RESUMEN
Portal cavernoma thrombosis is a complication of portal cavernoma. We describe the case of a 74-year-old patient who presented to the emergency department with abdominal pain. The computed tomography scan showed a mass from the head of the pancreas to the hepatic hilum not enhanced after injection of iodinated contrast. There was no dilatation of the bile ducts. Abdominal magnetic resonance ruled out a tumour and confirmed a portal cavernoma thrombosis. In 50 % of cases the etiology of the portal cavernoma is unknown. It is often asymptomatic. It may be discovered in case of complications of portal hypertension. In rare cases the portal cavernoma can compress the bile ducts. To our knowledge, portal cavernoma thrombosis has only been described in one article. It is important to search for a thrombophilic disorder when such a complication is found. We share this case report in order to raise awareness in the medical community about this rare complication.
La thrombose de cavernome portal est une complication du cavernome porte. Nous décrivons le cas d'un patient de 74 ans qui s'est présenté aux urgences pour des douleurs abdominales. La tomodensitométrie montrait un syndrome de masse de la tête du pancréas jusqu'au hile hépatique non rehaussé après injection de produit de contraste iodé. Il n'y avait pas de dilatation des voies biliaires. Une imagerie par résonance magnétique abdominale a permis d'infirmer l'hypothèse d'une masse tumorale et d'affirmer une thrombose du cavernome porte. Dans 50 % des cas, l'étiologie du cavernome portal est inconnue. Il est souvent asymptomatique. Il peut être découvert en cas de complications à la suite d'une hypertension portale. Dans de rares cas, le cavernome portal peut comprimer les voies biliaires. À notre connaissance, la thrombose de cavernome portal n'a été décrite que dans un seul article. Il est important de rechercher un désordre thrombophilique quand une telle complication est retrouvée. Nous partageons ce cas clinique afin de sensibiliser la communauté médicale à cette rare complication.
Asunto(s)
Vena Porta , Humanos , Anciano , Vena Porta/diagnóstico por imagen , Masculino , Hemangioma Cavernoso/complicaciones , Hemangioma Cavernoso/diagnóstico , Trombosis de la Vena/etiología , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/diagnóstico por imagen , Hipertensión Portal/etiología , Hipertensión Portal/complicaciones , Trombosis/etiología , Trombosis/diagnóstico por imagen , Trombosis/diagnóstico , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Immune thrombocytopenia (ITP) is a prevalent autoimmune bleeding disorder, with the primary objective of treatment being the prevention of bleeding. Clinical investigations have indicated that individuals with ITP face an elevated risk of thrombosis, and the occurrence of thromboembolic events in ITP patients can be attributed to a multitude of factors. However, establishing a definitive causal relationship between ITP and thrombosis remains challenging. METHODS: A two-sample Mendelian randomization (MR) study utilizing summary data from FinnGen consortium and UK Biobank was undertaken to investigate the causal association between ITP and thrombosis. The primary analysis employed the inverse-variance weighted (IVW) method, while supplementary analyses were conducted using the MR-Egger, weighted median, and MR-PRESSO approaches. RESULTS: Based on IVW method, there was a statistically significant but small positive correlation between ITP and thrombosis. Specifically, ITP patients exhibited a suggestive positive correlation with myocardial infarction and deep-vein thrombosis. However, our investigation did not identify any causal relationship between ITP and cerebral infarction, arterial embolism, other arterial embolisms, pulmonary embolism, thrombophlebitis, or portal vein thrombosis. Sensitivity analyses further confirmed the accuracy and robustness of these findings. CONCLUSIONS: This study presents empirical support for the causal relationship between ITP and thrombosis. It is important to note that a diminished platelet count does not serve as a preventive measure against thrombus formation. Consequently, when managing a newly diagnosed ITP patient, clinicians need to be aware that there is a slight elevation in the risk of thrombosis during treatment.
