Peripheral Arterial Thrombosis Research Articles

Floating ascending aortic thrombus with antiphospholipid syndrome: a case report

BackgroundAscending aortic thrombus is a rare disease that can cause fatal thromboembolism. The treatment for the disease is not well defined and depends on the clinical experience of surgeons. Most reports of thrombosis in antiphospholipid syndrome (APS) are associated with venous or peripheral arterial thrombosis, and there are almost no reports of thrombosis of the aorta.Case presentationA 74-year-old male was referred to our department with claudication of the left leg lasting 3 months. A computed tomography angiography (CTA) and a transthoracic echocardiography demonstrated that a floating and pedunculated mass associated with APS was located at ascending aortic lumen and an embolism in the left superficial femoral artery. Under deep hypothermic circulatory arrest, we resected a floating mass without the graft replacement. CTA 1 year after surgery showed no recurrence of thrombus.ConclusionWe experienced a rare case of floating ascending aortic thrombi. As in this case, we consider that a floating ascending aortic thrombus with embolic events should be performed by surgical intervention.

Effect of tranexamic acid in vascular surgery- a sub-study of the POISE-3 randomized clinical trial

Abstract Background/Introduction In the POISE-3 trial involving patients undergoing noncardiac surgery, tranexamic acid (TXA) reduced the incidence of the composite outcome of life-threatening bleeding, major bleeding, or bleeding into a critical organ at 30 days. Bleeding is a major issue in vascular surgery. However, TXA use may be limited due to concerns about its safety in this high-risk population. With 1,399 participants in POISE-3 undergoing vascular surgery, this is the largest trial assessing TXA's efficacy in this population. Purpose In this post hoc subgroup analysis, we aimed to investigate the interaction between surgery type (vascular/non-vascular) and the effects of TXA vs placebo on bleeding and cardiovascular (CV) safety outcomes in the POISE-3 population. Methods: Eligible patients were ≥45 years, undergoing inpatient noncardiac surgery, and at risk for bleeding and CV complications. Patients were randomised (1:1) to TXA 1 gm IV bolus at start and end of surgery (total 2 gm) or placebo. We used Cox proportional hazards models incorporating tests for interaction to analyse time to the first occurrence of the composite bleeding outcome, and the CV safety outcome (composite of myocardial injury after noncardiac surgery, non-hemorrhagic stroke, peripheral arterial thrombosis, or symptomatic proximal venous thromboembolism) at 30 days. Estimates of hazard ratios (HR) with 95% confidence intervals (CI) were calculated for each subgroup with the interaction P value. Results 9,468 of 9535 (99.3%) POISE-3 patients are included in this analysis; 1399 of whom underwent vascular surgery (699 TXA, 700 placebo). Majority (89.8%) of the vascular surgeries were aorto-iliac, peripheral vascular and extracranial surgeries. In the vascular surgery group, 12.6% of patients receiving TXA experienced the composite bleeding outcome versus 14.7% with placebo (HR 0.85, 95% CI 0.64-1.13). For non-vascular surgery patients, these rates were 8.6% with TXA and 11.3% with placebo (HR 0.74, 95% CI 0.65-0.86), with an interaction P value of 0.42. In vascular surgery patients, the CV safety outcome occurred in 20.2% with TXA versus 18.1% with placebo (HR 1.12, 95% CI 0.88-1.42). In the non-vascular surgery group, both TXA and placebo arms showed a 13.1% incidence rate (HR 1.00, 95% CI 0.89-1.13), with an interaction P value of 0.43. Conclusion In vascular surgery patients, there were higher rates of bleeding and cardiovascular events compared to those undergoing non-vascular surgeries; however, there was no significant interaction between the effects of TXA and the type of surgery. The overall POISE-3 trial provides the best estimate of effect with TXA for all patients including those undergoing vascular surgery. The main limitation is that this subgroup analysis was not pre-specified.

Patients With Non-Obstructive Coronary Artery Disease and Polyvascular Disease. Sub-Analysis of the Real-World Registry KAMMA (Clinical Registry on Patient Population With Polyvascular Disease in the Russian Federation and Eurasian Countries).

