Peripheral Arterial Thrombosis Research Articles

ГОДИЧНЫЕ ИСХОДЫ У БОЛЬНЫХ ИШЕМИЧЕСКОЙ БОЛЕЗНЬЮ СЕРДЦА С ПРОГРЕССИРУЮЩИМ АТЕРОСКЛЕРОЗОМ

Вackground. Progressive atherosclerosis syndrome, in contrast to spontaneous one, is accompanied by a more severe course and frequent complications. Therefore, it is crucial to define the risk stratification criteria and treatment of such patients. Purpose of the study to study one-year outcomes in patients with coronary heart disease with progressive atherosclerosis. Patient Characterization and Research Methods. The study included 202 patients with confirmed diagnosis of CHD: 147 men and 55 women. The mean age of the patients was (53,3 ± 7,16) years. The main group (100 patients) included those who had two (or more) additional cardiovascular events from the following in the two years before the study: MI or unstable angina pectoris, emergency artery stenting, stroke, peripheral artery thrombosis, critical ischemia or lower limb amputation, and the comparison group included 102 patients with CHD without such events. After 12 months from the time of inclusion, end points were evaluated. Statistical Analysis Methods. Microsoft Office Excel 2019 program was used. Results. The work revealed that patients with progressive atherosclerosis have worse long-term (one-year) prognosis in comparison with its spontaneous course; a significant influence on unfavorable outcomes is exerted by: Angina of any EF without surgical treatment - OR 4.125 (1.213; 14.027), multivessel coronary artery disease - OR 3.929, CI (1.156-13.350), C-reactive protein level 5 mg/L or higher - OR 18.667, CI (4.684-74.393).

Incidence of Thrombosis at Different Sites During the Follow-Up Period in Essential Thrombocythemia: A Systematic Review and Meta-Analysis.

Thrombotic events are the most frequent manifestations of essential thrombocythemia (ET). The objective of this study is to determine the incidence of thrombosis at different sites on follow-up in patients with ET. We searched PubMed, Web of Science, and The Cochrane Library databases and calculated the incidence of thrombosis by pooling and analyzing the extracted data using a random-effects model. A total of 70 studies (N = 25,805) were included in the analysis. The total and annual incidences of arterial thrombosis on follow-up were 13.4% and 2.0%, respectively. The total and annual incidences of the different manifestations of arterial thrombosis were as follows: stroke (5.3% and 0.8%), transient ischemic attack (5.1% and 1.2%), myocardial infarction (2.4% and 0.5%), unstable angina (0.9% and 0.2%), and peripheral arterial thrombosis (2.0% and 0.2%), respectively. In contrast, the total and annual incidences of arterial thrombosis in JAK2-positive patients were 18.4% and 2.7%, respectively. The total and annual incidences of arterial thrombosis in JAK2-negative patients were 5.9% and 0.8%, respectively. The total and annual incidences of venous thrombosis were 5.5% and 0.7%, respectively, and the incidences of the different manifestations of venous thrombosis at different sites were as follows: peripheral venous thrombosis (2.9% and 0.5%), superficial venous thrombosis (1.8% and 0.7%), deep venous thrombosis (1.6% and 0.3%), abdominal venous thrombosis (0.8% and 0.1%), pulmonary embolism (0.3% and 0.1%), and cerebral venous thrombosis (0.2% and 0%), respectively. The total and annual incidences of venous thrombosis in JAK2-positive patients were 7.4% and 1.2%, respectively. The total and annual incidences of venous thrombosis in JAK2-negative patients were 1.6% and 0.4%, respectively. The incidence of arterial thrombosis was higher than that of venous thrombosis in patients with ET. Arterial thrombosis manifested with cerebral arterial thrombosis, followed by cardiac thrombosis. Venous thrombosis events were mainly peripheral and superficial venous thrombosis. JAK2-positive patients have a higher incidence of arterial and venous thromboses than JAK2-negative patients, the sequence of thrombsis sites was similar to that of the overall patients.

COVID-19 and Thrombosis: Clinical Aspects.

