Thromboembolic Complications Research Articles

Outcomes of peripartum cardiomyopathy in North Africa: insights from a single-center observational study in Tunisia

BackgroundPeripartum cardiomyopathy (PPCM) is a rare but potentially life-threatening condition. Due to the scarcity of epidemiological data in North Africa, we conducted this study to assess the outcomes of PPCM in our region.Materials and methodsThis monocentric retrospective cohort study involving all patients diagnosed with PPCM was conducted between January 2010 and December 2022.ResultsTwenty-seven PPCM patients, with a median age of 33 years (Interquartile range (IQR) = 9), were included. 52% of patients were diagnosed during the postpartum period. Dyspnea New York Heart Association III/IV(NYHA III/IV) was the most common functional symptom (85%). The median left ventricle ejection fraction (LVEF) was 30% (IQR = 11%). Atrial fibrillation occurred in 11.1% of patients, thromboembolic complications occurred in 18.5%, Pulmonary edema occurred in 85% of patients and cardiogenic shock occurred in 14.8% of patients, with two patients requiring Extracorporeal Membrane Oxygenation (ECMO) support. The predominant mode of delivery was a cesarean Sect. (82% of patients), and the indication for a cesarean delivery was obstetrical in 59% of patients. Prematurity occurred in 36% of newborns, and intrauterine fetal death occurred in one pregnancy. The median follow-up was 24 months [6–144 months]. LVEF recovery was noted in 67% of patients. Bromocriptine was administered to six patients (22%), and none of these patients died and out of them, five patients recovered their LVEF (83%). The overall mortality rate during the follow-up period was 15%, comprising three in-hospital cardiac deaths and one occurring two years later due to refractory advanced heart failure. No significant differences were observed between LVEF recovery and LVEF non-recovery groups. Factors significantly associated with mortality were multiparity, poor antenatal care (ANC) attendance, thromboembolic events, cardiogenic shock, and Pulmonary edema. Five patients with LV recovery subsequently became pregnant, none experienced a relapse of PPCM. However, one of the descendants of a patient was diagnosed with dilated cardiomyopathy.ConclusionThis study revealed that the diagnosis of PPCM in our hospital is often delayed until symptoms become more advanced, resulting in high morbi-mortality.

Challenges in managing severe homozygous protein c deficiency: a case report

Protein C deficiency is a rare autosomal recessive disorder associated with a high risk of thromboembolic complications. This case report describes the challenges in managing a 23-year-old woman with severe homozygous protein C type 1 deficiency diagnosed since early infancy. Her medical history included misdiagnosed cellulitis, recurrent thrombosis, and permanent vision loss in one eye. The laboratory workup confirmed a diagnosis of severe protein C deficiency. Management involved a combination of fresh frozen plasma (FFP), protein C concentrate, warfarin, and heparin, with ongoing challenges due to recurrent thrombosis and anaphylaxis to FFP. This case highlights the challenges in the diagnosis and management of severe protein C deficiency. Although current treatment options provide partial control, further research is crucial to develop safer and more effective therapies to improve long-term outcomes for affected patients.

Haemorrhagic and thromboembolic outcomes in pregnant patients with mechanical heart valves who undergo interruption of anticoagulation for birth - A case series.

Anticoagulant therapy prevents thrombosis and thromboembolic events in patients with mechanical heart valves. Bridging anticoagulation around the time of birth represents a unique challenge. Few retrospective reviews or case series exist examining peripartum outcomes with bridging anticoagulation. Review of peripartum and postpartum anticoagulation management, with a focus on postpartum complications. Design: case series, single centre. Royal Brisbane and Women's Hospital, Australia between 1 January, 2000, and 1 August, 2022. all pregnant women with mechanical heart valves (any type) who birthed. intrapartum and postpartum haemorrhage, thrombosis, thromboembolic complications, cardiac events, readmission, and maternal death. There were 18 women, with 23 births. Sixteen births were via caesarean section (70%). Fourteen women (61%) experienced at least one significant haemorrhagic complication, one woman required a peripartum hysterectomy, one woman experienced atrial fibrillation, and one had a valvular thromboembolic complication. No maternal cerebral thromboses or maternal deaths were recorded. Women with mechanical heart valves who undergo bridging anticoagulation are associated with significant maternal morbidity. Most postpartum haemorrhagic complications were associated with bridging unfractionated heparin infusions in the first postnatal week. Bridging anticoagulation practices varied widely. Ongoing pooled data are required to inform evidence-based guidelines for postpartum anticoagulation management.