To study the clinical status and data of laboratory and instrumental examination of patients with non-obstructive ischemic heart disease (IHD) and multifocal atherosclerosis (MFA) included in the KAMMA registry. The subanalysis included 1,893 IHD patients who underwent coronary angiography (CAG) and ultrasonic examination of peripheral arteries. Based on the CAG data, patients were divided into two groups: group 1, patients with obstructive coronary atherosclerosis (CA) (maximum stenosis ≥50% and/or history of percutaneous coronary intervention/coronary artery bypass grafting, n=1728; 91.3%) and group 2, patients with non-obstructive CA (maximum stenosis <50%, n = 165; 8.7%). A comparative analysis based on the degree of coronary obstruction in patients with verified IHD who were included in the KAMMA registry showed that 8.7% of them had coronary artery stenosis of less than 50%. The overwhelming majority of patients with non-obstructive CA had MFA affecting the brachiocephalic arteries in 94.3% and the lower extremity arteries in 40.2%. Among patients with non-obstructive IHD, women predominated; risk factors such as smoking and type 2 diabetes mellitus were less frequent in this group than in the obstructive IHD group. Patients with non-obstructive CA more frequently had a history of dyslipidemia; they had higher total cholesterol and non-high-density lipoprotein cholesterol; and they more frequently received moderate-intensity statin therapy than patients with obstructive CA (55.8% vs. 34.5%). Characteristic features of patients with non-obstructive CA were less severe IHD and less frequent history of acute coronary syndrome. However, the incidence of stroke, peripheral arterial thrombosis, and chronic arterial insufficiency of the lower extremities did not differ in groups 1 and 2, whereas the incidence of paroxysmal atrial fibrillation was higher in the non-obstructive IHD group. IHD patients without coronary obstruction also require assessment of the peripheral arterial status, as they may have advanced MFA, which should be taken into account when choosing the "aggressiveness" of therapy.

Effect of distal ischemic preconditioning on cardiovascular events in adult patients with hip fracture one year after operation

To investigate the effect of remote ischemic preconditioning (RIPC) on major adverse cardiovascular events (MACE) in elderly patients with hip fracture 1 year after operation. Total of 314 elderly patients with hip fracture of gradeⅡand Ⅲ for American Society of Anesthesiologists (ASA) were treated by surgical operation from April 2015 to May 2020 including 116 males and 198 females, the age ranged from 60 to 76 years old. The subjects were divided into intervention group and control group according to whether received RIPC. Among them, 157 cases in intervention group included 56 males and 101 females with an average age of (68.12±7.13) years old and 157 cases in control group included 60 males and 97 females with an average age of (68.24±7.05) years old. Both groups were given routine anesthesia. The intervention group was treated with RIPC on the basis of routine anesthesia. The MACE events 1 year after operation in two groups were compared and analyzed. The OR values of RIPC for myocardial infarction, heart failure, stroke, nonfatal cardiac arrest, coronary revascularization, severe arrhythmia, peripheral artery thrombosis, readmission of cardiovascular disease, and all-cause death in patients with hip fracture one year after operation were 1.269, 1.304, 0.977, 1.089, 1.315, 1.335, 0.896, 0.774, 1.191, respectively, but there was no significant difference (P>0.05). RIPC did not significantly affect and change the occurrence of major cardiovascular adverse events within 1 year after hip fracture surgery. The long term impact of RIPC on clinical cardiovascular outcomes in non cardiac surgery needs to be confirmed in appropriate randomized clinical trials.

Five-Year Trends of Vascular Disease-Related Amputations in Romania: A Retrospective Database Study.

Background/Objectives: Lower extremity amputations (LEAs) are a burdensome complication of peripheral artery disease (PAD) and/or arterial embolism and thrombosis (AET). We assessed the trends in PAD- and/or AET-related LEAs in Romania. Methods: This retrospective study (2015-2019) analyzed data on minor and major LEAs in hospitalized patients recorded in the National School for Public Health, Management, and Health Education database. The absolute numbers and incidences of LEAs were analyzed by diagnosis type, year, age, sex, and amputation level. Results: Of 38,590 vascular disease-related amputations recorded nationwide, 36,162 were in PAD and 2428 in AET patients. The average LEA incidence in the general population was 34.73 (minimum: 31.96 in 2015; maximum: 36.57 in 2019). The average incidence of major amputations, amputations above the knee, hip amputations, amputations below the knee, and minor amputations was 16.21 (15.62 in 2015; 16.84 in 2018), 13.76 (13.33 in 2015; 14.28 in 2018), 0.29 (0.22 in 2017; 0.35 in 2019), 2.15 (2.00 in 2015; 2.28 in 2019), and 18.52 (16.34 in 2015; 20.12 in 2019), respectively. Yearly PAD- and/or AET-related amputations were significantly higher in men versus women. The overall number of LEAs increased with age, particularly in patients ≥ 70 years. The increase in the total number of amputations was mainly due to a constant rise in minor amputations for both groups, regardless of gender. Conclusions: PAD- and/or AET-related LEAs in Romania increased from 2015 to 2019, with men having a greater incidence than women. Raising awareness and effective management strategies are needed to prevent LEAs.

