scholarly journals Complete recovery of deep venous thrombosis from Coombs (+) Thrombotic Thrombocytopenic Purpura: Case report

2020 ◽  
Author(s):  
Mi Zhou ◽  
Jie Yin
Keyword(s):  
Venous Thrombosis ◽  
Antiplatelet Therapy ◽  
Anticoagulation Therapy ◽  
Vena Cava ◽  
Signs And Symptoms ◽  
Complete Recovery ◽  
Pulse Therapy ◽  
Vein Thrombosis ◽  
Nerve System ◽  
Deep Vein

Catheter-related DVT under the setting of TTP or TTP recovery stage may be presented as a more fulminant form. Certain guidelines for anticoagulation and antiplatelet therapy for thrombosis early should be further established. We present here a case of a patient presented with Comb (+) TTP and developed catheter-associated deep vein thrombosis (DVT). The patient was firstly diagnosed with Evans syndrome. However, he was refractory to a methylprednisolone pulse therapy with a combination of platelet transfusion and eventually developed microangiopathy of central nerve system. The immediate start of PEX (1500ml/d) induced a complete remission of acquired TTP and disappearance of neurological signs and symptoms. However, external iliac and femoro-popliteal venous thrombosis was diagnosed subsequently, inferior vena cava filter (IVC) filter was immediately planting accompanied with anticoagulation therapy. Meanwhile, PEX session was sustained as well as oral anticoagulant (rivaroxaban). 14 days later, the patient got full recovery. Our report aims at raising awareness of Catheter-related DVT under the setting of TTP should be cautious. It is necessary to start anticoagulation and antiplatelet therapy for thrombosis early, especially in such cases when PLT count > 50×109/L.

scholarly journals Complete Recovery of Deep Venous Thrombosis From Coombs (+) Thrombotic Thrombocytopenic Purpura: Case Report

2021 ◽  
Author(s):  
Mi Zhou ◽  
Jie Yin
Keyword(s):  
Mortality Rate ◽  
Venous Thrombosis ◽  
Thrombotic Thrombocytopenic Purpura ◽  
Anticoagulation Therapy ◽  
Vena Cava ◽  
Signs And Symptoms ◽  
Complete Recovery ◽  
Pulse Therapy ◽  
Thrombocytopenic Purpura ◽  
Vein Thrombosis

Abstract Background: Acute thrombotic thrombocytopenic purpura (TTP) is an aggressive thrombotic microangiopathy that if not treated, can have a 90% mortality rate. Timely, extensive plasma exchange (PEX) has been indicated to reduce the mortality rate to<10%, but its side effects are not well-known. We present here a case of a patient presented with Comb (+) TTP and developed catheter-associated deep vein thrombosis (DVT).Case presentation: A 27-year-young man presented with persistent thrombocytopenia and Coombs positive anemia was firstly diagnosed with Evans syndrome. However, he was refractory to a methylprednisolone pulse therapy with a combination of platelet transfusion and eventually developed microangiopathy of central nerve system. Sever pathogenesis was prevented by PEX. The immediate start of PEX (1500ml/d) induced a complete remission of acquired TTP and disappearance of neurological signs and symptoms. However, external iliac and femoro-popliteal venous thrombosis was diagnosed subsequently, inferior vena cava filter (IVC) filter was immediately planting accompanied with anticoagulation therapy. Meanwhile, PEX session was sustained as well as oral anticoagulant (rivaroxaban). 14 days later, the patient got full recovery.Conclusions: Catheter-related DVT under the setting of TTP should be cautious. It is necessary to start anticoagulation and antiplatelet therapy for thrombosis early, especially in such cases when PLT count > 50×109/L.

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.

IS IT POSSIBLE TO PREDICT THE EFFICIENCY OF THE FIBRINOLYTIC AND SURGICAL TREATMENT OF DEEP VEIN THROMBOSIS BY ULTRASOUND IMAGING AND DOPPLER ?

1987 ◽  
Author(s):  
A Elias ◽  
J L Bouvier ◽  
G Le Corff ◽  
A Serradimigni
Keyword(s):  
Surgical Treatment ◽  
Venous Thrombosis ◽  
Inferior Vena ◽  
Vena Cava ◽  
Complete Obstruction ◽  
Complete Occlusion ◽  
Vein Thrombosis ◽  
Floating Thrombus ◽  
Deep Vein ◽  
Total Disappearance

The sucess of the fibrinolytic or surgical treatment of venous thrombosis depends largely on how old the thrombosis is.To study the therapeutic predictibility of the ultrasonographic signs,their pretherapeutic aspects were compared to the results of the fibrinolytic treatment during 3 days or to the anatomic aspects intra-operatively. This prospective study was carried out on 21 patients presenting an isolated venous thrombosis confirmed by venography. 65 involved venous segments from the popliteal to the inferior vena cava were studied.The following are analyzed : 1) The C.W. Doppler signal when there is a complete obstruction of the femoral iliac junction : absence or presence of flow (MEDAS0NICS BF4A 5.3MHZ).2)The morphological and dynamic aspects of the vein, the thrombus and the flow using echographic test (DIASONICS DRF 400. 10-7.5-5MHZ) were retained as predictible signs of sucessfull treatment a hypodens^homogeneous thrombus with major venous dilation (about twice the controlateral vein) where there is a total obstruction, and a free floating thrombus or even “elastic”,soft,compressible when there is a partial obstruction.The opposite signs were interpreted as predicting a therapeutic failure : a dense heterogeneous adherent and hard thrombus.The criteria for thrombolysis efficiency is the total disappearance of the thrombus when there was a partial obstruction,or a recanalization (>50%)where there was a complete occlusion.The ultrasonographic predictible signs compared with the effective results are indicated in the following tables.Ultrasonography enables most cases tne recognition or a “recent” thrombus from an “old” one and allows talcing thus a cal-lated risk. If the evaluation of the echotexture of the thrombus is subjective and technique dependant, and if an objective measurement of the density distribution insight the clot as reported is preferable, a combined study of the other ultrasonographic parameters seems to be essential.