Predictors and Outcomes of Inappropriate Dosing of Direct Oral Anticoagulants in Patients Receiving Transcatheter Aortic Valve Implantation.

Direct oral anticoagulant (DOAC) dose adjustment is based on age, renal function, and body weight. There is a paucity of data describing the factors associated with the prescription of inappropriate dosage and their impact on clinical outcomes among patients receiving transcatheter aortic valve implantation (TAVI). In a single-center study, 432 patients who were on long-term DOAC therapy and underwent TAVI between 2015 and 2022 were included. We analyzed the predictors and outcomes of inappropriate dosing of DOACs; namely apixaban, dabigatran, edoxaban, and rivaroxaban. A composite endpoint, including all-cause mortality, life-threatening/major bleeding, stroke, peripheral thromboembolic complications, or myocardial infarction, was assessed after 1 year. In this TAVI cohort, inappropriate DOAC dosing was observed in 20.6% of patients. Inappropriate DOAC dosage was related to female gender (adj. odds ratio [OR] 2.72, 95% confidence interval [CI] 1.64-4.51, p < 0.001) as well as lower estimated glomerular filtration rate (eGFR) (adj. OR 0.99, 95% CI 0.98-1.00, p = 0.019), and to the administration of non-rivaroxaban DOACs (adj. OR 0.28, 95% CI 0.16-0.50, p < 0.001). After 1 year, patients on both appropriate and inappropriate DOAC dosage exhibited comparable rates of the composite endpoint (OR 0.88, 95% CI 0.53-1.46, p = 0.622). Old age (adj. OR 1.05, 95% CI 1.01-1.10, p = 0.018) as well as anemia (adj. OR 0.86, 95% CI 0.75-0.99, p = 0.031) emerged as independent predictors of the composite endpoint. In this TAVI cohort, female gender and renal insufficiency were associated with inappropriate DOAC dosage, whereas rivaroxaban was linked to appropriate dosing. Inadequate DOAC dosage did not translate into a worse outcome in our TAVI population. Prospective Segeberg TAVI Registry (ClinicalTrials.gov identifier: NCT03192774).

Tranexamic Acid Use in Total Shoulder Arthroplasty Continues to Increase and is Safe in High-Risk Patients

IntroductionTranexamic acid (TXA) is increasingly utilized in total shoulder arthroplasty (TSA) to minimize blood loss. Despite its benefits, concerns persist regarding its use in patients at elevated risk of postoperative venous thromboembolism (VTE). This study evaluates trends in TXA use and assesses its safety in both general and high-risk patient populations. MethodsPatients who underwent primary, elective anatomic TSA and reverse TSA from January 1st, 2016, to December 31st, 2020, were identified using the Premier database. TXA use trends and the proportion of patients requiring blood transfusions were reported. Patients were divided on the basis of having received TXA on the day of surgery or not. To account for confounding variables, a propensity score was generated for the probability of treatment with TXA. A sub analysis of high-risk patients, defined as those with a history of VTE, was performed using multivariable regression analyses. Endpoints included the 90-day risk of pulmonary embolism (PE), deep vein thrombosis (DVT), and transfusion. ResultsIn total, 86,356 patients underwent TSA from 2016 to 2020. Of these, 41,380 (47.9%) received TXA, and 44,976 (52.1%) did not. After matching, 28,232 received TXA, and 28,232 did not. The use of TXA increased from 33.4% in 2016 to 60.3% in 2020. The rates of transfusion decreased from 1.05% to 0.47%. Following matching, the risk of all thromboembolic complications (odds ratio [OR]: 0.98, 95%-Confidence Interval [CI]: 0.72-1.33, p=0.874), DVT (OR: 1.11, 95%-CI: 0.71-1.71, p=0.655), and PE (OR: 0.87, 95%-CI: 0.56-1.33, p=0.513) were similar between cohorts. The high-risk cohort comprised 4,757 patients with a history of VTE, of which 1,850 (38.9%) received TXA, and 2,907 (61.1%) did not. The use of TXA for high-risk patients increased from 27.4% to 52.0% while rates of transfusion decreased from 1.76% to 0.70%. Following multivariable regression, there was similar risk of all thromboembolic complications (adjusted OR [aOR]: 0.77, 95%-CI: 0.47-1.28, p=0.316), DVT (aOR: 0.96, 95%-CI: 0.39-2.36, p=0.92), and PE (aOR: 0.54, 95%-CI: 0.23-1.28, p=0.163) between high-risk cohorts. DiscussionTXA in shoulder arthroplasty usage has nearly doubled from 2016 to 2020 and is now administered to 60% of all patients. This rise in TXA use has been coupled with a significant decrease in the risk of blood transfusion. Patients receiving TXA were not at increased risk of thromboembolic, infectious, epileptogenic, surgical, and medical complications even if they had a history of VTE.

