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V De Stefano - One of the best experts on this subject based on the ideXlab platform.
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rare thromboses of cerebral splanchnic and upper extremity veins a narrative review
Thrombosis and Haemostasis, 2010Co-Authors: Ida Martinelli, V De StefanoAbstract:Venous Thrombosis typically involves the lower extremity circulation. Rarely, it can occur in the cerebral or splanchnic veins and these are the most frightening manifestations because of their high mortality rate. A third site of rare venous Thrombosis is the deep system of the upper extremities that, as for the lower extremity, can be complicated by pulmonary embolism and post-thrombotic syndrome. The authors conducted a narrative review focused on clinical manifestations, risk factors, and treatment of rare venous thromboses. Local risk factors such as infections or cancer are frequent in Thrombosis of cerebral or portal veins. Upper extremity deep-vein Thrombosis is mostly due to local risk factors (catheter- or effort-related). Common systemic risk factors for rare venous thromboses are inherited thrombophilia and oral contraceptive use; chronic myeloproliferative neoplasms are closely associated with splanchnic vein Thrombosis. In the acute phase rare venous thromboses should be treated conventionally with low-molecular-weight heparin. Use of local or systemic fibrinolysis should be considered in the case of clinical deterioration in spite of adequate anticoagulation. Anticoagulation with vitamin K-antagonists is recommended for 3–6 months after a first episode of rare venous Thrombosis. Indefinite anticoagulation is recommended for Budd-Chiari syndrome, recurrent Thrombosis or unprovoked Thrombosis and permanent risk factors. In conclusion, the progresses made in the last couple of decades in diagnostic imaging and the broadened knowledge of thrombophilic abnormalities improved the recognition of rare venous thromboses and the understanding of pathogenic mechanisms. However, the recommendations for treatment mainly derive from observational studies.
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The risk of Thrombosis in patients with acute leukemia: occurrence of Thrombosis at diagnosis and during treatment.
Journal of thrombosis and haemostasis : JTH, 2005Co-Authors: V De Stefano, Patrizia Chiusolo, Federica Sorà, E. Rossi, Luca Laurenti, Luana Fianchi, Gina Zini, Livio Pagano, Simona Sica, Giuseppe LeoneAbstract:To cite this article: De Stefano V, SoraF, Rossi E, Chiusolo P, Laurenti L, Fianchi L, Zini G, Pagano L, Sica S, Leone G. The risk of Thrombosis in patients with acute leukemia: occurrence of Thrombosis at diagnosis and during treatment. J Thromb Haemost 2005; 3: 1985-92. Summary. Background: Thromboembolism can occur during acute leukemia, especially acute lymphoid leukemia (ALL) treated with L-asparaginase. Yet, most reports are anecdotical and scarce data are available on the risk of Thrombosis in acute myeloid leukemia (AML). Objectives: To evaluate the risk of Thrombosis in patients with acute leukemia. Patients and methods: Three-hundred and seventy-nine consecutive adult patients with newly diagnosed acute leukemia were recruited in an observational cohort study conducted from January 1994 to December 2003. Diagnosis was ALL in 69 patients, acute promyelocytic leukemia (APL; FAB subtype M3) in 31, and non-M3 AML in 279. All first or recurrent symptomatic thromboembolic events objectively diagnosed were recor- ded. Results: Twenty-four patients of the overall 379 (6.3%; 95% CI 4.1%-9.2%) had a first Thrombosis, venous in 80% of the cases and arterial in 20%. At diagnosis, Thrombosis was a presenting manifestation in 13 cases (3.4% of the whole cohort): 1.4% in ALL, 9.6% in APL, and 3.2% in non-M3 AML patients. Follow-up was carried out on 343 patients without Thrombosis at diagnosis and further 11 thrombotic events (3.2%) were recorded. At 6 months from diagnosis, the cumulative incidence of Thrombosis was 10.6% in ALL, 8.4% in APL, and 1.7% in non-M3 AML patients. The patients who received L-asparaginase had a 4.9-fold increased risk of Thrombosis in comparison with those who did not (95% CI 1.5-16.0). The fatality rate due to Thrombosis was 0.8%. Conclusions: In patients with acute leukemia, the risk of Thrombosis is not negligible. Thombosis can be a presenting symptom at diagnosis in a significant portion of cases with APL (9.6%) and non-M3 AML (3.2%); a similar rate of Thrombosis can occur during the subsequent course of the disease. The incidence of symptomatic Thrombosis at diagnosis is relatively low in ALL patients (1.4%), but is significantly increased by further treatment up to 10.6%. Strategies of antithrombotic prophylaxis should be investigated in this setting.
