History Of Deep Venous Thrombosis Research Articles

Prediction of Health Status in Patients Undergoing Lower Extremity Intervention for Claudication

Identifying predictors of generic and disease-specific health status outcomes in patients with lower extremity peripheral artery disease (PAD) who undergo femoral-popliteal peripheral vascular intervention (PVI) for claudication remains an under-studied area. We aimed to identify important predictors of health status after PVI as the foundation for risk-based approaches to deploying therapies that improve patient outcomes. Baseline characteristics of 468 participants with claudication and femoral/popliteal stenosis treated with either the Stellarex paclitaxel-based drug coated balloon (DCB) or plain balloon angioplasty (PTA) from 2013 -2019 were included. The study examined 59 baseline variables and aimed to identify the most important predictors of generic (EQ-5D-3L and EQ-5D visual analogue scale [VAS]) and disease specific (Walking improvement Questionnaire [WIQ]) health status at 1 year. A random forest model was used to generate a rank variables based on their importance in predicting 1-year health status. Among included patients, mean ± SD age was 68.3 ± 9 years with 67.9% and 87% being male and white respectively. Baseline mean EQ-5D-3L, EQ-5D VAS and WIQ were 0.7 ± 0.3, 64.6± 16.0 and 30.7± 22.1, respectively. The most important variables for predicting EQ-5D-3L, EQ-5D VAS, and WIQ were a history of deep venous thrombosis, chronic lung disease and hypertension, respectively. Among patients undergoing PVI for claudication, comorbidities were the most important predictors of future health status, underscoring the need for an integrated approach for PAD disease management. Utilization of machine learning approaches can facilitate development of models to inform risk-based approaches to treatment.

Venous thromboembolism risk and its assessment in hospitalized patients

Abstract The annual incidence of symptomatic deep venous thrombosis (DVT) and venous thromboembolic (VTE) (DVT plus pulmonary embolism) in the adult population is estimated to be 50–100 and 75–150/100,000, respectively, and the incidence doubles for every 10-year increase in age. Patients admitted to hospitals, both surgical and medical, are at particularly increased risk for VTE, and the problem has been shown to continue after discharge. The risk is increased by age, obesity, malignancy, history of VTE, family history of DVT, stay in the intensive care unit, hereditary or acquired thrombophilia, and more recently, an elevated D-dimer. This risk is also affected by the nature and duration of the operation, type of anesthesia, immobility, dehydration, sepsis, varicose veins, inflammatory bowel disease, hormone replacement therapy, pregnancy, and pregnancy-related complications (stillborn infant, unplanned abortions, placental insufficiency, and growth retarded infant). Several risk assessment scoring systems are now available for clinical use. The ones most commonly used are the Rogers, Caprini, and Chao-Yang in surgical patients and the Padua, International Medical Prevention Registry on Venous Thromboembolism, and IMPROVEDD in acutely ill medical patients. The mandatory use of a risk assessment tool on admission and in high VTE risk patients at discharge as well and implementation of an evidence-based pathway for thromboprophylaxis have made the prevention of many fatal pulmonary emboli after surgery or hospitalization a reality.

Incidence and characteristic of deep venous thrombosis in hospitalized chronic heart failure patients.

This study was conducted to investigate the incidence of deep venous thrombosis (DVT), outcomes and its characteristics in patients with chronic heart failure (CHF) in a retrospective setting. Patients died of cardiac shock or acute exacerbation of heart failure (HF), admitted to intensive care unit (ICU) due to acute exacerbation of HF, patients decided to withdraw treatment and return home due to acute exacerbation of HF. From January 2015 to June 2022, we admitted 359 patients diagnosed with CHF, and lower limb ultrasonography was performed for the examination of DVT after admission. The incidence of DVT was recorded and patients with known risk factors of VTE were identifiedand excluded after incidence of DVT was calculated. Patients' clinical data were thencollected. The occurrence of DVT was 10.0% (36/359), as calf intramuscular vein thrombosis was the main constitution (n = 28, 75%). DVT patients with other factors (carcinoma, surgery, stroke, previous history of DVT) constituted a considerable part (33.3%, 12/36). Age, history of Diabetes Mellitus (DM), levels of DDi (D-Dimer), levels of alanine transferase (ALT) and left ventricular end-diastolic diameter (LVEDd) were independent predictors or risk factors of DVT in CHF patients, while chronic kidney disease (CKD) stage 1-4, white blood cell (WBC) and direct oral anticoagulant (DOAC) were protective factors. Incidence of DVT was correlated with a poor outcome of CHF patients (Pearson Chi-Square test, Value 19.612, P < 0.001). In this retrospective study, incidence of DVT was found to be relatively high among hospitalized CHF patients, while patients with DVT was associated with a poor prognosis.

