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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 -
Journal of Vascular Surgery May 1996Pharmacologic lysis or balloon thrombectomy are options to treat acute arterial thrombosis; however, little is known about their effects on functional changes in the... (Comparative Study)
Comparative Study
PURPOSE
Pharmacologic lysis or balloon thrombectomy are options to treat acute arterial thrombosis; however, little is known about their effects on functional changes in the arterial wall. The aim of this study was to determine function of the endothelium and smooth muscle in canine arteries revascularized after acute thrombosis with balloon thrombectomy or lytic therapy.
METHODS
Acute thrombosis was obtained by bilateral proximal and distal ligation of 8-cm. segments of the femoral arteries in dogs. After 24 hours, the ties were removed and the arteries randomized to treatment groups: group 1, balloon thrombectomy (# 4 Fogarty balloon catheter at 60 grams linear shear x 1 pass, n = 7); group 2, untreated, tie removal only (n = 6); group 3, regional intra-arterial urokinase infusion (4000 U/min x 90 min, n = 6); group 4, regional intra-arterial carrier infusion (0.43 ml/min x 90 min, n = 6); group 5, unoperated normal vessels (n = 5). After treatment, the arteries were removed and endothelial and smooth muscle responses examined in organ chambers. Endothelial loss was graded with light microscopy of vessel rings from each animal by an observer blinded to the treatment group. Findings were confirmed with scanning electron microscopy.
RESULTS
Treatment with urokinase did not alter endothelium-dependent relaxations or smooth muscle contractions compared with carrier infusion or untreated alone. Balloon catheter thrombectomy significantly reduced endothelium-dependent relaxations compared with all other groups in response to acetylcholine, bradykinin, and thrombin (p < 0.001). Contractions of smooth muscle in response to potassium chloride (60 mol/L) and phenylephrine (1 x 10-6 mol/L) were also reduced (p < 0.05). Rings from balloon thrombectomized arteries contracted in response to calcium ionophore A23187 (p < 0.001); these contractions were endothelium dependent and not reduced by indomethacin or blockade of endothelin A and B receptors. No significant differences in percentage of endothelial coverage between groups were assessed by light and electron microscopy.
CONCLUSION
Thrombolysis with urokinase caused no or minimal abnormalities in endothelial and smooth muscle function. Endothelium present after balloon thrombectomy produces contractile factors. Although the duration and recovery of these abnormalities in function are unknown, these findings support preferential use of urokinase over balloon thrombectomy when possible in acute arterial thrombosis or embolism.
Topics: Acute Disease; Animals; Catheterization; Dogs; Endothelium, Vascular; Femoral Artery; Male; Muscle Contraction; Muscle, Smooth, Vascular; Plasminogen Activators; Thrombectomy; Thrombolytic Therapy; Thrombosis; Urokinase-Type Plasminogen Activator
PubMed: 8667507
DOI: 10.1016/s0741-5214(96)70248-3 -
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 -
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 -
The Turkish Journal of Gastroenterology... Dec 2019
Topics: Arteries; Crohn Disease; Heart Diseases; Humans; Male; Thrombosis; Veins; Young Adult
PubMed: 31854315
DOI: 10.5152/tjg.2019.19323 -
Blood Jan 2020Patients with Philadelphia-negative myeloproliferative neoplasm (MPN) are prone to the development of second cancers, but the factors associated with these events have...
Patients with Philadelphia-negative myeloproliferative neoplasm (MPN) are prone to the development of second cancers, but the factors associated with these events have been poorly explored. In an international nested case-control study, we recruited 647 patients with carcinoma, nonmelanoma skin cancer, hematological second cancer, and melanoma diagnosed concurrently or after MPN diagnosis. Up to 3 control patients without a history of cancer and matched with each case for center, sex, age at MPN diagnosis, date of diagnosis, and MPN disease duration were included (n = 1234). Cases were comparable to controls for MPN type, driver mutations and cardiovascular risk factors. The frequency of thrombosis preceding MPN was similar for cases and controls (P = .462). Thrombotic events after MPN and before second cancer were higher in cases than in controls (11.6% vs 8.1%; P = .013), because of a higher proportion of arterial thromboses (6.2% vs 3.7%; P = .015). After adjustment for confounders, the occurrence of arterial thrombosis remained independently associated with the risk of carcinoma (odds ratio, 1.97; 95% confidence interval, 1.14-3.41), suggesting that MPN patients experiencing arterial events after MPN diagnosis deserve careful clinical surveillance for early detection of carcinoma. This study was registered at www.clinicaltrials.gov as NCT03745378.
