Arterial thrombosis, the unfairly forgotten actor in COVID-19: a case series

Abstract Background. - It is known that patients with COVID-19 are at increased risk of thrombosis. Although COVID-19 infection primarily affects the lower respiratory tract system, emerging reports suggest direct and indirect cardiovascular complications. However, the key mechanisms under thrombosis development at great arterial vessels are still unclear.Case presentation. – We report the cases of 4 patients who were admitted to our hospital and suffered from arterial thrombotic complications. All of them were older than 60 years and only 1 did not have cardiovascular risk factors. It should be noted that days prior to the diagnosis of arterial thrombosis, 3 of the 4 patients were under anticoagulant treatment. It is also interesting that in contrast to already known typical microvascular locations, our patients suffered from large arterial vessels thrombosis. Furthermore, none of them would present with severe respiratory symptoms. Conclusions. – The underlying mechanism of COVID-19-associated arterial thrombosis remains unclear and might be independent of the cytokine storm that occurs in patients with COVID-19-associated venous thrombosis. Also, the role of anti-platelets agents as prophylactic treatment in high-risk patients remains unclear. Multicenter clinical trials are necessary to clarify these issues.

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CLINICAL CHALLENGES FOR ANESTHESIOLOGIST FACING PATIENT WITH ACROMEGALY. CASE REPORT

10.35988/sm-hs.2020.069 ◽

2020 ◽

Vol 30 (3) ◽

pp. 56-59

Author(s):

Jūratė Gudaitytė ◽

Justina Jermolajevaitė ◽

Martynas Judickas

Keyword(s):

Atrial Fibrillation ◽

Case Report ◽

General Population ◽

Metabolic Disorders ◽

Upper Airway ◽

Cardiovascular Complications ◽

Case Presentation ◽

Increased Risk ◽

Fluid Regulation ◽

Class Iv

Background and objectives: Acromegaly is endocrinal disorder which results in changes involving general appearance as well as upper airway abnormalities, cardiovascular and metabolic disorders which can aggravate the anesthesia and can lead to complications. We aim to discuss the challenges for anesthesiologist that occurs facing patient with acromegaly and are necessary to investigate before performing any kind of intervention. Case Presentation: 79 years old male patient presented the hospital with recently diagnosed acromegaly for rectal prolapse surgery. From anamnesis he had NYHAIII with cardiomyopathy, atrial fibrillation and arterial hypertension, also multiple old compressive fractures Th10 – L5. He was graded with Mallampati score IV and ASA class IV. The complementary examinations were made to assess the possible complications. In induction of general anesthesia the intubation was performed using fibro- bronchoscope and anesthesia went without complications except hypotension which was managed. After surgery the patient was leaded to the postoperative room for further monitoring. Discussion and Conclusion: Acromegalic patients have an increased risk of difficulty during anesthesia compared to general population due to difficult intubation, cardiovascular complications , OSA , alteration in intraoperative glucose intolerance and fluid regulation. Therefore profound investigation and assessment are necessary to predict and prepare for possible difficulties in the surgery room.

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Thrombosis in IBD in the Era of JAK Inhibition

Current Drug Targets ◽

10.2174/1389450121666200902164240 ◽

2020 ◽

Vol 22 (1) ◽

pp. 126-136

Author(s):

Virginia Solitano ◽

Gionata Fiorino ◽

Ferdinando D’Amico ◽

Laurent Peyrin-Biroulet ◽

Silvio Danese

Keyword(s):

Small Molecules ◽

Arterial Thrombosis ◽

Protective Role ◽

Jak Inhibitors ◽

Thrombotic Risk ◽

Increased Risk ◽

Bowel Diseases ◽

Thrombotic Complications ◽

Inflammatory Bowel ◽

Inflammatory Effect

: Patients with inflammatory bowel diseases (IBD) have an increased risk of thrombosis. The interaction between inflammation and coagulation has been extensively studied. It is well-known that some drugs can influence the haemostatic system, but several concerns on the association between therapies and increased risk of thrombosis remain open. While biologics seem to have a protective role against thrombosis via their anti-inflammatory effect, some concerns about an increased risk of thrombosis with JAK inhibitors have been raised. We conducted a literature review to assess the association between biologics/small molecules and venous/arterial thrombotic complications. An increased risk of venous and arterial thrombosis was found in patients treated with corticosteroids, whereas anti-TNF were considered protective agents. No thromboembolic adverse event was reported with vedolizumab and ustekinumab. In addition, thromboembolic events rarely occurred in patients with ulcerative colitis (UC) after therapy with tofacitinib. The overall risk of both venous and arterial thrombosis was not increased based on the available evidence. Finally, in the era of JAK inhibitors, treatment should be individualized by evaluating the pre-existing potential thrombotic risk balanced with the intrinsic risk of the medication used.

