Deep Thrombosis Research Articles

Miniaturized Stacked Transducer for Intravascular Sonothrombolysis With Internal-Illumination Photoacoustic Imaging Guidance and Clot Characterization.

Thromboembolism in blood vessels can lead to stroke or heart attack and even sudden death unless brought under control. Sonothrombolysis enhanced by ultrasound contrast agents has shown promising outcome on effective treatment of thromboembolism. Intravascular sonothrombolysis was also reported recently with a potential for effective and safe treatment of deep thrombosis. Despite the promising treatment results, the treatment efficiency for clinical application may not be optimized due to the lack of imaging guidance and clot characterization during the thrombolysis procedure. In this paper, a miniaturized transducer was designed to have an 8-layer PZT-5A stacked with an aperture size of 1.4 × 1.4 mm2 and assembled in a customized two-lumen 10-Fr catheter for intravascular sonothrombolysis. The treatment process was monitored with internal-illumination photoacoustic tomography (II-PAT), a hybrid imaging modality that combines the rich contrast of optical absorption and the deep penetration of ultrasound detection. With intravascular light delivery using a thin optical fiber integrated with the intravascular catheter, II-PAT overcomes the penetration depth limited by strong optical attenuation of tissue. In-vitro PAT-guided sonothrombolysis experiments were carried out with synthetic blood clots embedded in tissue phantom. Clot position, shape, stiffness, and oxygenation level can be estimated by II-PAT at clinically relevant depth of ten centimeters. Our findings have demonstrated the feasibility of the proposed PAT-guided intravascular sonothrombolysis with real-time feedback during the treatment process.

Incidence of Deep Vein Thrombosis in Cerebral Palsy Following an Orthopaedic Surgical Event.

The purpose of this study was to identify the incidence of venous thromboembolism (VTE) and characterize the demographics, comorbidities, and risk factors for patients with cerebral palsy (CP) having orthopaedic surgery. All patients diagnosed with CP who underwent an orthopaedic surgical procedure at one institution between 2008 and 2017 were identified. Diagnosis codes and associated patient events were recovered from the electronic medical record. Each VTE event was reviewed to ascertain an actual VTE episode related to a surgical event. The review included 2583 orthopaedic surgical events in 1371 patients. Of the initial 88 cases identified, 28 cases had a deep thrombosis documented. Six cases of VTE occurred within 3 months following the surgical event. Three of these cases had thigh thrombosis, and 2 patients had upper arm thrombosis, and 1 patient had a superior vena cava thrombosis. On further workup, 5 of these 6 patients were identified as having a congenital hypercoagulable condition. VTE is a relatively rare occurrence after orthopaedic surgery in pediatric patients with CP, but when it occurs, a full hematologic workup for a congenital hypercoagulable condition is indicated. Based on the low incidence of thigh thrombosis, routine pharmacological or intermittent mechanical calf compression is not recommended. A careful clinical and family history should be performed to identify patients with possible genetic hypercoagulable conditions who would merit prophylaxis. Level IV.

Deep thrombosis characterization using photoacoustic imaging with intravascular light delivery.

Venous thromboembolism (VTE) is a condition in which blood clots form within the deep veins of the leg or pelvis to cause deep vein thrombosis. The optimal treatment of VTE is determined by thrombus properties such as the age, size, and chemical composition of the blood clots. The thrombus properties can be readily evaluated by using photoacoustic computed tomography (PACT), a hybrid imaging modality that combines the rich contrast of optical imaging and deep penetration of ultrasound imaging. With inherent sensitivity to endogenous chromophores such as hemoglobin, multispectral PACT can provide composition information and oxygenation level in the clots. However, conventional PACT of clots relies on external light illumination, which provides limited penetration depth due to strong optical scattering of intervening tissue. In our study, this depth limitation is overcome by using intravascular light delivery with a thin optical fiber. To demonstrate in vitro blood clot characterization, clots with different acuteness and oxygenation levels were placed underneath ten-centimeter-thick chicken breast tissue and imaged using multiple wavelengths. Acoustic frequency analysis was performed on the received PA channel signals, and oxygenation level was estimated using multispectral linear spectral unmixing. The results show that, with intravascular light delivery, clot oxygenation level can be accurately measured, and the clot age can thus be estimated. In addition, we found that retracted and unretracted clots had different acoustic frequency spectrum. While unretracted clots had stronger high frequency components, retracted clots had much higher low frequency components due to densely packed red blood cells. The PACT characterization of the clots was consistent with the histology results and mechanical tests.

