scholarly journals The Impact of SARS-CoV-2 Infection on Blood Coagulation and Fibrinolytic Pathways: A Review of Prothrombotic Changes Caused by COVID-19

2021 ◽  
Author(s):  
Mehran Bahraini ◽  
Akbar Dorgalaleh
Keyword(s):  
Current Knowledge ◽  
Severe Disease ◽  
Medical Personnel ◽  
Narrative Review ◽  
Clotting Factors ◽  
Local Inflammatory Response ◽  
Vein Thrombosis ◽  
Thrombotic Complications ◽  
Deep Vein ◽  
The Impact

AbstractThe cardinal pathology of coronavirus disease 2019 (COVID-19) is a primary infection of pulmonary tract cells by severe acute respiratory syndrome coronavirus 2, provoking a local inflammatory response, often accompanied by cytokine storm and acute respiratory distress syndrome, especially in patients with severe disease. Systemic propagation of the disease may associate with thrombotic events, including deep vein thrombosis, pulmonary embolism, and thrombotic microangiopathy, which are important causes of morbidity and mortality in patients with COVID-19. This narrative review describes current knowledge of the pathophysiological mechanisms of COVID-19-associated coagulopathy, with focus on prothrombotic changes in hemostatic mediators, including plasma levels of clotting factors, natural anticoagulants, components of fibrinolytic system, and platelets. It will also highlight the central role of endothelial cells in COVID-19-associated coagulopathy. This narrative review discusses also potential therapeutic strategies for managing thrombotic complications. Awareness by medical experts of contributors to the pathogenesis of thrombotic events in COVID-19 is imperative to develop therapeutics not limited to regular anticoagulants. Instituting cooperation among medical personnel and researchers may lessen this novel virus' impact now, and in the event of recurrence.

scholarly journals Transcriptomic Profiling of Femoral Veins in Deep Vein Thrombosis in a Porcine Model

Cells ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 1576
Author(s):  
Leszek Gromadziński ◽  
Łukasz Paukszto ◽  
Agnieszka Skowrońska ◽  
Piotr Holak ◽  
Michał Smoliński ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Porcine Model ◽  
Femoral Vein ◽  
Severe Disease ◽  
Control Group ◽  
Global Changes ◽  
High Morbidity ◽  
Clotting Factors ◽  
Vein Thrombosis ◽  
Deep Vein

Deep vein thrombosis (DVT) is a severe disease affecting the human venous system, accompanied by high morbidity and mortality rates caused by early and late complications. The study aimed at analyzing the changes in the transcriptome of the femoral vein caused by DVT in the porcine model based on the formation of the thrombus in vivo. The study was performed on 11 castrated male pigs: a thrombus was formed in each left femoral vein in six animals; the remaining five served as a control group. Total RNA was isolated from the left femoral veins of the experimental and control animals. High-throughput RNA sequencing was used to analyze the global changes in the transcriptome of veins with induced DVT. Applied multistep bioinformatics revealed 1474 differentially expressed genes (DEGs): 1019 upregulated and 455 downregulated. Functional Gene Ontology annotated 1220 of DEGs into 225 biological processes, 30 molecular functions and 40 cellular components categories. KEGG analysis disclosed TNF, NF-κB and apoptosis pathways’ overexpression in DVT samples. A thorough analysis of the detected DEGs indicated that a dysregulated inflammatory response and disturbed balance between clotting and anti-clotting factors play a crucial role in the process of DVT.

scholarly journals Splanchnic Vein Thrombosis in Acute Pancreatitis and Its Consequences

2021 ◽  
Vol 27 ◽  
pp. 107602962110102
Author(s):  
Łukasz Nawacki ◽  
Jarosław Matykiewicz ◽  
Ewa Stochmal ◽  
Stanisław Głuszek
Keyword(s):  
Acute Pancreatitis ◽  
Severe Disease ◽  
Vascular Complication ◽  
Strong Positive Correlation ◽  
Splanchnic Vein Thrombosis ◽  
Vein Thrombosis ◽  
Computed Tomography Scans ◽  
Negative Effect ◽  
Medical Histories ◽  
The Impact

