Deep Vein Thrombus Research Articles

Discovery of crucial cytokines associated with deep vein thrombus formation by protein array analysis

BackgroundExpanding the number of biomarkers is imperative for studying the etiology and improving venous thromboembolism prediction. In this study, we aimed to identify promising biomarkers or targeted therapies to improve the detection accuracy of early-stage deep vein thrombosis (DVT) or reduce complications.MethodsQuantibody Human Cytokine Antibody Array 440 (QAH-CAA-440) was used to screen novel serum-based biomarkers for DVT/non-lower extremity DVT (NDVT). Differentially expressed proteins in DVT were analyzed using bioinformatics methods and validated using a customized array. Diagnostic accuracy was calculated using receiver operating characteristics, and machine learning was applied to establish a biomarker model for evaluating the identified targets. Twelve targets were selected for validation.ResultsCytokine profiling was conducted using a QAH-CAA-440 (RayBiotech, USA) quantimeter array. Cross-tabulation analysis with Venn diagrams identified common differential factors, leading to the selection of 12 cytokines for validation based on their clinical significance. These 12 biomarkers were consistent with the results of previous array analysis: FGF-6 (AUC = 0.956), Galectin-3 (AUC = 0.942), EDA-A2 (AUC = 0.933), CHI3L1 (AUC = 0.911), IL-1 F9 (AUC = 0.898), Dkk-4 (AUC = 0.88), IG-H3 (AUC = 0.876), IGFBP (AUC = 0.858), Gas-1 (AUC = 0.858), Layilin (AUC = 0.849), ULBP-2 (AUC = 0.813)and FGF-9 (AUC = 0.773). These cytokines are expected to serve as biomarkers, targets, or therapeutic targets to differentiate DVT from NDVT.ConclusionsEDA-A2, FGF-6, Dkk-4, IL-1 F9, Galentin-3, Layilin, Big-h3, CHI3L1, ULBP-2, Gas-1, IGFBP-5, and FGF-9 are promising targets for DVT diagnosis and treatment.

HOXD9 regulated mitophagy to promote endothelial progenitor cells angiogenesis and deep vein thrombosis recanalization and resolution

BackgroundDeep vein thrombosis (DVT) is a common vascular surgical disease caused by the coagulation of blood in the deep veins, and predominantly occur in the lower limbs. Endothelial progenitor cells (EPCs) are multi-functional stem cells, which are precursors of vascular endothelial cells. EPCs have gradually evolved into a promising treatment strategy for promoting deep vein thrombus dissolution and recanalization through the stimulation of various physical and chemical factors.MethodsIn this study, we utilized a mouse DVT model and performed several experiments including qRT-PCR, Western blot, tube formation, wound healing, Transwell assay, immunofluorescence, flow cytometry analysis, and immunoprecipitation to investigate the role of HOXD9 in the function of EPCs cells. The therapeutic effect of EPCs overexpressing HOXD9 on the DVT model and its mechanism were also explored.ResultsOverexpression of HOXD9 significantly enhanced the angiogenesis and migration abilities of EPCs, while inhibiting cell apoptosis. Additionally, results indicated that HOXD9 specifically targeted the HRD1 promoter region and regulated the downstream PINK1-mediated mitophagy. Interestingly, intravenous injection of EPCs overexpressing HOXD9 into mice promoted thrombus dissolution and recanalization, significantly decreasing venous thrombosis.ConclusionsThe findings of this study reveal that HOXD9 plays a pivotal role in stimulating vascular formation in endothelial progenitor cells, indicating its potential as a therapeutic target for DVT management.Graphical

Iliopsoas Bursitis Compressing an External Iliac Vein Stent

We report a case of external iliac vein (EIV) compression due to iliopsoas bursitis. A 78-year-old man with a prior left total hip arthroplasty (THA) and left lower extremity (LLE) deep vein thrombus (DVT) presented with chronic LLE edema. Initial ultrasound examination revealed deep venous reflux and evidence of ipsilateral outflow vein obstruction. A left groin mass thought to be a hernia was noted. Conservative management was unsuccessful. Subsequent venography and intravascular ultrasound demonstrated severe stenosis of the distal EIV. A stent was placed but could not be fully expanded despite repeated venoplasty. Following the procedure, pelvic computed tomography (CT) showed extrinsic compression of the EIV and stent likely caused by iliopsoas bursitis.

