Venous Thromboembolic Disease and Bone Marrow Transplant: A Remarkable Cause of Mortality and Morbidity — Potentially Preventable

Abstract Thrombotic events are frequent in patients undergoing HSCT, being an important cause of morbidity and mortality. The highest incidence occurs three months after the transplant. There are several risk factors, which add to those already known for VTE: neoplasia, central venous catheters, immobilization, chemotherapy, infections, GVHD. In the series described, the frequencies are variable, between 0.5 and 23.5%, with an overall incidence of 5%. In patients with GVHD, this incidence increases, with up to 35% of events. METHODS A retrospective observational study that includes patients transplanted in our Unit between 2014 and 2017 has been conducted, with the objective of analyzing the incidence of VTE peri-TPH. Likewise, we have analyzed if it is associated to catheter, presence of CVRF, if there was a known medical history of thrombophilia, number of platelets at time of thrombosis, the heparin used and whether anticoagulation was maintained indefinitely or not. RESULTS Out of the 235 patients included in our series, 130 underwent an autologous transplant and 105 an allogeneic transplant. 18 thrombotic events occurred (9 men and 9 women, aged between 18 and 65 years), which means 7.5% (14 occurred between days 0-100, 12 in patients undergoing autologous hematopoietic stem cell transplantation). Three of them had thromboembolism and the rest deep vein thrombosis, 4 of which with catheter. The platelet count at the time of the event ranges from 21 to 409,000 / mm3. Regarding the heparin used, 2 were treated with Tinzaparin and the rest with Bemiparin. Only 1 of the patients presented prior VTE. Among the patients, there were some with CVRF and others without relevant medical history. Just in one patient, a family thrombophilia study had been performed prior to his hematological diagnosis, resulting in a deficit of protein S. In 8 of the patients, anticoagulation was maintained indefinitely with LMWH in the post-transplant period. CONCLUSIONS Our incidence approaches the literature, albeit the series of published cases are heterogeneous and with variable differences. Although the incidence of thrombosis in these patients is a cause of marked morbidity and mortality, the risk of bleeding also increases, therefore routine prophylaxis is not recommended in all patients. We must undergo an exhaustive analysis of the data to identify individually which patients may be candidates for prophylaxis, with the aim of reducing the incidence without raising the hemorrhagic risk of our patients. Disclosures No relevant conflicts of interest to declare.

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Catheter Directed Thrombolytic Therapy for Pediatric Cerebral Sinus Vein Thrombosis

Blood ◽

10.1182/blood-2019-132082 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 3666-3666

Author(s):

Marcela Torres ◽

Tyler Hamby ◽

Sarah Philip ◽

Jo Ann Tilley

Keyword(s):

