Venous Thrombosis In Patients Research Articles

Abstract P4-02-15: Thromboembolic events (TEE) in patients with HER2-negative, hormone receptor-positive metastatic breast cancer treated with Ribociclib combined with Letrozole or Fulvestrant. Real-world data

Abstract Background: Breast cancer is the most common cancer diagnosed among women worldwide. More than 70% of breast cancers are hormone receptor (HR)-positive, for which endocrine therapy (ET) is the preferred initial treatment especially so for those with low burden disease. Majority of patients with HR-positive metastatic breast cancer (mBC) acquire resistance to endocrine therapy. CDK4/6 inhibitors modulate this resistance and are integral treatment for patients with advanced HR-positive, HER2-negative breast cancer. Since their approval, CDK4/6 inhibitors are widely used in clinical practice. Thromboembolic events (TEE) were not a major issue among patients treated on clinical trials. However, conflicting data starts to emerge describing higher than expected rates of both arterial and venous thrombosis in patients treated with CDK4/6 inhibitors. In this study, we use real world data to study TEE rates in patients treated with ribociclib in real-world settings.Methods: The study is a retrospective analysis of individual patients’ data. All consecutive patients with mBC treated with ribociclib combined with aromatase inhibitors or fulvestrant were reviewed. Data were collected from patients’ electronic medical records and from radiology department archives. All episodes of radiology confirmed arterial or venous thrombosis were recorded. TEE was considered ribociclib related if diagnosed while patients on the drug or withing 4 weeks after the last dose.Results: During the study period, a total of 305 patients were enrolled. Median age (range) was 49 (22-87) years. All patients had metastatic disease and 168 (55.1%) were de novo metastasis. Most (n=241, 79.0%) of the patients had visceral metastasis at time of ribociclib therapy; only 64 (20.9%) had bone-only disease. Ribociclib was used in combination with letrozole in first-line setting in 195 (63.9%) and with fulvestrant or letrozole in 110 (35.9%) patients who failed one or more lines of ET or chemotherapy. Median duration (range) of ribociclib therapy was 7 (1-45) months. Episodes of venous thromboembolism were confirmed in only 5 (1.6%) patients; 3 were PE with or without DVT and 2 were lower extremity DVT and all were symptomatic. Another patient had arterial thrombosis (lower limb ischemia). During the chart review, 7 (2.3%) more patients had a confirmed diagnosis of VTE prior to ribociclib and another 4 (1.3%) patients had a confirmed episode after (range: 2-7 months) stopping it. All patients were treated with low-molecular heparin (LMWH) with no complications. Given the small number of patients with TEE, no clinical or pathological predictors could be used to identify subgroups of patients at higher risk for TEE while on ribociclib.Conclusions: In real-world settings, and contrary to recent reports, breast cancer patients treated with ribociclib with AI or fulvestrant are not at higher risk for arterial or venous thromboembolic events. Patients had similar rates prior to initiation, and after stopping ribociclib. Citation Format: Hikmat Abdel-Razeq, Faris Tamimi, Sarah Edaily, Baha' Sharaf, Mahmoud Abunasser, Osama Salama, Rashid Abdel-Razeq, Hazem Abdulelah, Rayan Bater. Thromboembolic events (TEE) in patients with HER2-negative, hormone receptor-positive metastatic breast cancer treated with Ribociclib combined with Letrozole or Fulvestrant. Real-world data [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-02-15.

Assessment of Risk Factors and Cognitive Level Associated with Venous Thrombosis Patients in a Coexistence of Multiple Diseases Study in Shanghai.