Analysis of tranexamic acid usage in adult spinal deformity patients with relative contraindications: does it increase the risk of complications?

Complex spinal deformity surgeries may involve significant blood loss. The use of antifibrinolytic agents such as tranexamic acid (TXA) has been proven to reduce perioperative blood loss. However, for patients with a history of thromboembolic events, there is concern of increased risk when TXA is used during these surgeries. This study aimed to assess whether TXA use in patients undergoing complex spinal deformity correction surgeries increases the risk of thromboembolic complications based on preexisting thromboembolic risk factors. Data were analyzed for adult patients who received TXA during surgical correction for spinal deformity at 21 North American centers between August 2018 and October 2022. Patients with preexisting thromboembolic events and other risk factors (history of deep venous thrombosis [DVT], pulmonary embolism [PE], myocardial infarction [MI], stroke, peripheral vascular disease, or cancer) were identified. Thromboembolic complication rates were assessed during the postoperative 90 days. Univariate and multivariate analyses were performed to assess thromboembolic outcomes in high-risk and low-risk patients who received intravenous TXA. Among 411 consecutive patients who underwent complex spinal deformity surgery and received TXA intraoperatively, 130 (31.6%) were considered high-risk patients. There was no significant difference in thromboembolic complications between patients with and those without preexisting thromboembolic risk factors in univariate analysis (high-risk group vs low-risk group: 8.5% vs 2.8%, p = 0.45). Specifically, there were no significant differences between groups regarding the 90-day postoperative rates of DVT (high-risk group vs low-risk group: 1.5% vs 1.4%, p = 0.98), PE (2.3% vs 1.8%, p = 0.71), acute MI (1.5% vs 0%, p = 0.19), or stroke (0.8% vs 1.1%, p > 0.99). On multivariate analysis, high-risk status was not a significant independent predictor for any of the thromboembolic complications. Administration of intravenous TXA during the correction procedure did not change rates of thromboembolic events, acute MI, or stroke in this cohort of adult spinal deformity surgery patients.

Three-Year Outcomes, Risk Factors for Restenosis After Stenting for DVT Combined with Iliac Vein Compression Syndrome.

This study aimed to evaluate the safety and efficacy of pharmacomechanical catheter-directed thrombolysis (PCDT) and stenting for treating acute iliofemoral deep venous thrombosis (DVT) combined with iliac vein compression syndrome (IVCS), and to identify the predictors of stent restenosis. Patients with acute proximal DVT combined with IVCS underwent PCDT and stenting from January 2017 to December 2022 were enrolled. Primary and secondary patency were assessed by duplex ultrasound (DUS). The morbidity of postthrombotic syndrome (PTS) was assessed by the Villalta score. Risk factors for stent restenosis were assessed using univariate and multivariate Cox regression models. Total of 254 patients were included. The mean follow-up time was 36.06 ± 17.66 months. The primary patency rates at 1 year, 3 years, and 5 years were 92.5%±1.7%, 85.4%±2.4%, and 82.4%±2.9%, respectively. The incidence of stent restenosis was 14.2%. Discontinuation of anticoagulants within one year [hazard ratio (HR) = 5.03; P = .048] was the factor associated with acute in-stent thrombosis. Previous DVT history (HR =2.29; P = .037) and stent placement across the inguinal ligament (HR =6.70; P < .001) were identified as independent risk factors significantly associated with stent restenosis. The overall PTS rate was 19.3%. PCDT with stenting is safe and effective for patients with iliofemoral DVT secondary to IVCS, leading to low rates of PTS. Previous DVT history and stents placed across the inguinal ligament may be predictors of stent restenosis. Furthermore, stent restenosis typically occurs within one year and is mainly caused by acute thrombosis due to discontinuation of anticoagulants.