Pediatric Patients ◽

Randomized Clinical Trials ◽

Conflicts Of Interest ◽

Case Series ◽

Protein S ◽

Cerebral Veins ◽

Vein Thrombosis ◽

Partial Resolution ◽

Neurologic Deficits ◽

Cerebral Sinus

Background: Cerebral sinus vein thrombosis (CSVT) involves the thrombosis of the dural sinus and/or cerebral veins and it is considered a form of stroke. The estimated incidence of CSVT in children is 0.6 per 100,000 children per year. Poor outcomes, including death, happen in 9 to 29% of patients affected by CSVT. In addition, neurologic deficits, affecting primarily cognition and behavior, are seen in 50% of affected children. No randomized clinical trials have been conducted on pediatric CSVT so current guidelines for treatment have been extrapolated primarily from adult studies. Published guidelines by the American College of Chest Physicians, American Heart Association and American Society of Hematology, support the use of anticoagulation with unfractionated heparin (UFH) or low molecular weight heparin (LMWH). These same guidelines also suggest that catheter directed thrombolysis (CDT) with tissue plasminogen activator (tPA) and mechanical thrombectomy (MT) could be used when there has been clinical deterioration or no improvement (clot progression) despite anticoagulation. In all cases, these are based on uncontrolled case series and expert opinion. There is very little data on the safety and efficacy of CDT and/or MT for pediatric CSVT. Method: Pediatric patients with CSVT seen at Cook Children's Medical Center from January 1, 2008 to December 31, 2018 were identified by searching EMR using ICD-9 and ICD-10 codes. From this group, patients treated with MT and CDT in addition to anticoagulation were selected and reviewed. Results: Five children (4 to 14 y/o) were treated with MT and CDT after failing anticoagulation with UFH or LMWH. Diagnosis was made by MRI/MRV and all had CSVT of multiple sinuses. Four patients had more than one underlying disorders/factors that increased their risk for thrombosis including: Ulcerative Colitis in 2, severe anemia in 2, Systemic Lupus Erythematosus (SLE) in 1, use of oral contraceptives together with obesity and bacterial sepsis in 1. Two patients did have a thrombophilia: Protein S deficiency in 1 and Protein S and C deficiency in another. One patient with SLE had a positive hexagonal phase neutralization test but rest of evaluation was negative. Three patients had systemic bleeding prior initiation of UFH and MT/CDT. All children were treated with UFH, and due to clinical neurologic deterioration and/or worsening of imaging findings (4 comatose and 1 with persistent increased ICP), all underwent thromboaspiration and catheter directed infusion of tPA for 17 to 48 hours at a dose of 1 to 2 mg/hr. All patients continued anticoagulation with UFH during catheter directed tPA infusion and after the catheter was removed. All cases had partial resolution of the sinus vein thrombosis, although 1 had quick reocclusion. Post procedure bleeding happened in 1 patient who had also had an external ventricular drainage placed and developed parenchymal and intraventricular hemorrhage that led to discontinuation of tPA infusion, and 2 patients developed petechial brain hemorrhages. Four patients had great neurologic recovery and minimal deficits, but 1 had significant neurologic deficits. One patient died from lupus complications. (Table) Conclusion: Endovascular therapy including MT and CDT with tPA in conjunction with systemic UFH, may have a role in pediatric patients with CSVT who have deterioration despite initial anticoagulation. In our series, after procedures, all patients had partial resolution of their CSVT (but 1 had quick reocclusion) and 4 out of 5 patients had good neurologic outcomes despite bad predictor signs (coma, extensive CSVT). Further studies are needed to identify which patients would benefit from early endovascular treatment. Table Disclosures No relevant conflicts of interest to declare.

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Protein S As a Potential Treatment for FIX-Derived Deep Vein Thrombosis

Blood ◽

10.1182/blood.v126.23.2277.2277 ◽

2015 ◽

Vol 126 (23) ◽

pp. 2277-2277

Author(s):

Vijaya Satish Sekhar Pilli ◽

Willium Plautz ◽

Rinku Majumder ◽

Paolo Simioni

Keyword(s):

Deep Vein Thrombosis ◽

Thrombin Generation ◽

Conflicts Of Interest ◽

Ex Vivo ◽

Protein S ◽

Factor Ix ◽

Wild Type ◽

Vein Thrombosis ◽

Deep Vein

Abstract Background: Every year, 0.1-0.2% of the USA population experiences deep vein thrombosis (DVT). Two causes of DVT are increased Factor IX (FIX) levels and hyperactivating mutations in FIX (FIX Padua variant- R338L and Malmo variant T148A). In principle, inhibition of activated FIX (FIXa) should alleviate DVT. Previous in vitro studies demonstrated that the anticoagulant Protein S (PS) inhibits the intrinsic pathway mediated by wild type FIXa, making PS an attractive candidate to treat DVT. Aims: To establish Protein S as a remedy for FIX-mediated DVT/Padua/Malmo Methods: Anisotropy, clotting assays, thrombin generation assays, co-localization, co-immunoprecipitation, and bleeding assays. Results: We further explored the physiological relevance of the PS-FIXa interaction and PS-mediated inhibition of FIXa by ex vivo (co-immunoprecipitation) and in vivo (co-localization) studies. Because PS can inhibit FIXa in vivo, we used competitive, direct anisotropy assays and co-immunoprecipitation assays to measure the efficiency PS and hyperactive FIXa (R338L) interaction. Interestingly, the results demonstrated that FIXa R338L has lost its affinity towards PS compared with wild type FIXa. The same finding was obtained by ex vivo thrombin generation assays and FXa generation assays supplemented with various concentrations of PS. Thus, to be inhibited, hyperactive FIX requires a greater amount of PS compared with wild type FIXa. We are further confirming this finding with mouse models. Conclusion: Addition of PS to plasma inhibits both wild type and R338L FIXa and extends clotting time. Previous studies showed that the addition of PS has no significant negative effects. Thus, we conclude that PS supplementation potentially constitutes a novel and effective treatment for FIX-mediated DVT. Disclosures No relevant conflicts of interest to declare.