In coronavirus disease 2019 (COVID-19), thrombus formation is related to the pathogenesis of acute respiratory distress syndrome (ARDS) and the progression of clinical symptoms. Severe damage to vascular endothelial cells and the associated cytokine storm after SARS-CoV-2 infection cause thrombogenesis and contribute to the development of more severe and unique thromboses compared to other infectious diseases. Thromboses occur more often in critically ill patients. In addition to pulmonary thromboembolism (PE) and deep vein thrombosis, acute myocardial infarction, peripheral arterial thrombosis, and aortic thrombosis have also been reported. In PE, thrombi develop in both pulmonary arteries and alveolar capillaries. These, together with intraalveolar fibrin deposition, interfere with effective gaseous exchange in the lungs and exacerbate the clinical symptoms of ARDS in patients with COVID-19. Pharmacological thromboprophylaxis is recommended for all hospitalized patients to prevent both thrombosis and aggravation of ARDS, and other organ failures. Although the pediatric population is mostly asymptomatic or develops mild disease after SARS-CoV-2 infection, a new inflammatory disorder affecting the cardiovascular system, multisystem inflammatory syndrome in children (MIS-C), has been reported. Similar to Kawasaki disease, acute myocarditis, coronary vasculitis, and aneurysms are typically seen in MISC, although these two are now considered distinct entities. A similar acute myocarditis is also observed in young male adults, in which a hyperinflammatory state after SARS-CoV-2 infection seems to be involved. Several side effects following vaccination against COVID-19 have been reported, including vaccine-induced immune thrombotic thrombocytopenia and acute myocarditis. Although these could be serious and life-threatening, the cases are very rare, thus, the benefits of immunization still outweigh the risks.

Cardiac involvement in a Spanish unicentric prospective cohort of patients with systemic lupus erythematosus.

Cardiac involvement is one of the most frequent manifestations of Systemic Lupus Erythematosus (SLE). Transthoracic echocardiogram (TTE) may be valuable for the early detection of cardiac abnormalities in SLE. Few studies analyze both TTE findings in SLE and the risk factors that predispose to different cardiac manifestations in a long follow-up cohort. We aimed to investigate cardiac involvement's prevalence, risk factors, and outcomes in a Spanish Lupus Clinic. Spanish single-center prospective study of cardiac involvement in SLE. Two hundred and one patients met the 2019 EULAR/ACR classification criteria, performed TTE, and were eligible for the study. Cardiac involvement was present in 43.8%. Patients with older age, hypertension, hyperlipidemia, higher body mass index, peripheral arterial disease, thrombosis, and major cardiovascular events had significantly more cardiac involvement. Neurological, hematological, and serosal involvement (pleuritis and/or pericarditis) were clinical risk factors for abnormal TTE. The combination of the four clinical variables (dyspnea, chest pain, cough, and/or syncope) was present in 40.9% of the patients with abnormal TTE in the follow-up and was superior to each of the manifestations separately. Troponin I (TnI) ≥ 0.2ng/mL and NTproBNP ≥ 300 pg/mL were excellent biomarkers with a good correlation with cardiac abnormalities. Anti-B2GP1 was the only autoantibody associated with cardiac involvement in our cohort. Presenting cardiac involvement was correlated with higher SLICC Damage Index and increased mortality risk in the 2-year follow-up period. Cardiac involvement in SLE is diverse, heterogeneous, and highly prevalent. Presenting a pathological TTE was associated with greater damage accrual and greater mortality. Based on our results, we consider that echocardiographic screening of patients with SLE is essential, especially those symptomatic and/or with risk factors, to diagnose and treat cardiac involvement earlier.

COVID-19 related peripheral arterial thrombotic events in intensive care unit and non-intensive care unit patients: A retrospective case series.