BackgroundVenous thrombosis (VTE) is a high-incidence disease that affects different systems of the body, but no comparative studies have been conducted to explore its incidence in different systems in patients with the coexistence of multiple diseases. Primary care is a medical institution that has the first contact with patients’ conditions. The majority of outpatients suffer from multiple diseases, and they are more prone to VTE, which is of significance and requires investigation. At the same time, we observed that the primary care patients’ cognition level of VTE is insufficiency at present, and the prevention and management of VTE in China is still in its infancy. Most studies focus on whether doctors and nurses are clear about the diagnosis and manifestations of VTE, however, few studies on patients’ cognitive level and influencing factors of symptoms and prevention of VTE. Therefore, it is necessary to study the causes of cognitive deficiency of VTE from the perspective of patients, conduct targeted cognitive and behavioral interventions, and finally achieve the purpose of improving the effect of VTE prevention and management.AimThis study aimed to explore the risk factors, cognitive level and cognitive potential influence factors of VTE in outpatients of primary care in Shanghai, as well as which diseases, are more likely to promote occurrence of VTE among patients with multiple diseases.MethodsA total of 710 patients were included in the analysis. Shanghai in China is divided into urban and suburban areas by their geographical location, and a random sample of 10 primary care areas was investigated, including 5 urban areas and 5 suburban areas. The Padua scale and the VTE cognitive level-related knowledge test scale were used for the investigation. Statistical software was used to conduct univariate Pearson correlation analysis and multivariate logistic regression analysis for VTE high-risk factors among outpatients of primary care. Furthermore, the high-risk factors for VTE and the types of chronic disease in patients with multiple diseases were subjected to subgroup analyses. t-test was used to statistically analyze cognitive level of VTE and the potential influence factors related to the patients’ VTE cognitive level.ResultsUnivariate analysis of risk factors for VTE in 710 outpatients showed that age (χ2=83.895, P<0.001), education (χ2=8.324, P=0.004), region (χ2=63.936, P<0.001), chronic disease (χ2=18.198, P<0.001) and the coexistence of multiple diseases (χ2=61.347, P<0.001) were the main risk factors for VTE risk in patients. Logistic multivariate regression analysis showed that age, region, chronic diseases and the coexistence of multiple diseases were independent risk factors for VTE risk in patients. The correlation between high risk of VTE in patients with multiple diseases and various types of chronic diseases was further analyzed by logistic multivariate regression. The results showed that diabetes mellitus (OR=1.636 [95% CI, 1.030–2.599], P=0.037), cerebral infarction (OR=8.484 [95% CI, 4.615–15.597], P<0.001), coronary heart disease (OR=2.987 [95% CI, 1.699–5.252], P<0.001), intracerebral hemorrhage (OR=15.130 [95% CI, 4.707–48.630], P<0.001), respiratory diseases (OR=3.470, [95% CI, 1.428–8.43], P=0.006) and malignant tumors (OR=4.576, [95% CI, 1.85–11.315], P=0.001) were independent risk factors for VTE among patients with co-existing diseases, and the risks from high to low were cerebral hemorrhage>cerebral infarction>malignant tumor>respiratory system disease>coronary heart disease> diabetes. In addition, patients’ age (t=6.869, P<0.001), region (t=3.420, P<0.001), education level (t=−7.341, P<0.001), chronic disease (t=5.875, P<0.001), BMI (t=6.404, P=0.012), smoking (t=4.152, P=0.042) were related to the VTE cognitive level.ConclusionGeneral practitioners should pay close attention to independent risk factors for VTE among patients in routine outpatient care, especially patients with co-existing diseases with independent risk for VTE, placing them high risk of VTE. At the same time, health education and other measures should be strengthened to improve the patients’ awareness and cognitive level of VTE to prevent the occurrence of VTE and its related complications.

ALCOHOL : A PROVOCATING FACTOR IN MALE CEREBRAL VENOUS THROMBOSIS – A PROSPECTIVE ANALYSIS IN WESTERN RAJASTHAN

BACKGROUND : Cerebral venous thrombosis is an uncommon cause of headache in our daily practice. However there is a need to identify its various provoking factors because timely and appropriate therapy can reverse the disease process , its acute complications and long term sequel. OBJECTIVE : To study the clinical prole in male Cerebral Venous Thrombosis patients . METHODS AND MATERIAL : This is a prospective cross sectional study of twenty ve male Cerebral Venous Thrombosis (CVT) patients diagnosed in outpatient clinic of neurology department at Dr S N medical college from the September , 2014 to august , 2018. Their ages ranged from 10 to 70 years with mean age of onset 31 yrs. All patients after taking informed consent with history suggestive of CVTand later diagnosed by imaging of brain ( MRI and MRV) were included. STATISTICALANALYSIS USED: All data were expressed as mean or patient's number (n) and percentage (%) as appropriate RESULTS: Among 25 male CVT patients , majority were young seen in 20-30yrs with mean age of 31yrs. Most common clinical presentation was headache [n=25(100%)] with or without vomiting followed by seizures [n=10 (40%)]. Most common site involved was transverse sinus [n=23(92%)]. Papilledema was observe in 21 patients (84%). Alcoholism [n=8 (32%)] and hyperhomocystenemia [n=6(24%)] were the risk factors seen in male CVT. CONCLUSION: Cerebral Venous Thrombois is found to be signicantly high in alcoholic males. Compared to other Indian studies there was not much disparity in clinical prole and risk factors.

Efficacy of Stent Thrombectomy Alone or Combined With Intermediate Catheter Aspiration for Severe Cerebral Venous Sinus Thrombosis: A Case-Series.