Splanchnic vein thrombosis (SVT) is a serious vascular complication that can occur in patients with acute pancreatitis. We assessed the incidence of SVT and its relationship with acute pancreatitis (AP) and associated complications. We carried out a retrospective analysis of medical histories from patients hospitalized with AP in a single surgical center. Histories were acquired from patients with abdominal and pelvic computed tomography scans performed between the 2nd and 3rd day of hospitalization. We assessed the impact and extent of thrombosis over the disease course. We found a strong positive correlation (Cramer’s V coefficient = 0.34) between SVT and disease severity. Mortality in the study group was 7.2% (8 patients) of which 5 patients (62.5%) were diagnosed with SVT. We observed an increased incidence of death among patients with thrombosis, with results approaching significance ( P = 0.056). In our study, we found that SVT has a negative effect on the course of AP and is associated with more severe disease and increased mortality.

Performance of the Wells score in predicting deep vein thrombosis in medical and surgical hospitalized patients with or without thromboprophylaxis: The R-WITT study

2021 ◽  
pp. 1358863X2199467
Author(s):  
Jean-Eudes Trihan ◽  
Michael Adam ◽  
Sara Jidal ◽  
Isabelle Aichoun ◽  
Sarah Coudray ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Risk Stratification ◽  
Hospitalized Patients ◽  
Operating Characteristics ◽  
Vein Thrombosis ◽  
Ultrasound Study ◽  
Wells Score ◽  
Deep Vein ◽  
The Impact ◽  
Test Probability

The Wells score had shown weak performance to determine pre-test probability of deep vein thrombosis (DVT) for inpatients. So, we evaluated the impact of thromboprophylaxis on the utility of the Wells score for risk stratification of inpatients with suspected DVT. This bicentric cross-sectional study from February 1, 2018 to January 31, 2019 included consecutive medical and surgical inpatients who underwent lower limb ultrasound study for suspected DVT. Wells score clinical predictors were assessed by both ordering and vascular physicians within 24 h after clinical suspicion of DVT. Primary outcome was the Wells score’s accuracy for pre-test risk stratification of suspected DVT, accounting for anticoagulation (AC) treatment (thromboprophylaxis for ⩾ 72 hours or long-term anticoagulation). We compared prevalence of proximal DVT among the low, moderate and high pre-test probability groups. The discrimination accuracy was defined as area under the receiver operating characteristics (ROC) curve. Of the 415 included patients, 30 (7.2%) had proximal DVT. Prevalence of proximal DVT was lower than expected in all pre-test probability groups. The prevalence in low, moderate and high pre-test probability groups was 0.0%, 3.1% and 8.2% ( p = 0.22) and 1.7%, 4.2% and 25.8% ( p < 0.001) for inpatients with or without AC, respectively. Area under ROC curves for discriminatory accuracy of the Wells score, for risk of proximal DVT with or without AC, was 0.72 and 0.88, respectively. The Wells score performed poorly for discrimination of risk for proximal DVT in hospitalized patients with AC but performed reasonably well among patients without AC; and showed low inter-rater reliability between physicians. ClinicalTrials.gov Identifier: NCT03784937.

The Future of Phlebology in Europe

2014 ◽  
Vol 29 (1_suppl) ◽  
pp. 181-185 ◽  
Author(s):  
Brahman Dharmarajah ◽  
Tristan RA Lane ◽  
Hayley M Moore ◽  
HA Martino Neumann ◽  
Eberhard Rabe ◽  
...  
Keyword(s):  
Cost Effective ◽  
Research Strategy ◽  
Clinical Severity ◽  
Venous Disease ◽  
Vein Thrombosis ◽  
Venous Diseases ◽  
Thrombus Removal ◽  
Deep Vein ◽  
The Impact

