scholarly journals COVID-19 and Stroke: Casual or Causal Role?

2020 ◽  
Vol 49 (3) ◽  
pp. 341-344 ◽  
Author(s):  
Carlo Emanuele Saggese ◽  
Chiara Del Bianco ◽  
Maria Rita Di Ruzza ◽  
Maria Magarelli ◽  
Roberto Gandini ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thrombosis ◽  
Balloon Catheter ◽  
Vascular Complications ◽  
Surface Protein ◽  
Recombinant Tissue Plasminogen Activator ◽  
Mass Effect ◽  
Health Concern ◽  
Direct Role ◽  
Ischemic Lesion

Background: The COVID-19 outbreak is currently the major public health concern worldwide. This infection, caused by the novel coronavirus Sars Cov2, primarily affects respiratory system, but there is increasing evidence of neurologic involvement and cerebrovascular accidents. Case Report: We present a case of stroke in a 62-year-old COVID-19-positive patient, with multiple vascular risk factors. The patient arrived 1 h after onset of symptoms, was treated with recombinant tissue plasminogen activator (rtPA) with improvement of neurologic deficits, and later developed right foot arterial ischemia (recanalized by balloon catheter angioplasty) and left arm superficial venous thrombosis. A control computed tomography (CT) scan 7 days after onset showed hemorrhagic transformation of ischemic lesion without mass effect. However, respiratory and neurologic conditions improved so that the patient was discharged to rehabilitation. Discussion: Until now, few cases of stroke in COVID-19 have been described, mainly in severe forms. This patient had ischemic injuries in different sites as well as venous thrombosis; hence, we speculate that Sars Cov2 could have a direct role in promoting vascular accidents since its receptor ACE2 is a surface protein also expressed by endothelial cells. This case suggests that COVID-19 can favor strokes and in general vascular complications, even in milder cases, and the presence of preexisting risk factors could play a determinant role.

scholarly journals Antithrombotic Management in Ischemic Stroke with Essential Thrombocythemia: Current Evidence and Dilemmas

2021 ◽  
Author(s):  
Shubhabrata Das ◽  
Anasua Deb
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Venous Thrombosis ◽  
Essential Thrombocythemia ◽  
Vascular Complications ◽  
Current Evidence ◽  
Increased Risk ◽  
Low Dose Aspirin ◽  
Thrombotic Diseases ◽  
Antithrombotic Management

Thrombotic diseases like ischemic stroke are common complications of essential thrombocythemia (ET) due to abnormal megakaryopoiesis and platelet dysfunction. Ischemic stroke in ET can occur as a result of both cerebral arterial and venous thrombosis. Management of ET is aimed at preventing vascular complications including thrombosis. Acute management of ischemic stroke in ET is the same as that in the general population without myeloproliferative disorder. However, an ET patient with ischemic stroke is at high risk for re-thrombosis and therefore additionally managed with cytoreductive therapy and antithrombotic agents. Given abnormal platelet production in ET, there is suboptimal suppression of platelets with the usual recommended dose of Aspirin for cardiovascular (CV) prevention. Hence, for optimal CV protection in ET, low dose Aspirin is recommended twice daily in an arterial thrombotic disease like atherothrombotic ischemic stroke in presence of the following risk factors: age > 60 years, Janus kinase2V617F gene mutation, presence of CV risk factors. In presence of the same risk factors, concurrent antiplatelet and anticoagulant therapy is suggested for venous thrombosis. However, increased risk of bleeding with dual anti-thrombotic agents poses a significant challenge in their use in cerebral venous thromboembolism or, atrial fibrillation in presence of the above-mentioned risk factors. We discuss these dilemmas about antithrombotic management in ischemic stroke in ET in this cased based review of literature in the light of current evidence.

scholarly journals Unusual Site Thrombosis: Focus on Myeloproliferative Neoplasms with Splanchnic or Cerebral Venous Thrombosis

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4257-4257
Author(s):  
Serena Rupoli ◽  
Lucia Canafoglia ◽  
Gianluca Svegliati Baroni ◽  
Michele Gironella ◽  
Giorgia Micucci ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Myeloproliferative Neoplasms ◽  
Haemoglobin Concentration ◽  
Vascular Complications ◽  
Similar Proportion ◽  
Unusual Site ◽  
Cell Counts