ObjectiveTo assess the safety and efficacy of stent thrombectomy alone or combined with intermediate catheter aspiration for severe cerebral venous sinus thrombosis.MethodWe retrospectively collected the clinical data of 7 patients with severe CVST who received endovascular treatment at our hospital from January 2017 to June 2020. The patients had at least one adverse prognostic factor (mental status disorder, comatose state, intracerebral hemorrhage, or thrombosis of the deep venous system).ResultsThe median age was 51 years. Three patients were women. Two or more venous sinuses were in involved in 5 patients. All patients received systemic anticoagulant therapy before endovascular therapy. Neurological deterioration was the main reason for patients with cerebral venous sinus thrombosis undergoing intravascular therapy. The median time from admission to intravascular therapy was 3 days (1–9 days). Primary endpoints: 6 patients (85.7%) had a modified Rankin scale score of 0 at day 90, and 1 patient (14.3%) had a modified Rankin scale score of 2 at day 90. Secondary endpoints: complete recanalization was achieved in 4 cases (57.1%) and partial recanalization in 3 cases (42.9%).ConclusionStent thrombectomy, combined with intermediate catheter aspiration, balloon dilation, and regional thrombolysis/anticoagulation treatment, is an effective strategy to treat severe cerebral venous sinus thrombosis patients who had inadequate response to anticoagulant therapy. This strategy can quickly eliminate the occluded venous sinus and improve prognosis of severe cerebral venous sinus thrombosis.

Передопераційна поширеність тромбозу вен нижніх кінцівок у хворих із переломами шийки стегнової кістки

Вступ. На сьогоднішній день актуальним питанням сучасної ортопедії та травматології залишається проблема тромбозу вен нижніх кінцівок і тромбоемболії легеневої артерії, що виникає у хворих із переломами шийки стегнової кістки. Мета — вивчення взаємозв’язку між терміном із моменту травми та передопераційною поширеністю тромбозу вен нижніх кінцівок у пацієнтів із переломом шийки стегнової кістки. Матеріали та методи. Протягом 2013–2014 років було проведено когортне дослідження на базі Київської обласної клінічної лікарні № 1 в ортопедо-травматологічному центрі 96 пацієнтів із переломами шийки стегнової кістки. Середній вік пацієнтів — 75 ± 10 років, 78 % — жінки, 22 % — чоловіки. Усім пацієнтам при госпіталізації було виконано ультразвукову діагностику вен нижніх кінцівок. Результати. Ми спостерігали найбільшу кількість тромбозів із 5-го по 14-й день із моменту травми. При аналізі виникнення тромбозів вен нижніх кінцівок за статевою приналежністю з 18 пацієнтів він спостерігався в 13 жінок і 5 чоловіків. Найбільша частота даних ускладнень виникала у віці від 75 років і старше. Обговорення. Венозна тромбоемболія є основною проблемою після оперативного лікування переломів шийки стегнової кістки. Ми можемо передбачити розвиток тромбозу вен у проміжку між часом від перелому шийки стегнової кістки та хірургічним втручанням, тому що пацієнти з переломом шийки стегнової кістки не можуть самостійно рухати травмованою кінцівкою протягом цього періоду. Висновки. 1. Основним фактором ризику розвитку тромбозу вен нижніх кінцівок при переломах шийки стегнової кістки є збільшення терміну з моменту травми до проведення оперативного лікування. 2. Ультразвукове дослідження, як ранній скринінговий метод діагностики венозних тромбоемболічних ускладнень, має виконуватися в найкоротші терміни у всіх пацієнтів із переломами шийки стегнової кістки, якщо неможливе виконання оперативного втручання, необхідно повторювати ультразвукову діагностику протягом 48 годин. 3. Фактором ризику для розвитку тромбозу вен нижніх кінцівок у передопераційний період є вік пацієнтів більше 75 років.

Portomesenteric Venous Thrombosis in Patients after Laparoscopic Bariatric Surgery

Objective: Obesity has become a worldwide epidemic that is directly related to chronic tissue inflammation and impaired fibrinolysis, both of which lead to an increased risk of thrombosis. The management of complications after bariatric surgery is still a challenge. The study aims to report the incidence of portomesenteric venous thrombosis (PMVT) in patients undergoing bariatric surgery. Introduction: Bariatric surgery is the procedure of choice for the treatment of obesity type III. Despite the safe technique, the surgeon must be aware of the risks linked to laparoscopy such as the PMVT. Computed tomography (CT) with intravenous contrast was the imaging method of choice for diagnosis. Materials and Methods: We performed a retrospective analysis of 4790 patients from August 1999 to June 2020 was observed the incidence of PMVT in this group. Of all patients, 72.8% were female and 27.2% male. The mean age was 46.3 years (34 - 72) and the mean BMI before bariatric surgery was 41.4 kg/m2. Results: The study showed an incidence of PMVT of 0.12% (N = 6), portal vein thrombosis was of 0.10% (n = 5) and 0.03% of MVT (n = 1). Of these, 72.5% (n = 3473 patients) underwent laparoscopic gastric bypass, 23.6% (n = 1131 patients) were submitted to the laparoscopic sleeve gastrectomy and 3.8% (n = 186 patients) to other procedures. The mean postoperative hospital stay for bariatric surgery was 3.3 days. The average time of hospital stay of patients complicated with PMVT range from 5 to 14 days. No patient died of complications related to PMVT. Conclusion: Portomesenteric vein thrombosis is a rare presentation after laparoscopic bariatric surgery. However, it is a serious complication that has a high index of suspicion for making its diagnosis. Conservative treatment using anticoagulants and thrombolytics is effective, it should always be considered the main treatment option. However, these patients must be followed up in the long term, as late complications can occur in high numbers of patients.

