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BMJ Case Reports Jul 2017Cancer is frequently associated with a hypercoagulable state. Almost 15% of patients with cancer will suffer a thromboembolic event during their clinical course. The...
Cancer is frequently associated with a hypercoagulable state. Almost 15% of patients with cancer will suffer a thromboembolic event during their clinical course. The aetiology of this hypercoagulable state is multifactorial and includes procoagulant factors associated with malignancy as well as the host's inflammatory response. Cancer-associated thrombophilia can present as venous thromboembolism, migratory superficial thrombophlebitis, arterial thrombosis, disseminated intravascular coagulation, thrombotic microangiopathy and rarely non-bacterial thrombotic endocarditis (NBTE). In this paper, we will describe an uncommon presentation of lung cancer on a non-smoker middle-aged woman, with recent diagnosis of pulmonary embolism, who develops malignant recurrent pleural effusion, NBTE with cutaneous and neurological manifestations, with a rapid evolution into shock, culminating in death. Diagnosis of NBTE requires a high degree of clinical suspicion. The mainstay of treatment is systemic anticoagulation to prevent further embolisation and underlying cancer control whenever is possible.
Topics: Adenocarcinoma, Papillary; Aged; Chest Pain; Diagnosis, Differential; Drainage; Echocardiography, Transesophageal; Endocarditis, Non-Infective; Fatal Outcome; Female; Humans; Lung Neoplasms; Paraneoplastic Syndromes; Pulmonary Embolism
PubMed: 28710195
DOI: 10.1136/bcr-2017-220217 -
Oxford Medical Case Reports Aug 2020Chikungunya virus (CHIKV) is an arthropod-borne virus that is transmitted by mosquitoes, and its main features are high fever and (debilitating) arthritis. Infection...
Chikungunya virus (CHIKV) is an arthropod-borne virus that is transmitted by mosquitoes, and its main features are high fever and (debilitating) arthritis. Infection with CHIKV, as well as other viruses, has been associated with hypercoagulable states and may be linked with the development of venous thrombosis. In fact, the development of deep venous thrombosis has been described in CHIKV infection. We present a case of superficial thrombophlebitis of the thoracic wall, known as Mondor's disease, associated with CHIKV infection. To our knowledge, this probable association has never been described before.
PubMed: 32793369
DOI: 10.1093/omcr/omaa065 -
Journal of Vascular Surgery. Venous and... Mar 2024The evidence for post-foam sclerotherapy compression stockings for varicose veins is limited. Thus, we examined the effects of post-procedural compression stockings on... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
The evidence for post-foam sclerotherapy compression stockings for varicose veins is limited. Thus, we examined the effects of post-procedural compression stockings on varicose vein patients undergoing foam sclerotherapy.
METHODS
The CONFETTI study was a prospective, single-center, randomized controlled trial. Patients with foam sclerotherapy-suitable varicose veins were randomly assigned to the compression group (CG) or the no compression stockings group (NCG) for 7 days. The primary outcome was post-procedural pain measured on a 100-mm visual analog scale for 10 days. Secondary outcomes included clinical severity, generic and disease-specific quality of life scores, return to normal activities and/or work, occlusion rates, degree of ecchymosis, CG compliance, and complications. Patients were reviewed at 2 weeks and 6 months.
RESULTS
A total of 139 patients were consented to and randomly assigned. The intention-to-treat analysis included 15 patients who did not receive the allocated intervention. Both groups had similar baseline characteristics. Of the patients, 63.3% and 55.4% returned for follow-up at 2 weeks and 6 months, respectively. Most of the veins treated were tributaries. The CG experienced significantly lower pain scores than the NCG, with median scores of 7 mm and 19 mm, respectively (Mann-Whitney U-test; P = .001). At 2 weeks, no differences were observed in ecchymosis or the time to return to normal activities or work. Both groups showed improvements in clinical severity and quality of life, and occlusion rates were comparable. The NCG experienced one deep venous thrombosis and superficial thrombophlebitis, whereas the CG experienced two superficial thrombophlebitis.
CONCLUSIONS
The CONFETTI study suggests that short-term post-procedural compression stockings are beneficial for reducing post-procedure pain.
Topics: Humans; Sclerotherapy; Quality of Life; Prospective Studies; Ecchymosis; Treatment Outcome; Varicose Veins; Thrombophlebitis; Saphenous Vein; Pain
PubMed: 38081513
DOI: 10.1016/j.jvsv.2023.101729 -
Cureus Feb 2022Mondor's disease is an uncommon cause of breast and chest pain. It is characterized by cord-like thickening of the superficial veins of the anterior chest wall mimicking...
