Therapeutic Anticoagulation Impacts MR Morphologic Recurrence Patterns in Glioblastoma—A Matched-Pair Analysis

Background: Glioblastoma (GBM) patients are at particularly high risk for thrombotic complications. In the event of a postoperative pulmonary embolism, therapeutic anticoagulation (tAC) is indispensable. The impact of therapeutic anticoagulation on recurrence pattern in GBM is currently unknown. Methods: We conducted a matched-pair cohort analysis of 57 GBM patients with or without tAC that were matched for age, sex, gross total resection and MGMT methylation status in a ratio of 1:2. Patients’ characteristics and clinical course were evaluated using medical charts. MRI characteristics were evaluated by two independent authors blinded to the AC status. Results: The morphologic MRI appearance in first GBM recurrence showed a significantly higher presence of multifocal, midline crossing and sharp demarcated GBM recurrence patterns in patients with therapeutic tAC compared to the matched control group. Although statistically non-significant, the therapeutic tAC cohort showed increased survival. Conclusion: Therapeutic anticoagulation induced significant morphologic changes in GBM recurrences. The underlying pathophysiology is discussed in this article but remains to be further elucidated.

A COVID-19 Patient with Simultaneous Renal Infarct, Splenic Infarct and Aortic Thrombosis during the Severe Disease

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with a high incidence of arterial and venous thrombotic complications. However, thromboembolic events in unusual sites such as limb and visceral arterial ischemia are reported rarely in the literature. Herein, we describe a rare case of a patient with severe coronavirus disease 2019 (COVID-19) infection who experienced severe abdominal pain during the hospitalization and presented simultaneously renal artery, splenic artery and vein as well as aortic thrombi despite prophylactic antithrombotic treatment. Information about his follow-up post discharge is also provided. This case report raises significant clinical implications regarding the correct dose of antithrombotic treatment during the acute phase of the severe COVID-19 infection and highlights the need for incessant vigilance in order to detect thrombosis at unusual sites as a possible diagnosis when severe abdominal pain is present in severe COVID-19 patients.

Risks of venous thromboembolic complications in related to combined oral contraceptives

Hormonal contraception is the most popular and effective reversible method for preventing unwanted pregnancy exerting multiple prophylactic and therapeutic effect along with contraceptive activity. The main adverse coupled to combined oral contraceptives (COCs) is its impact on the hemostasis and increased risk of venous thromboembolic complications. A great evolutionary path has been travelled after beginning application of hormonal contraception to reduce dose of its estrogen component and improving quality of gestagen component. Nevertheless, thrombotic complications related to COCs use still remain a pressing issue not only due to disease severity and high mortality rate from pulmonary embolism (PE), but also due to the difficulties in its timely diagnostics. Here we describe a clinical case of a 19-year-old patient suffering from vena cava inferior thrombosis complicated by PE after using COCs.

Polymorphism of folate metabolism genes and thrombotic complications in patients with functionally single ventricle

Aim. To analyze the relationships between the carriage of polymorphic variants in the folate metabolism genes and the development of thrombotic complications in patients with single ventricle (SV) during surgical treatment.Material and Methods. A total of 102 children with SV were examined in the performed research. All patients underwent surgical hemodynamic correction of congenital heart disease (CHD). According to a retrospective chart review, thrombosis was diagnosed in 12.7 % of the examined patients with SV. The analysis of polymorphism in the MTR A2756G enzyme gene revealed significant differences between the groups of patients with a history of thrombosis and without it.Results. We found that the risk of developing thrombosis was associated with the carriage of homozygous genotype 2756AA of the MTR enzyme gene (OR = 11.21; 95% CI: 1.39–89.96; p = 0.023).

The Outcome of Catheter-Directed Thrombolysis in COVID-19-Associated Deep Vein Thrombosis