Outcome of Secondary Interval Rheolytic Thrombectomy after Localized Intra-Arterial Catheter-Directed Thrombolysis through Power-Pulse Spray Technique in Cases of Partially Successful or Failed Primary Rheolytic Thrombectomy

Abstract Objectives The aim of this study was to evaluate the safety and effectiveness of secondary interval AngioJet rheolytic thrombectomy after localized intra-arterial catheter-directed thrombolysis (CDT) through power-pulse spray (PPS) technique in partially successful or failed primary AngioJet rheolytic thrombectomy cases of acute and subacute peripheral artery thrombosis. Materials and Methods This retrospective study included 12 acute (< 2 weeks) and subacute (2–4 weeks) peripheral arterial thrombosis patients who underwent primary thrombectomy alone without CDT and patients who received secondary thrombectomy after CDT through PPS at our institute between May 2022 and December 2022. Technical success, procedure-related complications (local and systemic), amputations, and 1-year patency were evaluated. Results The angiographic success after primary thrombectomy was evaluated in 12 patients (9 acute and 3 subacute), and the results were categorized into three groups. Of 12 patients, complete success, partial success, and failure were noted in three (25%), five (41.7%), and four (33.3%) patients, respectively, after primary thrombectomy alone. Complete luminal patency was restored in all nine cases of partial success and failure in postprimary thrombectomy through adjunctive PPS thrombolysis and secondary thrombectomy. Technical and clinical success was achieved in all patients (100%). Transient hemoglobinuria was seen in five (41.7%) patients, and all had long-segment occlusion. At 1 year follow-up, no reocclusion, limb loss, or death was noted. Conclusion Complete success after primary thrombectomy was more likely in the setting of short-segment occlusion and small-caliber arteries. In patients with partial success or failure after the primary thrombectomy alone, secondary thrombectomy may be performed after the adjuvant PPS thrombolysis to achieve complete recanalization.

Ağız Kavitesi Karsinomlu Hastada Kemoterapi Sonrası Akut Arteriyel Tromboz-Aile Hekimliği Uygulamasında Karar Vermenin Önemi-Olgu Sunumu

Oral cancer is most common in developing countries, but is also seen in the rest of the world. In more than 90% of cases, squamous cell is found. Treatment is surgical with or without subsequent adjuvant therapy. Patients with tumors have a higher risk of thrombosis, assuming that the underlying pathophysiological mechanism is endothelial dysfunction. The presented case describes the development of acute thrombosis of the right common femoral artery in a patient with late diagnosed carcinoma of the floor of the oral cavity after a consecutive treatment with cisplatin, 5-fluorouracil and cetuximab. A 62-year-old man was diagnosed with squamous cell carcinoma of the floor of the oral cavity, with subsequent surgical resection and radiotherapy. Due to recurrence, a laryngectomy was performed and 6 courses of chemotherapy with cisplatin, 5-fluorouracil and cetuximab were followed. 2 days after the last infusion, acute peripheral arterial thrombosis was developed. Cancer and applied antitumor therapy exert a synergistic effect on coagulation activation. The exact mechanisms by which thrombotic complications occur are not fully understood. They suggest a toxic damage to the vascular endothelium, which leads to a decreased expression of nitric oxide synthetase and, accordingly, vasodilation, a decrease in anticoagulants and an increase in the levels of procoagulants such as tissue factor, which activates coagulation and induces the activation of platelets. The general practitioner occupies a central role in the health care system in a number of countries. In order to be able to perform its complex activities and successfully solve diverse health problems it is necessary to possess specific knowledge and skills from various fields of medicine.

In Situ Endothelial SARS-CoV-2 Presence and PROS1 Plasma Levels Alteration in SARS-CoV-2-Associated Coagulopathies.

Coagulation decompensation is one of the complications most frequently encountered in COVID-19 patients with a poor prognosis or long-COVID syndrome, possibly due to the persistence of SARS-CoV-2 infection in the cardiovascular system. To date, the mechanism underlying the alteration of the coagulation cascade in COVID-19 patients remains misunderstood and the anticoagulant protein S (PROS1) has been described as a potential risk factor for complications related to COVID-19, due to PLpro SARS-CoV-2 enzyme proteolysis. Biopsies and blood samples were collected from SARS-CoV-2 positive and negative swab test subjects with coagulopathies (peripheral arterial thrombosis), and SARS-CoV-2 presence, ACE2 and CD147 expression, and plasmatic levels of PROS1 were evaluated. We reported a significant decrease of plasmatic PROS1 in the coagulopathic SARS-CoV-2 swab positive cohort, in association with SARS-CoV-2 in situ infection and CD147 peculiar expression. These data suggested that SARS-CoV-2 associated thrombotic/ischemic events might involve PROS1 cleavage by viral PLpro directly in the site of infection, leading to the loss of its anticoagulant function. Based on this evidence, the identification of predisposing factors, such as CD147 increased expression, and the use of PLpro inhibitors to preserve PROS1 function, might be useful for COVID-19 coagulopathies management.