Background Worldwide superficial and deep venous diseases are common and associated with significant individual and socioeconomic morbidity. Increasing burden of venous disease requires Phlebology to define itself as an independent specialty representing not only patients but the multidisciplinary physicians involved in venous care. Methods & Results In this article the scope of venous disease in Europe and subsequent future governance for treatment in the region is discussed. Superficial venous disease is common with 26.9-68.6% of European populations reported to have C2-C6 disease according to the CEAP (Clinical severity, Aetiology, Anatomy and Pathophysiology) scoring system. However, a significant disparity is observed in the treatment of superficial venous disease across Europe. Post thrombotic syndrome (PTS) after deep vein thrombosis (DVT) contributes to the increasing burden of deep venous disease. Aggressive thrombus removal for acute ileofemoral DVT provides a cost-effective 14.4% risk reduction in the development of PTS. Additionally, deep venous lesions requiring endovascular intervention are being increasingly performed to prevent recurrent thrombosis. The European College of Phlebology (ECoP) has been formed to provide a responsible body for the care of the European patient with venous disease. The role of the ECoP includes unifying European member states through standardised guideline production, identification of research strategy and provision of training and accreditation of physicians. Conclusion Creation of a European venous disease specific speciality will provide a patient centred approach through understanding of the impact of disease in the region and delivery of high quality diagnostics and treatment from an appropriately certified Phlebologist.

Anticoagulation Options

2015 ◽  
pp. 253-277
Author(s):  
Michael Mazzeffi ◽  
Ashleigh Lowery
Keyword(s):  
Cardiac Surgery ◽  
Ventricular Assist Devices ◽  
Therapeutic Drug ◽  
Thrombosis Prophylaxis ◽  
Clotting Factors ◽  
Ventricular Assist ◽  
Vein Thrombosis ◽  
Deep Vein Thrombosis Prophylaxis ◽  
Cardiac Valve Replacement ◽  
Deep Vein

There are multiple indications for anticoagulation in the cardiac surgery intensive care unit including cardiac valve replacement, mechanical circulatory pumps (ECMO and ventricular assist devices), deep vein thrombosis prophylaxis, treatment of heparin-induced thrombocytopenia, and treatment of other thrombotic conditions including pulmonary embolism. Anticoagulant medications broadly fall into two categories: antiplatelet drugs and inhibitors of protein clotting factors. In this chapter we will review anticoagulant medications, therapeutic drug monitoring, common indications for anticoagulation, and the risks associated with anticoagulation after cardiac surgery.

scholarly journals Use of Electronic Health Record Simulation to Understand the Accuracy of Intern Progress Notes

2016 ◽  
Vol 8 (2) ◽  
pp. 237-240 ◽  
Author(s):  
Christopher A. March ◽  
Gretchen Scholl ◽  
Renee K. Dversdal ◽  
Matthew Richards ◽  
Leah M. Wilson ◽  
...  
Keyword(s):  
Thrombosis Prophylaxis ◽  
Medical Problems ◽  
Vein Thrombosis ◽  
Patterns Of Use ◽  
Progress Notes ◽  
Deep Vein Thrombosis Prophylaxis ◽  
Electronic Health ◽  
Deep Vein ◽  
The Impact

ABSTRACT  With the widespread adoption of electronic health records (EHRs), there is a growing awareness of problems in EHR training for new users and subsequent problems with the quality of information present in EHR-generated progress notes. By standardizing the case, simulation allows for the discovery of EHR patterns of use as well as a modality to aid in EHR training.Background  To develop a high-fidelity EHR training exercise for internal medicine interns to understand patterns of EHR utilization in the generation of daily progress notes.Objective  Three months after beginning their internship, 32 interns participated in an EHR simulation designed to assess patterns in note writing and generation. Each intern was given a simulated chart and instructed to create a daily progress note. Notes were graded for use of copy-paste, macros, and accuracy of presented data.Methods  A total of 31 out of 32 interns (97%) completed the exercise. There was wide variance in use of macros to populate data, with multiple macro types used for the same data category. Three-quarters of notes contained either copy-paste elements or the elimination of active medical problems from the prior days' notes. This was associated with a significant number of quality issues, including failure to recognize a lack of deep vein thrombosis prophylaxis, medications stopped on admission, and issues in prior discharge summary.Results  Interns displayed wide variation in the process of creating progress notes. Additional studies are being conducted to determine the impact EHR-based simulation has on standardization of note content.Conclusions

scholarly journals Incidence of Upper Extremity Deep Vein Thrombosis in Acute Leukemia and Effect on Mortality