Propensity score-adjusted analysis on early tirofiban administration to prevent thromboembolic complications during stand-alone coil embolization of ruptured aneurysms

The glycoprotein IIb/IIIa antagonist tirofiban has been shown to prevent thromboembolic events during endovascular procedures, but the benefits and risks of its prophylactic early intraprocedural administration for stand-alone coil embolization of acutely ruptured aneurysms are still unclear. We conducted a retrospective single-center analysis of patients treated for aneurysmal subarachnoid hemorrhage with stand-alone coil embolization. Two study cohorts were compared according to the primary prophylactic antithrombotic medication during the procedure: patients receiving only intravenous heparin (HEP) versus patients receiving tirofiban in addition to heparin prior to final aneurysm obliteration (HEP + TF). Outcome endpoints were the incidence of angiographically visible thrombus formation or distal embolization, and the incidence of periprocedural intracranial hemorrhage (ICH). Of 204 cases, 159 were prophylactically treated with HEP and 45 with HEP + TF. Intraprocedural thromboembolic events were less frequent with HEP + TF before and after propensity score matching (PSM) (2.5% vs. 19.7%, p = 0.017). The incidence of ICH and symptomatic ICH did not differ between HEP + TF and HEP before and after PSM (20.5% vs. 30.7%, p = 0.29; and 5.1% vs. 4%, p = 0.88). Early intraprocedural tirofiban administration may be effective in preventing thromboembolic complications during stand-alone coil embolization of acutely ruptured aneurysms without increasing the risk of ICH.

ASSISTÊNCIA DE ENFERMAGEM A PACIENTES COM TROMBOFILIA NO PRÉ-NATAL

The research addressed the importance of nursing care for pregnant women with thrombophilia during prenatal care, a condition that increases the risk of thromboembolic complications for both mother and fetus. Thrombophilia is a hemostatic disorder characterized by an increased predisposition to thrombosis, which can be caused by hereditary or acquired factors, such as the use of hormones or medications. The general objective of the study was to describe the nursing care provided to these patients, focusing on risk identification, clinical monitoring during pregnancy, and preventive methods. The methodology used was a literature review with a quantitative approach, conducted based on selected articles from scientific databases such as PubMed, Google Scholar, and Scielo. Studies that addressed the topic of thrombophilia during prenatal care, focusing on health care and complication prevention, were included. The results showed that adequate nursing care, including detailed anamnesis, continuous monitoring, and medication management, is essential to prevent serious complications such as deep vein thrombosis and pregnancy loss. The study also highlighted the importance of preventive measures, such as adopting a balanced diet and engaging in physical activities, to reduce the risks associated with thrombophilia during pregnancy.