The Comparison of Pain intensity in the Patients Undergoing Thermal and Non-Thermal Ablation of Lower Extremity Veins for Chronic Venous Insufficiency with Visual Analogue Scale

Aim&#x0D; To compare the procedural pain intensity measured with VAS in patients undergoing thermal or non-thermal ablation of lower extremity veins for chronic venous insufficiency (CVI). &#x0D; Material and Method&#x0D; Patients who underwent a venous procedure, either thermal or non-thermal, in our clinic between June 2022 and December 2022 evaluated for inclusion to this retrospective study. The patients with available complete medical records in the database of the health center were included. Patients who had a history of deep venous thrombosis, thrombophlebitis, a venous intervention or who underwent open surgical venous procedure were excluded. Patients were asked to draw a line representing the intensity of the procedural pain on visual analogue scale (VAS). &#x0D; Results&#x0D; A total of 183 patients were evaluated and 60 (100%) patients whom complete medical records were available were included. The non-thermal ablation group included 30 (50%), the thermal ablation group included 30 (50%) patients. There were 14 (46.67%) males in non-thermal ablation group, 12 (40.00%) in thermal ablation group (P=0.602). The mean age in the non-thermal ablation group was 47.10 ± 9.84 years, 44.70 ± 8.84 years in the thermal ablation group (P=0.324). The procedure duration was significantly longer in thermal ablation group (22.70 ± 4.45 min in non-thermal ablation group vs 33.10 ± 3.64 min in thermal ablation group, P

Morbid Obesity Increases Length of Surgery in Elective Anterior Cervical Discectomy and Fusion Procedures but Not Readmission or Reoperation Rates: A Cohort Study

As the obesity epidemic grows, the number of morbidly obese patients undergoing anterior cervical discectomy and fusion (ACDF) continues to climb. Despite obesity's association with perioperative complications in anterior cervical surgery, morbid obesity's impact on ACDF complications remains controversial, and studies examining morbidly obese cohorts are limited. Single-institution, retrospective analysis of patients undergoing ACDF from September 2010 to February 2022. Demographic, intraoperative, and postoperative data were collected via review of the electronic medical record. Patients were categorized as non-obese [body mass index (BMI) < 30], obese (BMI 30-39.9), or morbidly obese (BMI ≥ 40). The associations of BMI class to discharge disposition, length of surgery, and length of stay (LOS) were assessed using multivariable logistic regression, multivariable linear regression, and negative binomial regression, respectively. A total of 670 patients undergoing single or multilevel ACDF were included, comprised of 413 (61.6%) non-obese, 226 (33.7%) obese, and 31 (4.6%) morbidly obese patients. BMI class was associated with prior history of deep venous thrombosis (p < 0.01), pulmonary thromboembolism (p < 0.05), and diabetes mellitus (p < 0.001). In bivariate analysis, there was no significant association between BMI class and reoperation or readmission rates at 30, 60 or 365 days postoperatively. In multivariable analysis, greater BMI class was associated with increased length of surgery (p = 0.03) but not LOS or discharge disposition. For patients undergoing ACDF, greater BMI class was associated with increased length of surgery but not reoperation rate, readmission rate, LOS, or discharge disposition.

Safety and Efficacy of Endovenous Ablation in Patients with a History of Deep Venous Thrombosis: A Study From the Venous Vascular Quality Initiative

Safety and Efficacy of Endovenous Ablation in Patients with a History of Deep Venous Thrombosis: A Study From the Venous Vascular Quality Initiative

Effectiveness of Virtual Rehabilitation Versus Therapeutic Exercises in the Balance Training of Lower Limb Among Post-Stroke Patients

Background: Stroke is the major source of death and disability and leads to impaired balance in post-stroke patients. Balance training is one of the main components of stroke rehabilitation. Virtual rehabilitation is gaining more popularity as it engages the patients attention in training. Objective: To evaluate the effects of virtual rehabilitation versus therapeutic exercises to improve the balance in patients with stroke. Methods: This randomized controlled trial conducted at Abdullah Hospital, Lalamusa from August to December 2022. The sample size of 30 participants was randomly divided into two groups virtual therapy group versus therapeutic exercises group, after taking their informed consent. Participants were recruited through the non-probability purposive sampling, between the age of 35 to 55 years, post-stroke survivors after 3 months and were able to stand up with or without assistive devices. Participants with auditory or visual dysfunction, a history of deep venous thrombosis, lower limb amputation, severe receptive or expressive aphasia, significant cognitive impairments and unstable hypertension were excluded. The data was collected from the patients by using Berg Balance Scale (BSS) at three different time frames: baseline, mid-intervention and post-intervention. The Shapiro-Wilk test was applied to calculate the normality of the data. For descriptive analysis, quantitative variables were calculated by mean and standard deviation whereas, for qualitative variables, frequency and percentages were used. To find significance an independent sample t-test was applied for between-group analysis and two-way repeated measure ANOVA was used to measure within-group analysis. Results: Both groups improved their balance after six months of intervention. Comparative analysis showed a significant improvement with p-value≤0.05 in both groups. The mean and standard deviation after six weeks of intervention in the virtual training group was 55.4±0.82 and the therapeutic exercise group was 54.47±1.3. This showed that the virtual rehabilitation group had improved balance in patients with stroke. Conclusion: Virtual rehabilitation was found to be effective in improving the balance of patients with stroke. It not only improves balance but also engages the patient in the treatment protocol. This rehabilitation is effective for the balance training of post-stroke patients.