Clinical and histopathological patterns of dermatosis in COVID-19 positive patients treated in the Unidad Médica de Alta Especialidad del Bajío, IMSS-T1, de León, Guanajuato

COVID-19 disease, besides presenting respiratory manifestations, can affect other organs such as kidneys, gastrointestinal system, heart, and skin. So far, five clinical variants of dermatoses have been described. Few reports discuss the severity associated with the cutaneous manifestations of COVID-19 and the prognosis. To describe the clinical and histopathological patterns of dermatoses in patients with COVID-19 infection. Prospective cohort study conducted in patients admitted to "IMSS T1" in Leon, Guanajuato, Mexico from September 2020 to January 2021. We identified those with COVID-19 dermatosis from the moment they were admitted; and those who developed them during hospitalization. Patients were invited to participate for a clinical evaluation and biopsy. The biopsies were described by an expert pathologist. The frequency of dermatological lesions was 15.7%. Those who developed dermatosis during their hospital stay presented higher mortality (p = 0.001) and severity of COVID-19 (p = 0.001) Vasoocclusive lesions were the most frequent in the hospital setting, and were associated to higher mortality (p = 0.003). The most frequent histopathological feature was superficial and deep thrombosis (58%). Patients who developed dermatologic lesions during hospitalization and those with vaso-occlusive dermatoses had higher morbi-mortality. Vaso-occlusive lesions could be considered as a poor prognostic factor.

Karakteristik Pasien Trombosis Vena Dalam: Tinjauan Sistematik

Introduction: Deep vein thrombosis (DVT) is one of the biggest causes of death in the world. DVT has various risk factors so that DVT patient presentation can be different in each age, sex, and race group. This review aimed to obtain information regarding characteristics of deep vein thrombosis patients.Method: This study used qualitative approach that is library research using books and other literatures as the main object. This study was conducted using search engine, such as Pubmed, Google Scholar, and Clinical Key to obtain journals related with characteristics of deep vein thrombosis patients. Result: From 17 literatures, we found that characteristics of deep thrombosis patients are different in each age, sex, and race group. The severity of DVT increased with increasing age because of other conditions usually found in older age. Men are more susceptible to have DVT than women without reproductive risk factors such as pregnancy and menopause. African has more severe DVT presentation than other races. Lowest risk is found in Asian, although there is no significant difference in mortality between races.Conclusions: Characteristics of DVT patients (incidence rate, risk factors, location, and severity) vary in each age, sex, and race group.

Predictive factors of venous recanalization in upper-extremity vein thrombosis.

Upper extremity venous thrombosis (UEVT) represents about 10% of venous thrombo-embolic disease. This is mainly explained by the increasing use of central venous line, for oncologic or nutritional care. The factors associated with venous recanalization are not known. The aim of this study was to investigate prognosis factor associated with venous recanalization after UEVT. This study included patients with UEVT diagnosed with duplex ultra-sonography (DUS) from January 2015 to December 2017 with DUS evaluations during follow-up. A multivariate Cox proportional-hazards-model analysis was performed to identify predictive factors of UEVT complete recanalization. This study included 494 UEVT, 304 proximal UEVT and 190 distal UEVT. The median age was 58 years, 39.5% were women. Clinical context was: hematological malignancy (40.7%), solid cancer (14.2%), infectious or inflammatory context (49.9%) and presence of venous catheters or pacemaker leads in 86.4%. The rate of recanalization without sequelae of UEVT was 38%. For all UEVT, in multivariate analysis, factors associated with complete vein recanalization were: thrombosis associated with central venous catheter (CVC) (HR:2.40, [1.45;3.95], p<0.001), UEVT limited to a venous segment (HR:1.94, [1.26;3.00], p = 0.003), occlusive thrombosis (HR:0.48 [0.34;0.67], p<0.0001), the presence of a PICC Line (HR:2.29, [1.48;3.52], p<0.001), a thrombosis of deep and distal topography (HR:1.70, [1.10;2.63], p = 0.02) or superficial thrombosis of the forearm (HR:2.79, [1.52;5.12], p<0.001). For deep and proximal UEVT, non-occlusive UEVT (HR:2.23, [1.49;3.33], p<0.0001), thrombosis associated with CVC (HR:1.58, [1.01;2.47], p = 0.04) and infectious or inflammatory context (HR:1.63, [1.10;2.41], p = 0.01) were factors associated with complete vein recanalization. In this study, factors associated with UEVT recanalization were UEVT limited to a venous segment, thrombosis associated with CVC, a thrombosis of deep and distal thrombosis topography and superficial thrombosis of the forearm. Occlusive thrombosis was associated with the absence of UEVT recanalization.