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Análisis de la Aleatorización Mendeliana , Púrpura Trombocitopénica Idiopática , Trombosis , Humanos , Púrpura Trombocitopénica Idiopática/epidemiología , Púrpura Trombocitopénica Idiopática/complicaciones , Púrpura Trombocitopénica Idiopática/genética , Púrpura Trombocitopénica Idiopática/diagnóstico , Púrpura Trombocitopénica Idiopática/sangre , Trombosis/epidemiología , Trombosis/etiología , Trombosis/diagnóstico , Trombosis/genética , Factores de RiesgoRESUMEN
BACKGROUND: Catheter-related thrombosis (CRT) is a thrombotic complication associated with using central venous catheters (CVCs). Although risk factors for CRT were identified in children, no nomograms or predictive tools are available for the pediatric population with CVCs. This study aimed to develop and validate a prediction model of asymptomatic CRT in children with CVCs. METHODS: This retrospective observational study included consecutive pediatric patients who admitted to the Children's Hospital Zhejiang University School of Medicine and received CVCs between October and December 2021. RESULTS: This study included 669 patients, 553 (314 males, aged 22.00 [0.36, 180.00] months, 62 with CRT) were in the training set, and 116 (62 males, aged 15.00 [1.13, 156.00] months, 16 with CRT) were in the validation set. Multivariate logistic regression showed that a catheter time of 0-3 days (OR = 0.201, 95%CI: 0.081-0.497, P = 0.001), catheter time of 4-7 days (OR = 0.412, 95%CI: 0.176-0.964, P = 0.041), male (OR = 3.976, 95%CI: 1.864-4.483, P < 0.001), congenital heart diseases (OR = 0.277, 95%CI: 0.078-0.987, P = 0.048), postoperative (OR = 0.161, 95%CI: 0.072-0.360, P < 0.001), and femoral CVC (OR = 2.451, 95%CI: 1.129-5.318, P = 0.002) were independently associated with CRT. The nomogram incorporating these variables showed relatively good discrimination (AUC = 0.77, 95%CI: [0.65, 0.90]) and calibration abilities in the validation set, and the decision curve analysis (DCA) yielded a clinical net benefit. CONCLUSION: A prediction model for CRT in children with CVC was established based on catheter time, sex, diseases, postoperative, and catheter vein. The nomogram based on logistic regression model showed favorable predictive performance.
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Catéteres Venosos Centrales , Nomogramas , Humanos , Masculino , Estudios Retrospectivos , Femenino , Niño , Adolescente , Lactante , Preescolar , Catéteres Venosos Centrales/efectos adversos , Factores de Riesgo , Trombosis/etiología , Trombosis/diagnóstico , Cateterismo Venoso Central/efectos adversos , Recién Nacido , Modelos LogísticosRESUMEN
Patients with liver cirrhosis often exhibit complex alterations in their hemostatic system that can be associated with both bleeding and thrombotic complications. While prophylactic correction of abnormal coagulation parameters should be avoided, an individualized approach is recommended prior to invasive procedures, whereby specific preventive measures to stabilize hemostasis should be based on the periprocedural bleeding risk. While the haemostatic system of patients with compensated cirrhosis is often in a rebalanced haemostatic state due to a parallel decline in both pro- and anti-haemostatic factors, a decompensation of liver cirrhosis can lead to destabilization of this fragile equilibrium. Since conventional coagulation tests do not adequately capture the complex changes in the hemostatic system in cirrhosis, functional analysis methods such as viscoelastic tests or thrombin generation assays can be used for evaluating the coagulation status. This review describes the underlying pathophysiological changes in the hemostatic system in liver cirrhosis, provides an overview of diagnostic methods and discusses therapeutic measures in case of bleeding and thrombotic complications.