Anti-hemostatic, antithrombotic, and chemical profiles of a curly-leaf variety of Petroselinum crispum (Apiaceae), a food and medicinal aromatic herb

Thrombosis is currently among the major causes of morbidity and mortality in the World. New prevention and therapy alternatives have been increasingly sought in medicinal plants. In this context, we have been investigating parsley, Petroselinum crispum (Mill.) Nym, an aromatic herb with two leaf varieties. We report here the in vitro, in vivo, and ex vivo anti-hemostatic and antithrombotic activities of a parsley curly-leaf variety. Aqueous extracts of aerial parts (PCC-AP), stems (PCC-S), and leaves (PCC-L) showed significant in vitro antiplatelet activity. PCC-AP extract exhibited the highest activity (IC50 2.92 mg/mL) when using ADP and collagen as agonists. All extracts also presented in vitro anticoagulant activity (APTT and PT) and anti-thrombogenic activity. PCC-S was the most active, with more significant interference in the factors of the intrinsic coagulation pathway. The oral administration of PCC-AP extract in rats caused a greater inhibitory activity in the deep vein thrombi (50%; 65 mg/kg) than in arterial thrombi formation (50%; 200 mg/kg), without cumulative effect after consecutive five-day administration. PCC-AP extract was safe in the induced bleeding time test. Its anti-aggregating profile was similar in ex vivo and in vitro conditions but was more effective in the extrinsic pathway when compared to in vitro results. Apiin and coumaric acid derivatives are the main compounds in PCC-AP according to the HPLC-DAD-ESI-MS/MS profile. We demonstrated for the first time that extracts from different parts of curly parsley have significant antiplatelet, anticoagulant, and antithrombotic activity without inducing hemorrhage, proving its potential as a source of antithrombotic compounds.

MID-TERM RESULTS OF HIGH TIBIAL OSTEOTOMY USING THE ANATOMICAL TOMOFIX MEDIAL HIGH TIBIAL PLATE

AbstractIntroductionCompared to the standard Tomofix plate, the anatomical Tomofix medial high tibial (MHT) plate has been shown to improve anatomical fit and post correction tibial contour, following high tibial osteotomy (HTO). Clinical data on surgical complications, osteotomy union rates and survivorship with the anatomical Tomofix MHT plate however remain limited. This study reports mid-term results of HTO surgery, using the anatomical Tomofix MHT plate.MethodsAll patients undergoing HTO surgery using the anatomical Tomofix MHT plate between 2017 and 2022 were included in the study. Data on complications, osteotomy union rates and survivorship were collected prospectively and retrospectively analysed.Results78 HTO procedures were performed using the anatomical Tomofix plate in 68 patients. Follow-up ranged between 6 weeks and 5 years. Postoperative complications included 5 hinge fractures that united without further intervention, 1 deep vein thrombus and 1 subclinical pulmonary embolism. There were no wound problems and no returns to theatre, other than for planned removal of metalwork at 1 year. All osteotomies united with no loss of correction. Only 1 HTO was successfully revised to a partial medial knee replacement 2.5 years following osteotomy. The 5-year survivorship was 98.7%.ConclusionThe anatomical Tomofix MHT plate achieves excellent biomechanical stability and union rates in HTO surgery, with minimal complications and excellent mid-term HTO survivorship.

Detection and treatment of thrombotic diseases by activating platelet

Nowadays thrombus has become one of the most prevalent diseases among the world, a large amount of population died of it. Thus, it is essential to improve the medical diagnose and treatment method to lower the morbidity as great as possible. Deep vein thrombus and artery thrombus, these two typical examples of thrombus will be given to illustrate the main methods of diagnose and treatment. In the stage of making diagnose, there are many traditional methods in medical fields like thrombelastogram, radiography, CT technology and X-rays. They are all proven medical technologies which can detect the thrombosis clearly through different principles. However, with the time goes by, Flow Cytometry, a new technology, has been developed through innumerable experiment and research. This technology is significant breakthrough in the history of blooding diagnose since it is more advanced than the classical method in many aspects. For instance, the thrombelastogram has low repeatability since it ‘s results are not always accurate; Radiography will cause risks since it will leave wounds for the patients; CT and X-rays are usually used in the phase of treatment but not in the early diagnose. Above all, it is better to combine these classical means with Flow Cytometry to make the diagnose more convenient and prevent getting thrombus as much as possible. For treatment of thrombus like Deep vein thrombus and artery thrombus, thrombolytic drugs, anticoagulant drugs, and antiplatelet drugs are mainly suggested. Other than those drugs, there are other drugs that may composed by other component are under ongoing research.