Psoas hematomas in COVID 19 patients

The psoas hematoma Is a frequent complication of anticoagulant treatment and is the first diagnosis to Be made in any patient on anticoagulants with psoitis, the diagnoses Will Be made on the basis of ultrasound or CT examinassions and the treatment Most often consists of 'abstention. Keywords: Psoas hématome; COVID; Mechanical ventilation; Embolisation; Surgery; Epigastric artery rupture Introduction OVID-19 disease is a highly thrombogenic pathology requiring anticoagulation at a curative dose to prevent occurrence of pulmonary embolism or deep thrombosis, in addition to thromboembolic risk it has a component hemorrhagic manifested by bleeding at localizations multiple. Among these hemorrhages, muscle hematomas deep classified as severe bleeding. They are conventionally treated with conservative treatment with the discontinuation of drug and specific reversion, and in rare cases, by surgical evacuation. However, the spread or reappearance of bleeding, although the effect of anticoagulants has been canceled, should suggest additional etiology.

COLATERAL BLOOD FLOW AT THROMBOSIS IN THE FEMORAL VENOUS COLLECTOR

Anatomical features of collateral circulation of a hip influence on the severity of a clinical picture at deep thromboses and play a role in the prevention of complications. This necessitates the assessment of collateral blood flow.&#x0D; The aim of research: to evaluate the compensatory possibilities of the collateral blood flow in the femoral venous collector in the acute venous thrombosis.&#x0D; Methods. The analysisis made of results examination and treatment of 790 patients with the acute thrombosis in the vena cava inferior system and being treated at the Transcarpathian Regional Clinical Hospital named after A. Novak and the Transcarpathian Regional Clinical Oncology Center during 2006–2016. The laboratory methods and the instrumental ones (ultrasound duplex scanning, X-ray phlebography, computed tomography, radionuclide flebo scintigraphy and ultrasound scanning of heart) were used for investigation of patients,&#x0D; Results of research. Deep vein thrombosis in the popliteal-femoral segments was observed in 322 (40.8%) of 790 patients. At the occlusion of the popliteal-femoral segments in the collateral blood flow take part the next vessels: superficial (large subcutaneous vein, small subcutaneous vein, posterior cutaneous femoral vein) and deep (deep femoral vein, vein-satellites of the main arteries, popliteal-femoral-sciaticpath, v. articularis genusuprema, vv. comitans n. ischiadici and abnormal femoral collateral), which quickly off set violations.&#x0D; At the spread of thrombosis to general femoral vein, the clinical picture of the disease becomes more pronounced, due to the exclusion from the blood flow of deep femoral vein and most superficial venous collaterals (posterior cutaneous femoral vein and large subcutaneous vein), which leads to a sharp decompensation of venous outflow.&#x0D; Conclusions. At the deep vein thrombosis in the popliteal-femoral segment the venouscollaterals, whichin 98.4% of cases occur secondarily, quickly compensate for hemodynamicdisorders, but at progression of thrombosis and exclusion of deep femoral and large subcutaneous veins in popliteal-femoral segments the decompensation of venous blood flow rapidly.&#x0D; Thrombosis of deep veins in the popliteal-femoral segment occurs secondarily, due to the spread of thrombotic masses from the tibial veins. The jugular vein share the source of thrombosis in only 1.6% of patients.&#x0D; At occlusion of a popliteal-femoral venous segment in collateral blood flow the following vessels participate: superficial (LSV, SSV, a back cutaneousvein of a hip) and deep (DFV, veins-satellites of the main arteries, popliteal-femoral-sciatic way, v. Articularis us vv. comitans n. Ischiadici and abnormal femoral collaterals), which quickly eliminate hemodynamic disturbancesin the popliteal-wall segment.&#x0D; The most pronounced clinical symptoms of deep vein thrombosis in the popliteal-femoral segment are observed when excluding from the collateral blood flow of the deep femoral and great saphenous veins.