Septic shock due to splenic abscess, complicated by empyema, secondary to colosplenic fistula post-gastrojejunostomy procedure: a case report

Background: Splenic abscess is a rare disease that can be due to many causes including infections or adnominal trauma and surgery. Complications of splenic abscess are fatal including septic shock which can be defined as sepsis leading to circulatory, cellular, and metabolic abnormalities, and the patient cannot maintain mean arterial pressure. Case Presentation: In this case, we report a 71-year-old male patient known to have diabetes mellitus, dyslipidemia, hypertension, and coronary artery disease. Past surgical history revealed that he underwent exploratory laparotomy and graham patch repair, followed by exploratory laparotomy with gastrojejunostomy. Patient has a history of deep venous thrombosis for 1 month on anticoagulant. He presented to the emergency department because of decreased level of consciousness. The patient appeared obtunded and pale, his blood pressure and oxygen saturation were low. Computed tomography (CT) pulmonary angiogram showed massive bilateral pleural effusion and abdominal CT showed splenic abscess and colosplenic fistula. Conclusion: Because splenic abscess secondary to previous abdominal surgeries is a rare condition, emergency physicians should have a high index of suspicion for such a rare phenomenon if they encounter severe sepsis or septic shock.

IBC-Ox32 Streamlining preoperative risk assessment: counterintuitive results in the Bariatric patient

Abstract Background Bariatric surgical operations continue to be performed in high numbers nationally, thus it is important to identify factors associated with post-surgical complications. This study aims to identify preoperative risk factors associated with bariatric surgery mortality. Methods A retrospective analysis was conducted on the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database to determine the strength of association between pre-operative exposures and 30-day mortality following bariatric surgery. A total of 701,265 primary bariatric operations were registered between the years of 2015 and 2017, consisting of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), adjustable gastric band (AGB), and duodenal switch (DS) Results From the 701,265 surgeries registered in the database, 636,286 had complete data points for the variables of interest and therefore were included in this analysis. The mean age of the cohort was 45.01 (SD= 11.96) years, mean BMI was 45.54 kg/m2 (SD=7.72), and 80.07% were female. Overall 30-day mortality was 0.10% (n=629). The association between the following preoperative variables and mortality within 30 days of bariatric surgery was not statistically significant: hyperlipidemia, history of pulmonary embolism, oxygen dependence, obstructive sleep apnea and history of venous stasis. Smoking status (AOR=1.38), insulin dependent diabetes (AOR=1.37) and the use of more than 3 hypertensive medications (AOR=1.30) were weakly associated with postoperative mortality (p&amp;lt;0.05; CI=95%). History of chronic obstructive pulmonary disease (COPD; AOR=2.00), partial functional dependency (AOR=2.09), renal insufficiency (AOR=1.63), dialysis (AOR=3.15), history of deep venous thrombosis (AOR=1.78), history of myocardial infarction (AOR=1.65) and history of cardiac surgery (AOR=1.87) were strongly associated with mortality (P&amp;lt;0.05; c.i. = 95%) Conclusion Bariatric surgery continues to be safe. Many factors that have traditionally been thought to contribute to mortality, such as diabetes, hypertension, smoking, and oxygen dependence may have little impact. Other variables such as previous heart surgery, functional dependency status and COPD may play a bigger role in adverse outcomes. While these associations do not determine causality, understanding the strength of them can guide physicians on preoperative risk assessment and care.