Topics: Arteries; Case-Control Studies; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Multivariate Analysis; Myeloproliferative Disorders; Neoplasms, Second Primary; Philadelphia Chromosome; Thrombosis
PubMed: 31869407
DOI: 10.1182/blood.2019002614 -
International Journal of Molecular... Jul 2020Platelets are major players in the occurrence of cardiovascular diseases. Auraptene is the most abundant coumarin derivative from plants, and it has been demonstrated to...
Platelets are major players in the occurrence of cardiovascular diseases. Auraptene is the most abundant coumarin derivative from plants, and it has been demonstrated to possess a potent capacity to inhibit platelet activation. Although platelets are anucleated cells, they also express the transcription factor, nuclear factor-κB (NF-κB), that may exert non-genomic functions in platelet activation. In the current study, we further investigated the inhibitory roles of auraptene in NF-κB-mediated signal events in platelets. MG-132 (an inhibitor of proteasome) and BAY11-7082 (an inhibitor of IκB kinase; IKK), obviously inhibited platelet aggregation; however, BAY11-7082 exhibited more potent activity than MG-132 in this reaction. The existence of NF-κB (p65) in platelets was observed by confocal microscopy, and auraptene attenuated NF-κB activation such as IκBα and p65 phosphorylation and reversed IκBα degradation in collagen-activated platelets. To investigate cellular signaling events between PLCγ2-PKC and NF-κB, we found that BAY11-7082 abolished PLCγ2-PKC activation; nevertheless, neither U73122 nor Ro31-8220 had effect on NF-κB activation. Furthermore, both auraptene and BAY11-7082 significantly diminished HO• formation in activated platelets. For in vivo study, auraptene prolonged the occlusion time of platelet plug in mice. In conclusion, we propose a novel inhibitory pathway of NF-κB-mediated PLCγ2-PKC activation by auraptene in human platelets, and further supported that auraptene possesses potent activity for thromboembolic diseases.
Topics: Animals; Arteries; Blood Platelets; Coumarins; Humans; I-kappa B Kinase; Mice; NF-kappa B; Phospholipase C gamma; Phosphorylation; Platelet Activation; Platelet Aggregation; Protein Kinase C; Signal Transduction; Thrombosis
PubMed: 32646046
DOI: 10.3390/ijms21134810 -
Journal of Thrombosis and Haemostasis :... May 2013High von Willebrand factor (VWF) levels are an established risk factor for arterial thrombosis, including coronary heart disease and ischemic stroke. It has been...
BACKGROUND
High von Willebrand factor (VWF) levels are an established risk factor for arterial thrombosis, including coronary heart disease and ischemic stroke. It has been hypothesized that von Willebrand disease (VWD) patients are protected against arterial thrombosis; however, this has never been confirmed in clinical studies.
OBJECTIVES
To investigate the prevalence of arterial thrombosis in VWD patients relative to the general population.
PATIENTS/METHODS
We included 635 adult patients with VWF levels ≤ 30 U dL(-1) , aged 16-85 years, from the nationwide cross-sectional 'Willebrand in the Netherlands' (WiN) study and compared the prevalence of arterial thrombosis with two reference populations from the general Dutch population adjusted for age and sex as standardized morbidity ratios (SMRs).
RESULTS
Twenty-nine arterial thrombotic events occurred in 21 patients (3.3%). Five patients suffered an acute myocardial infarction and three an ischemic stroke. Unstable angina pectoris was recorded 12 times, transient ischemic attack nine. The prevalence of all arterial thrombotic events combined (acute myocardial infarction, ischemic stroke and coronary heart disease) was 39% and 63% lower than in the two reference populations. The prevalence of cardiovascular disease in VWD was lower than in the general population, SMR 0.60 (95% CI, 0.32-0.98) for coronary heart disease and SMR 0.40 (95% CI, 0.13-0.83) for acute myocardial infarction. For ischemic stroke the prevalence was 35-67% lower compared with two reference populations, SMR 0.65 (95% CI, 0.12-1.59) and 0.33 (95% CI, 0.06-0.80), respectively.
CONCLUSIONS
This is the first study showing that VWD patients have a reduced prevalence of arterial thrombosis and provides important insights into the role of VWF in the pathogenesis of arterial thrombosis.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Arteries; Female; Humans; Male; Middle Aged; Prevalence; Risk Factors; Thrombosis; Young Adult; von Willebrand Diseases
PubMed: 23506463
DOI: 10.1111/jth.12194