Venous tromboembolic complications in stroke

Актуальность работы обусловлена поиском путей улучшения результатов лечения больных инсультом. Цель исследования: выявить критерии прогноза риска развития венозных тромбозов, а также ключевые звенья патогенеза тромбоэмболических осложнений у пациентов с острым инсультом. Материалы и методы: в проспективное исследование включено 145 больных с инсультом (104 с ишемическим (ИИ) и 41 с геморрагическим (ГИ)), госпитализированных в отделение нейрореанимации в период 3,5-24 часа от начала заболевания и имеющих на момент включения в исследование различную степень депрессии сознания (тяжелая степень инсульта). Пациентам проводилась терапия в соответствии со стандартами оказания медицинской помощи, согласно которым всем пациентам назначали антикоагулянтную терапию (АКТ). Выполняемый в динамике стандартный клинико-диагностический и лабораторный мониторинг был дополнен тестом «Тромбодинамика». Результаты: у 95% пациентов с инсультом зарегистрированы различные факторы риска венозных тромбоэмболических осложнений (ВТЭО). Тромбоэмболия легочной артерии (ТЭЛА) развилась в 24% случаев, преимущественно на 2-3 неделе, в среднем через 6 дней после отмены АКТ. Описана динамика и признаки дисбаланса в системе гемостаза у больных инсультом, нараставшие после отмены АКТ. Показано, что стандартные методы исследования системы гемостаза по сравнению с прямым методом менее информативны для выявления ВТЭО и оценки эффективности АКТ. Вероятность развития ВТЭО прямо пропорциональна скорости смены состояния гиперкоагуляции состоянием гипокоагуляции. При этом состояние фоновой гиперкоагуляции не коррелирует с развитием ВТЭО. Корреляционный анализ изменений в системе гемостаза с динамикой клинико-лабораторных маркеров у больных с тяжелым инсультом выявил закономерные изменения показателей коагуляционного гемостаза в условиях реализации разных схем стандартной АКТ. Эти схемы были сопоставимы по содержанию при развитии как ВТЭО и ТЭЛА, так и геморрагических осложнений. Вывод: К больным инсультом необходим персонализированный подход при динамическом мониторировании гемостаза и назначении антикоагулянтной терапии. This work was warranted by the need to improve results in the treatment of stroke. The aim of this study was to identify criteria for predicting the risk of venous thrombosis and to elucidate the pathogenesis of thromboembolic complications in patients with acute stroke. Materials and methods. This prospective study included 145 patients (104 patients with ischemic stroke and 41 patients (28.3%) with hemorrhagic stroke). All patients were hospitalized to the neuroresuscitation unit within 3.5 to 24 hours of the disease onset at different stages of consciousness impairment. The patients received anticoagulant therapy (ACT) according to current healthcare standards. Standard clinical diagnostic and laboratory monitoring was supplemented with a Thrombodynamics test. Results. Risk factors for venous thromboembolic events (VTE) were observed in 95% of patients. Pulmonary embolism developed in 24% of cases mostly during weeks 2-3, generally at 6 days of ACT withdrawal. Hemostatic changes and disbalance progressed after the ACT withdrawal. Standard methods of studying hemostasis were shown to be less informative in detecting VTE and evaluating ACT efficacy than the thermodynamics method. The probability of VTE was directly proportional to the velocity of hypercoagulation transformation into hypocoagulation. In this process, the background hypocoagulation was not correlated with the development of VTE. Analysis of correlations of hemostasis changes with changes in clinical-laboratory markers identified relationships of changes in coagulation hemostasis with different standard ACT programs. VTE, pulmonary embolism, and hemorrhagic complications developed in association with administration of comparable ACT programs to patients with severe stroke.

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Pulmonary Embolism and Severe Asthma: Case Report and Literature Review

Medicina ◽

10.3390/medicina55100647 ◽

2019 ◽

Vol 55 (10) ◽

pp. 647 ◽

Cited By ~ 1

Author(s):

Lee ◽

Keyword(s):

Pulmonary Embolism ◽

Severe Asthma ◽

Inflammatory Diseases ◽

Severe Disease ◽

Plasminogen Activator Inhibitor ◽

Cell Types ◽

Massive Pulmonary Embolism ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic ◽

