scholarly journals Dectin-1 and TIM3 Expression in Deep Vein Thrombosis of Lower Limbs (DVTLL)

2020 ◽  
Vol 9 (11) ◽  
pp. 3466
Author(s):  
Vincenza Barresi ◽  
Salvatore Napoli ◽  
Giorgia Spampinato ◽  
Daniele Filippo Condorelli ◽  
Salvatore Santo Signorelli
Keyword(s):  
Deep Vein Thrombosis ◽  
T Lymphocytes ◽  
Endothelial Damage ◽  
Lower Limbs ◽  
Fine Tuning ◽  
Venous Stasis ◽  
Venous Disease ◽  
Vein Thrombosis ◽  
Cd8 T Lymphocytes ◽  
Deep Vein

The pathophysiological mechanisms of venous thromboembolism are venous stasis, endothelial damage, and hypercoagulability, while less attention has been given to the role of both innate and native immunity. In this paper, we investigate the involvement of the activated immune system detected through some indicators such as TIM3 and Dectin-1 expressed by T lymphocytes. TIM3 and Dectin-1, two surface molecules that regulate the fine-tuning of innate and adaptive immune responses, were evaluated in patients affected by deep vein thrombosis of lower limbs (DVTLL). CD3+, CD4+ and CD8+ T lymphocytes obtained from patients affected by DVTLL were analysed using fluorescence-conjugated antibodies for TIM3 and Dectin-1 by an imaging flow cytometer. DVTLL patients showed a higher number of CD4+ and CD8+ T lymphocytes. TIM3 expression in T lymphocytes was very low in both DVTLL patients and controls. On the contrary, an increase in Dectin-1+ cells among CD4+ and CD8+ T lymphocytes from DVTLL patients was observed. Dectin-1 is known to play a role in inflammation and immunity and our result suggests its potential involvement in thrombotic venous disease.

scholarly journals Pathophysiological Processes Underlying the High Prevalence of Deep Vein Thrombosis in Critically Ill COVID-19 Patients

2021 ◽  
Vol 11 ◽  
Author(s):  
Sebastian Voicu ◽  
Chahinez Ketfi ◽  
Alain Stépanian ◽  
Benjamin G. Chousterman ◽  
Nassim Mohamedi ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Critically Ill ◽  
Venous Blood ◽  
Lower Limbs ◽  
Venous Stasis ◽  
Venous Blood Flow ◽  
Mechanically Ventilated ◽  
Vein Thrombosis ◽  
High Prevalence ◽  
Deep Vein

Coronavirus disease 2019 (COVID-19) predisposes to deep vein thrombosis (DVT) and pulmonary embolism (PE) particularly in mechanically ventilated adults with severe pneumonia. The extremely high prevalence of DVT in the COVID-19 patients hospitalized in the intensive care unit (ICU) has been established between 25 and 84% based on studies including systematic duplex ultrasound of the lower limbs when prophylactic anticoagulation was systematically administrated. DVT prevalence has been shown to be markedly higher than in mechanically ventilated influenza patients (6–8%). Unusually high inflammatory and prothrombotic phenotype represents a striking feature of COVID-19 patients, as reflected by markedly elevated reactive protein C, fibrinogen, interleukin 6, von Willebrand factor, and factor VIII. Moreover, in critically ill patients, venous stasis has been associated with the prothrombotic phenotype attributed to COVID-19, which increases the risk of thrombosis. Venous stasis results among others from immobilization under muscular paralysis, mechanical ventilation with high positive end-expiratory pressure, and pulmonary microvascular network injuries or occlusions. Venous return to the heart is subsequently decreased with increase in central and peripheral venous pressures, marked proximal and distal veins dilation, and drops in venous blood flow velocities, leading to a spontaneous contrast “sludge pattern” in veins considered as prothrombotic. Together with endothelial lesions and hypercoagulability status, venous stasis completes the Virchow triad and considerably increases the prevalence of DVT and PE in critically ill COVID-19 patients, therefore raising questions regarding the optimal doses for thromboprophylaxis during ICU stay.

