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Innovations (Philadelphia, Pa.) 2022Descending thoracic aortic thrombus (DTAT) is an under-recognized source of systemic emboli with potential catastrophic consequences. Imaging modalities such as... (Review)
Review
Descending thoracic aortic thrombus (DTAT) is an under-recognized source of systemic emboli with potential catastrophic consequences. Imaging modalities such as echocardiography, computed tomography, magnetic resonance imaging, and angiography can help identify and characterize the extent of embolic events. Established guidelines regarding the management of DTAT are currently lacking. Multiple treatment modalities are available; however, the effectiveness of each approach remains to be determined. In this study, we performed a review to examine the clinical presentation, diagnostic methods and findings, and outcomes of various treatment options for patients with DTAT. Medical management is the least invasive and most frequently chosen initial approach, offering a high reported success rate, whereas endovascular therapy can have a role in thrombus exclusion should conservative management fail.
Topics: Aorta, Thoracic; Aortic Diseases; Embolism; Humans; Thrombosis; Treatment Outcome
PubMed: 35866207
DOI: 10.1177/15569845221107011 -
The American Journal of Case Reports Aug 2021BACKGROUND Hypercoagulable states, including venous and arterial thromboses, manifesting as pulmonary thromboembolism or stroke have been observed in COVID-19; recently,...
BACKGROUND Hypercoagulable states, including venous and arterial thromboses, manifesting as pulmonary thromboembolism or stroke have been observed in COVID-19; recently, gastrointestinal thrombotic events have also been reported. This case report describes a patient with COVID-19 and abdominal pain, who developed coagulopathy and a rare association of hepatic artery thrombosis. Common hepatic artery thrombosis is usually observed among liver transplantation patients and has not been described in infectious disease. CASE REPORT A 45-year-old woman presented in the Emergency Department with a nonproductive cough, sore throat, asthenia, headache, myalgia, anosmia, and dysgeusia. On the 5th day after the onset of these symptoms, she tested positive for SARS-COV-2 and was managed with symptomatic drugs. Although her initial symptoms of COVID-19 improved progressively, on the 14th day she experienced acute abdominal pain. On the 16th day, she was hospitalized and administered intravenous analgesia. Abdominal computed tomography angiography revealed partial thrombosis in the common hepatic artery, which was confirmed by liver Doppler ultrasonography. Protein C and D-dimer levels peaked during this period. Serum tests for thrombophilia were negative. Subcutaneous enoxaparin (60 mg twice daily) was administered during hospitalization, and her abdominal pain improved significantly. She was discharged after 3 days and prescribed an oral anticoagulant for the next 30 days. CONCLUSIONS Thrombotic events are well-recognized complications of COVID-19 and recent reports show gastrointestinal involvement. This report of a rare association of hepatic artery thrombosis highlights the importance of investigating the thrombotic events in patients with abdominal pain and coagulopathy during COVID-19.
Topics: COVID-19; Enoxaparin; Female; Hepatic Artery; Humans; Middle Aged; SARS-CoV-2; Thrombosis
PubMed: 34333508
DOI: 10.12659/AJCR.932531 -
Scandinavian Journal of Immunology Nov 2021COVID-19 is a global pandemic with a daily increasing number of affected individuals. Thrombosis is a severe complication of COVID-19 that leads to a worse clinical...
COVID-19 is a global pandemic with a daily increasing number of affected individuals. Thrombosis is a severe complication of COVID-19 that leads to a worse clinical course with higher rates of mortality. Multiple lines of evidence suggest that hyperinflammation plays a crucial role in disease progression. This review compiles clinical data of COVID-19 patients who developed thrombotic complications to investigate the possible role of hyperinflammation in inducing hypercoagulation. A systematic literature search was performed using PubMed, Embase, Medline and Scopus to identify relevant clinical studies that investigated thrombotic manifestations and reported inflammatory and coagulation biomarkers in COVID-19 patients. Only 54 studies met our inclusion criteria, the majority of which demonstrated significantly elevated inflammatory markers. In the cohort studies with control, D-dimer was significantly higher in COVID-19 patients with thrombosis as compared to the control. Pulmonary embolism, deep vein thrombosis and strokes were frequently reported which could be attributed to the hyperinflammatory response associated with COVID-19 and/or to the direct viral activation of platelets and endothelial cells, two mechanisms that are discussed in this review. It is recommended that all admitted COVID-19 patients should be assessed for hypercoagulation. Furthermore, several studies have suggested that anticoagulation may be beneficial, especially in hospitalized non-ICU patients. Although vaccines against SARS-CoV-2 have been approved and distributed in several countries, research should continue in the field of prevention and treatment of COVID-19 and its severe complications including thrombosis due to the emergence of new variants against which the efficacy of the vaccines is not yet clear.
