High Antibody Levels to Prothrombin Imply a Risk of Deep Venous Thrombosis and Pulmonary Embolism in Middle-aged Men

SummaryAntibodies against phospholipid-binding plasma proteins, such as β2-glycoprotein I (β2-GPI) and prothrombin, are associated with thromboembolic events in patients with systemic lupus erythematosus and also in subjects with no evident underlying diseases. We wanted to examine whether increased levels of antibodies to negatively-charged phospholipids (cardiolipin), to phospholipid-binding plasma proteins β2-GPI and prothrombin and to oxidised low-density lipoprotein (LDL) were associated with risk of deep venous thrombosis or pulmonary embolism in subjects with no previous thrombosis. The antibodies were measured in stored serum samples from 265 cases of deep venous thrombosis of the lower extremity or pulmonary embolism occurring during a median follow-up of about 7 years and from 265 individually matched controls. The study subjects were middle-aged men participating in a cancer prevention trial of alpha-tocopherol and beta-carotene and the cases of thromboembolic events were identified from nationwide Hospital Discharge Register.The risk for thrombotic events was significantly increased only in relation to antiprothrombin antibodies. As adjusted for body mass index, number of daily cigarettes and history of chronic bronchitis, myocardial infarction and heart failure at baseline, the odds ratio per one unit of antibody was 6.56 (95% confidence interval 1.73-25.0). The seven highest individual optical density-unit values of antiprothrombin antibodies were all confined to subjects with thromboembolic episodes.In conclusion, the present nested case-control study showed that high autoantibody levels against prothrombin implied a risk of deep venous thrombosis and pulmonary embolism and could be involved in the development of the thrombotic processes.

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Thromboprophylaxis, Delta Sofa and Main Outcomes in Ventilated Patients: an Analysis of the MIMIC-III Clinical Database

10.21203/rs.3.rs-78878/v1 ◽

2020 ◽

Author(s):

Mrigendra Mani Bastola ◽

Craig Locatis ◽

Paul Fontelo

Keyword(s):

Pulmonary Embolism ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Treatment Outcomes ◽

Thromboembolic Events ◽

Clinical Database ◽

Icu Mortality ◽

Icu Admission ◽

Mimic Iii ◽

Ventilated Patients

Abstract Introduction: Critical care patients are at higher risk for thromboembolic disorders. There are limited studies regarding the effect of Heparin, Warfarin, Enoxaparin and Aspirin on ventilated patients, who are likely to both benefit from prophylaxis and suffer from adverse effects of blood thinners. Methods: This study analyzed the MIMIC-III clinical database on 4192 ventilated patients using Statistical Analysis Software (SAS, Version 9.4). Relevant data was systematically analyzed on the thromboprophylaxis agents and their effects on major treatment outcomes. Parameters studied were the length of ventilation, length of Intensive Care Unit (ICU) stays, ICU mortality, inpatient mortality, improvement in SOFA score, and occurrence of major thromboembolic events such as pulmonary embolism (PE) and deep venous thrombosis (DVT). Results: Except Aspirin, all thromboprophylactic agents showed statistically significant reduction on ICU mortality. None of the blood thinners showed statistically significant reduction in occurrences of pulmonary embolism and deep venous thrombosis. Heparin, Warfarin and Enoxaparin had adjusted Odds ratios of 0.59(p<0.01, 0.47-0.77), 0.23(p<0.05, 0.1-0.57) and 0.36(P<0.05, 0.16-0.83) for ICU mortality. Heparin, Warfarin and Enoxaparin had adjusted Odds ratios of 0.51(p<0.01, 0.38-0.68), 0.19(p<0.01, 0.06-0.59) and 0.42(P=0.06, 0.17-1.05) for overall ventilated patient hospital mortality, including after transfers to the inpatient ward.. Only Heparin (P<0.05, OR 1.52(1.07-2.15)) was associated with thrombocytopenia, which required platelet transfusion. None of the drugs showed statistically significant relationships with development of thromboembolic events after thromboprophylaxis. Only Heparin had mild effect on improvement in sequential organ failure assessment (delta SOFA) scores at 7 and 10 day after ICU admission (P<0.05, OR 1.17 (1.03-1.32)). Conclusion: Although the results supported the use of thromboprophylaxis in ventilated patients to improve treatment outcomes and decrease thromboembolic events, no benefits were indicated for using newer blood thinners (Enoxaparin) than older ones (Heparin & Warfarin). Heparin is related to both higher episodes of platelets transfusion and improvement of delta SOFA scores at end of first week of ICU admission. If validated by future research, the findings of this study might help practitioners and researchers to better understand thromboprophylaxis in ventilated patients.

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Deep Venous Thrombosis and Pulmonary Thromboembolism in a Physically Nonprepared Trekker in the Himalayas: An Autopsy Report

International Journal of Medical Toxicology and Forensic Medicine ◽

10.32598/ijmtfm.v11i4.34555 ◽

2021 ◽

Vol 11 (4) ◽

pp. 34555-34555

Author(s):

Senthil Kumar ◽

◽

Y. S. Bansa ◽

Dilip Vaishnav ◽

Lakshmi Narayanan ◽

...