DVT Prophylaxis in the Perioperative Setting

2002 ◽  
Vol 12 (9) ◽  
pp. 326-331 ◽  
Author(s):  
Agnes Arnold
Keyword(s):  
Deep Vein Thrombosis ◽  
Endothelial Damage ◽  
Venous Stasis ◽  
Vein Thrombosis ◽  
Dvt Prophylaxis ◽  
Deep Vein ◽  
The Impact

In last month's BJPN, Agnes Arnold discussed the pathophysiology of deep vein thrombosis and suggested ways that the risk could be reduced, particularly with respect to DVTs resulting from endothelial damage in surgery. In this, the second of a two-part series, Agnes continues by looking at hypercoagulability of blood and venous stasis and the impact of these conditions on the risk of DVT.

scholarly journals Recanalization after acute deep vein thrombosis

2013 ◽  
Vol 12 (4) ◽  
pp. 296-302 ◽  
Author(s):  
Gustavo Mucoucah Sampaio Brandao ◽  
Marcone Lima Sobreira ◽  
Hamilton Almeida Rollo
Keyword(s):  
Deep Vein Thrombosis ◽  
Vessel Wall ◽  
Lower Limbs ◽  
Venous Disease ◽  
Natural Evolution ◽  
Vein Thrombosis ◽  
Complex Process ◽  
History Of ◽  
Acute Deep Vein Thrombosis ◽  
Deep Vein

The process of recanalization of the veins of the lower limbs after an episode of acute deep venous thrombosis is part of the natural evolution of the remodeling of the venous thrombus in patients on anticoagulation with heparin and vitamin K inhibitors. This remodeling involves the complex process of adhesion of thrombus to the wall of the vein, the inflammatory response of the vessel wall leading to organization and subsequent contraction of the thrombus, neovascularization and spontaneous lysis of areas within the thrombus. The occurrence of spontaneous arterial flow in recanalized thrombosed veins has been described as secondary to neovascularization and is characterized by the development of flow patterns characteristic of arteriovenous fistulae that can be identified by color duplex scanning. In this review, we discuss some controversial aspects of the natural history of deep vein thrombosis to provide a better understanding of its course and its impact on venous disease.

scholarly journals The role of newer anticoagulants in prevention of deep vein thrombosis following joint replacements

2016 ◽  
Vol 3 (1) ◽  
pp. 4
Author(s):  
Anandha Prabu ◽  
Jambu N. ◽  
Ganesh Babu
Keyword(s):  
Deep Vein Thrombosis ◽  
Knee Arthroplasty ◽  
Factor Xa ◽  
Lower Limbs ◽  
Venous Stasis ◽  
Joint Replacements ◽  
Vein Thrombosis ◽  
Hip And Knee Arthroplasty ◽  
Newer Anticoagulants ◽  
Deep Vein

<p class="abstract"><strong>Background:</strong> Deep vein thrombosis following orthopedic surgeries particularly hip and knee arthroplasty is due to the accompanying blood vessel trauma, venous stasis, coagulation activation and older age in most of the patients. This study aims to study the efficacy of newer anticoagulants such as direct thrombin and direct factor Xa inhibitors in prevention of deep vein thrombosis (DVT) following arthroplasties<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> Tablet Apixaban 2.5 mg twice daily was administered for 15 days following total knee replacement (TKR) and 30 days following total hip replacement (THR) or hemiarthroplasties.  Patients were examined clinically and radiologically with colour doppler of both lower limbs from 5th-13th and 30th-42th day postoperatively during follow up.<strong></strong></p><p class="abstract"><strong>Results:</strong> Only 3 out of 53 patients who underwent hip/knee arthroplasty developed DVT (p &lt;0.05) which were found to be significant<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> The prevention of DVT in hip and knee arthoplasty using newer anticoagulant Apixaban was more efficacious, well tolerated with low rate of bleeding<span lang="EN-IN">.</span></p>

D-Dimer Test and Diagnosis of Deep Vein Thrombosis: A Comparative Study of 7 Assays

