RESUMEN
OBJECTIVES: Technical graft loss, usually thrombotic in nature, accounts for most of the pancreas grafts that are removed early after transplant. Although arterial and venous thrombosis can occur, the vein is predominantly affected, with estimated overall rate of thrombosis of 6% to 33%. In late diagnosis, the graft will need to be removed because thrombectomy will not restore its functionality. However, in early diagnosis, a salvage procedure should be attempted. MATERIALS AND METHODS: We conducted a retrospective, descriptive analysis of a prospective database of patients who underwent pancreas transplant from April 2008 to June 2020 at a single center. We evaluated post-transplant clinical glucose levels, imaging, treatment, and outcomes. We also performed a systematic review of publications for endovascular treatment of vascular graft thrombosis in pancreas transplant. RESULTS: In 67 pancreas transplants analyzed, 13 (19%) were diagnosed with venous thrombus. In 7 of 13 patients (54%), systemic anticoagulation was prescribed because of a non-occlusive thromboses, resulting in complete resolution for all 7 patients. Six patients (46%) required endovascular thrombectomy because of the presence of complete occlusive thrombosis; 4 of these patients (67%) needed a second procedure because of recurrence of the thrombosis. One of the 6 patients (17%) required a surgical approach, resulting in successful removal of the recurrent clot. Twelve of the 13 grafts (92%) were rescued. Graft survival at 1 year was 84%; graft survival at 3, 5, and 10 years remained at 70%. CONCLUSIONS: Pancreas vein thrombosis represents a frequent surgical complication and remains as a challenging problem. In our experience, early diagnoses and an endovascular approach combined with aggressive medical treatment and follow-up can be used for successful treatment and reduce graft loss.
Asunto(s)
Procedimientos Endovasculares , Trasplante de Páncreas , Terapia Recuperativa , Vena Esplénica , Trombectomía , Trombosis de la Vena , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Bases de Datos Factuales/estadística & datos numéricos , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/métodos , Trasplante de Páncreas/efectos adversos , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Terapia Recuperativa/efectos adversos , Terapia Recuperativa/métodos , Vena Esplénica/cirugía , Vena Esplénica/diagnóstico por imagen , Trombectomía/efectos adversos , Trombectomía/métodos , Factores de Tiempo , Resultado del Tratamiento , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/epidemiología , Trombosis de la Vena/etiología , Trombosis de la Vena/terapiaRESUMEN
INTRODUCTION: Despite the highly favorable prognosis, mortality occurs in nearly 2% of patients with cerebral venous thrombosis (CVT), in which decompressive craniectomy (DC) may be the only way to save the patient's life. The aim of this report is to describe the risk factors, neuroimaging features, in-hospital complications and functional outcome of severe CVT in patients treated with DC. MATERIALS AND METHODS: Consecutive malignant CVT cases treated with DC from a retrospective third-level hospital database were analyzed. Demographic, clinical, and functional outcomes were analyzed. RESULTS: Twenty-six patients were included (20 female, age 35.4±12.1 years); 53.8% of the patients had acute CVT, with neurological focalization as the most common symptom in 92.3% of the patients. Superior sagittal sinus thromboses were found in 84.6% of cases. Bilateral lesions were present in 10 patients (38.5%). Imaging on admission showed a parenchymal lesion (venous infarction±hemorrhagic lesion)>6cm measured along the longest diameter in 25 patients (96.2%). Mean duration of clinical neurological deterioration was 3.5 days; eleven patients (42.3%) died during hospitalization. CONCLUSION: In patients with severe forms of CVT, we found higher mortality than previously reported. DC is an effective life-saving treatment with acceptable functional prognosis for survivors.