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

High Altitude ◽

Pulmonary Thromboembolism ◽

Thromboembolic Events ◽

Fatal Pulmonary Embolism ◽

Autopsy Findings ◽

Autopsy Report

Deep Venous Thrombosis (DVT) and Subsequent Pulmonary Thromboembolism (PTE) in high altitude climbers is a well-known concept. The acclimatization process at high altitude is itself a thrombogenic event. Accordingly, when a physically nonprepared individual with preexisting thrombogenic risk factors attempts trekking at high altitude, they may end up with fatal thromboembolic events. Here, we report a case of a low-lander with multiple thrombogenic risk factors who developed DVT and PTE when he went for a trekking trip in the Himalayas. The risk factors, autopsy findings, and possible mechanism of developing fatal pulmonary embolism, in this case, are discussed here.

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Thromboprophylaxis, Delta SOFA and Main Outcomes in Ventilated Patients: An Analysis of the MIMIC-III Clinical Database

10.21203/rs.3.rs-121520/v1 ◽

2020 ◽

Author(s):

Mrigendra Bastola ◽

Craig Locatis ◽

Paul Fontelo

Keyword(s):

Pulmonary Embolism ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Treatment Outcomes ◽

Thromboembolic Events ◽

Clinical Database ◽

Icu Mortality ◽

Icu Admission ◽

Mimic Iii ◽

Ventilated Patients

Abstract Introduction: Critical care patients are at higher risk for thromboembolic disorders. There are limited studies regarding the effect of Heparin, Warfarin, Enoxaparin and Aspirin on ventilated patients, who are likely to both benefit from prophylaxis and suffer from adverse effects of blood thinners. Methods: This study analyzed the MIMIC-III clinical database on 4192 ventilated patients using Statistical Analysis Software (V9.4). Relevant data was systematically analyzed on the thromboprophylaxis agents and their effects on major treatment outcomes. Parameters studied were the length of ventilation, length of Intensive Care Unit (ICU) stays, ICU mortality, inpatient mortality, improvement in SOFA score (delta SOFA), and occurrence of major thromboembolic events such as pulmonary embolism (PE) and deep venous thrombosis (DVT). Results: Except Aspirin, all thromboprophylactic agents showed statistically significant reduction on ICU mortality. None of the blood thinners showed statistically significant reduction in occurrences of pulmonary embolism and deep venous thrombosis. The treatment groups did not show any significant difference in their baseline SOFA scores among the included ventilated patients (ANOVA, F=2.26, p=0.06). Heparin, Warfarin, Enoxaparin and Aspirin had adjusted Odds ratios of 0.59(p<0.01, 0.47-0.77), 0.23(p<0.05, 0.1-0.57), 0.36(P<0.05, 0.16-0.83) and 0.75(p=0.15, 0.51-1.1) for ICU mortality. Heparin, Warfarin, Enoxaparin and Aspirin had adjusted Odds ratios of 0.51(p<0.01, 0.38-0.68), 0.19(p<0.01, 0.06-0.59), 0.42(p=0.06, 0.17-1.05) and 0.84(p=0.43, 0.84-0.54) for overall ventilated patient hospital mortality, including after transfers to the inpatient ward. Only Heparin (p<0.05, OR 1.52(1.07-2.15)) was associated with thrombocytopenia episodes, which required platelets transfusion. None showed statistically significant relationships with development of thromboembolic events after thromboprophylaxis. Only Heparin had mild effect on improvement in sequential organ failure assessment (delta SOFA) scores at 7 and 10 day after ICU admission (p<0.05, OR 1.17 (1.03-1.32)). Conclusion: Although the results supported the use of thromboprophylaxis in ventilated patients to improve treatment outcomes, no benefits were indicated for using newer blood thinners (Enoxaparin) than older ones (Heparin & Warfarin). Heparin is related to both higher episodes of platelets transfusion and improvement of delta SOFA scores at end of first week of ICU admission. If validated by future research, the findings of this study might help practitioners and researchers to better understand thromboprophylaxis in ventilated patients.

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Thromboprophylaxis, Delta SOFA and Main Outcomes in Ventilated Patients: An Analysis of the MIMIC-III Clinical Database

10.21203/rs.3.rs-43372/v1 ◽

2020 ◽

Author(s):

Mrigendra M. Bastola ◽

Craig Locatis ◽

Paul Fontelo

Keyword(s):

Pulmonary Embolism ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Treatment Outcomes ◽

