scholarly journals Diffuse prothrombotic syndrome after ChAdOx1 nCoV-19 vaccine administration: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Nicole Ceschia ◽  
Valentina Scheggi ◽  
Anna Maria Gori ◽  
Angela Antonietta Rogolino ◽  
Francesca Cesari ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Vitamin K Antagonists ◽  
Limb Ischemia ◽  
Lower Limbs ◽  
Medical Community ◽  
Caucasian Woman ◽  
Acute Limb Ischemia ◽  
Ischemic Lesion ◽  
Hospitalization Period

Abstract Background Vaccine-induced immune thrombotic thrombocytopenia is emerging as one of the most relevant side effects of adenoviral-based vaccines against coronavirus disease 2019. Given the novelty of this disease, the medical community is seeking new evidence and clinical experiences on the management of these patients. Case presentation In this article, we describe the case of a 73-year-old Caucasian woman who presented with diffuse prothrombotic syndrome, both in the arterial and venous districts, following the first dose administration of ChAdOx1 CoV-19 vaccine. The main thrombotic sites included the brain, with both a cortical ischemic lesion and thromboses of the left transverse and sigmoid sinuses and the lower limbs, with deep venous thrombosis accompanied by subsegmental pulmonary thromboembolism. The deep venous thrombosis progressively evolved into acute limb ischemia, requiring surgical intervention with thromboendoarterectomy. Anticoagulation was maintained throughout the whole hospitalization period and continued in the outpatient setting using vitamin K antagonists for a recommended period of 6 months. Conclusions This case describes the management of vaccine-induced immune thrombotic thrombocytopenia in a complicated clinical scenario, including multisite arterial and venous thromboses. Given the complexity of the patient presentation, this case may implement the comprehension of the mechanisms and clinical features of this disease; it also provides a picture of the challenges related to the management, often requiring a multidisciplinary approach.

scholarly journals A catastrophic seronegative anti-phospholipid syndrome: case and literature review

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Vanda Pinto ◽  
Augusto Ministro ◽  
Nuno Reis Carreira ◽  
Ana Cardoso ◽  
Catarina Sousa Gonçalves ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
High Mortality ◽  
Pulmonary Arteries ◽  
Limb Ischemia ◽  
Lower Limbs ◽  
Renal Infarction ◽  
Vascular Events ◽  
Intensive Care Unit Treatment ◽  
Serological Tests ◽  
Hospital Emergency Room

Abstract Background Antiphospholipid Syndrome (APS) is a multisystemic autoimmune disease characterized by arterial and venous thrombosis and / or obstetric morbidity in the presence of at least one circulating anti-phospholipid antibody. The spectrum of vascular events varies from deep venous thrombosis to catastrophic APS, a rare form characterized by acute multiorgan thrombosis and high mortality. Case report We present the case of a 32-week pregnant woman arriving in the hospital emergency room with bilateral acute lower limb ischemia. In the obstetric evaluation, fetal death was declared. Computerized Tomography angiography showed pulmonary embolism of both pulmonary arteries, areas of splenic and right renal infarction and multiple arterial and venous thrombosis. The patient underwent urgent caesarean section and axillary-bifemoral bypass. No events registered. In the postoperative period, in an intensive care unit, treatment with rituximab and plasmapheresis were added to anticoagulant therapy. The laboratorial investigation was negative for thrombophilia and autoimmune diseases. Conclusion Catastrophic APS develops quickly, with multiorgan involvement and high mortality rate. The presented case poses a multidisciplinary challenge, with the surgical approach of extra-anatomical revascularization being less invasive and guaranteeing immediate perfusion of the lower limbs. Although the serological tests were negative for anti-phospholipid antibodies, this case hardly fits into another diagnosis. Therefore, it was treated as a catastrophic APS, having shown a favorable evolution.