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Trastornos de la Coagulación Sanguínea , Cirrosis Hepática , Humanos , Cirrosis Hepática/complicaciones , Cirrosis Hepática/diagnóstico , Trastornos de la Coagulación Sanguínea/diagnóstico , Trastornos de la Coagulación Sanguínea/terapia , Trastornos de la Coagulación Sanguínea/etiología , Pruebas de Coagulación Sanguínea , Hemorragia/etiología , Hemorragia/terapia , Hemorragia/diagnóstico , Trombosis/diagnóstico , Trombosis/etiología , Trombosis/terapia , Trombosis/prevención & controlAsunto(s)
Anticoagulantes , Hemorragia , Trombosis , Humanos , Hemorragia/inducido químicamente , Factores de Riesgo , Medición de Riesgo , Trombosis/etiología , Trombosis/epidemiología , Trombosis/diagnóstico , Trombosis/prevención & control , Trombosis/sangre , Anticoagulantes/efectos adversos , Anticoagulantes/uso terapéuticoRESUMEN
OBJECTIVE: To summarize the clinical characteristics of patients with renal angiomyolipoma (RAML) combined with inferior vena cava (IVC) tumor thrombus, and to explore the feasibility of partial nephrectomy and thrombectomy in this series of patients. METHODS: The clinical data of patients diagnosed with RAML combined with IVC tumor thrombus in the Department of Urology of the Peking University Third Hospital from April 2014 to March 2023 were retrospectively analyzed, and demographic and perioperative data of RAML patients with IVC tumor thrombus were recorded and collected from Electronic Medical Record System, including age, gender, surgical methods, and follow-up time, etc. The clinical characteristics between classic angiomyolipoma (CAML) patients with IVC tumor thrombus and epithelioid angiomyolipoma (EAML) patients with IVC tumor thrombus were compared to determine the clinical characteristics of these patients. RESULTS: A total of 11 patients were included in this study, including 7 patients with CAML with IVC tumor thrombus and 4 patients with EAML with IVC tumor thrombus. There were 9 females (9/11, 81.8%) and 2 males (2/11, 18.2%), with an average age of (44.0±17.1) years. 9 patients (9/11, 81.8%) experienced clinical symptoms, including local symptoms including abdominal pain, hematuria, abdominal masses, and systemic symptoms including weight loss and fever; 2 patients (2/11, 18.2%) with RAML and IVC tumor thrombus did not show clinical symptoms, which were discovered by physical examination. Among the 11 patients, 10 underwent radical nephrectomy with thrombectomy, of whom, 3 underwent open surgery (3/10, 30.0%), 2 underwent laparoscopic surgery (2/10, 20.0%), and 5 underwent robot-assisted laparoscopic surgery (5/10, 50.0%). In addition, 1 patient underwent open partial nephrectomy and thrombectomy. The patients with EAML combined with IVC tumor thrombus had a higher proportion of systemic clinical symptoms (100% vs. 0%, P=0.003), more intraoperative bleeding [400 (240, 3 050) mL vs. 50 (50, 300) mL, P =0.036], and a higher proportion of tumor necrosis (75% vs. 0%, P=0.024) compared to the patients with CAML combined with IVC tumor thrombus. However, there was no statistically significant difference in operation time [(415.8±201.2) min vs. (226.0±87.3) min, P=0.053] between the two groups. CONCLUSION: Compared with the patients with CAML and IVC tumor thrombus, the patients with EAML and IVC tumor thrombus had a higher rate of systemic symptoms and tumor necrosis. In addition, in the selected patients with CAML with IVC tumor thrombus, partial nephrectomy and tumor thrombectomy could be performed to better preserve renal function.
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Angiomiolipoma , Neoplasias Renales , Nefrectomía , Trombectomía , Vena Cava Inferior , Humanos , Angiomiolipoma/cirugía , Angiomiolipoma/diagnóstico , Angiomiolipoma/patología , Angiomiolipoma/complicaciones , Neoplasias Renales/cirugía , Neoplasias Renales/patología , Neoplasias Renales/diagnóstico , Femenino , Masculino , Vena Cava Inferior/cirugía , Vena Cava Inferior/patología , Estudios Retrospectivos , Nefrectomía/métodos , Trombectomía/métodos , Adulto , Persona de Mediana Edad , Trombosis de la Vena/cirugía , Trombosis de la Vena/etiología , Laparoscopía/métodos , Trombosis/cirugía , Trombosis/diagnósticoAsunto(s)
Aneurisma de la Aorta Torácica , Polimialgia Reumática , Trombosis , Humanos , Polimialgia Reumática/complicaciones , Polimialgia Reumática/diagnóstico , Aneurisma de la Aorta Torácica/complicaciones , Aneurisma de la Aorta Torácica/diagnóstico , Trombosis/complicaciones , Trombosis/diagnóstico por imagen , Trombosis/etiología , Trombosis/diagnóstico , Femenino , Anciano , Masculino , Anciano de 80 o más Años , Tomografía Computarizada por Rayos XRESUMEN
On the basis of author's request the publisher of Physiological Research decided to change the license of the article to CC BY license.