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Craniectomía Descompresiva , Trombosis de la Vena , Humanos , Femenino , Adulto Joven , Adulto , Persona de Mediana Edad , Craniectomía Descompresiva/métodos , Estudios Retrospectivos , Pronóstico , Resultado del Tratamiento , Trombosis de la Vena/cirugía , Trombosis de la Vena/complicaciones , Trombosis de la Vena/diagnósticoAsunto(s)
Hipertensión Portal , Trombosis de la Vena , Humanos , Trombosis de la Vena/diagnóstico , Vena PortaRESUMEN
ABSTRACT Cavernous sinus and superior ophthalmic vein thrombosis is a rare clinical condition, and little described in the literature. The clinical presentation is nonspecific and highly variable, and symptoms may include red eye, ophthalmoplegia, coma, and death. The main etiology results from infection of the paranasal sinuses. The final diagnosis must be made through imaging tests such as magnetic resonance imaging. We describe a case of cavernous sinus and superior ophthalmic vein thrombosis after COVID-19 infection in a 64-year-old patient with persistent ocular hyperemia and pain on eye movement. Ophthalmological examination showed preserved visual acuity, conjunctival hyperemia, dilation of episcleral vessels and retinal vascular tortuosity in the right eye. Magnetic resonance imaging confirmed the diagnosis. The association with the COVID-19 was raised, excluding other infectious causes. Enoxaparin and Warfarin were started with significant improvement in the ocular clinical presentation and maintenance of initial visual acuity after 12 months of follow-up.
RESUMO A trombose de seio cavernoso e veia oftálmica superior é uma condição clínica rara e pouco descrita na literatura. A apresentação clínica é inespecífica e altamente variável. Os sintomas podem incluir olho vermelho, oftalmoplegia, coma e morte. A etiologia principal resulta da infecção dos seios paranasais. O diagnóstico final deve ser efetuado por meio de exames de imagem, como ressonância magnética. Descrevemos um caso de trombose de seio cavernoso e veia oftálmica superior após COVID-19 em paciente de 64 anos e com quadro de hiperemia ocular persistente e dor à movimentação ocular. Ao exame oftalmológico, observou-se acuidade visual preservada, hiperemia conjuntival, dilatação de vasos episclerais e tortuosidade vascular retiniana em olho direito. A ressonância confirmou o diagnóstico. A associação com a COVID-19 foi levantada, excluindo-se demais causas infecciosas. Prescrevemos enoxaparina e varfarina, com melhora do quadro clínico ocular e manutenção da acuidade visual inicial após 12 meses de acompanhamento.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Trombosis de la Vena/etiología , Trombosis del Seno Cavernoso/etiología , COVID-19/complicaciones , Vasos Retinianos/patología , Tonometría Ocular , Warfarina/administración & dosificación , Imagen por Resonancia Magnética , Enoxaparina/administración & dosificación , Conjuntiva/patología , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/tratamiento farmacológico , Trombosis del Seno Cavernoso/diagnóstico , Trombosis del Seno Cavernoso/tratamiento farmacológico , Microscopía con Lámpara de Hendidura , SARS-CoV-2 , Anticoagulantes/administración & dosificaciónRESUMEN
Introducción: La enfermedad tromboembólica venosa es un trastorno en el que se forma un trombo en el interior de las venas, que bloquea el flujo sanguíneo y produce diferentes sintomatologías en función de su localización. Objetivos: Definir las características clínicas y epidemiológicas de los pacientes con trombosis venosa profunda y cáncer. Métodos: Se realizó un estudio descriptivo y retrospectivo de los pacientes que ingresaron en el Servicio de Flebolinfología del Instituto Nacional de Angiología y Cirugía Vascular, con el diagnóstico de trombosis venosa profunda y cáncer, durante el período entre enero y diciembre de 2018. Se estudiaron las siguientes variables: grupos de edad, sexo, diagnóstico al ingreso, factores de riesgo, tipos de cáncer y localización de la trombosis según Eco-Doppler. Resultados: El grupo de edad predominante fue 60-69 años (30,8 por ciento) y prevaleció el sexo femenino (61,5 por ciento). Sobresalió la localización del cáncer en las mamas y la próstata con tres casos cada uno (23,1 por ciento). El factor de riesgo predominante resultó la edad (38,4 por ciento), seguido por la presencia de metástasis (23,1 por ciento). Como sector predominante, según Eco-Doppler, se halló el femoropoplíteo (58,8 por ciento). Conclusiones: La trombosis venosa profunda afecta en gran medida a los pacientes con cáncer. Los más afectados tienen entre 60 y 69 años. Los factores de riesgo predominantes fueron la edad y la presencia de metástasis; y la localización más frecuente, los miembros inferiores, en específico, a nivel del sector femoropoplíteo(AU)