Magnetic Resonance Imaging of Cancer-Associated Deep Vein Thrombus in a Patient With Gastric Cancer.

Magnetic Resonance Imaging of Cancer-Associated Deep Vein Thrombus in a Patient With Gastric Cancer.

E018 COVID-19 vaccine-induced myositis

Abstract Background/Aims Through the COVID pandemic there have emerged reports of autoimmunity or new rheumatic diseases presenting in patients after they had COVID-19. This is thought to be caused by cross-reactivity of the COVID-19 spike protein to human antigens. Given the use of mRNA COVID-19 vaccinations which express the spike protein we might expect to see presentation of new rheumatic diseases following their use. We discuss a case where this appears to have occurred. Methods Our patient is a 24-year-old male with mixed phenotype acute leukaemia who had been treated with allogenic stem cell transplant and was currently in remission. He presented with fevers, palpitations, myalgia and bilateral arm and leg swelling. Symptoms began the day after receiving the first dose of an mRNA COVID-19 vaccination (Pfizer/BioNTech.) There were no other symptoms or recent change in medications. Physical examination revealed tender oedema in his forearms, biceps and thighs bilaterally with sparring of the hands. He had reduced power with shoulder (MRC 3/5), elbow (4), wrist (4+) and hip (4) movements. Observations revealed tachycardia and fevers up to 40C. Results Laboratory studies showed markedly elevated C-reactive protein (202), creatinine kinase (6697) and troponin (593) whilst investigations for infection were negative. An autoimmune panel was positive for anti-PM-SCL-75-Ab. An electrocardiogram showed sinus tachycardia. Echocardiogram was normal. Bilateral upper limb dopplers revealed no deep vein thrombus. An MRI of his thighs showed diffuse symmetrical oedema within the muscles, in keeping with an inflammatory myositis. A quadricep muscle biopsy showed evidence of MHC class 1 up-regulation, suggesting an inflammatory process. In addition, there were numerous macrophages evident in the endomysium. While this can be seen in graft-versus-host disease (GVHD), they would usually be found in the perimysium. After discussion between haematology, rheumatology and neurology, this was felt to be a case of vaccine induced myositis and myocarditis. Autoimmune myositis was thought to be less likely due to the relative sparing of the hands and the absence of Raynaud’s phenomenon. 1 gram of intravenous methylprednisolone was then given for 3 days. The patient had a marked response with defervescence, improving laboratory markers, improved myalgia and decreased limb swelling. The patient was stepped down to a reducing regime of prednisolone and discharged. Due to relapse whilst weaning he has started on mycophenalate mofetil and rituximab and now continues to improve. Conclusion There are case reports of myositis following COVID-19 vaccination but our patient’s case is complicated by the differential diagnosis of GVHD and concurrent myocarditis. Ongoing work is needed to clarify the exact link between vaccination and the presentation of a new inflammatory myositis, but it is important to recognise and start treatment early in order to preserve muscle bulk and ensure recovery. Disclosure L. Thompson: None. T. Nadin: None. J. Meiring: None. S. Thomas: None. R. Kumari: None. S. Carter: None. M. Akil: None. A. Alfred: None. N. Morley: None.

Utility and Clinical Outcomes of Perioperative Inferior Vena Cava Filter Prophylaxis in Spine Surgery Patients.