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clinical manifestations and management of inherited thrombophilia retrospective analysis and follow up after diagnosis of 238 patients with congenital deficiency of antithrombin iii protein c protein s
Thrombosis and Haemostasis, 1994Co-Authors: V De Stefano, Giuseppe Leone, Stefano Mastrangelo, Armando Tripodi, F Rodeghiero, Giancarlo Castaman, T Barbui, G Finazzi, B Bizzi, P M MannucciAbstract:The clinical history of 238 patients with inherited thrombophilia (AT III = 94, PC = 103, PS = 41) was analyzed retrospectively at diagnosis and in the follow-up period after diagnosis. At diagnosis 129 patients (54%) had suffered from Thrombosis, with a recurrence rate of 48%. The most frequent onset manifestation was deep vein Thrombosis of lower limbs (58%). Thrombotic history started before 40 in 80% of the cases. Forty-nine percent of the venous thromboses were preceded by a triggering event, in most cases pregnancy (17%) and surgery (12%). After diagnosis, follow-up lasted a total of 1,113 pt-years. A policy of short-term prophylaxis during risk situations for all patients and long-term prophylaxis in symptomatic patients failed to prevent venous thrombotic episodes (diagnosed by objective methods) in 4 previously asymptomatic subjects and recurrence in 7 previously symptomatic subjects. After knowledge of the patients' diagnosis the incidence of venous Thrombosis/100 pt-years was reduced as compared before diagnosis as total episodes (onset+recurrencies) (1.0 vs 1.9), onset episodes (0.7 vs 1.3) and recurrent episodes (1.3 vs 4.8), even though the differences were not statistically significant. However most of the venous thromboses occurred at a more advanced age (67% after 40 years) and without any apparent cause (83%), at significant variance with the period preceding the diagnosis; in particular the incidence of venous thrombotic onset in patients younger than 40 passed from 1.3/100 pt-years to 0.2/100 pt-years. In 6 recurrences after diagnosis a poor compliance for antithrombotic treatment was recognized.(ABSTRACT TRUNCATED AT 250 WORDS)
Craig S. Kitchens - One of the best experts on this subject based on the ideXlab platform.
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Thrombotic Storm: When Thrombosis Begets Thrombosis
The American journal of medicine, 1998Co-Authors: Craig S. KitchensAbstract:Abstract Patients with hypercoagulability may present with a single Thrombosis and subsequently develop progressive thromboses at other sites. With inadequate therapy, the thrombotic process may self-perpetuate, leading to multiple thromboses and even death. Six cases are presented demonstrating key features of what may be termed thrombotic storm: (1) an underlying hypercoagulable disorder; (2) a provocation to initiate Thrombosis; (3) rapid development of new thromboses; (4) response to prompt use of thrombolytic agent or anticoagulant therapy; and (5) remarkable good long-term prognosis if the cycle of Thrombosis is interrupted. Continued activation of coagulation by fresh Thrombosis is hypothesized as the cause of the syndrome, which may explain its control by anticoagulants. Whereas these unusual patients' courses most likely represent only an extreme of hypercoagulability and not a new disorder, their characteristic behavior warrants attention.
Eric Swanson - One of the best experts on this subject based on the ideXlab platform.
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ultrasound screening for deep venous Thrombosis detection a prospective evaluation of 200 plastic surgery outpatients
Plastic and reconstructive surgery. Global open, 2015Co-Authors: Eric SwansonAbstract:Deep venous Thrombosis is a serious surgical complication that can lead to fatal pulmonary emboli.1 The author recently reported the feasibility of Doppler ultrasound screening in plastic surgery outpatients.2 Clinical diagnosis of venous thromboembolism is known to be unreliable.3–10 A clinical diagnosis is confirmed by objective testing using ultrasound or venography in only about 20–35% of patients,4,5,7,10 making objective confirmation mandatory.4 Noninvasive ultrasound technology has replaced venography as the standard for screening.9 When compression ultrasound is complemented by Doppler color flow evaluation (“duplex” sonography), the sensitivity for Thrombosis detection is about 96%, with a high negative predictive value (99%).11 Only one large study12 [the Venous Thromboembolism Prevention (VTEP) study] compares the incidence of venous thromboembolism in plastic surgery inpatients treated with or without postoperative enoxaparin. The incidence of this complication was 1.2% in both groups.13 The VTEP study12 did not include screening examinations and did not provide information on the timing of deep venous thromboses. Anticoagulation carries a risk of bleeding and hematomas.14,15 In an effort to improve safety and reduce risk, the author advocates a Spontaneous breathing, Avoid gas, Face up, Extremities mobile (SAFE) anesthesia method, foregoing individual risk stratification and chemoprophylaxis.13 Objective data are needed regarding the natural history of deep venous Thrombosis in plastic surgery patients, so as to better inform patient management.13 The study hypothesis was that deep venous thromboses likely develop during surgery and that subclinical thromboses may go undetected and untreated.
Adrien Rohnei - One of the best experts on this subject based on the ideXlab platform.
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Unexpectedly high rate of phlebographic deep venous Thrombosis following elective general abdominal surgery among patients given prophylaxis with low-molecular-weight heparin.
