Multiple Thrombosis Research Articles

An autopsy of a patient with polyarteritis nodosa who developed fatal intestinal perforation accompanied by systemic multiple aneurysms and arterial thrombosis.

The patient was a 48-year-old man who had developed acute myocardial infarction 3 years earlier. He started experiencing recurrent attacks of abdominal pain 2 years earlier. One month before the presentation, he developed perforative peritonitis, which was treated with right hemicolectomy. Preoperative computed tomography revealed systemic thrombotic aneurysms and fibrinoid necrotizing vasculitis was detected in the vessels in the serosa of the resected intestinal specimen. These findings led to a diagnosis of polyarteritis nodosa. Despite the start of remission induction therapy with high-dose glucocorticoid and intermittent intravenous cyclophosphamide, the effect of immunosuppressive therapy was limited. Approximately 1 month after treatment initiation, he died from small intestinal perforation. Polyarteritis nodosa often exhibits nonspecific clinical symptoms, which make an early diagnosis difficult in some cases. Although the prognosis depends on the presence of ischemic lesions due to a ruptured aneurysm or intra-aneurysmal thrombi, it is not rare for the diagnosis to be made following acute myocardial infarction or acute abdominal pain. In young patients with ischemic organ dysfunction without any arteriosclerotic lesions at low risk of developing cardiovascular events, early diagnosis can be made by performing a whole-body examination with a differential diagnosis of polyarteritis nodosa.

Antiphospholipid syndrome followed idiopathic retroperitoneal fibrosis in the same patient: A case report and review of literature

AbstractIntroductionIdiopathic retroperitoneal fibrosis (IRPF) is a rare fibro‐inflammatory disease characterized by fibrous sclerosis of the retroperitoneal area and may be accompanied by other autoimmune diseases. Herein, we report an unusual case of IRPF with compression of retroperitoneal vessels, then diagnosed with antiphospholipid syndrome (APS), evidenced by multiple venous thrombosis and persistent positivity of antiphospholipid antibodies (aPLs). Along with literature reviews, we highlighted the important of screening for all possible causes in case of thrombosis secondary to IRPF.Case DescriptionA 46‐year‐old male patient was admitted in 2010 due to hypogastralgia and low back pain. The initial laboratory findings showed elevated inflammatory indicators, but negative results of immunology screening. Abdominal computed tomography (CT) revealed diffuse soft tissue in the retroperitoneal area. IRPF was first diagnosed and initially treated with glucocorticoids and immunosuppressants. Along the process of tapering the drugs, IRPF relapsed again. Reexamination of CT scan showed newly developed thrombus in the retroperitoneal vessels. APLs were evaluated and persistently positive with the interval of six months. The diagnosis of APS was confirmed. Glucocorticoids and immunosuppressants were prescribed again accompanied with warfarin. During 17‐month follow‐up periods, there was no relapse of symptoms again.ConclusionWhen IRPF is accompanied by venous thrombosis, in addition to blood flow stasis due to venous compression, other potential causes of thrombophilia should also be considered.

Thrombosis with thrombocytopenia syndrome following adenovirus vector-based vaccines to prevent COVID-19: Epidemiology and clinical presentation in Spain

BackgroundWe describe the epidemiological and clinical characteristics of thrombosis with thrombocytopenia syndrome (TTS) cases reported in Spain. MethodsWe included all venous or arterial thrombosis with thrombocytopenia following adenovirus vector-based vaccines (AstraZeneca or Janssen) to prevent COVID-19 disease between February 1st and September 26th, 2021. We describe the crude rate and the standardized morbidity ratio. We assessed the predictors of mortality. ResultsSixty-one cases were reported and 45 fulfilled eligibility criteria, 82% women. The crude TTS rate was 4/1 000 000 doses and 14–15/1 000 000 doses between 30–49 years. The number of observed cases of cerebral venous thrombosis was 6–18 higher than the expected in patients younger than 49 years. Symptoms started 10 (interquartile range (IQR): 7–14) days after vaccination. Eighty percent (95% confidence interval (CI): 65%–90%) had thrombocytopenia at the time of the emergency department visit, and 65% (95% CI: 49%–78%) had D-dimer >2000 ng/mL. Patients had multiple location thrombosis in 36% and fatal outcome in 24% cases. A platelet nadir < 50 000/μL (odds ratio (OR): 7.4; CI 95%: 1.2–47.5) and intracranial hemorrhage (OR: 7.9; IC95%: 1.3–47.0) were associated with fatal outcome. ConclusionTTS must be suspected in patients with symptoms 10 days after vaccination and thrombocytopenia and/or D-dimer increase.