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Continuous Ambulatory Peritoneal Dialysis in High-Risk Patients: Patients with Cardiovascular Diseases -Role of the Nurse

Peritoneal Dialysis International ◽

10.1177/089686089901902s83 ◽

1999 ◽

Vol 19 (2_suppl) ◽

pp. 499-503

Author(s):

Marie-Christine Z. Lambert ◽

Holger Schilling

Keyword(s):

Cardiovascular Disease ◽

Peritoneal Dialysis ◽

Ventricular Hypertrophy ◽

Cardiovascular Complications ◽

Left Ventricular ◽

Therapeutic Success ◽

Risk Patients ◽

Continuous Peritoneal Dialysis ◽

Artery Disease

Most patients receiving renal replacement therapy have cardiovascular disease. The most frequent conditions are left ventricular hypertrophy and coronary artery disease. Hemodialysis is associated with a characteristic spectrum of acute complications (such as hypotension, sudden death) that can be explained by typical dialysis -induced effects on the heart. With continuous peritoneal dialysis (CAPO) some of the cardiovascular complications are ameliorated owing to slow ultrafiltration and absence of an arteriovenous fistula. CAPO might be concluded to be the preferable option in patients with cardiovascular disease, but a few disadvantages, such as hyperlipidemia and hyperinsulinemia, also exist. Nurses also play an important role in the therapeutic success and outcomes of these patients.

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Serious complications and risk of re-operation after Dupuytren’s disease surgery: a population-based cohort study of 121,488 patients in England

Scientific Reports ◽

10.1038/s41598-020-73595-y ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Osaid Alser ◽

Richard S. Craig ◽

Jennifer C. E. Lane ◽

Albert Prats-Uribe ◽

Danielle E. Robinson ◽

...

Keyword(s):

Cohort Study ◽

High Risk ◽

Case Series ◽

Population Based ◽

Dupuytren’S Disease ◽

Dupuytren's Disease ◽

Systemic Complications ◽

Increased Risk ◽

Risk Patients ◽

Limited Fasciectomy

Abstract Dupuytren’s disease (DD) is a common fibro-proliferative disorder of the palm. We estimated the risk of serious local and systemic complications and re-operation after DD surgery. We queried England’s Hospital Episode Statistics database and included all adult DD patients who were surgically treated. A longitudinal cohort study and self-controlled case series were conducted. Between 1 April 2007 and 31 March 2017, 121,488 adults underwent 158,119 operations for DD. The cumulative incidence of 90-day serious local complications was low at 1.2% (95% CI 1.1–1.2). However, the amputation rate for re-operation by limited fasciectomy following dermofasciectomy was 8%. 90-day systemic complications were also uncommon at 0.78% (95% CI 0.74–0.83), however operations routinely performed under general or regional anaesthesia carried an increased risk of serious systemic complications such as myocardial infarction. Re-operation was lower than previous reports (33.7% for percutaneous needle fasciotomy, 19.5% for limited fasciectomy, and 18.2% for dermofasciectomy). Overall, DD surgery performed in England was safe; however, re-operation by after dermofasciectomy carries a high risk of amputation. Furthermore, whilst serious systemic complications were unusual, the data suggest that high-risk patients should undergo treatment under local anaesthesia. These data will inform better shared decision-making regarding this common condition.

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Role of Montgomery salivary stent placement during pharyngolaryngectomy, to prevent pharyngocutaneous fistula in high-risk patients

The Journal of Laryngology & Otology ◽

10.1017/s0022215112002502 ◽

2012 ◽

Vol 127 (1) ◽

pp. 54-57 ◽

Cited By ~ 9

Author(s):

S Bondi ◽

L Giordano ◽

P Limardo ◽

M Bussi

Keyword(s):