COVID-19 associated arterial thrombosis has been attributed to multiple inflammation and coagulation mechanisms. The aim of this study was to report the experience of a tertiary center on COVID-19 patients managed for acute peripheral arterial thrombosis. A single-center case series was conducted, including retrospectively collected data from all COVID-19 patients presenting arterial thrombosis, from March 2020 to February 2022. Intensive care unit (ICU) and non-ICU cases were included. The primary outcomes were mortality, successful revascularization, and amputation at 30days. Twenty patients presented peripheral arterial thrombosis (90% males, mean age 65years (16-82years)). Eighteen were diagnosed with the Delta variant and none was previously vaccinated. All cases presented acute lower limb ischemia; in 20% with bilateral involvement. Nine patients were hospitalized in the ward while 11 in the ICU. From the non-ICU cases, five presented Rutherford IIb and four cases, Rutherford's IIa ischemia. Six cases underwent revascularization (67%). Two of them were finally amputated (33%) and two died during hospitalization (33%). Two revascularizations were considered successful (33%). The ICU group presented mainly with Rutherford's III ischemia (54.5%). The mortality in the ICU cohort was 72.7%. Only one patient underwent successful revascularization and two were amputated in this subgroup. Early mortality was 50% for the total cohort while the type of management was not related to mortality. Covid-19 related arterial thrombosis in non-vaccinated population is associated with 50% early mortality; increased up to 72% in the ICU patients. The amputation rate was 20% while only 40% of the revascularizations were considered successful.

Abstract 10144: New Cardiovascular Events After Covid 19 Infection

Introduction: The incidence and persistence of cardiovascular events (CVES) occurring for the first time following COVID-19 is not completely established. Hypothesis: After COVID-19 there is an increased risk of new CVES that may persist several months after the acute infection. Methods: A retrospective claims analysis using the Symphony Health IDV, healthcare database of administrative medical and pharmacy claims for ~ 280 million lives in the USA. Patients with a claim for COVID-19 between April and June 2020 were identified and a sub cohort with new claims for CVES up to 12 months post COVID-19 was analyzed. Patients with prior history of CVES were excluded Results: 17,360 patients without prior history of CVES, age range 18-80 year (average: 55; SD: 16), 46% males and 54% females, experienced various CVES for the first-time post COVID-19. Specifically, a sub-cohort of 6,545 (38%) hospitalized patients experienced congestive heart failure (CHF) (18% ); myocardial infarction (MI) (36% ); stroke (54%);Arrythmias (54%); pulmonary embolism (15%) and peripheral arterial thrombosis (1%). Cardiomyopathy/myocarditis was reported in 253 patients. Of the new events, 25% of acute CHF, 46% of acute MI and 31% of acute stroke occurred within 28 days of hospitalization for COVID-19. The hazard of CVES peaked within 1 month from the onset of the infection and persisted up to 12 months after hospitalization. Highest residual risk factors were CHF, pericarditis, and myocarditis. Machine Learning analysis identified hypertension and COPD as strong predictors of new CVES post Covid-19. Conclusions: The occurrence of new CVES in survivors of COVID-19 is substantial. A deeper understanding of the biologic mechanisms triggering new cardiovascular disease after COVID-19 infection is needed to design interventions directed at preventing the incidence and persistence of new CVES post COVID-19 infection.

Site‐specific venous thrombosis in essential thrombocythemia: Impact on subsequent vascular events and survival

Site‐specific venous thrombosis in essential thrombocythemia: Impact on subsequent vascular events and survival

Kawasaki disease complicated by peripheral artery thrombosis: a case report and literature review

BackgroundPeripheral gangrene is rarely documented as a possible complication of Kawasaki disease (KD). There are many causes of peripheral gangrene, and the common cause is in situ thrombosis or embolism. Most cases are reported to have regrettable outcomes (amputation or necrotic shedding). Herein, we report the successful management of KD complicated by peripheral artery thrombosis in an older Chinese boy, and a review of all cases of peripheral gangrene in KD in the literature.Case presentationWe found that most of the children with this complication were under 1 year old, had a heavy inflammatory response combined with the use of cortisol and immunoglobulin, and most children had coronary artery lesions. In addition, Peripheral gangrene mainly occurred in the subacute or chronic stage, and the prognosis is poor.ConclusionsIn the presence of high risk factors, we consider it is necessary to monitor coagulation function and administer prophylactic anticoagulation therapy. When peripheral artery thrombosis or embolism occur, heparin and prostaglandins can be used for treatment.