Activator Inhibitor Type

Pulmonary embolism is a life-threatening disease. Its development is generally thought to be due to causes collectively known as the Virchow's triad. Chronic inflammations are associated with the activation of coagulation and increased risks of venous thromboembolic events. Asthma is one of the chronic inflammatory diseases associated with procoagulants and antifibrinolytic activities in the airways. Coagulation is activated in patients with asthma with the following steps of pathophysiology: Increased tissue factor expression in various cell types, decreased activity of the anticoagulant protein C system and inhibition of fibrinolysis through over-production of plasminogen activator inhibitor type 1 (PAI-1). Asthma is therefore likely a risk factor for pulmonary embolism, especially in those patients with severe disease conditions together with frequent exacerbation. Here we present a case of severe asthma associated with coagulopathy and complicated by massive pulmonary embolism, presented with typical S1Q3T3 on electrocardiography (ECG) and massive thrombosis on computed tomography angiography, successfully treated with directed catheter thrombolytic therapy.

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High incidence of in-hospital pulmonary embolism following joint arthroplasty with dalteparin prophylaxis

Thrombosis and Haemostasis ◽

10.1160/th09-07-0438 ◽

2010 ◽

Vol 103 (01) ◽

pp. 123-128 ◽

Cited By ~ 3

Author(s):

Jason Kerr ◽

Lori-Ann Linkins

Keyword(s):

Pulmonary Embolism ◽

Knee Arthroplasty ◽

Hip Arthroplasty ◽

Tertiary Care ◽

Signs And Symptoms ◽

Joint Arthroplasty ◽

Vein Thrombosis ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic ◽

Deep Vein

SummaryThe in-hospital incidence of pulmonary embolism (PE) in patients undergoing elective joint arthroplasty who receive a minimum of 10 days of dalteparin prophylaxis is reported to be less than 1%. Recent clinical experience raised suspicion that the incidence of PE was significantly higher at our tertiary care institution. It was the objective of this study to determine the incidence of in-hospital PE and symptomatic deep-vein thrombosis following elective joint arthroplasty in patients who received a minimum of 10 days of dalteparin prophylaxis. Consecutive charts of patients who underwent elective joint arthroplasty at our institution between January 2008 and June 2008 were reviewed. Data on risk factors for venous thromboembolism, objectively documented venous thromboembolic events, and signs and symptoms of PE were abstracted. Patients who received concomitant warfarin in the postoperative period were excluded. The study population consisted of 437 knee arthroplasty and 246 hip arthroplasty patients. The incidence of in-hospital PE following knee arthroplasty and hip arthroplasty was 4.6% and 0.4%, respectively. One out of every 10 knee patients, and one out of every 20 hip patients underwent testing for pulmonary embolism. Pulmonary embolism was diagnosed a median of 3.5 days after knee arthroplasty. The incidence of in-hospital PE in knee arthroplasty patients who received dalteparin prophylaxis was significantly higher than expected. Potential explanations for this finding include poor efficacy of dalteparin started 12–24 hours postoperatively and/or a low threshold for ordering diagnostic imaging for PE. Studies to clarify these issues are needed.

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Development of Venous Thromboembolic Events in Cancer Patients with Elevated Levels of Tissue Factor-Bearing Microparticles

Blood ◽

10.1182/blood.v112.11.3832.3832 ◽

2008 ◽

Vol 112 (11) ◽

pp. 3832-3832

Author(s):

Jeffrey Zwicker ◽

Howard A. Liebman ◽

Donna Neuberg ◽

Kenneth Bauer ◽

Furie Barbara ◽

...

Keyword(s):

