DVT). CASE REPORT An 84-year-old man with history of hypertension was admitted to the hospital because of 4 days of moderate left lower-limb edema. A thorough examination led to the diagnosis of the DVT. The duplicate IVC was discovered during venography. As the blood from the left common iliac vein mainly flowed to the left IVC, and there were no other communicating branches before the convergence of the left and right IVCs, which was located above the 1st lumbar vertebrae body near the junction of the hepatic vein and the IVC, the strategy of placing only 1 filter in the left inferior vena cava were chosen, rather than placing 1 filter above the confluence of bilateral IVC, or placing a filter in each IVC below the level of renal veins on each side. Following that, the DVT was safely treated with thrombolysis and aspiration without the risk of pulmonary embolism. CONCLUSIONS This case report presented the complete evaluation and management of a patient with lower-limb DVT accompanied by the malformation of duplicate IVC. The filter placement strategy with duplicate IVC in the literature was summarized. We concluded that even in emergency situations, with comprehensive consideration, it is possible to perform endovascular intervention successfully and achieve satisfactory treatment results.
Collapse
|
5
|
Cui X, Liu Q, Xia R, Liu J, Wang J, Chao A. Injury-Admission Time is an Independent Risk Factor for Deep Vein Thrombosis in Older Patients with Osteoporotic Hip Fracture. Med Sci Monit 2024; 30:e943587. [PMID: 38615190 PMCID: PMC11025399 DOI: 10.12659/msm.943587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/20/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Deep vein thrombosis is a common pre- and post-operative complication in older patients with osteoporotic hip fractures. Pre-operative thrombus can increase the risk of surgery. This study examined the association between the time from fracture to admission (injury-admission time) and deep vein thrombosis in older patients with osteoporotic hip fractures. MATERIAL AND METHODS Doppler ultrasound screening of deep lower-extremity veins was performed in patients with osteoporotic hip fractures between June 2019 and December 2021. Clinical data, including medical history, injury-admission time, and laboratory tests, were collected retrospectively. RESULTS Of the 439 patients, deep vein thrombosis was found in 139 (31.66%). The injury-admission time was significantly longer in the thrombosis group, which was positively associated with deep vein thrombosis (odds ratio 1.010, 95% confidence interval 1.003-1.017). The area under the curve to predict deep vein thrombosis was 0.619. The best cut-off value, sensitivity, and specificity were 21 h, 46.76%, and 75%, respectively. When the injury-admission period exceeded 21 h, the prevalence of deep vein thrombosis was 45.8% and the thrombosis incidence was significantly higher than in the <21 h group (24.9%). CONCLUSIONS Our results suggest that screening for deep vein thrombosis should be routinely performed for patients with osteoporotic hip fractures, particularly for those with injury-admission time ≥21 h.
Collapse
Affiliation(s)
- Xiuli Cui
- Department of Osteo-Internal Medicine, Tianjin Hospital (Tianjin University Tianjin Hospital), Tianjin, PR China
| | - Qingjun Liu
- Department of Geriatrics, The Second Hospital of Tianjin Medical University, Tianjin, PR China
| | - Ronglin Xia
- Department of Osteo-Internal Medicine, Tianjin Hospital (Tianjin University Tianjin Hospital), Tianjin, PR China
| | - Jiaolei Liu
- Department of Geriatrics, The Second Hospital of Tianjin Medical University, Tianjin, PR China
| | - Jun Wang
- Department of Osteo-Internal Medicine, Tianjin Hospital (Tianjin University Tianjin Hospital), Tianjin, PR China
| | - Aijun Chao
- Department of Osteo-Internal Medicine, Tianjin Hospital (Tianjin University Tianjin Hospital), Tianjin, PR China
| |
Collapse
|
6
|
Kostromina MA, Tukhovskaya EA, Shaykhutdinova ER, Palikova YA, Palikov VA, Slashcheva GA, Ismailova AM, Kravchenko IN, Dyachenko IA, Zayats EA, Abramchik YA, Murashev AN, Esipov RS. Unified Methodology for the Primary Preclinical In Vivo Screening of New Anticoagulant Pharmaceutical Agents from Hematophagous Organisms. Int J Mol Sci 2024; 25:3986. [PMID: 38612796 PMCID: PMC11011928 DOI: 10.3390/ijms25073986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/29/2024] [Accepted: 03/30/2024] [Indexed: 04/14/2024] Open
Abstract
The development of novel anticoagulants requires a comprehensive investigational approach that is capable of characterizing different aspects of antithrombotic activity. The necessary experiments include both in vitro assays and studies on animal models. The required in vivo approaches include the assessment of pharmacokinetic and pharmacodynamic profiles and studies of hemorrhagic and antithrombotic effects. Comparison of anticoagulants with different mechanisms of action and administration types requires unification of the experiment scheme and its adaptation to existing laboratory conditions. The rodent thrombosis models in combination with the assessment of hemostasis parameters and hematological analysis are the classic methods for conducting preclinical studies. We report an approach for the comparative study of the activity of different anticoagulants in vivo, including the investigation of pharmacodynamics and the assessment of hemorrhagic effects (tail-cut bleeding model) and pathological thrombus formation (inferior vena cava stenosis model of venous thrombosis). The reproducibility and uniformity of our set of experiments were illustrated on unfractionated heparin and dabigatran etexilate (the most common pharmaceuticals in antithrombic therapy) as comparator drugs and an experimental drug variegin from the tick Amblyomma variegatum. Variegin is notorious since it is a potential analogue of bivalirudin (Angiomax, Novartis AG, Basel, Switzerland), which is now being actively introduced into antithrombotic therapy.
Collapse
Affiliation(s)
- Maria A. Kostromina
- Laboratory of Biopharmaceutical Technologies, Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Miklukho-Maklaya Street, 16/10, 117997 Moscow, Russia
| | - Elena A. Tukhovskaya
- Biological Testing Laboratory, Branch of Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Pushchino, ProspektNauki, 6, 142290 Moscow, Russia
| | - Elvira R. Shaykhutdinova
- Biological Testing Laboratory, Branch of Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Pushchino, ProspektNauki, 6, 142290 Moscow, Russia
| | - Yuliya A. Palikova
- Biological Testing Laboratory, Branch of Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Pushchino, ProspektNauki, 6, 142290 Moscow, Russia
| | - Viktor A. Palikov
- Biological Testing Laboratory, Branch of Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Pushchino, ProspektNauki, 6, 142290 Moscow, Russia
| | - Gulsara A. Slashcheva
- Biological Testing Laboratory, Branch of Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Pushchino, ProspektNauki, 6, 142290 Moscow, Russia
| | - Alina M. Ismailova
- Biological Testing Laboratory, Branch of Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Pushchino, ProspektNauki, 6, 142290 Moscow, Russia
| | - Irina N. Kravchenko
- Biological Testing Laboratory, Branch of Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Pushchino, ProspektNauki, 6, 142290 Moscow, Russia
| | - Igor A. Dyachenko
- Biological Testing Laboratory, Branch of Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Pushchino, ProspektNauki, 6, 142290 Moscow, Russia
| | - Evgeniy A. Zayats
- Laboratory of Biopharmaceutical Technologies, Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Miklukho-Maklaya Street, 16/10, 117997 Moscow, Russia
| | - Yuliya A. Abramchik
- Laboratory of Biopharmaceutical Technologies, Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Miklukho-Maklaya Street, 16/10, 117997 Moscow, Russia
| | - Arkady N. Murashev
- Biological Testing Laboratory, Branch of Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Pushchino, ProspektNauki, 6, 142290 Moscow, Russia
| | - Roman S. Esipov
- Laboratory of Biopharmaceutical Technologies, Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Miklukho-Maklaya Street, 16/10, 117997 Moscow, Russia
| |
Collapse
|
7
|
Zifkos K, Bochenek ML, Gogiraju R, Robert S, Pedrosa D, Kiouptsi K, Moiko K, Wagner M, Mahfoud F, Poncelet P, Münzel T, Ruf W, Reinhardt C, Panicot-Dubois L, Dubois C, Schäfer K. Endothelial PTP1B Deletion Promotes VWF Exocytosis and Venous Thromboinflammation. Circ Res 2024. [PMID: 38563147 DOI: 10.1161/circresaha.124.324214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Endothelial activation promotes the release of procoagulant extracellular vesicles and inflammatory mediators from specialized storage granules. Endothelial membrane exocytosis is controlled by phosphorylation. We hypothesized that the absence of PTP1B (protein tyrosine phosphatase 1B) in endothelial cells promotes venous thromboinflammation by triggering endothelial membrane fusion and exocytosis. METHODS Mice with inducible endothelial deletion of PTP1B (End.PTP1B-KO) underwent inferior vena cava ligation to induce stenosis and venous thrombosis. Primary endothelial cells from transgenic mice and human umbilical vein endothelial cells were used for mechanistic studies. RESULTS Vascular ultrasound and histology showed significantly larger venous thrombi containing higher numbers of Ly6G (lymphocyte antigen 6 family member G)-positive neutrophils in mice with endothelial PTP1B deletion, and intravital microscopy confirmed the more pronounced neutrophil recruitment following inferior vena cava ligation. RT2 PCR profiler array and immunocytochemistry analysis revealed increased endothelial activation and adhesion molecule expression in primary End.PTP1B-KO endothelial cells, including CD62P (P-selectin) and VWF (von Willebrand factor). Pretreatment with the NF-κB (nuclear factor kappa B) kinase inhibitor BAY11-7082, antibodies neutralizing CD162 (P-selectin glycoprotein ligand-1) or VWF, or arginylglycylaspartic acid integrin-blocking peptides abolished the neutrophil adhesion to End.PTP1B-KO endothelial cells in vitro. Circulating levels of annexin V+ procoagulant endothelial CD62E+ (E-selectin) and neutrophil (Ly6G+) extracellular vesicles were also elevated in End.PTP1B-KO mice after inferior vena cava ligation. Higher plasma MPO (myeloperoxidase) and Cit-H3 (citrullinated histone-3) levels and neutrophil elastase activity indicated neutrophil activation and extracellular trap formation. Infusion of End.PTP1B-KO extracellular vesicles into C57BL/6J wild-type mice most prominently enhanced the recruitment of endogenous neutrophils, and this response was blunted in VWF-deficient mice or by VWF-blocking antibodies. Reduced PTP1B binding and tyrosine dephosphorylation of SNAP23 (synaptosome-associated protein 23) resulting in increased VWF exocytosis and neutrophil adhesion were identified as mechanisms, all of which could be restored by NF-κB kinase inhibition using BAY11-7082. CONCLUSIONS Our findings show that endothelial PTP1B deletion promotes venous thromboinflammation by enhancing SNAP23 phosphorylation, endothelial VWF exocytosis, and neutrophil recruitment.
Collapse
Affiliation(s)
- Konstantinos Zifkos
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Germany. (K.Z., M.L.B., D.P., K.K., W.R., C.R.)
| | - Magdalena L Bochenek
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Germany. (K.Z., M.L.B., D.P., K.K., W.R., C.R.)
- Department of Cardiology, Cardiology I, University Medical Center Mainz, Germany. (M.L.B., R.G., K.M., T.M., K.S.)
| | - Rajinikanth Gogiraju
- Department of Cardiology, Cardiology I, University Medical Center Mainz, Germany. (M.L.B., R.G., K.M., T.M., K.S.)
| | - Stephane Robert
- Aix Marseille University, INSERM 1263, INRAE, C2VN, France (S.R., L.P.-D., C.D.)
| | - Denise Pedrosa
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Germany. (K.Z., M.L.B., D.P., K.K., W.R., C.R.)
| | - Klytaimnistra Kiouptsi
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Germany. (K.Z., M.L.B., D.P., K.K., W.R., C.R.)
| | - Kateryna Moiko
- Department of Cardiology, Cardiology I, University Medical Center Mainz, Germany. (M.L.B., R.G., K.M., T.M., K.S.)
| | - Mathias Wagner
- Institute of Pathology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany (M.W.)
| | - Felix Mahfoud
- Department of Internal Medicine III, Cardiology, Angiology and Internal Intensive Care Medicine, Saarland University Hospital and Saarland University, Homburg, Germany (F.M.)
| | | | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center Mainz, Germany. (M.L.B., R.G., K.M., T.M., K.S.)
| | - Wolfram Ruf
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Germany. (K.Z., M.L.B., D.P., K.K., W.R., C.R.)
| | - Christoph Reinhardt
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Germany. (K.Z., M.L.B., D.P., K.K., W.R., C.R.)
| | | | - Christophe Dubois
- Aix Marseille University, INSERM 1263, INRAE, C2VN, France (S.R., L.P.-D., C.D.)
| | - Katrin Schäfer
- Department of Cardiology, Cardiology I, University Medical Center Mainz, Germany. (M.L.B., R.G., K.M., T.M., K.S.)
| |
Collapse
|
8
|
Kral-Pointner JB, Haider P, Szabo PL, Salzmann M, Brekalo M, Schneider KH, Schrottmaier WC, Kaun C, Bleichert S, Kiss A, Sickha R, Hengstenberg C, Huber K, Brostjan C, Bergmeister H, Assinger A, Podesser BK, Wojta J, Hohensinner P. Reduced Monocyte and Neutrophil Infiltration and Activation by P-Selectin/CD62P Inhibition Enhances Thrombus Resolution in Mice. Arterioscler Thromb Vasc Biol 2024; 44:954-968. [PMID: 38385292 PMCID: PMC11020038 DOI: 10.1161/atvbaha.123.320016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 02/07/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Venous thromboembolism is a major health problem. After thrombus formation, its resolution is essential to re-establish blood flow, which is crucially mediated by infiltrating neutrophils and monocytes in concert with activated platelets and endothelial cells. Thus, we aimed to modulate leukocyte function during thrombus resolution post-thrombus formation by blocking P-selectin/CD62P-mediated cell interactions. METHODS Thrombosis was induced by inferior vena cava stenosis through ligation in mice. After 1 day, a P-selectin-blocking antibody or isotype control was administered and thrombus composition and resolution were analyzed. RESULTS Localizing neutrophils and macrophages in thrombotic lesions of wild-type mice revealed that these cells enter the thrombus and vessel wall from the caudal end. Neutrophils were predominantly present 1 day and monocytes/macrophages 3 days after vessel ligation. Blocking P-selectin reduced circulating platelet-neutrophil and platelet-Ly6Chigh monocyte aggregates near the thrombus, and diminished neutrophils and Ly6Chigh macrophages in the cranial thrombus part compared with isotype-treated controls. Depletion of neutrophils 1 day after thrombus initiation did not phenocopy P-selectin inhibition but led to larger thrombi compared with untreated controls. In vitro, P-selectin enhanced human leukocyte function as P-selectin-coated beads increased reactive oxygen species production by neutrophils and tissue factor expression of classical monocytes. Accordingly, P-selectin inhibition reduced oxidative burst in the thrombus and tissue factor expression in the adjacent vessel wall. Moreover, blocking P-selectin reduced thrombus density determined by scanning electron microscopy and increased urokinase-type plasminogen activator levels in the thrombus, which accelerated caudal fibrin degradation from day 3 to day 14. This accelerated thrombus resolution as thrombus volume declined more rapidly after blocking P-selectin. CONCLUSIONS Inhibition of P-selectin-dependent activation of monocytes and neutrophils accelerates venous thrombosis resolution due to reduced infiltration and activation of innate immune cells at the site of thrombus formation, which prevents early thrombus stabilization and facilitates fibrinolysis.