Abstract This study retrospectively evaluated 144 consecutive patients with unusual site thrombosis who referred to our Thrombosis Center between 2000 and 2016. All patients were classified as having either splanchnic venous thrombosis (SVT; n=127) or cerebral venous thrombosis (CVT; n=17). On the presence and type of provoking risk factors, then patients were categorized into three groups: unprovoked, those with possibly resolved provoking factors (PR), and those with persistent provoking factors (PP). Among the identified risk factors regarded as PP, we focused on Myeloproliferative Neoplasms (MPN) and performed a clinical comparison between MPN patients with SVT (MPN-SVT) and those with CVT (MPN-SVT). The characteristics of our cohort well reflects the clinical heterogeneity of clinical features commonly found in the routine clinical practice of diagnosing unusual site thrombosis. One hundred and twenty seven SVT patients were included: 7 unprovoked SVT, 10 SVT with PR, 110 SVT with PP; seventeen patients showed CVT, 5 unprovoked, 6 CVT with PR and 6 CVT with PP. Major risk factor for SVT with PP was liver cirrhosis (71.6%), whereas for CVT were MPN (5 patients, 29.4%). MPN was present in 8 patients (6.2%) of SVT (MPN-SVT vs MPN-CVT, p=0.009). For MPN-SVT, 3 patients showed the morphological features of polycytemia vera (PV), 2 of essential thrombocytemia (ET), 1 of primary myelofibrosis (PMF) and 2 fell into the MPN unclassified category (U-MPN); distribution of MPN subtypes for CVT was as follows: 1 PV, 2 ET and 2 U-MPN. Molecular analysis identified the JAK2V617F mutation respectively in 75% patients with MPN-SVT and in 60% patients with MPN-CVT; bone marrow histological features supported the diagnosis of MPN in all cases. Median age at MPN-SVT diagnosis was 46 years (range 17-78) vs 43 years (range 31-84) for MPN-CVT. Coexisting PR and thrombophilic abnormalities were identified in 75% and 20% of MPN-SVT and MPN-CVT respectively, so MPN are per se a strong risk for thrombosis and the leading systemic cause of CVT. In four of five cases (80%), CVT antedate the clinical phenotype of an overt MPN, whereas SVT occurred at MPN diagnosis in five patients and during MPN follow-up in three patients (median 164 months, range 88-215). At diagnosis MPN-SVT tended to have significantly lower platelet and white blood cell counts and haemoglobin concentration than MPN-CVT (respectively p<0.001, p<0.001 and p=0.002). Similar proportion of MPN patients in the two groups received cytoreductive treatment (hydroxyurea and alpha interferon) and appropriate anticoagulant therapy that consisted of low molecular weight heparin (LMWH) followed by oral vitamin K antagonists (VKA). MPN-SVT and MPN-CVT experienced similar median duration of anticoagulation (26 months for MPN-SVT, range 1-62, and 26 months for MPN-CVT, range 4-168) and a good quality anticoagulation control (median time within therapeutic range of 71 vs 87% respectively for MPN-SVT and MPN-CVT). Seventy-five percent MPN-SVT and 80% of MPN-CVT remain on indefinite anticoagulation. All patients were alive at last follow-up and the results of imaging techniques showed resolution of thrombosis in 87.5% and 80% of MPN-SVT and MPN-CVT respectively; the probability of recanalization of the occluded vessels was 18 months and 4 months for MPN-SVT and MPN-CVT, respectively. Only in one patient with MPN-SVT, a major bleed occurred on-treatment while the incidence of recurrent thrombosis was the same for both MPN-SVT and MPN-CVT (0.02 per 100 patients-year). In conclusion, our study evaluated unselected populations with unusual site thrombosis that were followed in our Thrombosis Center, an anticoagulation clinic well experienced on pathogenic mechanisms and anticoagulant treatment. Our findings have practical implications and point out the role of MPN as a major contributory factor for the pathogenesis of CVT with PP, even in absence of overt myeloproliferative features and additional prothombotic factors. Regarding management of vascular complications, patients with MPN-SVT and MPN-CVT responded equally well and efficacy of anticoagulation was not affected by the site of thrombosis. Disclosures Offidani: Celgene: Honoraria, Research Funding; Janssen: Honoraria.

Resistance to Activated Protein C and Factor V Leiden as Risk Factors for Venous Thrombosis

1995 ◽  
Vol 74 (01) ◽  
pp. 449-453 ◽  
Author(s):  
Rogier M Bertina ◽  
Pieter H Reitsma ◽  
Frits R Rosendaal ◽  
Jan P Vandenbroucke
Keyword(s):  
Risk Factors ◽  
Venous Thrombosis ◽  
Protein C ◽  
Activated Protein C ◽  
Factor V Leiden ◽  
Factor V

scholarly journals Multidisciplinary Practice Variations of Anti-Thrombotic Strategies for Free Tissue Transfers

