scholarly journals Management of a case of thromboembolism post spine surgery: a case report

2021 ◽  
Vol 9 (10) ◽  
pp. 3194
Author(s):  
Manoj K. S. Tomer ◽  
Kalpana Shah ◽  
Shilpa Bhojraj ◽  
Pinki Devi
Keyword(s):  
Spine Surgery ◽  
Anticoagulation Therapy ◽  
Vena Cava ◽  
Cost Effective ◽  
Diagnostic Procedures ◽  
Lower Limbs ◽  
Vein Thrombosis ◽  
Surgery Patient ◽  
Patients At Risk ◽  
Low Sensitivity

Postoperative deep vein thrombosis (DVT) of lower limbs is often asymptomatic. In many patients, fatal pulmonary embolism (PE) is the first clinical manifestation of postoperative venous thromboembolism (VTE). Routine screening for asymptomatic DVT of the lower limbs has a low sensitivity and is quite impractical. For these reasons, routine and systematic prophylaxis in patients at risk, is the strategy of choice to reduce the burden of VTE after surgery. If used appropriately such prophylaxis is cost effective since it reduces the incidence of symptomatic thromboembolic events, which require costly diagnostic procedures and prolonged anticoagulation therapy. Here we report the post-operative course of a spine surgery patient, presenting with DVT in calf veins, which lodged into pulmonary artery and was managed successfully with low molecular weight heparin (LMWH), embolectomy, inferior vena cava (IVC) filter, and dabigatran.

scholarly journals Dermo-Hipodermites Bacterianas Agudas Não Necrotizantes: Erisipela e Celulite Infeciosa

2021 ◽  
Vol 34 (3) ◽  
pp. 217
Author(s):  
Maria Alexandra Rodrigues ◽  
Mónica Caetano ◽  
Isabel Amorim ◽  
Manuela Selores
Keyword(s):  
Risk Factors ◽  
Necrotizing Fasciitis ◽  
Lower Limbs ◽  
First Line ◽  
Correct Treatment ◽  
Vein Thrombosis ◽  
Group A ◽  
Low Sensitivity ◽  
Atypical Presentations ◽  
Main Complication

Non-necrotizing acute dermo-hypodermal infections are infectious processes that include erysipela and infectious cellulitis, and are mainly caused by group A β-haemolytic streptococcus. The lower limbs are affected in more than 80% of cases and the risk factors are disruption of cutaneous barrier, lymphoedema and obesity. Diagnosis is clinical and in a typical setting we observe an acute inflammatory plaque with fever, lymphangitis, adenopathy and leucocytosis. Bacteriology is usually not helpful because of low sensitivity or delayed positivity. In case of atypical presentations, erysipela must be distinguished from necrotizing fasciitis and acute vein thrombosis. Flucloxacillin and cefradine remain the first line of treatment. Recurrence is the main complication, so correct treatment of the risk factors is crucial.

scholarly journals Inferior Vena Cava Agenesis and Deep Vein Thrombosis: A Pharmacological Alternative to Vitamin K Antagonists

2019 ◽  
Author(s):  
Inês Esteves Cruz ◽  
Pedro Ferreira ◽  
Raquel Silva ◽  
Francisco Silva ◽  
Isabel Madruga
Keyword(s):  
Deep Vein Thrombosis ◽  
Inferior Vena Cava ◽  
Vitamin K ◽  
Oral Anticoagulation ◽  
Inferior Vena ◽  
Vitamin K Antagonists ◽  
Anticoagulation Therapy ◽  
Vena Cava ◽  
Vein Thrombosis ◽  
Deep Vein

Inferior vena cava (IVC) agenesis is a rare congenital abnormality affecting the infrarenal segment, the suprarenal or the whole of the IVC. It has an estimated prevalence of up to 1% in the general population that can rise to 8.7% when abnormalities of the left renal vein are considered. Most IVC malformations are asymptomatic but may be associated with nonspecific symptoms or present as deep vein thrombosis (DVT). Up to 5% of young individuals under 30 years of age with unprovoked DVT are found to have this condition. Regarding the treatment of IVC agenesis-associated DVT, there are no standard guidelines. Treatment is directed towards preventing thrombosis or its recurrence. Low molecular weight heparin and oral anticoagulation medication, in particular vitamin K antagonists (VKAs) are the mainstay of therapy. Given the high risk of DVT recurrence in these patients, oral anticoagulation therapy is suggested to be pursued indefinitely. As far as we know, this is the first case reporting the use of a direct factor Xa inhibitor in IVC agenesis-associated DVT. Given VKA monitoring limitations, the use of a direct Xa inhibitor could be an alternative in young individuals with anatomical defects without thrombophilia, but further studies will be needed to confirm its efficacy and safety.