Topics: Animals; Anticoagulants; Arteries; Blood Platelets; COVID-19; Endothelium, Vascular; Humans; Inflammation; Phenotype; SARS-CoV-2; Thrombosis; Venous Thrombosis
PubMed: 34940978
DOI: 10.1111/sji.13097 -
Experimental and Clinical... Dec 2022A hepatic vascular complication after liver transplant is a critical situation, often resulting in graft failure and potentially leading to patient death. Early...
OBJECTIVES
A hepatic vascular complication after liver transplant is a critical situation, often resulting in graft failure and potentially leading to patient death. Early diagnosis and treatment of vascular complications can provide prolonged graft survival and prohibit further complications. This study presents our experiences with endovascular treatment during the first week after liver transplant.
MATERIALS AND METHODS
Between January 2012 and February 2021, 240 liver transplants were performed, with 43 patients having early endovascular treatment (37 men; mean age 27 ± 2.9 years) at a single center. Early endovascular interventions were carried out 1 to 7 days (mean ± SD of 2.7 ± 0.24 days) after transplant. Patients with vascular complications were grouped by arterial, venous, and portal complications. In addition, arterial complications were subgrouped by occlusive (hepatic artery thrombosis) and nonocclusive (hepatic artery stenosis/splenic artery steal syndrome) complications. Patients had median follow-up of 47 ± 4 months.
RESULTS
In the first week after liver transplant, vascular complications included splenic artery steal syndrome in 27 patients (62.7%), hepatic complications in 10 patients (23.2%) (7 with hepatic artery thrombosis, 3 with hepatic artery stenosis), hepatic venous outflow complications in 4 patients (9.3%), and portal vein complications in 2 patients (4.6%). Only 1 patient required revision surgery because of excessive arterial kinking; the remaining patients with arterial complications were successfully managed with multiple endovascular treatment attempts. Patients with splenic artery steal syndrome were treated by selective arterial embolization with coil devices. Resistivity index, peak systolic velocity of hepatic arteries, and portal vein maximal velocity significantly improved (P < .001). Patients with hepatic venous outflow and portal vein complications who had endovascular treatments and vascular structures maintained good results over follow-up.
CONCLUSIONS
Early endovascular intervention is feasible and safe for hepatic vascular complications following liver transplant, with high success treatment rates with advances in interventional radiology.
Topics: Adult; Humans; Male; Young Adult; Constriction, Pathologic; Hepatic Artery; Hepatic Veins; Liver Diseases; Liver Transplantation; Radiology, Interventional; Retrospective Studies; Thrombosis; Treatment Outcome; Vascular Diseases; Postoperative Complications
PubMed: 36718007
DOI: 10.6002/ect.2022.0244 -
The Journal of International Medical... Jun 2020Patients with ovarian cancer are often in a hypercoagulable state and have a high risk of venous thrombosis, including deep vein thrombosis and pulmonary embolism.... (Review)
Review
Patients with ovarian cancer are often in a hypercoagulable state and have a high risk of venous thrombosis, including deep vein thrombosis and pulmonary embolism. However, arterial thrombosis is relatively rare in ovarian cancer. We report a case a 46-year-old woman with ovarian clear cell carcinoma who developed arterial and venous thrombosis in the lower extremities as the first manifestation. Her arterial thrombosis-related ischemic symptoms were not responsive to anticoagulant treatment of low-molecular-weight heparin, but improved after neoadjuvant chemotherapy and surgery. Therefore, we hypothesize that the optimal therapy for arterial thrombosis in ovarian cancer is treatment for the underlying disease (i.e., ovarian cancer). A thorough investigation is required to determine the relationships between arterial thrombosis and ovarian cancer and antithrombotic treatments for ovarian cancer related-arterial thrombosis.