Pulmonary Embolism ◽

Cancer Patients ◽

Tissue Factor ◽

Thrombus Formation ◽

P Value ◽

Prospective Clinical Study ◽

Thromboembolic Events ◽

Increased Risk ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic

Abstract Cancer cells shed procoagulant vesicles containing tissue factor, and these tissue factor-bearing microparticles (TFMP) may play a role in thrombus formation in vivo. Using impedance-based flow cytometry to quantify microparticles and a high affinity monoclonal antibody specific for tissue factor, we previously demonstrated the presence of tissue factor-bearing microparticles in platelet-poor plasma in cancer patients. In this case control study, tissue factor-bearing microparticles represented a 4-fold risk factor for venous thromboembolic events (VTE) in cancer patients with acute VTE compared to age, stage, sex, diagnosis-matched controls with cancer but without acute VTE. To further assess the relationship between tissue factor-bearing microparticles and VTE, we performed a retrospective analysis of deep venous thrombosis or pulmonary emboli diagnosed in cancer patients initially enrolled without evidence of VTE. All radiographic reports for the cancer-no VTE group in the 2 years following enrollment were analyzed by a reviewer blinded to microparticle status. Only documented evidence of a new proximal extremity deep vein thrombosis or pulmonary embolism was included in the analysis. The TFMP and no-TFMP groups did not differ significantly for age, sex, active cancer treatment, smoking status, diabetes, or the presence of metastatic disease at time of enrollment. Sixteen of the 60 patients in this group had measurable tissue factor-bearing microparticles, 4 (4/16; 25%) of which subsequently developed radiographic evidence of VTE within 12 months of enrollment. No thrombotic events were recorded among the 44 patients without detectable tissue factor-bearing microparticles within the initial 12 months; however, one patient developed a pulmonary embolism 17 months following enrollment. Identifying death without VTE as a competing risk, the one-year estimate of the rate of VTE in cancer patients with detectable tissue factor-bearing microparticles was 34.8%; among the same group without detectable tissue factor-bearing microparticles, the 1-year rate was 0% (Log Rank p-value=0.002). The presence of tissue factor-bearing microparticles in cancer patients initially thrombosis-free predicted a 7-fold increased risk of thrombosis over cancer patients who were negative for tissue factor-bearing microparticles (OR 7.00, 95% CI 0.85–82.74, P=0.02). These tissue factor-bearing microparticles appear to be derived from the underlying malignancy since samples analyzed from patients with pancreatic cancer demonstrated co-expression of both tissue factor and MUC-1, a transmembrane glycoprotein overexpressed in epithelial malignancies. These data further support the role of tissue factor-bearing microparticles in the pathogenesis of cancer-associated thrombosis and as a biomarker for the prediction of cancer patients at risk of thrombosis. A prospective clinical study, currently being initiated, is required to evaluate this biomarker for the prediction of VTE risk in cancer patients and the utility of thromboprophylaxis in patients with elevated numbers of tissue factor-bearing microparticles.

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Thromboembolic Events in Children and Young Adults With Pediatric Sarcoma

Journal of Clinical Oncology ◽

10.1200/jco.2006.06.9930 ◽

2007 ◽

Vol 25 (12) ◽

pp. 1519-1524 ◽

Cited By ~ 47

Author(s):

Ido Paz-Priel ◽

Lauren Long ◽

Lee J. Helman ◽

Crystal L. Mackall ◽

Alan S. Wayne

Keyword(s):

Pulmonary Embolism ◽

Young Adults ◽

Vena Cava ◽

Thromboembolic Events ◽

Pediatric Sarcoma ◽

Increased Risk ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic ◽

Localized Disease ◽

Children And Young Adults

Purpose Adults with malignancy are at increased risk for venous thromboembolic events (TEs). However, data in children and young adults with cancer are limited. Patients and Methods To determine the risk and clinical features of TEs in children and young adults with sarcoma, we reviewed records on 122 consecutive patients with sarcoma treated from October 1980 to July 2002. Results Twenty-three TEs were diagnosed in 19 of 122 (16%; 95% CI, 10% to 23%) patients. Prevalence by diagnosis was Ewing sarcoma, eight of 61 (13%); osteosarcoma, two of 20 (10%); rhabdomyosarcoma, four of 26 (15%); and other sarcomas, five of 15 (33%). TEs developed in 23% of patients with metastases at presentation versus 10% with localized disease (odds ratio, 2.59; 95% CI, 0.9 to 7.1; P < .06). Fifty-three percent of patients with thrombosis had a clot at presentation. A lupus anticoagulant was detected in four of five evaluated patients. There was a single fatality due to pulmonary embolism. Patients who were diagnosed with cancer after 1993 had a higher rate of TE (7% v 23%; P < .015). Of the 23 events, 43% were asymptomatic. Main sites of thromboses were deep veins of the extremities (10 of 23; 43%), pulmonary embolism (five of 23; 22%), and the inferior vena cava (four of 23; 17%). TEs were associated with tumor compression in eight of 23 (35%) and with venous catheters in three of 23 (13%). Conclusion Thromboembolism is common in pediatric patients with sarcomas. Thromboses are detected frequently around the time of oncologic presentation, may be asymptomatic, and seem to be associated with a higher disease burden. Children and young adults with sarcoma should be monitored closely for thrombosis.