Contextualizing cardiac dysfunction in critically ill patients with COVID-19.

Acute cardiac injury incidence in COVID-19 is about 13 times higher in the Intensive Care Unit (ICU)/severely ill than in less critical patients. Patients with cardiovascular comorbidities seem to be more prone to develop higher acuity of the infection, and myocardial injury has been reported amongst them in up to 15% of those hospitalized and up to 30% of ICU-admitted ones. The symptoms of over ischemia/heart failure may be challenging to distinguish as dyspnea and chest discomfort overlap with those due to COVID-19. Therefore, beside close monitoring with electrocardiography, biomarkers and, in case of demonstrated cardiac involvement, echocardiography, strategies to improve myocardial oxygen delivery should be promptly applied. The cytokine release with complement and iNO dysregulation are established mechanisms potentially leading to sepsis-related cardiomyopathy, making sepsis per se one of the potential mechanism leading to acute cardiac injury in COVID-19 patients. Moreover, the hyper-inflammation with endothelial dysfunction is likely be responsible of both pulmonary in-situ platelet aggregation and deep thrombosis potentially leading to severe pulmonary embolism and right ventricular failure. Besides the customary antithrombotic prophylaxis for critical patients, D-dimer levels and tighter coagulation monitoring are recommended and should guide the choice for anticoagulation treatment. We summarize the current knowledge regarding cardiovascular involvement in patient with COVID-19.

Reducing venous deep trombosis with immunonutrition in perioperative of total knee and hip arthroplasty

Rationale: total arthroplasties are surgeries to improve quality of life in elderly with severe osteoarthritis. Perioperative oral nutritional supplements (ONS) with specific nutrients can improve nutritional status, metabolic response to surgery and prevent postoperative complications. The aim is to evaluate whether ONS with immunomodulatory agents (arginine, omega-3 fatty acids and nucleotides) can reduce venous deep thrombosis (VDT) after total knee (TKA) and hip arthroplasty (THA) in elderly.

Use of mPEG-PLGA nanoparticles to improve bioactivity and hemocompatibility of streptokinase: In-vitro and in-vivo studies.

Streptokinase, a clot-dissolving agent, is widely used in treatment of cardiovascular diseases such as blood clots and deep thrombosis. Streptokinase is a cost-effective drug with a short biological half-life (i.e. 15 to 30min). In addition, due to its prokaryotic source, the immune response quickly reacts to the drug. Despite these limitations, streptokinase is still the first choice for diseases associated with thrombosis. In this work, streptokinase was encapsulated in mPEG-PLGA nanoparticles to improve its pharmacokinetic properties. The nanoparticles containing the enzyme were prepared by coaxial electrospray and their physicochemical properties, blood compatibility, circulation time and cell toxicity were evaluated. The results showed that the use of mPEG-PLGA nanoparticles to encapsulate the enzyme resulted in prolonged circulation time (up to 120min) with a slight decrease in its activity. In vivo studies also showed that the nanoparticles containing streptokinase did not have adverse effect on blood biochemistry parameters as well as liver and kidney tissues. As a result, the mPEG-PLGA nanoparticles showed the potential for increasing the biological activity of streptokinase with no important adverse effect.