Biomarkers of risk and prognosis in atrial fibrillation

Atrial fibrillation is one of the most common forms of arrhythmia and is associated with an increased risk of stroke, thromboembolism, and increased mortality among patients with cardiovascular disease. Identifying patients at high risk of developing atrial fibrillation and predicting the likelihood of acute cerebrovascular accidents of cardioembolic origin, as well as other thromboembolic complications, is key to optimizing treatment strategies and preventing complications. This article provides a comprehensive review of existing and new biomarkers used to assess the risk of onset and recurrence of atrial fibrillation, as well as to assess the safety of anticoagulation therapy for this arrhythmia. Genetic, inflammatory and metabolic markers are discussed in detail, as well as the role of oxidative stress in the context of pathophysiological processes, clinical manifestations of the disease and its complications. Particular attention is paid to the evaluation of markers that can be used to predict adverse outcomes and improve diagnostic accuracy. Limitations in the ability to routinely and widely use both existing and promising biomarkers are discussed. Their clinical significance, cost-effectiveness and possibilities for integration into everyday clinical practice are considered. The need for standardization of approaches to the comprehensive assessment of biomarkers, the importance of interdisciplinary collaboration and the development of individualized approaches to the treatment of patients with atrial fibrillation, including the use of biomarker data, are emphasized. Optimizing approaches to assessing patients with atrial fibrillation using current and promising biomarkers can help overcome existing limitations and facilitate their implementation in clinical practice, which in turn will improve diagnosis, treatment and prognosis of patients.

Laboratory possibilities of prognosis of local complications in hip replacement

BACKGROUND: Endoprosthetics of large joints is a frequently performed operation in traumatology practice. The progression of local infectious sequela among postoperative patients is of major socio-economic importance since more than 30% of cases of inflammatory postoperative reactions are complicated by sepsis. In recent years, new criteria have been sought to assess the risks of infection in the field of surgical intervention, and prognostic scales have also been developed. AIM: The aim of the study was to evaluate the prognostic value of coagulological, biochemical and hematological indicators of the risk of hemorrhagic complications in patients after hip replacement. MATERIALS AND METHODS: The study included 85 patients who were in the clinic of Traumatology and Orthopedics of the I.I. Mechnikov for planned hip replacement. The average age of the patients was 64 ± 10 years. There were 46 women (54%), 39 men (46%). All patients underwent clinical and laboratory examination before surgery, the day after surgery and before discharge. All patients received rivaroxaban (10 mg 1 time/day) after surgery for the prevention of venous thromboembolic complications (46 patients) or apixaban (2.5 mg 2 times/day) (39 patients) during the entire period of stay in the clinic. Retrospectively, depending on the occurrence of complications, the patients were divided into 2 groups: group 1 — 78 patients (42 women and 36 men), whose postoperative period passed without complications, and group 2 — 7 patients (4 women and 3 men), who had hemorrhagic cases. Screening coagulogram (International Normalized Ratio, Activated partial thromboplastin time, fibrinogen) was performed on the STA Compact analyzer (Stago, France), biochemical parameters (alanine aminotransferase, aspartate aminotransferase, creatinine, total calcium, ionized calcium, serum iron, C-reactive protein) were determined on the COBAS Integra 400plus analyzer, hematological parameters on the DxH800 analyzer (Beckman Coulter, USA). RESULTS: A retrospective analysis revealed that a decrease in serum iron in male patients before surgery is a marker of the prognosis of hemorrhagic complications. Prognostic significant laboratory indicators of the development of hemorrhagic complications in patients in the early period after hip replacement include an increase in fibrinogen and C-reactive protein; a decrease in serum iron. During the recovery period, the concentration of C-reactive protein and the relative number of monocytes are the most significant for assessing the risk of complications. CONCLUSIONS: Among the laboratory indicators in the structure of the weight coefficients of the prognosis of complications in patients undergoing hip replacement, it is necessary to evaluate the concentration of serum iron before surgery, especially in men, in the early postoperative period — C-reactive protein, fibrinogen and serum iron and at discharge — C-reactive protein and the number of monocytes as additional criteria for the risk of complications.

Long-term Impacts of Long COVID: Increased Incidence of Cardiomyopathies, Joint Diseases, and Psychoanxiety Disorders.