Assessment of the Safety of Enoxaparin a Low Molecular Weight Heparin for Prophylaxis against Deep Venous Thrombosis in Patients with Chronic Kidney Disease on Hemodialysis

Assessment of the Safety of Enoxaparin a Low Molecular Weight Heparin for Prophylaxis against Deep Venous Thrombosis in Patients with Chronic Kidney Disease on Hemodialysis

Incidence of deep venous thrombosis in patients with severe acute respiratory syndrome coronavirus disease 2019 and elevated plasma levels of the D-dimer

Background There is an increased risk of developing venous thromboembolism in patients with severe acute respiratory syndrome coronavirus disease (SARS COVID-19). As the D-dimer could be elevated in deep venous thrombosis (DVT), we aimed to investigate the incidence of DVT in patients with SARS COVID-19 and elevated plasma levels of the D-dimer. Patients and methods A prospective observational study was carried out to screen all patients with a confirmed diagnosis of SARS COVID-19 with plasma D-dimer levels above 1000 ng/ml for the presence of DVT without related symptoms using complete compression Doppler ultrasound. Results A total of 52 patients were included in the study. Among them, 34 (67.3%) were males. All patients received standardized thromboprophylaxis treatment. The screening results of complete compression Doppler ultrasound revealed DVT in eight (15.4%) patients. Among these patients, the DVT was proximal in one (1.9%) patient and bilateral distal in two (3.8%) patients. The D-dimer level was significantly higher in patients with DVT than in patients without DVT (4531 vs. 2048 ng/ml, odds ratio 9.4, 95% confidence interval 1.2–70.3). The diagnostic ability of the D-dimer was satisfactory, with an receiver operating characteristic curve of 0.71 (95% confidence interval 0.62–0.83). Conclusion The incidence of DVT without symptoms in patients with SARS COVID-19 and elevated plasma level of D-dimer was 15.4%, with a significant difference between patients with and without DVT in terms of the D-dimer. Therefore, the D-dimer is important for the diagnosis of DVT in patients with SARS COVID-19.

Cerebral venous thrombosis in patients with and without female specific sex factors - A single-center experience

Cerebral venous thrombosis in patients with and without female specific sex factors - A single-center experience

Screening of the Promising Direct Thrombin Inhibitors from Haematophagous Organisms. Part I: Recombinant Analogues and Their Antithrombotic Activity In Vitro.

The success in treatment of venous thromboembolism and acute coronary syndromes using direct thrombin inhibitors has stimulated research aimed at finding a new anticoagulant from haematophagous organisms. This study deals with the comparison between hirudin-1 from Hirudomedicinalis(desirudin), being the first-known and most well-studied natural anticoagulant, along with recombinant analogs of haemadin from the leech Haemadipsa sylvestris, variegin from the tick Amblyomma variegatum, and anophelin from Anopheles albimanus. These polypeptides were chosen due to their high specificity and affinity for thrombin, as well as their distinctive inhibitory mechanisms. We have developed a universal scheme for the biotechnological production of these recombinant peptides as pharmaceutical substances. The anticoagulant activities of these peptides were compared using the thrombin amidolytic activity assay and prolongation of coagulation time (thrombin time, prothrombin time, and activated partial thromboplastin time) in mouse and human plasma. The preliminary results obtained suggest haemadin as the closest analog of recombinant hirudin-1, the active substance of the medicinal product Iprivask (Aventis Pharmaceuticals, USA) for the prevention of deep venous thrombosis in patients undergoing elective hip or knee replacement surgery. In contrast, variegin can be regarded as a natural analog of bivalirudin (Angiomax, The Medicines Company), a synthetic hirudin-1 derivative certified for the treatment of patients undergoing percutaneous coronary intervention and of patients with unstable angina pectoris after percutaneous transluminal coronary angioplasty.

Expert Commentary on Postoperative Evaluation and Management of Portomesenteric Venous Thrombosis in Patients With Inflammatory Bowel Disease.

Expert Commentary on Postoperative Evaluation and Management of Portomesenteric Venous Thrombosis in Patients With Inflammatory Bowel Disease.