Comparative study between effectiveness of low molecular weight heparin injection and unfractionated heparin in terms of morbidity and outcome in COVID-19 cases

Background: The novel coronavirus 2019 presented a variety of disease spectrums that range from asymptomatic to sepsis with multi-organ dysfunction and death. One of the mechanisms being a hypercoagulable state with micro and macro-circulatory thrombosis is found in critically ill COVID-19 patient with ARDS with pathology consistent with a vascular occlusive aetiology of respiratory failure rather than more classic finding of ARDS. Venous thromboembolism, MI, acute peripheral arterial thrombosis is seen in COVID-19. Endothelial cells dysfunction induced by infection causing excess thrombin generation, fibrinolysins shutdown, hypoxia inducible transcription factor dependent signalling pathways, increasing blood viscosity leading to Hypercoagulable state. Early application of anticoagulant therapy in severe COVID-19 was suggested for improving outcome in patients with elevated d-dimer. Aim of study was comparing effectiveness of LMWH with unfractionated heparin in outcome of COVID-19.Methods: This retrospective observational study including 400 patients meeting inclusion criteria were divided 2 groups out of which 200 patients were treated with inj. LMWH and other 200 were treated with injection heparin and various parameters were compared. A probability value (p value) of less than or equal to 0.05 was considered statistically significant.Results: Death rate is seen lower with LMWH in critically ill patients with high discharge rate with minimal lab parameter derangement and high efficacy to lower down inflammatory markers (LDH, ferritin, CRP, D-dimer, ESR) in comparison to unfractionated heparin.Conclusions: Early use of LMWH may be beneficial for the outcome.

Relationship Between Gender Differences and Clinical Outcome in Patients With the Antiphospholipid Syndrome.

Antiphospholipid syndrome (APS), characterized by artherial and/or venous thrombosis, pregnancy morbidity and “antiphospholipid” antibodies (aPLs), is more common in women than in men, with a female to male ratio of about 3.5:1. Only few studies have investigated the clinical differences between male and female patients with APS. Therefore, this study was aimed to analyze the differences of clinical manifestations and laboratory tests, at diagnosis, between female and male APS patients and the clinical outcome. We enrolled 191 consecutive APS patients (125 with primary APS, PAPS, and 66 with secondary APS, SAPS) with a female predominant ratio of approximately 3:1 (142 vs 49). The prevalence of PAPS was higher in males than females (p<0.001). The analysis of aPL profile revealed that high IgM anti-cardiolipin (aCL) and high-medium IgG aCL titers were more frequent in males. In thrombotic APS peripheral arterial thrombosis was more common in male than female patients (p=0.049), as well as myocardial infarction (p=0.031). Multivariate analysis to correct for cardiovascular risk factors, high titer of aPLs and triple positivity for aPLs, revealed that the odds ratio for myocardial infarction in male was 3.77. Thus, APS may be considered as a disease in which serological (IgM titer) and clinical profiles are influenced by gender.

Association of Peripheral Arterial Occlusive Disease and Deep Venous Thrombosis with Risk of Consequent Sepsis Event: A Retrospective Population-Based Cohort Study.

Peripheral artery occlusive disease (PAOD) and deep vein thrombosis (DVT) can cause a variety of acute and chronic vascular complications and put patients at risk of subsequent sepsis. This study aimed to determine whether DVT compared with PAOD patients would increase the risk of sepsis. This study recruited 43,535 patients newly diagnosed as having PAOD and 6932 patients who were newly diagnosed as having DVT from a population of 2 million patients from the Longitudinal Health Insurance Database. Propensity score matching (PSM) between the PAOD and DVT groups was performed for age, sex, comorbidities, and prior antibiotic administration. A total of 4383 patients with PAOD and 4383 patients with DVT were analyzed for risk of sepsis. The incidence density of sepsis per 1000 person years for patients with PAOD was 25.75 (95% CI = 23.90 to 27.74) and 35.61 (95% CI = 33.29 to 38.09) for patients with DVT. After age, sex, associated comorbidities, and antibiotic administration were adjusted for, the risk of sepsis for the DVT group was 1.46-fold (95% CI = 1.32–1.62) higher than that for the PAOD group. In conclusion, patients with DVT were associated with a higher risk of subsequent sepsis than patients with PAOD. Aging was another risk factor.

