Higher Incidence Of Arterial Thrombosis Research Articles

КЛИНИЧЕСКИЙ СЛУЧАЙ ВНУТРИСЕРДЕЧНОГО ТРОМБОЗА НА ФОНЕ ПЕРЕНЕСЕННОЙ ИНФЕКЦИИ SARS-COV-2

The damage to humanity and global healthcare done by the COVID-19 pandemic is hard to overestimate. According to the World Health Organization (WHO), there were more than 500 million confirmed cases of SARS-CoV-2 infection, more than 6 million of which were fatal. The high incidence of arterial thrombosis and venous thromboembolic complications despite the ongoing antithrombotic therapy, often leading to death in patients with new coronavirus infection SARS-CoV-2, indicates the need for profound study of the pathogenetic aspects of procoagulant status and a more rational personalized approach in prophylactic measures in this category of patients. Special interest is the development of thrombotic complications in COVID-19 convalescents. This article presents a clinical case of a 43-year-old man with no cardiovascular history who suffered viral myocarditis with thrombus formation in the heart cavities, thrombosis of deep veins of the lower extremities and consequent pulmonary thromboembolism, all of which developed within a month after coronavirus infection. In the article authors discuss the leading pathophysiological mechanisms that potentially could propagate the development of thrombosis and thromboembolic complications in patients with COVID-19.

Disseminated intravascular coagulation as a form of presentation of coronavirus-19 disease. Clinical case

The covid-19 disease (coronavirus disease 2019) is a novel disease causing a world pandemic. Its presentation varies from an asymptomatic infection to a pneumonia with acute respiratory distress syndrome. We present a case presenting initially as a covid-19 pneumonia together with a disseminated intravascular coagulopathy consisting of arterial and venous thrombosis in different locations and a shock requiring admission in the intensive care unit. The abnormal coagulation test in covid-19 patients have been described since the first cases observed in Wuhan, China, as well as an increased incidence of venous thrombosis. On the contrary, a higher incidence of arterial thrombosis has not been described in these patients. The unusual case we present could be a manifestation of this altered tests.

PF682 MULTICENTER RETROSPECTIVE STUDY EVALUATING FIBROSIS RISK IN PATIENTS WITH ET DEPENDING ON THE TREATMENT SCENARIO

Background:The main objective of the treatment of essential thrombocythemia (ET) is to reduce thrombohemorrhagic events. According to last European LeukemiaNet (ELN) guidelines, hydroxycarbamide (HU) and interferon (IFN) are recommended as a first line therapy and anagrelide (ANA) is a second‐line therapy option in high‐risk patients with ET. According to the literature, ANA is not inferior to HU, but in some studies there was observed an association of ANA with a higher incidence of arterial thrombosis, bleeding complications and fibrotic progression. Thus, the panel of the ELN did not reached a consensus on recommending the ANA in first line therapy.Aims:to analyse the outcome of ET patients according to received therapy (ANA vs HU vs ANA plus HU vs no treatment)Methods:We performed the multicentre, retrospective study. The study was conducted in accordance with the Declaration of Helsinki. We analysed 993 ET patients diagnosed and treated between 1985 and 2017. Clinical and analytical data were collected at diagnosis (age, sex, WBC, Hgb, Plt, LDH, mutation status, karyotype, splenomegaly, IPSET, thrombosis previous at diagnosis). Patients with suspicious of prefibrotic fase of myelofibrosis (pre‐PMF), were excluded from the analysis. Patients were classified according to the therapy they received (HU, ANA, HU plus ANA, no therapy). The statistical analysis due the lack of normal distribution of variables was based on analysis of variance (ANOVA). The survival analysis was prepared using Kaplan‐Meier estimator.Results:There was 542 (54.6%) patients on HU, 117 (11.8%) on ANA, 75 (7.5%) on ANA plus HU, 33 (3.3%) with other therapy and 226 (22.8%) with no treatment. We did not find significant differences in clinical and analytical data at diagnosis between 4 groups of patients. The median follow‐up was 99 (> 12–354) months. Respect to the frequency of transformation to myelofibrosis, there was no significant differences between patients on ANA vs on HU (p = 0,848). However, we observed increased frequency of progression to myelofibrosis in patients on HU plus ANA vs no treatment (9.33 vs 3.54%; p = 0,046). There was no significant differences between patients on ANA vs no treatment and patients on HU vs no treatment. The overall survival free from fibrotic transformation (HU vs ANA vs HU plus ANA vs no treatment) is presented on a figure. Patients who presented fibrotic transformation vs no transformation had significantly higher LDH level at diagnosis (284.9 vs 246.7; p = 0.023). Moreover, fibrotic transformation was significantly more frequent in ET JAK2 (−) vs ET JAK2 (+) (8.9 vs 4.4; p = 0.057).Summary/Conclusion:There was no significant difference between fibrotic transformations in ET on HU vs ET on ANA. The risk of fibrotic transformation of ET seems to be related to analytical data and biological features previous to start the treatment but not with the therapy. The association between HU+ANA therapy and myelofibrosis transformation probably reflects a more advanced disease. Based on our data, contrary to previous observations, ANA does not seem to increase the risk of fibrosis. Concerning higher prevalence of fibrosis in HU+ANA ET therapy, further study is necessary to establish the safety of combined treatment.image