Chemoprophylaxis to Prevent Deep Venous Thrombosis in Patients Hospitalized for Pancreatitis: Beneficial or Harmful?

Introduction: Vascular complications in pancreatitis generally occur in the form of hemorrhage or thrombosis. Pancreatitis resulting in splanchnic thrombosis has been well studied, but the cause of this correlation has not been studied in the current era of increasing anticoagulant use for deep venous thrombosis (DVT) prophylaxis. Hemorrhagic pancreatitis and peri-pancreatic bleeding are also known phenomena encountered in relation to pancreatitis, but these risks are not well established in the setting of chemical prophylaxis for DVT.Objectives: Our objective was to identify whether chemical DVT prophylaxis in pancreatitis harms the patient by increasing the risk of hemorrhagic conversion of pancreatitis or peri-pancreatic hemorrhage or if it is beneficial by preventing splanchnic venous thrombosis in the abdominal vasculature that surrounds the pancreas.Methods: We undertook a retrospective chart review with approval from the Institutional Review Board on patients who were hospitalized for or developed pancreatitis during their hospital stay from April 2014 to July 2015. We reviewed the charts for imaging suggestive of venous thrombosis or the development of intra-abdominal hemorrhage at admission during hospitalization and within 30 days after hospitalization. We also reviewed the methods of DVT prophylaxis to identify any correlation with the risk of hemorrhage or thrombosis. A bedside index of severity in acute pancreatitis score was used within 24 hours of admission to calculate the severity of the patients’ pancreatitis. The data collected were analyzed for descriptive statistics, correlation using Pearson’s coefficient, and multivariate regression analysis using Microsoft Excel and SPSS Inc. Released 2009. PASW Statistics for Windows, Version 18.0. Chicago: SPSS Inc.Results: This study included 389 patients who met the inclusion criteria. Of these, 74.6% of patients received chemical prophylaxis, mostly low molecular weight heparin, and 18.5% of patients were not on chemical or mechanical means of DVT prophylaxis. Only 12 patients (3%) had complications related to thrombosis and hemorrhage. Seven patients had splanchnic venous thrombosis, one had a hemorrhagic conversion of pancreatitis, three had a peri-pancreatic hemorrhage, and one had both the hemorrhagic conversion of pancreatitis and peri-pancreatic hemorrhage. Ten patients out of 12 patients had complications before admission, and nine of the 12 patients were on chemical prophylaxis. Pearson’s coefficient showed no statistically significant correlation between the incidence of complications and the use of chemical DVT prophylaxis. Multivariate analysis showed no specific variable that increased the risk of complications.Conclusions: Our study showed that chemoprophylaxis for DVT in patients hospitalized for acute pancreatitis is neither harmful by causing hemorrhagic conversion of pancreatitis, peri-pancreatic hemorrhage nor beneficial by preventing splanchnic venous thrombosis.

Efficacy and Safety of Rivaroxaban in Patients with CAT: A Pooled Meta-Analysis of 3 Randomized Controlled Trials