Introduction: Venous thromboembolic disease is a disorder in which a thrombus forms inside the veins, which blocks blood flow and produces different symptoms depending on its location. Objectives: To define the clinical and epidemiological characteristics of patients with deep vein thrombosis and cancer. Methods: A descriptive and retrospective study of patients admitted in the Phlebolymphology Service of the National Institute of Angiology and Vascular Surgery, with the diagnosis of deep vein thrombosis and cancer, was conducted during the period between January and December 2018. The following variables were studied: age groups, sex, diagnosis upon admission, risk factors, types of cancer and location of thrombosis according to Eco-Doppler. Results: The predominant age group was 60-69 years (30.8 percent) and the female sex prevailed (61.5 percent). The location of cancer in the breasts and prostate stood out with three cases each (23.1 percent). The predominant risk factor was age (38.4 percent), followed by the presence of metastases (23.1 percent). As the predominant sector, according to Eco-Doppler, it was found the femoro-popliteal (58.8 percent). Conclusions: Deep vein thrombosis greatly affects cancer patients. The most affected are between 60 and 69 years old. The predominant risk factors were age and the presence of metastases; and the most frequent location, the lower limbs, specifically, at the level of the femoro-popliteal sector(AU)
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Epidemiología Descriptiva , Trombosis de la Vena/diagnósticoRESUMEN
Abstract Vein thrombosis of unusual sites such as the splanchnic region continues to be not only a diagnostic but also a therapeutic challenge for the clinician due to its manifestation and associated pathologies. Latent JAK2 (Janus kinase 2) positive myeloproliferative neoplasm associated with sticky platelet syndrome is unusual. We present a clinical case of a 38-year-old female patient who presented with sudden onset abdominal pain of a possible vascular origin. Splanchnic thrombosis was diagnosed in latent myeloproliferative neoplasm by identifying the JAK2V617F mutation and sticky platelet syndrome via platelet aggregometry. Off-label anticoagulation with rivaroxaban 20 mg/day was administered. During her outpatient follow-up, she did not suffer any new thrombotic episodes.
Resumen La trombosis venosa de sitios inusuales como la esplácnica continúa siendo un reto no solo diagnóstico sino también terapéutico para el clínico debido a su forma de presentación y las patologías asociadas. La neoplasia mieloproliferativa latente JAK2 (cinasa de Janus 2) positiva asociada con síndrome de plaqueta pegajosa es inusual. Se presenta un caso clínico de una paciente de 38 años de edad que debutó con dolor abdominal de inicio súbito que sugirió un posible origen vascular. Se diagnosticó trombosis esplácnica en relación con neoplasia mieloproliferativa latente por la identificación de la mutación de la JAK2V617F y síndrome de plaqueta pegajosa mediante agregometría plaquetaria. Se administró de manera off-label anticoagulación con rivaroxabán 20 mg/día. Durante su seguimiento ambulatorio no ha presentado nuevos episodios trombóticos.
Asunto(s)
Humanos , Femenino , Adulto , Trastornos de las Plaquetas Sanguíneas/diagnóstico , Vísceras/irrigación sanguínea , Trombosis de la Vena/diagnóstico , Trastornos Mieloproliferativos/diagnóstico , Síndrome , Trastornos de las Plaquetas Sanguíneas/genética , Trombosis de la Vena/genética , Janus Quinasa 2/genéticaRESUMEN
Phlegmasia cerulea dolens, a rare and potentially fatal complication of acute deep vein thrombosis, is characterized by substantial edema, intense pain, and cyanosis. Phlegmasia cerulea dolens may compromise limb perfusion and lead to acute ischemia, gangrene, amputation, and death. We present the case of a 61-year-old woman with a history of breast cancer who had signs and symptoms of phlegmasia cerulea dolens in her left leg. She was treated promptly with open surgical thrombectomy and sequential distal compression with use of an Esmarch bandage to ensure complete thrombus extraction. These techniques restored venous flow and saved her leg. Open surgical thrombectomy should be considered in the presence of limb-threatening acute deep vein thrombosis presenting as phlegmasia cerulea dolens.