2021 ◽  
pp. 229255032110247
Author(s):  
Minh N. Q. Huynh ◽  
Vinai Bhagirath ◽  
Michael Gupta ◽  
Ronen Avram ◽  
Kevin Cheung
Keyword(s):  
Risk Factors ◽  
Venous Thrombosis ◽  
Perceived Risk ◽  
Management Strategies ◽  
Free Flaps ◽  
Low Molecular Weight ◽  
National Surveys ◽  
Flap Failure ◽  
Multidisciplinary Practice ◽  
Practice Variations

Background: Venous thrombosis, the leading cause of free flap failure, may have devastating consequences. Many anti-thrombotic agents and protocols have been described for prophylaxis and treatment of venous thrombosis in free flaps. Methods: National surveys were distributed to microsurgeons (of both Plastics and ENT training) and hematology and thrombosis specialists. Data were collected on routine screening practices, perceived risk factors for flap failure, and pre-, intra-, and post-operative anti-thrombotic strategies. Results: There were 722 surveys distributed with 132 (18%) respondents, consisting of 102 surgeons and 30 hematologists. Sixty-five surgeons and 9 hematologists routinely performed or managed patients with free flaps. The top 3 perceived risk factors for flap failure according to surgeons were medical co-morbidities, past arterial thrombosis, and thrombophilia. Hematologists, however, reported diabetes, smoking, and medical co-morbidities as the most important risk factors. Fifty-four percent of physicians routinely used unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) as a preoperative agent. Surgeons routinely flushed the flap with heparin (37%), used UFH IV (6%), or both (8%) intra-operatively. Surgeons used a range of post-operative agents such as UFH, LMWH, aspirin, and dextran while hematologists preferred LMWH. There was variation of management strategies if flap thrombosis occurred. Different strategies consisted of changing recipient vessels, UFH IV, flushing the flap, adding post-operative agents, or a combination of strategies. Conclusions: There are diverse practice variations in anti-thrombotic strategies for free tissue transfers and a difference in perceived risk factors for flap failure that may affect patient management.

The prevalence and risk factors associated with preoperative deep venous thrombosis in lung cancer surgery

Surgery Today ◽  
2021 ◽  
Author(s):  
Toshiki Takemoto ◽  
Junichi Soh ◽  
Shuta Ohara ◽  
Toshio Fujino ◽  
Takamasa Koga ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Lung Cancer Surgery ◽  
Cancer Surgery ◽  
Factors Associated

scholarly journals Cerebral venous thrombosis in a patient with Down syndrome and coronavirus disease 2019: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Henry Robayo-Amortegui ◽  
Natalia Valenzuela-Faccini ◽  
Cesar Quecano-Rosas ◽  
Darlyng Zabala-Muñoz ◽  
Michel Perez-Garzon
Keyword(s):  
Risk Factors ◽  
Down Syndrome ◽  
Case Report ◽  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Epidemiological Data ◽  
Thromboembolic Disease ◽  
Hispanic Woman ◽  
Case Presentation ◽  
The World

Abstract Background The new coronavirus disease 2019 pandemic has spread throughout most of the world. Cerebral venous thrombosis is a rare thromboembolic disease that can present as an extrapulmonary complication in coronavirus disease 2019 infection. Case presentation We report the case of a Hispanic woman with Down syndrome who has coronavirus disease 2019 and presents as a complication extensive cerebral venous thrombosis. Conclusions Cerebral venous thrombosis is a rare thromboembolic disease that can present as an extrapulmonary complication in coronavirus disease 2019 infection. In the absence of clinical and epidemiological data, it is important to carry out further investigation of the risk factors and pathophysiological causes related to the development of cerebrovascular thrombotic events in patients with Down syndrome with coronavirus disease 2019 infection.

scholarly journals Seroprevalence of Toxoplasma gondii and associated risk factors in domestic pigs raised from Cuba

2021 ◽  
Author(s):  
Julio César Castillo-Cuenca ◽  
Álvaro Martínez-Moreno ◽  
José Manuel Diaz-Cao ◽  
Angel Entrena-García ◽  
Jorge Fraga ◽  
...  
Keyword(s):  
Risk Factors ◽  
Toxoplasma Gondii ◽  
Meat Products ◽  
Control Measures ◽  
Health Concern ◽  
Enzyme Linked Immunosorbent Assay ◽  
Serum Samples ◽  
Cross Sectional ◽  
Weaning Pigs ◽  
Associated Risk Factors

AbstractA cross-sectional study was carried out to determine the seroprevalence of Toxoplasma gondii and associated risk factors in pigs in the largest pork-producing region in Cuba. Serum samples from 420 pigs, including 210 sows and 210 post-weaning pigs, were tested for antibodies against T. gondii using a commercial indirect enzyme-linked immunosorbent assay. Anti-T. gondii antibodies were detected in 56 animals (13.3%, 95% CI: 10.1–16.6). A generalized estimating equations model revealed that the risk factors associated with higher seropositivity in pigs were altitude (higher in farm’s location < 250 m above sea level (masl) versus ≥ 250 masl) and age (higher in sows compared to post-weaning pigs). The results indicated that this protozoan parasite is widely distributed on pig farms in the study area, which is a public health concern since the consumption of raw or undercooked pork meat products containing tissue cysts is considered one of the main routes of T. gondii transmission worldwide. Control measures should be implemented to reduce the risk of exposure to T. gondii in pigs in Cuba.