scholarly journals Venous Thrombosis in Acquired Hemophilia: The Complex Management of Competing Pathologies

TH Open ◽  
2019 ◽  
Vol 03 (04) ◽  
pp. e325-e330 ◽  
Author(s):  
Manu Chhabra ◽  
Zhen Wan Stephanie Hii ◽  
Joseph Rajendran ◽  
Kuperan Ponnudurai ◽  
Bingwen Eugene Fan
Keyword(s):  
Venous Thrombosis ◽  
Vena Cava ◽  
Cost Effective ◽  
Major Surgery ◽  
High Dose ◽  
Acquired Hemophilia ◽  
Vein Thrombosis ◽  
Associated Conditions ◽  
Activated Prothrombin Complex Concentrates ◽  
Deep Vein

Abstract Introduction Venous thrombosis is rare in the setting of factor VIII (FVIII) deficiency. Cases of deep vein thrombosis (DVT) have been described in hemophiliacs after recent major surgery, or in association with the administration of FVIII concentrate and activated prothrombin complex concentrates, but occurrence of spontaneous DVT is even more uncommon. Aim We describe the challenging management of extensive DVT in a patient with acquired hemophilia A with concurrent hemorrhagic manifestations and review similar published cases. Methods We summarize a series of 10 cases with the following demographics: 6 males and 4 females; median age at presentation of 65 (21–80); mean inhibitor titer of 68.5 Bethesda Units (BU 1.9 to BU 350). Results Four cases were idiopathic and six had associated conditions (cancer [two cases], recent pregnancy [two cases], and recent surgery [two cases]). Three cases had an inferior vena cava filter inserted for acute lower limb DVT/pulmonary embolism. Inhibitor eradication was achieved with high-dose steroids with or without cyclophosphamide, and adjunct Rituximab administration was used in three cases. One patient received concurrent therapeutic plasma exchange (TPE). Inhibitor eradication was fastest with concurrent TPE at 6 days (range: 6–733 days). The 30-day survival was 90%. Conclusions There was adequate response of inhibitors to immunosuppression with steroids and cyclophosphamide therapy. For more refractory disease, Rituximab is emerging as a beneficial and cost-effective adjunct with better rates of complete remission, and the threshold for its use may be lowered in this complex cohort with dual competing pathologies.

High utilization rate of vena cava filters in deep vein thrombosis

2005 ◽  
Vol 93 (06) ◽  
pp. 1117-1119 ◽  
Author(s):  
Samuel Goldhaber ◽  
Victor Tapson ◽  
Michael Jaff
Keyword(s):  
Deep Vein Thrombosis ◽  
Anticoagulation Therapy ◽  
Vena Cava ◽  
Duplex Ultrasound ◽  
Physician Education ◽  
Utilization Rate ◽  
Thromboembolism Prophylaxis ◽  
Vein Thrombosis ◽  
Vena Cava Filters ◽  
Deep Vein

SummaryThe objective was to investigate newly diagnosed patients with deep vein thrombosis (DVT) who received inferior vena cava filters (IVCFs). A prospective registry enrolled 5451 patients from 183 US study sites. In all patients, examination by venous duplex ultrasound confirmed the diagnosis of DVT. We collected and analyzed data on 781 patients who received an IVCF . The most frequently prescribed treatments were low–molecular-weight heparin and unfractionated heparin, which were used as a bridge to warfarin in 39% (n=2143) and 35% (n=1926) of patients, respectively. Of the total population, 781 (14%) (235 outpatients, 546 inpatients) underwent IVCF placement. The most common reasons for IVCF placement were contraindication to anticoagulation (n = 271), prophylaxis (n = 259), major bleeding related to anticoagulation therapy (n = 92), and anticoagulation failure (n = 73). Multivariate analysis revealed that patients were more likely to undergo IVCF insertion with multiple system organ failure (odds ratio [OR], 3.6; 95% CI, 1.48–8.60), previous stroke (OR, 3.2; 95% CI, 2.11–4.74), or history of pulmonary embolism (OR, 2.4; 95% CI, 1.95–2.91). In conclusion, a surprisingly high 14% (781) of patients with confirmed DVT received an IVCF. Many of these patients may have warranted less invasive methods of venous thromboembolism prophylaxis. Improved physician education regarding mechanical and pharmacologic prophylaxis alternatives might reduce the use of IVCFs.