Acute mesenteric artery occlusion in hypobaric oxygen environment

Background: Acute mesenteric ischemia represents a challenge in Taif and related districts where hypobaric oxygen may add to other risk factors as prevalence of diabetes mellitus and obesity. The aim of this retrospective study was to record and discuss the underlying risk factors, pattern of presentation, methods of diagnosis and results of treatment of acute mesenteric ischemia in Taif Tertiary Hospitals.Methods: In this chart review and database study, thirty-one patients met the inclusion criteria in the period from January 2009 to December 2017. The outcomes included demographics, risk factors, clinical findings, diagnostic and therapeutic methods, in addition to the mortality and follow up of the study population.Results: The commonest presenting symptom was abdominal pain (100%), of them 45.2% had marked peritoneal signs. Diagnosis was established by CT angiography in 41.9% and after exploratory laparotomy in 58.1% of patients. Mesenteric artery thrombosis was the cause in 64.5% and embolism in 35.5%. In all patient’s necrotic bowel segments were resected followed by revascularization. Reoperation was performed in 32.3% of patients. Perioperative deaths were 41.9% and the overall mortality 58.1%.Conclusions: The findings of this study are not quite different from that performed on population living in normobaric oxygen environment except for a higher incidence of arterial thrombosis. Validation of these findings needs more standardized large prospective studies to avoid the impact of different confounding factors and the limited statistical power related to small sample sizes.

Pediatric En Bloc Kidney Transplants: Clinical and Immediate Postoperative US Factors Associated with Vascular Thrombosis.

Purpose To evaluate clinical and immediate postoperative ultrasonographic (US) risk factors associated with vascular thrombosis of pediatric en bloc kidney grafts. Materials and Methods This institutional review board-approved HIPAA-compliant retrospective study consisted of 195 recipients of pediatric en bloc kidney grafts throughout a 10-year period. The average recipient and donor age was 45 years (range, 7-74 years) and 9 months (range, 0-84 months), respectively. Clinical factors and immediate postoperative US findings were assessed. Categorical variables were evaluated by using the Fisher exact test and linear models with generalized estimating equations. Results Seventeen patients (23 kidneys) experienced thrombotic events. In six patients (eight kidneys), thrombosis occurred intraoperatively. The remaining 11 patients (15 kidneys) received a diagnosis of thrombosis on postoperative days 1-13. Recipients more than 40 years old had a higher incidence of arterial thrombosis than did younger recipients (eight of 62 vs three of 133, respectively; P < .01). Recipients were more likely to develop thrombosis with donor weight less than 5 kg (10 of 52 vs seven of 140 with donor weight of ≥ 5 kg; P < .01), with intraoperative perfusional concern (10 of 21 vs seven of 174 without; P < .01), or with right-sided allograft placement (10 of 64 vs seven of 131 left sided; P = .03). At US of the 15 postoperative thrombotic events, the incidence of thrombosis was greater when donor arterial velocity was less than 100 cm/sec (seven of 56 vs four of 126 with velocity ≥ 100 cm/sec; P = .04). An intrarenal arterial resistive index of less than 0.6 was associated with higher incidence of arterial thrombosis (nine of 123 vs zero of 217, respectively; P = .01). A resistive index greater than 0.8 was associated with a higher incidence of venous thrombosis (four of 13 vs one of 217, respectively; P = .04). Conclusion Clinical factors and immediate US findings can help stratify patients receiving pediatric en bloc kidneys into risk categories for vascular thrombosis that, if proven in prospective studies, could affect immediate postoperative treatment. (©) RSNA, 2015.