scholarly journals A review of risk factors associated with insulin omission for weight loss in type 1 diabetes

2021 ◽  
pp. 135910452110261
Author(s):  
Rebecca Hall ◽  
Leanna Keeble ◽  
Sandra-Ilona Sünram-Lea ◽  
Michelle To
Keyword(s):  
Risk Factors ◽  
Weight Loss ◽  
Type 1 Diabetes ◽  
Body Dissatisfaction ◽  
Vascular Complications ◽  
Anxiety And Depression ◽  
Weight Concerns ◽  
Complications And Mortality ◽  
Insulin Omission

Research suggests that as many as 60% of people with type 1 diabetes (T1D) admit to misusing insulin. Insulin omission (IO) for the purpose of weight loss, often referred to as diabulimia, is a behaviour becoming increasingly recognised, not least since prolonged engagement can lead to serious vascular complications and mortality. Several risk factors appear to be relevant to the development of IO, most notably gender, anxiety and depression and increased weight concerns and body dissatisfaction. Evidence suggests that women, especially young girls, are more likely to omit insulin as a method of weight loss compared to men. Mental health conditions such as anxiety and depression are increasingly prevalent in people with T1D compared to their peers, and appear to contribute to the risk of IO. Increased weight concerns and body dissatisfaction are further prominent risk factors, especially given increases in weight which often occur following diagnosis and the monitoring of weight by diabetes teams. This review presents evidence examining these risk factors which increase the likelihood of a person with T1D engaging in IO and highlights the complications associated with prolongment of the behaviour. Further research looking at the comorbidities of these risk factors, alongside other factors, would provide greater insight into understanding IO in people with T1D.

scholarly journals Incidence and risk factors for deep venous thrombosis of lower extremity after surgical treatment of isolated patella fractures

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Zhanchao Tan ◽  
Hongzhi Hu ◽  
Xiangtian Deng ◽  
Jian Zhu ◽  
Yanbin Zhu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lower Extremity ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Medical Data ◽  
Limited Information ◽  
Related Factors ◽  
Patella Fractures ◽  
Independent Risk Factors ◽  
Associated Risk Factors

Abstract Background Limited information exists on the incidence of postoperative deep venous thromboembolism (DVT) in patients with isolated patella fractures. The objective of this study was to investigate the postoperative incidence and locations of deep venous thrombosis (DVT) of the lower extremity in patients who underwent isolated patella fractures and identify the associated risk factors. Methods Medical data of 716 hospitalized patients was collected. The patients had acute isolated patella fractures and were admitted at the 3rd Hospital of Hebei Medical University between January 1, 2016, and February 31, 2019. All patients met the inclusion criteria. Medical data was collected using the inpatient record system, which included the patient demographics, patient’s bad hobbies, comorbidities, past medical history, fracture and surgery-related factors, hematological biomarkers, total hospital stay, and preoperative stay. Doppler examination was conducted for the diagnosis of DVT. Univariate analyses and multivariate logistic regression analyses were used to identify the independent risk factors. Results Among the 716 patients, DVT was confirmed in 29 cases, indicating an incidence of 4.1%. DVT involved bilateral limbs (injured and uninjured) in one patient (3.4%). DVT involved superficial femoral common vein in 1 case (3.4%), popliteal vein in 6 cases (20.7%), posterior tibial vein in 11 cases (37.9%), and peroneal vein in 11 cases (37.9%). The median of the interval between surgery and diagnosis of DVT was 4.0 days (range, 1.0-8.0 days). Six variables were identified to be independent risk factors for DVT which included age category (> 65 years old), OR, 4.44 (1.34-14.71); arrhythmia, OR, 4.41 (1.20-16.15); intra-operative blood loss, OR, 1.01 (1.00-1.02); preoperative stay (delay of each day), OR, 1.43 (1.15-1.78); surgical duration, OR, 1.04 (1.03-1.06); LDL-C (> 3.37 mmol/L), OR, 2.98 (1.14-7.76). Conclusion Incidence of postoperative DVT in patients with isolated patella fractures is substantial. More attentions should be paid on postoperative DVT prophylaxis in patients with isolated patella fractures. Identification of associated risk factors can help clinicians recognize the risk population, assess the risk of DVT, and develop personalized prophylaxis strategies.

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