-
Internal Medicine (Tokyo, Japan) May 2021
Topics: Humans; Leg; Thrombophlebitis
PubMed: 33229811
DOI: 10.2169/internalmedicine.6102-20 -
Frontiers in Immunology 2019Platelets are small anucleate cells present in the blood stream, their typical role in primary hemostasis has been well-described. However, new evidence suggests that... (Review)
Review
Platelets are small anucleate cells present in the blood stream, their typical role in primary hemostasis has been well-described. However, new evidence suggests that they have critically important roles in cancer progression and inflammation. Cancer cells can activate platelets, thus using them as physical shields from blood shear forces and natural killer (NK) cells. The activated platelets may also regulate hematopoietic and immune cell migration toward the tumor site; therefore, contributing to the cancer-associated inflammation. The activation of platelets by cancer cells may also contribute to metastasis and cancer progression by stimulating deep venous thrombosis and neutrophil extracellular trap formations (NETs) that "hide" cancer cells. We strived to review the current literature to dissect the role of platelets in cancer-associated thrombosis and tumor microenvironment inflammation.
Topics: Animals; Blood Platelets; Cell Movement; Extracellular Traps; Humans; Inflammation; Killer Cells, Natural; Neoplasm Metastasis; Neoplasms; Platelet Activation; Tumor Microenvironment; Venous Thrombosis
PubMed: 31417569
DOI: 10.3389/fimmu.2019.01805 -
International Angiology : a Journal of... Aug 2021There remain many questions regarding the pathophysiology and risk factors for endothermal heat induced thrombosis formation. Moreover, there are a paucity of data on... (Review)
Review
There remain many questions regarding the pathophysiology and risk factors for endothermal heat induced thrombosis formation. Moreover, there are a paucity of data on the timing of its occurrence, and there has been no consensus regarding for its treatment. The purpose of this review was to summarize the current knowledge on the pathophysiology, risk factors and treatment strategies for endothermal heat induced thrombosis. The PubMed database was searched from 2001 to present for endothermal heat induced thrombosis, EHIT, deep vein thrombosis, chronic venous insufficiency, varicose veins, endovenous laser and radiofrequency ablation (treatment). All relevant articles identified by the authors mentioning endothermal heat induced thrombosis were included in this review. A multitude of risk factors, several pathophysiological hypotheses and different treatment strategies are described in the literature. Endothermal heat induced thrombosis is marginally understood. There remains a theoretical risk for significant venous thromboembolic complications. With the new uniform classification of EHIT (American Venous Forum), healthcare providers should continue to investigate the nature of this event.
Topics: Catheter Ablation; Hot Temperature; Humans; Laser Therapy; Saphenous Vein; Thrombosis; Treatment Outcome; Varicose Veins; Venous Insufficiency; Venous Thrombosis
PubMed: 34008932
DOI: 10.23736/S0392-9590.21.04667-8 -
Archivos Argentinos de Pediatria Feb 2021In neonatology, more than 90 % of deep vein thromboses are related to catheter use. The objective of this study was to determine the incidence and risk factors...
INTRODUCTION
In neonatology, more than 90 % of deep vein thromboses are related to catheter use. The objective of this study was to determine the incidence and risk factors associated with central venous catheter-related deep vein thrombosis.
POPULATION AND METHODS
Observational and analytical study conducted in a prospective cohort. All central venous catheters were included using consecutive, non-random sampling. The screening protocol included a daily clinical examination and a Doppler ultrasound (7-10 days after insertion and/or 72 h after removal). Follow-up: from catheter insertion to catheter removal, death or patient counter-referral. The incidence density rate per 1000 catheter-days was estimated with its corresponding 95 % confidence intervals (CIs), and risk factors, using Cox multivariate analysis.
RESULTS
Thrombosis was identified in 22/264 catheters. The incidence density rate of thrombosis was 5.33 ‰ catheter-days (95 % CI: 3.34-8.07). Cardiovascular surgery and and the use of central catheters others than peripherally inserted ones, were independent risk factors for thrombosis (hazard ratio: 3.8 [95 % CI: 1.6-9] and 2.75 [95 % CI: 1.17-6.45]).
CONCLUSIONS
The incidence of central venous catheter-related deep vein thrombosis was 5.33 per 1000 catheter-days. A history of cardiovascular surgical procedures and and the use of central catheters others than peripherally inserted ones, were associated with a higher risk of this complication.