A Two Part Case Series on Acquired Hemophilia A

Abstract Introduction/Objective Acquired Hemophilia A is a rare condition with an incidence of 1 per 1.5 million per year. The average age at presentation is 74 years. It is due to spontaneous production of IgG autoantibodies that target endogenous factor viii. This disease should be considered when a patient presents with bleeding, an abnormal prolongation of activated partial thromboplastin time and /or no prior personal or family history of bleeding. Autoimmune disorders and malignancy are common associations. Pregnancy and surgery are common presenting scenarios. Methods/Case Report Case 1: 71 year old female with a history of deep venous thrombosis, and rheumatoid arthritis. Patient presented to the emergency department with a hemoglobin of 4.7 and coagulation studies showed a prolonged partial thromboplastin time of 119 seconds. Imaging revealed retroperitoneal bleeding. A mixing study showed no correction of partial thromboplastin time. The patient was treated with packed red blood cell transfusions until hemodynamically stable. Further coagulation studies revealed a factor VIII activity of 3L and factor VIII inhibitor level of 103 bethesda units. This confirmed suspicion of an acquired factor VIII inhibitor associated with the patient’s rheumatoid arthritis as the source of abnormal lab values and bleeding. Patient was treated with recombinant factor VIIa, novoseven, along with continuous prednisone and cyclophosphamide. Case 2: 82 year old male with history of IgG Kappa Monoclonal Gammopathy of Undetermined Significance. Patient presented with gastrointestinal bleeding and 4g/Dl hemoglobin. He received 5 units of packed red blood cells. Sigmoidoscopy revealed a rectal ulcer causing lower gastrointestinal bleeding. An advanced coagulation study revealed factor VIII activity of 1%, and inhibitor levels of 17 bethesda units. Patient was started on prednisone initially, followed by cyclophosphamide. However, bleeding continued. He was treated with 6 units of recombinant factor VIIa and packed red blood cell transfusions as required to keep hemoglobin levels at 7g/Dl. He was continued on prednisone at an increased dosage and discharged. Results (if a Case Study enter NA) NA. Conclusion Acquired Hemophilia A is a rare disease. It should be suspected anytime there is unprecedented bleeding and/or unexplained prolongation of partial thromboplastin time. It is diagnosed with factor VIII panel, including inhibitor. Treatment includes immunosuppresants, intravenous immunoglobulins, and recombinant factor VIIa.

Abstract 14626: Dissecting Out Risk Factors: A Case of Spontaneous Coronary Artery Dissection Without Traditional Risk Factors, in the Presence of Methamphetamine Use

Introduction: Methamphetamine use is not a traditional risk factor for spontaneous coronary artery dissection (SCAD). There have been several case reports suggesting an association between methamphetamine use and SCAD. Case: We present a case of a 50-year-old female with a history of hypertension, hyperlipidemia, stroke, and active tobacco use who presented with substernal chest pain radiating to the back and abdomen with associated dyspnea and diaphoresis. The patient was also taking warfarin for a prior history of deep venous thrombosis. Her serum 5 th generation troponin level was elevated to a peak of 1135 ng/L, and a 12-lead EKG showed ST-elevations not meeting STEMI criteria (1mm in V3, 2mm in V4, and 0.5mm in V5). Coronary angiography showed a short section of SCAD type 1 involving the mid portion of the LAD with TIMI 3 flow. There was no significant atherosclerotic disease throughout any of the vessels. The patient was managed conservatively with medical therapy and had resolution of her pain. CT-angiography of the chest, abdomen and pelvis was performed to rule out dissection involving the aorta and its branches and was unrevealing. Urine toxicology screening returned positive for methamphetamine. Given a lack of other traditional risk factors aside from gender, the patient was diagnosed with SCAD secondary to methamphetamine use. Discussion: Traditional risk factors for SCAD include female sex, fibromuscular dysplasia, connective tissue disease, multiparity (our patient was parity 1), and exogenous hormone use. Methamphetamine use as well as prescription amphetamines have been associated with SCAD in several case reports. SCAD tends to occur in women with an absence of risk factors for coronary artery disease. However, even in patients with multiple risk factors for atherosclerosis and an absence of risk factors for SCAD, SCAD should not be excluded in the differential when a history of amphetamine use is elicited.