Collapse
Affiliation(s)
- Julia B. Kral-Pointner
- Ludwig Boltzmann Institute for Cardiovascular Research (J.B.K.-P., P.L.S., K.H.S., A.K., R.S., K.H., H.B., B.K.P., J.W., P. Hohensinner), Medical University of Vienna, Austria
- Division of Cardiology, Department of Internal Medicine II (J.B.K.-P., P. Haider, M.S., M.B., C.K., C.H., J.W.), Medical University of Vienna, Austria
| | - Patrick Haider
- Division of Cardiology, Department of Internal Medicine II (J.B.K.-P., P. Haider, M.S., M.B., C.K., C.H., J.W.), Medical University of Vienna, Austria
| | - Petra L. Szabo
- Ludwig Boltzmann Institute for Cardiovascular Research (J.B.K.-P., P.L.S., K.H.S., A.K., R.S., K.H., H.B., B.K.P., J.W., P. Hohensinner), Medical University of Vienna, Austria
- Centre for Biomedical Research and Translational Surgery (P.L.S., K.H.S., A.K., H.B., B.K.P., P. Hohensinner), Medical University of Vienna, Austria
| | - Manuel Salzmann
- Division of Cardiology, Department of Internal Medicine II (J.B.K.-P., P. Haider, M.S., M.B., C.K., C.H., J.W.), Medical University of Vienna, Austria
| | - Mira Brekalo
- Centre for Biomedical Research and Translational Surgery (P.L.S., K.H.S., A.K., H.B., B.K.P., P. Hohensinner), Medical University of Vienna, Austria
| | - Karl H. Schneider
- Ludwig Boltzmann Institute for Cardiovascular Research (J.B.K.-P., P.L.S., K.H.S., A.K., R.S., K.H., H.B., B.K.P., J.W., P. Hohensinner), Medical University of Vienna, Austria
- Centre for Biomedical Research and Translational Surgery (P.L.S., K.H.S., A.K., H.B., B.K.P., P. Hohensinner), Medical University of Vienna, Austria
| | - Waltraud C. Schrottmaier
- Institute for Vascular Biology and Thrombosis Research (W.C.S., A.A.), Medical University of Vienna, Austria
| | - Christoph Kaun
- Division of Cardiology, Department of Internal Medicine II (J.B.K.-P., P. Haider, M.S., M.B., C.K., C.H., J.W.), Medical University of Vienna, Austria
| | - Sonja Bleichert
- Division of Vascular Surgery, Department of General Surgery (S.B., C.B.), Medical University of Vienna, Austria
| | - Attila Kiss
- Ludwig Boltzmann Institute for Cardiovascular Research (J.B.K.-P., P.L.S., K.H.S., A.K., R.S., K.H., H.B., B.K.P., J.W., P. Hohensinner), Medical University of Vienna, Austria
- Centre for Biomedical Research and Translational Surgery (P.L.S., K.H.S., A.K., H.B., B.K.P., P. Hohensinner), Medical University of Vienna, Austria
| | - Romana Sickha
- Ludwig Boltzmann Institute for Cardiovascular Research (J.B.K.-P., P.L.S., K.H.S., A.K., R.S., K.H., H.B., B.K.P., J.W., P. Hohensinner), Medical University of Vienna, Austria
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II (J.B.K.-P., P. Haider, M.S., M.B., C.K., C.H., J.W.), Medical University of Vienna, Austria
| | - Kurt Huber
- Ludwig Boltzmann Institute for Cardiovascular Research (J.B.K.-P., P.L.S., K.H.S., A.K., R.S., K.H., H.B., B.K.P., J.W., P. Hohensinner), Medical University of Vienna, Austria
- Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria (K.H.)
- Medical Faculty, Sigmund Freud University, Vienna, Austria (K.H.)
| | - Christine Brostjan
- Division of Vascular Surgery, Department of General Surgery (S.B., C.B.), Medical University of Vienna, Austria
| | - Helga Bergmeister
- Ludwig Boltzmann Institute for Cardiovascular Research (J.B.K.-P., P.L.S., K.H.S., A.K., R.S., K.H., H.B., B.K.P., J.W., P. Hohensinner), Medical University of Vienna, Austria
- Centre for Biomedical Research and Translational Surgery (P.L.S., K.H.S., A.K., H.B., B.K.P., P. Hohensinner), Medical University of Vienna, Austria
| | - Alice Assinger
- Institute for Vascular Biology and Thrombosis Research (W.C.S., A.A.), Medical University of Vienna, Austria
| | - Bruno K. Podesser
- Ludwig Boltzmann Institute for Cardiovascular Research (J.B.K.-P., P.L.S., K.H.S., A.K., R.S., K.H., H.B., B.K.P., J.W., P. Hohensinner), Medical University of Vienna, Austria
- Centre for Biomedical Research and Translational Surgery (P.L.S., K.H.S., A.K., H.B., B.K.P., P. Hohensinner), Medical University of Vienna, Austria
| | - Johann Wojta
- Ludwig Boltzmann Institute for Cardiovascular Research (J.B.K.-P., P.L.S., K.H.S., A.K., R.S., K.H., H.B., B.K.P., J.W., P. Hohensinner), Medical University of Vienna, Austria
- Division of Cardiology, Department of Internal Medicine II (J.B.K.-P., P. Haider, M.S., M.B., C.K., C.H., J.W.), Medical University of Vienna, Austria
| | - Philipp Hohensinner
- Ludwig Boltzmann Institute for Cardiovascular Research (J.B.K.-P., P.L.S., K.H.S., A.K., R.S., K.H., H.B., B.K.P., J.W., P. Hohensinner), Medical University of Vienna, Austria
- Centre for Biomedical Research and Translational Surgery (P.L.S., K.H.S., A.K., H.B., B.K.P., P. Hohensinner), Medical University of Vienna, Austria
| |
Collapse
|
9
|
Troupis CJ, Berman JS, Hammerschlag G, Upton AJ, Rhodes AN. Incidental central pulmonary emboli in outpatients with deep vein thrombosis. Intern Med J 2024; 54:626-631. [PMID: 37872855 DOI: 10.1111/imj.16249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 09/05/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND While it has been demonstrated that large asymptomatic pulmonary embolism (PE) can occur, many studies have assessed inpatients or patients with known risk factors for venous thromboembolism (such as malignancy). There are few data regarding incidental PE in outpatients with deep vein thrombosis (DVT) or assessing whether these emboli occur centrally or peripherally in the pulmonary arteries. AIMS To determine the rates of incidental central and peripheral PE in outpatients with proximal and distal DVT. METHODS This was a retrospective cross-sectional study of 120 patients attending our community imaging clinic between January 2015 and March 2020, with ultrasound-confirmed lower limb DVT, and subsequent computed tomography pulmonary angiogram (CTPA) within 24 h. Exclusion criteria were symptoms indicative of PE. Imaging reports were retrospectively reviewed to record the proximity of DVT and the location of any PE as either central (pulmonary trunk or main pulmonary arteries) or peripheral (lobar, segmental or subsegmental pulmonary arteries). RESULTS Incidental PE occurred in 71 patients (59.2%), with a rate of 77.5% in proximal and 50.0% in distal DVT. Sixteen patients had central PE (13.3% of all patients with DVT; 22.5% of all patients with PE). Two patients (both with proximal DVT) had PE in the pulmonary trunk. CONCLUSIONS Incidental PE occur frequently in outpatients with lower limb DVT, including the possibility of asymptomatic central emboli. Further studies with larger patient cohorts would be useful to assess the utility of baseline chest imaging in outpatients with DVT.
Collapse
Affiliation(s)
| | | | - Gary Hammerschlag
- Department of Respiratory Medicine & Sleep Disorders, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | - Alexander N Rhodes
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
10
|
Shawakh H, Bdeiwi H, Aljundi R, Kashkash F, Khoury A. A rare case of pancreatic adenocarcinoma accompanied by venous thrombosis, pleural and pericardial effusions. Ann Med Surg (Lond) 2024; 86:2277-2280. [PMID: 38576945 PMCID: PMC10990354 DOI: 10.1097/ms9.0000000000001870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/17/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction Pancreatic cancer is a deadly type of cancer with few symptoms until metastasis. It poses a high risk of cancer-associated thrombosis. Case presentation A 73-year-old male presented with fatigue, shortness of breath, weight loss since 9 months, and blood clots recently in his legs. Chest radiography revealed fluid accumulation in pleural and pericardial cavities. Later, a fluid examination revealed the presence of malignant cells in the pericardial fluid. After immunological tests and an upper gastrointestinal endoscopy were performed, a pancreatic tumour was suspected. The patient was administered anticoagulant treatment and palliative care, which resulted in improvement after one month. Discussion Pancreatic adenocarcinoma is a highly aggressive cancer with a strong tendency to metastasize, leading to pericardial and pleural effusion, thrombophlebitis, and poor prognosis. Conclusion This case indicates that venous thrombosis, pleural and pericardial effusions could be symptoms related to a pancreatic tumour.
Collapse
Affiliation(s)
| | | | | | - Fateh Kashkash
- Department of Pulmonology, Aleppo University Hospital, University of Aleppo, Faculty of Medicine, Aleppo, Syria
| | - Abdullah Khoury
- Department of Pulmonology, Aleppo University Hospital, University of Aleppo, Faculty of Medicine, Aleppo, Syria
| |
Collapse
|
11
|
Lei J, Pu H, Zhang L, Zeng C, Peng Z, Wu Z, Jiang Y, Wang R, Lu X. Drug-coated balloon therapy for in-stent restenosis in patients with iliofemoral deep vein thrombosis: A single-arm observational study. Catheter Cardiovasc Interv 2024; 103:752-757. [PMID: 38385905 DOI: 10.1002/ccd.30975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/13/2023] [Accepted: 02/02/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Iliofemoral deep vein thrombosis (IFDVT) causes severe symptoms and affect the quality of life to a great extent. Endovascular thrombectomy and stent implantation have been a feasible strategie to alleviate the signs and symptoms of IFDVT. However, venous in-stent restenosis (ISR) has become an emerging non-negligible problem. METHODS To evaluate the histological characteristics of venous ISR, neointima of arterial and venous ISR patients were collected and examed. To explore the effect of drug-coated balloon (DCB) on venous ISR lesions, we conducted a single-center retrospective case series study involving IFDVT patients with ISR after venous stenting who were treated with paclitaxel-coated balloon dilatation. RESULTS We found a collagen-rich matrix but not elastin, as well as fewer cells and less neovascularization in venous intimal hyperplasia compared with neointima in arteries. Thirteen IFDVT patients were involved in the study, with average preoperative stenosis degree of 87.69% ± 13.48%. After intervention, the stenosis degree was significantly reduced to 14.6% ± 14.36% immediately (p < 0.0001) and to 16.54% ± 15.73% during follow-up (p < 0.0001). During follow-up, the VEINES-QOL scores (p < 0.0001), VEINES-Sym scores (p < 0.0001), and Villalta scores (p = 0.04) of patients was improved significantly compared with those before intervention. No major adverse events were observed. CONCLUSIONS The use of DCB may have a positive effect in the treatment of venous ISR by targeting intimal hyperplasia. Moreover, the application of DCB dilatation in IFDVT stenting patients with ISR is deemed safe and effective.
Collapse
Affiliation(s)
- Jiahao Lei
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Hongji Pu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Linjie Zhang
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Chenlin Zeng
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Zhaoxi Peng
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Zhaoyu Wu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yihong Jiang
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Ruihua Wang
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, People's Republic of China
| | - Xinwu Lu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, People's Republic of China
| |
Collapse
|
12
|
Sousa JA, Achutegui MI, Juega-Mariño J, Requena M, Bernardo-Castro S, Rodrigo-Gisbert M, Rizzo F, Olivé M, Garcia-Tornel Á, Chaves AC, Rodriguez-Villatoro N, Muchada M, Pagola J, Rodriguez-Luna D, Rubiera M, Martins AI, Silva F, Veiga R, Nunes C, Machado E, Diana F, de Dios M, Hernández D, Ribo M, Molina C, Sargento-Freitas J, Tomasello A. Acute management of cerebral venous thrombosis: Indications, technique, and outcome of endovascular treatment in two high-volume centers. Interv Neuroradiol 2024:15910199241236819. [PMID: 38556254 DOI: 10.1177/15910199241236819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION After several uncontrolled studies and one randomized clinical trial, there is still uncertainty regarding the role of endovascular treatment (EVT) in cerebral venous thrombosis (CVT). This study aims to describe and assess different acute management strategies in the treatment of CVT. METHODS We performed a retrospective analysis of an international two-center registry of CVT patients admitted since 2019. Good outcome was defined as a return to baseline modified Rankin scale at three months. We described and compared EVT versus no-EVT patients. RESULTS We included 61 patients. Only one did not receive systemic anticoagulation. EVT was performed in 13/61 (20%) of the cases, with a median time from diagnosis to puncture of 4.5 h (1.25-28.5). EVT patients had a higher median baseline NIHSS [6 (IQR 2-17) vs 0 (0-2.7), p = 0.002)] and a higher incidence of intracerebral hemorrhage (53.8% vs 20.3%, p = 0.03). Recanalization was achieved in 10/13 (77%) patients. Thrombectomy was performed in every case with angioplasty in 7 out of 12 patients and stenting in 3 cases. No postprocedural complication was reported. An improvement of the median NIHSS from baseline to discharge [6 (2-17) vs 1(0-3.75); p < 0.001] was observed in EVT group. A total of 31/60 patients (50.8%) had good outcomes. Adjusting to NIHSS and ICH, EVT had a non-significant increase in the odds of a good outcome [aOR 1.42 (95%CI 0.73-2.8, p = 0.307)]. CONCLUSIONS EVT in combination with anticoagulation was safe in acute treatment of CVT as suggested by NIHSS improvement. Selected patients may benefit from this treatment.