Asunto(s)
Trombosis , Útero , Humanos , Femenino , Trombosis/etiología , Trombosis/prevención & control , Trombosis/diagnóstico , Útero/trasplante , AdultoRESUMEN
AIMS: Direct oral anticoagulants (DOACs) are increasingly used off-label to treat patients with left ventricular thrombus (LVT). We analysed available meta-data comparing DOACs and vitamin K antagonists (VKAs) for efficacy and safety. METHODS: We conducted a systematic search and meta-analysis of observational and randomized data comparing DOACs vs. VKAs in patients with LVT. Endpoints of interest were stroke or systemic embolism, thrombus resolution, all-cause death, and a composite bleeding endpoint. Estimates were pooled using a random-effects model meta-analysis, and their robustness was investigated using sensitivity and influential analyses. RESULTS: We identified 22 articles (18 observational studies, 4 small randomized clinical trials) reporting on a total of 3587 patients (2489 VKA vs. 1098 DOAC therapy). The pooled estimates for stroke or systemic embolism [odds ratio (OR): 0.81; 95% confidence interval (CI): 0.57, 1.15] and thrombus resolution (OR: 1.12; 95% CI: 0.86, 1.46) were comparable, and there was low heterogeneity overall across the included studies. The use of DOACs was associated with lower odds of all-cause death (OR: 0.65; 95% CI: 0.46, 0.92) and a composite bleeding endpoint (OR: 0.67; 95% CI: 0.47, 0.97). A risk of bias was evident particularly for observational reports, with some publication bias suggested in funnel plots. CONCLUSION: In this comprehensive analysis of mainly observational data, the use of DOACs was not associated with a significant difference in stroke or systemic embolism, or thrombus resolution, compared with VKA therapy. The use of DOACs was associated with a lower rate of all-cause death and fewer bleeding events. Adequately sized randomized clinical trials are needed to confirm these findings, which could allow a wider adoption of DOACs in patients with LVT.
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Cardiopatías , Hemorragia , Trombosis , Humanos , Administración Oral , Trombosis/mortalidad , Trombosis/tratamiento farmacológico , Trombosis/prevención & control , Trombosis/diagnóstico , Hemorragia/inducido químicamente , Resultado del Tratamiento , Factores de Riesgo , Cardiopatías/mortalidad , Cardiopatías/diagnóstico , Cardiopatías/tratamiento farmacológico , Cardiopatías/complicaciones , Anticoagulantes/efectos adversos , Anticoagulantes/administración & dosificación , Ventrículos Cardíacos/efectos de los fármacos , Femenino , Medición de Riesgo , Masculino , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/prevención & control , Anciano , Inhibidores del Factor Xa/efectos adversos , Inhibidores del Factor Xa/administración & dosificación , Vitamina K/antagonistas & inhibidores , Persona de Mediana EdadRESUMEN
Inflammation including immunothrombosis by neutrophil extracellular traps (NETs) has important implications in acute ischemic stroke and can affect reperfusion status, susceptibility to stroke associated infections (SAI) as well as functional clinical outcome. NETs were shown to be prevalent in stroke thrombi and NET associated markers were found in stroke patients' blood. However, little is known whether blood derived NET markers reflect the amount of NETs in thrombi. Conclusions from blood derived markers to thrombus composition might open avenues for novel strategies in diagnostic and therapeutic approaches. We prospectively recruited 166 patients with acute ischemic stroke undergoing mechanical thrombectomy between March 2018 and May 2021. Available thrombi (n = 106) were stained for NET markers DNA-histone-1 complexes and myeloperoxidase (MPO). Cell free DNA (cfDNA), deoxyribonuclease (DNase) activity, MPO-histone complexes and a cytokine-panel were measured before thrombectomy and after seven days. Clinical data, including stroke etiology, reperfusion status, SAI and functional outcome after rehabilitation, were collected of all patients. NET markers were present in all thrombi. At onset the median concentration of cfDNA in blood was 0.19 µg/ml increasing to 0.30 µg/ml at 7 days. Median DNase activity at onset was 4.33 pmol/min/ml increasing to 4.96 pmol/min/ml at 7 days. Within thrombi DNA-histone-1 complexes and MPO correlated with each other (ρ = 0.792; p < 0.001). Moreover, our study provides evidence for an association between the amount of NETs and endogenous DNase activity in blood with amounts of NETs in cerebral thrombi. However, these associations need to be confirmed in larger cohorts, to investigate the potential clinical implications for individualized therapeutic and diagnostic approaches in acute ischemic stroke.
