Artery Thrombosis In Patient Research Articles

C-reactive protein to albumin ratio and radial artery thrombosis post transradial angiography.

Aim: The aim is to evaluate the relationship between C-reactive protein (CRP) to albumin ratio (CAR) and radial artery thrombosis in patients undergoing radial angiography. Patients & methods: We prospectively included 261 consecutive patients undergoing radial angiography, assessing radial artery diameter and thrombosis presence. Results: The CRP values were significantly higher in radial artery thrombosis group compared with group without thrombosis (13.01 vs. 4.33mg/l, p<0.001, respectively). Also CAR was statistically significantly different between the group with thrombosis and the group without thrombosis (0.102 vs. 0.349, p<0.001). Conclusion: Our study is the first to assess CAR in radial thrombus development post-procedure in patients undergoing radial angiography. CAR can be useful in determining radial artery thrombosis after the coronary angiography.

Left middle cerebral artery and sigmoid sinuses thrombosis in a female patient with Crohn's disease

Introduction: Neurologic manifestations in patients with inflammatory bowel disease (IBD) appear to be more common than in the past. However, vascular events in IBD are still a rare presentation and were reported in few cases. Case presentation: A 48-year-old female patient known case of Crohn’s disease presented with sudden onset aphasia, headache, blurring of vision, and decreased level of consciousness for 2 hours. The patient looked ill, confused, agitated, and aphasic. Neurologic examination shows dysarthria and 0/5 power of the right upper and lower extremity. A brain CT without contrast was ordered and showed acute ischemic stroke. The patient received tPA (alteplase) immediately in the intensive care unit and was under observation. On admission, brain CT angiography, MRI, and MRV were performed, which showed middle cerebral artery and sigmoid sinuses thrombosis. The patient has undergone cerebral catheterization, and an MCA stent was inserted. Post catheterization, the patient’s right-sided extremity power was improved to 3/5. She was discharged from the hospital after 13 days in good general condition except for her expressive aphasia. Conclusion: To the best of our knowledge, here we report the first case presented with both; cerebral venous sinus thrombosis and cerebral arteries thrombosis in a patient with IBD. Clinicians must be considered ischemic stroke in any patients with IBD presented with acute neurological manifestation, and an urgent interventional approach must be performed.

Rivaroxaban: Management of Coronary Artery Thrombosis in a Patient Presenting with Anterior Wall Myocardial Infarction

Coronary artery thrombosis is one of the most common clinically manifested disease that if not treated timely leads to morbidity and mortality particularly stroke or myocardial infarction. Anti-platelets are already the first line of treatment that are adopted for the prevention of coronary artery thrombosis however, there is need of a novel and potent anticoagulant that could help to reduce the frequency of coronary or atherothrombotic events in patients presenting with coronary diseases. Case Summary: We present a case of anterior wall myocardial infarction (AWMI) driven by coronary artery thrombosis. The patient upon diagnosis was found to have a clot in proximal left anterior descending artery (LAD). The patient was treated and discharged on anticoagulation therapy. We examined and report the effectiveness of anticoagulation therapy via a novel oral anticoagulant. i.e. Rivaroxaban for managing the risk of coronary artery thrombosis associated with AWMI within our patient. Onset of coronary artery thrombosis is associated with the mortality in myocardial infarct patients, regardless of its timing. This calls out for the need to manage the disease by adopting strategies that would prevent the frequent onset of these events in myocardial infarction survivors. Treatment with Rivaroxaban has emerged as a promising oral anticoagulant that could potentially serve as a long-term anticoagulant for managing coronary artery thrombosis in patients with heart complications.

Effects of Verapamil on the Reduction of Radial Artery Thrombosis after Coronary Angiography: A Randomized Clinical Trial.

