Transverse mobility of pelvic kidney causing left lower extremity deep venous thrombosis

Abstract Background Immune-mediated necrotizing myopathy (IMNM) is characterized by proximal muscle weakness, elvated serum muscle enzyme levels, myopathic electromyography findings, and necrotic muscle fiber with few inflammatory cell infiltration in muscle biopsies. Statins, the first line drug to lower triglyceride and cholesterol level in blood, have been reported to be associated with statins-induced necrotizing autoimmune myopathy (SINAM). Although anti-3-hydroxy-3-methylglutarylcoenzyme-A reductase (anti-HMGCR) myopathy is considered as the leading myopathy related to the statins medication, anti-signal recognition particle (SRP) myopathy were also identified in several cases with statin exposure. The risk of deep venous thrombosis (DVT) is substantially high in individuals with autoimmune inflammatory diseases. But few studies have reported the occurrence and recommendation for treatment of DVT in patients with anti-SRP myopathy. Here, we reported a statin-exposed anti-SRP myopathy individual developed DVT who was successfully treated with catheter-directed thrombolysis (CDT) and systemic anticoagulants therapy. Case presentation A 56-year-old Chinese female came to the outpatient room with gradually progressive bilateral lower-extremity weakness. Magnetic resonance imaging revealed myopathy in bilateral thighs. Serum anti-SRP antibody was positive. She was diagnosed with anti-SRP myopathy. When treated with corticosteroids and immunosuppressants, the patient developed mild edema and pain of left lower extremity. Angiography and ultrasound revealed diffuse venous thrombosis of left lower extremity. Therapy was initiated with CDT and lower molecular weight heparin, then switched to once daily oral rivaroxaban. Meanwhile, steroids combined with tacrolimus were also carried on while simvastatin was discontinued. One month later, patient’s symptoms were resolved and only partial thrombosis in left femoral vein was remained. Conclusion The prevalence of DVT in patient with anti-SRP myopathy was rare. No well-established treatment strategy is available to manage the IMNM and DVT at the same time. The systemic anticoagulants therapy combined CDT can be an effective therapeutic approach to address extensive DVT in patient with anti-SRP myopathy.

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Microparticles as a Predictor of Acute Deep Venous Thrombosis in a Patient with Antiphospholipid Antibody Syndrome.

Blood ◽

10.1182/blood.v110.11.3984.3984 ◽

2007 ◽

Vol 110 (11) ◽

pp. 3984-3984

Author(s):

Erin Cockrell ◽

Ricardo Espinola ◽

Keith R. McCrae

Keyword(s):

Endothelial Cell ◽

Lower Extremity ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Antiphospholipid Antibody ◽

Antiphospholipid Antibody Syndrome ◽

Acute Thrombosis ◽

Left Lower Extremity ◽

Chronic Therapy ◽

Circulating Microparticles

Abstract Microparticles (MP) are cell membrane derived fragments released as a result of apoptosis or cellular activation that may be prothrombotic. Elevated numbers of microparticles may circulate in inflammatory and thrombophilic disorders. Here, we report a patient with Antiphospholipid Antibody Syndrome (APS) in whom increased levels of circulating microparticles preceded the onset of clinically-detectable deep venous thrombosis (DVT). The patient is a 36 year old Hispanic male with previously diagnosed APS (DRVVT ratio 2.6, ACA IgG > 120, and β2GPI IgG >100, IgA 74) complicated by several DVTs and transient ischemic attacks (TIA). Due to thrombosis on warfarin and enoxaparin, he was maintained on chronic therapy with fondaparinux. Microparticle analysis on three separate occasions was performed as part of an ongoing study of MPs in patients with antiphospholipid antibodies (aPL). The first analysis was performed during routine follow-up when the patient was asymptomatic. The second analysis was performed when the patient presented with complaints of left lower extremity tightness. Physical exam was normal, and Doppler ultrasound of the left lower extremity revealed chronic venous changes but no evidence of acute thrombosis. The patient was followed with plans for serial ultrasound examination. However, two days after this visit, the patient presented with acute DVT, confirmed by venous ultrasound. He was treated with five days of intravenous unfractionated heparin followed by reinstitution of fondaparinux. The third MP analysis was performed two weeks after the diagnosis of DVT. Isolation of MP was performed using a modification of previously described methods [Dignat-George et al, Thromb Haemost 91:668, 2004]. Platelet free plasma (PFP) was labeled with monoclonal antibodies for CD 144 and CD 105 (against endothelial cell VE cadherin and endoglin, respectively), and CD 41 (against platelet integrin αIIb) and analyzed by flow cytometry the same day as collection. Results of these analyses, expressed as number of MP/ml of PFP, are listed below. Antibody 2 Months Prior to DVT 2 Days Prior to DVT 2 Weeks After DVT Diagnosis Normal Range CD 144 3650 97704 16128 14815 ± 17714 n=13 CD 105 n/a 352656 24624 5890 ± 8754 n=5 CD 41 2550 42624 18864 1607 ± 2627 n=20 These results demonstrate normal levels of circulating MPs in this APS patient while asymptomatic. However, endothelial cell and platelet MPs increased 20–35 fold prior to the development of venous-ultrasound detectable DVT, and decreased following therapy. While previous reports have documented elevated levels of MP in the setting of established thrombosis, we believe that this is the first description of a serial analysis of microparticles in an APS patient during an asymptomatic period, during incipient thrombosis not otherwise clinically diagnosable, and after treatment of acute DVT. MPs may prove to be a sensitive marker of incipient DVT in patients with negative vascular ultrasound studies.