Introduction Published evidence of venous thrombotic complications of COVID-19 is lacking from India. This case series consists of twenty-nine adult patients who were COVID -19 positive and treated for Deep Vein Thrombosis (DVT) during the second wave of the COVID-19 pandemic, in India. The study was aimed at analyzing patient demographics of patients with DVT and the outcome of Catheter-Directed Thrombolysis (CDT) in COVID positive patients. Material and Methods: Patients who developed DVT while or after being COVID positive were managed between February and April 2021 at the institution of the first two authors and were included in this retrospective study. Demographic, clinical data, laboratory data, and treatment given were analyzed. All patients were followed up for 3 months with a Villalta score. Results: There were a total of 29 patients (12 male and 17 female) included in the study with a mean age of 47 ± 17 years. The average time of presentation from being COVID positive was 17.8 ± 3.6 days and one patient developed DVT after becoming Covid negative. All but one patient had lower limb involvement, with 42.8% having proximal and 57.2% distal DVT. All patients with Iliofemoral and two with Femoropopliteal DVT were treated with catheter-di thrombolysis and the other 15 patients were managed with anticoagulation alone. No re-thrombosis was observed in the thrombolysis group. Overall average Villalta score at 3 months was 10.7 ± 2.1 with a score of 10.58 ± 2.1 in the anticoagulation-only group and 10.85 ± 2.3 in the CDT group. Conclusion: COVID-19 seems to be an additional risk factor in the development of DVT. The outcome of such patients, treated by thrombolysis appears to be similar to non-COVID patients. In this, observational experience of the authors suggests that CDT could be offered to COVID positive patients with symptomatic Iliofemoral DVT with good outcomes and an acceptable post-intervention Villalta score.

SARS-Cov-2 and Associated Heart Failure

The newly emerged pandemic of coronavirus-induced disease of the year 2019 (COVID-19) has become the utmost health concern worldwide. Patients with COVID-19 are highly susceptible to develop hypercoagulable state increasing the risk of causing venous and arterial thrombosis at both small and large vessels. Additionally, in patients showing co-morbidities, for instance patients with inborn errors of metabolism linked to heart failure, the complications and mortalities are even higher than in any other case. In such frail patients already showing health concerns, the COVID-19-induced pneumonia may cause acute or chronic cardiovascular complications. Indeed, several reports of thrombotic complications in association with other complications has been presented, such as large vessels storks, clotting of catheters, and myocardial injury. Nevertheless, knowledge on the COVID-19-associated cardiovascular diseases remains scarce. Thus, in this chapter, the authors represent an overview of the available data on the induced heart failure related to COVID-19.

Prospects of using cilostazol in combined treatment of patients with obliterating atherosclerosis of lower limb arteries

Despite intensive study of pathophysiology, of molecular and cell mechanisms of progression of atherosclerosis, development and introduction of a wide range of new conservative and surgical treatment methods, until now the diseases of lower limb arteries (DLLA) are one of the most urgent problems of the modern vascular surgery and medicine in general. Intensive development of roentgen-endovascular methods of treatment for the diseases of lower limb arteries has led to a considerable revision of the tactics of management of this category of patients in the recent years. Despite the achievements of roentgen-endovascular surgery, frequency of obstructions after surgical revascularization of limbs remains high, both in early and late postoperative periods. It should also be noted that despite the intensive development of methods of therapy of patients with DLLA, frequency of limbs amputation in this category of patients remains high. One of the urgent problems of management of patients with DLLA after endovascular treatment is the problem of restenosis. In the recent years, new efficient methods of pharmacotherapy of DLLA have been developed and introduced into clinical practice, which allows significant improvement of medical prognosis in this category of patients and improvement of the outcomes. It should be noted that standard approaches to antithrombotic therapy in patients after endovascular surgeries based on use of antiaggregant drugs, can only decrease the rate of thrombotic complications, but not of restenosis, which, from the point of view of pathophysiology, is mainly hyperproliferative condition. Among promising approaches to treatment of restenosis, there is use of cilostazol, efficiency of which after endovascular surgeries on coronary and peripheral arteries has been proven in a number of studies.

Experience in treatment of patients with arterial and venous thrombosis with proven COVID-19

Background. COVID-19 is represented by a large number of different phenotypes, ranging from asymptomatic progress to the development of severe multiple organ dysfunction syndrome. The mechanisms of development of multiple organ dysfunction syndrome are multifactorial, including hypercoagulation with the formation of blood clots. They are often diagnosed as thrombotic complications with detection of blood clots not only in the veins and pulmonary arteries, but also in the heart and main arteries. An observational study shows that the incidence of venous and arterial thrombosis is as high as 31% in patients with COVID-19 pneumonia. However, large studies have not yet been conducted.Aim. To generalize and analyze our own observations of the clinical course of patients with thrombosis and COVID-19.Methods. The study included 5 male patients who had arterial and venous thrombosis and COVID-19 positive test. Results The experience of treatment of 5 patients with COVID-19 with arterial and venous thrombosis was analyzed. All patients showed characteristic changes in the coagulogram. The patient who, upon admission, had a negative test for COVID-19, and characteristic changes in the coagulogram appeared on the day of recurrent thrombosis, was of greatest interest. All patients received standard treatment and were discharged with improvement after testing negative for COVID-19.Conclusion. Generalization of the clinical course of patients with COVID-19 and thrombosis of various vascular regions allowed us to develop treatment tactics for these groups of patients.

