scholarly journals P.097 Safety of intrarterial reopro in thrombotic complications during coiling

2016 ◽  
Vol 43 (S2) ◽  
pp. S43-S43
Author(s):  
R Martinez-Perez ◽  
M Boulton ◽  
M Sharma
Keyword(s):  
Cerebral Angiography ◽  
Ruptured Aneurysm ◽  
Thrombotic Complication ◽  
Parent Vessel ◽  
Arterial Infusion ◽  
Routine Work ◽  
Distal Migration ◽  
Thrombotic Complications ◽  
Potential Risks ◽  
Work Up

Background: Abciximab is used for the treatment of thromboembolism occuring during endovascular procedures, however the experience with intra-arterial infusion is limited. The objective is to evaluate its safety and effectiveness during coiling complications. Methods: From an aneurysm coiling database, patients treated with intra-arterial abciximab due to thrombotic complications were selected. Patient were classified either as non-ruptured aneurysm for elective coiling or presenting with subarachnoid hemorrhage. They all had preand post-procedure cerebral angiography performed at our institution as part of routine work-up. Success rate was based on recanalization seen on cerebral angiography. Complications of using abciximab were reported. Results: 35 of 441 coiling patients had a thrombotic complication. 13 of them were treated using intra-arterial infusion of abciximab. 2 patients were male, median age 59. 6 patients presented with sub-arachnoid haemorrhage. 84 % of patients had at least partial recanalization, while 38 % experienced complete recanalization of the parent vessel. 45 % of patients had complications, none severe. 2 patients had aneurysm recanalization, 3 distal migration of thrombus and 1 had haemorrhage (non ruptured aneurysm). Conclusions: Inspite of being considered a safer alternative, use of intrarterial abciximab has potential risks, including hemorrhage, distal thromboembolism and aneurysm recanalization.

scholarly journals In Vitro Reproduction of Device Deformation Leading to Thrombotic Complications and Failure of Flow Diversion

2013 ◽  
Vol 19 (4) ◽  
pp. 432-437 ◽  
Author(s):  
Laurent Estrade ◽  
Alina Makoyeva ◽  
Tim E. Darsaut ◽  
Jimmy Ghostine ◽  
Evgueni Kouznetsov ◽  
...  
Keyword(s):  
Thrombotic Complication ◽  
Parent Vessel ◽  
Landing Zone ◽  
Aneurysm Neck ◽  
Recipient Vessel ◽  
Clinical Consequences ◽  
Thrombotic Complications ◽  
Residual Flows ◽  
The Relationship

Flow diverters (FDs) are increasingly used for complex intracranial aneurysms. As these self-expanding devices are deployed across an aneurysm neck, they can undergo deformations. The potential clinical consequences of FD deformations remain unclear. We describe an immediate thrombotic complication attributed to a stereotypical stenotic deformation of an FD extremity that can occur when landing zones are of insufficient length. This case is supplemented with in vitro studies showing the relationship between i) the length of the landing zones and ii) discrepancies between the diameter of the device and recipient vessel, and the severity of FD stenosis. In vitro, a shorter landing zone was associated with a progressive stenotic deformation of the terminal ends of all FDs studied. This deformation was more pronounced when the diameter of the device was oversized compared to the size of the recipient tube. In our clinical case, the presence of this deformation led to an immediate thrombotic complication, requiring deployment of a second stent to correct the observed stenosis. In addition, treatment failure ultimately led to a fatal rupture, a failure that can be explained by residual flows through a more porous transition zone, another characteristic FD deformation which occurs when they are oversized as compared to the parent vessel, but free to expand at the level of the aneurysm. Proper selection of device diameter and length of the landing zone is important, and may decrease the incidence of deformation-related complications.

scholarly journals Prolonged Thrombin Time in Asymptomatic Patient with Hypo Dysfibrogememia Tucson

2021 ◽  
Vol 4 (2) ◽  
pp. 7-8
Author(s):  
Suresh B Katakkar
Keyword(s):  
Breast Cancer ◽  
Fibrinogen Level ◽  
Asymptomatic Patient ◽  
Normal Serum ◽  
Protein Electrophoresis ◽  
Thrombotic Complication ◽  
Thrombin Time ◽  
History Of ◽  
Thrombotic Complications ◽  
Work Up

A 61 years female patient with known diagnosis of the breast cancer in remission for more than 10 years has Renaud’s disease. During her work up for lupus and lupus anticoagulant which both were negative a prolonged thrombin time was noted which was done by mistake. She has no history of bleeding or thrombosis and last recent surgery was 5 years ago for spinal stenosis and was uncomplicated. Her clinical examination is normal without evidence of any spontaneous bruises but colder hands. The thrombin time was greater than 125 seconds on two different occasions and correction of it by addition of normal plasma was down to 56 seconds and was thus incomplete. Her prothrombin time and PTT were normal and there was no evidence of FDP or D-Dimers. There was no evidence of circulating heparins. The fibrinogen level was normal. The para proteinmia was excluded by normal serum protein electrophoresis and by immunofixation . Thus it is felt that this patient has dysfibrinogenemia or hypo dysfibrinogenemia without bleeding or thrombotic complication. The literature review shows approximately 55% of dysfibrinogenemia patients do not have bleeding or thrombotic complications.