Introduction: CALLISTO, a comprehensive programme of research on cancer-associated thrombosis (CAT) , included 3 randomized trials of rivaroxaban versus low molecular weight heparin (LMWH) for the treatment of venous thrombosis in patients with solid and haematological cancers (SELECT-D, CASTA-DIVA and CONKO-11). A meta-analysis of these studies was conducted to improve the precision of current estimates of the efficacy and safety of rivaroxaban in this patient group and investigate how patient characteristics impact the treatment effects.Methods: The primary endpoint was the cumulative incidence of venous thromboembolism (VTE) recurrence at the end of the treatment period (≥3 months). Other endpoints included major bleeding (MB), a composite of MB or clinically relevant non-major bleeding (clinically relevant bleeding [CRB]) and deaths from any cause. All endpoints were assessed by 8 pre-defined subgroup analyses: age, gender, creatinine clearance, type of index VTE, index VTE localization, cancer localization, performance status and presence of metastases (Prospero submission 266227). Patient-level data were used in this analysis.The cumulative incidences of VTE recurrence, CRB were estimated using the Kalbfleisch and Prentice model, while the Kaplan-Meier model was used to estimate the incidence of death. Comparisons between rivaroxaban and LMWH for VTE recurrence, MB and CRB were assessed by sub-distribution hazard ratios (SubHR) and 95% confidence intervals (CI), whereas hazard ratios and 95% CIs were used for the all-cause death endpoint. The pooled treatment effect size of each study was estimated using fixed-effect and random-effects models.Results: When considering the prevention of VTE recurrence in the 3 randomized trials (N=804), an overall reduction of 48% was observed with rivaroxaban compared with LMWH (SubHR = 0.52, 95% CI 0.28─0.98). The estimation appeared to be homogeneous across subgroups of patients. In comparison with LMWH, rivaroxaban was associated with an increased risk of CRB (SubHR = 2.03, 95% CI 1.34─3.09), without significant difference in MB (SubHR = 1.24, 95% CI 0.60─2.57), and no difference was observed for death.Conclusions: This pooled analysis suggests that rivaroxaban may be an alternative treatment option for the prevention of VTE recurrence in cancer patients with VTE. The gain in statistical power has shown significant benefit, as well as some risk associated with rivaroxaban treatment in this complex patient population. The impact of patient characteristics on these treatment effects will be presented at the meeting. DisclosuresLaporte: Bayer Healthcare: Other: personal fees and non-financial support; Pfizer: Other: non-financial support; LEO Pharma: Other: non-financial support. Marshall: Bayer: Research Funding. Young: BMS/Pfizer Alliance: Honoraria; Leo Pharma: Honoraria; Chugai: Honoraria; Bayer: Honoraria, Research Funding. Riess: Bristel Myers Squibb: Honoraria; Bayer: Honoraria, Research Funding; Daiichi Sankyo: Honoraria; ASPEN: Honoraria; Leo Pharma: Honoraria; Pfizer: Honoraria. Sinn: BMS: Honoraria, Research Funding; Incyte: Honoraria, Research Funding; Pfizer: Honoraria; Servier: Consultancy, Honoraria, Research Funding; Astra Zenica: Consultancy, Research Funding; Amgen: Consultancy, Research Funding; MSD: Consultancy, Research Funding; Sanofi: Consultancy; Bayer: Research Funding. Girard: Bayer Healthcare: Other: Personal fees, Research Funding; LEO Pharma: Other: Perconal fees, Research Funding. Sanchez: BAYER: Other: reports grants, personal fees and non-financial suppor; BMS: Other: grants, personal fees and non-financial support; PFIZER: Other: personal fees and non-financial support; BOEHRINGER INGELHEIM: Other: personal fees and non-financial support; CHIESI: Other: personal fees; BOSTON SCIENTIFICS: Other: grants and personal fees.

RENAL VEIN THROMBOSIS WITH INFRAHEPATIC INFERIOR VENA CAVA EXTENSION IN A CASE OF ANTI dsDNA ANTIBODY NEGATIVE LUPUS NEPHRITIS

Systemic Lupus Erythematosis (SLE) is a chronic autoimmune disease of unknown cause that can affect virtually any organ of the body. Anti dsDNA antibody has been considered as a marker of renal disease. Hence elevated levels are expected in patients with Lupus Nephritis (LN). But in a subset of these patients anti dsDNA antibody is negative and this heralds the development of burned out LN (stage 5 LN) which predisposes patients to thrombosis. Prophylactic anticoagulation plays an important role in the management of such patients. We describe a case of a 19 year old female with lupus nephritis and renal vein thrombosis that had extended into the inferior vena cava. Her serology was strikingly signicant for the absence of anti dsDNA antibody. The factors that predispose to the development of venous thrombosis in patients with Lupus Nephritis are discussed. In conclusion, negative anti dsDNA antibodies heralds the development of stage ve Lupus Nephritis which predisposes to thrombosis. Guidelines for prophylactic anticoagulation as per serum albumin levels are also discussed.

SARS-CoV-2-Associated Cerebrovascular Disease Amid the COVID-19 Pandemic: A Systematic Review.

BackgroundCerebrovascular diseases associated with SARS-CoV-2 are being increasingly reported in the literature as the coronavirus disease 2019 (COVID-19) pandemic continues. However, a case-based retrospective analysis of the literature about SARS-CoV-2-cerebrovascular disease (SCVD) is not yet well established. Thus, we reviewed the literature on SCVD covering a comprehensive range of topics spanning the clinical features, mechanism, treatment, and outcomes of patients with SCVD.MethodsWe searched PubMed® and included single-case reports and case series with full text in English that reported original data of patients with CVD and a confirmed recent SARS-CoV-2 infection. Clinical data were extracted.ResultsWe included all 51 articles indexed in PubMed® that were published between January 1, 2020, and June 20, 2020. The selected studies reported a total of 167 cerebrovascular events including ischemic stroke, cerebral hemorrhage, subarachnoid hemorrhage, and cerebral venous thrombosis in patients with confirmed COVID-19. The detailed demographic and clinical characteristics of patients with CVD are summarized.ConclusionThis summary of patient characteristics may help clinicians better anticipate SCVD outcomes and complications in their COVID-19 patients.