Peristaltic Flow of Jeffrey Fluid in an Inclined Porous Tube with Multi-Thrombosis

The fact that multiple thrombosis opposes blood flow and flow is rare in blood vessels is refined to a normal condition with catheter application. The inner surface of the circular blood arteries may not be smooth in the majority of diseased instances. Additionally, the small blood vessel peristalsis mechanism is formed. In this paper, we discuss a mathematical model for the flow of biological fluid (blood) in a circular tube with multi-thrombosis considered under peristaltic wave propagation. The blood flow in this tube is restricted due to the many thromboses present, and the flow is redesigned with the aid of a catheter. We model this non-Newtonian blood flow issue for Jeffrey fluid. In most pathological cases, the inner surface of the circular blood vessels may not be smooth. Further, the mechanism of the peristalsis is established for small blood vessels. Because of this biological phenomenon, the peristaltic movement of Jeffrey fluid in a porous annulus with slip is examined. Equations that govern energy and momentum are solved exactly, and graphical interpretation is made using mathematical software. Streamline graphs show the many thromboses that increase in height. The wall shear stress graphs show a sinusoidally advancing wave with peaks and dips of different amplitudes. This tube's unique crest and trough amplitude are caused by the presence of multiple thromboses. We obtained the impact of the pressure gradient on the permeability parameter (β). The pressure gradient falls as the permeability parameter rises.

Complete Response of an Iraqi Patient with Multiple Liver Metastasis, Colon Cancer and Deep Vein Thrombosis to XELOX/Bevacizumab Treatment

Background: The incidence of colon cancer is rising globally, and several therapeutic techniques, such as surgery, radiation, and systemic therapy, are used to control this illness. Patients with initially treatable metastatic colorectal cancer and unresectable metastases receive preoperative chemotherapy. In patients with rapidly progressing cancer, this strategy aims to shrink the tumor, manage any micro-metastases, and avoid liver surgery. Case presentation: We present a rare case of an Iraqi patient with metastatic colon cancer and an initially unresectable liver metastasis. The patient initially experienced a partial response to chemotherapy with capecitabine, oxaliplatin (XELOX), and Bevacizumab, but after a few days, we observed deep venous thrombosis (DVT). We stopped the oxaliplatin and administered Capecitabine with bevacizumab as a chemotherapy treatment, observing no adverse effects during the therapy period and achieving a complete response with Capecitabine and bevacizumab. Conclusions: The full response in the liver and colon after treatment, which reduced the patients' treatment burden, was the case's unique result. Additionally, this study highlights deep vein thrombosis as a critical problem that can arise with the use of oxaliplatin.

Propylthiouracil-Induced Anti-Neutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis Presenting with Multiple Sterile Abscesses, Mononeuritis Multiplex, and Splenic Vein Thrombosis: A Case Report and Literature Review

Propylthiouracil-Induced Anti-Neutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis Presenting with Multiple Sterile Abscesses, Mononeuritis Multiplex, and Splenic Vein Thrombosis: A Case Report and Literature Review

Case report: A case of perineal prolapse of giant uterine fibroids complicated by multiple pulmonary embolisms and deep venous thrombosis

A 43-year-old woman with a history of uterine fibroids, anemia, and deep vein thrombosis presented with a chief symptom of prolapse of tumor from the perineum, complicated by infection. The case was further complicated by bilateral pulmonary multiple embolism, deep vein thrombosis, acute cardiac insufficiency, acute renal insufficiency, and shock. The patient was treated with preoperative placement of an inferior vena cava filter, open hysterectomy, and perioperative anticoagulation with low-molecular-weight heparin. She smoothly navigated the perioperative period and recovered completely.