scholarly journals Total preservation of patency and valve function after percutaneous pharmacomechanical thrombolysis using the Trellis®-8 system for an acute, extensive deep venous thrombosis

2012 ◽  
Vol 94 (2) ◽  
pp. e103-e105 ◽  
Author(s):  
JR Wormald ◽  
TRA Lane ◽  
PE Herbert ◽  
M Ellis ◽  
NJ Burfitt ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Venous Thrombosis ◽  
Lower Limb ◽  
Complete Recovery ◽  
Normal Function ◽  
Acute Management ◽  
Vein Thrombosis ◽  
Valve Function ◽  
Total Preservation ◽  
Deep Vein

Pharmacomechanical thrombolysis is being used increasingly for the treatment of deep vein thrombosis (DVT) and aims to reduce the severity of post-thrombotic syndrome. We report the case of a 60-year-old woman with extensive lower limb DVT that was treated using pharmacomechanical thrombolysis leading to complete recovery of her deep venous system. The prompt use of pharmacomechanical thrombolysis for the acute management of extensive DVT should be considered when treating patients with extensive DVT in order to facilitate return of normal function.

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  

Management of Acute Iliofemoral Deep Vein Thrombosis

2018 ◽  
Author(s):  
Albeir Y Mousa
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Inferior Vena ◽  
Vena Cava ◽  
External Compression ◽  
Vein Thrombosis ◽  
Surgical Thrombectomy ◽  
Deep Vein

Acute deep venous thrombosis (DVT) of iliofemoral segment is one of the most dreaded presentations of venous thromboembolism, as it can not only compromise the function of the extremity but may also result in pulmonary embolism and even death. There are many causes for acute iliofemoral DVT, including underdiagnosed May-Thurner syndrome, hypercoagulable syndrome, and external compression on iliocaval segment. The available treatment depends on the acuity of the symptoms. Acute iliofemoral DVT can be treated with medical anticoagulation, pharmacomechanical therapy, including thrombolysis or surgical thrombectomy. Chronic iliofemoral occlusion may be treated with recanalization of the occluded segments with angioplasty stenting. This review contains 4 Figures, 4 Tables and 63 references Key Words: acute, angioplasty, deep venous thrombosis, iliofemoral, inferior vena cava, pharmacomechanical therapy, occlusion, stent

Management of Acute Iliofemoral Deep Vein Thrombosis

2018 ◽  
Author(s):  
Albeir Y Mousa
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Inferior Vena ◽  
Vena Cava ◽  
External Compression ◽  
Vein Thrombosis ◽  
Surgical Thrombectomy ◽  
Deep Vein

Acute deep venous thrombosis (DVT) of iliofemoral segment is one of the most dreaded presentations of venous thromboembolism, as it can not only compromise the function of the extremity but may also result in pulmonary embolism and even death. There are many causes for acute iliofemoral DVT, including underdiagnosed May-Thurner syndrome, hypercoagulable syndrome, and external compression on iliocaval segment. The available treatment depends on the acuity of the symptoms. Acute iliofemoral DVT can be treated with medical anticoagulation, pharmacomechanical therapy, including thrombolysis or surgical thrombectomy. Chronic iliofemoral occlusion may be treated with recanalization of the occluded segments with angioplasty stenting. This review contains 4 Figures, 4 Tables and 63 references Key Words: acute, angioplasty, deep venous thrombosis, iliofemoral, inferior vena cava, pharmacomechanical therapy, occlusion, stent

scholarly journals Deep Venous Thrombosis Associated With Inferior Vena Cava Abnormalities And Hypoplastic Kidney In Siblings

2016 ◽  
Vol 62 (2) ◽  
pp. 266-268 ◽  
Author(s):  
Carmen Duicu ◽  
Gabriela Bucur ◽  
Iunius Simu ◽  
Florin Tripon ◽  
Oana Marginean
Keyword(s):  
Deep Vein Thrombosis ◽  
Inferior Vena Cava ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Inferior Vena ◽  
Vena Cava ◽  
Vein Thrombosis ◽  
Reduced Frequency ◽  
Angio Ct ◽  
Deep Vein

AbstractCongenital inferior vena cava anomalies have a reduced frequency in general population, many times being an asymptomatic finding. Patients caring such anomalies are at risk to develop deep vein thrombosis. In this paper, we present 2 siblings with deep venous thrombosis and inferior vena cava abnormalities, with a symptomatic onset at similar age. The inferior vena cava abnormality was documented by an angio-CT in each case. The thrombophilic workup was negative. Patients were treated with conservative therapy: low molecular weight heparin anticoagulants converted later to oral anticoagulant with resolution of symptoms and disappearance of the thrombus. Finally, in the absence of any risk factor in a young patient admitted with deep vein thrombosis investigations to exclude inferior vena cava anomalies are mandatory.

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