Topics: Adenocarcinoma, Clear Cell; Arteries; Biomarkers, Tumor; Biopsy; Chemotherapy, Adjuvant; Computed Tomography Angiography; Female; Heparin, Low-Molecular-Weight; Humans; Hysterectomy; Incidental Findings; Lower Extremity; Middle Aged; Neoadjuvant Therapy; Neoplasm Staging; Ovarian Neoplasms; Ovary; Peritoneal Neoplasms; Positron Emission Tomography Computed Tomography; Salpingo-oophorectomy; Thrombosis; Treatment Outcome; Ultrasonography
PubMed: 32485125
DOI: 10.1177/0300060520926742 -
JACC. Cardiovascular Interventions Feb 2022
Topics: Coronary Artery Disease; Coronary Vessels; Humans; Ischemia; Thrombosis; Treatment Outcome
PubMed: 35210050
DOI: 10.1016/j.jcin.2021.12.010 -
Annals of Vascular Surgery Oct 2022COVID-19 infection is associated not only with venous thromboses but also with arterial thromboses (COV-ATs) in relation with an endothelial dysfunction, a coagulopathy...
BACKGROUND
COVID-19 infection is associated not only with venous thromboses but also with arterial thromboses (COV-ATs) in relation with an endothelial dysfunction, a coagulopathy and rhythm disorders. The incidence, the topography, and the prognosis of COV-ATs remain poorly known. The objective of this study was to report the overall experience of the Greater Paris University Hospitals (Assistance Publique - Hopitaux de Paris, AP-HP) during the first pandemic wave of COVID-19 infection.
METHODS
After approval by the ethics committee, a study using the AP-HP clinical data warehouse was carried out between March and May 2020. Overall, 124,609 patients had a polymerase chain reaction for COVID-19 in our hospitals, of which 25,345 were positive. From 20,710 exploitable stays, patients tested positive for COVID who presented an episode of acute COV-AT (except coronary and intracranial arteries) were selected on the basis of the French medical classification for clinical procedures codes. The data are presented as absolute values with percentages and/or means with standard deviation.
RESULTS
Over the studied period, 60 patients (aged 71±14 years, 42 men) presented a COV-AT at the time of their hospitalization, an incidence of 0.2%. The arterial complication occurred 3±7 days after the COVID infection and was inaugural in 30% of the cases (n = 18). The sites of COV-AT were the lower extremities (n = 35%, 58%), the abdominal aorta (n = 10%, 17%), the thoracic aorta (n = 7%, 12%), the upper limbs (n = 7%, 12%), the cerebral arteries (n = 7%, 12%), the digestive arteries (n = 6%, 10%), the renal arteries (n = 2%, 3%), and the ophthalmic artery (n = 1%, 2%). Multiple COV-ATs were observed in 13 patients (22%). At the time of diagnosis, 20 (33%) patients were in intensive care, including six (10%) patients who were intubated. On computed tomography angiography, COVID lesions were classified as moderate and severe in 25 (42%) and 21 (35%) cases, respectively. Revascularization was attempted in 27 patients (45%), by open surgery in 16 cases, using endovascular techniques in 8 cases and with a hybrid approach in three cases. Six patients (22%) required reinterventions. The duration of hospitalization was 12±9 days. Early mortality (in-hospital or at 30 days) was 30% (n = 18). Nine (15%) patients presented severe nonlethal ischemic complications.
CONCLUSIONS
Arterial involvement is rare during COVID-19 infection. The aorta and the arteries of the limbs are the privileged sites. The morbi-mortality of these patients is high. Future studies will have to determine if the systematization of anticoagulation therapy decreases the incidence and the severity of the condition.
Topics: Male; Humans; COVID-19; SARS-CoV-2; Treatment Outcome; Thrombosis; Arteries
PubMed: 35780947
DOI: 10.1016/j.avsg.2022.04.055 -
Journal of Thrombosis and Haemostasis :... Oct 2020Thrombosis after liver transplantation is a leading cause of graft loss, morbidity, and mortality. Several known recipient- and surgery-related characteristics have been... (Observational Study)
Observational Study
BACKGROUND
Thrombosis after liver transplantation is a leading cause of graft loss, morbidity, and mortality. Several known recipient- and surgery-related characteristics have been associated with increased risk of thrombosis after transplantation. Potential donor-related risk factors, however, remain largely undefined.
OBJECTIVES
We aimed to identify risk factors for early post-transplantation thrombosis (<90 days) and to determine the impact of early postoperative thrombosis on long-term graft and patient survival.
PATIENTS/METHODS
A post hoc analysis was performed of an observational cohort study including all primary, adult liver transplantations performed between 1993 and 2018. Donor-, recipient-, and surgery-related characteristics were collected. Competing risk model analyses and multivariable regression analyses were performed to identify risk factors for developing early post-transplant thrombosis and graft failure.