Successful Treatment of Multiple Arterial Thrombosis in Premature Infant: Clinical Case

Background. Neonatal thrombosis remains a complex and urgent challenge due to the presence of certain features of the hemostasis system in newborns and the variety of clinical signs. Management approaches are still under consideration, therapeutic experience of thrombolytic therapy (TLT) remains limited and requires benefit-risk assessment. Clinical case description. Clinical case of premature infant with multiple arterial thrombosis diagnosed on the 1st day of life is presented. Modern diagnostic features have allowed to establish the right diagnosis quickly and to start the treatment in time despite the similarities of clinical signs with congenital heart disease. Conclusion. TLT and heparin therapy have saved the child’s life, reversed ischemia, and preserved lower limbs from death. Doctors must perform dynamic monitoring during TLT to diagnose and correct hemorrhagic complications in timely manner.

Pediatric frequent relapsing nephrotic syndrome with multiple cerebral infarctions accompanied by patent foramen ovale and cerebral venous sinus thrombosis: a case report

BackgroundIdiopathic nephrotic syndrome (NS) presents as a hypercoagulable state, of which thromboembolism (TE) is a well-known life-threatening complication. Although TE is more likely to occur in venous vessels than arterial vessels, arterial TE is important because it may cause after-effects, including tissue necrosis and cerebral infarction (CI); therefore, prompt diagnosis and appropriate treatment are required. We report a pediatric NS case with multiple CIs.Case presentationA 14-year-7-month-old Japanese girl was diagnosed with frequent relapsing NS, accompanied by headache and disturbance of consciousness during the second relapse. Brain magnetic resonance imaging (MRI) and four-dimensional computed tomography revealed multiple CIs, vasogenic edema, and cerebral venous sinus thrombosis (CVST). The patient had no underlying thrombophilia other than hypercoagulability due to NS and prednisolone (PSL), and no cardiac arrhythmia; however, a right-to-left shunt through the patent foramen ovale (PFO) was observed with the Valsalva maneuver by echocardiography. Therefore, we assumed that a potential cause of multiple CIs might be an embolic stroke, caused by thrombosis formed from a hypercoagulable state due to NS and PSL treatment and reached through PFO. Antiplatelet and anticoagulant therapies were administered for TE. She was treated with PSL and mycophenolate mofetil (MMF) for NS. Rituximab (RTX) was administered to prevent NS relapse after complete remission (CR). She underwent transcatheter PFO closure at age 14 years and 9 months because we considered that the right-to-left shunt through the PFO would be one of the risks for recurrent cerebral embolism when NS relapses. One year after the onset of CIs, an MRI indicated that the CVST had resolved, leaving no neurological sequelae due to CI; therefore, anticoagulant therapy was discontinued. And then she has been in CR for NS with only MMF therapy.ConclusionsCI is a serious complication in patients with NS. The pathogenesis of multiple CIs is various, including right-to-left shunt through PFO, in addition to the hypercoagulability due to NS. It is important to investigate and manage underlying risks such as PFO, besides preventing the relapses of NS by aggressive treatments using MMF and RTX, in patients with NS.

Long-term outcome of combined radiologic and surgical strategy for the management of biliary complications after pediatric liver transplantation

ObjectivesWe aimed to analyze the risk factors for management failure of BC after pediatric liver transplantation (pLT) by retrospectively analyzing primary pLT performed between 1997 and 2018 (n = 620 patients).ResultsIn all, 117/620 patients (19%) developed BC. The median (range) follow-up was 9 (1.4–21) years. Patient survival at 1, 5 and 10 years was 88.9%, 85.7%, 84.4% and liver graft survival was 82.4%, 77.4%, and 74.3% respectively. Graft not patient survival was impaired by BC (p = 0.01). Multivariate analysis identified the number of dilatation courses > 2 (p = 0.008), prolonged cold ischemia time (p = 0.004), anastomosed multiple biliary ducts (p = 0.019) and hepatic artery thrombosis (p = 0.01) as factors associated with impaired graft survival. The number of dilatation courses > 2 (p < 0.001) and intrahepatic vs anastomotic stricture (p = 0.014) were associated with management failure. Thus, repeated (> 2) radiologic dilatation courses are associated with impaired graft survival and management failure. Overall, graft but not patient survival was impaired by BC.