P1450Deep vein thrombosis after right sided catheter ablation; more common then previously thought?

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
C Bruce ◽  
S Rogers ◽  
K Saraf ◽  
G Kirkwood ◽  
N Kirkland ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Femoral Vein ◽  
Accessory Pathway ◽  
Significant Proportion ◽  
Anticoagulation Therapy ◽  
Vena Cava ◽  
Iliac Vein ◽  
P Value ◽  
Cardiac Catheter ◽  
Vein Thrombosis

Abstract Funding Acknowledgements Bristol-Myers Squibb Background Right sided cardiac catheter ablation has become an indispensable tool to treat supraventricular cardiac dysrhythmias, with ablation of certain arrhythmias having cure rates over 90%. Due to this the frequency of these procedures is increasing annually and it is imperative we understand the incidence of all complication. One lesser studied complication is that of deep vein thrombosis (DVT), for which catheter ablation demonstrates all elements of Virchow"s triad.  As right sided ablations are carried out to treat troublesome palpitations, not to reduce mortality, it is important all risks are identified, especially those which are themselves potentially life threatening and can be modified. Purpose   To determine the incidence of DVT after right sided cardiac catheter ablation. Methods   We undertook a prospective multi-center study recruiting adult patients undergoing clinically indicated cardiac ablation for atrioventricular nodal re-entrant tachycardia and atrioventricular re-entrant tachycardia with right sided accessory pathway. Important exclusion criteria included patients on anticoagulation or antiplatelet therapy. Participants underwent bilateral compression venous duplex ultrasonography from the inferior vena cava to the popliteal vein to access for DVT at 24 hours and between 10 to 14 days post-procedure. The uncannulated contralateral leg acted as a control. Result   At interim analysis 71 participants had completed the study with average age 47 year (+/- 14), procedure duration 67 minutes, and with a female predominance. Seven patients developed acute DVT in either the femoral or internal iliac vein in the access leg. No thrombus was seen in the control leg. This gives an incidence of 10% (95% CI 4-19%) with p value of 0.023 on Chi-square testing. Conclusion We found a statistically significant proportion of patients undergoing right sided cardiac catheter ablation developed acute proximal DVT on ultrasound. All patients were treated with 3 to 6 months of anticoagulation therapy in accordance with NICE guidelines. These results suggest that DVT may occur at a high frequency then previously thought in this cohort and supports the consideration of peri-procedural prophylactic anticoagulation. Abstract Figure. Acute thrombus in the femoral vein

Efficacy and Safety of Tinzaparin Sodium as a Bridging Agent for Patients on Oral Anticoagulant Undergoing General Surgery: Clinical Experience with the First 100 Consecutive Patients.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4123-4123
Author(s):  
Spiridon K. Volteas ◽  
Anastasios Babos
Keyword(s):  
Blood Loss ◽  
General Surgery ◽  
Oral Anticoagulant ◽  
Oral Anticoagulants ◽  
Lower Limbs ◽  
Duodenal Perforation ◽  
Efficacy And Safety ◽  
Vein Thrombosis ◽  
Surgery Patient ◽  
Tinzaparin Sodium

Abstract The aim of the present prospective study was to test the efficacy and safety of a bridging protocol in patients under oral anticoagulants (OA) who need to undergo general surgery. One hundred consecutive patients receiving oral anticoagulant accenocoumarol for various cardiovascular disorders entered the study. Patients underwent 107 scheduled operations (among them 41 cholecystectomies, 24 colectomies, 13 hernia repairs and 9 ERCPs, the 7 followed by cholecystectomy), receiving the low molecular weight heparin (LMWH) tinzaparin sodium as the bridging agent. At least 4 days prior to the operation the OA was replaced with tinzaparin at a daily dose of 175 anti-Xa IU per kg of body weight. Patients received no LMWH on the day of the operation and the OA was co-administered with tinzaparin on the second post-operative day and for at least 2 days. When target INR (2.5 to 3) was achieved, tinzaparin administration was stopped. Lower limbs color duplex was performed pre-operatively and on the 2nd, 8th–10th and 20th–30th post-operative day. Complete anticoagulation profile, intra-operative bleeding and post-operative blood loss, large haematoma development (over 5 cm in diameter), deep vein thrombosis (DVT) and 30-day morbidity and mortality were thoroughly recorded. During the 30-day period 1 patient died (from sepsis), 9 developed wound infections and three underwent re-operations (two for anastomotic leaks and one for duodenal perforation following ERCP). None of these events was related to the bridging process. There were no proximal DVTs. Three asymptomatic distal vein thromboses (2 posterior tibial and one peroneal ) were identified on post-operative duplex scan. No large wound haematomas were seen. One colorectal surgery patient had a drain blood loss of 460 ml on the first and 140 ml on the second post-operative day, requiring blood transfusion; tinzaparin administration was delayed for three days in this case. Finally, in 17 cases we had difficulties in adjusting INR levels to the desired range; in these cases tinzaparin administration was prolonged for 2–5 days. We conclude that our bridging protocol, using therapeutic doses of the LMWH tinzaparin sodium as the bridging agent, is both safe and effective for replacing OAs in patients undergoing general surgery operations.