Topics: Catheterization, Central Venous; Catheterization, Peripheral; Central Venous Catheters; Humans; Infant; Infant, Newborn; Prospective Studies; Risk Factors; Upper Extremity Deep Vein Thrombosis; Venous Thrombosis
PubMed: 33458978
DOI: 10.5546/aap.2021.eng.32 -
Orthopaedic Surgery Aug 2022Deep venous thrombosis (DVT) has been characterized by a disorder of venous return caused by abnormal blood clotting in deep veins. It often occurs in the lower limbs... (Review)
Review
Deep venous thrombosis (DVT) has been characterized by a disorder of venous return caused by abnormal blood clotting in deep veins. It often occurs in the lower limbs and is a common complication in orthopaedics. Therefore, relevant professional organizations domestic and overseas had formulated and constantly updated relevant guidelines to prevent the occurrence of DVT. According to the management strategy of the guidelines, the incidence of DVT can be significantly reduced. However, due to the variety of fractures types, the guidelines cannot expound precautions and characteristics of DVT for all fracture types at present, and there are other related unresolved problems. For example, there is still a lack of consistent optimal strategies for the management of DVT following isolated lower extremity fractures with a higher incidence. The best anticoagulant strategies for patients with upper limb fractures, pediatric fractures, and those combined with other injuries are rarely described in orthopaedic guidelines, but such fractures are common in clinical orthopaedics. The long-term complications after DVT, such as post-thrombotic syndrome, are not well-understood. In the absence of clear guidance, orthopaedic surgeons often resort to empiric anticoagulation or conservative treatment, so the prevention effects of DVT are inconsistent. The purpose of this review is to summarize the characteristics of DVT events after isolated lower extremity fractures and to discuss the unsolved issues in the guidelines by reviewing the previous literature and tracing the history of DVT discovery, to provide more scientific and comprehensive recommendations for the prediction and prevention of DVT.
Topics: Anticoagulants; Child; Fractures, Bone; Humans; Incidence; Lower Extremity; Retrospective Studies; Risk Factors; Venous Thrombosis
PubMed: 35633091
DOI: 10.1111/os.13306 -
World Neurosurgery Jul 2023Bleeding and thromboembolic complications frequently occur after subarachnoid hemorrhage (SAH) and substantially contribute to poor outcome. Viscoelastic testing could... (Review)
Review
OBJECTIVE
Bleeding and thromboembolic complications frequently occur after subarachnoid hemorrhage (SAH) and substantially contribute to poor outcome. Viscoelastic testing could be used for detection of coagulopathies after SAH. This review summarizes literature on the usefulness of viscoelastic testing to detect coagulopathy in patients with SAH and explores whether viscoelastic parameters are associated with SAH-related complications and clinical outcome.
METHODS
PubMed, Embase, and Google Scholar were systematically searched on August 18, 2022. Two authors independently selected studies that reported viscoelastic testing in patients with SAH and assessed the quality of studies using the Newcastle-Ottawa Scale or a previously reported framework for quality assessment. Data were meta-analyzed if methodologically possible.
RESULTS
The search yielded 19 studies (1160 patients with SAH). Pooling of data including all relevant studies was not possible for any of the outcome measurements because of methodological differences. Thirteen of 19 studies evaluated the association of coagulation profiles and SAH, of which 11 studies showed a hypercoagulable profile. Rebleeding was associated with platelet dysfunction, deep venous thrombosis was associated with faster clot initiation, and both delayed cerebral ischemia and poor outcome were associated with increased clot strength.
CONCLUSIONS
This explorative review shows that patients with SAH frequently have a hypercoagulable profile. Thromboelastography (TEG) and rotational thromboelastometry (ROTEM) parameters are associated with rebleeding, delayed cerebral ischemia, deep venous thrombosis, and poor clinical outcome after SAH; however, more research on the subject is needed. Future studies should focus on determining the optimal time frame and cutoff values for TEG or ROTEM to predict these complications.
Topics: Humans; Subarachnoid Hemorrhage; Blood Coagulation Disorders; Blood Coagulation Tests; Thrombelastography; Thrombophilia; Venous Thrombosis; Brain Ischemia
PubMed: 37004882
DOI: 10.1016/j.wneu.2023.03.108 -
Vascular Health and Risk Management 2022The SARS-CoV-2 disease predisposes infected individuals to thrombosis, the underlying mechanisms of which are not fully understood. The balance between pro-coagulant...
PURPOSE
The SARS-CoV-2 disease predisposes infected individuals to thrombosis, the underlying mechanisms of which are not fully understood. The balance between pro-coagulant factors and natural coagulation inhibitors in critically ill patients with Covid-19 is fundamental to the prevention and treatment of complications. The aim of the present study was to investigate the pulmonary injury patterns in Covid-19 having higher mortality in the presence of deep vein thrombosis in comparison to patients without venous thrombosis and determine the Gamma variant.