Association between Peripheral Arterial Thrombosis and COVID-19 using CT Angiography: A Retrospective Observational Study

Introduction: Arterial thromboembolism is a major cause of morbidity and mortality in Coronavirus Disease 2019 (COVID-19) patients in both General Inpatient ward and Intensive Care Unit (ICU) settings. As COVID-19 is associated with coagulopathy or vasculopathy, it is necessary to investigate whether the peripheral vessels were also affected due to COVID-19-related thrombosis. Computed Tomography Angiography (CTA) is a quick, accurate, non invasive, and reliable method for assessing the location, extent and severity of arterial thrombosis. Aim: To evaluate the association of acute peripheral arterial thrombosis in patients with COVID-19 infection and assess the differences in peripheral extremity clot burden using peripheral limb CTA. Materials and Methods: A retrospective observational study was conducted in the Department of Radiology, Topiwala National Medical College and B.Y.L. Nair Charitable. Hospital, Mumbai, Maharashtra, India, from April 2020 to April 2021. A total of 70 patients with medical records of acute limb ischaemia, consisting of 35 Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection-positive patients and 35 SARS-CoV-2 negative patients, who underwent peripheral CTA were included in the present study. For calculating arterial clot severity and extent in the peripheral extremities, three different systems were used. Age, sex, symptoms, co-morbidities, and CT thrombus burden score were analysed in both groups. The association between variables was analysed using the Chi- square test. Results: The age range of patients presenting with acute limb ischaemia was 24-74 years (mean age=50 years). Claudication, pain and redness had a significant association with COVID- 19 positive patients (p-value<0.001). It was also observed that proximal vessels had a slightly higher preponderance for thrombosis. A significant mean difference in arterial thrombus burden was observed in SARS-CoV-2 infection positive patients, with greater thrombus burden involving proximal vessels. In only the proximal vessels, the overall clot burden was 2.31±3.09 and 0.89±1.25 in the COVID-19 positive and negative groups, respectively (p-value=0.014). COVID-19 infected patients had a predilection for peripheral arterial thrombosis compared to controls, with a significant p-value of 0.034 in proximal upper limb involvement. Conclusion: Computed tomography angiography is the preferred diagnostic modality for the evaluation of arterial thrombosis. Greater clot burden was seen in the proximal vessels of both upper and lower limbs in COVID-19 patients.

Safety and efficacy of tranexamic acid in major non-cardiac vascular surgery: a systematic review and meta-analysis

Background: Tranexamic acid (TXA) is a synthetic lysine analogue that inhibits fibrinolysis. The effectiveness of TXA in obstetrics, trauma and orthopaedic and cardiac surgery is well established. However, concerns regarding its prothrombotic potential remain, which is an important consideration for vascular surgery. We aimed to evaluate the safety and efficacy of TXA in adults undergoing major non-cardiac vascular surgery. Methods: A pre-specified protocol (PROSPERO CRD42023427282) was followed. Relevant databases (PubMed, MEDLINE, EMBASE) were searched for randomised controlled trials (RCTs). Data extraction and risk of bias assessments were performed in duplicate. A random effects model was used to synthesise data from RCTs. Measures of effect were reported as relative risk (RR) with 95% confidence intervals (CIs). The primary safety outcome was a composite of arterial and venous thromboembolic events (composite of myocardial infarction, non-haemorrhagic stroke, peripheral arterial thrombosis and symptomatic proximal venous thromboembolism). Certainty of evidence was assessed using the GRADE approach. Results: After screening 1989 records, three RCTs were included, cumulatively enrolling 1,560 participants. In all trials, patients received either TXA (intravenously or orally) compared with placebo. There was no evidence of the effect of intravenous TXA on thromboembolic events (RR 1.10, 95% CI 0.89 to 1.36, two RCTs, 1460 participants, low certainty of evidence) or on critical bleeding (composite of life-threatening, critical and major organ bleed) (RR 0.85, 95% CI 0.65 to 1.11, two RCTs, 1460 participants, low certainty of evidence). TXA may reduce postoperative blood loss, especially at 0–4 hours (Cliff’s delta −0.41, 95% CI −0.19 to −0.59) and 0–24 hours (Cliff’s delta −0.37, 95% CI −0.14 to −0.55) after surgery. There was no evidence of an effect of TXA on reducing perioperative red blood cell (RBC) transfusion requirements (RR 0.66, 95% CI 0.11 to 3.95, one RCT, 100 participants). One RCT assessed oral TXA and found no evidence of an effect on type II endoleak post endovascular aneurysm repair. No thrombotic complications were reported in this RCT during the study period. Conclusions: We found no evidence of an effect of TXA on thromboembolic complications. While TXA appears to reduce early postoperative bleeding, the clinical relevance of this is uncertain. Due to limitations of study design and the variety of vascular procedures, the role of TXA in vascular surgery is still unclear. Ongoing trials may reduce this uncertainty. Registration: Prospectively registered on PROSPERO (CRD42023427282)