Single-center retrospective chart review study. This study aimed to assess the clinical outcomes of prophylactic inferior vena cava (IVC) filter use for pulmonary embolism (PE) prevention in spine surgery patients. IVC filters can serve an important prophylactic role in preventing PE, though research involving spine surgery patients is sparse. This Institutional Review Board-approved single-center retrospective study assessed the characteristics and outcomes of patients who underwent spine surgery and received perioperative IVC filters for PE prophylaxis from January 2007 until December 2021. Clinical outcomes centered primarily on the occurrence of venous thromboembolism (VTE) as well as complications related to filter placement and retrieval. Thrombi that may have been entrapped by the filters were recorded incidentally on computed tomography or during the filter retrieval procedure. This cohort included 380 spine surgery patients (female 51%/male 49%; median age, 61) who had received perioperative prophylactic IVC filters. The mean dwell time was 6.7 months (1-39mo), with an overall 62% retrieval rate. Retrievals were further categorized by retrieval complexity, with 92% classified as routine and 8% as involving advanced removal techniques, while complications involved 1% (four retrievals) and were all minor. Regarding VTE event occurrence, deep vein thrombi (DVT) were experienced by 11% of patients in the postplacement period, with 1% (n=4) experiencing a PE. There were 11 incidences of thrombi that were found within or near the filters (2.9%). A multivariate analysis further assessed patient characteristics that correlated with the occurrence of PE, DVT, entrapped filter thrombi, advanced technique filter removal, and removal complications. IVC filters in this high-risk spine surgery cohort achieved a relatively low rate of DVT and PE as well as a low complication rate, whereas several patient characteristics were identified that correlated with VTE events and filter retrieval outcomes.

The effects of pharmacomechanical thrombolysis treatment administered to patients with iliofemoral deep vein thrombus

Aim: In this study, the mid-term results of the pharmacomechanical thrombolysis treatment administered in patients with iliofemoral acute-subacute (patients with symptoms less than 21 days old whose DVT was diagnosed with physical examination and duplex ultrasonography) deep vein thrombus (DVT) were investigated. The cases were evaluated in terms of disease-related quality of life, and the presence of post-thrombotic syndrome (PTS) which occurred in patients after previous DVT and treatment, and if present, its severity was determined. Material and Methods: Disease-related status of 40 patients (24 males, 16 females; mean age 44; age interval 20-80 years) treated due to iliofemoral acute-subacute DVT with interventional method between July 2013 and January 2017 were retrospectively analyzed two years after the interventional treatment. These patients were considered as mid-term patients. The patients were evaluated with VEINES-QOL/Sym quality of life scale and the Villalta scale. The occurrence and severity of PTS, the presence of venous ulcer, and the diameter difference between legs were evaluated. Results: No venous ulcer was present in our cases. In the evaluation made with Villalta scale, PTS was not observed in 20 out of 40 cases, mild PTS was found in 15, moderate PTS in 4, and severe PTS was observed in 1 case. Conclusion: We have concluded that pharmacomechanical thrombolysis treatment administered in well-selected patients reduced the severity of PTS and increased the quality of life associated with disease in DVT treatment.

Transient Ischemic Attack Following Foam Sclerotherapy for Chronic Venous Ulcer with No Cardiac Defect - A Rare Case Scenario

Abstract Chronic venous insufficiency (CVI) constitutes one of the main causes for lower limb ulceration. Foam sclerotherapy forms an important part of CVI treatment. It is used to treat truncal incompetence, perforating veins, and primary and secondary varicosities as well as reticular and spider veins. It is used either alone or in addition to the endovenous ablative techniques. Although usually done as an office procedure, it can cause serious complications which include allergic reaction, deep-vein thrombus formation, superficial vein thrombosis, and ulceration if extravasated into the subcutaneous plane and rarely can cause various neurological manifestations such as transient visual loss, migraine, transient ischemic attack, speech disturbances, and stroke. Neurological complications amount to only 0.90% among all the complications according to a systematic review by Tharsi Saravananthan et al. The neurological complications are usually transient and generally occur due to patent foramen ovale (PFO). There are very few case reports mentioned in the literature where the neurological symptoms occur without any evidence of cardiac defects. Herein, we report a case where foam sclerotherapy was given for chronic venous ulcer, and the patient developed speech disturbance in the immediate postprocedure period which resolved on its own. His preoperative echocardiography was normal without any structural heart defects. This is one of the few cases to be reported in the literature where sclerotherapy-induced neurological complication has occurred without any evidence of PFO.