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Venous Thromboembolic Events in Idiopathic Inflammatory Myopathy: Occurrence and Relation to Disease Onset

Arthritis Care & Research ◽

10.1002/acr.23560 ◽

2018 ◽

Vol 70 (12) ◽

pp. 1849-1855 ◽

Cited By ~ 2

Author(s):

Aleksandra Antovic ◽

Antonella Notarnicola ◽

John Svensson ◽

Ingrid E. Lundberg ◽

Marie Holmqvist

Keyword(s):

Inflammatory Myopathy ◽

Disease Onset ◽

Idiopathic Inflammatory Myopathy ◽

Thromboembolic Events ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic

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COVID-19 Disease and Hypercoagulability Leading to Acute Ischemic Stroke

The Neurohospitalist ◽

10.1177/1941874420960324 ◽

2020 ◽

pp. 194187442096032

Author(s):

Naresh Mullaguri ◽

Madihah Hepburn ◽

James Matthew Gebel ◽

Ahmed Itrat ◽

Pravin George ◽

...

Keyword(s):

Pulmonary Embolism ◽

Ischemic Stroke ◽

Respiratory Failure ◽

Acute Phase ◽

Case Series ◽

Disease Case ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic ◽

Exposure Risks ◽

Cerebral Ischemic

Introduction: SARS-Coronavirus-2 infection leading to COVID-19 disease presents most often with respiratory failure. The systemic inflammatory response of SARS-CoV-2 along with the hypercoagulable state that the infection elicits can lead to acute thrombotic complications including ischemic stroke. We present 3 cases of patients with COVID-19 disease who presented with varying degrees of vascular thrombosis. Cases: Cases 1 and 2 presented as cerebral ischemic strokes without respiratory failure. Given their exposure risks, they were both tested for COVID-19 disease. Case 2 ultimately developed respiratory failure and pulmonary embolism. Cases 2 and 3 were found to have simultaneous arterial and venous thromboembolism (ischemic stroke and pulmonary embolism) as well as positive antiphospholipid antibodies. Conclusion: Our case series highlight the presence of hypercoagulability as an important mechanism in patients with COVID-19 disease with and without respiratory failure. Despite arterial and venous thromboembolic events, antiphospholipid and hypercoagulable panels in the acute phase can be difficult to interpret in the context of acute phase response and utilization of thrombolytics. SARS-CoV-2 testing in patients presenting with stroke symptoms may be useful in communities with a high case burden or patients with a history of exposure.

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Managing venous thromboembolic events in daily practise: ‘‘time is never enough’’

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2009.363 ◽

2016 ◽

Vol 71 (2) ◽

Author(s):

D. Anyfantakis ◽

E.K. Symvoulakis ◽

I. Mitrouska

Keyword(s):

Pulmonary Embolism ◽

Clinical Practice ◽

Clinical Case ◽

Daily Clinical Practice ◽

Thromboembolic Events ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic ◽

Threatening Condition ◽

Life Threatening

Pulmonary embolism is an insidious life-threatening condition. Its diagnosis represents a challenging topic in daily clinical practice since the recognition and the appropriate management of the condition can lead to the decrease of potentially fatal consequences. We present a clinical case which highlights the necessity for an increased level of ‘surveillance’ from the involved physicians since features of thromboembolic events may be elusive or vague.

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Pulmonary Embolism Following Outpatient Vasectomy

Current Urology ◽

10.1159/000442852 ◽

2015 ◽

Vol 9 (1) ◽

pp. 51-53

Author(s):

Frank E. Mott ◽

Bilal Farooqi ◽

Harry Moore

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Major Surgery ◽

Thromboembolic Events ◽

Radiological Imaging ◽

Review Of The Literature ◽

Pleuritic Chest Pain ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic ◽

Prolonged Immobilization

Venous thromboembolic events have several known major risk factors such as prolonged immobilization or major surgery. Pulmonary embolism has rarely been reported after an outpatient vasectomy was completed. We present the rare case of a healthy 32-year-old Caucasian male with no known risk factors who presented with pleuritic chest pain 26 days after his outpatient vasectomy was performed. Subsequently, he was found to have a pulmonary embolism as per radiological imaging. We explore the association between outpatient vasectomies and venous thromboembolic events. A review of the literature is also included.

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Prevalence of Thromboembolic Complications in COVID-19 Infection: A Systematic Review and Meta-Analysis

European Medical Journal ◽

10.33590/emj/20-00237 ◽

2021 ◽

pp. 70-80

Author(s):

Valeria Pergola ◽

Honoria Ocagli ◽

Giulia Lorenzoni ◽

Danila Azzolina ◽

Loira Leoni ◽

...