Collapse
Affiliation(s)
- João André Sousa
- Stroke Unit, Department of Neurology, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | - Maider Iza Achutegui
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Jesus Juega-Mariño
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Manuel Requena
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
- Department of Interventional Neuroradiology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Sara Bernardo-Castro
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Marc Rodrigo-Gisbert
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Federica Rizzo
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Marta Olivé
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Álvaro Garcia-Tornel
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Ana Carolina Chaves
- Department of Neuroradiology, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | | | - Marian Muchada
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Jorge Pagola
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - David Rodriguez-Luna
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Marta Rubiera
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Ana Inês Martins
- Stroke Unit, Department of Neurology, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | - Fernando Silva
- Stroke Unit, Department of Neurology, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | - Ricardo Veiga
- Department of Neuroradiology, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | - Cesar Nunes
- Department of Neuroradiology, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | - Egídio Machado
- Department of Neuroradiology, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | - Francesco Diana
- Department of Interventional Neuroradiology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Marta de Dios
- Department of Interventional Neuroradiology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - David Hernández
- Department of Interventional Neuroradiology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Marc Ribo
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
- Department of Interventional Neuroradiology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Carlos Molina
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - João Sargento-Freitas
- Stroke Unit, Department of Neurology, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | - Alejandro Tomasello
- Department of Interventional Neuroradiology, Hospital Universitari Vall dHebron, Barcelona, Spain
| |
Collapse
|
13
|
Aguiar de Sousa D, Lucas Neto L. Advances in Cerebral Venous Thrombosis. Stroke 2024. [PMID: 38511323 DOI: 10.1161/strokeaha.123.044266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Affiliation(s)
- Diana Aguiar de Sousa
- Stroke Center, Centro Hospitalar Universitário Lisboa Central, Portugal (D.A.d.S.)
- Instituto de Anatomia, Faculdade de Medicina, Universidade de Lisboa, Portugal (D.A.d.S., L.L.N.)
- L Lopes Lab, Instituto de Medicina Molecular JLA, Lisbon, Portugal (D.A.d.S.)
| | - Lia Lucas Neto
- Instituto de Anatomia, Faculdade de Medicina, Universidade de Lisboa, Portugal (D.A.d.S., L.L.N.)
- Department of Neuroradiology, Centro Hospitalar Lisboa Norte, Lisbon, Portugal (L.L.N.)
| |
Collapse
|
14
|
Chernysh IN, Mukhopadhyay S, Johnson TA, Brooks JA, Sarkar R, Weisel JW, Antalis TM. Time-dependent ultrastructural changes during venous thrombogenesis and thrombus resolution. J Thromb Haemost 2024:S1538-7836(24)00126-0. [PMID: 38492853 DOI: 10.1016/j.jtha.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 02/08/2024] [Accepted: 02/21/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Deep vein thrombosis is a common vascular event that can result in debilitating morbidity and even death due to pulmonary embolism. Clinically, patients with faster resolution of a venous thrombus have improved prognosis, but the detailed structural information regarding changes that occur in a resolving thrombus over time is lacking. OBJECTIVES To define the spatial-morphologic characteristics of venous thrombus formation, propagation, and resolution at the submicron level over time. METHODS Using a murine model of stasis-induced deep vein thrombosis along with scanning electron microscopy and immunohistology, we determine the specific structural, compositional, and morphologic characteristics of venous thrombi formed after 4 days and identify the changes that take place during resolution by day 7. Comparison is made with the structure and composition of venous thrombi formed in mice genetically deficient in plasminogen activator inhibitor type 1. RESULTS As venous thrombus resolution progresses, fibrin exists in different structural forms, and there are dynamic cellular changes in the compositions of leukocytes, platelet aggregates, and red blood cells. Intrathrombus microvesicles are present that are not evident by histology, and red blood cells in the form of polyhedrocytes are an indicator of clot contraction. Structural evidence of fibrinolysis is observed early during thrombogenesis and is accelerated by plasminogen activator inhibitor type 1 deficiency. CONCLUSION The results reveal unique, detailed ultrastructural and compositional insights along with documentation of the dynamic changes that occur during accelerated resolution that are not evident by standard pathologic procedures and can be applied to inform diagnosis and effectiveness of thrombolytic treatments to improve patient outcomes.
Collapse
Affiliation(s)
- Irina N Chernysh
- Department of Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Subhradip Mukhopadhyay
- Center for Vascular and Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA; Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Tierra A Johnson
- Center for Vascular and Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jacob A Brooks
- Center for Vascular and Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Rajabrata Sarkar
- Center for Vascular and Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA; Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - John W Weisel
- Department of Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Toni M Antalis
- Center for Vascular and Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA; Department of Physiology, University of Maryland School of Medicine, Baltimore, Maryland, USA; Research & Development Service, United States Department of Veterans Affairs Maryland Health Care System, Baltimore, Maryland, USA.
| |
Collapse
|
15
|
Bonnesen K, Poulsen CFB, Schmidt SAJ, Sørensen HT, Schmidt M. Autoimmune blistering disorders and cardiovascular risks: A population-based cohort study. J Am Acad Dermatol 2024:S0190-9622(24)00486-9. [PMID: 38492858 DOI: 10.1016/j.jaad.2024.02.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/22/2024] [Accepted: 02/27/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Autoimmune blistering disorders (ABDs) might elevate cardiovascular risk, but studies are lacking. OBJECTIVE The objective of this study was to examine if ABDs elevate the risk of atherosclerotic cardiovascular disease, heart failure, arrhythmia, venous thromboembolism, and cardiovascular death. METHODS A population-based cohort of Danish patients with ABD (≥18 years of age) diagnosed during 1996-2021 (n = 3322) was compared with an age- and sex-matched comparison cohort from the general population (n = 33,195). RESULTS Compared with the general population, patients with ABDs had higher 1-year risks of atherosclerotic cardiovascular disease (3.4% vs 1.6%), heart failure (1.9% vs 0.7%), arrhythmia (3.8% vs 1.3%), venous thromboembolism (1.9% vs 0.3%), and cardiovascular death (3.3% vs 0.9%). The elevated risk persisted after 10 years for all outcomes but arrhythmia. The hazard ratios associating ABDs with the outcomes during the entire follow-up were 1.24 (1.09-1.40) for atherosclerotic cardiovascular disease, 1.48 (1.24-1.77) for heart failure, 1.16 (1.02-1.32) for arrhythmia, 1.87 (1.50-2.34) for venous thromboembolism, and 2.01 (1.76-2.29) for cardiovascular death. The elevated cardiovascular risk was observed for both pemphigus and pemphigoid. LIMITATIONS Our findings might only generalize to patients with ABDs without prevalent cardiovascular diseases. CONCLUSION Patients with ABDs had an elevated cardiovascular risk compared with age- and sex-matched controls.
Collapse
Affiliation(s)
- Kasper Bonnesen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Christian F B Poulsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Cardiology, Gødstrup Regional Hospital, Herning, Denmark; Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Sigrun A J Schmidt
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Cardiology, Gødstrup Regional Hospital, Herning, Denmark
| |
Collapse
|
16
|
Garate D, Woolridge K, Wilkerson MG, Munoz Gonzalez A. Association between hidradenitis suppurativa and increased risk of venous thromboembolism: A multicenter retrospective cohort study. J Am Acad Dermatol 2024:S0190-9622(24)00475-4. [PMID: 38460789 DOI: 10.1016/j.jaad.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/12/2024] [Accepted: 03/02/2024] [Indexed: 03/11/2024]
Affiliation(s)
- David Garate
- University of Texas Medical Branch, John Sealy School of Medicine, Galveston, Texas
| | - Katherine Woolridge
- Department of Dermatology, University of Texas Medical Branch, Galveston, Texas
| | - Michael G Wilkerson
- Department of Dermatology, University of Texas Medical Branch, Galveston, Texas
| | | |
Collapse
|
17
|
Poredoš P, Mukherjee D, Blinc A. Statins and Venous Thromboembolic Disease - Where are we Now? Curr Vasc Pharmacol 2024; 22:CVP-EPUB-138921. [PMID: 38441024 DOI: 10.2174/0115701611308323240229050237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 01/01/1970] [Accepted: 02/12/2024] [Indexed: 03/06/2024]
Abstract
Classical risk factors for atherosclerosis also play a role in the pathogenesis of venous thromboembolism (VTE). Low-density lipoprotein cholesterol has prothrombotic and endothelium- deteriorating effects which are not limited to the arterial system. The association between hypercholesterolemia and VTE has been established, but the benefits of statins in the prevention of VTE assessed by observation studies seemed equivocal. The large, randomized trial Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) recorded the occurrence of VTE as a protocol-specified endpoint and reported a reduced incidence of VTE among subjects taking 20 mg of rosuvastatin daily vs placebo (hazard ratio 0.57; 95% confidence interval 0.37-0.86; p=0.007). Similar results were confirmed by meta-analyses of observation studies and randomized trials. Recently, a Mendelian randomization study that took the presence of gene variants coding for less efficient hydroxymethyl-glutaryl coenzyme A reductase activity as a proxy for statin treatment, confirmed a small, but significant negative association between the score of selected genetic polymorphisms and the incidence of VTE. However, since the protective effects of statins are limited, they should not be substituted for guideline-recommended VTE prophylaxis or anticoagulation treatment.
Collapse
Affiliation(s)
- Pavel Poredoš
- Department of Vascular Diseases, University Medical Centre Ljubljana, Slovenia
| | - Debabrata Mukherjee
- Department of Internal Medicine, Texas Tech University Health Sciences Center at El Paso, Texas 79905, USA
| | - Aleš Blinc
- Department of Vascular Diseases, University Medical Centre Ljubljana, Slovenia
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Slovenia
| |
Collapse
|
18
|
Weller J, Krzywicka K, van de Munckhof A, Dorn F, Althaus K, Bode FJ, Bandettini di Poggio M, Buck B, Kleinig T, Cordonnier C, Dizonno V, Duan J, Elkady A, Chew BLA, Garcia-Esperon C, Field TS, Legault C, Morin Martin M, Michalski D, Pelz J, Schoenenberger S, Nagel S, Petruzzellis M, Raposo N, Skjelland M, Zimatore DS, Aaron S, Sanchez van Kammen M, Aguiar de Sousa D, Lindgren E, Jood K, Scutelnic A, Heldner MR, Poli S, Arauz A, Conforto AB, Putaala J, Tatlisumak T, Arnold M, Coutinho JM, Günther A, Zimmermann J, Ferro JM. Endovascular treatment of cerebral sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia. Eur Stroke J 2024; 9:105-113. [PMID: 37771138 PMCID: PMC10916823 DOI: 10.1177/23969873231202363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/03/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION There is little data on the role of endovascular treatment (EVT) of cerebral venous sinus thrombosis (CVST) due to vaccine-induced immune thrombotic thrombocytopenia (VITT). Here, we describe clinical characteristics and outcomes of CVST-VITT patients who were treated with EVT. PATIENTS AND METHODS We report data from an international registry of patients who developed CVST within 28 days of SARS-CoV-2 vaccination, reported between 29 March 2021 and 6 March 2023. VITT was defined according to the Pavord criteria. RESULTS EVT was performed in 18/136 (13%) patients with CVST-VITT (92% aspiration and/or stent retrieval, 8% local thrombolysis). Most common indications were extensive thrombosis and clinical or radiological deterioration. Compared to non-EVT patients, those receiving EVT had a higher median thrombus load (4.5 vs 3). Following EVT, local blood flow was improved in 83% (10/12, 95% confidence interval [CI] 54-96). One (6%) asymptomatic sinus perforation occurred. Eight (44%) patients treated with EVT also underwent decompressive surgery. Mortality was 50% (9/18, 95% CI 29-71) and 88% (8/9, 95% CI 25-66) of surviving EVT patients achieved functional independence with a modified Rankin Scale score of 0-2 at follow-up. In multivariable analysis, EVT was not associated with increased mortality (adjusted odds ratio, 0.66, 95% CI 0.16-2.58). DISCUSSION AND CONCLUSION We describe the largest cohort of CVST-VITT patients receiving EVT. Half of the patients receiving EVT died during hospital admission, but most survivors achieved functional independence.
Collapse
Affiliation(s)
- Johannes Weller
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Katarzyna Krzywicka
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Anita van de Munckhof
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Franziska Dorn
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | | | - Felix J Bode
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | | | - Brian Buck
- Division of Neurology, University of Alberta Hospital, Edmonton, AB, Canada
| | - Timothy Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172 – LilNCog – Lille Neuroscience & Cognition, Lille, France
| | - Vanessa Dizonno
- Vancouver Stroke Program, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Jiangang Duan
- Department of Neurology and Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ahmed Elkady
- Department of Neurology, Saudi German Hospital, Jeddah, Saudi Arabia
| | | | | | - Thalia S Field
- Vancouver Stroke Program, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Catherine Legault
- Division of Neurology, McGill University Health Centre, Montreal, QC, Canada
| | - Mar Morin Martin
- Department of Neurology, Hospital Complex of Toledo, Toledo, Spain
| | | | - Johann Pelz
- Department of Neurology, University of Leipzig, Leipzig, Germany
| | | | - Simon Nagel
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
- Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Marco Petruzzellis
- Neuroradiology Unit, Azienda Ospedaliera Consorziale Policlinico di Bari, Italy
| | - Nicolas Raposo
- Department of Neurology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France and Inserm, Toulouse NeuroImaging Center, Université de Toulouse, Toulouse, France
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | | | - Sanjith Aaron
- Neurology Unit, Department of Neurological Sciences, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Mayte Sanchez van Kammen
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Diana Aguiar de Sousa
- CEEM and Institute of Anatomy, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- Stroke Centre, Lisbon Central University Hospital, Lisbon, Portugal
| | - Erik Lindgren
- Department of Neurology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Katarina Jood
- Department of Neurology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Adrian Scutelnic
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sven Poli
- Department of Neurology & Stroke, Eberhard-Karls University, Tuebingen, Germany and Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tuebingen, Germany
| | - Antonio Arauz
- Instituto Nacional de Neurologia y Neurocirugia, Mexico City, Mexico
| | - Adriana B Conforto
- Hospital das Clinicas/São Paulo University and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Neurology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Albrecht Günther
- Department of Neurology, Jena University Hospital, Jena, Germany
| | | | - José M Ferro
- Centro de Estudas Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Portugal
| |
Collapse
|
19
|
Saposnik G, Bushnell C, Coutinho JM, Field TS, Furie KL, Galadanci N, Kam W, Kirkham FC, McNair ND, Singhal AB, Thijs V, Yang VXD. Diagnosis and Management of Cerebral Venous Thrombosis: A Scientific Statement From the American Heart Association. Stroke 2024; 55:e77-e90. [PMID: 38284265 DOI: 10.1161/str.0000000000000456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Cerebral venous thrombosis accounts for 0.5% to 3% of all strokes. The most vulnerable populations include young individuals, women of reproductive age, and patients with a prothrombotic state. The clinical presentation of cerebral venous thrombosis is diverse (eg, headaches, seizures), requiring a high level of clinical suspicion. Its diagnosis is based primarily on magnetic resonance imaging/magnetic resonance venography or computed tomography/computed tomographic venography. The clinical course of cerebral venous thrombosis may be difficult to predict. Death or dependence occurs in 10% to 15% of patients despite intensive medical treatment. This scientific statement provides an update of the 2011 American Heart Association scientific statement for the diagnosis and management of cerebral venous thrombosis. Our focus is on advances in the diagnosis and management decisions of patients with suspected cerebral venous thrombosis. We discuss evidence for the use of anticoagulation and endovascular therapies and considerations for craniectomy. We also provide an algorithm to optimize the management of patients with cerebral venous thrombosis and those with progressive neurological deterioration or thrombus propagation despite maximal medical therapy.