Archives of Surgery, 1993Co-Authors: Henri Bounameaux, Dominique Didier, Olivier Huber, Ebrahim Khabiri, P A Schneider, Adrien RohneiAbstract:• One hundred ninety-four patients undergoing elective general abdominal surgery were randomized in a single-blind study to receive one daily subcutaneous injection of a low-molecular-weight heparin, dalteparin sodium (2500 IU, n=97) or nadroparin calcium (3075 IU, n=97), two regimens that are approved in Europe to prevent deep venous Thrombosis. On the eighth postoperative day, bilateral ascending leg phlebography (n=185) showed the presence of deep venous Thrombosis in 45 cases (24.3%; 95% confidence interval, 18% to 31%), with a significantly higher rate (on intention-to-treat) among the patients who received the lower dosage (30 vs 15 deep venous thromboses). We conclude that the two regimens of low-molecular-weight heparin that were used in this study failed to prevent postoperative phlebographically proved deep venous Thrombosis in one of four patients. ( Arch Surg. 1993;128:326-328)
David Antoniucci - One of the best experts on this subject based on the ideXlab platform.
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impact of platelet reactivity after clopidogrel administration on drug eluting stent Thrombosis
Journal of the American College of Cardiology, 2007Co-Authors: Piergiovanni Buonamici, Angela Migliorini, Guia Moschi, Rita Paniccia, Rossella Marcucci, Anna Maria Gori, Gian Franco Gensini, Rosanna Abbate, Alberto Santini, David AntoniucciAbstract:OBJECTIVES: We sought to determine whether nonresponsiveness to clopidogrel as revealed by high in vitro post-treatment platelet reactivity is predictive of drug-eluting stent (DES) Thrombosis. BACKGROUND: No data exist about the impact of nonresponsiveness to clopidogrel on the risk of DES Thrombosis. METHODS: We conducted a prospective observational cohort study from July 2005 to August 2006 in an academic hospital. A total of 804 patients who had successful sirolimus- or paclitaxel-eluting stent implantation were assessed for post-treatment platelet reactivity after a loading dose of 600 mg of clopidogrel. Patients with platelet aggregation by 10 mumol adenosine 5'-diphosphate > or =70% were defined as nonresponders. All patients received chronic dual antiplatelet treatment (aspirin 325 mg and clopidogrel 75 mg daily) for 6 months. The primary end point was the incidence of definite/probable early, subacute, and late stent Thrombosis at 6-month follow-up. RESULTS: The incidence of 6-month definite/probable stent Thrombosis was 3.1%. All stent thromboses were subacute or late. Of 804 patients, 105 (13%) were not responsive to clopidogrel. The incidence of stent Thrombosis was 8.6% in nonresponders and 2.3% in responders (p < 0.001). By multivariate analysis, the predictors of stent Thrombosis were as follows: nonresponsiveness to clopidogrel (hazard ratio [HR] 3.08, 95% confidence interval [CI] 1.32 to 7.16; p = 0.009), left ventricular ejection fraction (HR 0.95, 95% CI 0.92 to 0.98; p = 0.001), total stent length (HR 1.01, 95% CI 1.00 to 1.02; p = 0.010), and ST-segment elevation acute myocardial infarction (HR 2.41, 95% CI 1.04 to 5.63; p = 0.041). CONCLUSIONS: Nonresponsiveness to clopidogrel is a strong independent predictor of stent Thrombosis in patients receiving sirolimus- or paclitaxel-eluting stents.
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impact of platelet reactivity after clopidogrel administration on drug eluting stent Thrombosis
Journal of the American College of Cardiology, 2007Co-Authors: Piergiovanni Buonamici, Angela Migliorini, Guia Moschi, Rita Paniccia, Rossella Marcucci, Anna Maria Gori, Gian Franco Gensini, Rosanna Abbate, Alberto Santini, David AntoniucciAbstract:Objectives We sought to determine whether nonresponsiveness to clopidogrel as revealed by high in vitro post-treatment platelet reactivity is predictive of drug-eluting stent (DES) Thrombosis. Background No data exist about the impact of nonresponsiveness to clopidogrel on the risk of DES Thrombosis. Methods We conducted a prospective observational cohort study from July 2005 to August 2006 in an academic hospital. A total of 804 patients who had successful sirolimus- or paclitaxel-eluting stent implantation were assessed for post-treatment platelet reactivity after a loading dose of 600 mg of clopidogrel. Patients with platelet aggregation by 10 μmol adenosine 5′-diphosphate ≥70% were defined as nonresponders. All patients received chronic dual antiplatelet treatment (aspirin 325 mg and clopidogrel 75 mg daily) for 6 months. The primary end point was the incidence of definite/probable early, subacute, and late stent Thrombosis at 6-month follow-up. Results The incidence of 6-month definite/probable stent Thrombosis was 3.1%. All stent thromboses were subacute or late. Of 804 patients, 105 (13%) were not responsive to clopidogrel. The incidence of stent Thrombosis was 8.6% in nonresponders and 2.3% in responders (p Conclusions Nonresponsiveness to clopidogrel is a strong independent predictor of stent Thrombosis in patients receiving sirolimus- or paclitaxel-eluting stents.