1996 ◽  
Vol 76 (04) ◽  
pp. 518-522 ◽  
Author(s):  
A Elias ◽  
I Aptel ◽  
B Huc ◽  
J J Chale ◽  
F Nguyen ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Latex Agglutination ◽  
Lower Limbs ◽  
First Episode ◽  
Lower Sensitivity ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
D Dimer

SummaryThe current D-Dimer ELISA methods provide high sensitivity and negative predictive value for the diagnosis of deep vein thrombosis but these methods are not suitable for emergency or for individual determination. We have evaluated the performance of 3 newly available fast D-Dimer assays (Vidas D-Di, BioMerieux; Instant IA D-Di, Stago; Nycocard D-Dimer, Nycomed) in comparison with 3 classic ELISA methods (Stago, Organon, Behring) and a Latex agglutination technique (Stago). One-hundred-and-seventy-one patients suspected of presenting a first episode of deep vein thrombosis were investigated. A deep vein thrombosis was detected in 75 patients (43.8%) by ultrasonic duplex scanning of the lower limbs; in 11 of them the thrombi were distal and very limited in size (<2 cm). We compared the performance of the tests by calculating their sensitivity, specificity, positive and negative predictive value for different cut-off levels and by calculating the area under ROC curves. The concordance of the different methods was evaluated by calculating the kappa coefficient. The performances of the 3 classic ELISA and of the Vidas D-Di were comparable and kappa coefficients indicated a good concordance between the results provided by these assays. Their sensitivity slightly declined for detection of the very small thrombi. Instant IA D-Di had a non-significantly lower sensitivity and negative predictive value than the 4 previous assays; however its performance was excellent for out-patients. As expected, the Latex assay had too low a sensitivity and negative predictive value to be recommended. In our hands, Nycocard D-Dimer also exhibited low sensitivity and negative predictive value, which were significantly improved when the plasma samples were tested by the manufacturer. Thus significant progress has been made, allowing clinical studies to be planned to compare the safety and cost-effectiveness of D-Dimer strategy to those of the conventional methods for the diagnosis of venous thrombosis.

Diagnosis of Deep Vein Thrombosis by Combination of Doppler Ultrasound Flow Examination and Strain Gauge Plethysmography

1982 ◽  
Vol 47 (02) ◽  
pp. 141-144 ◽  
Author(s):  
H Bounameaux ◽  
B Krähenbühl ◽  
S Vukanovic
Keyword(s):  
Deep Vein Thrombosis ◽  
Negative Predictive Value ◽  
Doppler Ultrasound ◽  
Strain Gauge ◽  
Predictive Value ◽  
Lower Limbs ◽  
Vein Thrombosis ◽  
Non Invasive ◽  
Strain Gauge Plethysmography ◽  
Deep Vein

SummaryDoppler ultrasound flow examination, strain gauge plethysmography and contrast venography were performed in 160 lower limbs of 80 in-patients. Deep vein thrombosis (DVT) was suspected in 87 limbs. Using measurement of venous stop-flow pressure, the Doppler method had an overall sensitivity of 83%. By combined use of Doppler and Plethysmography, sensitivity was increased to 96%. Specificity was 62% and 51%, respectively. With a positive and a negative predictive value of 80% and 73%, respectively, the combination of both non-invasive methods cannot reliably replace venography in the diagnosis of DTV, although all (40/40) thromboses proximal to or involving the popliteal segment were detected by either Doppler and Plethysmography or both.After exclusion of 14 patients (18%) suffering from conditions known to alter the results of these non-invasive methods, the positive predictive value of abnormal findings in both Doppler and Plethysmography was increased to 94% for suspected limbs, whilst negative predictive value of both negative Doppler and Plethysmography was 90%, allowing the avoidance of venography in these patients.