Collapse
|
20
|
Moureau N. Hydrophilic biomaterial intravenous hydrogel catheter for complication reduction in PICC and midline catheters. Expert Rev Med Devices 2024; 21:207-216. [PMID: 38445649 DOI: 10.1080/17434440.2024.2324885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/26/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION More than 30% of peripherally inserted central catheters (PICCs) and midline catheters experience complications. Most complications are related to thrombotic cellular adherence to catheter materials. AREAS COVERED This manuscript outlines PICC and midline catheter complications, the need to reduce complications and how hydrogel catheters may provide a solution to address these unmet needs based on available evidence. EXPERT OPINION Patients commonly require PICC or midline catheters for treatment to establish a reliable form of intravenous access. Catheters, while reliable in most cases, are not without complications, including occlusion, thrombosis and infection, each related to cellular adherence to the catheter material. Hydrophilic catheter coatings and composites have been developed to mitigate these thrombotic complications, reduce adherence of blood and bacterial cells to catheters and provide greater patient safety with these devices. Hydrogel materials are highly biocompatible and have been effective in reducing cellular adherence and the formation of biofilms on surfaces. Smooth hydrophilic catheter surfaces are potentially more comfortable for the patient, with reduced friction during insertion and removal. A catheter constructed of hydrophilic biomaterial, a hydrogel composite material, may minimize thrombotic complications in PICC and midline catheters, improving catheter performance and outcomes for patients.
Collapse
Affiliation(s)
- Nancy Moureau
- Nursing Research, PICC Excellence,Inc. Griffith University, Brisbane, Queensland, Australia
| |
Collapse
|
21
|
Yuan S, Xu F, Zhang H, Chen J, Ruan X, Li Y, Burgess S, Åkesson A, Li X, Gill D, Larsson SC. Proteomic insights into modifiable risk of venous thromboembolism and cardiovascular comorbidities. J Thromb Haemost 2024; 22:738-748. [PMID: 38029854 PMCID: PMC7615672 DOI: 10.1016/j.jtha.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/30/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) has been associated with several modifiable factors (MFs) and cardiovascular comorbidities. However, the mechanisms are largely unknown. OBJECTIVES We aimed to decipher proteomic pathways underlying the associations of VTE with MFs and cardiovascular comorbidities. METHODS A 2-stage network Mendelian randomization analysis was conducted to explore the associations between 15 MFs, 1151 blood proteins, and VTE using data from a genome-wide meta-analysis including 81 190 cases of VTE. We used protein data from 35 559 individuals as the discovery analysis, and from 2 independent studies including 10 708 and 54 219 participants as the replication analyses. Based on the identified proteins, we assessed the druggability and examined the cardiovascular pleiotropy. RESULTS The network Mendelian randomization analyses identified 10 MF-VTE, 86 MF-protein, and 34 protein-VTE associations. These associations were overall consistent in the replication analyses. Thirty-eight pathways with directionally consistent direct and indirect effects in the MF-protein-VTE pathway were identified. Low-density lipoprotein receptor-related protein 12 (LRP12: 34.3%-58.1%) and coagulation factor (F)XI (20.6%-39.6%) mediated most of the associations between 3 obesity indicators and VTE. Likewise, coagulation FXI mediated most of the smoking-VTE association (40%; 95% CI, 20%-60%) and insomnia-VTE association (27%; 95% CI, 5%-49%). Many VTE-associated proteins were highly druggable for thrombotic conditions. Five proteins (interleukin-6 receptor subunit alpha, LRP12, prothrombin, angiopoietin-1, and low-density lipoprotein receptor-related protein 4) were associated with VTE and its cardiovascular comorbidities. CONCLUSION This study suggests that coagulation FXI, a druggable target, is an important mediator of the associations of obesity, smoking, and insomnia with VTE risk.
Collapse
Affiliation(s)
- Shuai Yuan
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Fengzhe Xu
- Key Laboratory of Growth Regulation and Translational Research of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China
| | - Han Zhang
- Department of Big Data in Health Science School of Public Health, Center of Clinical Big Data and Analytics of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jie Chen
- Department of Big Data in Health Science School of Public Health, Center of Clinical Big Data and Analytics of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xixian Ruan
- Department of Gastroenterology, the Third Xiangya Hospital, Central South University, Changsha, China
| | - Yuying Li
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Stephen Burgess
- Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Agneta Åkesson
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Xue Li
- Department of Big Data in Health Science School of Public Health, Center of Clinical Big Data and Analytics of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dipender Gill
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Susanna C. Larsson
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
- Unit of Medical Epidemiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| |
Collapse
|
22
|
Tøndel BG, Sejrup JK, Morelli VM, Løchen ML, Njølstad I, Mathiesen EB, Wilsgaard T, Hansen JB, Brækkan SK. Joint effect of ischemic stroke and obesity on the risk of venous thromboembolism: the Tromsø Study. Res Pract Thromb Haemost 2024; 8:102392. [PMID: 38665865 PMCID: PMC11043863 DOI: 10.1016/j.rpth.2024.102392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/12/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
Background Patients with ischemic stroke have increased risk of venous thromboembolism (VTE). Obesity is prevalent in stroke patients and a well-established risk factor for VTE. Whether obesity further increases the VTE risk in patients with stroke remains unclear. Objectives We investigated the joint effect of ischemic stroke and obesity on the risk of incident VTE in a population-based cohort. Methods Participants (n = 29,920) were recruited from the fourth to sixth surveys of the Tromsø Study (1994-1995, 2001, and 2007-2008) and followed through 2014. Incident events of ischemic stroke and VTE during follow-up were recorded. Hazard ratios (HRs) of VTE with 95% CIs were estimated according to combined categories of ischemic stroke and obesity (body mass index ≥ 30 kg/m2), with exposure to neither risk factors as reference. Results During a median follow-up of 19.6 years, 1388 participants experienced ischemic stroke and 807 participants developed VTE. Among those with stroke, 51 developed VTE, yielding an incidence rate of VTE after stroke of 7.2 per 1000 person-years (95% CI, 5.5-9.5). In subjects without stroke, obesity was associated with a 1.8-fold higher VTE risk (HR, 1.76; 95% CI, 1.47-2.11). In nonobese subjects, stroke was associated with a 1.8-fold higher VTE risk (HR, 1.77; 95% CI, 1.27-2.46). Obese subjects with stroke had a 2-fold increased VTE risk (HR, 2.44; 95% CI, 1.37-4.36). Conclusion The combination of obesity and ischemic stroke did not yield an excess risk of VTE. Our findings suggest that obese subjects with ischemic stroke do not have a more than additive risk of VTE.
Collapse
Affiliation(s)
- Birgitte G. Tøndel
- Thrombosis Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Joakim K. Sejrup
- Thrombosis Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Thrombosis Research Center, Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Vânia M. Morelli
- Thrombosis Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Thrombosis Research Center, Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Maja-Lisa Løchen
- Epidemiology of Chronic Diseases Research Group, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Inger Njølstad
- Epidemiology of Chronic Diseases Research Group, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ellisiv B. Mathiesen
- Brain and Circulation Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Epidemiology of Chronic Diseases Research Group, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - John-Bjarne Hansen
- Thrombosis Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Thrombosis Research Center, Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Sigrid K. Brækkan
- Thrombosis Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Thrombosis Research Center, Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| |
Collapse
|
23
|
Milazzo N, Pizzuto S, Gratieux J, Sgreccia A, Di Maria F, Coskun O, Condette-Auliac S, Boulin A, Rodesch G, Consoli A. A case of spontaneous brain arteriovenous malformation occlusion: Imaging analysis and clinical debate. Interv Neuroradiol 2024:15910199231226142. [PMID: 38418386 DOI: 10.1177/15910199231226142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
The spontaneous occlusion of brain arteriovenous malformations (bAVMs) is a rare event, particularly for unruptured ones. Associated factors include single-venous drainage and small nidus size. Most of the previously reported cases were ruptured bAVMs. We report the case of a middle-aged male patient with an unruptured, rolandic, left-sided bAVM associated with a 30-year history of refractory epilepsy. We documented the spontaneous thrombosis of the venous drainage of the AVM without any sign of bleeding. Finally, we underline the difference between ruptured-induced occlusion and truly spontaneous thrombosis of the bAVMs.
Collapse
Affiliation(s)
- Nicola Milazzo
- Department of Therapeutic and Interventional Neuroradiology, Hospital Foch, Suresnes, France
- Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Images, Azienda Ospedaliera Universitaria Policlinico G Martino, Messina, Italy
| | - Silvia Pizzuto
- Department of Therapeutic and Interventional Neuroradiology, Hospital Foch, Suresnes, France
| | - Julie Gratieux
- Department of Therapeutic and Interventional Neuroradiology, Hospital Foch, Suresnes, France
| | - Alessandro Sgreccia
- Department of Therapeutic and Interventional Neuroradiology, Hospital Foch, Suresnes, France
| | - Federico Di Maria
- Department of Therapeutic and Interventional Neuroradiology, Hospital Foch, Suresnes, France
| | - Oghuzan Coskun
- Department of Therapeutic and Interventional Neuroradiology, Hospital Foch, Suresnes, France
| | | | - Anne Boulin
- Department of Therapeutic and Interventional Neuroradiology, Hospital Foch, Suresnes, France
| | - Georges Rodesch
- Department of Therapeutic and Interventional Neuroradiology, Hospital Foch, Suresnes, France
| | - Arturo Consoli
- Department of Therapeutic and Interventional Neuroradiology, Hospital Foch, Suresnes, France
| |
Collapse
|
24
|
Zeng J, Zhao L, Jiang H, Yang X, Liao L, Zhang Y, Lei H. Challenges of Post-Venipuncture Jugular Venous Thrombosis in Patients with Secondary Hyperparathyroidism: A Case Report. Am J Case Rep 2024; 25:e943270. [PMID: 38379277 PMCID: PMC10896707 DOI: 10.12659/ajcr.943270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/09/2024] [Accepted: 01/01/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Hyperparathyroidism is a common issue in patients on long-term hemodialysis, necessitating parathyroidectomy with deep venipuncture. These patients frequently exhibit a heightened incidence of vascular calcification, complicating deep venipuncture and increasing the risk of associated complications. Therefore, a crucial aspect of preoperative assessment in this population involves identifying vascular calcification, with a preference for ultrasound-guided intraplane puncture. Special care is required to prevent blood vessel injuries and postoperative complications such as deep vein thrombosis. CASE REPORT We present the case of a 66-year-old woman with secondary hyperparathyroidism who encountered challenges during an internal jugular vein puncture, leading to subsequent thrombosis. Initial attempts were hindered by calcification of the internal jugular vein's vascular wall, resulting in stratified damage to the vessel's wall. However, the ultrasound-guided in-plane puncture technique successfully allowed the insertion of a central venous catheter without further damage to the vascular wall. On the postoperative fourth day, thrombus formation was observed in the damaged vascular wall from the initial puncture. CONCLUSIONS The ultrasound-guided in-plane puncture technique is advantageous in overcoming the difficulties associated with puncturing through deep vein calcification in patients with secondary hyperparathyroidism. This technique also diminishes the likelihood of complications such as venous thrombosis.
Collapse
Affiliation(s)
- Jian Zeng
- Department of Anesthesiology, Shenzhen Longgang Central Hospital, Shenzhen, Guangdong, PR China
| | - Li Zhao
- Continuing Education, Shenzhen Health Capacity Building and Continuing Education Center, Shenzhen, Guangdong, PR China
| | - Hui Jiang
- Department of Ultrasound, Shenzhen Longgang Central Hospital, Shenzhen, Guangdong, PR China
| | - Xiongtiao Yang
- Department of Anesthesiology, Shenzhen Longgang Central Hospital, Shenzhen, Guangdong, PR China
| | - Lin Liao
- Department of Anesthesiology, Shenzhen Longgang Central Hospital, Shenzhen, Guangdong, PR China
| | - Yanli Zhang
- Department of Anesthesiology, Shenzhen Longgang Central Hospital, Shenzhen, Guangdong, PR China
| | - Hongyi Lei
- Department of Anesthesiology, Shenzhen Longgang Central Hospital, Shenzhen, Guangdong, PR China
| |
Collapse
|
25
|
Yamaoka-Tojo M, Tojo T. Prevention of Natural Disaster-Induced Cardiovascular Diseases. J Clin Med 2024; 13:1004. [PMID: 38398317 PMCID: PMC10889681 DOI: 10.3390/jcm13041004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
Natural disasters, such as floods and landslides caused by heavy rainfall, earthquakes, and tsunamis, can induce stress, which may contribute to the onset and aggravation of various cardiovascular diseases. The circulatory system is most susceptible to the effects of stress, and stress-related cardiovascular diseases, such as Takotsubo cardiomyopathy, pulmonary thromboembolism, hypertension, stroke triggered by increased blood pressure, and acute myocardial infarction, can occur during natural disasters. The risk of developing angina pectoris, arrhythmia, sudden cardiac death, and heart failure increases rapidly and can persist for several months. Moreover, treating cardiovascular diseases is essential during the acute phase, and continuous disease management is necessary during the chronic phase. However, disaster medical care for the victims must be given priority during natural disasters, which may cause a delay in diagnosis or access to necessary treatment for pre-existing medical conditions that could worsen or may cause death in patients with cardiovascular diseases. In this review, we summarize the predisposing factors for cardiovascular diseases that have been obtained through disasters such as major earthquakes and provide potential insights to help medical staff prevent the onset and aggravation of cardiovascular diseases during disasters.