High Risk of Thrombosis in a Prospective Cohort of Adults with Primary Immune Thrombocytopenia

Background: Patients with primary Immune thrombocytopenia (ITP) have an increased risk of bleeding but paradoxically also an increased thromboembolic risk. Aim: The aim of this study was to prospectively assess the occurrence and risk factors of symptomatic venous thrombotic events (VTE) and arterial thrombotic events (ATE) in patients with primary immune thrombocytopenia. Methods: This study included 160 adult patients with primary ITP enrolled in the Vienna ITP Biobank, a dual-center cohort study (Medical University of Vienna; Hanusch Hospital) that prospectively collects data of patients diagnosed with primary ITP (EC 1843/2016). Patients with primary ITP and a history of VTE or ATE, as well as those who experienced new or recurrent thrombotic events (TE) during the observation period, were categorized into two groups: with-thrombosis and without-thrombosis. The patient characteristics were compared using a chi-squared or Fisher's exact test for categorical and for numerical data were performed using the Mann-Whitney-U-test. The association between clinical risk factors and thrombosis were performed by univariable analyses using logistic regression model. Results: Of the 160 ITP patients (Table 1), 22 patients (13.8%) had 25 documented ATE or VTE. These events consisted of 11 ATE (44%), including 7 acute myocardial infarctions, 3 cerebral vascular events (stroke or TIA), and 1 peripheral artery thrombosis, and 14 (65%) venous events (1 superficial vein thrombosis, 7 deep vein thromboses, 2 deep vein thromboses with pulmonary embolism and 4 cases of isolated pulmonary embolism). 8 (36.4%) of 22 patients had a history of thrombosis. 17 (77.3%) patients experienced TE during the median observation period of 2.2 (1-3) years. Of them 14 (82.4%) patients had a new TE and 3 (17.6%) recurrent TE. The cumulative 1- and 5-year incidence of TE accounting for competing mortality were 1.9 % and 5.0%. Four (18.2%) patients with thrombosis died during the follow-up period. The cause of death was unclear for three patients, while one patient died from pulmonary embolism. Patients with thrombosis were significantly older (p=0.001) and had more comorbidities than patients without thrombosis (Table 1). There was no difference in the platelet counts between the groups. Antiphospholipid antibodies were present in 14.4% of the patients, and their prevalence was higher in the thrombosis group (p=0.002). In the univariable regression analysis, factors such as older age ≥75 years (OR 1.06; 95%CI 1.03-1.09, p=0.001) diabetes mellitus (OR 4.02; 95%CI 1.20-13.413, p=0.024), presence of antiphospholipid antibodies (OR 6.04; 95%CI 2.01-25.63, p=0.003), particularly lupus anticoagulant positivity (OR 5.39 95%CI 1.8-13.0, p=0.002), and splenectomy (OR 3.07; 95%CI 1.13-12.63, p=0.031) were significantly associated with a higher risk of arterial and venous thrombotic events among ITP patients. Body-Mas-Index, disease duration, tobacco use, hypertension, and use of corticosteroids or thrombopoietin receptor agonist (TPO-RA) were not associated with increased risk of VTE and ATE. Conclusion: We observed a high rate of ATE and VTE in our patients with primary ITP. Additionally, ITP patients commonly present with typical risk factors for thrombotic events, suggesting a strict management of cardiovascular risk factors. Close monitoring and tailored treatment strategies should minimize the risk of bleeding and thrombotic events.

Early 6 months usage of single anTiplAtelet OR anTicoAgulant followed by single antiplatelet after transcatheter aortic valve replacement: protocol for a multicentre, open-label, randomised controlled clinical trial

IntroductionThe strategy for initiating antithrombotic therapy to prevent bioprosthetic valve thrombosis (BPVT) after transcatheter aortic valve replacement (TAVR) remains uncertain. There is still lacking evidence on the efficacy and safety...

S3187 Peripheral Arterial Thrombosis: A Potential Complication in Inflammatory Bowel Disease

S3187 Peripheral Arterial Thrombosis: A Potential Complication in Inflammatory Bowel Disease

Pulmonary vasculitis in Behçet's disease: reference atlas computed tomography pulmonary angiography (CTPA) findings and risk assessment-management proposal.