In situ formed depot of elastin-like polypeptide-hirudin fusion protein for long-acting antithrombotic therapy

Thrombosis, induced by abnormal coagulation or fibrinolytic systems, is the most common pathology associated with many life-threatening cardio-cerebrovascular diseases. However, first-line anticoagulant drugs suffer from rapid drug elimination and risk of hemorrhagic complications. Here, we developed an in situ formed depot of elastin-like polypeptide (ELP)-hirudin fusion protein with a prodrug-like feature for long-term antithrombotic therapy. Highly secretory expression of the fusion protein was achieved with the assistance of the Ffu312 tag. Integration of hirudin, ELP, and responsive moiety can customize fusion proteins with properties of adjustable in vivo retention and controllable recovery of drug bioactivity. After subcutaneous injection, the fusion protein can form a reservoir through temperature-induced coacervation of ELP and slowly diffuse into the blood circulation. The biological activity of hirudin is shielded due to the N-terminal modification, while the activated key proteases upon thrombus occurrence trigger the cleavage of fusion protein together with the release of hirudin, which has antithrombotic activity to counteract thrombosis. We substantiated that the optimized fusion protein produced long-term antithrombotic effects without the risk of bleeding in multiple animal thrombosis models.

Multiple Thromboses during Anticoagulant Therapy in a Patient with Paroxysmal Nocturnal Hemoglobinuria with Splenic Infarction

Multiple Thromboses during Anticoagulant Therapy in a Patient with Paroxysmal Nocturnal Hemoglobinuria with Splenic Infarction

Multiple thromboses, including intracardiac thrombi, accompanied by HIT during ECMO successfully treated with NOACs: A case report.

Unfractionated heparin remains the mainstay of anticoagulation therapy during extracorporeal membrane oxygenation (ECMO) maintenance. However, its continued use in clinical practice exposes patients to the risk of developing heparin-induced thrombocytopenia (HIT). A 50-year-old male was diagnosed with multiple thromboses, including an intracardiac thrombi, accompanied by HIT during ECMO after cardiogenic shock related to acute myocardial infarction. The patient was successfully treated with new oral anticoagulants (NOAC), without significant complications. HIT during ECMO resulting in multiple thromboses is rare. To our knowledge, this is the first reported case of NOAC use in this context. Although thrombocytopenia and thrombosis can occur for various reasons during ECMO maintenance, it is important to consider HIT as a potential cause. NOACs can be considered as a therapeutic option.

Digenic Inheritance of PROC and SERPINC1 Mutations Contributes to Multiple Sites Venous Thrombosis.

Venous thromboembolism (VTE) represents a worldwide health challenge, impacting millions of people each year. The genesis of venous thrombosis is influenced in part by genetic components. Hereditary thrombosis is described as a genetically determined susceptibility to VTE. In the present study, a male patient was referred to our department presenting with multiple venous thrombosis events in different locations. Given a lack of identifiable risk factors, we aimed to investigate the possible genetic factor underlying venous thrombosis. Whole-exome sequencing was employed to examine genes linked to inherited thrombophilia in the proband. Putative variants were subsequently confirmed through Sanger sequencing within the family. The proband was identified as carrying two genetic mutations. One is the novel c.400G > C (p.E134Q) mutation affecting the final nucleotide of exon 5 in the PROC gene, potentially impacting splicing. The other is a previously reported heterozygous nonsense variant c.1016G > A (p.W339X) in the SERPINC1 gene. The proband inherited the former from her mother and the latter from her father. The presence of digenic inheritance in the patient reflects the complex phenotype of venous thrombosis and demonstrates the significance of an unbiased approach to detect pathogenic variants, especially in patients with a high risk of hereditary thrombosis.