Collapse
Affiliation(s)
- Minako Yamaoka-Tojo
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara 252-0373, Japan
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara 252-0373, Japan
| | - Taiki Tojo
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara 252-0373, Japan
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara 252-0374, Japan
| |
Collapse
|
26
|
de Winter MA, Xu Y, Stacey D, Wells PS. Qualitative experiences, values, and decisional needs of patients with unprovoked venous thromboembolism who suffer bleeding-"This pill will keep you alive tonight". Res Pract Thromb Haemost 2024; 8:102360. [PMID: 38559571 PMCID: PMC10978529 DOI: 10.1016/j.rpth.2024.102360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 04/04/2024] Open
Abstract
Background Contemporary guidelines recommend extended-duration anticoagulation among patients with a first unprovoked venous thromboembolism (VTE). Little is known about whether this recommendation aligns with patient values after a bleeding complication. Objectives To explore the experiences, values, and decisional needs of patients with unprovoked VTE related to extended-duration treatment after an anticoagulant-associated bleed. Methods In this descriptive, qualitative study, face to face online semistructured interviews were conducted with patients with unprovoked VTE who had experienced bleeding and continued anticoagulant treatment in one academic hospital in Canada. Data were analyzed using directed content analysis to identify themes. Themes were mapped onto the Ottawa Decisional Support Framework to identify decisional needs. Results Between September and December 2021, 14 patients were interviewed (age 41-69 years; 9 females). Many patients were not aware of the option to stop anticoagulation and had limited understanding of the decision about treatment duration. Despite the negative quality-of-life impact of clinically relevant bleeding during VTE treatment, the majority continued anticoagulation due to emotional trauma of VTE diagnosis, a perception that bleeding would be more manageable than VTE recurrence, a desire to maintain a connection to subspecialty care or non-VTE related benefits (eg, cancer diagnosis, protection from COVID-19). Patients' decisional needs included lack of choice awareness, inadequate support for participation, lack of personalized risk stratification, and inadequate information on monitoring and managing heavy menstrual bleeding. Conclusion Despite the impact of anticoagulant-associated bleeding on quality of life, patients preferred continuing with anticoagulation for reasons extending beyond secondary VTE prevention. Effective decision-support interventions are needed to address unmet decisional needs.
Collapse
Affiliation(s)
- Maria A. de Winter
- Department of Acute Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Internal Medicine, Diakonessenhuis, Utrecht, The Netherlands
| | - Yan Xu
- Department of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dawn Stacey
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Philip S. Wells
- Department of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| |
Collapse
|
27
|
Kamiya S, Kato T, Yasuuji M, Tanaka H, Tsutsumi YM. Elastic Banding Compression as a Novel Treatment to Maintain Hemodynamics in a Patient With Klippel-Trenaunay Syndrome. Cureus 2024; 16:e54156. [PMID: 38496151 PMCID: PMC10940870 DOI: 10.7759/cureus.54156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 03/19/2024] Open
Abstract
Klippel-Trenaunay syndrome (KTS) is also associated with venous thrombosis originating from varicose veins in the lower extremities, pulmonary embolism, and pulmonary hypertension. This study describes the anesthetic management of laparoscopic cholecystectomy in a 54-year-old male KTS patient with orthostatic hypotension due to massive varicose veins in the lower extremities and pulmonary thromboembolism. Compressing the varicosities with an elastic bandage can maintain stable circulatory dynamics even under general anesthesia management to prevent position and insufflation-induced changes that can occur spontaneously.
Collapse
Affiliation(s)
- Satoshi Kamiya
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima, JPN
| | - Takahiro Kato
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima, JPN
| | - Masakazu Yasuuji
- Department of Anesthesiology and Critical Care, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, JPN
| | - Hiroyuki Tanaka
- Department of Anesthesiology and Critical Care, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, JPN
| | - Yasuo M Tsutsumi
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima, JPN
| |
Collapse
|
28
|
Zakai NA, Wilkinson K, Sparks AD, Packer RT, Koh I, Roetker NS, Repp AB, Thomas R, Holmes CE, Cushman M, Plante TB, Al-Samkari H, Pishko AM, Wood WA, Masias C, Gangaraju R, Li A, Garcia D, Wiggins KL, Schaefer JK, Hooper C, Smith NL, McClure LA. Development and validation of a risk model for hospital-acquired venous thrombosis: the Medical Inpatients Thrombosis and Hemostasis study. J Thromb Haemost 2024; 22:503-515. [PMID: 37918635 PMCID: PMC10872863 DOI: 10.1016/j.jtha.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/04/2023] [Accepted: 10/20/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Regulatory organizations recommend assessing hospital-acquired (HA) venous thromboembolism (VTE) risk for medical inpatients. OBJECTIVES To develop and validate a risk assessment model (RAM) for HA-VTE in medical inpatients using objective and assessable risk factors knowable at admission. METHODS The development cohort included people admitted to medical services at the University of Vermont Medical Center (Burlington, Vermont) between 2010 and 2019, and the validation cohorts included people admitted to Hennepin County Medical Center (Minneapolis, Minnesota), University of Michigan Medical Center (Ann Arbor, Michigan), and Harris Health Systems (Houston, Texas). Individuals with VTE at admission, aged <18 years, and admitted for <1 midnight were excluded. We used a Bayesian penalized regression technique to select candidate HA-VTE risk factors for final inclusion in the RAM. RESULTS The development cohort included 60 633 admissions and 227 HA-VTE, and the validation cohorts included 111 269 admissions and 651 HA-VTE. Seven HA-VTE risk factors with t statistics ≥1.5 were included in the RAM: history of VTE, low hemoglobin level, elevated creatinine level, active cancer, hyponatremia, increased red cell distribution width, and malnutrition. The areas under the receiver operating characteristic curve and calibration slope were 0.72 and 1.10, respectively. The areas under the receiver operating characteristic curve and calibration slope were 0.70 and 0.93 at Hennepin County Medical Center, 0.70 and 0.87 at the University of Michigan Medical Center, and 0.71 and 1.00 at Harris Health Systems, respectively. The RAM performed well stratified by age, sex, and race. CONCLUSION We developed and validated a RAM for HA-VTE in medical inpatients. By quantifying risk, clinicians can determine the potential benefits of measures to reduce HA-VTE.
Collapse
Affiliation(s)
- Neil A Zakai
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA; Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA; Department of Medicine, University of Vermont Medical Center, Burlington, Vermont, USA.
| | - Katherine Wilkinson
- Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Andrew D Sparks
- Department of Medical Biostatistics, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Ryan T Packer
- Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Insu Koh
- Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA; SyllogisTeks, Chesterfield, Missouri, USA
| | - Nicholas S Roetker
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
| | - Allen B Repp
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA; Department of Medicine, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Ryan Thomas
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA; Department of Medicine, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Chris E Holmes
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA; Department of Medicine, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA; Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA; Department of Medicine, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Timothy B Plante
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA; Department of Medicine, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Hanny Al-Samkari
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Allyson M Pishko
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - William A Wood
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Camila Masias
- Miami Cancer Institute, Baptist Health South Florida, Coral Gables, Florida, USA
| | - Radhika Gangaraju
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ang Li
- Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - David Garcia
- Division of Hematology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kerri L Wiggins
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Jordan K Schaefer
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Craig Hooper
- Division of Blood Disorders, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nicholas L Smith
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA; Department of Epidemiology, University of Washington, Seattle, Washington, USA; Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Office of Research and Development, Seattle, Washington, USA
| | - Leslie A McClure
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| |
Collapse
|
29
|
Juenger J, Mahlmann A, Udelnow A, Bauersachs R, Braun-Dullaeus RC, Herold J. The Role of Anticoagulants and Platelet Aggregation Inhibitors in the Treatment of Pseudoaneurysms and Risk of Venous Thrombosis. Angiology 2024; 75:156-165. [PMID: 36468771 DOI: 10.1177/00033197221143321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Pseudoaneurysms (PSA) are one of the most common complications after arterial punctures. This retrospective study examined whether platelet aggregation inhibitors (APT) or anticoagulants (AC) lower the success rates of PSA treatment. A total of 468 patients with PSA were retrospectively analyzed between 2010 and 2018, and 238 were included in the study. Despite co-medication with APT or AC, thrombin injection (TI) was superior to compression bandage (CB) therapy in treating PSA (TIwAC 79 vs CBwAC 51%; P = .004 and TIwAPT 93 vs CBwAPT 54%; P = .001). There was no decrease in PSA-associated thrombosis in patients requiring anticoagulation after TI. The success rates of the TI and CB groups were compared in patients with and without AC therapy, and the latter was significantly lower. A reduced success rate was not observed in CB therapy patients requiring APT. In contrast, better results were seen in the TI group. Regarding PSA treatment, TI therapy is significantly superior to CB, including in patients requiring concomitant AC or APT therapy. PSA-associated thrombosis also occurs in patients requiring anticoagulation, and sonography should be performed. Concomitant medication use with APT does not significantly influence PSA therapy success or prevention of PSA-associated thrombosis.
Collapse
Affiliation(s)
- Jonas Juenger
- Department of Vascular Medicine - Angiology, Klinikum Darmstadt, Germany
- Children's Hospital Prinzessin Margaret, Darmstadt, Germany
| | - Adrian Mahlmann
- Center for Vascular Medicine, Clinic of Angiology, St.-Josefs-Hospital, Katholisches Krankenhaus Hagen gem, GmbH, Germany
| | - Andrei Udelnow
- Department of Surgery, Dietrich Bonhoeffer Diakonie Hospital, Neubrandenburg, Germany
| | - Rupert Bauersachs
- Department of Vascular Medicine - Angiology, Klinikum Darmstadt, Germany
| | | | - Joerg Herold
- Department of Vascular Medicine - Angiology, Klinikum Darmstadt, Germany
| |
Collapse
|
30
|
Kawakado K, Tsubata Y, Hotta T, Yamasaki M, Ishikawa N, Fujitaka K, Kubota T, Kobayashi K, Isobe T. Risk Factors for Bleeding Events in Japanese Patients with Advanced Lung Cancer: Data from the Rising-VTE/NEJ037 Study. Cancers (Basel) 2024; 16:301. [PMID: 38254791 PMCID: PMC10814048 DOI: 10.3390/cancers16020301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Despite the occurrence of various hemorrhagic events during advanced lung cancer treatment, few researchers have reported on their risk factors. Moreover, the development of cancer-related thromboembolism indicates anticoagulant use. However, adverse events such as bleeding should be monitored. In this study, we aimed to identify factors that influence the onset of hemorrhagic events in patients with lung cancer. The Rising-VTE/NEJ037 study was a multicenter, prospective, observational study. A total of 1008 patients with lung cancer who were unsuitable for radical resection or radiation were enrolled and followed up for 2 years. Multivariate analysis using a Cox proportional hazard model was performed to compare the outcomes of the time to the onset of hemorrhagic events for 2 years after registration. Hemorrhagic events occurred in 115 patients (11.4%), with 35 (30.4%) experiencing major bleeding. Significant risk factors included venous thromboembolism (VTE) (hazard ratio [HR]: 4.003, p < 0.001) and an Eastern Cooperative Oncology Group Performance Status score of 1 (HR: 2.476, p < 0.001). Factors that significantly reduced hemorrhagic event risk were female sex (HR: 0.454, p = 0.002) and M1a status (HR: 0.542, p = 0.038). VTE is a risk factor for hemorrhagic events in patients with advanced lung cancer, and risks associated with anticoagulant therapy should be considered.
Collapse
Affiliation(s)
- Keita Kawakado
- Department of Internal Medicine, Division of Medical Oncology and Respiratory Medicine, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo 693-8501, Japan; (K.K.); (T.H.); (T.I.)
| | - Yukari Tsubata
- Department of Internal Medicine, Division of Medical Oncology and Respiratory Medicine, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo 693-8501, Japan; (K.K.); (T.H.); (T.I.)
| | - Takamasa Hotta
- Department of Internal Medicine, Division of Medical Oncology and Respiratory Medicine, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo 693-8501, Japan; (K.K.); (T.H.); (T.I.)
| | - Masahiro Yamasaki
- Department of Respiratory Disease, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, 1-9-6, Senda-Machi, Naka-ku, Hiroshima 730-8619, Japan;
| | - Nobuhisa Ishikawa
- Department of Respiratory Medicine, Hiroshima Prefectural Hospital, 1-5-54 Ujina-Kanda, Minami-ku, Hiroshima 734-8530, Japan;
| | - Kazunori Fujitaka
- Department of Respiratory Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan;
| | - Tetsuya Kubota
- Department of Respiratory Medicine and Allergology, Kochi University Hospital, 185-1 Kohasu, Oko-Cho, Nankoku 783-8505, Japan;
| | - Kunihiko Kobayashi
- Department of Respiratory Medicine, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka 350-1298, Japan;
| | - Takeshi Isobe
- Department of Internal Medicine, Division of Medical Oncology and Respiratory Medicine, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo 693-8501, Japan; (K.K.); (T.H.); (T.I.)
| |
Collapse
|
31
|
Scarano M, D'Arrigo S, De Letteriis S, Grasso S, Pittiruti M, Scoppettuolo G. Risk of thrombophlebitis associated with continuous peripheral infusion of vancomycin: The effect of dilution. J Vasc Access 2024; 25:107-112. [PMID: 35608270 DOI: 10.1177/11297298221095778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Although several guidelines recommend that prolonged administration of vancomycin should be preferably carried out by a central venous access, vancomycin is often given peripherally. Whether such risk may be affected by different modalities of administration in terms of dilution and time of infusion, it is a matter of controversy. METHODS This single-center prospective study enrolled all consecutive patients requiring prolonged intravenous infusion of vancomycin (1 g/day) using long peripheral cannula "mini-midline." Patients were randomized in study group (4 mg/ml) and control group (20 mg/ml). All patients were systematically evaluated every 24 h by the Visual Exit-Site Score and a daily ultrasound scan of the veins of the arm. RESULTS The daily ultrasound evaluation showed venous thrombosis at the distal tip of the cannula in all patients, in both groups. After this finding in the first 14 patients, the study was interrupted. All thromboses were completely asymptomatic and occurred in absence of any sign of catheter malfunction. The onset of thrombosis was significantly earlier in the control group (ranging from 24 to 48 h) than in the study group (ranging from 48 to 96 h), with an average of 30 ± 11 versus 68 ± 16 h (p < 0.001). CONCLUSION Continuous intravenous infusion of vancomycin should be preferably delivered by a central venous access, as largely recommended by current guidelines, since peripheral infusion is inevitably associated with venous thrombosis, independently from the type of peripheral venous access device adopted (short peripheral cannula vs long peripheral cannula) and from the extent of dilution.
