Abstract
Venous thromboembolism (VTE), consisting of deep vein thrombosis (DVT) and pulmonary embolism (PE), requires a forensic age determination to ascertain their causal relationship with recent events, such as trauma or medical treatment. The main objective of this systematic review is to identify the current state-of-the-art immunohistochemical methods for age determination of fatal VTE. A literature search was performed through different databases, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Within the study, we have selected only cases represented by deceased patients for DVT and/or PTE in which thromboembolic material was collected during an autoptic examination and then subjected to a histological and an immunohistochemical investigation. Studies based on animal models were not included. We assessed bias risk. A database-based search produced a total of 19 articles. After excluding duplicate items from the selection, 14 articles were reviewed. Ten articles were excluded because they did not meet the inclusion criteria. The results have pointed out 4 studies that were included in the present analysis for a total of 157 samples of DVT and 171 PTE samples. These were analyzed using traditional histological and immunohistochemical techniques. The results must be interpreted with a critical eye because of their heterogeneity in terms of time, geography, and study design. The present review highlights the importance of associating specific immunohistochemical markers with a histological analysis for the timing of DVT/PTE fatal events. Further future experiences will hopefully endorse actual knowledge on the subject to increase the accuracy in the assessment of thrombus-embolus age.
Highlights
Venous thromboembolism (VTE) consists of two clinical conditions: deep vein thrombosis (DVT) and pulmonary embolism (PE)
Venous thromboembolism (VTE), consisting of deep vein thrombosis (DVT) and pulmonary embolism (PE), requires a forensic age determination to ascertain their causal relationship with recent events, such as trauma or medical treatment
We have selected only cases represented by deceased patients for DVT and/or pulmonary arterial thromboembolism (PTE) in which thromboembolic material was collected during an autoptic examination and subjected to a histological and an immunohistochemical investigation
Summary
Venous thromboembolism (VTE) consists of two clinical conditions: deep vein thrombosis (DVT) and pulmonary embolism (PE). They certainly share the same pathogenesis, but the way they develop may vary from clinically silent, to massive embolism causing death [1,2]. Since PE is, in most cases, the consequence of DVT, most of the existing data on its epidemiology, risk factors, and natural history are derived from studies that have examined VTE as a whole [3,4]. VTE is the third most frequent cardiovascular disease with a total annual incidence ranging from 104 to 183 cases per 100,000 population [4,5,8]. The incidence increases with age in both sexes and is higher in men (130 cases per 100,000 population) than in women (110 cases per 100,000 population)
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