Browsing by Subject "thrombosis"

Now showing 1 - 7 of 7
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    Coagulopathy of Dengue and COVID-19: Clinical Considerations
    (MDPI, 2022-08-25) Islam, Amin; Cockcroft, Christopher; Elshazly, Shereen; Ahmed, Javeed; Joyce, Kevin; Mahfuz, Huque; Islam, Tasbirul; Rashid, Harunor; Laher, Ismail; Medicine, School of Medicine
    Thrombocytopenia and platelet dysfunction commonly occur in both dengue and COVID-19 and are related to clinical outcomes. Coagulation and fibrinolytic pathways are activated during an acute dengue infection, and endothelial dysfunction is observed in severe dengue. On the other hand, COVID-19 is characterised by a high prevalence of thrombotic complications, where bleeding is rare and occurs only in advanced stages of critical illness; here thrombin is the central mediator that activates endothelial cells, and elicits a pro-inflammatory reaction followed by platelet aggregation. Serological cross-reactivity may occur between COVID-19 and dengue infection. An important management aspect of COVID-19-induced immunothrombosis associated with thrombocytopenia is anticoagulation with or without aspirin. In contrast, the use of aspirin, nonsteroidal anti-inflammatory drugs and anticoagulants is contraindicated in dengue. Mild to moderate dengue infections are treated with supportive therapy and paracetamol for fever. Severe infection such as dengue haemorrhagic fever and dengue shock syndrome often require escalation to higher levels of support in a critical care facility. The role of therapeutic platelet transfusion is equivocal and should not be routinely used in patients with dengue with thrombocytopaenia and mild bleeding. The use of prophylactic platelet transfusion in dengue fever has strained financial and healthcare systems in endemic areas, together with risks of transfusion-transmitted infections in low- and middle-income countries. There is a clear research gap in the management of dengue with significant bleeding.
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    Combined Hormonal Contraceptives: The Culprit of Acute Portal Vein Thrombosis
    (2021-06-10) Ayala Castillo, Crystal; Lugo, Adrian; Lingamurthy, Manjesh; Rascon-Aguilar, Ivan
    Oral contraceptive medications are known to increase the risk of developing blood clots. Most commonly, these thrombi are found as deep vein thrombi (DVTs) or pulmonary emboli (PEs). The incidence of portal vein thrombosis is much rarer in patients without comorbidities like liver cirrhosis, malignancies, and hematologic disorders. In this case report, we present the cause of a female's epigastric abdominal pain to stem from portal vein thrombosis while on combination oral contraceptive pills (OCPs). A 34-year-old Caucasian female with a history of hypothyroidism, obesity, and oral contraceptive use presented to the emergency room complaining of epigastric abdominal pain for two days. The pain radiated to her back, and she described it as pressure-like in nature with intermittent episodes of nausea. She reported taking norethindrone-ethinyl estradiol for contraception for several years prior. No history of blood clots in the past. Physical examination was pertinent for tenderness in the epigastric area. Vital signs were stable. A blood pregnancy test was negative. Liver enzymes were within normal limits. A complete abdominal ultrasound was unremarkable. Computerized tomography of the abdomen without contrast revealed left portal vein hyperattenuation which was suggestive for acute portal vein thrombosis (Figure 1). Serological testing performed to rule out inherited thrombophilia were negative (Table 1). The patient was subsequently started on anticoagulation and was discharged hemodynamically stable with close outpatient follow up. Portal vein thrombosis can present acutely or exist in chronic states in a broad array of underlying causes. Risk factors include: liver cirrhosis, malignancy, hematologic disorders, thrombophilia, inflammatory disease, and while on hormonal therapies. In the current literature, the most typical sites to find venous thromboembolisms while on OCPs are in the deep veins of the legs and the pulmonary vasculature. Finding a thrombus in the portal vasculature is rare when there is no associated liver disease. Other contributing factors in our patient were obesity and the presence of hypothyroidism. We believe this case report is noteworthy as it helps clinicians suspect portal vein thrombi in patients that are chronically on OCPs. This will help decrease morbidity and mortality and will help guide future management of birth control, possibly by helping form a guideline for contraceptive use in the setting of unusual thrombus locations.