Histopathological Features of Cancer-Associated Venous Thromboembolism: Presence of Intrathrombus Cancer Cells and Prothrombotic Factors.

Cancer-associated venous thromboembolism (VTE) is a critical complication in patients with cancer. However, the pathological findings of VTE are limited. Here, we investigated the histopathological features of cancer-associated VTE in human autopsy cases. We clinically examined the autopsy cases of VTE with (n=114) and without cancer (n=66) and immunohistochemically analyzed the expression of prothrombotic factors in intrathrombus cancer cells, the thrombus contents of erythrocytes, fibrin, platelets, citrullinated histone H3, and degree of organization. Vascular wall invasion or small cell clusters of cancer cells was observed in thrombi in 27.5% of deep vein thrombosis and 25.9% of pulmonary embolism cases. The majority of the cancer cells in deep vein thrombi appeared to be invading the vessel wall, whereas the majority of pulmonary thrombi had cancer cell clusters, consistent with embolization via blood flow. These cancer cells were immunohistochemically positive for TF (tissue factors) or podoplanin in up to 88% of VTE cases. The frequency of TF-positive monocyte/macrophages in thrombi was higher in cancer-associated VTE than that in VTE without cancer. Citrullinated histone H3 was predominantly observed in the early stages of organizing thrombi. There was no significant difference in thrombus components between VTE with cancer and without cancer groups. Vascular wall invasion or cancer cell clusters in thrombi might influence thrombogenesis of cancer-associated VTE. TF and podoplanin in cancer cells and in monocyte/macrophages may induce coagulation reactions and platelet aggregation. Neutrophil extracellular traps may play a role in the early stages of VTE, regardless of cancer status.

Outcomes from the ClotTriever Outcomes Registry show symptom duration may underestimate deep vein thrombus chronicity: Presented at Eastern Vascular Society meeting, September 23-26, 2021, Charleston, SC.

Objective: The all-comer ClotTriever Outcomes registry assessed indicators of thrombus chronicity in patients with acute, subacute, and chronic lower extremity deep vein thrombosis (DVT). The effectiveness of the ClotTriever System (Inari Medical, Irvine, CA) by chronicity subgroup was also assessed and reported here in this subanalysis.

COVID-19-Associated Pulmonary Embolism: Review of the Pathophysiology, Epidemiology, Prevention, Diagnosis, and Treatment.

COVID-19 is associated with endothelial activation in the setting of a potent inflammatory reaction and a hypercoagulable state. The end result of this thromboinflammatory state is an excess in thrombotic events, in particular venous thromboembolism. Pulmonary embolism (PE) has been of special interest in patients with COVID-19 given its association with respiratory deterioration, increased risk of intensive care unit admission, and prolonged hospital stay. The pathophysiology and clinical characteristics of COVID-19-associated PE may differ from the conventional non-COVID-19-associated PE. In addition to embolic events from deep vein thrombi, in situ pulmonary thrombosis, particularly in smaller vascular beds, may be relevant in patients with COVID-19. Appropriate prevention of thrombotic events in COVID-19 has therefore become of critical interest. Several changes in viral biology, vaccination, and treatment management during the pandemic may have resulted in changes in incidence trends. This review provides an overview of the pathophysiology, epidemiology, clinical characteristics, and risk factors of COVID-19-associated PE. Furthermore, we briefly summarize the results from randomized controlled trials of preventive antithrombotic therapies in COVID-19, focusing on their findings related to PE. We discuss the acute treatment of COVID-19-associated PE, which is substantially similar to the management of conventional non-COVID-19 PE. Ultimately, we comment on the current knowledge gaps in the evidence and the future directions in the treatment and follow-up of COVID-19-associated PE, including long-term management, and its possible association with long-COVID.

Clinical progress note: Noncardiac complications in adults with congenital heart disease.

Clinical progress note: Noncardiac complications in adults with congenital heart disease.