The trans-radial approach significantly reduces access bleeding and underlying vascular complications and is associated with lower health care costs than the transfemoral approach. One of the most common complications, however, is radial artery occlusion (RAO). This study investigates the effects of verapamil on radial artery thrombosis in patients referred to Taleghani Hospital in Tehran between 2020 and 2021. Patients were randomized into 2 groups: the first group received verapamil, nitroglycerin, and heparin and the second group nitroglycerin and heparin. To randomly assign 100 cases to the 2 experimental and control groups, we first formed a framework for sampling 100 people (from 1 to 100); then, based on the table of random numbers, we assigned the first 50 numbers to the experimental group and the remainder to the control group. The 2 groups were compared for radial artery thrombosis. This study evaluated 100 candidates for coronary angiography in 2 groups of 50 with and without verapamil. The mean age was 58.6±11.2 years in the group with verapamil and 58.1±12.7 years in the group without verapamil (P=0.84). The difference between the 2 groups in terms of heart failure was statistically significant (P<0.028). The prevalence of clinical thrombosis was 2.0% in the group with verapamil and 22.0% in the group without verapamil (P<0.004). The prevalence of ultrasound-confirmed thrombosis was 4.0% in the group with verapamil and 36.0% in the group without verapamil (P<0.001). Intra-arterial injection of verapamil added to heparin and nitroglycerine during trans-radial angiography could significantly reduce RAO.

Molecular genetic determinants of arterial thrombosis in patients with thoracoabdominal malignant tumors

Background. Acute ischemic cerebral circulation disorder and myocardial infarction occupy one of the first places among the causes of postoperative mortality in patients with malignant tumors of thoracoabdominal localization. The issue of the role of molecular genetic factors of cardiovascular risk in the development of these complications has not been resolved at present.Objective. To analyze the effect of polymorphisms of hemostasis system genes on the development of coronary artery and cerebral artery thrombosis in patients with malignant tumors of thoracoabdominal localization.Materials and methods. The study included 163 patients operated in the Oncological Department of Surgical Methods of Treatment No. 11 (Thoracic Oncology) of the N.N. Blokhin National Medical Research Center of Oncology in 2018-2019. Two study groups consisted of patients with myocardial infarction (n = 62) and ischemic stroke (n = 24) in the perioperative period or in the anamnesis. The data of patients with a history of both myocardial infarction and ischemic stroke (n = 4) were taken into account in both groups. The control group (n = 81) included patients who had no severe concomitant cardiovascular pathology, including a family history. A molecular genetic study to determine polymorphisms of the genes of the hemostasis system was performed in the Laboratory of Clinical Oncogenetics of the N.N. Blokhin National Medical Research Center of Oncology using the reagents “Cardiogenetics of Thrombophilia” (DNA Technology LLC, Russia; RU No. FSR 2010/08414 dated 11/22/2016).Results. In patients with malignant tumors of thoracoabdominal localization who have suffered a myocardial infarction, in comparison with patients without cardiovascular pathology, a statistically significant difference in the frequency of carriage of homozygous variants of the genes FGB (χ2 = 8.18, p = 0.005), ITGA2 (χ2 = 9.48, p = 0.003), PAI-1 (χ2 = 4.45, p = 0.035), heterozygous forms of genes F5 (χ2 = 4.0, p = 0.046), ITGA2 (χ2 = 14.72, p &lt;0.001), ITGB3 (χ2 = 4.28, p = 0.039), as well as the total frequency of genetic aberrations in these genes. In the group of patients who suffered an ischemic stroke, a statistically significant difference was determined relative to the control group in the frequency of carriage of the heterozygous variant of the mutation in the F2 gene (χ2 = 6.881, p = 0.009), the homozygous form of the mutation of the ITGA2 gene (χ2 = 15.724, p &lt;0.001), the heterozygous variant of the mutation in the ITGB3 gene (χ2 = 3.861, p = 0.05), as well as the total frequency of carrying mutations in these genes. The study did not obtain a significant difference in the studied and control groups with respect to the frequency of polymorphism carriers G/A of the F7 gene (coagulation factor VII) and G/T of the F13 gene (coagulation factor XIII) associated with a reduced risk of thrombotic conditions. In all patients who had a myocardial infarction, and in 91.7 % of cases, several procoagulant polymorphisms were noted in the genotype of patients who had an ischemic stroke; in the group of patients without cardiovascular diseases, this indicator was 53 %, the difference in the groups was statistically significant (χ2 = 39.61, p &lt;0.001; χ2 = 11.685, p &lt;0.001, respectively).Conclusion. Based on the results of a molecular genetic study of factors associated with a high thrombogenic risk, a statistically significant difference in the frequency of occurrence of polymorphic markers F5 G1691A, FGB G(-455)A, ITGA2 C807T, ITGB3 T1565C, PAI-1 4G(-675)5G was revealed in patients with thoracoabdominal localization tumors who had suffered a myocardial infarction, and F2 G20210A, ITGA2 C807T, ITGB3 T1565C who had suffered an ischemic stroke, compared with cancer patients without concomitant cardiovascular pathology. The data of the conducted study make it possible to identify groups of oncological patients with increased risk of developing cardiovascular complications in the perioperative period and take additional measures to prevent thrombotic complications.