RESULTS
From a total of 748 adult liver transplantations, 58 recipients (7.8%) developed a thrombosis after a median of 7 days. Post-transplantation thrombotic events included 25 hepatic artery thromboses, 13 portal vein thromboses, and 22 other thrombotic complications. Donor history of smoking was independently associated with early postoperative thrombosis (odds ratio [OR] 2.42; 95% confidence interval [CI], 1.29-4.52). Development of early post-transplant thrombosis was independently associated with patient mortality (hazard ratio [HR] 3.61; 95% CI 1.54-8.46) and graft failure (HR 5.80, 95% CI 3.26-10.33), respectively.
CONCLUSION
Donor history of smoking conveys a more than two-fold increased risk of thrombosis after liver transplantation, independent of other factors. Post-transplant thrombosis was independently associated with decreased patient and graft survival.
Topics: Adult; Hepatic Artery; Humans; Liver Transplantation; Postoperative Complications; Retrospective Studies; Risk Factors; Thrombosis; Tobacco Smoking
PubMed: 32614986
DOI: 10.1111/jth.14983 -
BMC Pregnancy and Childbirth Nov 2021Umbilical artery thrombosis is a rare complication of pregnancy strongly associated with poor fetal and perinatal outcomes, such as intrauterine asphyxia, fetal growth...
BACKGROUND
Umbilical artery thrombosis is a rare complication of pregnancy strongly associated with poor fetal and perinatal outcomes, such as intrauterine asphyxia, fetal growth restriction, and stillbirth. Its pathogenesis remains unclear, and there is the added challenge of selecting an appropriate delivery time to achieve excellent neonatal outcomes.
METHODS
Our Hospital is a critical maternal rescue center with approximately 7000 births annually. We present a series of 8 cases of umbilical artery thrombosis diagnosed at the hospital between Apr 1, 2018, and Jan 31, 2020. We identified the cases through a keyword search of the maternity and pathology information management systems.
RESULTS
Three patients were diagnosed with a transabdominal ultrasound scan and hypoxia on fetal heart monitoring. All three patients had emergency cesarean section delivery. Four patients were observed closely for 5 to 13 weeks from initial detection by an ultrasound scan to delivery. Only one patient was diagnosed after vaginal delivery by Hematoxylin-eosin staining of umbilical cord sections. Seven patients had deliveries by cesarean section, and one patient had a vaginal delivery. All infants were born alive.
CONCLUSIONS
Umbilical artery thrombosis is a challenging and rare condition that can occur at different gestational ages, especially when diagnosed in the third trimester and accompanied by fetal growth restriction. Consequently, these patients require close monitoring of umbilical blood flow and fetal growth and intervention at the appropriate time to achieve an optimal outcome.
Topics: Adult; Cesarean Section; Female; Fetal Growth Retardation; Fetal Hypoxia; Fetal Monitoring; Gestational Age; Humans; Infant, Newborn; Pregnancy; Pregnancy Complications, Cardiovascular; Thrombosis; Ultrasonography, Prenatal; Umbilical Arteries
PubMed: 34809600
DOI: 10.1186/s12884-021-04264-9 -
Cardiology Journal 2021Prostacyclin and analogues are successfully used in the treatment of pulmonary arterial hypertension (PAH) due to their vasodilatory effect on pulmonary arteries.... (Review)
Review
Prostacyclin and analogues are successfully used in the treatment of pulmonary arterial hypertension (PAH) due to their vasodilatory effect on pulmonary arteries. Besides vasodilatory effect, prostacyclin analogues inhibit platelets, but their antiplatelet effect is not thoroughly established. The antiplatelet effect of prostacyclin analogues may be beneficial in case of increased risk of thromboembolic events, or undesirable in case of increased risk of bleeding. Since prostacyclin and analogues differ regarding their potency and form of administration, they might also inhibit platelets to a different extent. This review summarizes the recent evidence on the antiplatelet effects of prostacyclin and analogue in the treatment of PAH, this is important to consider when choosing the optimal treatment regimen in tailoring to an individual patients' needs.
Topics: Epoprostenol; Hemorrhage; Humans; Hypertension, Pulmonary; Pulmonary Artery; Thrombosis
PubMed: 33200814
DOI: 10.5603/CJ.a2020.0164