Исход COVID-19 тяжелого течения у ребенка с морбидным ожирением

Obesity is one of the most essential medical and social problems. When it was noted that obese children had higher risks of disease, complications and mortality, the overweight effect on the course and outcome of infectious respiratory diseases became particularly important during the flu pandemic. According to numerous studies, obesity has been considered as a predictor of the adverse and even fatal outcome of COVID-19, participating in the formation of multisystem inflammatory syndrome in children (MIS-C). This article demonstrates a case study of severe COVID-19 complicated by MIS-C, multiple thrombosis, and multiple organ dysfunction syndrome in a 9-year-old child with morbid obesity. The article describes the patient management and the complex of diagnostic and therapeutic measures conducted. The main pathogenetic mechanisms of the inflammatory process explaining the association between obesity and the SARS-CoV-2 coronavirus damaging effects are also considered. The need for timely diagnosis and treatment of both obesity itself and comorbid pathology is shown to prevent potentially life-threatening conditions. KEYWORDS: children, obesity, new coronavirus infection, COVID-19, SARS-CoV-2, multisystem inflammatory syndrome, premorbid history, thrombosis, multiple organ dysfunction syndrome. FOR CITATION: Kartashova D.A., Bokova T.A., Razheva I.V., Bevz A.S., Vorontsova S.V. Severe COVID-19 course outcome in a child with morbid obesity. Russian Journal of Woman and Child Health. 2024;7(1):79–85 (in Russ.). DOI: 10.32364/2618-8430-2024-7-1-12.

Critical Prognostic Factors in Cerebral Venous Sinus Thrombosis: An Observational Study.

Cerebral venous sinus thrombosis (CVST) presents with a wide variety of neurological symptoms in various combinations and has a high mortality rate of up to 50%. Recent advances in neuroimaging and therapeutic interventions have brought it down to 10%-20%. The study aims to identify critical prognostic factors associated with poor outcomes in patients with CVST. All cases of CVST aged >18 years from July 2015 to July 2020 who were not terminally ill and bedridden before the illness were evaluated at the entry point for various risk factors and after 30 days for outcome assessment with the modified Rankin scale (mRS). The outcome was dichotomized, applying mRS <3 as a good outcome, and analyzed with the Chi-square test or the Fischer's exact test in a bivariate analysis to identify associated variables. A total of 149 subjects were studied. Glasgow Comma Scale (GCS) <9 (P<0.001), focal neurological deficits (P = 0.05), the presence of a mass effect (P<0.001), and the need for decompressive hemicraniectomy (P<0.001) were associated with poor outcomes. Age, gender, diagnostic delay, seizures at onset, papilledema, parenchymal lesions, deep sinus involvement, and multiple sinus thrombosis were not associated with a poor outcome. In our study, early diagnosis and treatment of CVST is associated with an overall favorable outcome even in the presence of traditional poor prognostic factors such as age, seizures at onset, deep sinus involvement, and multiple sinus involvement in the face of conventional risk factors. A large country-wide prospective study might help in elucidating the poor prognostic factors.

Multiple intrathoracic thrombosis detected on ct scan in patient with antiphospholipid antibody syndrome: case report

Antiphospholipid antibody syndrome (APS) is the clinical correlation between antiphospholipid antibodies and hypercoagulability syndrome. The prevalence of APS in the general population is undetermined. APS disease carries a notable risk of vascular thrombosis. CT scan is the preferred imaging method for assessing thrombosis, although the timing of image acquisition should be considered. The case report detailed the discovery of many intrathoracic thromboses on a CT scan of a patient diagnosed with the uncommon condition APS. Case study: A 34-year-old woman was hospitalized due to dyspnea, cough, and a 3 kg weight loss over a three-month period. She has a background in Deep Vein Thrombosis (DVT). The test results showed abnormalities in protein C, protein S, and high D-dimer levels. The CT scan revealed numerous intrathoracic thrombi. Antiphospholipid syndrome (APS) is an immunological condition that elevates the likelihood of blood clot formation, resulting in thrombosis inside the arteries and veins. The approximate occurrence rate of APS is five occurrences per 100,000 individuals annually. Antiphospholipid syndrome (APS) leads to the formation of blood clots in the legs, a condition referred to as deep vein thrombosis (DVT). This patient had a history of deep vein thrombosis (DVT) and many blood clots within the chest cavity. A CT scan revealed persistent blood clots in the main pulmonary artery and the right and left pulmonary arteries. Antiphospholipid syndrome (APS) can lead to the formation of blood clots in both arteries and veins. CT scan is the preferred method for evaluating thrombosis, and numerous phases are required to examine all blood arteries.