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Biomarcadores , Trampas Extracelulares , Accidente Cerebrovascular Isquémico , Humanos , Trampas Extracelulares/metabolismo , Biomarcadores/sangre , Masculino , Femenino , Anciano , Accidente Cerebrovascular Isquémico/sangre , Accidente Cerebrovascular Isquémico/diagnóstico , Persona de Mediana Edad , Estudios Prospectivos , Peroxidasa/sangre , Anciano de 80 o más Años , Ácidos Nucleicos Libres de Células/sangre , Trombectomía , Trombosis/sangre , Trombosis/diagnóstico , Neutrófilos/metabolismoRESUMEN
Spontaneous pampiniform plexus thrombosis is an extremely rare condition. Its aetiology and pathophysiology are unknown, and its diagnosis remains challenging. We present the first case of an adolescent patient with bilateral spontaneous pampiniform plexus thrombosis. He presented with a 2-day history of bilateral testicular pain. Biochemical investigations were unremarkable, and the patient did not have any risk factors. Ultrasound of the scrotum demonstrated bilateral pampiniform plexus thrombosis. He was managed conservatively and repeat scrotal ultrasound 3 months later revealed complete resolution. This case adds to the minimal literature on spontaneous pampiniform plexus thrombosis, supporting diagnosis via scrotal ultrasound while recommending conservative management without the use of anticoagulation for patients with no pre-existing coagulopathy.
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Escroto , Humanos , Masculino , Adolescente , Escroto/diagnóstico por imagen , Ultrasonografía , Tratamiento Conservador , Trombosis/diagnóstico por imagen , Trombosis/diagnóstico , Trombosis/tratamiento farmacológico , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/tratamiento farmacológicoRESUMEN
A man in his 40s presented to the emergency department after 2 weeks of abdominal pain and bloating. Radiological investigations revealed multiple unusual sites of thrombosis, including large thrombi in his portal and mesenteric veins, and a left ventricular thrombus with resultant embolic infarcts to his spleen, kidneys, coronary arteries and brain. Standard causes of underlying thrombophilia were excluded. A serum protein electrophoresis and serum-free light chains, with subsequent bone marrow biopsy, lead to the diagnosis of smouldering multiple myeloma (sMM), albeit an unusual presentation with severe clinical sequelae. Although sMM is known to be associated with an increased risk of venous thromboembolism, it is not recognised to cause thrombosis in both venous and arterial vascular beds simultaneously. Physicians encountering patients with multiple thrombi in unusual vascular beds without clear aetiology should consider an underlying monoclonal gammopathy in their list of differentials.