Outcomes from the ClotTriever Outcomes Registry show symptom duration may underestimate deep vein thrombus chronicity

ObjectiveThe all-comer ClotTriever Outcomes registry assessed indicators of thrombus chronicity in patients with acute, subacute, and chronic lower extremity deep vein thrombosis (DVT). The effectiveness of the ClotTriever System (Inari Medical, Irvine, CA) by chronicity subgroup was also assessed and reported here in this subanalysis. MethodsAll-comer patients with lower extremity DVT were enrolled, with no limitation based on the patients’ symptom duration. Chronicity was assessed three times and compared: before the procedure based on symptom duration, during the procedure based on available pre-thrombectomy imaging, and visual inspection of the extracted thrombus morphology after thrombectomy. Patients were grouped into acute, subacute, and chronic subgroups according to their post-thrombectomy thrombus chronicity based on thrombus morphology. Analyses on baseline and procedural characteristics along with thrombus removal were performed across subgroups. The effectiveness of thrombus removal was determined by Marder scores adjudicated by an independent core laboratory, with a prespecified primary effectiveness end point of complete or near-complete (≥75%) thrombus removal. ResultsOf the 260 treated limbs from 250 patients, using symptom duration alone, 70.7% were considered acute, 20.9% subacute, and 8.4% chronic. Upon visual inspection, the extracted thrombus chronicity was approximately one-third in each subgroup: 32.7% had acute thrombus, 35.4% subacute thrombus, and 31.9% chronic thrombus. Chronicity assessed using symptom duration alone mismatched the post-thrombectomy chronicity in 55.1% of limbs (P < .0001) with 49.0% being more chronic than suggested by the patients’ duration of symptoms. Chronicity assessed using pre-thrombectomy imaging mismatched the post-thrombectomy chronicity in 17.5% of limbs (P < .0001). No patients received thrombolytics and 99.6% were treated in a single session. Complete or near-complete thrombus removal was achieved in a high percentage of limbs regardless of thrombus chronicity: 90.8%, 81.9%, and 83.8% in limbs with acute, subacute, and chronic thrombus, respectively. ConclusionsThis subanalysis from the all-comer ClotTriever Outcomes registry demonstrates that extracted thrombus in DVT may be more chronic than suggested by the patients’ duration of symptoms. The addition of imaging is helpful to determine the ability of thrombus to respond to therapy. Irrespective of thrombus chronicity, the ClotTriever system can be effective at removing acute, subacute, and chronic thrombus in a single-session procedure without the need for thrombolytics.

Neutrophils Mediate Pulmonary Artery Thrombosis In Situ.

Pulmonary embolism is a life-threatening condition, which can result in respiratory insufficiency and death. Blood clots occluding branches of the pulmonary artery (PA) are traditionally considered to originate from thrombi in deep veins (usually in legs). However, growing evidence suggests that occlusion of the vessels in the lungs can develop without preceding deep vein thrombosis (DVT). In this work, we used an inferior vena cava (IVC) complete ligation model of DVT in Wistar rats to explore the possibility and mechanisms of PA thrombosis under the conditions where all routes of thrombotic mass migration from peripheral veins are blocked. We demonstrate that rats both with normal and reduced neutrophil counts developed thrombi in the IVC, although, neutropenia caused a substantial decrease in thrombus size and a shift from fresh fibrin toward mature fibrin and connective tissue inside the thrombus. Massive fibrin deposition was found in the PA branches in the majority of DVT rats with normal neutrophil counts, but in none of the neutropenic animals. Neutrophil ablation also abolished macroscopic signs of lung damage. Altogether, the results demonstrate that thrombi in the lung vasculature can form in situ by mechanisms that require local neutrophil recruitment taking place in the DVT setting.

Russian Medical Academy of Postgraduate Education, Moscow

Examination and treatment results of 120 patients with closed injuries of the ankle joint are presented. In 76 patients with various patterns and severity of closed injuries duplex crus veins examination using color Doppler to evaluate the venous blood circulation was performed within the first 24 hours. Mural deep vein thrombus of the crus was diagnosed in 26 (34.2%)) patients. Deep vein occlusion (posterior tibial vein) was detected in type B2 injuries 14 (45.2%) out of 31 examined patients, in type B3 11 (36. 7%)) out of 30 patients and in type C2 1 (9.1%)) out of 11 patients. Elaborated diagnostic curative scheme gave a two times decrease of the ratio of chronic venous circulation disturbance as compared to control and in 34.2%) of patients the development of postthrombophlebitic syndrome was prevented.