Mondor's disease is an uncommon cause of breast and chest pain. It is characterized by cord-like thickening of the superficial veins of the anterior chest wall mimicking many life-threatening illnesses such as pulmonary thromboembolism and myocardial infarction. The disease may have been caused by trauma, other hypercoagulable states, or underlying breast diseases such as infection or carcinoma breast, but, in most cases, its etiology remains unknown. Mondor's disease is usually self-limited and can be managed conservatively. Although a rare and benign diagnosis, Mondor's disease should be a part of the differentials of chest pain, and its diagnosis can be made on the basis of a thorough clinical examination alone, which reduces not only costs but also the risks of further testing for patients presenting with chest pain. We highlight the case of a 40-year-old premenopausal female patient who presented to the outpatient department with stretching aching chest pain on the left side, which got aggravated on movements of the arm and relieved on rest. Mondor's disease is not considered a differential diagnosis for chest pain due to a lack of awareness about it. Creating awareness of this condition through this case report would help to reduce unnecessary investigations and valuable time spent and would help identify a serious underlying cause, especially early stage carcinoma of the breast.
PubMed: 35317031
DOI: 10.7759/cureus.22320 -
The Cochrane Database of Systematic... Jul 2014Since hypercoagulability might result in recurrent miscarriage, anticoagulant agents could potentially increase the chance of live birth in subsequent pregnancies in... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Since hypercoagulability might result in recurrent miscarriage, anticoagulant agents could potentially increase the chance of live birth in subsequent pregnancies in women with unexplained recurrent miscarriage, with or without inherited thrombophilia.
OBJECTIVES
To evaluate the efficacy and safety of anticoagulant agents, such as aspirin and heparin, in women with a history of at least two unexplained miscarriages with or without inherited thrombophilia.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 October 2013) and scanned bibliographies of all located articles for any unidentified articles.
SELECTION CRITERIA
Randomised and quasi-randomised controlled trials that assessed the effect of anticoagulant treatment on live birth in women with a history of at least two unexplained miscarriages with or without inherited thrombophilia were eligible. Interventions included aspirin, unfractionated heparin (UFH), and low molecular weight heparin (LMWH) for the prevention of miscarriage. One treatment could be compared with another or with no-treatment (or placebo).
DATA COLLECTION AND ANALYSIS
Two review authors (PJ and SK) assessed the studies for inclusion in the review and extracted the data. If necessary they contacted study authors for more information. We double checked the data.
MAIN RESULTS
Nine studies, including data of 1228 women, were included in the review evaluating the effect of either LMWH (enoxaparin or nadroparin in varying doses) or aspirin or a combination of both, on the chance of live birth in women with recurrent miscarriage, with or without inherited thrombophilia. Studies were heterogeneous with regard to study design and treatment regimen and three studies were considered to be at high risk of bias. Two of these three studies at high risk of bias showed a benefit of one treatment over the other, but in sensitivity analyses (in which studies at high risk of bias were excluded) anticoagulants did not have a beneficial effect on live birth, regardless of which anticoagulant was evaluated (risk ratio (RR) for live birth in women who received aspirin compared to placebo 0.94, (95% confidence interval (CI) 0.80 to 1.11, n = 256), in women who received LMWH compared to aspirin RR 1.08 (95% CI 0.93 to 1.26, n = 239), and in women who received LMWH and aspirin compared to no-treatment RR 1.01 (95% CI 0.87 to 1.16) n = 322).Obstetric complications such as preterm delivery, pre-eclampsia, intrauterine growth restriction and congenital malformations were not significantly affected by any treatment regimen. In included studies, aspirin did not increase the risk of bleeding, but treatment with LWMH and aspirin increased the risk of bleeding significantly in one study. Local skin reactions (pain, itching, swelling) to injection of LMWH were reported in almost 40% of patients in the same study.
AUTHORS' CONCLUSIONS
There is a limited number of studies on the efficacy and safety of aspirin and heparin in women with a history of at least two unexplained miscarriages with or without inherited thrombophilia. Of the nine reviewed studies quality varied, different treatments were studied and of the studies at low risk of bias only one was placebo-controlled. No beneficial effect of anticoagulants in studies at low risk of bias was found. Therefore, this review does not support the use of anticoagulants in women with unexplained recurrent miscarriage. The effect of anticoagulants in women with unexplained recurrent miscarriage and inherited thrombophilia needs to be assessed in further randomised controlled trials; at present there is no evidence of a beneficial effect.