The COVID-19 pandemic has intensified inquiries into the interplay between diabetes and disease severity, and the long-term impact of long-COVID. This study specifically explored the implications of different antithrombotic treatments on COVID-19 patients. It aimed to assess the long-term efficacy and safety of Vitamin K antagonists (VKA) and direct oral anticoagulants (DOACs) in mitigating thromboembolic complications in COVID-19 patients. We conducted a study on 157 patients diagnosed with COVID-19 from August 2021 to August 2023. The study evaluated shifts in anticoagulant therapy recommendations, tracking the transition from VKA to DOACs, and analyzed associated health outcomes. A significant shift from VKA to DOACs prescriptions was observed, especially in high-risk patients. Despite the change in antithrombotic treatments, incidences of varices and varices with hemorrhoids increased by 2.6% and 3.2%, respectively. Long-COVID was also linked to higher occurrences of diabetes and gastrointestinal diseases. Joint diseases rose by 14%, indicating persistent inflammation. Cardiomyopathies increased by 3.9%, predominantly in high-risk groups, and psychoanxiety disorders surged by 39.5%, highlighting the need for further research. DOAC usage was more common in older age groups, with a 10.2% increase in recommendations among high-risk patients (p<0.05). The study underscores the evolving landscape of antithrombotic therapy in managing COVID-19 complications. Despite the increased use of DOACs, the rise in various health conditions suggests the necessity for personalized treatment strategies tailored to patient risk profiles.

Protamine administration after catheter ablation of atrial fibrillation using electroporation: a randomized controlled trial

Abstract Background Safety of protamine administration after catheter ablation of atrial fibrillation (AF) using pulse-field system has not been previously described in a prospective randomized trial. Methods Consecutive patients with paroxysmal, persistent or long-standing persistent AF undergoing catheter ablation of AF using Farapulse system were randomly assigned in 1:1 ratio for protamine administration before sheaths removal. All vascular punctions were navigated using a direct ultrasound control. Right femoral vein was used for FaraDrive (16 F) sheath and left femoral vein for ICE (11 F) and decapolar diagnostic catheter (7 F). All sheaths were removed immediately at the end of procedure with subsequent local haemostasis with figure-of-eight suture. Primary endpoint was early and late access site complications. Secondary endpoints were significant bleeding, thromboembolic events and duration of hospital stay. Results 428 consecutive patients were enlisted into the study (213 in protamine group; 215 in control group). Baseline and procedural characteristics were similar between both groups. ACT before venous sheath removal was higher in patients not receiving protamine (330.1 ± 38.6 vs. 189.3 ± 44.7 seconds, P &amp;lt; 0.001). There were no significant differences in both primary and secondary endpoints between both groups: groin hematoma (5 vs 5; p = NS); there were no thromboembolic complications in both groups and no significant differences of hospital stay duration. Conclusion Protamine administration after atrial fibrillation ablation using Farapulse system is not necessary when using ultrasound navigated vascular access and haemostasis with figure of eight suture.

Antiplatelet Agents in Endovascular Neurointerventional Procedures

Minimally invasive, image-guided endovascular procedures are becoming increasingly prevalent as techniques and technologies have advanced, particularly within the realm of neurovascular interventions. Endovascular approaches ubiquitously result in endothelial injury with subsequent risk of thromboembolic complications. Periprocedural antiplatelet agent use is an integral component of the management of patients undergoing endovascular neurointerventional procedures. This patient population has a unique risk profile encompassing thromboembolic and hemorrhagic complications simultaneously, and the precise balance of these risks impacts patient outcomes almost as much as the interventional procedure itself. Clinical experience and study consensus demonstrate overall improved outcomes with the use of periprocedural antiplatelet agents, though current practices remain highly institution and practitioner-dependent. This focused review will discuss the major mechanisms of action of antiplatelet agents, and their clinical indications and management in the periprocedural neurointerventional setting. Despite the importance of antiplatelet agents in the management of neurointerventional patients, many questions remain. Further research and clinical expertise are needed to establish standardized, procedure-specific, antiplatelet regimens as well as standardized monitoring of antiplatelet agent regimen efficacy and safety.