TH Open ◽  
2020 ◽  
Vol 04 (04) ◽  
pp. e309-e317
Author(s):  
Christina Poh ◽  
Ann Brunson ◽  
Theresa Keegan ◽  
Ted Wun ◽  
Anjlee Mahajan
Keyword(s):  
Deep Vein Thrombosis ◽  
Acute Leukemia ◽  
Upper Extremity ◽  
Lymphoblastic Leukemia ◽  
Cox Proportional Hazards ◽  
High Risk Population ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
Deep Vein ◽  
The Impact

AbstractThe cumulative incidence, risk factors, rate of subsequent venous thromboembolism (VTE) and bleeding and impact on mortality of isolated upper extremity deep vein thrombosis (UE DVT) in acute leukemia are not well-described. The California Cancer Registry, used to identify treated patients with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) diagnosed between 2009 and 2014, was linked with the statewide hospitalization database to determine cumulative incidences of UE DVT and subsequent VTE and bleeding after UE DVT diagnosis. Cox proportional hazards regression models were used to assess the association of UE DVT on the risk of subsequent pulmonary embolism (PE) or lower extremity deep vein thrombosis (LE DVT) and subsequent bleeding, and the impact of UE DVT on mortality. There were 5,072 patients identified: 3,252 had AML and 1,820 had ALL. Three- and 12-month cumulative incidences of UE DVT were 4.8% (95% confidence interval [CI]: 4.1–5.6) and 6.6% (95% CI: 5.8–7.5) for AML and 4.1% (95% CI: 3.2–5.1) and 5.9% (95% CI: 4.9–7.1) for ALL, respectively. Twelve-month cumulative incidences of subsequent VTE after an incident UE DVT diagnosis were 5.3% for AML and 12.2% for ALL. Twelve-month cumulative incidences of subsequent bleeding after an incident UE DVT diagnosis were 15.4% for AML and 21.1% for ALL. UE DVT was associated with an increased risk of subsequent bleeding for both AML (hazard ratio [HR]: 2.07; 95% CI: 1.60–2.68) and ALL (HR: 1.62; 95% CI: 1.02–2.57) but was not an independent risk factor for subsequent PE or LE DVT for either leukemia subtype. Isolated incident UE DVT was associated with increased leukemia-specific mortality for AML (HR: 1.42; 95% CI: 1.16–1.73) and ALL (HR: 1.80; 95% CI: 1.31–2.47). UE DVT is a relatively common complication among patients with AML and ALL and has a significant impact on bleeding and mortality. Further research is needed to determine appropriate therapy for this high-risk population.

The Impact of Body Mass Index on Lower Extremity Duplex Ultrasonography for Deep Vein Thrombosis Diagnosis

2015 ◽  
Vol 29 (6) ◽  
pp. 1136-1140 ◽  
Author(s):  
Anahita Dua ◽  
Sapan S. Desai ◽  
Alexander Nodel ◽  
Jennifer A. Heller
Keyword(s):  
Body Mass Index ◽  
Deep Vein Thrombosis ◽  
Lower Extremity ◽  
Body Mass ◽  
Duplex Ultrasonography ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
The Impact

Coagulation Changes Under An Effective Urokinase Dosage Regimen

1981 ◽  
Author(s):  
G Schöffel ◽  
R Zimmermann ◽  
J Harenberg
Keyword(s):  
Deep Vein Thrombosis ◽  
Plastic Material ◽  
Dosage Schedule ◽  
Clot Lysis ◽  
Clotting Factors ◽  
Thrombolytic Activity ◽  
Vein Thrombosis ◽  
Euglobulin Clot Lysis Time ◽  
Glass Surfaces ◽  
Deep Vein