Statistical Analysis ◽

High Risk ◽

Retrospective Analysis ◽

Stent Placement ◽

Pharyngocutaneous Fistula ◽

Preventive Effect ◽

Increased Risk ◽

Risk Patients ◽

Base Of The Tongue

AbstractObjective:To evaluate the incidence of pharyngocutaneous fistula after pharyngolaryngectomy with and without a Montgomery salivary stent.Design:Retrospective analysis of patients with factors that predispose to the development of pharyngocutaneous fistula (i.e. disease extending to the supraglottic region, base of the tongue or pyriform sinuses, and/or radiochemotherapy).Subjects:Between 2002 and 2008, 85 pharyngolaryngectomies were performed in our clinic. Of these patients, 31 were at increased risk of fistula development, of whom 45 per cent developed fistulas post-operatively. This subgroup of 31 patients was compared with a second subgroup of 22 patients at high risk of fistula development, treated between 2009 and 2011 with pharyngolaryngectomy and with a Montgomery salivary stent placed in advance during closure of the neopharynx.Results:Statistical analysis showed a significant reduction in the rate of fistula development, from 45 to 9 per cent (p < 0.01), with application of the salivary stent.Conclusion:These data confirm the preventive effect of a salivary stent placed during pharyngolaryngectomy, for patients at high risk of fistula development.

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Cerebral amyloid angiopathy–associated intracerebral hemorrhage: pathology and management

Neurosurgical FOCUS ◽

10.3171/2012.1.focus11370 ◽

2012 ◽

Vol 32 (4) ◽

pp. E7 ◽

Cited By ~ 46

Author(s):

Prachi Mehndiratta ◽

Sunil Manjila ◽

Thomas Ostergard ◽

Sylvia Eisele ◽

Mark L. Cohen ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Cerebral Amyloid Angiopathy ◽

Management Strategies ◽

Case Series ◽

The Elderly ◽

Postoperative Hemorrhage ◽

Amyloid Angiopathy ◽

Increased Risk ◽

Cerebral Amyloid

Amyloid angiopathy–associated intracerebral hemorrhage (ICH) comprises 12%–15% of lobar ICH in the elderly. This growing population has an increasing incidence of thrombolysis-related hemorrhages, causing the management of hemorrhages associated with cerebral amyloid angiopathy (CAA) to take center stage. A concise reference assimilating the pathology and management of this clinical entity does not exist. Amyloid angiopathy–associated hemorrhages are most often solitary, but the natural history often progresses to include multifocal and recurrent hemorrhages. Compared with other causes of ICH, patients with CAA-associated hemorrhages have a lower mortality rate but an increased risk of recurrence. Unlike hypertensive arteriolar hemorrhages that occur in penetrating subcortical vessels, CAA-associated hemorrhages are superficial in location due to preferential involvement of vessels in the cerebral cortex and meninges. This feature makes CAA-associated hemorrhages easier to access surgically. In this paper, the authors discuss 3 postulates regarding the pathogenesis of amyloid hemorrhages, as well as the established clinicopathological classification of amyloid angiopathy and CAA-associated ICH. Common inheritance patterns of familial CAA with hemorrhagic strokes are discussed along with the role of genetic screening in relatives of patients with CAA. The radiological characteristics of CAA are described with specific attention to CAA-associated microhemorrhages. The detection of these microhemorrhages may have important clinical implications on the administration of anticoagulation and antiplatelet therapy in patients with probable CAA. Poor patient outcome in CAA-associated ICH is associated with dementia, increasing age, hematoma volume and location, initial Glasgow Coma Scale score, and intraventricular extension. The surgical management strategies for amyloid hemorrhages are discussed with a review of published surgical case series and their outcomes with a special attention to postoperative hemorrhage.

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The hardness of the vessel wall in patients with arterial hypertension

Systemic Hypertension ◽

10.26442/sg29073 ◽

2015 ◽

Vol 12 (2) ◽

pp. 43-48

Author(s):

O D Ostroumova ◽

A I Kochetkov ◽

I I Kopchenov ◽

T F Guseva ◽

O V Bondarec

Keyword(s):

Arterial Hypertension ◽

Vessel Wall ◽

Antihypertensive Drugs ◽

Blood Pressure Level ◽

Vascular Wall ◽

Cardiovascular Complications ◽

Increased Risk ◽

The Status ◽

The Difference

The article deals with the role of the hardness of the vessel wall in the pathogenesis of arterial hypertension and its complications and cardiovascular mortality. We discussed the factors increasing the hardness of the vessel wall, such as age, blood pressure level, atherosclerosis, smoking and diabetes mellitus. We showed the indicators reflecting the status of the vascular wall and which could play a role of markers of increased risk of cardiovascular complications. We reviewed the data concerning the improvement of the parameters of the hardness of the vessel wall under the influence of antihypertensive therapy using the angiotensin II type 1 receptor blocker - candesartan. We discussed the possible mechanisms of the candesartan influence on the elastic properties of the vessels. We stressed that the effect on the hardness of the arteries on using antihypertensive drugs, even within the same class, was different, which, apparently, was associated with the difference in the pharmacokinetic properties.

