-
Thrombosis Research Aug 2020Estrogen, in the clinical setting is used primarily for contraception and hormone replacement therapy. It has been well established that estrogen increases the risk of... (Review)
Review
Estrogen, in the clinical setting is used primarily for contraception and hormone replacement therapy. It has been well established that estrogen increases the risk of both arterial and venous thrombosis. While estrogen is known to induce a prothrombotic milieu through various effects on the hemostatic pathways, the exact molecular mechanism leading to those effects is not known. The most common clinical presentation of estrogen-related thrombosis is venous thromboembolism (VTE) of the deep veins of the legs or pulmonary vessels, usually within the first few months of use. Estrogen has also been associated with increased risk of "unusual site" thromboses, as well as arterial thrombosis. Women at high-risk of thrombosis need careful evaluation and counseling for contraception, pregnancy, menopausal hormonal therapy and other estrogen-related conditions or treatments in order to lower the risk of thromboses. We review the most recent evidence on management of high-estrogen states in women at high-risk of thrombosis, as well as emerging data on unique populations such as transgender women. More studies are needed to better understand the pathophysiology of hormone-related thrombosis, as well as more comprehensive techniques to stratify risks for thrombosis so as to enable tailoring of recommendations for each individual.
Topics: Contraception; Estrogen Replacement Therapy; Estrogens; Female; Humans; Risk Factors; Thrombosis; Venous Thromboembolism; Venous Thrombosis
PubMed: 32450447
DOI: 10.1016/j.thromres.2020.05.008 -
Nature Feb 2008Thrombosis--localized clotting of the blood--can occur in the arterial or the venous circulation and has a major medical impact. Acute arterial thrombosis is the... (Review)
Review
Thrombosis--localized clotting of the blood--can occur in the arterial or the venous circulation and has a major medical impact. Acute arterial thrombosis is the proximal cause of most cases of myocardial infarction (heart attack) and of about 80% of strokes, collectively the most common cause of death in the developed world. Venous thromboembolism is the third leading cause of cardiovascular-associated death. The pathogenic changes that occur in the blood vessel wall and in the blood itself resulting in thrombosis are not fully understood. Understanding these processes is crucial for developing safer and more effective antithrombotic drugs.
Topics: Anticoagulants; Atherosclerosis; Drug-Eluting Stents; Humans; Platelet Aggregation Inhibitors; Thrombosis; Venous Thrombosis
PubMed: 18288180
DOI: 10.1038/nature06797 -
Lancet (London, England) Jul 2009Long-term central venous catheters (CVCs) are important instruments in the care of patients with chronic illnesses, but catheter occlusions and catheter-related... (Review)
Review
Long-term central venous catheters (CVCs) are important instruments in the care of patients with chronic illnesses, but catheter occlusions and catheter-related thromboses are common complications that can result from their use. In this Review, we summarise management of these complications. Mechanical CVC occlusions need cause-specific treatment, whereas thrombotic occlusions usually resolve with thrombolytic treatment, such as alteplase. Prophylaxis with thrombolytic flushes might prevent CVC infections and catheter-related thromboses, but confirmatory studies and cost-effectiveness analysis of this approach are needed. Risk factors for catheter-related thromboses include previous catheter infections, malposition of the catheter tip, and prothrombotic states. Catheter-related thromboses can lead to catheter infection, pulmonary embolism, and post-thrombotic syndrome. Catheter-related thromboses are usually diagnosed by Doppler ultrasonography or venography and treated with anticoagulation therapy for 6 weeks to a year, dependent on the extent of the thrombus, response to initial therapy, and whether thrombophilic factors persist. Prevention of catheter-related thromboses includes proper positioning of the CVC and prevention of infections; anticoagulation prophylaxis is not currently recommended.
Topics: Algorithms; Anticoagulants; Biomechanical Phenomena; Catheterization, Central Venous; Catheters, Indwelling; Clinical Protocols; Decision Trees; Equipment Failure; Fibrinolytic Agents; Humans; Phlebography; Practice Guidelines as Topic; Primary Prevention; Risk Factors; Therapeutic Irrigation; Thrombosis; Ultrasonography, Doppler
PubMed: 19595350
DOI: 10.1016/S0140-6736(09)60220-8 -
Journal of Thrombosis and Haemostasis :... Oct 2018
Topics: Biomedical Research; Editorial Policies; Hemostasis; Humans; Journal Impact Factor; Periodicals as Topic; Thrombosis
PubMed: 30288947
DOI: 10.1111/jth.14285 -
Hamostaseologie Dec 2023
Topics: Humans; Cardiovascular Diseases; Thrombosis
PubMed: 38096835
DOI: 10.1055/a-2031-8165 -
Journal of Thrombosis and Haemostasis :... Dec 2018
Topics: Biomedical Research; Editorial Policies; Hemostasis; Humans; Periodicals as Topic; Thrombosis
PubMed: 30506644
DOI: 10.1111/jth.14326 -
Critical Care Medicine Jan 2022Vaccine-induced immune thrombotic thrombocytopenia is an unexpected consequence of the coronavirus disease 2019 pandemic era. We reviewed the pathogenesis, clinical...
