Pentoxifylline-Induced Thrombocytopenia

2015 ◽  
Vol 28 (6) ◽  
pp. 572-576 ◽  
Author(s):  
Michelle W. Tan ◽  
Grant E. Sklar
Keyword(s):  
Lower Limb ◽  
Surgical Intervention ◽  
Limb Ischemia ◽  
Blood Film ◽  
Probability Scale ◽  
Peripheral Artery ◽  
Lower Limb Ischemia ◽  
Peripheral Blood Film ◽  
Artery Disease ◽  
Chinese Male

Pentoxifylline-induced thrombocytopenia is rare, and information is lacking about its presentation. We describe a 72-year-old Chinese male who developed thrombocytopenia after initiation of pentoxifylline for the treatment of chronic lower limb ischemia due to peripheral artery disease. Venous thromboembolism had been ruled out with an ultrasound. Vascular surgeons had also determined there was no indication for surgical intervention. Four days after initiation of pentoxifylline, he developed thrombocytopenia, and his platelets were 68 × 103/μL. He was not in overt disseminated intravascular coagulation (DIC), based on his International Society for Thrombosis and Hemostasis (ISTH) DIC score of 4. Dengue fever, which is endemic in Singapore, was ruled out. Pseudothrombocytopenia was also excluded with a peripheral blood film. When his platelets continued to fall, pentoxifylline was discontinued on the fifth day of treatment, and platelets normalized 48 hours after discontinuation. Pentoxifylline was a probable cause of thrombocytopenia using the Naranjo Adverse Drug Reaction Probability Scale (score = 7). The patient did not receive further doses of pentoxifylline. Prescribers should be aware of the risk of thrombocytopenia with pentoxifylline therapy and discontinue its use promptly if it is suspected.

scholarly journals Vascular Complications of Lower Limb Ischemia in Patients with Femoral Venoarterial Extracorporeal Membrane Oxygenation

2020 ◽  
Vol 23 (3) ◽  
pp. E305-E309
Author(s):  
Xiaozu Liao ◽  
Zhou Cheng ◽  
Liqiang Wang ◽  
Binfei Li ◽  
Weizhao Huang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Femoral Artery ◽  
Lower Limb ◽  
Independent Risk Factor ◽  
Limb Ischemia ◽  
Peripheral Artery ◽  
Lower Limb Ischemia ◽  
Ischemia Group ◽  
Artery Disease ◽  
Va Ecmo

Background: Lower limb ischemia in patients with extracorporeal membrane oxygenation (ECMO) via femoral artery catheterization negatively affects patient mortality and survivors’ quality of life [Gulkarov 2020]. In this study, ECMO was established via femoral artery catheterization. This study aimed to identify the risk factors of lower limb ischemia to provide sufficient evidence for its prevention. Methods: All patients with venoarterial (VA) ECMO via femoral artery catheterization in Zhongshan People’s Hospital from January 2008 to November 2019 retrospectively were analyzed. Patients’ general information and ECMO-related information were obtained, and the main outcome variables were survival and discharge and intubation-related adverse events (limb ischemia and incision bleeding). Logistic regression analysis was used to determine the independent risk factors of limb ischemia in patients with VA ECMO. Results: A total of 179 (98 [54.7%] men and 81 [45.3%] women) eligible patients were included in this study. Moreover, a total of 90 patients (48.9%) had low cardiac output, 41 (22.3%) had acute myocardial infarction, and 33 (17.9%) had fulminant myocarditis. Eighty-six (48.04%) patients survived to hospital discharge, 36 (20.11%) had limb ischemia, and 42 (23.46%) had incision bleeding. Furthermore, the ECMO-assisted time was 114.23 ± 67.88 hours. There was no significant difference in age, sex, and Sequential Organ Failure Assessment score between the limb ischemia group and the non-limb ischemia group. Multivariate logistic regression analysis showed that peripheral artery disease (odds ratio, 27.12; 95% confidence interval, 5.614–130.96) was an independent risk factor of limb ischemia in patients with ECMO. Conclusion: Limb ischemia is a common complication in patients with VA ECMO, and peripheral artery disease is an independent risk factor of limb ischemia in patients with VA ECMO via femoral artery catheterization.