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Effects of Multiple Myeloma (MM) Therapy and Type of Thromboprophylaxis On the Incidence and Timing of Venous Thromboembolism (VTE) and Factors Predictive of VTE.

Blood ◽

10.1182/blood.v120.21.2244.2244 ◽

2012 ◽

Vol 120 (21) ◽

pp. 2244-2244

Author(s):

Jatin J. Shah ◽

Aparna Hegde ◽

Xiao Zhou ◽

Sheeba K. Thomas ◽

Michael Wang ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Conflicts Of Interest ◽

Univariate Analysis ◽

Cancer Center ◽

Hematopoietic Stem ◽

Vein Thrombosis ◽

Increased Risk ◽

Multivariate Proportional Hazard ◽

The Impact

Abstract Abstract 2244 Background: Patients (pts) with MM are at increased risk for VTE due to various risk factors related to the host, disease, and treatment. Immunomodulatory drugs (IMiDs) such as thalidomide and lenalidomide have further increased the risk of VTE. Several studies have shown the VTE risk can be reduced with the use of low molecular weight heparin (LMWH) or aspirin thromboprophylaxis. Based on these findings, VTE thromboprophylaxis has been recommended in pts receiving IMiDs + Dexamethasone (Dex), but the impact of these guidelines on patient outcomes in clinical practice is unclear. The objective of this observational study was to evaluate the incidence, timing and risk factors of VTE and the impact of different types of thromboprophylaxis on the incidence of VTE. Methods: This was a retrospective cohort study, and included all MM pts newly referred to the M.D. Anderson Cancer Center in 2006. Medical records of these pts were reviewed for the type and site of VTE, the incidence and timing of VTE during the five-year period from the referral date, and the risk factors, including pt demographics, co-morbidities, baseline laboratory values, types of MM and treatment, and types of thromboprophylaxis. Univariate and multivariate proportional hazard models were fitted to find the independent risk factors predictive of VTE. The stepwise selection method was employed to build a multivariate model using variables with p<0.15 in univariate analysis. Results: The cumulative incidence of VTE was 24% (38/159 pts) during the 5-year follow up period. Of the 38 pts with VTE, 25 (66%) had deep vein thrombosis (DVT), 11 (29%) had pulmonary embolus (PE), and 2 had concurrent DVT and PE. Most of the pts (32/38, 84%) had VTE within 1 year from the referral date. The incidence of recurrent VTE among these pts was 27.5% (11/38 pts), for a total of 52 episodes. Since the majority of VTEs and recurrences were within one year, we examined the risk factors for VTE during this period. Treatment with IMiDs + Dex and thromboprophylaxis with LMWH or Coumadin were independent predictive factors as shown below. The incidence of VTE was highest in pts exposed to IMiDs + Dex (30/38 pts), even after discontinuation of treatment, with most episodes (17/30) occurring during the preparation (7/30) or within 30 days (10/30) following hematopoietic stem cell transplantation (HSCT), when most (16/17) pts were not receiving anti-coagulants. Conclusions: These findings suggest that patients treated with IMiDs + Dex are at high risk for VTE, even after discontinuation of this treatment, especially, during and after the HSCT period. Future studies are needed to investigate VTE prevention strategies for this high-risk pt population. Disclosures: No relevant conflicts of interest to declare.

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NF-Kb Inhibition in Endothelial Cells Enhances the Self-Renewal and Regeneration of the Hematopoietic System

Blood ◽

10.1182/blood.v124.21.353.353 ◽

2014 ◽

Vol 124 (21) ◽

pp. 353-353

Author(s):

Michael Gustave Poulos ◽

Jason M. Butler

Keyword(s):