EVALUATION OF THE FREQUENCY OF ARTERIAL AND VENOUS THROMBOSIS AND PREDISPOSING FACTORS IN PATIENTS USING ELTROMBOPAG

Eltrombopag is a small molecule thrombopoietin-receptor agonist used orally for the treatment.There is a high risk of thrombosis associated with the use of Eltrombopag. Our aim in this study is evaluating the incidence of arterial and venous thrombosis in patients using Eltrombopag and followed up in our center with the diagnosis of ITP, MDS and aplastic anemia, and contributing to the literature with the data of Central Black Sea by retrospectively evaluating the predisposing factors. In this study, the data of 144 patients who were treated with Eltrombopag with the diagnosis of ITP, MDS and aplastic anemia at Ondokuz Mayıs University Faculty of Medicine Hematology Clinic between 2009-2019 were analyzed retrospectively. The data of the patients were obtained retrospectively from the hospital management information system. The study included 144 patients who treated with Eltrombopag. 66 (45.8%) of the patients were male and 78 (54.2%) were female. The mean age of the patients was 54.12 ± 20.08 years. 102 (70.8%) of the patient were diagnosed with ITP, 31 (21.5%) with aplastic anemia and 12 (7.6%) with MDS. Thrombosis was observed in 7 (4.9%) of 144 patients who treated with Eltrombopag. Venous thrombosis was found in 6 (4.2%) of these patients and arterial thrombosis was found in one patient (0.7%). Eltrombopag treatment poses a risk for thromboembolic events. The treatment process should be followed closely especially in patients with known risk factors for thrombosis.

SOFA Score as a Reliable Tool to Detect High Risk for Venous Thrombosis in Patients With Critical Stage SARS-CoV-2.

Background: Severe acute respiratory syndrome from coronavirus-2 (SARS-CoV-2) has been associated with an increased risk of venous thromboembolism (VTE). Different anticoagulation protocols have been applied in several studies in the absence of clear evidence. A reliable deep venous thrombosis (DVT) indicator in critical patients with SARS-CoV-2 could guide the anticoagulation treatment; however, it has not yet been identified, and clinical applicability of the most common markers is debatable. The aim of our study was to determine the actual incidence of DVT in critically ill SARS-CoV-2 patients and to find a reliable tool to identify patients who might benefit from therapeutic-intensity anticoagulation.Methods: From March 1, 2020 to May 31, 2020, all patients admitted to the intensive care unit (ICU) for SARS-CoV-2 at Ospedale Regionale di Locarno, Locarno, Switzerland, were prospectively enrolled and screened daily with ultrasound for DVT. Following international consensus, a higher-intensity thromboprophylaxis was administered to all patients who were not at increased risk for bleeding. Sepsis-induced coagulopathy (SIC) and sequential organ failure assessment (SOFA) scores were calculated and time-to-DVT event in a COX proportional-hazard regression model was performed. A receiver operating characteristic (ROC) curve was used to determine sensitivity and specificity and the Youden's Index to establish the best threshold.Results: A total of 96 patients were enrolled. Deep venous thrombosis was detected in 37% of patients. Sepsis-induced coagulopathy and SOFA scores were both correlated to DVT. A SIC score of 1 vs. ≥2 showed a close association with DVT, with sensitivity, specificity, and positive and negative predictive values of 90.0, 48.1, and 49.1, and 89.7%, respectively. Most significantly though, a SOFA score of 1 or 2 points was shown to be the most accurate value in predicting the absence of DVT, indicating no need for therapeutic-intensity anticoagulation. Its sensitivity, specificity, and positive and negative predictive values were 87.9, 100, and 100, and 93.7%, respectively. The D-dimer test showed lower sensitivity and specificity whereas platelet count and aPTT were not found to be correlated to DVT.Conclusions: Patients with SOFA scores of 1 or 2 are at low risk of developing DVT and do not require therapeutic-intensity anticoagulation. Conversely, patients with scores ≥3 are at high risk of developing DVT.

Incidence, and preoperative and intraoperative prognostic factors of deep venous thrombosis in patients with glioma following craniotomy

ObjectivesThe aim of this study was to investigate the incidence of deep vein thrombosis (DVT) and the preoperative and intraoperative risk factors associated with DVT in glioma patients MethodsWe conducted a retrospective analysis of data obtained from glioma patients at Sanbo Hospital (Beijing, China) between 2018 and 2021. Symptomatic DVT was confirmed by Doppler ultrasonography. Multivariable logistic regression analysis was used to identify preoperative and intraoperative characteristics associated with DVT. Basic clinical variables and laboratory results were analyzed. ResultsA total of 492 glioma patients were included. Of these, 73 (14.84%) developed DVT, and three (0.61%) developed DVT and pulmonary embolism (PE). Multivariate analyses revealed that the following factors were highly predictive of post-operative DVT: older age ranges of 46––55 years (odds ratio [OR]: 2.94; 95% confidence interval [CI]: 1.41––6.13; p = 0.004), 56––65 years (OR: 7.86; 95% CI: 3.63––17.03; p < 0.001), and > 65 years (OR: 4.94; 95% CI: 1.83––13.33; p = 0.002); partial thromboplastin time (APTT; OR: 0.91; 95% CI: 0.84––1.00; p = 0.040); D-dimer (OR: 2.21; 95% CI: 1.28––3.82; p = 0.005); and surgery duration (OR: 2.87; 95% CI: 1.6 ––5.07; p < 0.001) ConclusionsOlder age, preoperative APTT, D-dimer, and surgery duration independently increased the risk of developing postoperative DVT. These findings may facilitate the development of a thrombosis risk score that will allow physicians to develop individualized strategies to prevent DVT as early as possible.