Respiratory Support During Pulmonary Artery Thromboembolia (Review)

Pulmonary artery thromboembolia (PATE) is not a clinical entity as such, but a complication of different diseases and conditions leading to deep thrombosis in the low tension circulation system, right cardiac chambers or causing local thrombosis in the pulmonary artery system. PATE is characterized by complex pathogenesis of respiratory failure of varying severity, which makes it difficult to choose a respiratory support technique.Purpose of the overview: to show advantages of different respiratory support techniques and prospects of high-flux oxygen therapy with regard to PATE pathophysiology.82 sources were selected based on the principle of combining clinical and experimental data from papers published over the recent 5 years and earlier that are still relevant for medical practice.The overview presents the structure of main causes and prevalence of PATE and considers thrombogenesis stages and predominant manifestations of respiratory failure during PATE occurring due to inconsistency between pulmonary ventilation and perfusion. Review discusses five methods of respiratory therapy in PATE patients: low-flux and high-flux oxygen therapy, non-invasive and invasive artificial lung ventilation, extracorporeal blood oxygenation. Finally, the paper shows the efficacy and limitations of these methods.Conclusion. High-flux oxygen therapy seems to be the most effective and promising technique in PATE patients thanks to absence of adverse cardiohemodynamic consequences, subjective comfort for patients, and relation to minimal risks of secondary infectious complications.Nevertheless, the clinical experience accumulated is insufficient to make an absolute choice of one particular technique for respiratory support during PATE. It is necessary to continue investigating the clinical efficacy of high-flux oxygen therapy in the specific population of patients who experienced PATE.

A STROBE cohort study of 755 deep and superficial upper-extremity vein thrombosis.

Upper extremity vein thrombosis (UE-VT) are more and more frequent pathologies and yet little studied. The aim is to describe the clinical and ultrasound features, UE-VT-related diseases, and the prevalence of pulmonary embolism (PE) and associated deaths.All UE-VT patients diagnosed by Doppler-ultrasound in Nantes University Hospital, from January 2015 to December 2017, were included retrospectively. UE-VT suspicion patterns, clinical features, UE-VT topography, and prevalence of PE and death were analyzed.Seven hundred and fifty-five UE-VT were analyzed, including 427 deep thrombosis (UE-DVT) and 328 superficial thrombosis (UE-SVT). In 86.2% (n = 651) UE-VT were related to endovascular devices. Among these thrombosis, one third is in connection with a PICC LINE and one quarter with a peripheral venous line. Forty nine percent (n = 370) of the patients had solid neoplasia or hematological malignancies. An inflammatory or systemic infectious context was found in 40.8% (n = 308) of the cases. The most frequently observed clinical sign at the UE-VT diagnosis was edema (28.6%). Among the UE-SVT it was the presence of an indurated cord (33.2%) and among the UE-DVT the indication of the Doppler-ultrasound was mainly a suspicion of infection on endovascular device (35.1%). In 10.6% (n = 80) of the cases the UE-VT were asymptomatic. The most frequently thrombosed veins were brachial basilic veins (16.7% of all thrombosed segments) followed by jugular (13%) and subclavian (12.3%) veins; 61.3% (n = 463) of UE-VT were in the right upper extremity; 63.3% (n = 478) UE-VT were occlusive. The occurrence of PE is 4% and the death rate is 10.2%, mainly related to the severe comorbidities of patients with UE-VT.UE-VT occurs in particular clinical contexts (hematological malignancies, solid cancers, systemic infections) and in the majority of endovascular devices (86.2%). The occurrence of PE is low.

Single Blind, Randomised Study Regarding the Treatment of the Telangiectasia of the Lower Limbs (C1EAP) Using Polidocanol 0,5%, 1%, and Nd:YAG Laser.