METHODS
A retrospective study was conducted involving the evaluation of 200 medical records of patients with Covid-19 and a clinical suspicion of deep vein thrombosis (DVT) at the intensive care unit of a public hospital. The sample was divided into two groups of patients were formed - those positive and those negative for DVT. Statistical analysis involved the use of Fisher's exact test, the paired -test and chi-square test.
RESULTS
Patients with DVT had more severe lung injuries (greater than 70%) compared to those without DVT (p = 0.003). Lesions affecting 50% to 70% of the lung area occurred in little more half of the group with DVT and just under half in the group without DVT (p = 0.5). Pulmonary lesions affecting less than 50% of the lung occurred more in patients without DVT (p = 0.0001). The Gamma variant increased prevalence of the both DVT and mortality (p=0.0001).
CONCLUSION
Deep vein thrombosis is an aggravating factor of mortality in patients with SARS-CoV-2, and the Gamma variant is an aggravating factor of both thrombotic events and mortality.
Topics: Humans; COVID-19; SARS-CoV-2; Lung Injury; Retrospective Studies; Risk Factors; Venous Thrombosis
PubMed: 36353368
DOI: 10.2147/VHRM.S367930 -
Journal of Vascular Surgery. Venous and... May 2021The pandemic of coronavirus disease 2019 (COVID-19) has caused devastating morbidity and mortality worldwide. In particular, thromboembolic complications have emerged as...
OBJECTIVE
The pandemic of coronavirus disease 2019 (COVID-19) has caused devastating morbidity and mortality worldwide. In particular, thromboembolic complications have emerged as a key threat for patients with COVID-19. We assessed our experience with deep vein thrombosis (DVT) in patients with COVID-19.
METHODS
We performed a retrospective analysis of all patients with COVID-19 who had undergone upper or lower extremity venous duplex ultrasonography at an academic health system in New York City from March 3, 2020 to April 12, 2020 with follow-up through May 12, 2020. A cohort of hospitalized patients without COVID-19 (non-COVID-19) who had undergone venous duplex ultrasonography from December 1, 2019 to December 31, 2019 was used for comparison. The primary outcome was DVT. The secondary outcomes included pulmonary embolism, in-hospital mortality, admission to the intensive care unit, and antithrombotic therapy. Multivariable logistic regression was performed to identify the risk factors for DVT and mortality.
RESULTS
Of 443 patients (COVID-19, n = 188; and non-COVID-19, n = 255) who had undergone venous duplex ultrasonography, the COVID-19 cohort had had a greater incidence of DVT (31% vs 19%; P = .005) than had the non-COVID-19 cohort. The incidence of pulmonary embolism was not significantly different statistically between the COVID-19 and non-COVID-19 cohorts (8% vs 4%; P = .105). The DVT location in the COVID-19 group was more often distal (63% vs 29%; P < .001) and bilateral (15% vs 4%; P < .001). The duplex ultrasound findings had a significant impact on the antithrombotic plan; 42 patients (72%) with COVID-19 in the DVT group had their therapy escalated and 49 (38%) and 3 (2%) had their therapy escalated and deescalated in the non-DVT group, respectively (P < .001). Within the COVID-19 cohort, the D-dimer level was significantly greater in the DVT group at admission (2746 ng/mL vs 1481 ng/mL; P = .004) and at the duplex examination (6068 ng/mL vs 3049 ng/mL; P < .01). On multivariable analysis, male sex (odds ratio [OR], 2.27; 95% confidence interval [CI], 1.06-4.87; P = .035), intensive care unit admission (OR, 3.42; 95% CI, 1.02-11.44; P = .046), and extracorporeal membrane oxygenation (OR, 5.5; 95% CI, 1.01-30.13; P = .049) were independently associated with DVT.
CONCLUSIONS
Given the high incidence of venous thromboembolic events in this population, we support the decision to empirically initiate therapeutic anticoagulation for patients with a low bleeding risk and severe COVID-19 infection. Duplex ultrasonography should be reserved for patients with a high clinical suspicion of venous thromboembolism for whom anticoagulation therapy could result in life-threatening consequences. Further study of patients with COVID-19 is warranted to elucidate the etiology of vascular thromboembolic events and guide the prophylactic and therapeutic interventions for these patients.
Topics: Anticoagulants; COVID-19; Chemoprevention; Extracorporeal Membrane Oxygenation; Female; Fibrin Fibrinogen Degradation Products; Humans; Intensive Care Units; Male; Middle Aged; New York City; Outcome and Process Assessment, Health Care; Pulmonary Embolism; Retrospective Studies; Risk Adjustment; SARS-CoV-2; Ultrasonography, Doppler, Duplex; Venous Thrombosis
PubMed: 33039545
DOI: 10.1016/j.jvsv.2020.09.010 -
BMC Medical Informatics and Decision... Nov 2021An increase in the incidence of central venous catheter (CVC)-associated deep venous thrombosis (CADVT) has been reported in pediatric patients over the past decade. At...