Topics: Abortion, Habitual; Anticoagulants; Antiphospholipid Syndrome; Aspirin; Enoxaparin; Female; Heparin, Low-Molecular-Weight; Humans; Live Birth; Nadroparin; Pregnancy; Pregnancy Complications, Hematologic; Randomized Controlled Trials as Topic; Thrombophilia
PubMed: 24995856
DOI: 10.1002/14651858.CD004734.pub4 -
BMC Urology Apr 2022Penile Mondor disease is a superficial dorsal vein thrombophlebitis of the penis, which mainly affects young and middle-aged men. It generally manifests as a visible...
BACKGROUND
Penile Mondor disease is a superficial dorsal vein thrombophlebitis of the penis, which mainly affects young and middle-aged men. It generally manifests as a visible painful cord located along the dorsal surface of the penis with signs of skin inflammation. The condition is usually self-limiting, but in severe cases a surgical procedure may be necessary in addition to pharmacological treatment. Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 is associated with a frequent incidence of thrombophilia; therefore, such a prothrombotic state during infection may be a significant risk factor for penile Mondor disease.
CASE PRESENTATION
The 34-year-old patient reported moderate pain felt on the surface of the penis. During the medical interview, the patient did not admit significant risk factors for Mondor Disease, apart from the previous, a month earlier COVID-19 disease. Examination revealed swelling erythema and a thick indurated cord on the surface of the penis. Color Doppler ultrasound was performed to confirm assumptions and exclude thrombosis of other penile vessels. Based on visible clots in the course of the superficial penile vein and after exclusion of vasculitis due to autoimmune disease the diagnosis of penile Mondor disease was made. Pharmacological therapy was implemented to further break down the clot and prevent rethrombosis in the penile vessels. The patient did not report any treatment complications and returned for a control visit, which revealed complete clot dissolution on ultrasound; therefore, complete recovery was stated.
CONCLUSIONS
This case report presents the correlation between SARS-Cov-2 infection and penile Mondor disease, based on the confirmed influence of COVID-19 on the pathophysiology of thrombosis. It can be concluded that COVID- 19 is a risk factor for Mondor disease, as in the presented case the virus was the only prothrombotic risk factor for the patient. Consequently, the possibility of developing thrombosis in the form of penile Mondor disease should be taken into account among patients with post-COVID-19 and active SARS-Cov-2 infection.
Topics: Adult; COVID-19; Humans; Male; Middle Aged; Penis; Risk Factors; SARS-CoV-2; Thrombosis
PubMed: 35413893
DOI: 10.1186/s12894-022-01002-x -
Clinical and Applied... 2019Catheter-related (CR) thrombosis is a significant complication of midline catheters (MCs) and peripherally inserted central catheters (PICCs). Limited existing data for... (Comparative Study)
Comparative Study
Catheter-related (CR) thrombosis is a significant complication of midline catheters (MCs) and peripherally inserted central catheters (PICCs). Limited existing data for MCs suggest a favorable complication profile for MCs. To compare incidence of CR thrombosis between MCs and PICCs and to evaluate the impact of quantity of lumens and catheter diameter on CR thrombosis. This was a retrospective comparison spanning 13 months of MCs and PICCs for symptomatic CR thrombosis at an 1100 bed tertiary care academic medical center. Adult patients who had an MC or a PICC placed by the were included. Data were collected using the electronic medical record. Statistical analysis was performed using SAS software. A total of 2577 catheters were included in the analysis with 1094 MCs and 1483 PICCs. One hundred thirty (11.88%) MCs developed CR thrombosis (deep vein thrombosis [DVT] or superficial venous thrombophlebitis [SVT]) as compared to 112 (6.88%) PICCs (odds ratio [OR]: 1.82; P < .0001). Midline catheters had a 53% greater odds of developing CR DVT than PICCs (7.04% MCs and 4.72% PICCs; OR: 1.53; P = .0126). For CR SVT, MCs have a 2.29-fold greater odds of developing CR SVT than PICCs (4.84% MCs and 2.16% PICCs; OR: 2.29; P = .0002). For MCs and PICCs, the incidence of CR thrombosis was 13.50% for double lumen/5F lines and was 6.92% for single lumen/4F lines (OR: 2.10; P = <.0001). Symptomatic CR thrombosis is a serious, life-threatening complication that occurs more frequently in MCs compared to PICCs. Inserters should consider placement of single lumen catheters with the smallest diameter to reduce this risk when a midline is used.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Catheterization, Central Venous; Catheterization, Peripheral; Female; Humans; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Risk Assessment; Risk Factors; Thrombosis; Venous Thrombosis
PubMed: 30909723
DOI: 10.1177/1076029619839150 -
Journal of Vascular Surgery Cases and... Dec 2022Cyanoacrylate glue closure (CAC) is being increasingly used as a minimally invasive procedure for the treatment of symptomatic incompetent saphenous veins. The most...