Keyword(s):

Pulmonary Embolism ◽

Thromboembolic Event ◽

Event Rate ◽

Meta Analysis ◽

Diagnostic Testing ◽

Venous Thromboembolic Event ◽

Thromboembolic Complications ◽

Analytical Estimate ◽

Venous Thromboembolic ◽

Registration Number

Introduction: The coronavirus disease (COVID-19) infection is proved to be involved in the onset of thromboembolism episodes. This study aims to evaluate the prevalence of thromboembolic complications in patients with COVID-19 from March until May 2020. Methods: A literature review was conducted in MEDLINE (via PubMed), Scopus, Embase, Cochrane, and CINHAL without any language and date of publication restriction (Prospero registration number CRD42020186925). The inclusion criteria were as following: 1) patients with diagnosis of COVID-19; 2) occurrence of thromboembolic event, and 3) patients older than 18 years of age. A multi-variable random effects model was computed accounting for correlations among outcomes by considering a heterogeneous compound symmetry covariance matrix. Results: Observational studies included 2,442 participants from 268 to 7,999 participants per study, 1,014 (41.52%) were male and 825 (33.78%) were female. The multi-variable pooled event rate of acute myocardial infarction was rare, estimated to be 0.03 (95% confidence interval [CI]: 0.00–0.07; p=0.23); this is also true for the meta-analytical estimate of disseminated intravascular disease which was 0.04 (95% CI: 0.00–0.08; p=0.03). Conversely, other events were found to be more frequent. Indeed, the pooled proportion of pulmonary embolism was 0.14 (95% CI: 0.08–0.20; p<0.001), while the venous thromboembolic event rate is 0.15 (95% CI: 0.09-0.30; p=0.04). The pooled intrahospital mortality rate was equal to 0.12 (95% CI: 0.08–0.16; p<0.001). Conclusions: Thromboembolic events, particularly venous thromboembolic event rate and pulmonary embolism, are a frequent complication in patients hospitalised with COVID-19. These findings suggest that the threshold for clinical suspicion should be low to trigger prompt diagnostic testing and that evaluation of therapeutic treatment should be considered in patients in intensive care units with COVID-19.

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Fatal pulmonary embolism following ultrasound-guided foam sclerotherapy combined with multiple microphlebectomies

Phlebology The Journal of Venous Disease ◽

10.1177/0268355515603873 ◽

2016 ◽

Vol 31 (7) ◽

pp. 449-455 ◽

Cited By ~ 6

Author(s):

Cornelis MA Bruijninckx

Keyword(s):

Pulmonary Embolism ◽

Oral Contraceptive ◽

Fatal Pulmonary Embolism ◽

Thromboembolic Complications ◽

Ultrasound Guided ◽

Foam Sclerotherapy ◽

Venous Thromboembolic ◽

Fatal Course ◽

Venous Interventions ◽

Pharmacological Thromboprophylaxis

Ambulatory ultrasound-guided foam sclerotherapy (UGFS) for refluxing saphenous veins is considered a safe therapy. Venous thromboembolic complications after UGFS as well as after all other ambulatory ablative venous interventions are rarely reported. This paper reports a fatal pulmonary embolism (PE) following UGFS in combination with an extended phlebectomy, and questions what measures should be taken to minimize the risk for thromboembolic complications after these procedures. In the reported case (unsuspected), extensive non-occluding atherosclerosis as well as obesity in combination with use of an oral contraceptive might have contributed to the development of the PE while the use of a β-blocker might have increased its fatal course considerably. Routine measurement of the ankle-brachial pressure index reduces the risk for undetected atherosclerosis. It appears that ‘in the real world’ of ambulatory phlebological treatments thromboembolic complications are more common (2.4–4.7%) and appear accompanied by post-procedural mortality. It is concluded therefore that pharmacological thromboprophylaxis appears warranted in selected cases, perhaps even routine application could be considered. Attention is drawn to the highly thrombogenic but not uncommon combination of overweight and use of oral contraceptive. Apart from applying some form of pharmacological thromboprophylaxis, technical adaptations that might prevent or reduce spill over of foam into the deep venous system should be considered. Firstly, next to adherence to the generally accepted maximum of 10 mL of foam per session, it seems prudent to maximize the injected volume of foam per site. Secondly, it seems best to inject the foam in an elevated leg without groin compression. The concentration of the sclerosant does not appear decisive in this respect, although higher concentrations appear more effective and therefore might be injected in lower volumes without compromising efficacy.

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