Resolution of pulmonary artery thrombosis in patients with moderate COVID-19 disease

ABSTRACT Novel Coronavirus disease (COVID-19) has been widely described as the cause for a proinflammatory and hypercoagulable state. The inflammatory process involving the alveolar vascular endothelium in the respiratory system, is a determining factor for the onset of primary Pulmonary Artery Thrombosis (PAT) even in patients with heparin prophylactic treatment. Little is known about the efficacy of the anticoagulant therapy during the course of PAT caused by COVID-19. In this paper we describe the results obtained in patients with moderate COVID-19 disease, previously threated with prophylactic enoxaparin, who then received full Anticoagulant treatment after diagnosis of PAT. After three months Computed Tomography Pulmonary Angiography demonstrated a complete resolution of the vascular obstructive lesions in all patients, while all the coagulation tests were normal.

Clinical case of myocardial infarction complicated by pulmonary artery thrombosis in patient with oncopathology - difficulties of patient management

The aim – to determine the peculiarities of duration and treatment of a patient with myocardial infarction, complicated by pulmonary artery thrombosis and oncopathology, to show the complexity of management of such a group of patients.Matherial and methods. A clinical examination of the patient with myocardial infarction, complicated by pulmonary artery thrombosis and oncopathology was conducted.Results. Oncopatients are diagnosed acute coronary syndrome with elevation of ST segment more frequently compared to other patients. Oncothrombosis risk is connected with hypercoagulation and thrombocytopenia, cardiotoxicity of antitumor treatment, prolonged immobilization and procoagulant activity of malignant neoplasms.Сonclusion. Acute coronary syndrome and pulmonary artery thrombosis demand comprehensive approach to treatment, this group of patients has an increased risk of cardiovascular death, multidisciplinary approach and comprehensive analysis of such patients promotes early detection of pathology and timely treatment and prevention. Effective treatment for oncopatients with venous thrombosis are direct oral anticoagulants that reduce the risk of recurrent thrombosis, but should be used with caution in patients who have increased risk of major bleeding, the only recommended ones are rivaroxaban and edoxaban, also low-molecular-weight heparins, which can be prescribed to patients with risk of bleeding, cancer and inflammatory diseases of the gastrointestinal tract.

Impact of Donor Risk Index on Risk of Hepatic Artery Thrombosis in Patients After Orthotopic Liver Transplantation

BackgroundHepatic artery thrombosis (HAT) is one of the most severe complications after liver transplantation (LT). HAT can lead to early graft loss and retransplantation or death of the recipient. MethodsThis retrospective cohort study was conducted using data from patients treated between January 2008 and December 2013 in the Department of General, Transplant and Liver Surgery at the Medical University of Warsaw. A total of 750 patients underwent LT over this period. ResultsHAT occurred in 27 patients (2.1%). The median DRI was 1.414 (IQR 1.103–1.578) points and median donor age was 47 (IQR 33–56) years. The optimal cut-off value of DRI in predicting HAT was ≥1.328 points. The cutoff point was characterized by sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 88.0%, 41.3%, 5.5% and 98.9%, respectively (AUC = 0.605, 95% CI 0.477–0.733). A DRI ≥1.328 was a significant risk factor for HAT (OR = 5.16, 95% confidence interval [CI] 1.529–17.48, P = .008). The optimal cutoff point for donor age was 50 years and was characterized by sensitivity, specificity, PPV, and NPV of 66.7%, 55.8%, 5.3%, and 97.8%, respectively. Donor age ≥50 years (OR = 2.53, 95% CI 1.123–5.714, P = .025) was a significant risk factor for HAT. ConclusionDRI is a clinically relevant factor that allows estimating the risk of HAT after liver transplantation from a deceased donor. To reduce the incidence of this complication, the allocation of organs taken from donors at DRI exceeding 1.328 for recipients without other HAT risk factors should be considered.