Endothelial Cells ◽

Inflammatory Responses ◽

Conflicts Of Interest ◽

Chemotherapeutic Agents ◽

Morbidity And Mortality ◽

Self Renewal ◽

Hematopoietic Stem ◽

Hematopoietic System ◽

Hematopoietic Recovery ◽

Angiocrine Factors

Abstract Adult hematopoietic stem cells (HSCs) are defined by their ability to undergo self-renewal and maintain the capacity to generate all of the mature hematopoietic cell types within the blood and immune system. These unique qualities make the HSC clinically useful in bone marrow (BM) transplantation settings for a wide variety of hematological diseases. It has been demonstrated that maintenance of the HSC is dependent upon the cell-intrinsic properties of the HSC itself, as well as the extrinsic properties of the BM microenvironment. Within the hematopoietic microenvironment, we have shown that endothelial cells (ECs) are indispensable in supporting HSC self-renewal and differentiation into lineage-committed progeny during regenerative hematopoiesis. Furthermore, we have demonstrated that Akt signaling endows ECs with the capacity to instructively support HSC self-renewal through the expression of pro-hematopoietic angiocrine factors during homeostasis and hematopoietic regeneration following myelosuppressive stress. However, despite advances in the understanding of HSC biology, the exact mechanisms that regulate the balance between self-renewal and lineage-specific differentiation are still unknown. In order to expand our understanding of the body’s vascular network in regulating HSCs and hematopoietic regeneration, we have now focused on identifying the downstream signaling pathways of Akt within ECs that are responsible for the production of the pro-hematopoietic angiocrine factors. Because of the strong supporting data demonstrating that NF-kB signaling regulates hematopoietic function, we have focused on the Akt/NF-kB signaling axis in the vascular niche and demonstrated that inhibition of NF-kB within ECs results in a significant expansion of functional HSCs. Inhibition of the NF-kB pathway by expression of an IkBa super suppressor (IkBa-SS) via lentiviral transduction in primary ECs resulted in the expansion of phenotypic HSCs, while blocking differentiation of progenitor cells in vitro with an increase in the functional potential of the expanded HSCs. Utilizing a transgenic mouse model (Tie2.IkBa-SS) in which the NF-kB signaling pathway is inhibited specifically in ECs, we found that there was a significant increase in phenotypic and functional HSCs in vivo. Endothelial-specific inhibition of NF-kB signaling resulted in an increase in HSC quiescence and serial administration of low-dose chemotherapeutic agents resulted in an increase in self-renewal activity, suggesting that suppressing NF-kB signaling in ECs controls hematopoiesis by preventing premature exhaustion of the HSC pool. Following hematopoietic insult, Tie2.IkBa-SS mice undergo a rapid recovery of hematopoiesis and the hematopoietic system is largely protected following myelosuppression when compared to controls. Gene profiling of freshly isolated BM ECs from Tie2.IkBa-SS mice suggests that the enhancement of functional hematopoiesis is, in part, due to BM ECs upregulating pro-HSC angiocrine factors, as well as suppressing the production of cytokines and growth factors responsible for eliciting inflammatory responses, forcing the differentiation of HSCs. Furthermore, transplantation of BM ECs isolated from Tie2.IkB-SS mice significantly enhanced overall hematopoietic recovery following an LD50 dose of myeloablation, suggesting that transplantation of ECs could have tremendous therapeutic potential in mitigation the side effects of myeloablative injury by decreasing the morbidity and mortality associated with hematopoietic insults. In conclusion, our data demonstrates that the IkBa-dependent NF-kB pathway in ECs can regulate the production of pro-hematopoietic angiocrine factors that promote the maintenance and expansion of the HSC pool. Additionally, we have potentially unlocked a novel therapeutic application for the transplantation of genetically modified BM ECs following myeloablative treatment. Therapeutic transplantation of BM ECs may create a more permissive microenvironment that promotes an increase in the number of engrafted HSCs following BM transplantation, accelerating the rate of hematopoietic recovery following radiation or chemotherapeutic regimens and decreasing the morbidity and mortality associated with life threatening pancytopenias. Disclosures No relevant conflicts of interest to declare.

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Venous Thromboembolic Disease in Children Associated with COVID-19

Blood ◽

10.1182/blood-2020-142964 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 27-28

Author(s):

Shalu Narang ◽

Kavita Morparia ◽

Prachi Sharma

Keyword(s):