Risk factors for venous thrombosis in patients with endoprosthetics of hip joints

Background. Important part of orthopaedic surgery is endoprosthetics of hip joints, which eliminates pain syndrome, restores the amplitude of movements and the support ability of the lower limb. But there is a number of complications; venous thromboembolism among them occupies a leading place.&#x0D; Material and methods. 219 patients with a mean age of 64.7 ± 3.8 years were operated. In 137 (62.1%) observations, total cement hip replacement was performed for osteoarthritis. 82 (37.4%) patients received total and unipolar cement hip replacement for cervical femoral neck fractures.&#x0D; Results. Clinical manifestations of non-specific connective tissue dysplasia were detected in 83 (37.9%) patients, which were confirmed by the laboratory determination of the level of general, bound and free oxyproline. In the postoperative period, the thrombotic process in the venous system of the inferior vena cava was diagnosed in 23 (10.5%) observations. Operative intervention on the hip joint in patients with nonspecific dysplasia of connective tissue in 11 (13.3%) cases was complicated by the development of venous thrombosis. In patients without non-specific connective tissue dysplasia, postoperative thrombosis in the system of the inferior vena cava was diagnosed in 12 (8.8%) observations.&#x0D; Conclusions. Patients with osteoarthrosis of the hip joint and the femoral neck fracture accompanied by the non-specific dysplasia of the connective tissue are characterized by expressed levels of endothelial dysfunction and increased activity of the blood-coagulation system.

Predictors of acute deep venous thrombosis in patients hospitalized for COVID-19.

Deep venous thrombosis (DVT) is associated with high mortality in coronavirus disease 2019 (COVID-19) but there remains uncertainty about the benefit of anti-coagulation prophylaxis and how to decide when ultrasound screening is indicated. We aimed to determine parameters predicting which COVID-19 patients are at risk of DVT and to assess the benefit of prophylactic anti-coagulation.Adult hospitalized patients with positive severe acute respiratory syndrome coronavirus-2 reverse transcription-polymerase chain reaction (RT-PCR) undergoing venous duplex ultrasound for DVT assessment (n = 451) were retrospectively reviewed. Clinical and laboratory data within 72 hours of ultrasound were collected. Using split sampling and a 10-fold cross-validation, a random forest model was developed to find the most important variables for predicting DVT. Different d-dimer cutoffs were examined for classification of DVT. We also compared the rate of DVT between the patients going and not going under thromboprophylaxis.DVT was found in 65 (14%) of 451 reverse transcription-polymerase chain reaction positive patients. The random forest model, trained and cross-validated on 2/3 of the original sample (n = 301), had area under the receiver operating characteristic curve = 0.91 (95% confidence interval [CI]: 0.85-0.97) for prediction of DVT in the test set (n = 150), with sensitivity = 93% (95%CI: 68%-99%) and specificity = 82% (95%CI: 75%-88%). The following variables had the highest importance: d-dimer, thromboprophylaxis, systolic blood pressure, admission to ultrasound interval, and platelets. Thromboprophylaxis reduced DVT risk 4-fold from 26% to 6% (P < .001), while anti-coagulation therapy led to hemorrhagic complications in 14 (22%) of 65 patients with DVT including 2 fatal intra-cranial hemorrhages. D-dimer was the most important predictor with area under curve = 0.79 (95%CI: 0.73-0.86) by itself, and a 5000 ng/mL threshold at 7 days postCOVID-19 symptom onset had 75% (95%CI: 53%-90%) sensitivity and 81% (95%CI: 72%-88%) specificity. In comparison with d-dimer alone, the random forest model showed 68% versus 32% specificity at 95% sensitivity, and 44% versus 23% sensitivity at 95% specificity.D-dimer >5000 ng/mL predicts DVT with high accuracy suggesting regular monitoring with d-dimer in the early stages of COVID-19 may be useful. A random forest model improved the prediction of DVT. Thromboprophylaxis reduced DVT in COVID-19 patients and should be considered in all patients. Full anti-coagulation therapy has a risk of life-threatening hemorrhage.