Comparison of complications during catheter ablation of atrial fibrillation between radiofrequency and cryoballoon ablation: insights from a nation-wide claims-based database

Abstract Background Few large-scale, real-world studies have compared the safety of radiofrequency (RF) catheter ablations (CA) with that of cryoballoon ablations of atrial fibrillation (AF), especially in east Asian countries. Methods This retrospective, cross-sectional study used a nationwide administrative claims database, to compare complication-incidence rates between patients who underwent RFCA and cryoballoon ablation of AF. We used data from Medical Data Vision Co., Ltd, that is derived from the health claims, Diagnosis Procedure Combination (DPC) system, and flat-fee payment system in Japan. We first extracted hospitalization records with CA with diagnosis of AF. Exclusion criteria were 1) records with diagnoses of atrial flutter or atrial tachycardia, 2) patients aged &amp;lt;20 years old, 3) CA of AF performed other than RFCA or cryoballoon, 4) records with insufficient clinical data, and 5) patients who were prescribed both direct oral coagulants and warfarin. Complications were defined using the following ICD-10 diagnosis codes: major bleeding (I31.9, I97.1, J98.5, J048, J0021); thromboembolism (H342, I24, I269, I740, I741, I744, I748, I749, K550, K868, N280, or T790); ischemic stroke (G45, or I63); cardiac tamponade (I31.9, I97.1, or J98.5); and vascular access complications (hematoma: S701, S801, T140 or T810; and/or pseudoaneurysms: I72.4). Logistic regression analyses were performed to estimate odds ratios and 95% confidence intervals (CI) for major bleeding, systemic thromboembolism, ischemic stroke, and cardiac tamponade. Results Among the 32,797,540 records between June 2011 and August 2020 from 426 hospitals, 41,347 records who underwent CA of AF (Median 68 [60–74] years old, 30.2 % women) were included in the study. A total of 36,729 RFCA (88.8%) and 4,618 cryoballoon ablation (11.2%) cases were included in the cohort. Major bleeding, systemic thromboembolism, ischemic stroke, cardiac tamponade, and vascular access complications occurred in 194 (0.5%), 193 (0.5%), 116 (0.3%), 414 (1.0%) and 115 (0.3%) patients, respectively. As a result of logistic regression analysis, when cryoballoon ablation was used as a reference, RFCA was associated with higher risk of cardiac tamponade (OR 1.54, 95% CI 1.09–2.25, P = 0.02), while it was not associated with higher or lower risk of other complications (major bleeding OR [95% CI ]1.21 [0.77–2.04]; thromboembolism 1.74 [1.03–3.22]; ischemic stroke 1.88 [0.94–4.47]; vascular access complication; 1.00 [0.58–1.87]). Conclusion Compared to cryoballoon ablations, RFCA was associated with higher risk of cardiac tamponade, using nationwide administrative claims database.

The Value of Cardiac MRI in the Diagnosis of Left Intraventricular Apical Thrombus after Myocardial Infarction: A Case Report

Left ventricular thrombus is a dreadful complication in post-myocardial infarction and should be researched, especially in patients with ventricular dysfunction, given the high thromboembolic risk in these patients. Several studies have shown that transthoracic echocardiography (TTE) lacks specificity when compared with cardiac magnetic resonance imaging (MRI) in the discovery of intraventricular thrombus. However, MRI remains a costly and time-consuming examination, especially in developing countries. In our clinical case, cardiac MRI enabled us to diagnose an apical intra- LV thrombus in the post-infarction period, which guided us in the correct management of the patient and avoided any thromboembolic complications. Today, cardiac MRI confirms its value as a reference imaging tool in the management of ischemic heart disease.

Flow Diversion for Intracranial Aneurysms With Incorporated Branch: A Subanalysis From the SEASE International Registry

BACKGROUND The presence of an incorporated branch as well as its anatomical relationship to the intracranial aneurysms (IAs) and the parent artery may affect the occlusion outcome following flow diversion. This study evaluated the safety and effectiveness of the cobalt‐chromium Surpass Evolve (Stryker), a 64‐wire flow diversion device for the treatment of IAs with incorporated branches. METHODS This subanalysis uses data from the SEASE (Safety and Effectiveness Assessment of Surpass Evolve) registry to retrieve data related to IAs with incorporated branches. Those IAs were classified by a core lab into 4 categories based on their anatomical relationship to the parent artery and branch: (A) sidewall anatomic, (B) sidewall hemodynamic, (C) neck branch, and (D) dome branch. We compared the outcomes based on their incorporated branch's relation to the dome (A–C versus D). RESULTS This study included 67 patients and IAs. Most IAs were in the posterior communicating artery (46.3%), with a median size of 4.35 mm. Age, sex, comorbidities, baseline functional‐status, and IA features were similar between the 2 groups. Among those, 53 (79.1%) had branches emerging from the dome, and 14 (20.9%) had branches originating from other locations (A = 7, B = 2, and C = 5). At a median imaging follow‐up of 10.5 months, complete occlusion was lower in IAs with a branch from the sac compared with those with the neck (60.8% versus 92.9%; P = 0.026), with an overall occlusion of 67.7%. Thromboembolic and hemorrhagic complications, as well as retreatment, were reported in 1.6% and 3.1% of cases, respectively, with no significant differences between groups. CONCLUSION Our analysis underscores the influence of branch origin on occlusion rates, with the neck‐originating branch demonstrating higher occlusion rates. These insights emphasize the role of anatomical considerations in treatment strategies, follow‐up timelines, and designing future clinical trials. Further studies are warranted to explore these variations across different flow diversion technologies.