Antiphospholipid Antibodies ◽

Conflicts Of Interest ◽

Acute Infection ◽

Nasopharyngeal Swab ◽

Antiphospholipid Antibody ◽

Delayed Presentation ◽

Close Family Member ◽

Vein Thrombosis ◽

Short Period ◽

Venous Thromboembolic

Venous thromboembolism (VTE) in children is rare and VTE in association with antiphospholipid antibodies (lupus anticoagulant, cardiolipin antibodies and beta-2 glycoprotein I) is even rarer. The development of these antibodies can be due to an acute infection or an autoimmune disease. Recently, these antibodies have been noted to be present in conjunction with SARS-CoV-2 in adult patients with VTE. We report 5 cases of VTE associated with presence of antiphospholipid antibodies in children over a short period during the coronavirus 19 pandemic. One child had SARS-CoV-2 PCR positive on nasopharyngeal swab while 2 had positive antibodies (IgM) to SARS-CoV-2. One adolescent female had features of Multi-Inflammatory System in Children (MIS-C) a few weeks before presenting with multiple pulmonary emboli and DVT. Thrombotic events included DVT of lower extremity (3 patients), multiple PE (2 patients), orbital vein thrombosis (1 patient) and upper extremity DVT (1 patient). Two of these patients had both DVT and PE. All patients had one or more antiphospholipid antibody present. Two adolescent females had new onset of systemic lupus erythematous. All patients were treated with systemic anticoagulation with heparin (initially with unfractionated heparin if clinically unstable and later changed to low molecular weight heparin). We report a cluster of adolescents with unusual thrombotic complications with antiphospholipid antibody positivity during the coronavirus 19 pandemic, 3 with positive virologic criteria, one with delayed presentation after MIS-C like features and one with close family member exposure. We hypothesize that VTE in children is likely due to development of antiphospholipid antibodies when associated with SARS-CoV-2 infection. Disclosures No relevant conflicts of interest to declare.

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Evaluation the Risk Factor of Transplantation-Associated Thrombotic Microangiopathy.

Blood ◽

10.1182/blood.v116.21.4527.4527 ◽

2010 ◽

Vol 116 (21) ◽

pp. 4527-4527

Author(s):

Weiyan Zheng ◽

Yi Luo ◽

Yamin Tan ◽

Jingsong He ◽

Jimin Shi ◽

...

Keyword(s):

Thrombotic Microangiopathy ◽

Conflicts Of Interest ◽

Rare Complication ◽

Complete Response ◽

Marrow Transplant ◽

Multiple Organ ◽

Unrelated Donor ◽

Nervous Symptom ◽

Hematopoietic Stem ◽

Design And Methods

Abstract Abstract 4527 Background: Transplantation-associated thrombotic microangiopathy (TA-TMA) is lifethrewten though rare complication of allogeneic hematopoietic stem cell transplantation (HSCT). Diagnosis of TA-TMA is difficult due to its variation of criteria. Recently two new diagnositic criteria for TA-TMA have recently been proposed: the Bone Marrow Transplant Clinical Trials Network (BMTCTN) and the International Working Group (IWG) criteria. Our purpose is to investigate the indence and risk facter of TA-TMA in our institute. Study design and methods: All 8 cases of TA-TMA previously diagnosed at our institution between October 2005 and August 2010 were retrospectively evaluated and analysised. Table I showed the transplant details and patients characteristics. Results: Six patients performed Matched Unrelated Donor HSCT, two were haploidentical donor HSCT. Four patients complicated with hypohepatia, but only three patients had renal insufficient. The incidence of central nervous symptom abnormalities or dysfunction was very high (sever of eight patients). Four of eight patients were CSA linked TA-TMA, withdrawing CSA resulted in complete response. The other four patients were no CSA linked TA-TMA and developed aGVHD or CMV infection before TA-TMA. They had badly response to common treatment including plasma exchange (PE), steroid treatment and immunosuppression decreased. All of them died of multiple organ failure. Table II showed TA-TMA manifestations and associated circumstance of the patient. Conclusion: Our experience suggests that CSA linked TA-TMA is totally different from no CSA linked TA-TMA. The former had good response and prognosis, the later were always associated with GVHD, hypohepatia and virus infectious. The mortality of no CSA linked TA-TMA is high, they had poor prognosis and badly response. Disclosures: No relevant conflicts of interest to declare.

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Outcome of Patients with Beta-Thalassemia Major Given Either Bone Marrow and Frozen Cord Blood of Same Sibling or Bone Marrow Transplantation from Sibling Donors

Blood ◽

10.1182/blood.v124.21.2538.2538 ◽

2014 ◽

Vol 124 (21) ◽

pp. 2538-2538

Author(s):

Xuedong Wu ◽

Jianyun Wen ◽

Pei Fuyu ◽

Libai Chen ◽

Jianyun Liao ◽

...