scholarly journals COVID-19 as the cause of thrombosis: recognising COVID-19 infection in apparently asymptomatic patients

2021 ◽  
Vol 14 (1) ◽  
pp. e241027
Author(s):  
Kyle B Varner ◽  
Emily J Cox
Keyword(s):  
Emergency Department ◽  
Direct Result ◽  
Abdominal Ct ◽  
Call To Action ◽  
Asymptomatic Patients ◽  
Pulmonary Manifestations ◽  
Abdominal Ct Scan ◽  
Thrombotic Complications ◽  
Work Up ◽  
Renal Thrombosis

COVID-19 has serious thrombotic complications in critically ill patients; however, thrombus is not a typical presenting symptom. This case report describes a patient with no respiratory symptoms who presented to the emergency department with abdominal pain. The pain was attributed to renal thrombosis, but the patient was found to have no risk factors for thrombotic disease and subsequent hypercoagulable work-up was unremarkable. Pulmonary manifestations of COVID-19 infection were detected incidentally on the abdominal CT scan and confirmed via PCR test. The patient was isolated and went on to develop mild respiratory failure secondary to COVID-19 infection. This case suggests that unexplained thrombus in otherwise asymptomatic patients can be a direct result of COVID-19 infection, and serves as a call to action for emergency department clinicians to treat unexplained thrombotic events as evidence of COVID-19.

scholarly journals Practicability and Diagnostic Yield of One-Stop Stroke CT with Delayed-Phase Cardiac CT in Detecting Major Cardioembolic Sources of Acute Ischemic Stroke

2021 ◽  
Author(s):  
Friederike Austein ◽  
Matthias Eden ◽  
Jakob Engel ◽  
Annett Lebenatus ◽  
Naomi Larsen ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Early Stage ◽  
Recurrent Stroke ◽  
Cardiac Computed Tomography ◽  
Standard Of Care ◽  
Routine Work ◽  
One Stop ◽  
Work Up ◽  
Delayed Phase ◽  
Multimodal Ct

Abstract Purpose Recurrent stroke is considered to increase the incidence of severe disability and death. For correct risk assessment and patient management it is essential to identify the origin of stroke at an early stage. Transthoracic echocardiography (TTE) is the initial standard of care for evaluating patients in whom a cardioembolic source of stroke (CES) is suspected but its diagnostic capability is limited. Transesophageal echocardiography (TEE) is considered as gold standard; however, this approach is time consuming, semi-invasive and not always feasible. We hypothesized that adding a delayed-phase cardiac computed tomography (cCT) to initial multimodal CT might represent a valid alternative to routine clinical echocardiographic work-up. Material and Methods Patients with suspected acute cardioembolic stroke verified by initial multimodal CT and subsequently examined with cCT were included. The cCT was evaluated for presence of major CES and compared to routine clinical echocardiographic work-up. Results In all, 102 patients with suspected acute CES underwent cCT. Among them 60 patients underwent routine work-up with echocardiography (50 TTE and only 10 TEE). By cCT 10/60 (16.7%) major CES were detected but only 4 (6.7%) were identified by echocardiography. All CES observed by echocardiography were also detected by cCT. In 8 of 36 patients in whom echocardiography was not performed cCT also revealed a major CES. Conclusion These preliminary results show the potential diagnostic yield of delayed-phase cCT to detect major CES and therefore could accelerate decision-making to prevent recurrence stroke. To confirm these results larger studies with TEE as the reference standard and also compared to TTE would be necessary.

A Retrospective Propensity Score-Matched Early Thromboembolic Event Analysis of Prothrombin Complex Concentrate vs Fresh Frozen Plasma for Warfarin Reversal Prior to Emergency Neurosurgical Procedures

Neurosurgery ◽  
2017 ◽  
Vol 82 (6) ◽  
pp. 877-886 ◽  
Author(s):  
Prateek Agarwal ◽  
Kalil G Abdullah ◽  
Ashwin G Ramayya ◽  
Nikhil R Nayak ◽  
Timothy H Lucas
Keyword(s):  
Propensity Score ◽  
Intracranial Hemorrhage ◽  
Fresh Frozen Plasma ◽  
Neurosurgical Procedures ◽  
Thrombotic Complication ◽  
Propensity Score Matching Analysis ◽  
Therapeutic Anticoagulation ◽  
Fresh Frozen ◽  
Thrombotic Complications ◽  
Frozen Plasma