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

Thrombosis has long been recognized as a potentially life-threatening complication in children with congenital heart disease (CHD), children with acquired heart disease, and in adults with CHD. High-risk groups include patients with shunt- dependent single ventricles (shunt thrombosis, 8%–12%; 4%

Thrombosis and morphology of plaque rupture using optical coherence tomography

Background Thrombosis following plaque rupture is the main cause of acute coronary syndrome, but not all plaque ruptures lead to thrombosis. There are limited in vivo data on the relationship between the morphology of ruptured plaque and thrombosis. Methods We used optical coherence tomography (OCT) to investigate the morphology of plaque rupture and its relation to coronary artery thrombosis in patients with coronary heart disease. Forty-two patients with coronary artery plaque rupture detected by OCT were divided into two groups (with or without thrombus) and the morphological characteristics of ruptured plaque, including fibrous cap thickness and broken cap site, were recorded. Results The fibrous cap of ruptured plaque with thrombus was significantly thinner compared to caps without thrombus ((57.00±17.00)μm vs. (96.00±48.00)μm; P=0.0076). Conclusions Plaque rupture associated with thrombosis occurs primarily in plaque covered by a thin fibrous cap. Thick fibrous caps are associated with greater stability of ruptured plaque.

Old and new anticoagulant drugs: A minireview

The limits of traditional anticoagulants, such as heparin and warfarin, have prompted the search for new agents for prophylaxis and treatment of arterial and venous thromboembolism, including factor Xa and thrombin inhibitors. These agents can be given orally, and their most significant advantage is that no laboratory monitoring is needed. The anti-Xa inhibitor rivaroxaban and the direct thrombin inhibitor dabigatran etexilate are licensed for prophylaxis of venous thromboembolism (VTE) in high-risk orthopedic surgery. They are at least as safe and effective as heparins but much more expensive. Dabigatran, rivaroxaban, and other agents currently in the pipeline of clinical development have the potential to replace warfarin in the two most frequent indications for anticoagulation, i.e. secondary prophylaxis of VTE and atrial fibrillation. Prevention and treatment of coronary artery thrombosis in patients with ischemic heart disease is another area of investigation for the role of new anticoagulants. These drugs have the potential to meet some currently unmet needs of traditional anticoagulants, but available clinical data warrant confirmation and expansion. Lack of specific antidotes for anticoagulation reversal and the high cost are important limitations of their use.

Coronary artery bypass grafting in a patient with polycythaemia rubra vera - a rare indication with a spectrum of complication: a case report

Coronary artery bypass surgery for coronary artery thrombosis in patients with polycythaemia rubra vera has been rarely described. The main issue with such patients is their risk of both bleeding and thrombosis and as such the ideal postoperative management of such cases is unknown. Hereby, we describe a case of a 62-year-old man with polycythaemia rubra vera who underwent coronary artery bypass surgery. Although his initial postoperative course was complicated, his long-term outcome was good.

Pulmonary thrombosis in adults with Eisenmenger syndrome

ObjectivesWe sought to determine the prevalence of pulmonary artery thrombosis in patients with Eisenmenger syndrome and to identify individuals at highest risk. BackgroundEisenmenger syndrome is associated with pulmonary arterial thrombus formation. Both the prevalence and the determinants of pulmonary arterial thrombosis are unknown. MethodsThis is a review of patients with Eisenmenger syndrome seen at the Toronto Congenital Cardiac Centre for Adults, Canada. Patients underwent a contrast-enhanced computed tomographic (CT) scan of the thorax. ResultsForty-nine consecutive patients with Eisenmenger syndrome were seen in our hospital. Fifteen patients did not undergo CT angiograms; therefore, 34 patients (mean age 42 ± 10 years) were included in the study. Responsible shunts included ventricular septal defect (65%), atrial septal defect (15%), patent ductus arteriosus (9%), and other (11%). The prevalence of proximal pulmonary artery thrombus was 21% (7/34) of patients. Evidence of more distal vessel thrombosis was observed in 43% (3/7) of the patients who had visible thrombus in the proximal pulmonary arteries. Patients with thrombus were more likely to be female (86% vs. 37%, p = 0.04) and to have lower oxygen saturations (72% ± 9% vs. 85% ± 6%, p = 0.01). Differences in functional status did not identify patients at highest risk for thrombosis. ConclusionsPatients with Eisenmenger syndrome have a substantial risk of pulmonary artery thrombus formation. Women and patients with lower oxygen saturations are at the highest risk of developing thrombosis. In the context of an increased bleeding tendency in these patients, the role of anticoagulation treatment needs to be determined.