Asunto(s)
Neoplasias , Trombosis de la Vena , Femenino , Humanos , Pierna/irrigación sanguínea , Persona de Mediana Edad , Trombectomía/métodos , Procedimientos Quirúrgicos Vasculares , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/etiología , Trombosis de la Vena/cirugíaRESUMEN
INTRODUCTION AND OBJECTIVES: Optimal treatment of hepatocellular carcinoma (HCC) involving portal vein tumor thrombus (PVTT) remains controversial. MATERIALS AND METHODS: A total of 627 HCC patients with PVTT after initial treatment with one of the following at Affiliated Tumor Hospital of Guangxi Medical University: liver resection (LR, n = 225), transarterial chemoembolization (TACE, n = 298) or sorafenib (n = 104) were recruited and randomly divided into the training cohort (n = 314) and internal validation cohort (n = 313). Survival analysis were repeated after stratifying patients by Cheng PVTT type. RESULTS: Resection led to significantly higher OS than the other two treatments among patients with type I or II PVTT. TACE worked significantly better than the other two treatments for patients with type III. All three treatments were associated with similar OS among patients with type IV. These findings were supported by the internal validation cohort. CONCLUSIONS: Our results suggest that the optimal treatment for HCC involving PVTT depends on the type of PVTT. LR may be more appropriate for type I or II PVTT; TACE, for type III Sorafenib may be more appropriate than invasive treatments for patients with type IV PVTT.
Asunto(s)
Carcinoma Hepatocelular/terapia , Quimioembolización Terapéutica/métodos , Hepatectomía/métodos , Neoplasias Hepáticas/terapia , Vena Porta , Sorafenib/administración & dosificación , Trombosis de la Vena/etiología , Antineoplásicos/administración & dosificación , Carcinoma Hepatocelular/complicaciones , Carcinoma Hepatocelular/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Infusiones Intraarteriales , Neoplasias Hepáticas/complicaciones , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/patología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/terapiaRESUMEN
BACKGROUND: Since the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) pandemic, there have been many reports of increased incidence of venous thromboembolism and arterial events as a complication. OBJECTIVE: To determine the incidence of symptomatic thrombotic events (TEs) in patients hospitalized for SARS-CoV2 disease (coronavirus 19 [Covid-19]). METHODS: A retrospective single-center cohort study with adult patients with a positive reverse transcriptase-polymerase chain reaction (rt-PCR) for SARS-CoV2, included from the date of diagnosis of Covid-19 and followed for 90 days or until death. RESULTS: A total of 1621 patients were included in this study. The median age was 73 years (interquartile range25th-75th [IQR] 53-87 years) and 57% (913) were female. Overall mortality was 21.6% (348). The overall incidence of symptomatic TEs within 90 days of diagnosis was 1.8% (30 of 1621) occurring in 28 patients, including an incidence of pulmonary embolism of 0.9% (15, 95% confidence interval [CI] 0.60%-1.6%), deep venous thrombosis of 0.61% (10, 95% CI 0.2%-1%), ischemic stroke of 0.25% (4, 95% CI 0.09%-0.65%), and ischemic arterial events of 0.06% (1, 95% CI 0.008%-0.43%). No acute coronary syndrome events were recorded. The incidence of symptomatic TEs was significantly lower in the general ward than in intensive care units (1.2% vs 5.7%; p < .001). The median time since positive rt-PCR for SARS-CoV2 to symptomatic TE was 22.5 days (IQR 19-43 days). There was no significant difference in the proportion of patients receiving (53.6%) and not receiving thromboprophylaxis (66.5%) and the development of TEs. CONCLUSION: The overall incidence of symptomatic TEs among these patients was lower than the incidence previously reported.
