Coagulation Disorders
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Animals ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. 2612
Lorella Maniscalco ◽  
Katia Varello ◽  
Simona Zoppi ◽  
Giuseppina Abbamonte ◽  
Marta Ferrero ◽  

PIVKA-II is an aberrant form of vitamin K that has been demonstrated to be increased in human coagulation disorders and in some neoplastic diseases. In veterinary medicine, PIVKA-II levels have been demonstrated to be useful for distinguishing anticoagulant poisoning from other coagulopathies. In forensic pathology, there is the need to distinguish malicious poisoning from other causes of death and, in some cases, identifying poisoned dogs from dogs that died as a result of other coagulative disorders can be challenging. In this study, dogs that suddenly died underwent necropsy, histological examination, and toxicological analysis to establish cause of death. PIVKA-II immunohistochemical expression was evaluated on hepatic and renal tissues, and on neoplastic lesions when present. A total of 61 dogs were analyzed and anticoagulant substances were identified in 16 of the 61. Immunolabelling for PIVKA-II was observed in 27 of 61 cases in the liver and in 24 of 61 cases in the kidneys. Among the poisoned dogs, the PIVKA-II expression was present in the liver in 15 of 16 cases and in the kidneys in 16 of 16. Neoplastic lesions represented mainly by haemangiosarcomas were negative. This study highlights how the immunohistochemical expression of PIVKA-II in hepatic and renal tissues can be useful to identify patients with coagulative disorders due to clinical condition or the ingestion of anticoagulants substances.

Folia Medica ◽  
2021 ◽  
Vol 63 (4) ◽  
pp. 613-617
Diamantoula Pagkou ◽  
Theodosios Papavramidis ◽  
Xanthippi Mavropoulou ◽  
Moysis Moysidis ◽  
Ioannis Patsalas

Subgaleal hematoma, accumulation of blood in the loose areolar tissue of the subgaleal space of the skull, is considered the most catastrophic complication of instrumental delivery. It is a rare finding in older ages, usually associated with coagulation disorders, severe head trauma leading to skull base fractures and accidental or abusive hair pulling. Complications include periorbital necrotising fasciitis, permanent blindness, infections and, in extreme rare cases, airway obstruction. Most cases of subgaleal hematoma resolve spontaneously, without the need of aspiration or drainage. We present here the case of a 62-year-old male on anticoagulant therapy with apixaban for chronic atrial fibrillation, who came to the emergency department after a car accident suffering from mild head trauma. The patient was complaining of a diffuse headache and physical examination showed a large ecchymosis and edema on the frontal area of the head. His neurological examination was unremarkable. Full-body computed tomography (CT) revealed a fracture of the third right rib. Twelve hours after admission, due to an excessive decrease of hematocrit, a second CT was performed. Although the images didn’t show intracranial hemorrhage or skull base fractures, a large and diffuse hematoma of the subaponeurotic space was observed and the diagnosis of subgaleal hematoma was confirmed. Massive subgaleal hematoma after mild head trauma is rather infrequent. Early diagnosis improves outcomes and can avert serious complications. Therapeutic strategy should be based on the severity of each case. In our case, conservative treatment appeared to be a valid alternative to surgery, as hematoma resolved spontaneously within 10 days. It is noteworthy that the use of anticoagulation is the only evident factor that could have been the precipitating factor for the development of the hematoma in our patient.

2021 ◽  
Vol 9 (9) ◽  
Arunkumar Shadamarshan R ◽  
Rohit Sharma ◽  
Ishan Pradhan ◽  
Pramod Kumar