The role of oculopneumoplethysmography in detecting acute carotid artery thrombosis in patients with neurologic deficits after carotid endarterectomy

Background: This study analyzes the role of oculopneumoplethysmography (OPG/Gee) in detecting acute carotid thrombosis (CAT) after carotid endarterectomy (CEA) in a timely fashion for immediate exploration, and minimizing unnecessary surgery. Patients and methods: Fifty-three patients with neurologic deficits that were noticed after CEA in the operating or recovery room had immediate OPG/Gee. Patients with a positive OPG underwent immediate exploration. Patients with a negative OPG had a duplex ultrasound (DU), and if positive for ≥50% stenosis, the patient underwent exploration. If the DU was negative, the patient underwent cerebral computed tomography scanning and angiography. Results: Thirty-one of 53 (58%) had a positive OPG, 30 (97%) of whom had CAT on exploration. Twenty-two of 53 (42%) with a negative OPG had a DU, 4 of whom had ≥50% stenosis (1 thrombosis) that was confirmed by exploration. The remaining 18 patients had a negative DU that was confirmed by angiography. OPG had an overall accuracy of 96% in detecting acute CAT, with a sensitivity of 97%, specificity of 95%, positive predictive value (PPV) of 97%, and a negative predictive value (NPV) of 95%. Combined OPG and selective DU had an overall accuracy of 98% in detecting surgically correctable lesions, with 100% sensitivity, 95% specificity 97% PPV, and 100% NPV. Mandatory exploration in all 53 patients would have resulted in 19 (36%) unnecessary surgeries versus 1 of 53 (2%) if exploration had been done based on OPG with selective DU ( P <0.05). Even if exploration was done based only on the OPG, 30 of 34 surgical lesions would have been explored within a few minutes; only 4 would have been delayed until a DU was performed. Conclusions: OPG/Gee is very sensitive and timely in detecting acute CAT, and carotid exploration in these patients can improve the results of CEA. It also minimizes unnecessary explorations. Patients with a negative OPG should undergo DU, and if positive, they should undergo exploration.

Hepatic artery thrombosis after liver transplantation: diagnosis with spiral CT.

The purpose of this study was to prospectively evaluate spiral CT with maximum-intensity projection in the diagnosis of hepatic artery thrombosis in patients with liver transplants. Thirty liver transplant recipients (19 men, 11 women; mean age, 49 years) underwent Doppler sonography and spiral CT with maximum-intensity projection to evaluate both hepatic parenchyma and hepatic vessels. In five cases, these examinations were followed by angiography for suspected hepatic artery thrombosis. Among the 30 patients, results of both Doppler sonography and spiral CT were abnormal in five patients. In all five patients, Doppler sonography revealed an absence of intrahepatic arterial signal (sensitivity, 100%). Spiral CT showed the hepatic artery to be patent from its origin to the anastomosis and then occluded distally in four patients and showed occlusion of the entire hepatic artery in one patient (sensitivity, 100%). Aortography and/or selective arteriography of the celiac axis confirmed the diagnosis of hepatic artery thrombosis in all five cases. The other 25 patients had a normal clinical outcome, 24 with normal findings on Doppler sonograms (specificity, 96%), and 23 with normal findings on spiral CT. Two patients had false-positive CT studies because of technical failures (specificity, 92%). Spiral CT with maximum-intensity projection is highly accurate in identifying hepatic artery thrombosis after liver transplantation.

Celiac compression syndrome and liver transplantation.

The authors assessed the prevalence and clinical significance of the celiac compression syndrome in liver transplantation patients. Compression of the celiac axis by the median arcuate ligament of the diaphragm, causes a decrease in celiac artery blood flow which may lead to hepatic artery thrombosis in patients undergoing orthotopic liver transplantation. From July 1991 to July 1992, 17 (10%) cases of celiac compression syndrome were identified among 164 consecutive adult patients who underwent liver transplantation. The diagnosis was confirmed by blood flow recording demonstrating a typical pattern of accentuated decrease in celiac blood flow during expiration. Surgical transection of the median arcuate ligament resulted in normalization of the hepatic artery blood flow. In two cases (11.7%), an interposition iliac graft from the recipient supra-celiac aorta was used for the arterial reconstruction. During the follow-up period of up to 15 months, there was no incidence of hepatic artery thrombosis. The clinical significance of the celiac compression syndrome is evident in liver transplantation in which the collateral circulation to the liver is compromised and the celiac artery remains the only source of arterial blood. It is imperative to identify and remove the obstruction of the celiac axis to prevent severe complications and potential graft loss.