Clotting of Hemodialysis Access in Patients with COVID-19 in an Inner-City Hospital

<b><i>Background:</i></b> An increased incidence of thrombotic complications in patients with coronavirus disease 2019 (COVID-19) has been reported. Severe acute kidney injury (AKI) is one of the major clinical manifestations of COVID-19 with the need for renal replacement therapy. It was observed that hemodialysis (HD) accesses tended to thrombose more often in the COVID-19 population than in non-COVID-19 patients. We hypothesize that the hypercoagulable state of COVID-19 is associated with higher incidence of access clotting. <b><i>Method:</i></b> In this retrospective single-centered study at Kings County Hospital in New York City, 1,075 patients with COVID-19 were screened, and 174 patients who received HD from January 3, 2021 to May 15, 2020 were enrolled to examine the risk factors of dialysis access clotting in patients with COVID-19. <b><i>Results:</i></b> Of the 174 patients, 109 (63%) were COVID-19 positive. 39 (22.6%) patients had dialysis access clotting at least once during their hospitalization, and they had significantly higher body mass index (BMI) (<i>p</i> = 0.001), higher rates of COVID-19 (<i>p</i> = 0.015), AKI (<i>p</i> &#x3c; 0.001), higher platelet counts (<i>p</i> = 0.029), higher lactate dehydrogenase levels (<i>p</i> = 0.009), and lower albumin levels (<i>p</i> = 0.001) than those without access malfunctions. Low albumin levels (<i>p</i> = 0.008), AKI (<i>p</i> = 0.008), and high BMI (<i>p</i> = 0.018) were risk factors associated with HD access clotting among COVID-19 patients. <b><i>Conclusion:</i></b> Patients with COVID-19 who receive HD for AKI with high BMI are at a higher risk of clotting their HD access.

PREDICTION OF THE OCCURRENCE AND DEVELOPMENT OF FATAL VASCULAR COMPLICATIONS IN COVID-19 USING FUZZY MATHEMATICAL MODELS

Целью исследования является разработка метода прогнозирования возникновения и развития тромботических осложнений (тромботических прецедентов), провоцируемых действием новой коронавирусной инфекции (COVID-19) на организм человека, позволяющего усовершенствовать лечебно-диагностические мероприятия для пациентов с данной патологией. В качестве базового математического аппарата была выбрана методология синтеза гибридных нечетких решающих правил, хорошо зарекомендовавшая себя в процессе решения задач с нечётким описанием исследуемых классов со структурой данных аналогичной решаемой в работе задачи. В ходе проводимых исследований были синтезированы математические модели прогнозирования возникновения и развития тромботических прецедентов. Экспертное оценивание и математическое моделирование показали, что уверенность в правильном принятии решений по прогнозу появления и развития исследуемого класса тромботических осложнений превышает величину 0,9. В работе получены нечёткие математические модели прогнозирования возникновения и развития тромботических прецедентов у людей с подтверждённой коронавирусной инфекцией, для которой ведущим фактором риска является вторичный антифосфолипидный синдром с возникновением микроангиопатии. В ходе проведенных исследований была показана целесообразность использования полученных результатов в практике работы таких врачей, как иммунологи, инфекционисты, пульмонологи, кардиологи и сердечно-сосудистые хирурги The aim of the study is to develop a method for predicting the occurrence and development of thrombotic complications (thrombotic precedents) provoked by the action of a new coronavirus infection (COVID-19) on the human body, which allows improving therapeutic and diagnostic measures for patients with this pathology. The methodology of synthesis of hybrid fuzzy decision rules was chosen as the basic mathematical apparatus, which proved itself well in the process of solving problems with a fuzzy description of the classes under study with a data structure similar to the problem being solved in the work. In the course of the research, mathematical models for predicting the occurrence and development of thrombotic precedents were synthesized. Expert evaluation and mathematical modeling have shown that confidence in the correct decision-making on the prognosis of the occurrence and development of the studied class of thrombotic complications exceeds 0.9. The paper presents fuzzy mathematical models for predicting the occurrence and development of thrombotic precedents in people with confirmed coronavirus infection, for which the leading risk factor is secondary antiphospholipid syndrome with the occurrence of microangiopathy. In the course of the conducted studies, the expediency of using the results obtained in the practice of such doctors as immunologists, infectious disease specialists, pulmonologists, cardiologists and cardiovascular surgeons was shown