Pawan. N. Karwa ◽  
Ramesh D Ingole ◽  
Avinash. B Thalkari

Deep vein thrombosis commonly known as DVT has globally about 1–2 per 1000 population cases. The rate of Mortality is high; About 6% death cases occurs within primary 30 days of DVT by the primarily through pulmonary embolism, and also about 13% of patients with the pulmonary embolism. Among treated patients, about 20–50% develop post-thrombotic syndrome (PTS) after DVT, and 3% develop chronic thromboembolic pulmonary hypertension after pulmonary embolism.3,4 After 3–6 months of anticoagulation, VTE recurs in up to 40% of patients within 10 years. The risk of recurrence is two- to threefold higher after unprovoked than provoked VTE. Deep Vein thrombosis (DVT) is a life-threatening condition which may lead to sudden death as an immediate complication due to formation of thrombo-embolism. DVT is associated with various risk factors such as prolonged immobilization, inflammation, and/or coagulation disorders including muscular or venous injury. Deep venous thrombosis (DVT) frequently occurs in the lower limb. Successful treatment of DVT exclusively by the use of the different remedies has rarely been recorded in peer-reviewed journals. The present case report intends to record yet another case of DVT in a patient cured exclusively Since this report is based on a single case of recovery, results of more such cases are warranted to strengthen the outcome of the present study.

2021 ◽  
Vol 2 (7) ◽  
Yoriko Kato ◽  
Wataro Tsuruta ◽  
Hisayuki Hosoo ◽  
Tetsuya Yamamoto

BACKGROUND The pathogenesis and endovascular treatment strategy for spontaneously thrombosed unruptured cerebral aneurysms have not yet been comprehensively described. OBSERVATIONS The authors reported on a 78-year-old woman who had large bilateral unruptured cavernous carotid artery aneurysms that induced chronic disseminated intravascular coagulation and acquired factor XIII deficiency. The right aneurysm was symptomatic and partially thrombosed. Hemorrhagic diathesis and abnormal values of laboratory data improved after administration of recombinant human thrombomodulin followed by endovascular treatment in which three pipeline embolization devices were deployed for the right aneurysm. LESSONS To the best of the authors’ knowledge, this was the first report of an unruptured cerebral aneurysm leading to coagulation disorders with clinical manifestation that was treated successfully by endovascular intervention after intensive perioperative management.

2021 ◽  
Vol 11 (2) ◽  
pp. 058-063
Kingsley Chukwuka Amaihunwa ◽  
Emmanuel Asuquo Etim ◽  
Everista Odaburhine Osime ◽  
Zacchaeus Awortu Jeremiah

Background/Objectives: Aged people with obesity are vulnerable to coagulation disorders arising from alterations in procaogulants. Therefore, this study aims to evaluate the effect of age on procaogulant such as: fibrinogen (FG), von willebrand factor (vWF), Soluble Vascular Cell Adhesion Molecules (sVCAM) tissue factor (TF), Tissue Plasminogen Activator (tPA) and Plasminogen Activator Inhibitor (PAI) in obese people. Materials and Method: 312 subjects with age between 18 and 65years were enrolled for this study comprising of 111males and 201females who were further grouped into age ranges of 20-39years, 40-49years and 50-59years respectively. 4.5mls of venous blood was collected into Ethylene Diamine Tetra-acetic Acid (EDTA) container. Plasma obtained was analyzed using ELISA method. Results: FG values in obese people within age range 20-29years was 100.59±209.23ng/ml while FG level of people within age range 40-49years and 50-59years were71.14±64.24ng/ml and 41.83±15.63ng/ml respectively at p<0.05. PAI of those within age range of 20-39years was 411.65±349.88pg/ml while PAI of people in age range of 50-59years was 265.92±64.30pg/ml. sVCAM of people in the age range of 20-39years was 8.24±12.61u/l and people within the age range of 50-59years had sVCAM value of 4.42±1.17u/l. TF values of people within the age range of 20-39years was 82.03±54.21pg/ml while people in the age range of 50-59years had TF value of 74.54±20.05pg/ml at P<0.05. vWF of people within age range of 50-59years was 84.88±58.96u/l while younger people in the age range of 20-29years had vWF value of 74.59±55.32u/l at P<0.05. Conclusion: Procaogulants such as: FG, PAI, sVCAM and TF were higher in younger people than in older people with obesity at Sapele southern Nigeria.