Akute Koronarthrombose und Myokardischämie nach Chemotherapie bei Morbus Hodgkin

A 37 year old man without coronary risk factors or known heart disease showed progression of Hodgkin's disease after radiation and multiple chemotherapy. One day after the first cycle of chemotherapy with methotrexate, Ifosfamide and etoposide, he had an acute myocardial ischemia. The creatinin-kinase was elevated up to 325 U/l. Coronary angiography showed a thrombus in the left anterior descending coronary artery (LAD), while the other coronary arteries were normal. Ventriculography showed an apical akinesia. After 7 days of treatment with heparin coronary angiogram was normalized, without any stenosis in the LAD. To our knowledge this is the first documented case of a coronary artery thrombosis and myocardial ischemia after chemotherapy in a patient without coronary heart disease. We conclude that chemotherapy can cause myocardial ischemia by coronary artery thrombosis in patients without prior heart disease.

Myocardial ischemia and reperfusion: The role of oxygen radicals in tissue injury

Thrombolytic therapy has gained widespread acceptance as a means of treating coronary artery thrombosis in patients with acute myocardial infarction. Although experimental data have demonstrated that timely reperfusion limits the extent of infarction caused by regional ischemia, there is growing evidence that reperfusion is associated with an inflammatory response to ischemia that exacerbates the tissue injury. Ischemic myocardium releases archidonate and complement-derived chemotactic factors, e.g., leukotriene B4 and C5a, which attract and activate neutrophils. Reperfusion of ischemic myocardium accelerates the influx of neutrophils, which release reactive oxygen products, such as superoxide anion and hydrogen peroxide, resulting in the formation of a hydroxyl radical and hypochlorous acid. The latter two species may damage viable endothelial cells and myocytes via the peroxidation of lipids and oxidation of protein sulfhydryl groups, leading to perturbations of membrane permeability and enzyme function. Neutrophil depletion by antiserum and inhibition of neutrophil function by drugs, e.g., ibuprofen, prostaglandins (prostacyclin and PGE1), or a monoclonal antibody, to the adherence-promoting glycoprotein Mo-1 receptor, have been shown to limit the extent of canine myocardial injury due to coronary artery occlusion/reperfusion. Recent studies have challenged the hypothesis that xanthine-oxidase-derived oxygen radicals are a cause of reperfusion injury. Treatment with allopurinol or oxypurinol may exert beneficial effects on ischemic myocardium that are unrelated to the inhibition of xanthine oxidase. Furthermore, the human heart may lack xanthine oxidase activity. Further basic research is needed, therefore, to clarify the importance of xanthine oxidase in the pathophysiology of reperfusion injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Unstable Angina Associated with Factor VIII Concentrate Therapy for Hemophilia A