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The role of endothelial damage and dyslipidemia in the development of cardiovascular pathology in psoriatic arthritis

Vestnik dermatologii i venerologii ◽

10.25208/vdv1206 ◽

2021 ◽

Vol 97 (2) ◽

pp. 16-22

Author(s):

Zarema R. Khismatullina ◽

Ksenia M. Koreshkova

Keyword(s):

Psoriatic Arthritis ◽

Vascular Wall ◽

Cardiovascular Complications ◽

Endothelial Damage ◽

Very Low Density Lipoproteins ◽

Cardiovascular Pathology ◽

Immune Mediated ◽

Increased Risk ◽

Complications And Mortality

An increased risk of cardiovascular events has now been identified in patients with psoriatic arthritis. The chronic immune-mediated inflammation underlying psoriatic arthritis (PA) leads to the development of dyslipidemia, atherosclerosis and its complications, in particular, a high risk of cardiovascular complications. For PA, dyslipidemias are most characteristic, manifested by an increased level of low and very low density lipoproteins, triglycerides and total cholesterol, which correlates with the activity of the disease. The literature review studied the pathogenesis of dyslipidemias and vascular wall lesions in psoriatic arthritis, analyzed the literature on cardiovascular complications and mortality among patients with PA, studied the issues of total cardiovascular risk, presented the results of numerous clinical studies that allow PA to be considered a disease associated with increased the risk of cardiovascular complications. Considering the role of proinflammatory cytokines in the pathogenesis of psoriatic arthritis, early detection of endothelial lesions represents the most promising direction in the prevention of cardiovascular diseases, which are the main cause of mortality in this group of patients.

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Experimental models for vascular endothelial dysfunction

Bangladesh Journal of Pharmacology ◽

10.3329/bjp.v16i3.52948 ◽

2021 ◽

Vol 16 (3) ◽

pp. 65-83

Author(s):

Anchal Garg ◽

Vardan Gupta ◽

Ritu Tomar ◽

Mandeep Kumar Arora

Keyword(s):

Endothelial Dysfunction ◽

Animal Models ◽

Underlying Mechanism ◽

Cardiovascular Complications ◽

Experimental Models ◽

New Drugs ◽

Vascular Endothelial ◽

Vascular Endothelial Dysfunction ◽

Vascular Integrity ◽

Increased Risk

Vascular endothelial dysfunction is characterized by apoptosis of endothelial cells, an imbalance between vasoconstrictory and vasodilatory substances, the imbalance between ROS and antioxidants, vascular remodeling, loss of vascular integrity which leads to an increased risk of cardiovascular complications. To date, no therapeutic intervention is available as a promising agent. This may be due to a poor understanding of the underlying mechanism involved in vascular endothelial dysfunction in the pathogenesis. Animal models sharing identical features as that of humans are paramount to understand fundamental physiology, mechanism and to explore new targets for developing therapeutic agents. Thus, it becomes mandatory to re-explore the available animal models for a better understanding of molecular pathways involving vascular endothelial dysfunction. The purpose of this paper is to review different models for vascular endothelial dysfunction to the outlook for developing new drugs to treat vascular endothelial dysfunction.

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The Role of Patiromer in Delaying the Onset of Renal Replacement Therapy in Patients with Advanced Renal Failure

Case Reports in Nephrology ◽

10.1155/2021/6987456 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Nand K. Wadhwa ◽

Jason A. Kline ◽

Sreedhar R. Adapa

Keyword(s):

Chronic Kidney Disease ◽

Renal Failure ◽

Case Series ◽

Cardiovascular Morbidity And Mortality ◽

Increased Risk ◽

Stage 4 ◽

Initiation Of Dialysis ◽

Life Threatening ◽

Potassium Binding

Patients with chronic kidney disease (CKD) are at an increased risk of developing hyperkalemia, which can be potentially life threatening. Hyperkalemia is frequently encountered with renin-angiotensin-aldosterone system inhibitor (RAASi) therapy use in patients with CKD and often results in the underdosing or discontinuation of these drugs. RAASi therapy has been proven to delay the progression of CKD, ameliorate proteinuria, and reduce the overall risk of cardiovascular morbidity and mortality. Patiromer is a sodium-free, potassium-binding polymer used for the treatment of hyperkalemia. We present a case series of four patients with Stage 4 or 5 CKD in whom the initiation of dialysis was delayed with the use of patiromer. For one patient, dialysis was delayed by 18 months, whereas the remaining three patients, in whom hyperkalemia was one of the main complications, remain dialysis independent to date.

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