Endovascular Treatment of Venous Outflow and Portal Venous Complications After Liver Transplantation

Liver transplantation continues to rapidly evolve, and in 2020, 8906 orthotopic liver transplants were performed in the United States. As a technically complex surgery with multiple vascular anastomoses, stenosis and thrombosis of the venous anastomoses are among the recognized vascular complications. While rare, venous complications may be challenging to manage and can threaten the graft and the patient. In the last 20 years, endovascular approaches have been increasingly utilized to treat post-transplant venous complications. Herein, the evaluation and interventional treatment of post-transplant venous outflow complications, portal vein stenosis, portal vein thrombosis, and recurrent portal hypertension with transjugular intrahepatic portosystemic shunt (TIPS) are reviewed.

Coronavirus disease 2019-associated thrombotic microangiopathy treated with plasma exchange and antihypertensive therapy in a patient with HIV: A case report with literature review.

Coronavirus disease 2019 (COVID-19) is an infectious disease that often causes complications in multiple organs and thrombosis due to abnormal blood coagulation. This case report aimed to describe the clinical course of COVID-19-associated thrombotic microangiopathy (TMA) and reviewed the comprehensive information on TMA, thrombotic thrombocytopenic purpura (TTP), and atypical hemolytic uremic syndrome associated with COVID-19 in the past literature. A 46-year-old Japanese man was diagnosed with human immunodeficiency virus infection 10 years ago and treated with antiretroviral therapy. The patient presented with fever, malaise, hematuria, and bilateral upper abdominal discomfort for the past 4 days. COVID-19-associated TMA was diagnosed based on a positive polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 and laboratory findings such as thrombocytopenia, acute kidney injury, and hemolytic anemia. Malignant hypertension and human immunodeficiency virus infection were also considered as differential diagnoses of TMA. Considering the possibility of TTP, plasma exchange was performed, and glucocorticoids were administered. Hemodialysis was performed for acute kidney injury. Antihypertensive drugs were administered to control the high blood pressure. Platelet count and renal function improved, and hemodialysis was no longer required. The patient was in good general condition and was discharged from the hospital. COVID-19-associated TMA should be considered as a differential diagnosis during the COVID-19 epidemic. Excessive inflammation and severe COVID-19 are not essential for TMA development. Early intervention using conventional TMA treatments, such as plasma exchange and corticosteroids, might be important in improving prognosis while differentiating between TTP and atypical hemolytic uremic syndrome. Antihypertensive therapy may be helpful in the treatment of COVID-19-associated TMA.

Platelet-derived microvesicles induce intracellular calcium mobilization in human platelets.

Platelet-derived microvesicles (PMVs) represent a significant proportion of microvesicles in circulation and have been linked to various pathophysiological complications. Recent research suggests that PMVs carry significant amounts of cargo that can affect cellular functions by influencing calcium oscillations in target cells. As calcium is involved in multiple cellular processes, including hemostasis and thrombosis, this study aimed to investigate the impact of PMVs on platelet calcium mobilization. The study found that PMVs increase platelet intracellular calcium levels via both intracellular storage and extracellular space in a dose-dependent manner. The study highlighted the critical role of the dense tubular system, acidic vacuoles, mitochondrial stores, and store-operated calcium entry (SOCE) in PMV-mediated calcium release in human platelets. Moreover, the study revealed that PMV-induced calcium rise in platelets does not occur via sarcoendoplasmic reticulum calcium ATPase, and extracellular calcium addition further increases the calcium level in platelets, demonstrating the involvement of SOCE. These findings provide insights into the platelet stimulation signaling mechanisms and contributes to our understanding of platelet and cell behavior when exposed to PMV-rich environments.