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Arteriopatías Oclusivas/epidemiología , COVID-19/epidemiología , Embolia Pulmonar/epidemiología , Tromboembolia/epidemiología , Trombosis de la Vena/epidemiología , Anciano , Anciano de 80 o más Años , Argentina/epidemiología , Arteriopatías Oclusivas/sangre , Arteriopatías Oclusivas/diagnóstico , COVID-19/sangre , COVID-19/diagnóstico , Femenino , Humanos , Incidencia , Accidente Cerebrovascular Isquémico/sangre , Accidente Cerebrovascular Isquémico/diagnóstico , Accidente Cerebrovascular Isquémico/epidemiología , Masculino , Persona de Mediana Edad , Admisión del Paciente , Embolia Pulmonar/sangre , Embolia Pulmonar/diagnóstico , Estudios Retrospectivos , Tromboembolia/sangre , Tromboembolia/diagnóstico , Factores de Tiempo , Trombosis de la Vena/sangre , Trombosis de la Vena/diagnósticoRESUMEN
INTRODUCTION: Venous sinus thrombosis (VST) is a rare entity in pediatrics, probably under-diagnosed and poten tially serious, described as a cause of stroke in childhood. OBJECTIVE: To describe the clinical presenta tion, risk factors, treatment, and evolution of pediatric patients with VST. PATIENTS AND METHOD: Re trospective study of patients admitted to a referral hospital, diagnosed with VST, aged between one month and seventeen years, from January 2011 to December 2019. The following data were re viewed: age at diagnosis, sex, signs and symptoms of presentation, predisposing mechanisms, study of thrombophilias, treatment and duration of treatment, follow-up protocol, long-term sequelae, and mortality. Due to their differences in clinical presentation, the sample was divided into two age groups: young children between 1 month and 5 years and older children and adolescents between 6 and 17 years. RESULTS: 17 patients were diagnosed with VST, 45% were women, with a median age of 4.5 years. The most frequent symptoms in older children (6-17 years old) were headache (80%) and diplopia (60%). In children under 5 years old, the most frequent clinical presentation was cerebellar ataxia (42%), asymptomatic (34%), and headache (25%). In 23.5% of the total, VST was a casual fin ding in neuroimaging. 13 patients presented relevant histories such as complicated otitis media with mastoiditis (53%), severe traumatic head injury (6%), and resection of a space-occupying lesion of the brain (6%). 23% of the cases were idiopathic and in 23% there were prothrombotic factors. The treatment of choice in all patients was low-molecular-weight heparin. During the short-term follow- up, 11.8% presented self-limited neurological symptoms. One patient presented long-term paresis of the sixth paired cranial nerve. There were no deaths or recurrences of the episode in our series. CONCLUSIONS: VST is a rare entity and it usually appears with signs and symptoms of intracranial hy pertension. It is a potentially serious condition and early diagnosis and treatment can help minimize long-term sequelae.
Asunto(s)
Trombosis de los Senos Intracraneales , Trombosis de la Vena , Adolescente , Anticoagulantes/uso terapéutico , Niño , Preescolar , Femenino , Estudios de Seguimiento , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , Lactante , Imagen por Resonancia Magnética , Masculino , Estudios Retrospectivos , Factores de Riesgo , Trombosis de los Senos Intracraneales/diagnóstico , Trombosis de los Senos Intracraneales/tratamiento farmacológico , Trombosis de los Senos Intracraneales/etiología , Trombosis de los Senos Intracraneales/mortalidad , Centros de Atención Terciaria , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/tratamiento farmacológico , Trombosis de la Vena/etiología , Trombosis de la Vena/mortalidadRESUMEN
ABSTRACT BACKGROUND: Although it is known that the new coronavirus disease (COVID-19), which was first seen in Wuhan, China, in December 2019 and has affected the whole world, mainly targets the respiratory tract, cases of this disease with a wide clinical spectrum are emerging as information is shared. CASE REPORT: We present the case of a pregnant woman who was diagnosed with venous sinus thrombosis after she developed headache and hemiparesis. Polymerase chain reaction (PCR) positivity lasted for two weeks after COVID-19 had been diagnosed. CONCLUSIONS: In patients with suspected COVID-19, especially in the presence of causes of hypercoagu- lability and presence of atypical features, venous sinus thrombosis needs to be kept in mind in making the differential diagnosis.