Tranexamic Acid in Patients Undergoing Noncardiac Surgery

BackgroundPerioperative bleeding is common in patients undergoing noncardiac surgery. Tranexamic acid is an antifibrinolytic drug that may safely decrease such bleeding.MethodsWe conducted a trial involving patients undergoing noncardiac surgery. Patients were randomly assigned to receive tranexamic acid (1-g intravenous bolus) or placebo at the start and end of surgery (reported here) and, with the use of a partial factorial design, a hypotension-avoidance or hypertension-avoidance strategy (not reported here). The primary efficacy outcome was life-threatening bleeding, major bleeding, or bleeding into a critical organ (composite bleeding outcome) at 30 days. The primary safety outcome was myocardial injury after noncardiac surgery, nonhemorrhagic stroke, peripheral arterial thrombosis, or symptomatic proximal venous thromboembolism (composite cardiovascular outcome) at 30 days. To establish the noninferiority of tranexamic acid to placebo for the composite cardiovascular outcome, the upper boundary of the one-sided 97.5% confidence interval for the hazard ratio had to be below 1.125, and the one-sided P value had to be less than 0.025.ResultsA total of 9535 patients underwent randomization. A composite bleeding outcome event occurred in 433 of 4757 patients (9.1%) in the tranexamic acid group and in 561 of 4778 patients (11.7%) in the placebo group (hazard ratio, 0.76; 95% confidence interval [CI], 0.67 to 0.87; absolute difference, −2.6 percentage points; 95% CI, −3.8 to −1.4; two-sided P<0.001 for superiority). A composite cardiovascular outcome event occurred in 649 of 4581 patients (14.2%) in the tranexamic acid group and in 639 of 4601 patients (13.9%) in the placebo group (hazard ratio, 1.02; 95% CI, 0.92 to 1.14; upper boundary of the one-sided 97.5% CI, 1.14; absolute difference, 0.3 percentage points; 95% CI, −1.1 to 1.7; one-sided P=0.04 for noninferiority).ConclusionsAmong patients undergoing noncardiac surgery, the incidence of the composite bleeding outcome was significantly lower with tranexamic acid than with placebo. Although the between-group difference in the composite cardiovascular outcome was small, the noninferiority of tranexamic acid was not established. (Funded by the Canadian Institutes of Health Research and others; POISE-3 ClinicalTrials.gov number, NCT03505723.)

Post–COVID-19 Arterial Thrombosis: A Systematic Review

COVID-19 (coronavirus disease 2019) is associated with coagulation defects, including endothelial dysfunction, inflammation, hypoxia, cytokine release, and hypercoagulability. We aimed to summarize the available cases of arterial peripheral thrombosis in the setting of post–COVID-19 infection and the use of biomarkers and related pharmacologic therapies to describe the better medical and surgical treatments based on the reported outcomes. We executed a systematic review following the 2020 PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. We searched PubMed, Embase, Scopus, and the Cochrane Library for studies reported from March 2020 to September 2021 with serologic confirmation of a resolved SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection. Related questions regarding high-yield end points included the location of the thrombosis, amputation, reintervention rates, mortality, anticoagulant therapy, and biomarkers. Of the 398 matching results, 23 reports met the inclusion criteria of post–COVID-19 thrombosis, arterial, venous, peripheral, and cured. The literature review included 12 case reports, 3 incidence reports, 3 literature reviews, 2 meta-analyses, 1 observational cohort study, and 2 prospective analyses. The overall presentation consisted of peripheral arterial thrombosis (33.3%), venous thrombosis (63.2%), and mixed events (3.5%). Most of the studies had used low-molecular-weight heparin monotherapy as a part of the medical management. There was no difference in the use of clopidogrel and aspirin as antiplatelet agents. Other pharmacologic alternatives were nonfractionated heparin, enoxaparin, warfarin, rivaroxaban, and apixaban. Open thrombectomy was the most common procedure used for COVID-19 thrombosis complications (40%), with mortality of 27.2%, followed by endovascular thrombectomy (15%), amputation (12.5%), exploratory laparotomy (5%), and endarterectomy (2.5%). We found 38 reported biomarkers, which were classified into seven categories related to an inflammatory process, coagulation time, clotting factors, cardiorespiratory function, kidney function, metabolic profile, and autoimmunity. An initial D-dimer level >1.250 ng/mL might identify COVID-19 patients at risk of arterial thrombotic events. Additional end points were associated with increased creatinine, interleukin-6, interferon gamma-induced protein-10, D-dimer, and C-reactive protein levels. COVID-19 infection is associated with a high risk of arterial and venous post-thrombotic complications, with a variable clinical and anatomic presentation, high mortality, and high amputation risk. Microcirculatory alterations can be reflected by a panel of biomarkers. The medical and surgical management of these patients could depend on the availability of resources regarding the context of medical attention. Nevertheless, considering the highly inflammatory context, endovascular interventions with less systemic stress should be considered in addition to thromboprophylaxis measures.