Abstract 497: Clinical Significance of Heparin Induced Thrombocytopenic Thrombotic Syndrome with Initiation of Anti-heparin Antibodies Negative: A Case Report and Literature Review

2013 ◽  
Vol 33 (suppl_1) ◽  
Author(s):  
Qi Shi, MD ◽  
Robert Paulino ◽  
Michael Kiel ◽  
Huimin Wu ◽  
Sandhya Samavedam ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Platelet Count ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Doppler Ultrasound ◽  
Therapeutic Range ◽  
Bypass Graft ◽  
Acute Limb Ischemia ◽  
Repeated Testing ◽  
Mortality And Morbidity

Introduction Heparin induced thrombocytopenia thrombosis Syndrome has a high mortality and morbidity in cardiac surgical patients in spite of early diagnosis and management. We present a case with multiple acute deep venous thrombosis (DVT) after using unfractionated heparin (UFH) during coronary artery bypass graft (CABG) with initiation of HIT antibodies negative. Case presentation A 70-year-old male complained of left leg pain 2 days after CABG for an acute ST-elevation myocardial infarction. Patient was treated with UFH intravenous during CABG. Platelet count was 78 x 109/L that was 130 x 109/L before the procedure. Anti-heparin antibodies IgM/IgG were negative. Venous Doppler ultrasound showed an acute deep venous thrombosis (DVT) in the left peroneal vein. However, after the patient was treated with Coumadin anticoagulation for 7 days with INR in therapeutic range (2-3), the patient presented for right low extremity pain. Platelet count was 40 x 109/L. Anti-heparin antibodies IgM and IgG were repeatedly positive. Venous Doppler ultrasound showed multiple bilateral lower extremities acute DVTs. Patient had thrombectomy and continued with coumadin anticoagulation at INR in therapeutic range for 3 months. Discussion HITTS is an immune-mediated drug reaction that occurs more frequently in patients undergoing cardiovascular surgery. Thrombosis caused by the HIT/T syndrome is most commonly venous thromboembolism. Thrombosis is arterial in about 20% of cases, including acute limb ischemia, myocardial infarction, or stroke. Previous clinical data has shown that about 40% of high titer-negative HIT antibodies were associated with a positive result in repeated testing several days later, which is the same as our presentation. The mortality and morbidity rates of HITTS are approximately 30% and 60%, respectively, and an additional ~10% of patients require amputations or suffer other major morbidity. However, with early recognition and intervention, mortality can be reduced from >30 to <10%. Obviously, repeated testing to identify patients who have HIT despite a negative initial HIT test in several days is greatly recommended. Diagnosis is essentially clinical and negative results from laboratory assays do not exclude the diagnosis.

scholarly journals Home versus in-hospital treatment of outpatients with acute deep venous thrombosis of the lower limbs

2014 ◽  
Vol 59 (5) ◽  
pp. 1362-1367.e1 ◽  
Author(s):  
Francisco Lozano ◽  
Javier Trujillo-Santos ◽  
Manuel Barrón ◽  
Pedro Gallego ◽  
Dimitrios Babalis ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Lower Limbs ◽  
Hospital Treatment

Deep venous thrombosis of lower limbs in adolescents: a study in a tertiary hospital

2019 ◽  
Vol 0 (0) ◽  
Author(s):  
Catarina Faria ◽  
Henedina Antunes ◽  
Teresa Pontes ◽  
Ana Antunes ◽  
Sofia Martins ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Oral Contraceptive ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Positive Family History ◽  
Oral Contraceptive Pill ◽  
Tertiary Hospital ◽  
Lower Limbs ◽  
Factor V Leiden Mutation