Pulmonary artery aneurysms (PAAs) are the most well-defined type of pulmonary vascular complication in Behçet's disease (BD).The aim of this study is to analyze which CT pulmonary angiography (CTPA) signs are associated with serious morbidity and mortality. The study included 42 BD patients with pulmonary vascular complications. All patients' medical records were reviewed retrospectively in terms of demographics, disease characteristics, laboratory investigations, pulmonary manifestations, arterial and/or venous thrombosis and CTPA vascular and parenchymal findings. Deep venous thrombosis was observed in 31(73.8%) patients, arterial thrombosis in 13(31%), peripheral arterial aneurysms in 12(286%), haemoptysis in 38 (90.5%), and fatal haemoptysis in 8(19 %) patients. CTPA revealed: in situ thrombosis in 14(33.3%) patients, true stable PAAs in 13(31), true unstable PAAs in 11(26.2%), stable pulmonary artery pseudoaneurysms (PAPs) in 7(16.7%), unstable PAPs in 17(40.5%), the latter were associated with perianeurysmal leaking in 26(61.9%) and bronchial indentation in 19(45.2%).In regression analysis, fatal outcomes were associated with age in years (p=0.035), arterial thrombosis (p=0.025), peripheral arterial aneurysms (p=0.010), intracardiac thrombosis (p=0.026) and positively associated with haemoptysis severity (p<0.001). Peripheral arterial thrombosis and/or aneurysms, intracardiac thrombosis and haemoptysis severity are predictor of fatal outcomes in BD pulmonary vasculitis. PAPs with perianeurysmal alveolar haemorrhage and/or bronchial indentation are serious CTPA signs that require prompt identification and aggressive treatment. PAPs are a more serious aneurysmal pattern than true PAAs because they are a contained rupture of a PA branch in the context of pulmonary vasculitis.

АНАЛИЗ МАРКЕРОВ СИСТЕМЫ ГЕМОСТАЗА У ПАЦИЕНТОВ С ФИБРИЛЛЯЦИЕЙ ПРЕДСЕРДИЙ НЕКЛАПАННОГО ГЕНЕЗА С ТРОМБОЭМБОЛИЧЕСКИМИ ОСЛОЖНЕНИЯМИ

Introduction. Atrial fibrillation (AF) is one of the most common heart rhythm disorders. The risk of developing thromboembolic complications, including ischemic stroke, in patients with AF is 5 times higher than that in patients with sinus rhythm; therefore, one of the main directions in the treatment of patients with this rhythm disorder is the prevention of thromboembolic complications. Objective: to study the markers of monitoring the blood coagulation system in the blood serum of patients with non-valvular AF receiving anticoagulant therapy and having a history of thrombotic and thromboembolic complications. Materials and methods. The study included 31 healthy volunteers (without a history of AF, thrombosis) and 31 patients over 18 years of age with a diagnosis of AF (mean age 66.2±8.1), receiving anticoagulant therapy and having a history of thrombotic and thromboembolic events. complications. Therapy taken by patients at the time of inclusion in the study was in line with current recommendations and included standard conventional antiarrhythmic and anticoagulant therapy, as well as therapy for the underlying cardiovascular disease. Biomarkers of thrombus formation and pro-inflammatory activation (L-selectin, thrombomodulin) were determined by enzyme immunoassay using diagnostic kits from BiomedicaGmbH, Austria. Results. During the screening of 2820 patients treated in the Department of CHLSRS&amp;EX for the nosology of AF in the period 01.2020-01.2023, 31 patients were included in the study, who were diagnosed with thrombotic and thromboembolic complications (0.01% of the total number of screened patients) against the background of regular anticoagulant therapy . Among all patients included in the study, thrombotic complications in AF were as follows: thrombosis of the left atrial appendage was noted in 17 patients (54%), spontaneous echo contrast of grade II or more in 5 patients (16%), cardioembolic stroke - in 3 patients (10%) , thrombosis of peripheral arteries (2 (6%)), thrombosis on EKS electrodes (2 (6%)). The concentration of soluble thrombomodulin in the blood serum of patients with thrombotic and thromboembolic complications was reduced compared with the group of healthy volunteers (2073.0±548.6 vs. 2845.3±726.4 pg/ml; p=0.004). Serum levels of L-selectin in patients with thrombotic and thromboembolic complications were reduced compared to healthy volunteers (1.5±0.6 vs. 2.4±1.3 µg/mL; p=0.04). Conclusion. In patients with thrombotic and thromboembolic complications that occurred against the background of adequate anticoagulant therapy, there was a decrease in serum soluble thrombomodulin and L-selectin, which may indicate damage to the endothelium, activation of thrombus formation and inflammation.