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Humanos , Femenino , Embarazo , Trombosis de la Vena/diagnóstico , SARS-CoV-2/aislamiento & purificación , SARS-CoV-2/genética , COVID-19/complicaciones , Cefalea/etiología , Paresia/etiología , Trombosis de los Senos Intracraneales/diagnóstico por imagen , China , Reacción en Cadena de la Polimerasa , Trombofilia , Prueba de COVID-19 , COVID-19/diagnósticoRESUMEN
Catatonic patients may develop deep vein thrombosis (DVT) and pulmonary embolism (PE) due to prolonged periods of immobility. These life-threatening conditions demand prompt recognition and management. We describe the case of a patient with catatonia who presented to anesthesia for electroconvulsive therapy (ECT) at the outset of the current coronavirus disease 2019 pandemic. She complained of breathing difficulty and was suspected to have COVID-19 infection. On further evaluation, she was found to have DVT and PE and required oxygen therapy and intensive care management. The diagnostic delay in our patient would have probably not occurred, had it not been for the existing pandemic situation.
Asunto(s)
COVID-19/diagnóstico , Catatonia/complicaciones , Diagnóstico Tardío , Terapia Electroconvulsiva , Embolia Pulmonar/diagnóstico , Trombosis de la Vena/diagnóstico , Anestesia , Catatonia/terapia , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad , Oxígeno/uso terapéutico , Embolia Pulmonar/terapia , Tomografía Computarizada por Rayos X , Trombosis de la Vena/terapiaRESUMEN
BACKGROUND: Although it is known that the new coronavirus disease (COVID-19), which was first seen in Wuhan, China, in December 2019 and has affected the whole world, mainly targets the respiratory tract, cases of this disease with a wide clinical spectrum are emerging as information is shared. CASE REPORT: We present the case of a pregnant woman who was diagnosed with venous sinus thrombosis after she developed headache and hemiparesis. Polymerase chain reaction (PCR) positivity lasted for two weeks after COVID-19 had been diagnosed. CONCLUSIONS: In patients with suspected COVID-19, especially in the presence of causes of hypercoagu- lability and presence of atypical features, venous sinus thrombosis needs to be kept in mind in making the differential diagnosis.
Asunto(s)
COVID-19/complicaciones , Cefalea/etiología , SARS-CoV-2 , Trombosis de la Vena/diagnóstico , COVID-19/diagnóstico , Prueba de COVID-19 , China , Femenino , Humanos , Paresia/etiología , Reacción en Cadena de la Polimerasa , Embarazo , SARS-CoV-2/genética , SARS-CoV-2/aislamiento & purificación , Trombosis de los Senos Intracraneales/diagnóstico por imagen , TrombofiliaAsunto(s)
Janus Quinasa 2/genética , Mutación , Vena Porta , Complicaciones Cardiovasculares del Embarazo/diagnóstico , Trombosis de la Vena/diagnóstico , Dolor Abdominal/etiología , Adulto , Femenino , Humanos , Nacimiento Vivo , Imagen por Resonancia Magnética , Embarazo , Complicaciones Cardiovasculares del Embarazo/genética , Resultado del Embarazo , Esplenomegalia/etiología , Trombosis de la Vena/complicaciones , Trombosis de la Vena/genéticaRESUMEN
Abstract Our study describes a fatal case of phlegmasia cerulea dolens and massive venous thrombosis in a patient taking rivaroxaban regularly to treat cerebral venous sinus thrombosis. Blood tests samples were positive for lupus anticoagulant. The unique evolution of the case, as well as the positivity for lupus anticoagulant, raises the possibility of an acquired hypercoagulation syndrome. We highlight the fact that the test recommended as the first line for lupus anticoagulant diagnosis (dilute Russell viper venom time) is the most affected by rivaroxaban, leading to a high prevalence of false-positive results. We also discuss potential diagnoses for the current case and review the current state-of-the-art of use of the novel oral anticoagulation agents in this unusual situation. So far, there are no recommendations to use such agents as first options in cerebral venous sinus thrombosis or in hypercoagulation syndromes.