Central Retinal Artery Occlusion Following Sphenopalatine Artery Embolization: A Case Report and Review of the Literature.

Report of a case of central retinal artery occlusion following sphenopalatine artery (SPA) embolization. A review of the literature describing complications following SPA embolization and ligation. Retrospective case report and literature review. A 68-year-old woman with a history notable for hypertension, hyperlipidemia, and eight years of intermittent right-sided epistaxis previously requiring blood transfusions underwent right-sided embolization of the SPA with the neurosurgery service. SPA embolization was achieved with Embosphere microspheres and Concerto coils. No thromboembolic complications were noted at the conclusion of the case. On waking from general anesthesia, the patient reported painless right sided vision loss and was found to have best-corrected visual acuity of light perception, a relative afferent pupillary defect, and a cherry-red spot with vascular attenuation consistent with central retinal artery occlusion (CRAO). CRAO can be a complication of ipsilateral SPA embolization.

Prediction of Thrombus Formation within an Oxygenator via Bioimpedance Analysis.

Blood clot formation inside the membrane oxygenator (MO) remains a risk in extracorporeal membrane oxygenation (ECMO). It is associated with thromboembolic complications and normally detectable only at an advanced stage. Established clinical monitoring techniques lack predictive capabilities, emphasizing the need for refinement in MO monitoring towards an early warning system. In this study, an MO was modified by integrating four sensor fibers in the middle of the hollow fiber mat bundle, allowing for bioimpedance measurement within the MO. The modified MO was perfused with human blood in an in vitro test circuit until fulminant clot formation. The optical analysis of clot residues on the extracted hollow fibers showed a clot deposition area of 51.88% ± 14.25%. This was detectable via an increased bioimpedance signal with a significant increase 5 min in advance to fulminant clot formation inside the MO, which was monitored by the clinical gold standard (pressure difference across the MO (dp-MO)). This study demonstrates the feasibility of detecting clot growth early and effectively by measuring bioimpedance within an MO using integrated sensor fibers. Thus, bioimpedance may even outperform the clinical gold standard of dp-MO as a monitoring method by providing earlier clot detection.

Ability of Activated Clotting Time Measurements to Monitor Unfractionated Heparin Activity During NonCardiac Arterial Procedures

Activated clotting time (ACT) measurements are frequently used to monitor unfractionated heparin activity during non-cardiac arterial procedures (NCAP). Accuracy of ACT-guided heparinization is mandatory to prevent heparin under- and overdosing, thereby minimizing thrombo-embolic complications (TEC) and bleeding risk. The main objective of this study was to investigate accuracy of ACT to monitor heparin activity during NCAP using the Hemostasis Management System Plus with high-range cartridges. ACT values were compared with anti-Xa measurements, regarded as the standard test to measure active heparin. This was a single centre, prospective, observational cohort study. Perioperative blood samples of patients undergoing NCAP between December 2022 and September 2023 were used to perform bedside ACT measurements and anti-Xa assays in the clinical laboratory. Primary outcome was correlation between ACT and anti-Xa measurements. TEC, mortality and bleeding complications within 30 days postoperatively or during primary admission were also scored. 196 pairs of ACT and anti-Xa measurements were performed in 34 patients. Strong correlation was observed between anti-Xa and ACT measurements (Pearson correlation coefficient = 0.84, 95% CI = 0.79 - 0.87, p < 0.001). Apart from anti-Xa, no additional variables were associated with ACT in multivariate linear regression analyses (regression coefficient β = 36.7, 95% CI = 33.3 - 40.1, p < 0.001). Bleeding complications occurred in 29% of the patients, while both TEC and mortality were observed in one patient. strong correlation and an independent association were observed between heparin activity measured by anti-Xa and ACT using the Hemostasis Management System Plus.