Two approaches to modeling the risk of progressive atherosclerosis

Progressive or accelerated atherosclerosis is accompanied by unfavorable clinical outcomes. Studying and understanding this process and creating a personalized method for assessing the risk and prognosis of this disease are necessary to optimize approaches to treatment and prevention.Aim: To compare two approaches to the creation of prognostic risk model of progressive atherosclerosis: non-linear regression model of logistic type and free cross-platform visual programming system Orange method.Material and Methods. The retrospective cohort study included 202 patients with confirmed coronary heart disease: 147 men and 55 women. The mean age of the patients was 53.3 ± 7.16 years. Group 1 included patients with myocardial infarction or unstable stenocardia, emergency arterial stenting, stroke, peripheral arterial thrombosis, critical ischemia and lower extremity amputation within 2 years before inclusion in the study. Patients in the comparison group did not have these events. Predictive models of the influence of different studied parameters on the probability of rapid progression of atherosclerosis were built using factor and correlation analysis and free cross-platform Orange visual programming system.Results. The authors’ suggested approaches to the evaluation of the risk of progressive atherosclerosis have a good prognostic accuracy (sensitivity 94.1, specificity 97.0 and accuracy 95.5 coefficients, respectively) for the regression model and 0,950 (95,0%) for the machine learning model. However, the construction of the regression model is a more complex procedure compared to the second approach, where the choice of informative indicators for the prediction model is made by Orange. Nevertheless, the above two approaches can successfully complement each other, allowing to build more accurate predictive risk models.Conclusion. The proposed authors’ approaches to assessing the risk of progressive atherosclerosis have a good prognostic accuracy.

Limb Salvage after Covid-19 Related Major Arterial Thrombosis in an 81 -Year Lady with Critical Limb Ischemia: A Case Report

Hypercoagulable state and thromboembolic events are common extra-pulmonary complications of COVID-19 that are increasingly reported in the literature. Unfortunately unlike VTE, no remarkable data are available on arterial thrombosis in SARS-CoV2 infected patients, and despite the use of anticoagulant and antiplatelet therapies, severe arterial thrombotic complications are observed. The objective of this case study is to share our experience about COVID-19 related peripheral arterial thrombosis and highlight the management plan of the resulting CLI in an elderly patient. It is a case report of an 81- year lady that developed fever, vomiting, and bone aches for 3 days before being transferred to the fever hospital with gastrointestinal upset, where she was admitted to normal ward and the diagnosis of COVID-19 was confirmed by RT-PCR. The patient improved and discharged to home after one week, 5 days later she started to complain of painful right foot then the pain involved the whole leg later on with fixed color changes and coldness, however, the diagnosis of acute ischemia was missed for one week more until the patient came to our department, and arterial duplex revealed extensive thrombosis of the SFA, popliteal and tibial arteries with CLI (ABI was&lt;0.4). The patient was prepared for prompt vascular intervention and surgical embolectomy was performed via combined popliteal and femoral approaches. A long, thick, more gelatinous and darker thrombus was retrieved both proximally and distally. The limb was saved with fairly good distal runoff. Unfortunately, one week after the operation the patient slipped and developed fracture neck femur of the same limb, and she was operated on one month later. The patient had uneventful postoperative course, and such lucky 81years lady kept a viable well-functioning limb and could walk again. In conclusion, the key points of our case study include vigilant consideration of the arterial thrombosis in COVID-19 infected patients, routine monitoring of D-dimer levels with initiation of full-dose anticoagulation if levels elevated by six times the upper limit of normal, as well as prompt diagnosis of ALI, and urgent surgical revascularization to save the limb.

#5551 THE TROPONIN LEVEL AND ITS INFLUENCE ON RENAL AND CARDIOVASCULAR EFFECTS IN RENAL TRANSPLANT RECIPIENTS

Abstract Background and Aims Cardiovascular (CV) morbidity and mortality are highly prevalent in renal transplant recipients (RTRs). As such, assessments of CV status using troponin concentrations could help to identify patients at risk for death or CV events and as a predictor for deterioration of graft function. The aim of the study was to investigate the biomarker troponin for the prediction of adverse renal and cardiovascular outcomes in stable RTRs. Method 305 stable RTRs with a median age of 53 years, (60.6% male) transplanted between 1994 and 2018 were enrolled in the study. General characteristics are shown in Table 1. At baseline, troponin, NT-pro BNP, carotid-femoral pulse wave velocity (cfPWV) and pulse pressure (PP) were measured. Troponin was measured during a routine baseline visit in stable RTR without cardiac symptoms. The median troponin concentration (11 ng/l) was used as cut-off. Patients were divided into two groups high (≥11 ng/l) and low (&amp;lt;11 ng/l) troponin and followed for 54 months. During this time CV events (stroke, myocardial infarction, peripheral artery thrombosis) death, graft loss and deterioration of renal graft function (increasing creatinine ≥30%) or proteinuria (urine protein creatinine ratio UPCR ≥500 mg/g) were monitored. Results At baseline, significant differences were observed between groups in terms of creatinine, eGFR, troponin, UPCR, PP, and PWV. In the group with baseline troponin ≥11ng/l, more patients had coronary artery disease/peripheral obliterans artery disease (CAD/POAD), heart failure (HF), and diabetes. Baseline troponin correlated only weakly with age (R = 0.47), cfPWV (R = 0.41), eGFR (R = −0.52). During follow-up, patients with high troponin experienced more frequently an increase in creatinine ≥30% (32.9% vs 13%), doubling creatinine (11.2% vs 3.1%), an increase in UPCR (22.4% vs 9.2%), graft loss (16.1% vs 1,8%), death (13.3% vs 0%), and CV events (6.3% vs 4.9%). Conclusion 1. Age, arterial stiffness, and eGFR only have a weakly impact on troponin in stable RTR. 2. Higher troponin is associated with poor outcomes and might be useful not only for the identification of patients with high-risk CV events but also for the deterioration of allograft function.