AbstractBackgroundVenous thromboembolism (VTE) – which includes deep venous thrombosis (DVT) and pulmonary embolism (PE) – has been increasingly recognized in the pediatric population. The estimated incidence is 0.07–0.14 cases per 10,000 children. Most cases are associated with two or more risk factors. Medium and long-term complications include recurrence and post-thrombotic syndrome (PTS).ObjectiveTo characterize the adolescent population with the diagnosis of DVT of lower limbs in a tertiary hospital, regarding its clinical presentation, associated risk factors, treatment and outcome.MethodsRetrospective analysis of adolescents with the diagnosis of DVT of lower limbs in our hospital for a period of 7 years.ResultsEight patients were identified; seven were females; median age was 15 years. The main symptoms were local pain and edema. Left lower limb was affected in six patients. PE occurred in two cases. Positive family history of venous thromboembolism was found in five patients. Seven patients had at least two identifiable risk factors. Combined oral contraceptive pill use was the most common (seven patients). Factor V Leiden mutation was found in three patients and protein C deficiency in one. Iliac vein compression syndrome was diagnosed in one patient. The median time for discharge was 8 days. Election treatment was enoxaparin followed by warfarin, for a median period of 10.9 months. Three patients developed PTS.ConclusionsAlthough uncommon, VTE is an emerging reality in adolescents, particularly in females using oral contraceptive pills. Appropriated prevention strategies and treatment are required as most orientations are extrapolated from adults.

Metabolic and Inflamatory Proteins Differently Expressed in Platelets From Deep Venous Thrombosis Patients

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 5256-5256
Author(s):  
Mariane Cristina Flores Nascimento ◽  
Karina Kleinfelder-Fontanesi ◽  
Fernanda Loureiro de Andrade Orsi ◽  
Steven H Seeholzer ◽  
Harry Ischiropoulos ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Conflicts Of Interest ◽  
Lower Limbs ◽  
Apolipoprotein A1 ◽  
Blood Samples ◽  
Orbitrap Mass Spectrometer ◽  
Inflammatory Processes ◽  
History Of

Abstract Abstract 5256 BACKGROUND: Deep venous thrombosis (DVT) is multi-causal disease associated to a high morbi-mortality due to complications as pulmonary embolism and post-flebitic syndrome. The incidence is about 20 to 30%, and 25% of the patients will present recurrence in 5 years. The identification of new risk factors is important in clinical practice to prevent new thrombotic events. The role of the platelets on DVT is still not well defined. AIM: The objective of this study was to analyze the hole proteins profile of platelets obtained from DVT patients and compare to the same matherial derived from healthy controls. PATIENTS: peripheral blood samples were collected from 3 spontaneous DVT patients and from 1 sibling and 1 neighbor for each patient in order to minimize the genetic and environmental interferences. These patients presented spontaneous and recurrent episodes of lower limbs proximal DVT and all of them mentioned a familiar history of coagulation disorders. METHODS: the platelets were washed, lysed, and the proteins were alkylated, reduced, precipitated with acetone and hydrolyzed by trypsin. 100mg of peptides were then separated by hydrophobicity using HPLC, and 8 fractions were obtained and directed to the LTQ-Orbitrap mass spectrometer. The proteins search was performed by Sorcerer-SEQUEST. RESULTS: We identified 5 proteins that were present on patients and absent in all the controls: Apolipoprotein A1 Binding-Protein, Coatomer (z1 sub-unit), Estradiol 11–17-b Dehydrogenase, Leucotriene A-4 Hydrolase and Sorbitol Dehydrogenase. Western-Blotting was performed with specific antibodies and validated the results. CONCLUSIONS: with this study it was possible to identify proteins up to date non-related to the physiopathology of DVT, that could be involved with metabolic and inflammatory processes. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Cost-Effectiveness of Dabigatran Compared to Vitamin-K Antagonists for the Treatment of Deep Venous Thrombosis in the Netherlands Using Real-World Data

PLoS ONE ◽  
2015 ◽  
Vol 10 (8) ◽  
pp. e0135054 ◽  
Author(s):  
Merlijn W. J. van Leent ◽  
Jelena Stevanović ◽  
Frank G. Jansman ◽  
Maarten J. Beinema ◽  
Jacobus R. B. J. Brouwers ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
The Netherlands ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Vitamin K ◽  
Real World ◽  
Vitamin K Antagonists ◽  
Real World Data ◽  
World Data
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