Keyword(s):

Bone Marrow ◽

Stem Cell ◽

Cord Blood ◽

Conflicts Of Interest ◽

Thalassemia Major ◽

Marrow Transplant ◽

Beta Thalassemia ◽

Hematopoietic Stem ◽

Cell Sources ◽

Insignificant Difference

Abstract Background: Hematopoietic stem cell transplantation (HSCT) is the only curative treatment for thalassemia major (TM). Bone marrow (BM) and cord blood (CB) are biologically different stem cell sources. Methods: We analyed the results of a retrospective study of HSCT in 29 chlidren (median age at transplantation was 6 years old) with β-TM after the combined infusion of G-CSF primed bone marrow (BM) and cord blood (CB) from the same transplantation to outcomes in children with β-TM who had received BM (n=26).Patients treated with bone marrow transplant (BMT)were closely matched to the co-transplant group in terms of age, human leucocyte antigen (HLA) matching and duration of follow-up.Compared to BMT group, the donors in co-transplant group were younger (median age 2 vs. 4 years old, p=0.015) Results: In the co-transplant group,the mean total nucleated cells (TNC) was 2.63×108/kg(range,1.26-3.72×108/kg) and the CB was 0.39×108/kg(range,0.27-0.71×108/kg), respectively.The mean TNC (3.02 vs. 2.79×108/kg, p=0.532) and CD34+cells (7.55 vs. 6.94×106/kg, p=0.227) were insignificantly difference between the co-transplant group and BMT group. Of the 53 patients who had successful engraftment,patients who received a co-transplant had a lower incidence of ≥ grade II acute (3.3 vs. 20.8, p=0.047) and chronic(0vs.16.7%,p=0.022) graft versus host disease (GVHD) compared to BM transplant (BMT) recipients. There was no graft rejection (GR) after co-transplant, but GR happened two patients (7.7%) in BMT group(p=0.132).We found insignificant difference in neutrophils (18.7vs.19.9 days, p= 0.956) and platelet (24.7vs. 26.2 days, p=0.235) engraftment time between the co-transplant and BMT group. All patients were followed up until june 30, 2014, the 5 year probability of overall survival (OS), transplant free survival (TFS) and transplant-related mortality (TRM) were similar for the two groups. The 5-year probability of OS and TFS were 89.7% and 89.7% in the co-transplant group, 92.3%and 84.6% after BMT (P=0.740 and 0.573, respectively). Conclusions: Our data suggest that the lower risk of GVHD is retained with co-transplant group. The incidence of GR lower in the co-transplant group, although a larger cohort of patients will be needed to confirm this inital obser-vation.Here,we suggest transplantation of G-CSF primed BM a,nd CB of same sibling appears to be a feasible and effective strategy to further optimize outcomes of HSCT for TM with decreasing the risk of the occurrence of GVHD. Disclosures No relevant conflicts of interest to declare.

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Autoimmune Protein S Deficiency and Deep Vein Thrombosis after Chickenpox

Thrombosis and Haemostasis ◽

10.1055/s-0038-1650245 ◽

1996 ◽

Vol 75 (01) ◽

pp. 212-213 ◽

Cited By ~ 5

Author(s):

Flora Peyvandi ◽

Elena Faioni ◽

Gian Alessandro Moroni ◽

Alberto Rosti ◽

Luigi Leo ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Protein S ◽

Protein S Deficiency ◽

Vein Thrombosis ◽

S Deficiency ◽

Deep Vein

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A Protein S Deficient Family with Portal Vein Thrombosis

Thrombosis and Haemostasis ◽

10.1055/s-0038-1660107 ◽

1985 ◽

Vol 54 (03) ◽

pp. 724-724 ◽

Cited By ~ 26

Author(s):

Géza Sas ◽

György Blaskó ◽

Iván Petrö ◽

John H Griffin

Keyword(s):

Portal Vein ◽

Portal Vein Thrombosis ◽

Protein S ◽

Vein Thrombosis

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Recurrence of Upper Extremity Deep Vein Thrombosis Secondary to COVID-19

Viruses ◽

10.3390/v13050878 ◽

2021 ◽

Vol 13 (5) ◽

pp. 878

Author(s):

Yesha H. Parekh ◽

Nicole J. Altomare ◽

Erin P. McDonnell ◽

Martin J. Blaser ◽

Payal D. Parikh

Keyword(s):

Deep Vein Thrombosis ◽

Lower Extremity ◽

Upper Extremity ◽

Thromboembolic Events ◽

Vein Thrombosis ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic ◽

Deep Vein

Infection with SARS-CoV-2 leading to COVID-19 induces hyperinflammatory and hypercoagulable states, resulting in arterial and venous thromboembolic events. Deep vein thrombosis (DVT) has been well reported in COVID-19 patients. While most DVTs occur in a lower extremity, involvement of the upper extremity is uncommon. In this report, we describe the first reported patient with an upper extremity DVT recurrence secondary to COVID-19 infection.

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