Peripheral Arterial Thrombosis following Russell's Viper Bites.

Envenomings by Russell's viper ( Daboia russelii ), a species of high medical importance in India and other Asian countries, commonly result in hemorrhage, coagulopathies, necrosis, and acute kidney injury. Although bleeding complications are frequently reported following viper envenomings, thrombotic events occur rarely (reported only in coronary and carotid arteries) with serious consequences. For the first time, we report three serious cases of peripheral arterial thrombosis following Russell's viper bites and their diagnostic, clinical management, and mechanistic insights. These patients developed occlusive thrombi in their peripheral arteries and symptoms despite antivenom treatment. In addition to clinical features, computed tomography angiography was used to diagnose arterial thrombosis and ascertain its precise locations. They were treated using thrombectomy or amputation in one case that presented with gangrenous digits. Mechanistic insights into the pathology through investigations revealed the procoagulant actions of Russell's viper venom in standard clotting tests as well as in rotational thromboelastometry analysis. Notably, Russell's viper venom inhibited agonist-induced platelet activation. The procoagulant effects of Russell's viper venom were inhibited by a matrix metalloprotease inhibitor, marimastat, although a phospholipase A 2 inhibitor (varespladib) did not show any inhibitory effects. Russell's viper venom induced pulmonary thrombosis when injected intravenously in mice and thrombi in the microvasculature and affected skeletal muscle when administered locally. These data emphasize the significance of peripheral arterial thrombosis in snakebite victims and provide awareness, mechanisms, and robust strategies for clinicians to tackle this issue in patients.

Inactivated whole-virion SARS-CoV-2 vaccines and long-term clinical outcomes in patients with coronary atherosclerosis disease in China: a prospective cohort study.

Publicized adverse events after vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) raised concern among patients with coronary atherosclerosis disease (CAD). We sought to study the association between SARS-CoV-2 vaccines and long-term clinical outcomes including ischaemic and bleeding events among patients with CAD. Inpatients diagnosed with CAD by coronary angiography, without a history of SARS-CoV-2 infection and vaccination, were included between 1 January and 30 April 2021, and underwent follow-up until 31 January 2022. Two doses of inactivated whole-virion SARS-CoV-2 vaccine (CoronaVac, BBIBPCorV, or WIBP-CorV) were available after discharge, and the group was stratified by vaccination. The primary composite outcomes were cardiovascular death, non-fatal myocardial infarction, stent thrombosis, unplanned revascularization, ischaemic stroke, venous thrombo-embolism, or peripheral arterial thrombosis. The bleeding outcomes were Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding. Cox regression models with vaccination status as a time-dependent covariate were used to calculate the hazard ratio (HR) for the outcomes. A propensity score matching method was used to reduce confounding biases. This prospective cohort study included 2078 individuals with CAD, 1021 (49.1%) were vaccinated. During a median follow-up of 9.1 months, 45 (4.3%) primary composite outcomes occurred in the unvaccinated group, and 33 (3.2%) in the vaccinated group. In Cox regression, the adjusted HR was 1.13 [95% confidence interval (CI) 0.65-1.93]. The adjusted HR for the bleeding outcomes associated with vaccination was 0.81 [95% CI 0.35-1.19]. After matching, the adjusted HR for the primary composite outcomes associated with vaccination was 1.06 [95% CI 0.57-1.99] and for the bleeding outcomes was 0.91 [95% CI 0.35-2.38]. Similar results were found in the seven prespecified subgroups. No grade 3 adverse reactions after vaccination were recorded. Our results indicated no evidence of an increased ischaemic or bleeding risk after vaccination with inactivated SARS-CoV-2 vaccine among Chinese patients with CAD, with limited statistical power.