scholarly journals Markers Of Coagulation And Hemostatic Activation Identify COVID-19 Patients At High Risk For Thrombotic Events, ICU Admission and Intubation

2020 ◽  
Author(s):  
Darwish Alabyad ◽  
Srikant Rangaraju ◽  
Michael Liu ◽  
Rajeel Imran ◽  
Christine L. Kempton ◽  
...  
Keyword(s):  
Thrombotic Event ◽  
Anticoagulation Therapy ◽  
Vascular Events ◽  
Icu Admission ◽  
Vein Thrombosis ◽  
Coagulation Marker ◽  
Increased Risk ◽  
Patients At Risk ◽  
Deep Vein ◽  
D Dimer

ABSTRACTBackgroundCoronavirus disease 2019 (COVID-19) has been associated with a coagulopathy giving rise to venous and arterial thrombotic events. The objective of our study was to determine whether markers of coagulation and hemostatic activation (MOCHA) on admission could identify COVID-19 patients at risk for thrombotic events and other complications.MethodsCOVID-19 patients admitted to a tertiary academic healthcare system from April 3, 2020 to July 31, 2020 underwent standardized admission testing of MOCHA profile parameters (plasma d-dimer, prothrombin fragment 1.2, thrombin-antithrombin complex, and fibrin monomer) with abnormal MOCHA defined as ≥ 2 markers above the reference. Prespecified thrombotic endpoints included deep vein thrombosis, pulmonary embolism, myocardial infarction, ischemic stroke, and access line thrombosis; other complications included ICU admission, intubation and mortality. We excluded patients on anticoagulation therapy prior to admission and those who were pregnant.ResultsOf 276 patients (mean age 59 ± 6.4 years, 47% female, 62% African American race) who met study criteria, 45 (16%) had a thrombotic event. Each coagulation marker on admission was independently associated with a vascular endpoint (p<0.05). Admission MOCHA with ≥ 2 abnormalities (n=203, 74%) was associated with in-hospital vascular endpoints (OR 3.3, 95% CI 1.2-8.8), as were admission D-dimer ≥ 2000 ng/mL (OR 3.1, 95% CI 1.5-6.6), and admission D-dimer ≥ 3000 ng/mL (OR 3.6, 95% CI 1.6-7.9). However, only admission MOCHA with ≥ 2 abnormalities was associated with ICU admission (OR 3.0, 95% CI 1.7-5.2) and intubation (OR 3.2, 95% CI 1.6-6.4), while admission D-dimer ≥2000 ng/mL and admission D-dimer ≥ 3000 ng/mL were not associated. MOCHA and D-dimer cutoffs were not associated with mortality. Admission MOCHA with <2 abnormalities (26% of the cohort) had a sensitivity of 88% and negative predictive value of 93% for a vascular endpoint.ConclusionsAdmission MOCHA with ≥ 2 abnormalities identified COVID-19 patients at increased risk of ICU admission and intubation during hospitalization more effectively than isolated admission D-dimer measurement. Admission MOCHA with <2 abnormalities identified a subgroup of patients at low risk for vascular events. Our results suggest that an admission MOCHA profile can be useful to risk-stratify COVID-19 patients.