Association of duplex ultrasonography findings with the severity of chronic venous disease in Thai patients

IntroductionChronic venous disease (CVD) is characterized by venous hypertension and stasis, which occur because of valvular incompetence and/or venous outflow obstruction. This study aimed to investigate the relationship between CVD clinical presentation and duplex ultrasonography findings in a Thai patient population. MethodThis cross-sectional study examined patients diagnosed with CVD at the Chulabhorn Hospital Vascular Clinic (Bangkok, Thailand) between December 1, 2018 and October 1, 2021. Patient data was obtained from the medical records and review of lower limb venous ultrasonography studies. Patients were assessed using the Clinical, Etiological, Anatomical, and Pathological (CEAP) classification of venous disorders: mild-to-moderate CVD was defined as C1 to C3 and severe CVD was defined as C4 to C6. ResultsOverall, 260 CVD patients were analyzed (60 men and 200 women). More than 75% of the patients were women and more than 80% had bilateral lower limb involvement. Factors associated with severe CVD were older age, female sex, high body mass index, hypertension, diabetes mellitus, and history of deep venous thrombosis. The most common CEAP classification was C2 (38.8%), followed by C1 (33.85%), C4 (12.2%), C3 (9.23%), C6 (3.46%), and C5 (2.31%). Two-thirds of the patients had great saphenous vein reflux and nearly half had perforator vein reflux. Perforator reflux and small saphenous vein reflux were significantly associated with severe CVD (P < 0.001 and P = 0.028, respectively). Higher number of venous systems involved was significantly associated with severe CVD (P = 0.005). Reflux time of the great saphenous vein correlated with severe CVD and VCSS (P = 0.026 and P = 0.037, respectively). Mean diameters of the superficial vein, perforator vein, and deep vein and reflux times of the perforator and deep veins were not significantly associated with severe CVD. ConclusionThe major risk factors for severe CVD are older age, female sex, high body mass index, hypertension, diabetes mellitus, and history of deep venous thrombosis. The most common CEAP classification was C2 (39%). Great saphenous vein reflux was the most common type of reflux in our study population. Increasing number of venous systems involved increased the risk of severe CVD. The presence of perforator vein reflux and small saphenous vein reflux also increased the risk of severe CVD. Reflux time of the great saphenous vein correlated with severe CVD and venous clinical severity score.

A disturbed balance between blood complement protective factors (FH, ApoE) and common pathway effectors (C5a, TCC) in acute COVID-19 and during convalesce

A complement effect on homeostasis during infection is determined by both cytotoxic (activate complement component 5 (C5a) terminal cytotoxic complex (TCC)), and cytoprotective elements (complement factor H (FH), as well as apolipoprotein E (ApoE)). Here, we investigated the gap in knowledge in their blood milieu during SARS-CoV-2 infection with respect to the viral burden, level of tissue necrosis, and immunological response. 101 patients hospitalized with a PCR-confirmed diagnosis of COVID-19 had blood collected at H1 (48 h), H2 (3–4 Days), H3 (5–7 days), H4 (more than 7 days up to 93 days). Pre-existing conditions, treatment, the incidence of cerebrovascular events (CVA), a history of deep venous thrombosis (DVT) and pulmonary embolism (PE), and mortality was collected using electronic medical records. Plasma C5a, TCC, FH, and ApoE were considered as a complement milieu. Tissue necrosis (HMGB1, RAGE), non-specific inflammatory responses (IL-6, C-reactive protein), overall viral burden (SARS-CoV-2 spike protein), and specific immune responses (IgG, IgA, IgM directed αS- & N-proteins) were assessed simultaneously. C5a remained elevated across all time points, with the peak at 5–7 days. Studied elements of complement coalesced around three clusters: #0 (↑↑↑C5a, ↑↑TCC, ↓↓ApoE), #1 ↑C5a, ↑TCC, ↑↑↑FH); #2 (↑C5a, ↑TCC, ↑FH, ↑↑↑ApoE). The decline in FH and ApoE was a predictor of death, while TCC and C5a correlated with patient length of stay, APACHE, and CRP. Increased levels of C5a (Δ = 122.64; p = 0.0294; data not shown) and diminished levels of FH (Δ = 836,969; p = 0.0285; data not shown) co-existed with CVA incidence. C5a correlated storngly with blood RAGE and HMGB1, but not with viral load and immunological responsiveness. Remdesivir positively affected FH preservation, while convalescent plasma treatment elevated C5a levels. Three clusters of complement activation demonstrated a various milieu of ApoE & FH vs C5a & TCC in COVID-19 patients. Complement activation is linked to increased necrosis markers but not to viral burden or immune system response.