Brief Report1 August 1986Unstable Angina Associated with Factor VIII Concentrate Therapy for Hemophilia AROBERT G. KOPITSKY, M.D., EDWARD M. GELTMAN, M.D.ROBERT G. KOPITSKY, M.D.Search for more papers by this author, EDWARD M. GELTMAN, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-105-2-215 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe importance of intracoronary thrombosis in patients with atherosclerotic coronary stenosis has been well established in the pathogenesis of acute transmural myocardial infarction (1). Recent angiographic studies have shown that intracoronary thrombi also occur in many patients who have unstable angina without myocardial infarction (2-5). In patients with severe atherosclerotic coronary obstruction, it is conceivable that a severe coagulation defect could partially protect against unstable angina or acute myocardial infarction by impairing the ability to form intracoronary thrombi; correction of the defect could negate this protection. We describe a case of severe unstable angina associated with the use of factor...References1 DEWOODSPORESNOTSKE MJR. Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction. N Engl J Med. 1980;303:897-902. CrossrefMedlineGoogle Scholar2. HOLMESHARTZLERSMITHFUSTER DGHV. Coronary artery thrombosis in patients with unstable angina. Br Heart J. 1981; 45:411-6. CrossrefMedlineGoogle Scholar3. VETROVECLEINBACHGOLDCOWLEY GRHM. Intracoronary thrombolysis in syndromes of unstable ischemia: angiographic and clinical results. Am Heart J. 1982;104(4 pt 2):946-52. CrossrefMedlineGoogle Scholar4. MANDELKORNWOLFSINGH JNS. Intracoronary thrombus in nontransmural myocardial infarction and in unstable angina pectoris. Am J Cardiol. 1983;52:1-6. CrossrefMedlineGoogle Scholar5. ZACKISCHINGERAKERDINCERKENNEDY PTUBH. The occurrence of angiographically detected intracoronary thrombus in patients with unstable angina pectoris. Am Heart J. 1984;108:1408-12. CrossrefMedlineGoogle Scholar6. BUJAWILLERSON LJ. Clinicopathologic correlates of acute ischemic heart disease syndromes. Am J Cardiol. 1981;47:343-56. CrossrefMedlineGoogle Scholar7. GALLINOHAEBERLIBAURSTRAUB AAHP. Fibrin formation and platelet aggregation in patients with severe coronary artery disease: relationship with the degree of myocardial ischemia. Circulation. 1985;72:27-30. CrossrefMedlineGoogle Scholar8. OLIVA P. Unstable rest angina with ST-segment depression: pathophysiologic considerations and therapeutic implications. Ann Intern Med. 1984;100:424-40. LinkGoogle Scholar9. FUERTHMAHRER JP. Myocardial infarction after factor IX therapy. JAMA. 1981;245:1455-6. CrossrefMedlineGoogle Scholar10. SULLIVANPURDYBILLINGHAMGLADER DLMB. Fatal myocardial infarction following therapy with prothrombin complex concentrates in a young man with hemophilia A. Pediatrics. 1984;74:279-81. MedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: ROBERT G. KOPITSKY, M.D.; EDWARD M. GELTMAN, M.D.Affiliations: Washington University School of Medicine St. Louis, Missouri PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byParadoxical thrombosis part 1: factor replacement therapy, inherited clotting factor deficiencies and prolonged APTTEndothelial dysfunction in haemophilia patientsClassic Polyarteritis Nodosa Presenting Rare Clinical Manifestations in a Patient with Hemophilia APotential role for rFVIIa in transfusion medicineAcute left anterior descending artery occlusion in a hemophiliac A patient during recombinant factor VIII infusion: Treatment with coronary angioplastySevere Haemophilia A Patient with Factor V Leiden Homozygosity Associated with Portal Vein Thrombosis and Myocardial InfarctionCerebral infarct associated with factor V Leiden mutation in a boy with hemophilia AFactor VIII, HIV and AIDS in haemophiliacs: an analysis of their relationshipAssociation of severe haemophilia A and factor V Leiden: report of three casesFatal complication of desmopressinFactor VIII, HIV and AIDS in haemophiliacs: An analysis of their relationshipDeep venous thrombosis in hemophilia A 1 August 1986Volume 105, Issue 2Page: 215-216KeywordsAcute myocardial infarctionCardiology and cardiovascular diseasesHemophilia AMyocardial infarctionPathogenesisStable coronary artery diseaseStenosisThrombosisUnstable angina ePublished: 1 December 2008 Issue Published: 1 August 1986 PDF downloadLoading ...

Late axillary artery thrombosis in patients with occluded axillary-femoral bypass grafts

The axillary-femoral bypass graft is an alternative to direct anatomic procedures for patients with aortoiliac occlusive disease. Touted for its low morbidity and mortality rates, with corresponding improved patency rates, this extra-anatomic procedure has been considered safe and effective. Noncompromising upper extremity ischemia and one case of upper extremity loss, associated with early graft thrombosis, have been reported previously. This article describes two cases of late axillary artery thrombosis, occurring 4 and 6 months after graft thrombosis, which severely jeopardized the viability of the ipsilateral upper extremity. Experience with these patients has shown that a thrombosed axillary-femoral bypass graft may jeopardize the viability of the ipsilateral upper extremity many months after its failure. The absence of information in the literature regarding this complication suggests this is a rare complication of thrombosed axillary-femoral grafts.