Collapse
Affiliation(s)
- Marianna Scarano
- Department of Anesthesia and Intensive Care 2 "A. Brienza," A.O.U. Policlinico "Giovanni XXIII," Bari, Italy
| | - Sonia D'Arrigo
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Lazio, Italy
| | - Sestilio De Letteriis
- Department of Anesthesia and Intensive Care 2 "A. Brienza," A.O.U. Policlinico "Giovanni XXIII," Bari, Italy
| | - Salvatore Grasso
- Department of Anesthesia and Intensive Care 2 "A. Brienza," A.O.U. Policlinico "Giovanni XXIII," Bari, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giancarlo Scoppettuolo
- Department of Infective Diseases, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
32
|
Bakas JM, Moelker A, Malskat WSJ, Van Rijn MJE. Exercise Intolerance That Resolved After venous Stenting of the Inferior Vena Cava. Vasc Endovascular Surg 2024; 58:100-104. [PMID: 37403814 PMCID: PMC10644689 DOI: 10.1177/15385744231188801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
Venous stenting could alleviate exercise intolerance associated with chronic inferior vena cava (IVC) obstruction. We describe a 36-year-old male patient with an unknown IVC-obstruction. The obstruction was discovered after a bi-iliac deep vein thrombosis (DVT). The thrombus was resolved using thrombolysis. In the chronic phase, the patient developed exercise intolerance without any leg-specific symptoms or signs. Venous stenting was performed to open the IVC-obstruction, 1 year after the acute DVT. His physical condition improved, but cardiac magnetic resonance imaging at rest did not reveal hemodynamical changes after stenting. The Short Form Health Survey (SF-36) physical and mental component summaries were increased from 40.3 to 46.1 and 42.2 to 53.7, respectively. In patients with iliocaval obstruction, improved venous flow without changes in resting hemodynamics can enhance exercise intolerance and quality of life, even in the absence of leg symptoms. Diagnostic tools performed only at rest may miss abnormalities.
Collapse
Affiliation(s)
- Jay M. Bakas
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Adriaan Moelker
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Wendy S. J. Malskat
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Marie Josee E. Van Rijn
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, Netherlands
| |
Collapse
|
33
|
Jin ZY, Li CM, Zheng K, Qu H, Yang WT, Wen JH, Zhang WD, Ren HL. Nomogram for predicting pulmonary embolism in gynecologic inpatients with isolated distal deep venous thrombosis. Int J Gynaecol Obstet 2024; 164:324-333. [PMID: 37597155 DOI: 10.1002/ijgo.15050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/29/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE To investigate the incidence of isolated distal deep venous thrombosis (IDDVT) concurrent with pulmonary embolism (PE) in gynecologic inpatients, analyze the risk factors for IDDVT with PE, and establish a nomogram model for IDDVT patients with PE. METHODS A total of 260 patients were diagnosed with IDDVT between December 2017 and November 2020. The incidence of PE in these patients was determined using computed tomography pulmonary angiography. Logistic regression analysis was used to identify the related risk factors. On this basis, nomogram risk prediction models were established. RESULTS Among 260 patients with IDDVT, 106 (40.8%) had concurrent PE, of whom 74 (28.5%) experienced silent PE. Univariate logistic analysis demonstrated statistical significance for body mass index (BMI; P = 0.044), glucocorticoid therapy (P = 0.009), hypertension (P < 0.001), and diabetes (P < 0.001). Multivariate logistic analysis revealed that these were independent risk factors for IDDVT with PE that retained statistical significance. A nomogram based on these factors was constructed to predict PE in patients with IDDVT. Its receiver operating characteristic (ROC) showed an area under the curve of 0.710 (95% confidence interval 0.642-0.779), with prediction sensitivity of 64.2% and prediction specificity of 76.6%. CONCLUSIONS In the present study, a high prevalence of PE was found in gynecologic inpatients with IDDVT. Glucocorticoid therapy, hypertension, diabetes, and BMI were independent risk factors for IDDVT patients with PE. Taking these risk factors into account, a nomogram risk prediction model was developed to help facilitate early detection of concurrent PE.
Collapse
Affiliation(s)
- Zhen-Yi Jin
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Chun-Min Li
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Kai Zheng
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hong Qu
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wen-Tao Yang
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jia-Hao Wen
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wang-De Zhang
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hua-Liang Ren
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
34
|
Órfão J, Melo M, Mendes N, Germano A, Soares M, Barbosa L, Freire F. Unilateral vocal fold paralysis as a port complication. J Vasc Access 2024; 25:331-335. [PMID: 35891580 DOI: 10.1177/11297298221113690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Unilateral vocal fold paralysis (UVFP) is a frequent finding in otorhinolaryngology practice, but its occurrence as a port complication was very rarely described in English Literature. The authors report a 55-year-old woman with a pancreatic adenocarcinoma who presented a left vocal fold paralysis that occurred concurrently with a venous thrombosis of the left subclavian vein, where a totally implantable venous-access had been previously placed. Although the patient's oncologic disease, that could mislead to a neoplastic cause of the UVFP, the authors came across with an unusual etiology and to their best knowledge, it is the first case of irreversible UVFP associated with onsite thrombosis of the vessel where a port was implanted. The objective of this article is to present and discuss this rare case of UVFP secondary to a port complication and to review the main mechanisms of iatrogenic vocal fold paralysis related to these devices.
Collapse
Affiliation(s)
- João Órfão
- Department of Otorhinolaryngology, Hospital Prof. Doutor Fernando Fonseca, Lisbon, Portugal
| | - Marta Melo
- Department of Otorhinolaryngology, Hospital Prof. Doutor Fernando Fonseca, Lisbon, Portugal
| | - Nuno Mendes
- Department of Otorhinolaryngology, Hospital Prof. Doutor Fernando Fonseca, Lisbon, Portugal
| | - Ana Germano
- Department of Radiology, Hospital Prof. Doutor Fernando Fonseca, Lisbon, Portugal
| | - Mafalda Soares
- Department of Otorhinolaryngology, Hospital Prof. Doutor Fernando Fonseca, Lisbon, Portugal
| | - Leonel Barbosa
- Department of Otorhinolaryngology, Hospital Prof. Doutor Fernando Fonseca, Lisbon, Portugal
| | - Filipe Freire
- Department of Otorhinolaryngology, Hospital Prof. Doutor Fernando Fonseca, Lisbon, Portugal
| |
Collapse
|
35
|
Mohapatra AK, Todaro AM, Castoldi E. Factor V variants in bleeding and thrombosis. Res Pract Thromb Haemost 2024; 8:102330. [PMID: 38404937 PMCID: PMC10883835 DOI: 10.1016/j.rpth.2024.102330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/04/2024] [Indexed: 02/27/2024] Open
Abstract
A state-of-the-art lecture titled "Factor V variants in bleeding and thrombosis" was presented at the International Society on Thrombosis and Haemostasis (ISTH) congress in 2023. Blood coagulation is a finely regulated cascade of enzymatic reactions culminating in thrombin formation and fibrin deposition at the site of injury. Factor V (FV) plays a central role in this process, as its activated form is an essential procoagulant cofactor in prothrombin activation. However, other molecular forms of FV act as anticoagulant cofactors of activated protein C and tissue factor pathway inhibitor α, respectively, thereby contributing to the regulation of coagulation. This dual procoagulant and anticoagulant character makes FV a central regulator of the hemostatic balance, and quantitative and qualitative alterations of FV may be associated with an increased risk of bleeding or venous thrombosis. Here, we review the procoagulant and anticoagulant functions of FV and the manifold mechanisms by which F5 gene mutations may affect the balance between these opposite functions and thereby predispose individuals to bleeding or venous thrombosis. In particular, we discuss our current understanding of the 3 main pathological conditions related to FV, namely FV deficiency, activated protein C resistance, and the overexpression of FV-short, a minor splicing isoform of FV with tissue factor pathway inhibitor α-dependent anticoagulant properties and an emerging role as a key regulator of the initiation of coagulation. Finally, we summarize relevant new data on this topic presented during the 2023 ISTH Congress.
Collapse
Affiliation(s)
- Adarsh K. Mohapatra
- Department of Biochemistry, CARIM, Maastricht University, Maastricht, the Netherlands
| | - Alice M. Todaro
- Department of Biochemistry, CARIM, Maastricht University, Maastricht, the Netherlands
| | - Elisabetta Castoldi
- Department of Biochemistry, CARIM, Maastricht University, Maastricht, the Netherlands
| |
Collapse
|
36
|
Xu Y, Xu M, Zheng X, Jin F, Meng B. Generation of a Predictive Clinical Model for Isolated Distal Deep Vein Thrombosis (ICMVT) Detection. Med Sci Monit 2023; 29:e942840. [PMID: 38160251 PMCID: PMC10765549 DOI: 10.12659/msm.942840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/02/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Isolated distal deep vein thrombosis (ICMVT) increases the risk of pulmonary embolism. Although predictive models are available, their utility in predicting the risk is unknown. To develop a clinical prediction model for isolated distal calf muscle venous thrombosis, data from 462 patients were used to assess the independent risk variables for ICMVT. MATERIAL AND METHODS The area under curve (AUC) for Model A and Model B were calculated and other risk factors were based on age, pitting edema in the symptomatic leg, calf swelling with least 3 cm larger than the asymptomatic leg, recent bed rest for 3 days or more in the past 4 weeks, requiring general or major surgery with regional anesthesia, sex, and local tenderness distributed along the deep venous system as independent predictors of calf muscle venous thrombosis. Model A includes the risk variables for C-reactive protein and D-dimer. RESULTS The area under ROC curve for Model A training set was 0.924 (95% CI: 0.895-0.952), the area under ROC curve for Model B training set was 0.887 (95% CI: 0.852-0.922), and the AUC difference between the 2 models was statistically significant (P<0.001); the area under ROC curve for Model A obtained in the validation set was 0.902 (95% CI: 0.844-0.961), the area under ROC curve for Model B was 0.842 (95% CI: 0. 0.773-0.910), and the difference between the 2 models was statistically significant (P=0.012). CONCLUSIONS Predictive Model A better predicts isolated calf muscle venous thrombosis and is able to help clinicians rapidly and early diagnose ICMVT, displaying higher utility for missed diagnosis prevention and disease therapy.
Collapse
Affiliation(s)
- Yan Xu
- Department of Ultrasound, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang, PR China
| | - Mingmin Xu
- Department of Ultrasound, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang, PR China
| | - Xiaofang Zheng
- Department of Ultrasound, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang, PR China
| | - Fengxia Jin
- Department of Ultrasound, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang, PR China
| | - Bin Meng
- Department of Ultrasound, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang, PR China
| |
Collapse
|
37
|
Tian L, Zhu J, Li X, Huang L, Tian L. Preoperative Systemic Immune-Inflammatory Index as a Predictive Biomarker for Lower Extremity Deep Vein Thrombosis after Breast Cancer Surgery: Stratified Nursing Intervention to Reduce Incidence. Med Sci Monit 2023; 29:e942087. [PMID: 38104239 PMCID: PMC10734205 DOI: 10.12659/msm.942087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/13/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Lower extremity deep vein thrombosis (LEDVT), a common postoperative breast cancer complication, depends on multiple factors, such as systemic inflammation and immune status. We assessed the preoperative systemic immune-inflammatory index (SII) as a LEDVT risk predictor and did stratified nursing intervention based on it. MATERIAL AND METHODS A retrospective analysis was conducted on 552 patients who underwent breast cancer surgery from January 2019 to May 2020. Univariate and multivariate methods were used to screen independent risk factors for postoperative LEDVT, and effects of risk stratification and nursing intervention on the validation cohort were observed. RESULTS A total of 46 patients (8.3%) developed postoperative LEDVT. Compared with the control group, the LEDVT group had older age, higher proportion of menopause, higher preoperative Autar score, SII, and plasma D-dimer level, lower albumin level, and later postoperative pathological stage, with statistically significant differences (P<0.05). Multivariate logistic regression showed SII, plasma D-dimer, and menopause were independent predictors of postoperative LEDVT. ROC curve analysis showed SII had the strongest predictive ability, with an AUC of 0.714. Subsequently, 126 patients in the validation set were stratified according to the preoperative SII score, and intensified nursing intervention was implemented for high-risk patients, resulting in a significant reduction in the incidence of LEDVT (3.3% vs 8.3%, P=0.046). CONCLUSIONS Preoperative SII level can be used as an independent risk predictor of postoperative LEDVT in breast cancer patients. Applying it for risk stratification and implementing intensified nursing intervention for high-risk patients can significantly reduce the incidence of postoperative LEDVT.