scholarly journals The role of hypoxia-inducible factorin the syndrome of chronic lower limb ischemia and influence of diabetes mellitus on process of angiogenesis

2017 ◽  
Vol 16 (3) ◽  
pp. 4-9 ◽  
Author(s):  
M. N. Kudykin ◽  
V. V. Beschastnov ◽  
R. A. Deryabin ◽  
G. E. Sheiko ◽  
L. M. Celousova ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Lower Limb ◽  
Hypoxia Inducible Factor ◽  
Limb Ischemia ◽  
Peripheral Artery ◽  
Lower Limb Ischemia ◽  
Cell Responses ◽  
Patients With Diabetes ◽  
Artery Disease

In this review, we pay attention to the role of the hypoxia-inducible factor (HIF) in the development of response of the organism to hypoxia. Special attention is given to the regulation of the cell responses to hypoxia in chronic peripheral artery disease in patients with diabetes mellitus (DM). Cells can survive by activation of a transcription of genes, involved in angiogenesis, glucose metabolism and cell proliferation. Artificial rising of concentration and activity of HIF stimulates an angiogenesis and improves ulcers healing of the lower extremities. The data of the literature are provided on the possible methods of increasing HIF concentration in tissues, which could be a new way to stimulate wound healing in the patients with DM.

THE ROLE OF X-RAY ENDOVASCULAR SURGERY IN THE TREATMENT OF OBLITERATING ATHEROSCLEROSIS OF THE LOWER EXTREMITY ARTERIES IN ELDERLY AND SENILE PATIENTS

2020 ◽  
Vol 4 (2) ◽  
pp. 1069-1073
Author(s):  
S.V. Mshar ◽  
◽  
V. Yanushko ◽  
Keyword(s):  
High Risk ◽  
Peripheral Artery Disease ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Peripheral Artery ◽  
Lower Limb Ischemia ◽  
X Ray ◽  
Surgical Methods ◽  
Artery Disease ◽  
Methods Of Treatment

Obliterating atherosclerosis ranks third in the system of cardiovascular disease. With age the incidence of peripheral artery disease increases and makes 3-5% in general population. The most difficult group of patients with peripheral artery disease (PAD) or obliterating atherosclerosis is elderly patients. Currently there is a tendency to increase the life expectancy and aging of the Belarusian population. Elderly and senile patients with obliterating atherosclerosis (PAD) are characterized by a multi-level lesion and damage to the distal parts of the arterial bed, an increase in the number of comorbidities, a high risk of cardiovascular death, and seeking medical help often at the stage of critical lower limb ischemia. Patients at high risk of cardiovascular complications with intermittent lameness are subject to conservative treatment. When developing a clinic for critical lower limb ischemia, due to the low effectiveness of conservative methods of treatment, it is worth considering revascularization of the lower limb arteries. Open surgical methods of treatment are associated with a high risk of complications and mortality. X-ray endovascular methods of treatment of patients of the older age group are characterized by a lower risk of complications, lower injury rate. The use of low-injury x-ray endovascular and hybrid methods of treatment in elderly and senile patients can improve the results of treatment (reduce the frequency of amputations, reduce the risk of complications, improve the quality of life).

scholarly journals EXTRA-ANATOMIC BYPASS IN PATIENTS WITH CRITICAL LOWER LIMB ISCHEMIA AND CORONARY ARTERY DISEASE

2019 ◽  
Vol 20 (2) ◽  
pp. 231-233
Author(s):  
Oksana Vyacheslavovna Burlaku ◽  
◽  
Vadim Vladimirovich Franz ◽  
Sergey Andreevich Stefanov ◽  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Lower Limb Ischemia ◽  
Artery Disease

scholarly journals Major adverse cardiovascular and limb events in patients with diabetes and concomitant peripheral artery disease treated with sodium glucose cotransporter 2 inhibitor versus dipeptidyl peptidase-4 inhibitor