OBJECTIVES
Vaccine-induced immune thrombotic thrombocytopenia is an unexpected consequence of the coronavirus disease 2019 pandemic era. We reviewed the pathogenesis, clinical presentation, diagnosis, and treatment of this rare side effect.
DATA SOURCES
Online search of published medical literature through PubMed, Scopus, Web of Science, and Google Scholar using the terms "COVID-19," "vaccine," "thrombosis" was performed.
STUDY SELECTION
Articles were chosen for inclusion based on their relevance to coronavirus disease 2019, vaccine, and thrombosis.
DATA SYNTHESIS
Vaccine-induced immune thrombotic thrombocytopenia manifests most often as unusual thromboses (cerebral venous sinus thrombosis, splanchnic vein thrombosis) but sometimes also "usual" thromboses (arterial stroke, pulmonary embolism, deep-vein thrombosis), with oftentimes severe thrombocytopenia, that becomes clinically evident 5-30 days after adenovirus-vectored coronavirus disease 2019 vaccine administration. Most patients have disseminated intravascular coagulation. These features are the result of vaccine-triggered formation of anti-platelet factor 4 immunoglobulin G that activate platelets, clinically mimicking autoimmune heparin-induced thrombocytopenia. Early recognition based on thrombosis (sometimes, hemorrhage), thrombocytopenia, and d-dimer elevation within the day 5-30 postvaccine "window" is important given treatment with high-dose IV immunoglobulin plus nonheparin anticoagulation.
CONCLUSIONS
Vaccine-induced immune thrombotic thrombocytopenia is a serious complication of vaccination that is not feasible to anticipate or prevent. When the patient presents with sustained headache, neurologic symptoms/signs, abdominal pain, dyspnea, or limb pain/swelling beginning 5-30 days post vaccination, platelet count and d-dimer must be measured, and imaging for thrombosis performed. Confirmation of vaccine-induced immune thrombotic thrombocytopenia diagnosis should be ordered (platelet factor 4/polyanion enzyme-linked immunosorbent assay; platelet factor 4-enhanced platelet activation testing) as treatment is initiated (nonheparin anticoagulation, IV immunoglobulin).
Topics: Age Factors; COVID-19; COVID-19 Vaccines; Enzyme-Linked Immunosorbent Assay; Humans; SARS-CoV-2; Sex Factors; Thrombocytopenia; Thrombosis
PubMed: 34259661
DOI: 10.1097/CCM.0000000000005211 -
Blood Jul 2022Infection with the SARS-CoV-2 virus, resulting in COVID-19 disease, has presented a unique scenario associated with high rates of thrombosis. The risk of venous...
Infection with the SARS-CoV-2 virus, resulting in COVID-19 disease, has presented a unique scenario associated with high rates of thrombosis. The risk of venous thrombosis is some three- to sixfold higher than for patients admitted to a hospital for other indications, and for patients who have thrombosis, mortality appears to increase. Thrombosis may be a presenting feature of COVID-19. Pulmonary thrombi are the most frequent events, some related to deep vein thrombosis, but also to in situ microvascular and macrovascular thrombosis. Other venous thromboses include catheter- and circuit-associated in patients requiring hemofiltration and extracorporeal membrane oxygenation. Arterial thrombosis is less commonly documented, with 3% of patients in intensive care units having major arterial strokes and up to 9% having myocardial infarction, both of which are most likely multifactorial. Risk factors for thrombosis above those already documented in hospital settings include duration of COVID-19 symptoms before admission to the hospital. Laboratory parameters associated with higher risk of thrombosis include higher D-dimer, low fibrinogen, and low lymphocyte count, with higher factor VIII and von Willebrand factor levels indicative of more severe COVID-19 infection. All patients should receive thromboprophylaxis when admitted with COVID-19 infection, but the dose and length of treatment are still debated. Thrombosis continues to be treated according to standard VTE guidelines, but adjustments may be needed depending on other factors relevant to the patient's admission.
Topics: Anticoagulants; COVID-19; Hemorrhage; Humans; SARS-CoV-2; Thrombosis; Venous Thromboembolism; Venous Thrombosis
PubMed: 35452509
DOI: 10.1182/blood.2021012247 -
Hamostaseologie Feb 2024
Topics: Humans; Purpura, Thrombocytopenic, Idiopathic; Thrombocytopenia; Thrombosis
PubMed: 38417798
DOI: 10.1055/s-0044-1782593 -
CMAJ : Canadian Medical Association... Aug 2021
Topics: Adolescent; Cavernous Sinus; Humans; Male; Sphenoid Sinusitis; Thrombosis
PubMed: 34400491
DOI: 10.1503/cmaj.201317-f