Small popliteal aneurysm thrombosis after SARS-CoV-2 vaccination.

The impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic cannot be overstated. So far, more than 5 million people have succumbed. The virus essentially held the world hostage until effective vaccines were developed and released. Although generally safe, novel therapies are not devoid of risk. For instance, venous thromboembolic complications of SARS-CoV-2 vaccine have been widely documented.1 This letter narrates the rare case of peripheral arterial thrombosis after coronavirus disease 2019 immunization.

COVID-19–related Peripheral Arterial Thrombosis Treated in a Large Health Maintenance Organization

BackgroundCOVID-19 was initially identified as an acute respiratory disease, but it was quickly recognized that multiple organ systems could be affected. Venous thrombosis and pulmonary embolism have been well reported. However, there is a paucity of data on COVID-19–related arterial thrombosis. We examined the incidence, characteristics, treatment, and outcome in patients with acute COVID-19–related arterial thrombosis in a large health maintenance organization (HMO).MethodsA retrospective multicenter case review was performed from March 2020 to March 2021. Cases were identified through a questionnaire sent to vascular surgeons. Patient characteristics, imaging, treatment, and outcome were reviewed. Successful revascularization was defined as restoration of blood flow with viability of the end organ and absence of death within 30 days. Limb salvage was defined as prevention of major amputation (transtibial or transfemoral) and absence of death in 30 days.ResultsThere were 37,845 patients admitted with COVID-19 complications during this time. Among this group, 26 patients (0.07%) had COVID-19–related arterial thrombosis. The mean age was 61.7 years (range, 33–82 years) with 20 men (77%) and 6 women (23%). Ethnic minorities comprised 25 of 26 cases (96%). Peripheral arterial disease (PAD) was present in 4 of 26 (15%), active smoking in 1 of 26 (3.8%), and diabetes in 19 of 26 (73%) cases. Most patients developed acute arterial ischemia in the outpatient setting, 20 of 26 (77%). Of the outpatients, 6 of 20 (30%) had asymptomatic COVID-19 and 14 of 20 (70%) had only mild upper respiratory symptoms. Distribution of ischemia was as follows: 23 patients had at least one lower extremity ischemia, one patient had cerebral and lower extremity, one had mesenteric and lower extremity, and one had upper extremity ischemia. Revascularization was attempted in 21 patients, of which 12 of 21 (57%) were successful. Limb salvage was successful in 13 of 26 (50%) patients. The overall mortality was 31% (8/26).ConclusionsOur experience in a large HMO revealed that the incidence of COVID-19–related arterial thrombosis was low. The actual incidence is likely to be higher since our method of case collection was incomplete. The majority of arterial thrombosis occurred in the outpatient setting in patients with asymptomatic or mild/moderate COVID-19 respiratory disease. Acute ischemia was the inciting factor for hospitalization in these cases. Acute lower extremity ischemia was the most common presentation, and limb salvage rate was lower than that expected when compared to ischemia related to PAD. Arterial thrombosis associated with COVID-19 portends a significantly higher mortality. Education of primary care providers is paramount to prevent delayed diagnosis as most patients initially developed ischemia in the outpatient setting and did not have a high cardiovascular risk profile.

Acute limb ischaemia: not an uncommon complication of COVID-19 infection.