Phosphatidylserine and the thrombin–antithrombin complex as markers for hypercoagulability in Egyptian beta-thalassemia patients

Background Hypercoagulability is a known complication of thalassemia, in particular, thalassemia intermedia. Several factors contribute to this hypercoagulability, including chronic platelet activation and the presence of other comorbid conditions. In addition, the oxidation of globin subunits in thalassemic red blood cells (RBCs) triggers the formation of reactive oxygen species. These factors lead to the exposure of negatively charged phospholipids like phosphatidylserine (PS), which ultimately causes increased thrombin generation, particularly in splenectomized patients. Aim This study aimed to assess the risk for hypercoagulability in thalassemic patients using PS expression on RBCs and the thrombin–antithrombin (TAT) complex in plasma. Patients and methods This study included 50 thalassemic patients (19 patients with splenectomy and 31 patients without splenectomy) and 30 apparently healthy individuals as a control group. Patients were subjected to assessment of history for deep venous thrombosis or pulmonary hypertension by echocardiography. Annexin V was used to detect PS expression on RBCs by flow cytometry, while the enzyme-linked immunosorbent assay was used to detect the TAT complex in plasma. Results Erythrocyte PS expression was significantly higher (P&lt;0.001) in thalassemic patients than in the control group. The TAT complex level revealed no significant difference between thalassemia patients and the control group (P=0.468). Patients with pulmonary hypertension showed a statistically significant higher PS expression and TAT complex level. However, there was no significant increase in PS expression or TAT level in patients with a history of deep venous thrombosis only. Conclusion Increased PS expression and TAT complex level may be a risk factor for pulmonary hypertension in thalassemia patients with splenectomy.

Intracoronary thrombus visualized by optical coherence tomography in a patient with antiphospholipid syndrome

Abstract A patient with a history of deep venous thrombosis on warfarin underwent coronary angiography and was found to have a red intracoronary thrombus in the mid left anterior descending artery by optical coherence tomography. Percutaneous coronary intervention was successfully performed. On discharge, the patient continued triple therapy with aspirin, clopidogrel, and apixaban for 30 days then discontinued aspirin. A hypercoagulable work up was notable for antiphospholipid syndrome and lifelong anticoagulation was recommended. The patient continued apixaban twice daily given recurrent thrombosis while on warfarin and was event free at 6-month follow up.

Differential diagnosis between pulmonary artery sarcoma and central chronic pulmonary thromboembolism:a preliminary study on CT signs

Objective: To improve the diagnostic accuracy of pulmonary artery sarcoma, and to distinguish it from central chronic pulmonary thromboembolism using CT scans. Methods: In this retrospective study, two groups of pulmonary artery sarcoma (PAS group) and central chronic pulmonary thromboembolism (central CPTE group) confirmed by pathology at our hospital between August 2009 and July 2019 were enrolled, clinical features and pre-operative CT pulmonary artery manifestation were collected, and the key points of differential diagnosis were summarized. Results: The study was composed of 13 cases in the PAS group including 10 males (76.9%), with an average age of (45.4±15.5) years. There were 19 patients in the central CPTE group including 14 males (73.7%), with an average age of (38.6±14.1) years. There were no significant differences in gender and age between the two groups. Deep venous thrombosis in the lower extremities was significantly higher in the central CPTE group than in the PAS group (7/19 vs. 0/13, P=0.025), and the N-terminal pro-brain natriuretic peptide value was higher in the central CPTE group than in the PAS group [674.50(261.70-1 977.70) vs. 66.00(28.10-505.50),P=0.001]. In CT pulmonary angiography, the involvement of the main pulmonary artery, and the proximal lesion showing an acute angle to the pulmonary artery wall were more common in the PAS group [11(84.6%) vs. 5(26.3%), P=0.003; 11(84.6%) vs. 2(10.5%), P<0.001, respectively]. The swelling index of the main pulmonary and the left/right main pulmonary arteries in the PAS group were significantly higher, as well as the dilatation in the lobar and segmental pulmonary arteries [1.19±0.17 vs. 0.99±0.19,P=0.006, 10(76.9%) vs. 2(10.5%), P<0.001, respectively]. The right ventricular transverse diameter/left ventricular transverse diameter (RVd/LVd) and pulmonary artery diameter/ascending aortic diameter ratio (Pad/Aod) were significantly lower in PAS group than those in the central CPTE group (0.97±0.19 vs. 1.23±0.35,P=0.020; 0.98±0.25 vs. 1.15±0.20,P=0.039). Conclusions: In CT pulmonary angiography, filling defects involving the main pulmonary artery and showing expansive growth were highly suggestive of pulmonary artery sarcoma. The history of deep venous thrombosis of the lower extremities was helpful for the diagnosis of chronic pulmonary embolism.