Cyanoacrylate glue closure (CAC) is being increasingly used as a minimally invasive procedure for the treatment of symptomatic incompetent saphenous veins. The most common adverse event associated with CAC has been phlebitis, including hypersensitivity phlebitis, superficial thrombophlebitis, and granulomatous phlebitis. This complication can be serious and debilitating. In the present report, we have described a case of symptomatic septicemia after CAC that required surgical excision of the treated saphenous veins.
PubMed: 36262917
DOI: 10.1016/j.jvscit.2022.09.008 -
Blood Apr 2020The diagnosis of recurrent ipsilateral deep vein thrombosis (DVT) is challenging, because persistent intravascular abnormalities after previous DVT often hinder a... (Clinical Trial)
Clinical Trial
The diagnosis of recurrent ipsilateral deep vein thrombosis (DVT) is challenging, because persistent intravascular abnormalities after previous DVT often hinder a diagnosis by compression ultrasonography. Magnetic resonance direct thrombus imaging (MRDTI), a technique without intravenous contrast and with a 10-minute acquisition time, has been shown to accurately distinguish acute recurrent DVT from chronic thrombotic remains. We have evaluated the safety of MRDTI as the sole test for excluding recurrent ipsilateral DVT. The Theia Study was a prospective, international, multicenter, diagnostic management study involving patients with clinically suspected acute recurrent ipsilateral DVT. Treatment of the patients was managed according to the result of the MRDTI, performed within 24 hours of study inclusion. The primary outcome was the 3-month incidence of venous thromboembolism (VTE) after a MRDTI negative for DVT. The secondary outcome was the interobserver agreement on the MRDTI readings. An independent committee adjudicated all end points. Three hundred five patients were included. The baseline prevalence of recurrent DVT was 38%; superficial thrombophlebitis was diagnosed in 4.6%. The primary outcome occurred in 2 of 119 (1.7%; 95% confidence interval [CI], 0.20-5.9) patients with MRDTI negative for DVT and thrombophlebitis, who were not treated with any anticoagulant during follow-up; neither of these recurrences was fatal. The incidence of recurrent VTE in all patients with MRDTI negative for DVT was 1.1% (95% CI, 0.13%-3.8%). The agreement between initial local and post hoc central reading of the MRDTI images was excellent (κ statistic, 0.91). The incidence of VTE recurrence after negative MRDTI was low, and MRDTI proved to be a feasible and reproducible diagnostic test. This trial was registered at www.clinicaltrials.gov as #NCT02262052.
Topics: Adult; Aged; Anticoagulants; Female; Humans; Incidence; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies; Recurrence; Venous Thrombosis
PubMed: 32016390
DOI: 10.1182/blood.2019004114 -
The Journal of Hand Surgery Jul 2022A 54-year-old woman with leukemia presented with coronavirus disease 2019 and a right upper-extremity indwelling peripherally inserted central catheter line for...
A 54-year-old woman with leukemia presented with coronavirus disease 2019 and a right upper-extremity indwelling peripherally inserted central catheter line for chemotherapy administration. On hospital admission day 9, she developed acute right upper-extremity edema and pain. Ultrasound demonstrated complete superficial and deep venous thrombosis up to the proximal subclavian vein. Her examination result was consistent with acute phlegmasia cerulea dolens and compartment syndrome, but respiratory instability prevented transfer and vascular surgery intervention. Instead, we performed bedside fasciotomies and administered therapeutic heparin, and the limb was salvaged. This case underscores the potential for successful limb salvage in patients with phlegmasia in the setting of coronavirus disease 2019 via compartment release and therapeutic anticoagulation.
Topics: COVID-19; Compartment Syndromes; Extremities; Female; Humans; Middle Aged; Sepsis; Thrombophlebitis; Venous Thrombosis
PubMed: 34127316
DOI: 10.1016/j.jhsa.2021.04.028