Collapse
Affiliation(s)
- Lu Tian
- The Third Central Clinical College of Tianjin Medical University, Tianjin, PR
China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, PR
China
- Artificial Cell Engineering Technology Research Center, Tianjin, PR
China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, PR
China
- Third Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, PR
China
| | - Jun Zhu
- Third Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, PR
China
| | - Xia Li
- Third Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, PR
China
| | - Lei Huang
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, PR
China
- Artificial Cell Engineering Technology Research Center, Tianjin, PR
China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, PR
China
- Heart Center, Tianjin Third Central Hospital, Tianjin, PR
China
| | - Li Tian
- The Third Central Clinical College of Tianjin Medical University, Tianjin, PR
China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, PR
China
- Artificial Cell Engineering Technology Research Center, Tianjin, PR
China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, PR
China
- Department of Nursing, The Third Central Hospital of Tianjin, Tianjin, PR
China
| |
Collapse
|
38
|
Qin D, Cai H, Liu Q, Lu T, Tang Z, Shang Y, Cui Y, Wang R. Nomogram model combined thrombelastography for venous thromboembolism risk in patients undergoing lung cancer surgery. Front Physiol 2023; 14:1242132. [PMID: 38162832 PMCID: PMC10757630 DOI: 10.3389/fphys.2023.1242132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 12/01/2023] [Indexed: 01/03/2024] Open
Abstract
Background: The aim of this study was to develop a nomogram model in combination with thromboelastography (TEG) to predict the development of venous thromboembolism (VTE) after lung cancer surgery. Methods: The data of 502 patients who underwent surgical treatment for lung cancer from December 2020 to December 2022 were retrospectively analyzed. Patients were then randomized into training and validation groups. Univariate and multivariate logistic regression analyses were carried out in the training group and independent risk factors were included in the nomogram to construct risk prediction models. The predictive capability of the model was assessed by the consistency index (C-index), receiver operating characteristic curves (ROC), the calibration plot and decision curve analysis (DCA). Results: The nomogram risk prediction model comprised of the following five independent risk factors: age, operation time, forced expiratory volume in one second and postoperative TEG parameters k value(K) and reaction time(R). The nomogram model demonstrated better predictive power than the modified Caprini model, with the C-index being greater. The calibration curve verified the consistency of nomogram between the two groups. Furthermore, DCA demonstrated the clinical value and potential for practical application of the nomogram. Conclusion: This study is the first to combine TEG and clinical risk factors to construct a nomogram to predict the occurrence of VTE in patients after lung cancer surgery. This model provides a simple and user-friendly method to assess the probability of VTE in postoperative lung cancer patients, enabling clinicians to develop individualized preventive anticoagulation strategies to reduce the incidence of such complications.
Collapse
Affiliation(s)
- Da Qin
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, China
- Organ Transplantation Center, The First Hospital of Jilin University, Changchun, China
| | - Hongfei Cai
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, China
| | - Qing Liu
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, China
| | - Tianyu Lu
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, China
| | - Ze Tang
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, China
| | - Yuhang Shang
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, China
| | - Youbin Cui
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, China
- Organ Transplantation Center, The First Hospital of Jilin University, Changchun, China
| | - Rui Wang
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, China
- Organ Transplantation Center, The First Hospital of Jilin University, Changchun, China
| |
Collapse
|
39
|
Zhang J, Chen J, Yang X, Han J, Chen X, Fan Y, Zheng H. Novel risk prediction models, involving coagulation, thromboelastography, stress response, and immune function indicators, for deep vein thrombosis after radical resection of cervical cancer and ovarian cancer. J OBSTET GYNAECOL 2023; 43:2204162. [PMID: 37089113 DOI: 10.1080/01443615.2023.2204162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
This study aimed to investigate the predictive value of coagulation, thromboelastography, stress response, and immune function indicators for the occurrence of deep venous thrombosis (DVT) following radical resection of cervical cancer and ovarian cancer. We conducted a prospective, single-centre, case-control study that included 230 cervical cancer patients and 230 ovarian cancer patients. In the testing cohort, the final predictive model for cervical cancer patients was: Logit(P)=9.365-0.063(R-value)-0.112(K value) +0.386(α angle)+0.415(MA)+0.276(FIB)+0.423(D-D)+0.195(IL-6)+0.092(SOD). For ovarian cancer patients, the final model was: Logit(P)= -2.846-0.036(R-value)-0.157(K value) +0.426(α angle) +0.172(MA) +0.221(FIB)+0.375(CRP) -0.126(CD4+/CD8+). In the validation cohort, these models exhibited good predictive efficiency, with a false-positive rate of 12.5% and a false-negative rate of 2.9% for cervical cancer patients, and a false-positive rate of 14.3% and a false-negative rate of 0% for ovarian cancer patients. In conclusion, the risk prediction models developed in this study effectively improve the predictive accuracy of DVT following radical resection of cervical and ovarian cancer.
Collapse
Affiliation(s)
- Jing Zhang
- Department of Gynaecology and Obstetrics, JiangSu XiangShui Hospital of Chinese Medicine, XiangShui, China
| | - Jia Chen
- Department of Gynaecology and Obstetrics, JiangSu XiangShui Hospital of Chinese Medicine, XiangShui, China
- School of Medicine, Nantong University, Nantong, China
| | - Xiuqing Yang
- Department of Gynaecology and Obstetrics, JiangSu XiangShui Hospital of Chinese Medicine, XiangShui, China
| | - Jing Han
- Department of Gynaecology and Obstetrics, JiangSu XiangShui Hospital of Chinese Medicine, XiangShui, China
| | - Xiaofeng Chen
- Department of Gynaecology and Obstetrics, JiangSu XiangShui Hospital of Chinese Medicine, XiangShui, China
| | - Yueping Fan
- Department of Gynaecology and Obstetrics, JiangSu XiangShui Hospital of Chinese Medicine, XiangShui, China
| | - Hui Zheng
- Department of Gynaecology and Obstetrics, JiangSu XiangShui Hospital of Chinese Medicine, XiangShui, China
| |
Collapse
|
40
|
Lee Cervi A, Applegate D, Stevens SM, Woller SC, Baumann Kreuziger LM, Punchhalapalli K, Wang TF, Lecumberri R, Greco K, Bai Y, Bolger S, Fontyn S, Schulman S, Foster G, Douketis JD. Antithrombotic management of patients with deep vein thrombosis and venous stents: an international registry. J Thromb Haemost 2023; 21:3581-3588. [PMID: 37739038 DOI: 10.1016/j.jtha.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/31/2023] [Accepted: 09/10/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND In patients with acute deep vein thrombosis (DVT) treated with catheter-based thrombolysis and venous stenting, poststenting anticoagulant management is uncertain. OBJECTIVES To determine the type and duration of antithrombotic therapy used in patients who have received venous stents for treatment of acute lower extremity DVT. METHODS We created an international registry of patients with leg DVT from 2005 to 2019 who received venous stents as part of their acute management. We collected data on baseline clinical characteristics and pre-venous and post-venous stent antithrombotic therapy. RESULTS We studied 173 patients with venous stents: 101 (58%) were aged ≤50 years, 105 (61%) were female, and 128 (74%) had risk factors for thrombotic disease. DVT was iliofemoral in 150 (87%) patients, and catheter-based treatment was given within 7 days of diagnosis in 92 (53%) patients. After venous stenting, 109 (63%) patients received anticoagulant-only therapy with a direct oral anticoagulant (29%), warfarin (22%), or low-molecular-weight heparin (10%), and 59 (34%) received anticoagulant-antiplatelet therapy. In patients taking anticoagulant-only therapy, 29% received indefinite treatment; in patients on anticoagulant-antiplatelet therapy, 19% received indefinite treatment. Factors associated with combined anticoagulant-antiplatelet therapy vs anticoagulant-only therapy were use of thrombolytic, thrombectomy, and aspiration interventions (odds ratio [OR], 5.11; 95% CI, 1.45-18.05); use of balloon angioplasty (OR, 2.62; 95% CI, 1.20-5.76); and immediate stent restenosis (OR, 7.2; 95% CI, 1.45-5.89). CONCLUSION Anticoagulant therapy without concomitant antiplatelet therapy appears to be the most common antithrombotic strategy in patients with DVT and venous stenting. More research is needed to determine outcomes of venous stenting in relation to antithrombotic therapy.
Collapse
Affiliation(s)
- Andrea Lee Cervi
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Scott M Stevens
- Intermountain Healthcare, Murray, Utah, USA; University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Scott C Woller
- Intermountain Healthcare, Murray, Utah, USA; University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Lisa M Baumann Kreuziger
- Blood Research Institute, Versiti, Milwaukee, Wisconsin, USA; Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Tzu-Fei Wang
- Department of Medicine, University of Ottawa at The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Ramon Lecumberri
- Hematology Service, University Clinic of Navarra, Pamplona, Spain
| | - Kaity Greco
- Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Yuxin Bai
- Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Samantha Bolger
- Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Stephanie Fontyn
- Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Sam Schulman
- Department of Medicine, Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada; Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russian Federation
| | - Gary Foster
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Biostatistics Unit, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | | |
Collapse
|
41
|
Nie Y, Lu N, Liao L, Liu Z, Gu A, Huang X, Tie C, Liu H, Huang Z, Xie G. Black-Blood Magnetization Prepared 2 Rapid Acquisition Gradient Echoes: A Fast and Three-Dimensional MR Black-Blood T 1 Mapping Technique for Quantitative Assessment of Atherosclerosis and Venous Thrombosis. J Magn Reson Imaging 2023. [PMID: 38009385 DOI: 10.1002/jmri.29156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Blood flow signals may be a confounder in quantifying T1 values of plaque or thrombus and how to realize black-blood T1 mapping remains a challenge task. PURPOSE To develop a fast and three-dimensional black-blood T1 mapping technique for quantitative assessment of atherosclerosis and venous thrombosis. STUDY TYPE Sequence development and optimization via phantoms and volunteers as well as pilot prospective. PHANTOM AND SUBJECTS Numerical simulations, a standard phantom, 8 healthy volunteers (mean age, 22 ± 1 years; 5 males), and 19 patients (mean age, 57 ± 14 years; 13 males) with atherosclerosis or venous thrombosis. FIELD STRENGTH/SEQUENCE 3T/inversion recovery spin-echo sequence (IR-SE), magnetization prepared 2 rapid acquisition gradient echoes (MP2RAGE), and black-blood prepared MP2RAGE (BB-MP2RAGE). ASSESSMENT The black-blood preparation (i.e., delay alternating with nutation for tailored excitation, DANTE) was incorporated into MP2RAGE for black-blood T1 mapping. The BB-MP2RAGE was optimized numerically based on the Bloch equation, and then the phantom study was performed to verify the accuracy of T1 mapping by BB-MP2RAGE against IR-SE and MP2RAGE. Preliminary clinical validation was prospectively performed to assess the flow suppression effect and its potential application in plaque and thrombosis identification. STATISTICAL TESTS Pearson correlation test, Bland-Altman analysis, paired t-test, and intraclass correlation coefficient. A P value <0.05 indicates a statistically significant difference. RESULTS Phantom experiments showed comparable accuracy of T1 maps by BB-MP2RAGE with IR-SE and MP2RAGE (all r2 > 0.99); Compared to MP2RAGE, BB-MP2RAGE effectively nulled the blood flow signals, and had a significant improvement in contrast-to-noise ratio between static tissue and blood (250.5 ± 66.6 vs. 91.9 ± 35.9). BB-MP2RAGE can quantify plaque or thrombus T1 relaxation time with blood flow signal suppression. DATA CONCLUSION Accurate T1 mapping with sufficient blood flow suppression was achieved by BB-MP2RAGE. BB-MP2RAGE has the potential to quantitatively characterize atherosclerosis and venous thrombosis. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 1.
Collapse
Affiliation(s)
- Yuhui Nie
- School of Biomedical Engineering, The Sixth Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Na Lu
- School of Biomedical Engineering, The Sixth Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Liping Liao
- Department of Radiology, The First People's Hospital of Qinzhou, Qinzhou, China
| | - Zeping Liu
- School of Biomedical Engineering, The Sixth Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Anyan Gu
- School of Biomedical Engineering, The Sixth Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xin Huang
- School of Biomedical Engineering, The Sixth Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Changjun Tie
- Paul C. Lauterbur Imaging Center, Shenzhen Institutes Advanced Technology, Shenzhen, Guangdong, China
| | - Hongyan Liu
- School of Biomedical Engineering, The Sixth Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zehe Huang
- Department of Radiology, The First People's Hospital of Qinzhou, Qinzhou, China
| | - Guoxi Xie
- School of Biomedical Engineering, The Sixth Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| |
Collapse
|
42
|
Ma YH, Yang Y, Li JH, Yao BC, Chen QL, Wang LQ, Guo ZG, Guo SZ. NDUFB11 and NDUFS3 regulate arterial atherosclerosis and venous thrombosis: Potential markers of atherosclerosis and venous thrombosis. Medicine (Baltimore) 2023; 102:e36133. [PMID: 37986300 PMCID: PMC10659644 DOI: 10.1097/md.0000000000036133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/24/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023] Open
Abstract
Atherosclerosis is a chronic disease that thickens the blood vessel walls and narrows the lumen. Venous thrombosis is a blood clot that forms in the body's deep veins or pulmonary arteries. However, the relationship between NDUFB11 and NDUFS3 and atherosclerosis and venous thrombosis is unclear. We employed data files that combined atherosclerosis and chronic stress groups. Subsequently, we conducted differential gene expression analysis (DEGs) and performed weighted gene co-expression network analysis (WGCNA). We constructed and analyzed a protein-protein interaction (PPI) network. Further analyses included functional enrichment analysis, gene set enrichment analysis (GSEA), gene expression heatmaps, immune infiltration analysis, and mRNA analysis. By comparing our findings with the Comparative Toxicogenomics Database (CTD), we identified the most relevant diseases associated with the core genes. Additionally, we utilized TargetScan to screen for miRNAs regulating the central DEGs. To validate our results, we conducted Western Blot experiments at the cellular level. A total of 1747 DEGs were co-identified. According to the Gene Ontology (GO) analysis of differentially expressed genes, they were primarily enriched in mitochondrial gene expression, mitochondrial envelope, organelle membrane, and mitochondrial inner membrane categories. Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis revealed that the target cells were mainly enriched in metabolic pathways, ribosomes, and histidine metabolism. The intersection of enriched terms from both GO and KEGG analyses showed significant enrichment in mitochondrial gene expression, mitochondrial envelope, organelle inner membrane, ribosomal structural constituents, histidine metabolism, and oxidative phosphorylation. Eight core genes were identified, including NDUFS5, UQCRQ, COX6C, COX7B, ATP5ME, NDUFS3, NDUFA3, and NDUFB11. The gene expression heatmap demonstrated that core genes (NDUFB11 and NDUFS3) were downregulated in atherosclerosis with venous thrombosis samples and upregulated in normal samples. CTD analysis revealed that the core genes NDUFB11 and NDUFS3 were associated with pain, arterial diseases, atherosclerosis, arteritis, venous thrombosis formation, and venous thromboembolism. We added Western Blot basic cell experiment for verification. NDUFB11 and NDUFS3 are downregulated in atherosclerosis and venous thrombosis, associated with poorer prognosis, and may serve as potential biomarkers for both diseases.