Resumo Nosso estudo descreve um caso fatal de flegmasia cerúlea dolens e trombose venosa maciça em um paciente usando regularmente rivaroxabana para o tratamento de trombose de seio venoso cerebral. A investigação laboratorial foi positiva para o anticoagulante lúpico. A evolução única do caso aumenta a possibilidade de uma síndrome de hipercoagulabilidade adquirida, bem como a positividade para o anticoagulante lúpico. Destacamos o fato de que o teste recomendado como primeira linha para o diagnóstico de anticoagulante lúpico (veneno de víbora de Russel diluído) é o mais afetado pela rivaroxabana, levando a uma alta prevalência de resultados falso-positivos. Também discutimos os potenciais diagnósticos para o presente caso e revisamos o estado da arte atual dos novos agentes de anticoagulação oral usados nessa situação incomum. Até o presente momento, não há recomendações para o uso de tais agentes como primeira opção na trombose de seios venosos cerebrais ou nas síndromes de hipercoagulação.
Asunto(s)
Humanos , Femenino , Adulto , Tromboflebitis/complicaciones , Trombosis de la Vena/complicaciones , Rivaroxabán/efectos adversos , Anticoagulantes/efectos adversos , Trombosis de los Senos Intracraneales/tratamiento farmacológico , Tromboflebitis/diagnóstico , Trombosis de la Vena/diagnóstico , Inhibidores del Factor XaRESUMEN
Resumo Apesar de a fisiopatologia da coagulopatia associada à doença do coronavírus 2019 (COVID‐19) não ser bem conhecida, a ocorrência de embolia pulmonar (EP) é frequentemente observada. No entanto, foram descritos na literatura poucos casos de pacientes que tiveram COVID-19 oligossintomática, sem nenhum fator de risco para tromboembolismo venoso (TEV) e que apresentaram EP aguda extensa. Relatamos um caso de paciente com COVID-19 oligossintomática, complicada por trombose venosa profunda e, posteriormente, EP aguda extensa, sugerindo que esses quadros devem ser considerados de forma sistemática mesmo em pacientes com COVID-19 oligossintomática e sem fatores de risco conhecidos para TEV.
Abstract Although the pathophysiology of coagulopathy associated with the 2019 coronavirus disease (COVID-19) is not well known, occurrence of pulmonary embolism (PE) is frequently observed. However, few cases have been described in the literature in which patients who had asymptomatic COVID-19, with no risk factors for venous thromboembolism (VTE), presented extensive acute PE. We report the case of a patient with asymptomatic COVID-19, complicated by deep vein thrombosis and later by extensive acute PE, suggesting that these conditions should be systematically considered, even in asymptomatic COVID-19 patients with no known risk factors for VTE.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Embolia Pulmonar/etiología , COVID-19/complicaciones , Enfermedades Oligosintomáticas , Factores de Riesgo , Trombosis de la Vena/complicaciones , Trombosis de la Vena/diagnósticoRESUMEN
The Wells criteria for DVT are used to calculate risk of DVT based on clinical criteria.
Asunto(s)
Técnicas de Apoyo para la Decisión , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Trombosis de la Vena/diagnóstico , Diagnóstico Diferencial , Medicina de Emergencia Basada en la Evidencia , Humanos , Valor Predictivo de las Pruebas , Medición de Riesgo , UltrasonografíaRESUMEN
A 12-year-old girl with severe acute respiratory syndrome coronavirus 2 infection presented as phlegmasia cerulea dolens with venous gangrene. Emergent mechanical thrombectomy was complicated by a massive pulmonary embolism and cardiac arrest, for which extracorporeal cardiopulmonary resuscitation and therapeutic hypothermia were used. Staged ultrasound-assisted catheter-directed thrombolysis was used for treatment of bilateral pulmonary emboli and the extensive lower extremity deep vein thrombosis while the patient received extracorporeal membrane oxygenation support. We highlight the need for heightened suspicion for occult severe acute respiratory syndrome coronavirus 2 infection among children presenting with unusual thrombotic complications.