A new variant of coronavirus (2019-nCoV) causing acute respiratory distress in humans was identified for the first time in 2019, in Wuhan, China. One of the many complications of infection with this coronavirus is hypercoagulopathy, resulting in acute thrombosis; often leading to acute limb ischaemia. Herein, we report 20 cases of COVID-19 with peripheral arterial thrombosis involving either upper or lower limbs. Some patients underwent vascular procedures and most had to undergo amputation at some level. All the cases (n=20) were referred to us during the 8-month period June 2020 to March 2021. The most common age group was between 51 and 60 years, of whom 80% were males; all the patients had diabetes. The right lower limb was most affected (50%); 15 patients underwent embolectomy. Twenty-five per cent of patients presented with wet gangrene. One patient with upper limb thrombosis recovered after embolectomy and did not require any amputation. Eighty-five per cent of patients underwent some form of amputation and the mortality rate was 10%. Arterial thrombosis is one complication patients may develop during COVID-19 illness, which may affect the outcome. Patients with comorbid conditions like diabetes are at higher risk of developing arterial thrombosis during COVID-19 infection. Susceptibility to coagulopathy may continue even after patient discharge and it is important that both patients and treating physicians are aware of this limb-threatening complication and seek early medical attention.

PERSONALIZED RISK ASSESSMENT OF RAPIDLY PROGRESSIVE ATHEROSCLEROSIS

Abstract. Вackground. Progressive atherosclerosis is accompanied by unfavorable clinical outcomes, study and understanding of this process, creation of risk assessment method is necessary for individualization of approaches to treatment and prevention of this condition. Purpose of the study. Creation of risk assessment method of atherosclerosis progression for personalized approach to treatment, rehabilitation and secondary prevention. Patient Characteristics and Study Methods. A retrospective cohort study included 202 patients with coronary heart disease: 147 men and 55 women. The mean age of the patients was 53.3±7.16 years. Group 1 included patients who had had myocardial infarction or unstable angina, emergency arterial stenting, stroke, peripheral artery thrombosis, critical ischemia, and lower extremity amputation within 2 years before study inclusion. Patients in the comparison group did not have these events. The influence of each of the studied parameters on the probability of fast progressing atherosclerosis was determined by factor and correlation analysis. Results. As a result of the study, an innovative method for predicting the risk of developing rapidly progressing atherosclerosis in a patient was developed, including determining the patient's age, the presence or absence of carotid stenosis by 50% or more of the vessel lumen on at least one side, body mass index obesity, history of stable angina pectoris, high-sensitivity C-reactive protein (hsSRP) and high-density lipoprotein cholesterol (HDL-cholesterol) serum concentrations. The sensitivity, specificity and accuracy of the proposed method are above 80%. An application for the registration of the invention was filed to the Russian Federal Service for Intellectual Property, Patents and Trademarks (Rospatent). Conclusion. The proposed model was developed on the basis of studying the indexes in Russian patients. It shows the weight of one or another factor that influences the probability of rapidly progressing atherosclerosis. The model is easy to use and allows to individualize prophylaxis in this category of patients.

Earlier onset of peripheral arterial thrombosis in homozygous MTHFR C677T carriers than in other MTHFR genotypes: a cohort study.

To investigate whether age at first presentation of pure peripheral arterial thrombosis (PAT) in lower and upper limbs and in the splanchnic circulation occurs earlier in carriers of the methylenetetrahydrofolate reductase (MTHFR) T677T genotype compared to the heterozygous and wild type and to identify predictors of a possible earlier onset. Retrospective cohort study on 27 MTHFR TT, 29 MTHFR TC and 29 MTHFR CC participants; data regarding age, sex, age at PAT, clinical history (dyslipidaemia, hypertension, smoking, obesity) and homocysteine (HC) measured by immunoassay were collected. Age at PAT was lower in MTHFR TT than MTHFR TC and CC (43 ± 9 vs 47 ± 9 vs 51 ± 4years, respectively, p = 0.02); plasma HC was higher in MTHFR TT than in the other groups (25 ± 19 vs 12.7 ± 6.7 vs 11.3 ± 3.3μmol/l, respectively, p < 0.001) while the activated partial thromboplastin ratio (aPTTr) was lower in MTHFR TT than in other genotypes (0.90 ± 0.10 vs 0.97 ± 0.12 vs 0.97 ± 0.08μmol/L p < 0.001). Among categorical variables, MTHFR TT and dyslipidaemia independently predicted age at AT (p = 0.01 & p = 0.03, respectively) whereas among the continuous variables HC independently predicted age at PAT (p = 0.02) as well as the aPTTr (p = 0.001); smoking predicted lower limb PAT (p = 0.005). MTHFR TT carriers develop their first PAT an average of 4 and 8years earlier than MTHF CT and CC genotypes; MTHFR TT, dyslipidaemia and plasma HC contribute to the prematurity of the PAT while the interplay between elevated HC and smoking may affect type of arterial district occlusion.