A Revised Arterial Anastomosis Technique for Improving Mouse Renal Transplant Outcomes.

PURPOSE: One of the most challenging research microsurgical techniques is the mouse kidney transplant. Despite being first reported over 40 years ago, very few laboratories have been able to make use of this important model due to its technical difficulty. One of the main obstacles to using this procedure is the high incidence of arterial thrombosis with traditional arterial anastomosis. We hypothesized that thrombosis is caused by a tortuous route and areas of turbulence along the path blood flows from recipient abdominal aorta to donor aorta, and on into the renal artery. We propose that disruption in smooth flow dynamics leads to thrombus formation and graft loss. METHODS: Kidney transplants were performed using traditional and revised methods. Kidney histology and apoptosis were assessed by a nephropathologist in a blinded fashion, and function was measured using serum creatinine (sCr). Acute tubular injury (ATI) was scored as follows: 0 = none, 1 ≤10%, and 5 > 75% of tubules involved. RESULTS: Traditional arterial anastomosis involved square dissection of the donor abdominal aorta which, when sewn to the recipient aorta required blood flow to negotiate a bend of >90°. Here we describe a revised method of donor aorta harvest by creating a heel and toe cuff (Fig. 1a). The traditional method resulted in a tortuous path (Fig. 1b), while the revised method straightened the flow path and reduced the recipient aorta to donor arterial cuff angle to <90° (Fig. 1c). Arterial thrombus incidence decreased from 35% to 0%, without a change in warm ischemia time ( 38 ± 3 vs. 38 ± 5 mins for revised technique vs. traditional technique, P=NS). The revised technique resulted in excellent function (sCr=0.4mg/dL) and histology, with pathological ATI score=1, and apoptosis score=0. CONCLUSION: The revised arterial anastomosis technique using a heel and toe cuff results in a straighter flow path thereby reducing thrombus formation and improving mouse renal transplant outcomes.Figure: No Caption available.

Hypereosinophilic Syndrome, Churg-Strauss Syndrome and Parasitic Diseases: Possible Links between Eosinophilia and Thrombosis

Throughout the past decade, a possible role of eosinophils in blood coagulation and thrombosis has been suggested. We conducted a Pubmed (MEDLINE) search of case and series referring to any kind of thrombotic events described in three conditions characterised by persistent blood eosinophilia, i.e. the hypereosinophilic syndrome (HES), the Churg Strauss syndrome (CSS), and parasitic infestations from 1966 to date. One hundred and ninety-two articles were found regarding thrombotic events in HES and CSS, and 209 cases of thrombosis were extracted. One hundred and seventy- seven articles dealing with parasitic diseases and thrombosis were found, but only 15 manuscripts reporting thrombosis of unknown origin in 22 patients were selected. In HES, arterial thromboses were more frequent than in CSS (p=0.006), representing almost half of the cases (45%), while venous and mixed artero-venous thrombosis were respectively 28% and 27%. In contrast, in CSS there was a predominance of venous thrombosis (56%, p=0.006), with arterial thrombosis representing 38% of total thrombotic events, and mixed thrombosis being the least frequent (4%). The higher incidence of arterial thrombosis in HES patients can be explained by the common cardiac involvement (64% of patients). In the 22 patients with parasitoses and thrombosis, 15 had arterial thrombosis (68%) and 7 had venous thrombosis (32 %). Literature analysis shows that there are numerous reports of thrombotic events in patients with eosinophil-related disorders supporting a role for eosinophils in thrombosis. This observation raises the problem of prevention and treatment of thromboembolism particularly in HES and CSS patients.

High incidence of arterial thrombosis in young patients treated for multiple myeloma: results of a prospective cohort study

