Deep Venous Thrombosis and Pulmonary Thromboembolism in a Physically Nonprepared Trekker in the Himalayas: An Autopsy Report

Deep Venous Thrombosis (DVT) and Subsequent Pulmonary Thromboembolism (PTE) in high altitude climbers is a well-known concept. The acclimatization process at high altitude is itself a thrombogenic event. Accordingly, when a physically nonprepared individual with preexisting thrombogenic risk factors attempts trekking at high altitude, they may end up with fatal thromboembolic events. Here, we report a case of a low-lander with multiple thrombogenic risk factors who developed DVT and PTE when he went for a trekking trip in the Himalayas. The risk factors, autopsy findings, and possible mechanism of developing fatal pulmonary embolism, in this case, are discussed here.

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Massive Fatal Pulmonary Embolism While on Therapeutic Heparin Drip

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/2324709620914787 ◽

2020 ◽

Vol 8 ◽

pp. 232470962091478

Author(s):

Said Hajouli

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Fatal Pulmonary Embolism ◽

Heparin Infusion ◽

Therapeutic Anticoagulation

Venous thromboembolism (VTE) includes deep venous thrombosis (DVT) and pulmonary embolism (PE). In this article, we present a case of a patient with an acute DVT who was treated with a therapeutic heparin drip, then developed syncope while in the hospital and found to have massive bilateral PEs. This case aims to arouse the medical staff’s awareness of the VTE diagnosis even if the patient is fully anticoagulated. We review the indications for DVT hospitalization, heparin infusion monitoring, risk factors for developing PE from DVT, mechanisms of developing PE from DVT while on therapeutic anticoagulation, and signs and treatment of massive PE.

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High Antibody Levels to Prothrombin Imply a Risk of Deep Venous Thrombosis and Pulmonary Embolism in Middle-aged Men

Thrombosis and Haemostasis ◽

10.1055/s-0038-1657711 ◽

1997 ◽

Vol 78 (04) ◽

pp. 1178-1182 ◽

Cited By ~ 59

Author(s):

Timo Palosuo ◽

Jarmo Virtamo ◽

Jari Haukka ◽

Philip R Taylor ◽

Kimmo Aho ◽

...

Keyword(s):

Pulmonary Embolism ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Plasma Proteins ◽

Alpha Tocopherol ◽

Index Number ◽

Thromboembolic Events ◽

Middle Aged ◽

Phospholipid Binding ◽

Antiprothrombin Antibodies

SummaryAntibodies against phospholipid-binding plasma proteins, such as β2-glycoprotein I (β2-GPI) and prothrombin, are associated with thromboembolic events in patients with systemic lupus erythematosus and also in subjects with no evident underlying diseases. We wanted to examine whether increased levels of antibodies to negatively-charged phospholipids (cardiolipin), to phospholipid-binding plasma proteins β2-GPI and prothrombin and to oxidised low-density lipoprotein (LDL) were associated with risk of deep venous thrombosis or pulmonary embolism in subjects with no previous thrombosis. The antibodies were measured in stored serum samples from 265 cases of deep venous thrombosis of the lower extremity or pulmonary embolism occurring during a median follow-up of about 7 years and from 265 individually matched controls. The study subjects were middle-aged men participating in a cancer prevention trial of alpha-tocopherol and beta-carotene and the cases of thromboembolic events were identified from nationwide Hospital Discharge Register.The risk for thrombotic events was significantly increased only in relation to antiprothrombin antibodies. As adjusted for body mass index, number of daily cigarettes and history of chronic bronchitis, myocardial infarction and heart failure at baseline, the odds ratio per one unit of antibody was 6.56 (95% confidence interval 1.73-25.0). The seven highest individual optical density-unit values of antiprothrombin antibodies were all confined to subjects with thromboembolic episodes.In conclusion, the present nested case-control study showed that high autoantibody levels against prothrombin implied a risk of deep venous thrombosis and pulmonary embolism and could be involved in the development of the thrombotic processes.

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Upper extremity deep venous thrombosis: risk factors, diagnosis, treatment

Romanian Journal of Medical Practice ◽

10.37897/rjmp.2016.1.5 ◽

2016 ◽

Vol 11 (1) ◽

pp. 28-32

Author(s):

Camelia C. DIACONU ◽

◽

Mădălina ILIE ◽

Mihaela Adela IANCU ◽

◽

...

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

High Risk ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Upper Extremity ◽

Brachiocephalic Vein ◽

Risk Of Death ◽

Thrombosis Risk ◽

Effort Thrombosis

Upper extremity deep venous thrombosis is a condition with increasing prevalence, with high risk of morbidity and mortality, due to embolic complications. In the majority of the cases, thrombosis involves more than one venous segment, most frequently being affected the subclavian vein, followed by internal jugular vein, brachiocephalic vein and basilic vein. Upper extremity deep venous thrombosis in patients without risk factors for thrombosis is called primary deep venous thrombosis and includes idiopathic thrombosis and effort thrombosis. Deep venous thrombosis of upper extremity is called secondary when there are known risk factors and it is encountered mainly in older patients, with many comorbidities. The positive diagnosis is established only after paraclinical and imaging investigations, ultrasonography being the most useful diagnostic method. The most important complication, with high risk of death, is pulmonary embolism. Treatment consists in anticoagulant therapy, for preventing thrombosis extension and pulmonary embolism.