The treatment of leg telangiectasias could be done with liquid sclerotherapy or Nd:YAG laser. We evaluated randomly, in a simple blind, the efficacy of the treatment with 0,5% polidocanol (POL-0,5), 1% polidocanol (POL-1) and Nd:YAG laser (LAS) on 132 patient (264 limbs) with telangiectasia of the lower limbs with less than 2mm diameter (C1EAP). The main objective was to evaluate the efficacy of the sclerotherapy (chemical compared with Nd:YAG-LAS). Secondary objectives were: possible major complications (deep thrombosis, severe burns, ischemic complications, etc.), the percentage of the local complications, the cosmetic aspect-evaluated by both the patient and the doctor and the grade of discomfort of the patient during and after the procedure. Comparing the treatment with Nd:YAG laser (LAS), polidecanol-0.5% (POL-0.5), polidecanol 1% (POL-1), it was noticed that telangiectasias smaller than 1mm led to good and very good results in all the cases treated with Nd:YAG laser and the same outcome was obtained in one third of the subjects treated with POL-0.5, vs. 47.81% of patients treated with POL-1. When telangiectasias were larger than 1mm diameter, good and very good results occurred in 86.36% of patients treated with LAS and 100% of the cases treated with POL-0.5 and POL-1. In conclusion, we consider that leg telangiectasias can be treated with good results using Nd:YAG laser or sclerotherapy with polidocanol, Nd:YAG laser being reccomended for telangiectasia under than 1 mm diameter while sclerotherapy in larger vessels.

Elastic compression after ultrasound-guided foam sclerotherapy in overweight patients does not improve primary venous hemodynamics outcomes

ObjectiveLower extremity varicose veins have a high prevalence and can be associated with significant morbidity in their more advanced presentations; overweight patients tend to present with more severe clinical symptoms and conventional surgical treatment remains challenging. Although the advent of ultrasound-guided foam sclerotherapy (UGFS) increased the treatment options for these patients, the need for elastic compression after UGFS remains controversial. MethodsOverweight patients with lower extremity varicose veins secondary to great saphenous vein reflux were treated with UGFS and then randomized to use or no use of a 3-week treatment of elastic compression stockings. Follow-up was performed by clinical evaluation and duplex ultrasound examination. The primary outcome measure was the absence of venous reflux in the great saphenous vein. ResultsOne hundred thirty-five lower limbs were treated; 72 limbs were randomized to elastic compression and 63 limbs to the control group. There were no statistically significant differences in the number of procedures (P = .64) or the mean foam volume per procedure (P = .27) between groups. There was no difference in the reflux rate at either 3 weeks (26% vs 35%; P = .16) or 3 months (25% vs 21%; P = .85). Major complications were venous deep thrombosis (n = 2), neurologic event (n = 1), and ischemic ulceration (n = 1); the overall rate was 3% in both groups—2 of 62 in control patients and 2 of 69 in compression patients (P = .45). Venous diameter reduction was noted in both groups during treatment (P < .05) but with greater decrease in greater saphenous vein diameter in patients treated with compression. ConclusionsElastic compression stockings for 3 consecutive weeks after UGFS in overweight patients did not decrease great saphenous vein reflux, need for repeat procedures, or the volume of foam injected. However, UGFS was associated with a greater and uniform reduction in saphenous vein diameter at all times after the procedure.

Catheter Related Thrombosis (CRT) in Hematologic Malignancy: A Retrospective Study of Venous Thromboembolism Management

Introduction: Central Venous Catheters (CVC) improve quality of life for patients with hematologic malignancy but long-term presence may result in CRT. Optimal treatment of CRT is uncertain. Here, we focus on a retrospective study of CRT in patients with hematologic malignancy to identify clinical features associated with increased risk for recurrent thrombosis. Methods: Demographic and management information of patients with CRT and hematologic malignancy was extracted from the medical record of a single academic medical center. Data was described using summary statistics. Nonparametric Cox proportional hazard models were utilized for thrombosis recurrence and bleeding occurrence. Unadjusted models were utilized for CRT treatment, type of anticoagulation, platelet count, and other factors. Results: 85 patients were included for analysis. Summary statistics are noted in Table 1. Median platelet count differed across initial treatment approach [Anticoagulation (AC): 177 (106.5- 662), Anticoagulation and Catheter Removal (AC+): 112 (61.75-304), Catheter Removal only 24 (20.25-35.5), No treatment 30.5 (16.75-10.8), p&lt;0.0001]. For CRT treatment, patients with AC+ have more than a 660 % chance of thrombosis recurrence compared to AC as reference group. This significant difference is also seen in the Kaplan Meir curves for CRT treat (log-rank p=0.0484), Figure 1. Of note, 15 patients treated with AC+ developed recurrent thrombosis, the majority of which (53%, 8/15) occurred within 100 days. Of these patients, 62% (5/8 patients) had at least 2 days delay in starting anticoagulation while no delays in starting anticoagulation were noted in patients who were primarily treated with AC. Of the 8 patients who received no therapy for CRT, 7/8 patients (87%) had noted brachial (peripheral deep). Discussion: Significant variability in management of CRT in patients with hematologic malignancy is noted. Platelet count at time of thrombosis may influence treatment decision. Our data indicate that treatment with anticoagulation is superior to treatment without anticoagulation. The difference in thrombosis recurrence seen in patients who received AC v. AC+ could potentially be explained by delays in starting AC in the latter group. Interestingly, patients who did not receive any therapy for CRT had no recurrence, which may be explained by the fact that the majority had peripheral deep thrombosis, which are less likely to have deep recurrences. In addition, type of anticoagulation used for treatment was notHowever, our data is limited by its population of single institutional patients and retrospective nature. Prospective, studies are needed to better delineate differences in outcomes. Disclosures Jaglal: NOVARTIS: Consultancy.