Collapse
Affiliation(s)
- Yan-Hong Ma
- Department of ICU, The Fourth Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Yin Yang
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, PR China
| | - Jing-Hui Li
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, PR China
| | - Bo-Chen Yao
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, PR China
| | - Qing-Liang Chen
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, PR China
| | - Lian-Qun Wang
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, PR China
| | - Zhi-Gang Guo
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, PR China
| | - Su-Zhi Guo
- Department of ICU, The Fourth Hospital of Hebei Medical University, Shijiazhuang, PR China
| |
Collapse
|
43
|
Song JH, Chun KC, Han GH, Yang SW, Yoon SH, Yuk JS, Ahn J, Nam SH, Kim J, Kim M. Case Report: Upper limb superficial venous thrombosis associated with oral contraceptives mimicking soft tissue mass. Front Cardiovasc Med 2023; 10:1263662. [PMID: 38028493 PMCID: PMC10679400 DOI: 10.3389/fcvm.2023.1263662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background Venous thrombosis associated with the use of oral contraceptives (OCs) occurs mostly in the deep veins of the lower extremity. A lesion of the upper extremity is rare, and the majority of thrombotic events that occur in the superficial vein of the upper extremity are caused by intravenous catheters. We present a rare case of superficial venous thrombus on the upper extremity in a woman with a history of long-term OC use. Case presentation A 35-year-old woman, with an 8-year history of OC use, presented with a 2-year history of painfully palpable masses on her left forearm. The lesion mimicking soft tissue mass was confirmed to be superficial venous thrombi through ultrasound and magnetic resonance imaging. Conservative treatment including non-steroidal anti-inflammatory drugs, vasoprotective agents, and aspirin was prescribed. Through consultation with the Department of Obstetrics and Gynecology, it was confirmed that the current OCs could be discontinued, and the pain was almost relieved after conservative treatment. Conclusions If thrombotic events occur in the superficial vein of the upper extremity without intravenous catheters, detailed medical history taking and the possibility of OCs should be considered.
Collapse
Affiliation(s)
- Jun Hyeong Song
- Department of Rehabilitation Medicine, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
| | - Kyoung-Chul Chun
- Department of Obstetrics and Gynecology, Inje University College of Medicine, Ilsan-Paik Hospital, Gyeonggi, Republic of Korea
| | - Gwan Hee Han
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
| | - Seung-Woo Yang
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
| | - Sang-Hee Yoon
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
| | - Jin-Sung Yuk
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
| | - Jaeki Ahn
- Department of Rehabilitation Medicine, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
| | - Sang Hyun Nam
- Department of Plastic Surgery, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
| | - Jongwoo Kim
- Department of Family Medicine, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
| | - Myounghwan Kim
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
| |
Collapse
|
44
|
Herron C, McGovern E, Shahanavaz S. Use of mechanical thrombectomy in very early-onset inflammatory bowel disease patient with extensive venous thrombosis. Cardiol Young 2023; 33:2405-2407. [PMID: 37317799 DOI: 10.1017/s1047951123001506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Mechanical thrombectomy is generally used in adult patients with pulmonary embolism or extensive venous thromboembolism, but it is starting to become more prevalent in the children. We present a unique case of a 3-year-old female with very early-onset inflammatory bowel disease with extensive venous thromboembolism who underwent successful mechanical thrombectomy.
Collapse
Affiliation(s)
- Christopher Herron
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
- Division of Cardiology The Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Eimear McGovern
- Division of Pediatric Cardiology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Shabana Shahanavaz
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
- Division of Cardiology The Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH, USA
| |
Collapse
|
45
|
Nakaya Y, Hayashi K, Suzuki A, Sato M. Hepatic Cyst and Thrombus in the Inferior Vena Cava. Intern Med 2023; 62:3257. [PMID: 36858517 PMCID: PMC10686724 DOI: 10.2169/internalmedicine.1588-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/20/2023] [Indexed: 03/03/2023] Open
Affiliation(s)
- Yuka Nakaya
- Department of Rehabilitation Medicine, Fukui General Hospital, Japan
| | - Koji Hayashi
- Department of Rehabilitation Medicine, Fukui General Hospital, Japan
| | - Asuka Suzuki
- Department of Rehabilitation Medicine, Fukui General Hospital, Japan
| | - Mamiko Sato
- Department of Rehabilitation Medicine, Fukui General Hospital, Japan
| |
Collapse
|
46
|
Gris JC, Nikolaeva MG, Khizroeva J, Bitsadze V, Makatsariya A, Ripart S, Perez-Martin A. Is intimate partner abuse underestimated as a precipitating factor for venous thromboembolism in women? J Thromb Haemost 2023; 21:3203-3206. [PMID: 37598883 DOI: 10.1016/j.jtha.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/26/2023] [Accepted: 08/05/2023] [Indexed: 08/22/2023]
Abstract
Major and minor trauma increase the risk of venous thromboembolism (VTE), but violence against young women is not reported as a precipitating factor for thrombosis. Here, we report 20 cases of first VTE events in women of childbearing age after evidence of intimate partner violence. Other risk factors for VTE were often associated. In most cases, women did not report this state of violence at the first consultation and their doctors did not suspect it. We imagine that it is an underdiagnosed situation and should call for a systematic evaluation. Screening for intimate partner abuse could have significant consequences, both on protecting women who are affected by it and better evaluating the risk of bleeding with anticoagulant treatment in this situation.
Collapse
Affiliation(s)
- Jean-Christophe Gris
- Department of Haematology, CHU Nîmes, Univ Montpellier, Nîmes, France; Faculty of Pharmaceutical and Biological Sciences, Montpellier University, Montpellier, France; UMR UA11 INSERM IDESP - Montpellier University, Montpellier, France; Department of Obstetrics and Gynaecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
| | | | - Jamilya Khizroeva
- Department of Obstetrics and Gynaecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Victoria Bitsadze
- Department of Obstetrics and Gynaecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Alexander Makatsariya
- Department of Obstetrics and Gynaecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Sylvie Ripart
- Department of Obstetrics and Gynaecology, CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Antonia Perez-Martin
- UMR UA11 INSERM IDESP - Montpellier University, Montpellier, France; Department of Vascular Medicine, CHU Nîmes, Univ Montpellier, Nîmes, France
| |
Collapse
|
47
|
Rocha D, Lobato CT, Melo Pinto D, Marques F, Marques T, Guedes C. Venous Thromboembolism Prophylaxis in Medical and Surgical Patients - What's Our Reality? Cureus 2023; 15:e49444. [PMID: 38149162 PMCID: PMC10750990 DOI: 10.7759/cureus.49444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2023] [Indexed: 12/28/2023] Open
Abstract
INTRODUCTION Venous thromboembolism (VTE) includes pulmonary embolism (PE), deep vein thrombosis (DVT) in lower limbs, and thrombosis in rare locations. VTE is a common cardiovascular disease, being the leading preventable cause of in-hospital death. Both surgical and acute medical patients have an elevated risk of developing VTE. VTE risk assessment is essential to identify patients who might benefit from VTE prophylaxis accurately. Clinical data on risk factors and prophylaxis in Portugal are scarce. We aimed to determine the proportion of at-risk patients who received prophylaxis and the incidence of bleeding events. We also intended to study the rate of VTE in a cohort of medical and surgical patients during the hospitalization period and three months after discharge. METHODS During one week in 2020, adults admitted for more than 72hr to a medical or surgical ward were included. The study excluded patients with a diagnosis of VTE three months before hospitalization and who were either chronically receiving anticoagulation therapy or had started it 48 hours after admission. Risk assessments were based on the Padua Prediction Score (PPS) for medical patients and the Caprini Risk Assessment Model (CRAM) for surgical patients. We used CHEST guidelines, 9th edition, to determine the adequacy of the prophylactic method. RESULTS A total of 123 patients were analyzed, 18.7% of which tested positive for SARS-CoV-2. VTE risk in surgical patients was categorized as very low or low (16.6%), moderate (37.5%), and high (43.8%), according to the CRAM. Risk in medical patients was categorized as low (60.0%) or high (40.0%) according to the PPS. We estimated that VTE chemoprophylaxis was overused in about 30.0% of patients vs. 7.0% who were at risk and did not receive appropriate chemoprophylaxis. The rate of thromboembolic events was 4.1% (n=5), 2 of which happened after discharge. Two of these patients were under VTE prophylaxis during hospitalization. Major bleeding occurred in 2.4% of patients (n=3). DISCUSSION A significant number of hospitalized patients are deemed to be at risk for VTE, making appropriate prophylaxis essential. The results emphasize the insufficient management of VTE prophylaxis.
Collapse
Affiliation(s)
- Diana Rocha
- Internal Medicine, Hospital Pedro Hispano, Matosinhos, PRT
| | | | | | | | | | | |
Collapse
|
48
|
Henke PK, Nicklas JM, Obi A. Immune cell-mediated venous thrombus resolution. Res Pract Thromb Haemost 2023; 7:102268. [PMID: 38193054 PMCID: PMC10772895 DOI: 10.1016/j.rpth.2023.102268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/23/2023] [Accepted: 11/07/2023] [Indexed: 01/10/2024] Open
Abstract
Herein, we review the current processes that govern experimental deep vein thrombus (DVT) resolution. How the human DVT resolves at the molecular and cellular level is not well known due to limited specimen availability. Experimentally, the thrombus resolution resembles wound healing, with early neutrophil-mediated actions followed by monocyte/macrophage-mediated events, including neovascularization, fibrinolysis, and eventually collagen replacement. Potential therapeutic targets are described, and coupling with site-directed approaches to mitigate off-target effects is the long-term goal. Similarly, timing of adjunctive agents to accelerate DVT resolution is an area that is only starting to be considered. There is much critical research that is needed in this area.
Collapse
Affiliation(s)
- Peter K. Henke
- Department of Surgery, University of Michigan Health System, Frankel Cardiovascular Center, Ann Arbor, Michigan, USA
| | - John M. Nicklas
- Department of Medicine, Brown University Medical School, Providence, Rhode Island, USA
| | - Andrea Obi
- Department of Surgery, University of Michigan Health System, Frankel Cardiovascular Center, Ann Arbor, Michigan, USA
| |
Collapse
|
49
|
Beleva EA. Splanchnic Vein Thrombosis in Myelofibrosis-An Underappreciated Hallmark of Disease Phenotype. Int J Mol Sci 2023; 24:15717. [PMID: 37958701 PMCID: PMC10649007 DOI: 10.3390/ijms242115717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
Splanchnic vein thrombosis (SVT) encompasses thrombosis in the vessels of the splanchnic basin and has a relatively rare occurrence with a reported frequency in the general population of 1-2%. An episode of seemingly unprovoked SVT almost always triggers a diagnostic work-up for a Philadelphia chromosome-negative myeloproliferative neoplasm (MPN), since atypical site thrombosis is a hallmark of MPN-associated thrombophilia. Primary myelofibrosis (PMF) is a rare MPN with an estimated incidence between 0.1 and 1/100,000 per year. Although prothrombotic tendency in PMF is not envisioned as a subject of specific therapeutic management, unlike other MPNs, such as polycythemia vera (PV) and essential thrombocythemia (ET), thrombotic risk and SVT prevalence in PMF may be comparably high. Additionally, unlike PV and ET, SVT development in PMF may depend more on procoagulant mechanisms involving endothelium than on blood cell activation. Emerging results from registry data also suggest that PMF patients with SVT may exhibit lower risk and better prognosis, thus highlighting the need for better thrombotic risk stratification and identifying a subset of patients with potential benefit from antithrombotic prophylaxis. This review highlights specific epidemiological, pathogenetic, and clinical features pertinent to SVT in myelofibrosis.
Collapse
Affiliation(s)
- Elina A. Beleva
- Clinic of Hematology, Military Medical Academy, 1606 Sofia, Bulgaria;
- QSAR and Molecular Modelling, Institute of Biophysics and Biomedical Engineering, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria
| |
Collapse
|
50
|
Hisada Y, Archibald SJ, Bansal K, Chen Y, Dai C, Dwarampudi S, Balas N, Hageman L, Key NS, Bhatia S, Bhatia R, Mackman N, Gangaraju R. Biomarkers of bleeding and venous thromboembolism in patients with acute leukemia. medRxiv 2023:2023.10.18.23297216. [PMID: 37905148 PMCID: PMC10615001 DOI: 10.1101/2023.10.18.23297216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Background Coagulopathy and associated bleeding and venous thromboembolism (VTE) are major causes of morbidity and mortality in patients with acute leukemia. The underlying mechanisms of these complications have not been fully elucidated. Objectives To evaluate the associations between biomarker levels and bleeding and VTE in acute leukemia patients. Patients/Method We examined plasma levels of activators, inhibitors and biomarkers of the coagulation and fibrinolytic pathways in patients ≥18 years with newly diagnosed acute leukemia compared to healthy controls. Multivariable regression models were used to examine the association of biomarkers with bleeding and VTE in acute leukemia patients. The study included 358 patients with acute leukemia (29 acute promyelocytic leukemia [APL], 253 non-APL acute myeloid leukemia [AML] and 76 acute lymphoblastic leukemia [ALL]), and 30 healthy controls. Results Patients with acute leukemia had higher levels of extracellular vesicle (EV) tissue factor (TF) activity, phosphatidylserine-positive EVs, plasminogen activator inhibitor-1 (PAI-1), plasmin-antiplasmin complexes, cell-free DNA and lower levels of citrullinated histone H3-DNA complexes compared to healthy controls. APL patients had the highest levels of EVTF activity and the lowest levels of tissue plasminogen activator among the acute leukemia patients. There were 41 bleeding and 37 VTE events in acute leukemia patients. High EVTF activity was associated with increased risk of bleeding (sHR 2.30, 95%CI 0.99-5.31) whereas high PAI-1 was associated with increased risk of VTE (sHR 3.79, 95%CI 1.40-10.28) in these patients. Conclusions Our study shows alterations in several biomarkers in acute leukemia and identifies biomarkers associated with risk of bleeding and VTE.
Collapse
Affiliation(s)
- Yohei Hisada
- UNC Blood Research Center, Division of Hematology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Sierra J. Archibald
- UNC Blood Research Center, Division of Hematology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Karan Bansal
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Yanjun Chen
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Chen Dai
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Sindhu Dwarampudi
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Nora Balas
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Lindsey Hageman
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Nigel S. Key
- UNC Blood Research Center, Division of Hematology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Ravi Bhatia
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Nigel Mackman
- UNC Blood Research Center, Division of Hematology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Radhika Gangaraju
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, USA
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, USA
| |
Collapse
|