BACKGROUND
An increase in the incidence of central venous catheter (CVC)-associated deep venous thrombosis (CADVT) has been reported in pediatric patients over the past decade. At the same time, current screening guidelines for venous thromboembolism risk have low sensitivity for CADVT in hospitalized children. This study utilized a multimodal deep learning model to predict CADVT before it occurs.
METHODS
Children who were admitted to intensive care units (ICUs) between December 2015 and December 2018 and with CVC placement at least 3 days were included. The variables analyzed included demographic characteristics, clinical conditions, laboratory test results, vital signs and medications. A multimodal deep learning (MMDL) model that can handle temporal data using long short-term memory (LSTM) and gated recurrent units (GRUs) was proposed for this prediction task. Four benchmark machine learning models, logistic regression (LR), random forest (RF), gradient boosting decision tree (GBDT) and a published cutting edge MMDL, were used to compare and evaluate the models with a fivefold cross-validation approach. Accuracy, recall, area under the ROC curve (AUC), and average precision (AP) were used to evaluate the discrimination of each model at three time points (24 h, 48 h and 72 h) before CADVT occurred. Brier score and Spiegelhalter's z test were used measure the calibration of these prediction models.
RESULTS
A total of 1830 patients were included in this study, and approximately 15% developed CADVT. In the CADVT prediction task, the model proposed in this paper significantly outperforms both traditional machine learning models and existing multimodal deep learning models at all 3 time points. It achieved 77% accuracy and 90% recall at 24 h before CADVT was discovered. It can be used to accurately predict the occurrence of CADVT 72 h in advance with an accuracy of greater than 75%, a recall of more than 87%, and an AUC value of 0.82.
CONCLUSION
In this study, a machine learning method was successfully established to predict CADVT in advance. These findings demonstrate that artificial intelligence (AI) could provide measures for thromboprophylaxis in a pediatric intensive care setting.
Topics: Anticoagulants; Artificial Intelligence; Central Venous Catheters; Child; Critical Care; Humans; Venous Thromboembolism; Venous Thrombosis
PubMed: 34838025
DOI: 10.1186/s12911-021-01700-w -
Annals of Vascular Surgery Aug 2019The aim of the study was to assess results of interventions for iliocaval obstruction or compression in patient with acute and chronic venous disease.
BACKGROUND
The aim of the study was to assess results of interventions for iliocaval obstruction or compression in patient with acute and chronic venous disease.
METHODS
Patients with chronic venous insufficiency (CVI) C3-C6 (Clinical, Etiology, Anatomy, Pathology - classification of venous insufficiency) and acute deep venous thrombosis were assessed by ultrasound scan, computed tomography, venography, and/or intravascular ultrasound, and if an obstruction in their iliocaval or iliofemoral segments were confirmed, they underwent venoplasty and stenting. Acute deep venous thrombosis cases were treated with pharmacomechanical and/or catheter-directed thrombolysis and residual obstruction was then stented.
RESULTS
One hundred eighteen consecutive limbs were treated between October 2011 and December 2017. Thirty-two limbs had an active ulcer (27%), 27 limbs had healed ulcer or advanced skin changes (23%), 39 limbs had swelling with or without other symptoms of CVI (33%), 15 limbs had acute symptomatic deep venous thrombosis (13%), and the residual 5 iliac vein cases were causing pelvic congestion syndrome (4%). Patency rates of the stents in acute cases were 84.6%, 76.9%, 76.9%, and in chronic cases (combined thrombotic and nonthrombotic) 93.1%, 91%, and 89.9% in 3, 6, and 12 months, respectively. A relief of symptoms was achieved in 81.5 % of limbs at some stage during the first 12 months (most of them within the first 3 months), although at the end of this period only 59.3% remained free of symptoms. There was no limb loss and no mortality within 30 days from the intervention.
CONCLUSIONS
Iliocaval and iliofemoral venoplasty and stenting in both acute and chronic obstruction cases can be performed safely with good patency rates and reasonable improvement of symptoms of CVI.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Chronic Disease; Computed Tomography Angiography; Endovascular Procedures; Femoral Vein; Humans; Iliac Vein; Limb Salvage; Middle Aged; Phlebography; Risk Assessment; Risk Factors; Stents; Thrombolytic Therapy; Time Factors; Treatment Outcome; Vascular Patency; Vena Cava, Inferior; Venous Insufficiency; Venous Thrombosis; Young Adult
PubMed: 30826434
DOI: 10.1016/j.avsg.2018.12.082