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Hsin-Fu Lee ◽  
Shao-Wei Chen ◽  
Jia-Rou Liu ◽  
Pei-Ru Li ◽  
Lung-Sheng Wu ◽  
...  
Keyword(s):  
Peripheral Artery Disease ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Study Groups ◽  
Dipeptidyl Peptidase ◽  
Research Database ◽  
Peripheral Artery ◽  
Dipeptidyl Peptidase 4 ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Artery Disease

Abstract Background Whether sodium glucose co-transporter 2 inhibitors (SGLT2i) are associated with a lower risk of cardiovascular as well as adverse lower limb events in patients with type-2 diabetes mellitus (T2DM) and concomitant peripheral artery disease (PAD) is unclear. We aimed to evaluate the risk of cardiovascular and limb events, and death associated with the use of SGLT2i compared with dipeptidyl peptidase-4 inhibitors (DPP4i) among a longitudinal and national cohort of patients with T2DM. Methods In this nationwide retrospective cohort study based on the Taiwan National Health Insurance Research Database, we identified a total of 11,431 and 93,972 consecutive T2DM patients with PAD taking SGLT2i and DPP4i, respectively, from May 1, 2016, to December 31, 2017. We used 1:1 propensity score matching (PSM) to balance covariates across study groups. Patients were followed from the drug index date until the occurrence of clinical outcomes, death, discontinuation of the index drug, or the end of the study period, whichever occurred first. Results Overall, 56% and 44% of the patients were treated with dapagliflozin and empagliflozin, respectively. The use of SGLT2i had comparable risks of ischemic stroke and acute myocardial infarction, and was associated with lower risks of congestive heart failure (CHF) [hazard ratio (HR): 0.66; 95% confidence interval (CI) 0.49–0.89; p = 0.0062], lower limb ischemia requiring revascularization (HR: 0.73; 95% CI 0.54–0.98; p = 0.0367) or amputation (HR: 0.43; 95% CI 0.30–0.62; p < 0.0001), and cardiovascular death (HR: 0.67; 95% CI 0.49–0.90; p = 0.0089) when compared with the DDP4i group after PSM. The subgroup analysis revealed consistent results for CHF and major adverse limb outcomes for SGLT2i versus DPP4i among patients aged ≥ 75 years, the presence of chronic kidney disease and established cardiovascular disease was consistent with the main analysis. Conclusions SGLT2i were associated with lower risks of CHF and adverse lower limb events compared with DPP4i among patients with T2DM and PAD in real-world practice.

scholarly journals A Peculiar Case of a Floating Angio-Seal

2016 ◽  
Vol 10 (1) ◽  
pp. 44-47 ◽  
Author(s):  
R.C. Dettmers ◽  
W.M.P.F. Bosman ◽  
M.A.J. van den Broek ◽  
H.T.C. Veger ◽  
P.Ph.A. Hedeman Joosten ◽  
...  
Keyword(s):  
Lower Limb ◽  
Surgical Intervention ◽  
Vascular Complications ◽  
Limb Ischemia ◽  
Closure Device ◽  
Vascular Closure Device ◽  
Puncture Site ◽  
Lower Limb Ischemia ◽  
Routine Physical Examination ◽  
Peculiar Case

Purpose To show a complication of the use of an Angio-Seal™ closure device. Case We present a patient with a systolic murmur in his femoral artery after PCI. The murmur was caused by a dislocated Angio-Seal™, a vascular closure device. This was diagnosed by Doppler Ultrasound. The device was surgically removed. Conclusion Vascular complications, such as lower limb ischemia, requiring surgical intervention tend to be higher after use of a vascular closure device. We advise routine physical examination of the puncture site after percutaneous closure with a vascular closure device, such as an Angio-Seal™. The removal of the device can be performed via an open or endoscopic approach, based on available experience.

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