Epidemiology and Pattern of Thromboembolism in Aseer Central Hospital, a Multispecialty Hospital in Aseer Region, Abha in Southern Saudi Arabia

2020 ◽  
Author(s):  
Aziz S
Keyword(s):  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Demographic Data ◽  
Venous Blood ◽  
Pulmonary Veins ◽  
Lower Limbs ◽  
Central Hospital ◽  
Vein Thrombosis ◽  
Hospitalization Period ◽  
Deep Vein

Background: Venous Thromboembolism (VTE) is a clinical disorder characterized by the pathological occurrence of single or many thrombi developing mainly in the deep veins of the lower limbs and pulmonary veins but also other parts of the venous circulation, albeit less. A frequently occurring venous thrombosis is a deep vein thrombosis (DVT), which is the presence of thrombus in deep veins of the lower extremity. Once this clot fragment is swept off (embolism), it moves along with the venous blood and flows to the pulmonary vessels, where it may result in a clinically significant disorder called pulmonary thromboembolism (PTE). Thrombosis occurring in the superficial veins would only cause discomfort but generally with insignificant consequences. Aim: This study aimed to assess patterns and risk factors of venous thromboembolism (VTE) among patients in the Aseer region. Methodology: A record-based descriptive analysis (retrospective) was used in this study. The clinical study targeted the patients with venous thromboembolism (VTE including PE & DVT) either admitted with the diagnosis or complicated during the hospitalization period in Aseer Central Hospital during the period from January 2010 to June 2019. Data extracted using pre-structured data collection sheet. The extracted data were patients' bio-demographic data, VTE related data, treatment received and relevant complications of treatment, and patient’s follow-up history. Results: The study included total of 207 patients with thromboembolism. The age of patients was between 15 - 100 years old with the average age being 57.3+12.9 years. Approximately 58% of the patients were female. Deep vein thrombosis (DVT) was recorded in 60.4% of the cases and 27.5% of them were diagnosed with pulmonary embolism (PE) while 12.1% had both PE and DVT. Exact of 59.6% of cases with PE had immobilization history for 24 to 72 hours as compared to 31.2% of DVT and 44% of patients with mixed thromboembolism. DM was recorded among 14% of PE cases and 21.6% of DVT. Warfarin with Enoxaparin was the most frequently given treatment in total (23.2%). Heparin followed by Warfarin was the second most common treatment. Conclusions and recommendation: The study revealed that VTE was commonly reported especially DVT and PE among the recorded cases and it was bilateral in a considerable number of cases. Immobilization with chronic disease and morbid obesity was noted as the most significant predictor for VTE.

Analysis of therapy effectiveness of deep vein thrombosis of lower limbs with warfarin and rivaroxaban in the long-term period

2020 ◽  
Author(s):  
А.А. Полянцев ◽  
Д.В. Фролов ◽  
Д.В. Линченко ◽  
Ю.В. Щелокова ◽  
Т.А. Литвинова ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Oral Anticoagulants ◽  
Lower Limbs ◽  
Prophylactic Regimen ◽  
Therapy Regimen ◽  
Vein Thrombosis ◽  
Group 2 ◽  
Deep Vein ◽  
Group 1