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    Complete Resolution of a Large Bicuspid Aortic Valve Thrombus with Anticoagulation in Primary Antiphospholipid Syndrome
    (Frontiers, 2016-09-20) Rachwan, Rayan Jo; Daher, Ghassan E.; Fares, Jawad; Rachoin, Rachoin; Medicine, School of Medicine
    Native aortic valve thrombosis in primary antiphospholipid syndrome (APLS) is a rare entity. We describe a 38-year-old man who presented with neurological symptoms and a cardiac murmur. Transthoracic echocardiography detected a large bicuspid aortic valve thrombus. Laboratory evaluation showed the presence of antiphospholipid antibodies. Anticoagulation was started, and serial echocardiographic studies showed complete resolution of the aortic valve vegetation after 4 months. The patient improved clinically and had no residual symptoms. This report and review of the literature suggests that vegetations in APLS can be treated successfully with conservative treatment, regardless of their size.
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    Computer-based device and model for predicting probability of death from thrombosis
    (2012-08) Kline, Jeffrey A.
    A computer-based device and predictive model executable by computer software for use with the device to predict or estimate a percentage probability of death from thrombosis in a patient with active cancer.
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    DD of Arthritis
    (Association of Kenya Physicians, 2007) Association of Kenya Physicians Scientific Conference (11th : Mar. 2007 : Eldoret, Kenya)
    Patient with Musculo-skeletal Complaints -Summary 1.Soft Tissue Rheumatism or Arthritis 2.Arthritis –Monoarticular-Crystals, Gout-Infective –acute –G+ve –ve-Chronic –Koch'sPolyarticular-:-(Asymmetrical)SSA -Reiter's, Reactive AS Psoriasis(Symetrical):-RA, SLE, DM. PM, Scleroderma APS, Vasculitis 3.Extraarticular features… 4.Laboratory, Imaging workup : DIAGNOSIS
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    Efficacy of Bivalirudin for Therapeutic Anticoagulation in COVID-19 Patients Requiring ECMO Support
    (Elsevier, 2022-02) Trigonis, Russell; Smith, Nikki; Porter, Shelley; Anderson, Eve; Jennings, Mckenna; Kapoor, Rajat; Hage, Chadi; Moiz, Salwa; Garcia, Jose; Rahman, Omar; Medicine, School of Medicine
    OBJECTIVES: The Coronavirus Disease 2019 (COVID-19) pandemic has been associated with cases of refractory acute respiratory distress syndrome (ARDS) sometimes requiring support with extracorporeal membrane oxygenation (ECMO). Bivalirudin can be used for anticoagulation in patients on ECMO support, but its efficacy and safety in patients with COVID-19 is unknown. The authors set out to compare the pharmacologic characteristics and dosing requirements of bivalirudin in patients requiring ECMO support for ARDS due to COVID-19 versus ARDS from other etiologies. DESIGN AND SETTING: This retrospective case-control study was performed at Indiana University Health Methodist Hospital in Indianapolis, Indiana. PARTICIPANTS: Patients were included if they were on venovenous ECMO support between June 2019 and June 2020, and divided into two groups: ARDS secondary to COVID-19 and those with ARDS from another etiology (Non-COVID). INTERVENTIONS: Patient demographics, such as age, sex, weight, chronic comorbid conditions, baseline antiplatelet and anticoagulant use, antiplatelet use during ECMO, and need for renal replacement therapy were collected, and compared between groups. Time to activated partial thromboplastin time (aPTT) goal, percentage of time at aPTT goal, bivalirudin rates, total bivalirudin requirements, total duration on bivalirudin, total duration on ECMO, mortality, and complications associated with ECMO were collected and compared between groups. MEASUREMENTS AND MAIN RESULTS: A total of 42 patients met inclusion criteria (n = 19 COVID-19, n = 23 non-COVID). However, percentages of aPTTs at goal were maintained more consistently in patients with COVID-19 versus non-COVID (86% v 74%: p < 0.01). Higher median (IQR) daily rates (3.1 μg/kg/min [2.3-5.2] v 2.4 μg/kg/min [1.7-3.3]: p = 0.05) and higher median (IQR) maximum rates of bivalirudin (5 μg/kg/min [3.7-7.5] v 3.8 μg/kg/min [2.5-5]: p = 0.03) were required in the COVID-19 group versus the non-COVID group. Time to goal aPTT was similar between groups. There were no differences in complications associated with anticoagulation, as demonstrated by similar rates of bleeding and thrombosis between both groups. CONCLUSIONS: Patients on ECMO with ARDS from COVID-19 require more bivalirudin overall and higher rates of bivalirudin to maintain goal aPTTs compared with patients without COVID-19. However, COVID-19 patients more consistently maintain goal aPTT. Future randomized trials are needed to support efficacy and safety of bivalirudin for anticoagulation of COVID-19 patients on ECMO.