AbstractBACKGROUNDReversal of therapeutic anticoagulation prior to emergency neurosurgical procedures is required in the setting of intracranial hemorrhage. Multifactor prothrombin complex concentrate (PCC) promises rapid efficacy but may increase the probability of thrombotic complications compared to fresh frozen plasma (FFP).OBJECTIVETo compare the rate of thrombotic complications in patients treated with PCC or FFP to reverse therapeutic anticoagulation prior to emergency neurosurgical procedures in the setting of intracranial hemorrhage at a level I trauma center.METHODSSixty-three consecutive patients on warfarin therapy presenting with intracranial hemorrhage who received anticoagulation reversal prior to emergency neurosurgical procedures were retrospectively identified between 2007 and 2016. They were divided into 2 cohorts based on reversal agent, either PCC (n = 28) or FFP (n = 35). The thrombotic complications rates within 72 h of reversal were compared using the χ2 test. A multivariate propensity score matching analysis was used to limit the threat to interval validity from selection bias arising from differences in demographics, laboratory values, history, and clinical status.RESULTSThrombotic complications were uncommon in this neurosurgical population, occurring in 1.59% (1/63) of treated patients. There was no significant difference in the thrombotic complication rate between groups, 3.57% (1/28; PCC group) vs 0% (0/35; FFP group). Propensity score matching analysis validated this finding after controlling for any selection bias.CONCLUSIONIn this limited sample, thrombotic complication rates were similar between use of PCC and FFP for anticoagulation reversal in the management of intracranial hemorrhage prior to emergency neurosurgical procedures.

Numbers of host "helper" T cells and proliferating cells predict survival in diffuse small-cell lymphomas.

1989 ◽  
Vol 7 (8) ◽  
pp. 1009-1017 ◽  
Author(s):  
L J Medeiros ◽  
L J Picker ◽  
A B Gelb ◽  
J G Strickler ◽  
S W Brain ◽  
...  
Keyword(s):  
Patient Survival ◽  
T Antigen ◽  
Small Cell ◽  
Proliferating Cells ◽  
Actuarial Survival ◽  
Ki 67 ◽  
Lymphoid Malignancies ◽  
Routine Work ◽  
B Lineage ◽  
Work Up

Diffuse small-cell lymphomas of B-lineage comprise a group of immunophenotypically related lymphoid malignancies that display variable clinical aggressiveness. We compared a variety of clinical, pathologic, and immunologic characteristics of 64 B-lineage diffuse small-cell lymphomas to patient survival in an effort to define prognostically relevant subtypes of these neoplasms. Neither clinical parameters nor histological subclassification correlated with patient outcome. In contrast, three immunologic features of these lymphomas showed a statistically significant relationship with actuarial survival. Neoplasms that manifested greater than or equal to 25% Ki-67+ cells (proliferation-associated antigen), less than 25% Leu 4+ cells (pan-T antigen), or less than 15% Leu 3+ cells (helper/inducer T-subset antigen) were associated with significantly decreased patient survival as compared to neoplasms with the reverse phenotype (P = .02, P = .003, P = .0005, respectively). Leu 3 findings were of particular importance in initial biopsies (P = .0007), while the Ki-67 findings were significant regardless of time of biopsy (P = .01 for biopsies at diagnosis and P = .004 for other biopsies). These data indicate that immunologic analysis can demonstrate subsets of diffuse small-cell lymphoma with different biologic potential, and suggest that such analysis be included in the routine work-up of patients with this type of neoplasm.

scholarly journals Potential risks related to anabolic steroids use on nervous, cardiovascular and reproductive systems disorders in men

2018 ◽  
Vol 31 (3) ◽  
pp. 135-159 ◽  
Author(s):  
Agnieszka Kujawska ◽  
Joanna Androsiuk-Perkowska ◽  
Jakub Husejko ◽  
Marcin Kozuchowski ◽  
Daria Bieniek ◽  
...  
Keyword(s):  
Health Risks ◽  
Anabolic Steroids ◽  
Biochemical Mechanism ◽  
Negative Effects ◽  
Potential Health ◽  
Amateur Sport ◽  
Thrombotic Complications ◽  
Potential Risks ◽  
The Many ◽  
The Relationship

AbstractAnabolic steroids (AS) have been a subject of intensive research for the last several decades. Due to wide use of AS in pharmacological treatment and in professional and amateur sport, it is, hence, worthwhile to describe the biochemical mechanism of the effects of AS usage in humans and its potential health risks. In this work, the relationship between diet and its effect on the level of testosterone in blood is described. Testosterone affects the nervous system, however, there is need for further researches to examine the influence of AS therapy on emotional and cognitive functioning. AS therapy has known negative effects on the cardiovascular system: cardiac hypertrophy can occur, blood pressure can vastly increased, thrombotic complications can come about. These effects are observed not only in patients who are treated with AS, but also in athletes. The paper also describes the relationship between AS and reproductive system diseases. Decreased libido and erectile dysfunction are only some of the many side effects of an incorrect AS treatment.

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