Введение. Влияние стандартной и альтернативных схем антикоагулянтной терапии на степень и скорость реканализации глубоких вен привлекает внимание современных исследователей. Цель исследования: сравнение эффективности терапии тромбоза глубоких вен (ТГВ) нижних конечностей варфарином и ривароксабаном в отдаленном периоде. Материалы и методы. В исследование включено 94 пациента с ТГВ нижних конечностей, которые были разделены на 2 группы в зависимости от назначенной схемы лечения. Средний возраст 50 пациентов группы 1 составил 44,0 12,6 лет, 44 больных группы 2 39,5 11,7 лет. Пациентам группы 1 был назначен варфарин, группы 2 ривароксабан в течение 6 мес после выписки. Конечная точка наблюдения 4 года. Результаты. Прием антикоагулянта ранее установленного срока прекратили 18 (36) пациентов из группы 1 и 2 (4,5) пациента из группы 2. Режим эластической компрессии в обеих группах пациенты соблюдали нерегулярно. Рецидив венозных тромбоэмболических осложнений в группе 1 отмечен в 11 (22) случаях, в группе 2 у 7 (15,9) пациентов. Отрицательная динамика ультразвукового обследования складывалась у пациентов обеих групп: у 16 пациентов группы 1 и у 9,1 группы 2 появились признаки поражения ранее неизмененных вен или окклюзия ранее проходимой вены после перенесенного тромбоза без клиники острого венозного тромбоза в анамнезе. Трофические расстройства отмечены у одного пациента группы 2 и у 1/3 пациентов группы 1 к четвертому году наблюдения. Значимые отличия между группами были получены по таким параметрам, как приверженность к лечению и степень тяжести венозной недостаточности, оцениваемая клинически, в пользу ривароксабана. Заключение. Неудовлетворительные результаты лечения при использовании стандартной схемы терапии ТГВ требуют назначения препаратов из группы новых оральных антикоагулянтов с возможным внедрением схемы профилактического приема. Introduction. Effect of standard and alternative anticoagulant therapy regimens on the degree and rapidity of deep vein recanalization attracts the attention of modern researchers. Aim: to compare the treatment effectiveness of deep vein thrombosis (DVT) of lower limbs with warfarin and rivaroxaban in the long-term period. Materials and methods. The study included 94 patients with DVT of lower limbs they were divided into 2 groups depending on the prescribed treatment regimen. The average age of 50 patients of group 1 was 44.0 12.6 years, 44 patients of group 2 39.5 11.7 years. Warfarin was prescribed to patients of group 1, rivaroxaban to patients of group 2 treatment was prescribed for 6 months after discharge. The endpoint of observation was 4 years. Results. 18 (36) patients from group 1 and 2 (4.5) patients from group 2 stopped taking the anticoagulant earlier than target date. Elastic compression treatment patients in both groups kept irregularly. Recurrence of venous thromboembolic complications in group 1 was noted in 11 (22) cases, in group 2 in 7 (15.9) patients. The negative ultrasound dynamics was observed in patients of both groups: 16 of patients in group 1 and 9.1 in group 2 had lesion signs of previously unchanged veins or occlusion of a previously passable vein after thrombosis without clinic of acute venous thrombosis. Trophic disorders were identified in 1 patient in group 2 and in 1/3 of patients in group 1 by the 4th year of observation. Significant differences between the groups were obtained in favor of rivaroxaban according to such parameters as adherence to treatment and the severity of venous insufficiency. Conclusion. Unsatisfactory results of DVT treatment with standard therapy regimen require the administration of new oral anticoagulants with the possible introduction of prophylactic regimen.

Abnormal Blood Yield Stress as an Aetiological Factor in Postoperative Deep Venous Thrombosis

1975 ◽  
Author(s):  
W. V. Humphreys ◽  
A. Walker ◽  
D. Charlesworth
Keyword(s):  
Deep Vein Thrombosis ◽  
Yield Stress ◽  
Malignant Disease ◽  
Aetiological Factor ◽  
Venous Stasis ◽  
Vein Thrombosis ◽  
High Incidence ◽  
Deep Vein ◽  
Postoperative Deep Venous Thrombosis ◽  
Low Shear

An elevated blood viscosity could lead to increased venous stasis and a higher incidence of post-operative deep vein thrombosis. Immediately preoperatively we have measured, using a Contraves low shear 2 viscometer, blood yield stress and viscosity at high and low shear rate in 28 general surgical patients. These patients were then screened by the standard I125 fibrinogen technique to detect the development of deep vein thrombosis post-operatively.13 patients developed a deep vein thrombosis. These patients had a significantly higher blood yield stress, corrected to a standard haemoerit of 45%, than the others (P < 0.01 students t). All other viscosity parameters were normal in these patients. Patients with malignant disease had a very high incidence of thrombosis (90%: 30%) and significantly higher yield stress values (mean 0.26 dynes/cm2: mean 0.194 dynes/cm2, P < 0.0005 students t) compared to patients with benign disease.We conclude that a high blood yield stress could be an important aetiological factor in thrombosis and the high values obtained in patients with malignant disease could partly explain the high incidence in these patients.

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