AbstractThis prospective study evaluated the risk of arterial thrombosis in 195 consecutive patients aged 18 to 65 years with newly diagnosed multiple myeloma (MM). All patients were treated with 3 cycles of VAD (vincristine, doxorubicin, and dexamethasone) or TAD (thalidomide-AD) or PAD (bortezomib-AD) in national trials, followed by high-dose melphalan and autologous stem cell transplantation. For a period of 522 patient-years, 11 of the 195 patients (5.6%) developed arterial thrombosis. The highest incidence was seen during induction chemotherapy courses. Median age at onset of arterial thrombosis was 59 years (range, 43-65 years). Hypertension and smoking were significantly associated with arterial thrombosis with a relative risk of 11.7 (2.23-61.2) and 15.2 (1.78-130), respectively. Factor VIII levels (FVIII:C) correlated significantly with age (P = .02) and higher International Scoring System (ISS) stage (P = .001). A higher FVIII:C was associated with arterial thrombosis (hazard ratio [HR] = 1.85; 95% confidence interval [CI] = 0.99-3.47) after adjustment for age, ISS score, and assigned treatment arm. MM patients have an increased risk for arterial thrombotic events during and after induction chemotherapy. Hypertension, smoking, and high factor VIII levels, possibly reflecting disease activity, contribute to the risk of arterial thrombosis.

High Incidence of Arterial Thrombosis in Young Patients Treated for Multiple Myeloma:Results of a Prospective Cohort Study.

Abstract 149▪▪This icon denotes an abstract that is clinically relevant.It is well known that patients with multiple myeloma (MM) are at high risk for venous thromboembolism (VTE). Thrombotic complications are most frequently seen in patients treated with thalidomide based regimens. Several other risk factors for VTE have been identified including abnormalities in coagulation factors, such as high factor VIII levels, APC resistance and hypofibrinolysis. Recently a few cases of MM patients and arterial thromboembolism (ATE) have been reported. Therefore we prospectively studied the risk of ATE in 195 consecutive patients aged <66 years with previously untreated MM. All patients were treated according to the HOVON 50 study protocol, a prospective randomized phase III study on the effects of 3 courses of doxorubicin and dexamethasone with thalidomide (TAD) or vincristine (VAD) followed by high dose melphalan and thalidomide or interferon-alpha2 maintenance or the HOVON 65 study protocol, a prospective randomised phase III study on the effects of 3 courses doxorubicin and dexamethasone with vincristine (VAD) or bortezomib (PAD), followed by high dose melphalan and bortezomib or thalidomide maintenance. All patients treated with TAD courses received prophylaxis for VTE with low molecular-weight heparin. During a follow-up of 522.4 patient-years 11 patients (5.6%) developed ATE. Most events occurred within one year after start of treatment (64%). Median age at onset of ATE was 59 years (range 43–65). For myocardial infarction we demonstrated an annual incidence of 0.77% in men and 0.19% in women compared to an equal age group, 55–59 years, described by Parikh et al in the Framingham Heart Study population who reported annual incidences of 0.22% in men and 0.04% in women, respectively. For cerebral ischemic events we demonstrated an annual incidence of 0.77% in men and 0.19% in women compared to 0.29% in men and 0.22% in women in the general Dutch population, aged 55–59, as described by Gijsen and Poos. Of thrombophilic factors a statistically significant higher factor VIII:C (FVIII:C) was observed in symptomatic patients, 2.93 IU/ml (1.16–6.45) versus 2.15 (0.74–6.48) (p=0.03). FVIII:C correlated significantly with age (p=0.02) and ISS stage (p=0.001). Adjustment for age and ISS stage, revealed a RR for ATE of 11.67 (95% CI: 2.23–61.18) for hypertension, a RR of 15.17 (1.78–129.54) for smoking and a RR of 1.85 (0.99–3.47) for each IU/ml increase in FVIII level, respectively. In conclusion, MM patients are at high risk for arterial thrombotic events during and following induction chemotherapy. High factor VIII levels, which may reflect disease activity, contribute to the risk of ATE especially in patients with known risk factors for cardiovascular disease. Disclosures:Sonneveld:Johnson&Johnson: Consultancy.

UMBILICAL ARTERY CATHETERIZATION: DEMONSTRATION OF ARTERIAL THROMBOSIS BY AORTOGRAPHY

One hundred consecutive admissions to a neonatal intensive care unit were included in a prospective study designed to ascertain the frequency of clinically silent thrombosis among infants with umbilical artery catheters. Eighteen of 19 infants (95%) had distinct arterial thrombus formation demonstrated by hand injection of contrast media at the time of catheter removal. In addition, 7 of the 12 patients (58%) who died were found to have clots present by necropsy. Only one patient had clinical evidence of vascular occlusion prior to the pullout aortogram, though a second infant became symptomatic 4 hours after the study and subsequently died. Careful selection of patients in whom umbilical artery catheters are inserted is emphasized because of the unexpectedly high incidence of arterial thrombosis associated with this procedure.