Biomarkers of Hemostatic Dysregulation and Inflammation in Lymphoma: Potential Relevance to Thrombogenesis

ObjectiveCancer‐associated thrombosis and venous thromboembolism (VTE) continue to be a major complication of malignancy. There is increased incidence of clinically overt deep thrombosis (DVT) in cancer patients. Profiling biomarkers involved in hemostatic dysregulation and inflammatory processes in the lymphoma patient population may provide additional insight into the pathogenesis of thrombotic complications in lymphoma. This study aimed to profile hemostatic dysregulation and inflammatory biomarkers in patients with Hodgkin lymphoma, non‐Hodgkin lymphoma and chronic lymphocytic leukemia/small lymphocytic lymphoma. The primary hypothesis of this study is that hemostatic activation and inflammatory biomarkers may be increased in lymphoma patients.MethodsCitrated blood samples were collected from the Hematology Clinic, University of Belgrade, Serbia. Plasma levels of plasmin activator (PAI‐1), D‐dimer (DD), Factor XIIIa (XIIIa), C‐reactive protein (CRP), microparticle (MP), Von Willebrand Factor (vWF), Protein S (PS), urokinase like plasminogen activator (uPA), tumor necrosis factor alpha (TNF‐α), Beta 2 glycoprotein (β2GPI), and Fibronectin (FN) were measured in 96 lymphoma patients, along with a control/pooled plasma prepared from 50 healthy normal individuals. Commercially available ELISA kits were used for profiling these markers. All results were compiled and calculated as mean + SD and % change.ResultsThe results from this study demonstrated elevated levels of DD, CRP, vWF, TNF‐α, uPA, and PS in comparison to normal human plasma. Plasma levels were decreased for PAI‐1 (3%), XIIIa (5%), MP (46%), β2GPI (8%) and FC (15%). Of the lymphoma patient samples with elevated levels of biomarkers, 34% of individual patients had elevated DD, 66% had elevated CRP levels, 50% had elevated vWF levels, 80% had elevated levels of TNFα, and 90% had elevated levels of uPA. However, when comparing each specific type of lymphoma in relation to the ratio of each biomarkers (DD, CRP, vWF, TNF‐α, and uPA), there was no significant difference between individual lymphoma subgroups (p&gt;.05).ConclusionThe elevated levels of hemostatic dysregulation and inflammatory biomarkers in lymphoma patient samples are suggestive of an increased VTE risk in these patients. The elevated DD, CRP, vWF, TNFα, and uPA clearly suggest a trend towards increased thrombogenesis. Individual patients showing increased amounts of each elevated biomarker proves the significance and use of D‐dimer, CRP, vWF, TNFα and uPA in identifying the level of thrombosis risk.Support or Funding InformationNone.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

The Successful Treatment of Pulmonary Embolism as a Complication after Uterine Fibroid Embolization (Case Report)