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    Thrombosis, Bleeding, and the Observational Effect of Early Therapeutic Anticoagulation on Survival in Critically Ill Patients With COVID-19
    (ACP, 2021) Al-Samkari, Hanny; Gupta, Shruti; Leaf, Rebecca Karp; Wang, Wei; Rosovsky, Rachel P.; Brenner, Samantha K.; Hayek, Salim S.; Berlin, Hanna; Kapoor, Rajat; Shaefi, Shahzad; Melamed, Michal L.; Sutherland, Anne; Radbel, Jared; Green, Adam; Garibaldi, Brian T.; Srivastava, Anand; Leonberg-Yoo, Amanda; Shehata, Alexandre M.; Flythe, Jennifer E.; Rashidi, Arash; Goyal, Nitender; Chan, Lili; Mathews, Kusum S.; Hedayati, S. Susan; Dy, Rajany; Toth-Manikowski, Stephanie M.; Zhang, Jingjing; Mallappallil, Mary; Redfern, Roberta E.; Bansal, Amar D.; Short, Samuel A.P.; Vangel, Mark G.; Admon, Andrew J.; Semler, Matthew W.; Bauer, Kenneth A.; Hernán, Miguel A.; Leaf, David E.; Medicine, School of Medicine
    Background: Hypercoagulability may be a key mechanism of death in patients with coronavirus disease 2019 (COVID-19). Objective: To evaluate the incidence of venous thromboembolism (VTE) and major bleeding in critically ill patients with COVID-19 and examine the observational effect of early therapeutic anticoagulation on survival. Design: In a multicenter cohort study of 3239 critically ill adults with COVID-19, the incidence of VTE and major bleeding within 14 days after intensive care unit (ICU) admission was evaluated. A target trial emulation in which patients were categorized according to receipt or no receipt of therapeutic anticoagulation in the first 2 days of ICU admission was done to examine the observational effect of early therapeutic anticoagulation on survival. A Cox model with inverse probability weighting to adjust for confounding was used. Setting: 67 hospitals in the United States. Participants: Adults with COVID-19 admitted to a participating ICU. Measurements: Time to death, censored at hospital discharge, or date of last follow-up. Results: Among the 3239 patients included, the median age was 61 years (interquartile range, 53 to 71 years), and 2088 (64.5%) were men. A total of 204 patients (6.3%) developed VTE, and 90 patients (2.8%) developed a major bleeding event. Independent predictors of VTE were male sex and higher D-dimer level on ICU admission. Among the 2809 patients included in the target trial emulation, 384 (11.9%) received early therapeutic anticoagulation. In the primary analysis, during a median follow-up of 27 days, patients who received early therapeutic anticoagulation had a similar risk for death as those who did not (hazard ratio, 1.12 [95% CI, 0.92 to 1.35]). Limitation: Observational design. Conclusion: Among critically ill adults with COVID-19, early therapeutic anticoagulation did not affect survival in the target trial emulation.