Thromboembolic Events ◽

Clinical Database ◽

Odds Ratios ◽

Icu Mortality ◽

Mimic Iii ◽

Ventilated Patients

Abstract Introduction: Critical care patients are at higher risk for thromboembolic disorders. There are limited studies regarding the effect of Heparin, Warfarin, Enoxaparin and Aspirin on ventilated patients, who are likely to both benefit from prophylaxis and suffer from adverse effects of blood thinners. Methods: This study analyzed the MIMIC-III clinical database on 4192 ventilated patients using Statistical Analysis Software (SAS, Version 9.4). Relevant data was systematically analyzed on the thromboprophylaxis agents and their effects on major treatment outcomes. Parameters studied were the length of ventilation, length of Intensive Care Unit (ICU) stays, ICU mortality, inpatient mortality, improvement in SOFA score, and occurrence of major thromboembolic events such as pulmonary embolism (PE) and deep venous thrombosis (DVT). Results: Except Aspirin, all thromboprophylactic agents showed statistically significant reduction on ICU mortality. None of the blood thinners showed statistically significant reduction in occurrences of pulmonary embolism and deep venous thrombosis. Heparin, Warfarin and Enoxaparin had adjusted Odds ratios of 0.59(p<0.01, 0.47-0.77), 0.23(p<0.05, 0.1-0.57) and 0.36(P<0.05, 0.16-0.83) for ICU mortality. Heparin, Warfarin and Enoxaparin had adjusted Odds ratios of 0.51(p<0.01, 0.38-0.68), 0.19(p<0.01, 0.06-0.59) and 0.42(P=0.06, 0.17-1.05) for overall ventilated patient hospital mortality, including after transfers to the inpatient ward.. Only Heparin (P<0.05, OR 1.52(1.07-2.15)) was associated with thrombocytopenia episodes, which required platelets transfusion. None of the drugs showed statistically significant relationships with development of thromboembolic events after thromboprophylaxis. Only Heparin had mild effect on improvement in sequential organ failure assessment (delta SOFA) scores at 7 and 10 day after ICU admission (P<0.05, OR 1.17 (1.03-1.32)). Conclusion: Although the results supported the use of thromboprophylaxis in ventilated patients to improve treatment outcomes and decrease thromboembolic events, no benefits were indicated for using newer blood thinners (Enoxaparin) than older ones (Heparin & Warfarin). The results of this analysis might help practitioners select, maintain, and switch blood thinners in ventilated patients.

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Novel Oral Anticoagulants, A Subject in Continuing Debate

Internal Medicine ◽

10.2478/inmed-2018-0013 ◽

2018 ◽

Vol 15 (2) ◽

pp. 43-52

Author(s):

Maria-Magdalena Leon-Constantin ◽

Alexandra Maștaleru ◽

Ovidiu Mitu ◽

Madalina Zota ◽

Teodor Vasilcu ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Embolism ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Thrombin Inhibitors ◽

Direct Thrombin Inhibitors ◽

Thromboembolic Events ◽

Factor X ◽

Venous Thromboembolic Events ◽

Prevention Of Thromboembolic Events

AbstractCoumarin anticoagulants era (warfarin, acenocumarol) seems to be coming to an end with the launch of the novel anticoagulants like dabigatran, rivaroxaban, apixaban and edoxaban. Dabigatran (Pradaxa) is a prothrombin (factor II) inhibitor that doesn't necessitate monitoring by coagulation tests, doesn't have food or drug interactions, except for P-gp inhibitors. Rivaroxaban (Xarelto) is a direct inhibitor of factor X and is approved for the prevention of thromboembolic events in patients with non-valvular atrial fibrillation and for the prevention of deep venous thrombosis in patients undergoing orthopaedic surgery (hip and knee prosthesis). Apixaban (Eliquis) is a direct inhibitor of factor X and is indicated for the prevention of venous thromboembolic events in patients undergoing hip or knee arthroplasty, the prevention of thromboembolic events in patients with non-valvular atrial fibrillation and treatment or prevention of recurrences in patients with deep vein thrombosis or pulmonary embolism. Edoxaban (Savaysa), recently approved is USA, is a direct inhibitor of factor X and is indicated for deep venous thrombosis, pulmonary embolism and for the prevention of thromboembolic events in patients with non-valvular atrial fibrillation. The most recent studies focus on antidotes specifically designed to bind and neutralise the anticoagulant activity of both direct thrombin inhibitors and direct factor Xa inhibitors. The drugs currently being studied are idarucizumab, a specific antidote, andexanet alfa, a class-specific antidote and ciraparantag, a universal antidote. Of these, only idarucizumab was approved by the FDA.

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Perforation of inferior vena cava during filter placement

VASA ◽

10.1024/0301-1526/a000087 ◽

2011 ◽

Vol 40 (2) ◽

pp. 157-162 ◽

Cited By ~ 6

Author(s):

Piecuch ◽

Wiewiora ◽

Nowowiejska-Wiewiora ◽

Szkodzinski ◽

Polonski

Keyword(s):

Pulmonary Embolism ◽

Inferior Vena Cava ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Inferior Vena ◽

Vena Cava ◽

Retroperitoneal Hematoma ◽

Ivc Filter ◽

Filter Placement ◽

Therapeutic Method

The placement of an inferior vena cava (IVC) filter is a therapeutic method for selected patients with deep venous thrombosis and pulmonary embolism. However, insertion and placement of the filter may be associated with certain complications. For instance, retroperitoneal hematoma resulting from perforation of the wall by the filter is such a very rare but serious complication. We report the case of a 64-year-old woman with perforation of the IVC wall and consecutive hematoma caused by the filter who was treated surgically.

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