Variants in chondroitin sulfate metabolism genes in thrombotic storm.

Introduction: Thrombotic storm (TS) presents as a severe, acute thrombotic phenotype, characterized by multiple clotting events and frequently affecting younger adults. Understanding the extensive hypercoagulation of an extreme phenotype as TS will also provide insight into the pathogenesis of a wider spectrum of thrombotic disorders.

Material And Methods: We completed whole exome sequencing on 26 TS patients, including 1 multiplex family, 13 trios and 12 isolated TS patients.

Surgery and hemostasis.

Purpose Of Review: Blood coagulation exists to halt excessive blood loss. It is paradoxical that surgery and trauma simultaneously represent major risk factors for both hemorrhagic and thrombotic complications. A summary of the available evidence used to guide contemporary approaches to perioperative care will be reviewed.

How I treat catastrophic thrombotic syndromes.

Catastrophic thrombotic syndromes are characterized by rapid onset of multiple thromboembolic occlusions affecting diverse vascular beds. Patients may have multiple events on presentation, or develop them rapidly over days to weeks. Several disorders can present with this extreme clinical phenotype, including catastrophic antiphospholipid syndrome (APS), atypical presentations of thrombotic thrombocytopenic purpura (TTP) or heparin-induced thrombocytopenia (HIT), and Trousseau syndrome, but some patients present with multiple thrombotic events in the absence of associated prothrombotic disorders.

Clinical causes and treatment of the thrombotic storm.

Thrombotic storm represents an extreme prothrombotic phenotype, characterized by multiple thrombotic events affecting diverse vascular beds occurring over a brief period of time. Thrombotic events involve venous and arterial circulation, including unusual locations, such as cerebral sinus venous thrombosis, intra-abdominal thromboembolic occlusions and microvascular events. Some patients will have antiphospholipid antibodies, but a significant number have no identifiable hypercoagulable state.

Thrombotic storm revisited: preliminary diagnostic criteria suggested by the thrombotic storm study group.

Physicians periodically encounter patients with an extraordinarily accelerated course of hypercoagulability who develop thromboses in multiple organ systems over days to weeks. Such patients may harbor underlying hypercoagulable clinical conditions, but their clinical course sets them apart from most patients with similar risk factors. Underlying triggers of "thrombotic storm" include pregnancy, inflammation, trauma, surgery, and infection.

How I treat superficial venous thrombosis.

Thrombosis of superficial veins has long been regarded as a benign disorder. If patients with a clinical diagnosis of superficial venous thrombosis (SVT) are thoroughly evaluated, the degree and extent of thrombosis in patients with SVT are characteristically underestimated (∼ 75% of the time) and such patients have coexistence (∼ 25% of the time) of, and/or rapid progression (∼ 10% of the time) to, systemic venous thromboembolism (VTE). Pulmonary embolism (PE; ∼ 25% of the time) and death (∼ 1% of the time) occur.

Thrombocytopenia and thrombosis in disseminated intravascular coagulation (DIC).

Disseminated intravascular coagulation (DIC) is the physiologic result of pathologic overstimulation of the coagulation system. Despite multiple triggers, a myriad of laboratory abnormalities, and a clinical presentation ranging from gross hemostatic failure to life-threatening thrombosis, or even both simultaneously, a simplified clinical approach augmented by a few readily available tests allows prompt identification of the process and elucidation of treatment opportunities. Platelet counts in DIC may be low, especially in acute sepsis-associated DIC, yet increased in malignancy-associated chronic DIC.

Successful thrombolytic therapy for acute kidney injury secondary to thrombosis of suprarenal inferior vena cava filter.

Inferior vena cava (IVC) thrombosis is a complication that occurs in 1-32% of patients inserted with IVC filters (IVCF). Deployment of the filter in the suprarenal position is advocated in certain clinical conditions, and some reports suggest a higher incidence of renal complications in that position, especially among patients with malignancy. We report a case of acute kidney injury (AKI) due to acute thrombosis of a suprarenal IVCF, which was successfully treated with systemic thrombolytic therapy.

Chronic oral anticoagulant therapy for extrahepatic visceral thrombosis is safe.

Background: Patients with hypercoagulability may thrombose visceral veins with resultant portal hypertension, esophagogastric varices, and hemorrhage. The role of chronic oral anticoagulant therapy in such patients is unclear. On the one hand, such patients are prone to significant hemorrhage and thus anticoagulant therapy may seem contraindicated.

Disseminated intravascular coagulation: treat the cause, not the lab values.

Disseminated intravascular coagulation (DIC) is a manifestation of an underlying pathologic process such as cancer, infection, trauma, or obstetric catastrophe. It can manifest as thrombosis, bleeding, or both. To succeed, treatment must address the underlying cause.

A feasibility study of continuing dose-reduced warfarin for invasive procedures in patients with high thromboembolic risk.

Background: The management of perioperative anticoagulation therapy for patients having a high risk of thromboembolism who are receiving long-term oral anticoagulant therapy is uncertain. The prevalent approach is to discontinue oral anticoagulation therapy and initiate heparin therapy. Another potential strategy is to continue oral anticoagulation therapy with a temporary adjustment of warfarin intensity to a preoperative international normalized ratio (INR) of 1.

Thrombocytopenia due to acute venous thromboembolism and its role in expanding the differential diagnosis of heparin-induced thrombocytopenia.

Thrombocytopenia is an uncommon but serious consequence of heparin administration. Occasionally patients with massive acute venous thromboembolism (VTE) will develop thrombocytopenia. As heparin or some thrombin inhibitor is strongly indicated in acute VTE, it is important to distinguish this event from heparin-induced thrombocytopenia (HIT).

The contact system.

Objectives: To review the literature for conditions, diseases, and disorders that affect activity of the contact factors, and further to review the literature for evidence that less than normal activity of any of the contact factors may be associated with thrombophilia.

Data Sources: MEDLINE search for English-language articles published from 1988 to 2001 and pertinent references contained therein, as well as search of references in recent relevant articles and reviews.

Study Selection: Relevant clinical and laboratory information was extracted from selected articles.