Quantification of Hemodynamic Parameters in Primary Great Saphenous Reflux using Colour Doppler in Clinical Settings and Effect of GSV Ablation on the Venous Arterial Flow Index

Purpose: The aim of our study was to quantify venous reflux in outpatient settings using color Doppler and document objective improvement in hemodynamic parameters post ablation. Methods: Venous reflux was measured using color Doppler using venous-arterial flow index (VAFI), recirculation index (RCI), and percentage diameter change (PDC) (n = 30) and compared with healthy volunteers (n = 30), adjusted for age, sex, and body mass index (BMI). Patients with concomitant peripheral arterial disease (PAD), past history of deep venous thrombosis, chronic venous insufficiency, and venous ulcers were excluded from the study. Patients with reflux underwent RFA and VAFI was measured 6 months after treatment. Data were analyzed using IBM SPSS statistics software version 25. Tests of normality were applied before choosing statistical tests. Box-and-whisker plots with outliers were used to illustrate the difference between case and control groups. VAFI scores were compared pre- and postoperatively and Wilcoxon signed-rank test was applied for the comparison. P &lt; 0.05 defined statistical significance. Results: Thirty patients with primary GSV reflux along with 30 healthy volunteers were adjusted for age, sex, and BMI. Clinical part of CEAP classification was C0 = 2, C1 = 6, C2 = 16, and C3 = 6 in reflux group and C0 = 26 and C1 = 4 in (n = 30) in healthy volunteers. There was a statistical difference in RCI, PDC, and VAFI across both groups (P &lt; 0.5). In addition, VAFI decreased significantly after treatment at 6 months (1.38 preoperative to 0.95 postoperative, SD P &lt; 0.5). Of the 30 patients, 21 had pain as the primary presenting symptom; 81% (17) reported a significant decrease in pain scores associated with hemodynamic improvement. Conclusion: RCI, PDC, and VAFI are accurate quantitative measurements of reflux in outpatient settings. VAFI is useful in objectifying the results of treatment. Symptomatic improvement in terms of pain score can be used to supplement the hemodynamic improvement though further substantiation of the above would be required in a larger cohort.

Negative Venous Leg Ultrasound in Acute Pulmonary Embolism: Prevalence, Clinical Characteristics and Predictors.

The purpose of this study was to investigate the prevalence, clinical characteristics, and predictors of negative venous leg ultrasound in acute pulmonary embolism (PE). We retrospectively analyzed a cohort of 168 patients with acute PE (median age 73 years, 44% women) evaluated with complete venous leg ultrasound. A multivariate logistic regression analysis was performed to identify the independent predictors of negative venous ultrasound in acute PE. Venous leg ultrasound was negative for deep venous thrombosis (DVT) in 78 patients (46.4%). Patients with negative venous ultrasound were less likely to have a history of DVT (7.7% vs. 20.0%, p = 0.0273) and had significantly lower D-dimer levels (median 2.5 vs. 6.2 mg/dL p < 0.0001). Negative venous ultrasound was more frequent in PE diagnosed with V/P-SPECT than in PE diagnosed with CT (66.2% vs. 34.0%, p < 0.0001). The prevalence of negative venous ultrasound increased with more peripherally located PE (29.5% for central/lobar, 43.1% for segmental, and 60.6% for subsegmental PE, p = 0.0049). For the multivariate analysis, a diagnosis of PE with V/P-SPECT rather than CT (OR 3.2, p = 0.0056) and lower D-dimer levels (OR 0.94, p = 0.0266) were independent predictors of negative venous ultrasound. In conclusion, venous leg ultrasound was negative for DVT in almost half of patients with acute PE. Negative venous ultrasound was more common in patients with no history of DVT, lower D-dimer levels, PE diagnosed with V/P-SPECT rather than CT, and more peripherally located PE.