In preliminary studies we demonstrated an increased thrombolytic activity with higher dosages of urokinase in the therapy of deep vein thrombosis. From that time this higher urokinase dosage schedule (loading dose 250,000 IU, initial maintenance dosage 2000 IU/kg/h in combination with 1520 U heparin/kg/h) was used and suggested as ideal.In 10 patients with deep vein thrombosis treated according to this dosage schedule following coagulation parameters were determined before the beginning of the therapy, after 1,4,12 h and then at least once per day up to 7-14 days:aPTT, thrombin clotting time, fibrinogen (according to Clauss, Ratnoff and Menzie and radial immunodiffusion), TEG, euglobulin clot lysis time, inhibitors of fibrinolysis, plasminogen, antithrombin III, fpA, clotting factors V and VIII. The coagulation analysis showed a progressive decrease of fibrinogen to 50100 mg% and of plasminogen to about 40 % within 12-36 h. At this time a reduction of the urokinase dose by 30-40 % and further only slight corrections became necessary. Additional investigations demonstrated a more pronounced fibrinogenolytic effect when dissolving and applying urokinase in plastic material and avoiding contact with glass surfaces. These findings suggested a 30% saving of urokinase.The highly effective urokinase dosage schedule here described has been proved practicable and rendered too frequent coagulation controls superfluous. The saving of urokinase by using plastic material introduced a modification of our urokinase regimen:Loading dose 250,000 IU, followed by 2000 IU/kg/h for only 8 h, then 1000 IU/kg/h with further slight individual dose corrections.

scholarly journals Cost-effectiveness of rivaroxaban compared with enoxaparin plus warfarin for the treatment of hospitalised acute deep vein thrombosis in China

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e038433
Author(s):  
Li Yang ◽  
Jingjing Wu
Keyword(s):  
Deep Vein Thrombosis ◽  
Cost Effectiveness ◽  
Cost Saving ◽  
Transition Probabilities ◽  
Sensitivity Analyses ◽  
Vein Thrombosis ◽  
Life Years ◽  
Acute Deep Vein Thrombosis ◽  
Deep Vein ◽  
The Impact

ObjectiveLimited economic evaluation data for rivaroxaban compared with standard of care (SoC) exists in China. The objective of this analysis was to evaluate the cost-effectiveness of rivaroxaban compared with current SoC (enoxaparin overlapped with warfarin) for the treatment of acute deep vein thrombosis (DVT) in China.MethodsA Markov model was adapted from a payer’s perspective to evaluate the costs and quality-adjusted life years (QALYs) of patients with DVT treated with rivaroxaban or enoxaparin/warfarin. Clinical data from the EINSTEIN-DVT trial were obtained to estimate the transition probabilities. Data on Chinese health resource use, unit costs and utility parameters were collected from previously published literature and used to estimate the total costs and QALYs. The time horizon was set at 5 years and a 3-month cycle length was used in the model. A 5% discount rate was applied to the projected costs. One-way sensitivity analyses and probabilistic sensitivity analyses were undertaken to assess the impact of uncertainty on results.ResultsRivaroxaban therapy resulted in an increase of 0.008 QALYs and was associated with lower total costs compared with enoxaparin/warfarin (US$4744.4 vs US$5572.4, respectively), demonstrating it to be a cost-saving treatment strategy. The results were mainly sensitive to length of hospitalisation due to DVT on enoxaparin/warfarin, cost per day of hospitalisation and the difference in length of stay of rivaroxaban-treated and enoxaparin/warfarin-treated patients.ConclusionRivaroxaban therapy resulted in a cost saving compared with enoxaparin/warfarin for the anticoagulation treatment of patients with hospitalised acute DVT in China.Trial registration numberNCT00440193; Post-results.

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