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Mieloma Múltiple , Humanos , Masculino , Mieloma Múltiple/complicaciones , Mieloma Múltiple/diagnóstico , Trombosis de la Vena/etiología , Trombosis de la Vena/diagnóstico por imagen , Adulto , Trombosis/etiología , Trombosis/diagnóstico por imagen , Trombosis/diagnóstico , Paraproteinemias/complicaciones , Paraproteinemias/diagnóstico , Diagnóstico DiferencialRESUMEN
BACKGROUND: Pediatric patients with acute lymphoblastic leukemia (ALL) are at highest risk of venous thromboembolism during the induction therapy (IT). These events are not predictable by conventional coagulation assays. OBJECTIVES: To investigate the utility of global coagulation assays (GCAs) for assessing the hemostatic state in children with ALL during IT. METHODS: We included children with ALL (n = 15) and healthy controls (n = 15). Analyses were performed at different time points during IT of the AIEOP-BFM protocols. In addition to prothrombotic biomarkers, natural anticoagulant proteins, and in vivo thrombin generation (TG) markers, ex vivo TG was measured using the gold standard calibrated automated thrombogram method, automated ST Genesia, and thrombodynamics analyzer (TD). The latter also provided measurement of fibrin clot formation. RESULTS: Different from conventional coagulation assays and in vivo TG markers, ex vivo GCAs detected increasing prothrombotic changes during IT. Particularly, TG measured with TD as expressed by endogenous thrombin potential was already significantly elevated at days 8 to 12 (P < .01) and continued to increase during IT compared with prior to beginning treatment, indicating a very early shift toward a procoagulant state. A similar pattern was observed for the rate of fibrin clot formation (stationary rate of clot growth: P < .01 at days 8-12). Remarkably, in patients developing thrombotic complications (n = 5), both GCAs, ST Genesia and TD, showed a significantly higher endogenous thrombin potential very early (already at days 8-12, P < .05), well before clinical manifestation. CONCLUSION: GCAs capture prothrombotic changes early during IT in ALL pediatric patients. If confirmed, this approach will allow tailoring thromboprophylaxis in children with ALL at highest risk for venous thromboembolism.
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Coagulación Sanguínea , Leucemia-Linfoma Linfoblástico de Células Precursoras , Trombina , Tromboembolia Venosa , Humanos , Niño , Leucemia-Linfoma Linfoblástico de Células Precursoras/sangre , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Pruebas de Coagulación Sanguínea , Femenino , Masculino , Trombina/metabolismo , Preescolar , Estudios de Casos y Controles , Adolescente , Tromboembolia Venosa/sangre , Tromboembolia Venosa/etiología , Tromboembolia Venosa/diagnóstico , Factores de Tiempo , Valor Predictivo de las Pruebas , Factores de Riesgo , Biomarcadores/sangre , Trombosis/sangre , Trombosis/etiología , Trombosis/diagnósticoRESUMEN
In the treatment of coronavirus infections, it is important not only to understand the course of the disease, but also to understand what is happening in the human body, especially in the circulatory system, that is, which disorders lead to deterioration and further complications. Hemostasis disorder in COVID-19 plays an important role in the etiology and clinical manifestations of the disease. The ability to identify factors and risk groups for the development of thrombotic complications, the ability to dynamically interpret peripheral blood parameters and coagulograms, knowledge of diagnostic criteria for possible hemostasis disorders (for example, DIC syndrome, sepsis-associated coagulopathy, antiphospholipids, hemophagocytosis and hypercoagulation syndrome) are necessary to determine the indications for the test. Differentiated prescribing of clinically justified therapy (including anticoagulants and blood components) is important, which determines the complexity of treatment and prognosis for patients with COVID-19. This article is a review of the literature on the topic of hemostasis disorders in elderly and senile patients with mesenteric thrombosis in COVID 19 over the past few years.