Deep Vein Thrombosis and Venous Thromboembolism in the Critically Ill

2017 ◽  
Author(s):  
Kathryn L. Butler ◽  
George Velmahos
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Critically Ill ◽  
Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Vena Cava ◽  
Vein Thrombosis ◽  
Vena Cava Filters ◽  
Deep Vein

Venous thromboembolism (VTE) poses unique diagnostic and therapeutic dilemmas in the intensive care unit (ICU). Immobility, inflammatory states, and trauma uniquely predispose surgical ICU patients to deep vein thrombosis and pulmonary embolism. Concurrently, the risks of perioperative and traumatic bleeding complicate management of VTE, with anticoagulation contraindicated in many scenarios. This review surveys the latest evidence in the diagnosis and management of VTE among critically ill surgical patients. It discusses evidence-based guidelines regarding diagnostic imaging, anticoagulation, prophylaxis, inferior vena cava filters, non–vitamin K oral anticoagulants, and surgical and catheter-based therapies. The review also examines the special challenges encountered when treating multisystem trauma patients.  Key words: anticoagulation therapy, deep vein thrombosis, pharmacoprophylaxis, pulmonary embolism, venous thromboembolism  

Abstract P112: Markers of Coagulation and Hemostatic Activation Identify Covid-19 Patients at High Risk for Thrombotic Events

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Darwish Alabyad ◽  
Srikant RANGARAJU ◽  
Michael Liu ◽  
Rajeel Imran ◽  
Christine L Kempton ◽  
...  
Keyword(s):  
At Risk ◽  
Thrombotic Event ◽  
Anticoagulation Therapy ◽  
Composite Endpoint ◽  
Icu Admission ◽  
Vein Thrombosis ◽  
Coagulation Marker ◽  
Patients At Risk ◽  
Thrombotic Complications ◽  
Deep Vein

Introduction: COVID-19 has been associated with venous and arterial thrombotic complications. The objective of our study was to determine whether markers of coagulation and hemostatic activation (MOCHA) on admission could identify COVID-19 patients at risk for thrombotic events. Methods: COVID-19 patients admitted to a tertiary academic healthcare system from April 3, 2020 to July 31, 2020 underwent admission testing of MOCHA profile parameters (plasma d-dimer, prothrombin fragment 1.2, thrombin-antithrombin complex, and fibrin monomer). For this analysis we excluded patients on outpatient anticoagulation therapy preceding admission. Prespecified endpoints monitored during hospitalization included deep vein thrombosis, pulmonary embolism, myocardial infarction, ischemic stroke and access line thrombosis. Results: During the study period, 276 patients were included in the analysis cohort (mean age 59 ± 6.3 years, 47% female, 83% non-white race). Arterial and venous thrombotic events occurred in 43 (16%) patients (see Table). Each coagulation marker was independently associated with the composite endpoint (p<0.05). Admission MOCHA with ≥ 2 abnormalities was associated with the composite endpoint (OR 3.1, 95% CI 1.2-8.3), ICU admission (OR 3.2, 95% CI 1.8-5.5) and intubation (OR 2.8, 95% CI 1.5-5.5). Admission MOCHA with < 2 abnormalities (26% of the cohort) had sensitivity of 88% and a negative predictive value of 93% for an in-hospital endpoint. Conclusion: Admission MOCHA with ≥ 2 abnormalities identified COVID-19 patients at risk for a thrombotic event, ICU admission and intubation while < 2 abnormalities identified a subgroup of patients who were at low risk for thrombotic events. Our results suggest that an admission MOCHA profile can be useful to risk stratify COVID-19 patients. Further studies are needed to determine whether an admission MOCHA profile can guide anticoagulation therapy and improve overall clinical outcomes.

scholarly journals Endovascular Therapy Is Effective for Leriche Syndrome with Deep Vein Thrombosis

2015 ◽  
Vol 2015 ◽  
pp. 1-5
Author(s):  
Tasuku Higashihara ◽  
Nobuo Shiode ◽  
Tomoharu Kawase ◽  
Hiromichi Tamekiyo ◽  
Masaya Otsuka ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Endovascular Therapy ◽  
Inferior Vena ◽  
Anticoagulation Therapy ◽  
Vena Cava ◽  
Stenotic Lesion ◽  
Vein Thrombosis ◽  
Leriche Syndrome ◽  
Angiographic Result ◽  
Deep Vein

A 65-year-old man presented to our hospital due to intermittent claudication and swelling in his left leg. He had Leriche syndrome and deep vein thrombosis. We performed endovascular therapy (EVT) for Leriche syndrome, and a temporary filter was inserted in the inferior vena cava. He received anticoagulation therapy for deep vein thrombosis. The stenotic lesion in the terminal aorta was stented with an excellent postprocedural angiographic result and dramatic clinical improvement after EVT. This case suggests that EVT can be a treatment for Leriche syndrome.

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