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Extremely High Incidence of Lower Extremity Deep Venous Thrombosis in 48 Patients With Severe COVID-19 in Wuhan

Circulation ◽

10.1161/circulationaha.120.047407 ◽

2020 ◽

Vol 142 (2) ◽

pp. 181-183 ◽

Cited By ~ 61

Author(s):

Bin Ren ◽

Feifei Yan ◽

Zhouming Deng ◽

Sheng Zhang ◽

Lingfei Xiao ◽

...

Keyword(s):

Lower Extremity ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

High Incidence

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Incidence and risk factors for deep venous thrombosis of lower extremity after surgical treatment of isolated patella fractures

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02240-9 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Zhanchao Tan ◽

Hongzhi Hu ◽

Xiangtian Deng ◽

Jian Zhu ◽

Yanbin Zhu ◽

...

Keyword(s):

Risk Factors ◽

Lower Extremity ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Medical Data ◽

Limited Information ◽

Related Factors ◽

Patella Fractures ◽

Independent Risk Factors ◽

Associated Risk Factors

Abstract Background Limited information exists on the incidence of postoperative deep venous thromboembolism (DVT) in patients with isolated patella fractures. The objective of this study was to investigate the postoperative incidence and locations of deep venous thrombosis (DVT) of the lower extremity in patients who underwent isolated patella fractures and identify the associated risk factors. Methods Medical data of 716 hospitalized patients was collected. The patients had acute isolated patella fractures and were admitted at the 3rd Hospital of Hebei Medical University between January 1, 2016, and February 31, 2019. All patients met the inclusion criteria. Medical data was collected using the inpatient record system, which included the patient demographics, patient’s bad hobbies, comorbidities, past medical history, fracture and surgery-related factors, hematological biomarkers, total hospital stay, and preoperative stay. Doppler examination was conducted for the diagnosis of DVT. Univariate analyses and multivariate logistic regression analyses were used to identify the independent risk factors. Results Among the 716 patients, DVT was confirmed in 29 cases, indicating an incidence of 4.1%. DVT involved bilateral limbs (injured and uninjured) in one patient (3.4%). DVT involved superficial femoral common vein in 1 case (3.4%), popliteal vein in 6 cases (20.7%), posterior tibial vein in 11 cases (37.9%), and peroneal vein in 11 cases (37.9%). The median of the interval between surgery and diagnosis of DVT was 4.0 days (range, 1.0-8.0 days). Six variables were identified to be independent risk factors for DVT which included age category (> 65 years old), OR, 4.44 (1.34-14.71); arrhythmia, OR, 4.41 (1.20-16.15); intra-operative blood loss, OR, 1.01 (1.00-1.02); preoperative stay (delay of each day), OR, 1.43 (1.15-1.78); surgical duration, OR, 1.04 (1.03-1.06); LDL-C (> 3.37 mmol/L), OR, 2.98 (1.14-7.76). Conclusion Incidence of postoperative DVT in patients with isolated patella fractures is substantial. More attentions should be paid on postoperative DVT prophylaxis in patients with isolated patella fractures. Identification of associated risk factors can help clinicians recognize the risk population, assess the risk of DVT, and develop personalized prophylaxis strategies.

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