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COVID-19 , SARS-CoV-2 , Trombosis , Humanos , COVID-19/complicaciones , COVID-19/fisiopatología , Anciano , Trombosis/etiología , Trombosis/diagnóstico , Trombosis/sangre , Trastornos de la Coagulación Sanguínea/etiología , Trastornos de la Coagulación Sanguínea/diagnóstico , Trastornos de la Coagulación Sanguínea/sangre , Hemostasis/fisiología , Anticoagulantes/uso terapéutico , Anticoagulantes/administración & dosificaciónRESUMEN
This novel report presents the first known case, to our knowledge, of a 16-year-old male patient who experienced intraventricular thrombosis and pulmonary embolism after a Nuss procedure for pectus excavatum, attributed to chronic bar displacement. Two years after the operation, the patient experienced post-exercise cough and hemoptysis, which led to his admission. Imaging revealed pulmonary embolism, thrombosis in the right ventricular outflow tract, and lung infiltrative lesions. We hypothesize that the chronic bar displacement led to its embedment in the right ventricle, resulting in thrombus formation, which subsequently contributed to partial pulmonary embolism. Surgery revealed the bars' intrusion into the right ventricle and lung. This case highlights the risk of severe complications from bar displacement in the Nuss procedure, which necessitates long-term follow-up evaluation, caution against strenuous activities after surgery, and use of thoracoscopic guidance during bar implantation and removal. It underscores the importance of vigilant evaluation for late-stage complications in patients with respiratory distress or thrombosis after a Nuss procedure.
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Tórax en Embudo , Embolia Pulmonar , Trombosis , Humanos , Embolia Pulmonar/etiología , Embolia Pulmonar/diagnóstico , Masculino , Adolescente , Tórax en Embudo/cirugía , Trombosis/etiología , Trombosis/diagnóstico por imagen , Trombosis/diagnóstico , Ventrículos Cardíacos/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
The management of anticoagulant therapy in pregnant women with mechanical heart valves (MHVs) is difficult and often challenging even for clinicians experienced in the field. These pregnancies, indeed, are burdened with higher rates of complications for both the mother and the fetus, compared to those in women without MHVs. The maternal need for an optimal anticoagulation as provided by vitamin K antagonists is counterbalanced by their teratogen effect on the embryo and fetus. On the other hand, several concerns have been raised about the efficacy of heparins in pregnant women with MHVs, considering the high risk of thrombotic complications in these patients. Therefore, numerous clinical issues about the management of pregnant women with MHVs remain unanswered, such as the selection of the best anticoagulant agent, the optimal anticoagulation levels to be achieved and maintained, and the evaluation of long-term effects for both the mother and the fetus. Based on a comprehensive review of the current literature, the Italian Federation of the Centers for the Diagnosis and the Surveillance of the Antithrombotic Therapies (FCSA) proposes experience-based suggestions and expert opinions. Particularly, this consensus document aims at providing practical guidance for clinicians dealing with pregnant women with MHVs, to optimize maternal and fetal outcomes while guaranteeing adequate anticoagulation. Finally, FCSA highlights the need for the creation of multidisciplinary teams experienced in the management of pregnant women with MHVs during pregnancy, delivery, and postpartum, in order to better deal with such complex clinical issues and provide a comprehensive counseling to these patients.
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Anticoagulantes , Prótesis Valvulares Cardíacas , Complicaciones Cardiovasculares del Embarazo , Humanos , Embarazo , Femenino , Anticoagulantes/uso terapéutico , Anticoagulantes/efectos adversos , Complicaciones Cardiovasculares del Embarazo/tratamiento farmacológico , Complicaciones Cardiovasculares del Embarazo/diagnóstico , Italia , Trombosis/prevención & control , Trombosis/diagnóstico , Consenso , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Factores de Riesgo , Heparina/efectos adversos , Heparina/uso terapéuticoRESUMEN
Therapeutic anticoagulation showed inconsistent results in hospitalized patients with COVID-19 and selection of the best patients to use this strategy still a challenge balancing the risk of thrombotic and hemorrhagic outcomes. The present post-hoc analysis of the ACTION trial evaluated the variables independently associated with both bleeding events (major bleeding or clinically relevant non-major bleeding) and the composite outcomes thrombotic events (venous thromboembolism, myocardial infarction, stroke, systemic embolism, or major adverse limb events). Variables were assessed one by one with independent logistic regressions and final models were chosen based on Akaike information criteria. The model for bleeding events showed an area under the curve of 0.63 (95% confidence interval [CI] 0.53 to 0.73), while the model for thrombotic events had an area under the curve of 0.72 (95% CI 0.65 to 0.79). Non-invasive respiratory support was associated with thrombotic but not bleeding events, while invasive ventilation was associated with both outcomes (Odds Ratio of 7.03 [95 CI% 1.95 to 25.18] for thrombotic and 3.14 [95% CI 1.11 to 8.84] for bleeding events). Beyond respiratory support, creatinine level (Odds Ratio [OR] 1.01 95% CI 1.00 to 1.02 for every 1.0 mg/dL) and history of coronary disease (OR 3.67; 95% CI 1.32 to 10.29) were also independently associated to the risk of thrombotic events. Non-invasive respiratory support, history of coronary disease, and creatinine level may help to identify hospitalized COVID-19 patients at higher risk of thrombotic complications.ClinicalTrials.gov: NCT04394377.