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Risk Factors Associated with Symptomatic Pulmonary Embolism of Catheter Directed Thrombolysis for Lower Extremity Deep Venous Thrombosis

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2015.07.036 ◽

2015 ◽

Vol 50 (5) ◽

pp. 658-663 ◽

Cited By ~ 9

Author(s):

F.H. Li ◽

Y. Zhao ◽

X.H. Wang ◽

Q.N. Fu ◽

H. Liu ◽

...

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Lower Extremity ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Factors Associated ◽

Catheter Directed Thrombolysis ◽

Symptomatic Pulmonary Embolism

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Risk factors for presence and severity of pulmonary embolism in patients with deep venous thrombosis

Journal of Vascular Surgery Venous and Lymphatic Disorders ◽

10.1016/j.jvsv.2017.08.015 ◽

2018 ◽

Vol 6 (1) ◽

pp. 7-12 ◽

Cited By ~ 5

Author(s):

Nancy Huynh ◽

Wassim H. Fares ◽

Kirstyn Brownson ◽

Anand Brahmandam ◽

Alfred I. Lee ◽

...

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Venous Thrombosis ◽

Deep Venous Thrombosis

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Venographic Studies on the Role of Valve Pockets in Thrombogenesis with Clinical Comments

10.1055/s-0039-1689615 ◽

1975 ◽

Author(s):

L. Diener ◽

J.L.E. Ericsson ◽

F. Lund

Keyword(s):

Pulmonary Embolism ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Contrast Medium ◽

Lower Limbs ◽

Fatal Pulmonary Embolism ◽

Early Type ◽

Clinical Series ◽

Good Agreement

In postmortem exploration of the veins of the lower limbs for studies of the frequency and significance of thromboembolism intraosseous venography with injection of contrast medium into the calcaneus was performed followed by complete dissection of the leg veins. A good agreement was found between venographic results and dissection findings. Out of the 596 legs examined, deep venous thrombosis was found in 229 (38%). In 32 of the lower limbs (5.4%) a definite localization and adherence of thrombi to valve pockets was noted. Altogether, 37 such thrombi were encountered. In addition 9 small thrombi of early type were found floating freely in the venous lumen just above a pocket. Microscopically the thrombi showed the greatest degree of organization at the bottom of the valve pocket speaking for this localization as the origin of formation. This is in accordance with the fact that stasis of blood would be most pronounced at the bottom of valve pockets as shown by retention of contrast medium in pockets in clinical venography. In a clinical series of venographies performed after hip surgery several thrombi located to valve pockets were found. Some of these thrombi had proximally free floating tails forming a potential menace of fatal pulmonary embolism.

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The Role of Apolipoprotein (A) In Pathogenesis and Clinical Course of Deep Venous Thrombosis

Polish Journal of Surgery ◽

10.2478/pjs-2014-0092 ◽

2015 ◽

Vol 86 (11) ◽

Cited By ~ 1

Author(s):

Marek Chrapko ◽

Adam Skwarzyński ◽

Wacław Karakuła ◽

Tomasz Zubilewicz

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Serum Level ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Clinical Course ◽

Newly Diagnosed ◽

Apolipoprotein A ◽

Duplex Doppler

AbstractDeep venous thrombosis is widespread disease, which complications, like: pulmonary embolism and postphlebitis syndrome areimportant social problem. There are many well-known and accurately described risk factors, though in many cases etiology remains unexplained. Further research into causes of deep venous thrombosis seem to be fully justified.was the evaluation of the influence of apolipoprotein (a) serum level in patients with deep venous thrombosis and the changes of its concentration during the treatment.26 patients with newly diagnosed deep venous thrombosis (DVT) were enrolled to the study. Diagnosis of DVT was established by use of physical examination and duplex Doppler. Measurements of apolipoprotein (a) and D-dimers serum level were recorded on the following days, starting from the day of the initial diagnosis: 1, 7, 14 and 84.Statistically significant increase of the level of serum apolipoprotein (a) has been found during properly conducted treatment.Alterations of the concentration of serum apoliprotein (a) during the deep venous thrombosis treatment, indicates the involvement of apolipoprotein (a) in pathogenesis of deep venous thrombosis.

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Massive Pulmonary Thromboembolism and Stroke

Case Reports in Medicine ◽

10.1155/2011/398571 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Poobalan Naidoo ◽

Richard Hift

Keyword(s):

Pulmonary Embolism ◽

Antiretroviral Therapy ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Pulmonary Thromboembolism ◽

Positive Outcome ◽

Massive Pulmonary Embolism ◽

Hiv Positive ◽

Rapid Improvement ◽

Intravenous Streptokinase

A 38-year-old HIV-positive female, recently started on antiretroviral therapy, presented in extremis. She had features suggestive of an HIV-associated cardiomyopathy complicated by the following problems: a four-day-old stroke, extensive deep venous thrombosis, and massive pulmonary embolism. She received intravenous streptokinase with rapid improvement, both haemodynamically and, unexpectedly, neurologically. Our case illustrates that a positive outcome is potentially possible where the two conditions coincide.

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