Background: Uterine fibroid embolization (UFE) is as an effective alternative to hysterectomy and myomectomy. However, UFE is associated with a wide spectrum of complications including in rare instances thromboembolic events and even pulmonary embolism (PE). Case Presentation: A case of a 36-year-old woman suffering from a symptomatic uterine fibroid is described as follows. The patient underwent UFE and overnight she suddenly collapsed with signs of massive PE. In consequence of cardiopulmonary resuscitation and urgent systemic thrombolytic therapy, cardiac activity was restored successfully. Discussion &amp; Conclusion: This constitutes another report of PE developed following UFE. In the case described here PE occurred 26 hours after the procedure was performed. Before UFE all patients should undergo complete examination for exclusion of pre-existing venous deep thrombosis and coagulopathies.

Akute Beinvenenthrombose – moderne Diagnostik und Therapie

Acute deep pelvic vein thrombosis (DVT) is usually anon-fatal disease that causes lifelong damage. In the case of clinical suspicion of DVT, D‑dimer determination and/or imaging must be performed. If atimely diagnosis is not possible, anticoagulation should be started. The focus of treatment is the safety of the patient. All studies on thrombus-eliminating procedures, such as thrombolysis, operative open thrombectomy and endovascular revascularization, did not show any advantages over pure anticoagulation and are associated with specific risks. The minimum duration of anticoagulation is 3months. Thereafter, the decision of prolonged anticoagulation must be made individually for each patient. Compression therapy is an integral part of the treatment of acute TVT in Germany, even the evidence for its effectivenes with respect to the prevention of post-thrombotic syndrome is low.

2099. Catheter-related Staphylococcus aureus Bacteremia and Septic Thrombosis: The Role of Anticoagulation and Duration of Intravenous Antibiotic Therapy

BackgroundCatheter-related septic thrombosis is suspected in patients with persistent Central Line-associated Blood Stream Infection (CLABSI) after 72 hours of appropriate antimicrobial therapy. There are limited data outlining the characteristics of the disease and the adequate duration of antimicrobials. In addition, the role of anticoagulation in the management of septic thrombosis remains unclear. We herein studied the clinical characteristics of staphylococcus aureus catheter-related septic thrombosis as well as the appropriate management and duration of treatment.MethodsWe conducted this retrospective study where we included patients with CLABSI due to Staphylococcus aureus who had a concomitant radiographic evidence of thrombosis at the level of catheter placement between the years 2005 and 2017. We collected data pertaining to patients’ medical history, clinical presentation, management, treatment and outcome within 3 months of bacteremia onset. Failure was defined as persistence of signs and symptoms at 72 hours, persistence bacteremia at 48–96 hours, relapse, complications or overall mortality.ResultsA total of 128 patients were included. The median age was 55 years. Total relapse/recurrence rate was 8% and all-cause mortality within 3 months was 16%. We found no significant difference in overall outcome between patients who had deep vs. superficial thrombosis. Patients with superficial thrombosis were found to have higher rate of pulmonary complications (25% vs. 6%; P = 0.01) compared with those with deep thrombosis. Patients who received less than 28 days of intravascular antibiotic therapy had higher all-cause mortality (31 vs. 5% P = 0.001). A multivariate logistic regression analysis identified two independent predictors of treatment failure: presence in the ICU at any point during their illness (odds ratio (OR) = 2.74, 95% confidence interval (CI) = 1.08–6.99, P = 0.034) and not receiving anticoagulation (OR = 0.24, 95% CI = 0.11–0.54, P < 0.001).ConclusionIntravenous antimicrobial therapy for 28 days or longer carries a survival advantage over shorter duration of therapy and anticoagulation as an adjunctive treatment is an independent predictor of successful antimicrobial therapy.Disclosures I. Raad, The University of Texas MD Anderson Cancer Center: Shareholder, Licensing agreement or royalty. The Unversity of Texas MD Anderson Cancer Center: Shareholder, Dr. Raad is a co-inventor of the Nitroglycerin-Citrate-Ethanol catheter lock solution technology which is owned by the University of Texas MD Anderson Cancer Center (UTMDACC) and has been licensed to Novel Anti-Infective Technologies LLC, in which UTMDACC and Licensing agreement or royalty.