Thrombotic Conditions in Patients with COVID-19: Dynamics of D-Dimer and Tactics of Anticoagulant Therapy

In patients with COVID-19, histological examination of the pulmonary vessels shows serious disorders (local thrombosis and microangiopathy), significantly different to those in the control group composed of patients with influenza. Some studies have shown that coronavirus enters cells by binding angiotensin-converting enzyme 2 which is found mainly on the alveolar epithelium and endothelium. The increase in D-dimer levels is typical for patients with COVID-19. Although many inflammatory processes can affect D-dimer levels, an increase in D-dimer during COVID-19 is more likely to indicate thrombosis. The aim. To analyze the patients who have suffered from COVID-19 and to determine possible risk factors for the development of thrombotic complications and define the surgical or medical therapy tactics. Material and methods. The study was conducted from October 2020 to April 2021 in Ukraine (Zaporizhzhia, Uzhhorod, Kherson and Kyiv). We analyzed 121 patients aged 46.9± 15.3 years, 64 (52.8%) men and 57 (47.1%) women. All the patients had positive PCR test for COVID-19. The changes in D-dimer were analyzed. Results. Forty-one (33.9%) patients had thrombotic complications. Pulmonary embolism (PE) was diagnosed in 14 patients, deep vein thrombosis (DVT) in 17, acute stroke in 2 and peripheral artery thrombosis in 8 cases. An increase in D-dimer level was observed in most patients and was not associated with clinical manifestations of thrombosis. At a D-dimer level of 11,000-10,564 ng/ml the patients had clinical symptoms of thrombotic condition which was confirmed by computed tomography or ultrasound examination. At an increase over 725-7000 ng/ml, there were no clinical signs of thrombosis. We performed standard medical therapy in patients with PE and DVT. In case of arterial thrombosis open surgery was performed in 4 patients and direct catheter thrombolysis in 1 case. Conclusion. In our opinion, anticoagulants should be prescribed for patients with a D-dimer level of more than 700 ng/ml. Full anticoagulation is prescribed for severe forms of COVID-19 or confirmed thrombosis. We didn’t find any correlation between the development of thrombotic complications in patients with COVID-19 and comorbidities, body mass index and other factors. Medical therapy was successful in all cases of PE and DVT, anticoagulants were prescribed for 1 year. Femoral artery thrombectomy was successfully performed in 4 patients. After direct catheter thrombolysis we got peripheral pulse. In all cases of arterial thrombosis, we prescribed anticoagulants for 2 months after discharge and acetylsalicylic acid for a long time.

Acute Arterial Thrombosis of Lower Extremities in COVID-19 Patients.

Clinical signs and symptoms of COVID-19 varied from asymptomatic forms to severe, life-threatening conditions that required treatment in intensive care units. These severe forms of illness are connected with a hypercoagulable state due to excessive inflammation, hypoxia, immobilisation, and altered angiotensin-converting enzyme 2 (ACE-2). In total, 17 COVID-19 positive patients were diagnosed with peripheral arterial thrombosis (AT), 13 of them had COVID-19 pneumonia. Laboratory findings in patients with X-ray confirmed pneumonia showed a four times higher neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP) and three times higher lactate dehydrogenase level (LDH) than patients without confirmed pneumonia. Patients with pneumonia had significantly more bilateral occlusions of the lower extremities and a significantly higher percentage with complete occlusion of the arteries than patients without pneumonia. The rate of limb loss was 35.3%. They were all from the group with COVID-19 pneumonia. Ten out of thirteen patients with pneumonia died due to acute respiratory distress syndrome (ARDS). All patients without pneumonia were discharged from the hospital. The aim of this retrospective study was to report the incidence of arterial thrombosis of lower extremities and their complications in the acute phase of the infection among COVID-19 patients admitted to the hospital for treatment.