Investigating the Source of Fatal Pulmonary Thromboembolism in a Coronial Postmortem Population.

The incidence of how often a deep vein thrombosis is found in the calves of the legs at coronial postmortem examination is unclear. This study retrospectively examined postmortem examination reports from Australian Coronial investigations of sudden death resulting from pulmonary thromboembolism to determine the likelihood of dissection of the deep veins of calves of the legs revealing the source of a pulmonary thromboembolism. From 450 cases taken from the National Coronial Information System (NCIS) for 2016, the postmortem reports of 327 cases were reviewed to provide demographic details of victims of sudden death from pulmonary thromboembolism. In 235 cases, it was possible to determine in 76.6% a thrombus had been found in the deep veins of the calves of the legs after dissection. In 141 cases, it was documented that both sides had been examined. From these, it was determined there was no statistically significant difference in the prevalence of thrombus in either side. However, it was shown that the presence of an abnormality of a lower limb (such as leg or hip infection, burns, surgery and nonoperated fractures, or a larger circumference) increased the likelihood that a deep vein thrombus would be found on that side.

PULMONARY EMBOLISM CASES WHICH OCCURRED UNDER ENOXAPARIN SODIUM 4000 IU PROPHYLAXIS

TOPIC: Pulmonary Vascular Disease TYPE: Global Case Reports INTRODUCTION: Some surgical based guidelines recommends standart 4000 IU Enoxaparin for VTE prophylaxis. However fixed dose enoxaparin will often fail to achieve therapeutic levels, since for therapeutic anticoagulation, enoxaparin is dosed based on weight (1mg/kg). To draw attention to this issue, we presented 3 cases who developed PE while receiving 4000 IU Enoxaparin prophylaxis. CASE PRESENTATION: Cases Case 1:A 27-year-old, 72 kilogram male patient, who had no known chronic disease history, was using Enoxaparin sodium 4000 international units (IU) regularly once a day after the meniscus operation. Complaints of back pain and shortness of breath developed two weeks after the operation In the computed tomography pulmonary angiography(CTPA), filling defects in the middle and lower lobar branches of the right lung and extending to the lingular segment of the upper lobe of the left lung were seen. The patient was followed up in our department with the diagnosis of bilateral lobar pulmonary embolism (PE).Case 2:An 80-year-old 65-kilogram female patient with a known chronic obstructive pulmonary disease, atrial fibrillation (AF), hypertension, was using a new generation oral anticoagulant (NOAC) due to AF. NOAC was discontinued upon the development of ecchymotic lesions in the body, and Enoxaparin sodium 4000 IU was added to the treatment once a day.. Three weeks after the treatment change, the patient was admitted to the emergency department with the complaint of dyspnea, and a thrombus extending from the distal of both main pulmonary arteries to the bilateral lower and upper lobe bronchial artery was detected in the CTPA, and he was followed up in our service with the diagnosis of massive PE. DISCUSSION: Case 3: An 81 years old, 67-kilogram female patient with a diagnosis of hypertension and Alzheimer's disease admitted to the hospital with complaints of shortness of breath and swelling in the legs for a week. Seven months ago, Enoxaparin sodium 4000 IU was planned twice a day in an external center due to pulmonary embolism. The patient continued to use LMWH 4000 IU once a day after the 3rd month of his own request. CTPA revealed filling defects in the right pulmonary artery upper lobe posterior and lower lobe posterobasal segments. Lower extremity venous Doppler ultrasonography revealed deep vein thrombus (DVT). When compared with previous examinations, it was observed that pulmonary embolism had newly developed and the patient was followed up with segmental PE + DVT diagnoses. CONCLUSIONS: Although low-dose LMWH treatment is recommended in some guidelines and drug package insert for PE prophylaxis, the cases we have presented suggest that it would be safer to consider the patient's weight when administering LMWH prophylaxis. REFERENCE #1: Prophylactic Enoxaparin Dosing in Obese Orthopedic Patients: A Literature SearchVan N Tran 1, Ilya Varfolomeev 2, Geoff Hill 3 DISCLOSURES: No relevant relationships by MELTEM GUNDUZ, source=Web Response No relevant relationships by H.Canan Hasanoglu, source=Web Response