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COVID-19 , Productos de Degradación de Fibrina-Fibrinógeno , Hemorragia , Trombosis , Humanos , COVID-19/sangre , COVID-19/complicaciones , COVID-19/diagnóstico , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , Hemorragia/sangre , Hemorragia/diagnóstico , Hemorragia/etiología , Hemorragia/inducido químicamente , Masculino , Femenino , Trombosis/sangre , Trombosis/etiología , Trombosis/diagnóstico , Anciano , Persona de Mediana Edad , Hospitalización , Factores de Riesgo , SARS-CoV-2 , Anticoagulantes/uso terapéutico , Anticoagulantes/efectos adversosAsunto(s)
Atrios Cardíacos , Hematoma , Embolia Pulmonar , Terapia Trombolítica , Trombosis , Humanos , Embolia Pulmonar/tratamiento farmacológico , Embolia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/diagnóstico , Hematoma/diagnóstico , Hematoma/diagnóstico por imagen , Diagnóstico Diferencial , Terapia Trombolítica/métodos , Atrios Cardíacos/diagnóstico por imagen , Trombosis/tratamiento farmacológico , Trombosis/diagnóstico por imagen , Trombosis/diagnóstico , Cardiopatías/diagnóstico por imagen , Cardiopatías/tratamiento farmacológico , Cardiopatías/diagnóstico , Masculino , Femenino , Tabique Interatrial/diagnóstico por imagenRESUMEN
The Myeloproliferative Neoplasm Symptom Assessment Total Symptom Score (MPN-SAF TSS) is a surrogate marker for symptom evaluation in chronic myeloproliferative neoplasms (MPNs). However, insufficient data are available regarding the relationship among the MPN-SAF TSS, JAK2 mutation allele burden, and thrombosis. In this retrospective analysis, we aimed to determine the genetic burdens, clinical features, and relationships with MPN-SAF TSS in MPN patients. One hundred thirty JAK2V617F-positive patients with MPNs were included in our study. We calculated the MPN-SAF TSS for all patients and compared it with their clinical characteristics. Patients with higher JAK2V617F mutation allele burden had higher MPN-SAF TSS values (p=0.008). Patients with thrombosis had higher MPN-SAF TSS than patients without thrombosis (p=0.003). The mean MPN-SAF TSS was higher in patients with primary myelofibrosis compared to those with polycythemia vera and essential thrombocythemia. Thrombosis was associated with increased symptom severity in several domains, including fatigue, abdominal discomfort, inactivity, night sweats, pruritus, weight loss, and early satiety. Additionally, an increase in JAK2 allele burden was observed with higher symptom scores. The MPN-SAF TSS proved to be a reliable tool for assessing symptom burden in Turkish MPN patients. Furthermore, the significant association between thrombosis occurrence and symptom severity suggests that thrombotic events may contribute to symptom development. Notably, increasing JAK2 allele burden was correlated with more severe symptoms, highlighting its potential role in predicting disease burden. This study emphasizes the importance of symptom assessment in MPN patients and supports the incorporation of the MPN-SAF TSS in routine clinical practice to enhance patient care and management.