2021 ◽  
Vol 14 (8) ◽  
pp. e244878
Luís Lourenço Graça ◽  
Maria João Amaral ◽  
Marco Serôdio ◽  
Beatriz Costa

A 62-year-old Caucasian female patient presented with abdominal pain, vomiting and fever 1 day after administration of COVID-19 vaccine. Bloodwork revealed anaemia and thrombocytosis. Abdominal CT angiography showed a mural thrombus at the emergence of the coeliac trunk, hepatic and splenic arteries, and extensive thrombosis of the superior and inferior mesenteric veins, splenic and portal veins, and the inferior vena cava, extending to the left common iliac vein. The spleen displayed extensive areas of infarction. Aetiological investigation included assessment of congenital coagulation disorders and acquired causes with no relevant findings. Administration of COVID-19 vaccine was considered a possible cause of the extensive multifocal thrombosis. After reviewing relevant literature, it was considered that other causes of this event should be further investigated. Thrombosis associated with COVID-19 vaccine is rare and an aetiological relationship should only be considered in the appropriate context and after investigation of other, more frequent, causes.

Toshiaki Iba ◽  
JH Levy ◽  
Marcel Levi

A number of viral infectious diseases have emerged or reemerged from wildlife vectors that have generated serious threats to global health. Increased international traveling and commerce increase the risk of transmission of viral or other infectious diseases. In addition, recent climate changes accelerate the potential spread of domestic disease. The Coronavirus disease 2019 (COVID-19) pandemic is an important example of the worldwide spread, and the current epidemic will unlikely be the last. Viral hemorrhagic fevers, such as Dengue and Lassa fevers, may also have the potential to spread worldwide with a significant impact on public health with unpredictable timing. Based on the important lessons learned from COVID-19, it would be prudent to prepare for future pandemics of life-threatening viral diseases. Among the various threats, this review focuses on the coagulopathy of acute viral infections since hypercoagulability has been a major challenge in COVID-19, but represents a different presentation compared to viral hemorrhagic fever. However, both thrombosis and hemorrhage are understood as the result of thromboinflammation due to viral infections, and the role of anticoagulation is important to consider.

2021 ◽  
Vol 11 (1) ◽  
Kehong Chen ◽  
Yu Lei ◽  
Yani He ◽  
Fei Xiao ◽  
Yan Yu ◽  

AbstractRenal injury is common in patients with coronavirus disease 2019 (COVID‐19). We aimed to determine the relationship of estimated glomerular filtration rate (eGFR) and acute kidney injury (AKI) with the characteristics, progression, and prognosis of COVID-19 in-patients. We retrospectively reviewed 1851 COVID-19 patients admitted to 3 hospitals in Wuhan, China. Clinical, laboratory, radiological, treatment, complication, and outcome data were analyzed. Patients were stratified according to levels of eGFR (≥ 90 vs. 60–89 vs. < 60 mL/min/1.73 m2). The risk of reaching the composite endpoint—intensive care unit admission, invasive ventilation, or death—was compared. On admission, 25.5% patients had renal impairment (eGFR < 90 mL/min/1.73 m2), but only 2.6% patients had chronic kidney disease (CKD). The overall in-hospital AKI incidence was 6.7%. Severe illness and comorbidities (hypertension, diabetes, CKD, and cardiovascular/cerebrovascular diseases) were more common among patients with low eGFR (< 90 mL/min/1.73 m2). Despite the more frequent use of intensive oxygen therapy, continuous blood purification, and glucocorticoid treatment, the prognosis of these patients was unsatisfactory, with the incidence of the composite endpoint (15.4% vs. 19.6% vs. 54.5%; P = 0.000) and complications (AKI, respiratory failure, cardiac injury, coagulation disorders, sepsis, etc.) increasing with decreasing eGFR. Kaplan–Meier survival analysis revealed that patients with eGFR < 90 mL/min/1.73 m2 or AKI had significantly escalated risks of reaching the composite endpoint. Multivariate regression analysis showed that renal insufficiency (eGFR < 60 mL/min/1.73 m2) on admission and in-hospital AKI independently predicted poor prognosis among COVID-19 in-patients. And renal impairment on admission was a greater predictor of poor prognosis in non-elderly patients than that in elderly patients. Early and continuous renal-function monitoring and early AKI diagnosis are necessary to predict and prevent the progression of COVID-19.

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