Lessons learned from 12 years using the Woven Endobridge for the treatment of cerebral aneurysms in a multi-center series

Intrasaccular flow disruption with the Woven Endobridge (WEB) has become a well-established endovascular technique for the treatment of intracranial aneurysms. This study presents our 12-year experience with the WEB and evaluates its evolving indications, procedures, and outcomes. A consecutive series of 324 aneurysms treated with WEB between 2011 and 2023 at three neurovascular centers was retrospectively analyzed and the study group was divided into four treatment periods. Uni- and multivariate analyses were performed to evaluate factors associated with technical success, thromboembolic complications, and angiographic outcome. The mean aneurysm size was 7.0 ± 3.6 mm and decreased during the study period, while the proportion of atypical sites for WEB implantation increased. WEB implantation was technically successful in 96.0%, and the ratio of WEB width to dome width increased during the study period, indicating oversizing. The neurological complication rate was 4.9% (1.5% major, 3.4% minor) and the mid-term complete occlusion rate was 60.6% (81.9% adequate occlusion), with no statistical differences in either outcome measure between the study periods. In multivariate analyses, the use of WEB 17 was associated with increased technical success (HR: 7.4, 95%CI: 2.4-23.6, p<0.01), whereas ruptured aneurysm status (HR: 2.5, 95%CI: 1.0-6.0, p=0.04) and the use of additional stents (HR: 4.8, 95%CI: 1.6-14.4, p<0.01) predicted thromboembolic complications. Appropriate oversizing of the WEB favored mid-term complete occlusion (HR: 10.5, 95%CI: 1.3-83.3, p=0.03). The results suggest an expansion of the indications for WEB implantation and highlight the importance of oversizing for treatment efficacy.

Role of Tumor Microenvironment in the Risk of Thromboembolic Complications in Ovarian Cancer

Introduction. Incidence of ovarian cancer remains high in the overall prevalence of oncological pathology. Adjuvant chemotherapy refers to its treatment options. Patients with oncological pathology are faced with a high risk of thrombosis and thromboembolism, with up to 30% lethal outcome within a month of its development. A number of cancer cells are known to induce platelet aggregation, contributing to thrombosis and metastasis as a result of this interaction. Accordingly, the paper is aimed at presenting a clinical case for demonstrating the role of P-selectin expression in the complications in a patient with ovarian cancer. Materials and methods. The present paper evaluates platelet activation marker in a patient undergoing chemotherapy courses after cytoreductive surgery. Following the case conference and in accordance with the clinical recommendations of the Russian Oncology Association (AOR) and Russian Society of Clinical Oncology (RUSSCO), cytoreduction (CC-0), radical hysterectomy, transverse colectomy, left hemicolectomy with rectum resection were performed. The interventions included ascendostomy, pelvic, lateral right-sided and left-sided peritonectomy, pelvic lymphoadenectomy, total omentectomy, Renape-French HIPEC (hyperthermic intraperitoneal chemotherapy), abdominal and pelvic drainage. Expression of P-selectin on the platelet surface was measured as a marker of platelet activation. Results and discussion. At the time of admission, the patient had high CD62 expression activity compared to healthy volunteers (CD62 ADP- — 11.2%, CD62 ADP — 24.7% vs CD62 ADP- — 1.3%, CD62 ADP — 17.2%). During the complex treatment of ovarian cancer, the platelet activation increased (CD62 ADP- — 21.8 %, CD62 ADP+ — 30.1 %). At discharge, CD62 expression values reached the conditional norm, presumably indicating thrombosis development. Conclusion. Tumor microenvironment influences the hemostasis system. Detailed study into this issue obtains a high potential for the prevention of primary and secondary thromboembolic complications in oncologic patients.