Thrombophilia due to Activated Protein C Resistance
|
|
- Melvin Hill
- 6 years ago
- Views:
Transcription
1 CASE REPORT JIACM 2005; 6(3): Thrombophilia due to Activated Protein C Resistance Kamal S Saini*, Mrinal M Patnaik*, Vidya S Nagar**, Alaka K Deshpande*** Abstract Thrombophilia is a hereditary or acquired condition that predisposes individuals to thrombo-embolic events. In patients with a positive family history, or young patients without clear-cut risk factors for thrombosis, it is a relatively easy decision to recommend a thrombophilia profile. The problem arises when these risk factors are camouflaged under the presence of other known and relatively common factors like hyperlipidaemia, cigarette smoking, etc. Here we describe the case of an elderly male who was a chronic smoker and a hypertensive, who presented to us with a neuro-deficit secondary to a pontine infarct. He had suffered in the past from deep vein thrombosis and claudication due to arterial obstruction. Investigations revealed that he had an underlying Activated protein C resistance due to factor V Leiden mutation. Keywords: Thrombophilia, Activated protein C resistance, Factor V Leiden mutation, Deep vein thrombosis, Arterial thrombosis. Introduction Thrombophilia is defined as a hereditary or acquired condition that predisposes individuals to thromboembolic events like myocardial infarction, stroke, deep vein thrombosis, pulmonary embolism, and recurrent miscarriages. The most common cause of hereditary thrombophilia is Activated protein C resistance 1, which is usually caused by the factor V Leiden mutation. Thrombophilic factors generally predispose young individuals to either arterial and/or venous thrombosis, depending on their type and nature. The problem arises when these factors are camouflaged under common acquired prothrombotic conditions like smoking, hypertension, and hyperlipidaemia. In this case report we describe a middle-aged male who had presented to us with repeated episodes of arterial and venous thrombosis. He was a heavy smoker and had poorly controlled hypertension. It was thought all along that these risk factors were responsible for the thrombotic events. He presented to us with a neuro-deficit due to a catastrophic pontine infarct. It was then that we detected that he also had an underlying genetic defect, producing a prothrombotic state, which was then getting accentuated by the acquired risk factors. This defect was identified as the Activated protein C resistance due to the factor V Leiden mutation. Case report A 52-year-old Muslim male was referred to our centre for the management of a catastrophic neuro-deficit. The deficit was acute in onset, and was associated with complete loss of sensorium and generalised tonic clonic convulsions. The patient was unresponsive and had a deviation of the angle of the mouth towards the right side. On examination, his blood pressure was 190/110 mm Hg. He had loss of horizontal conjugate gaze with left facial and bulbar palsy. An urgent CT scan of the brain revealed a large pontine infarct with significant peri-lesional oedema. Within a few hours of admission, the patient developed raised intracranial tension, and went into respiratory failure for which he had to receive assisted mechanical ventilation. The patient then had a stormy course in the critical care unit. He developed ventilatoracquired pneumonia, which then evolved into sepsis with renal failure. It took five weeks before he could be weaned off all artificial life supporting devices and was finally shifted to the medical ward. A detailed history and review of his medical records revealed that in the past, the patient had suffered from several episodes of arterial and venous thrombosis. In 1991, at the age of 44, he suffered from inferior wall myocardial infarction, following which coronary angiography was done which revealed the presence of significant triple vessel disease. He * Chief Resident, ** Associate Professor, *** Professor, Department of Medicine, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra.
2 was advised to undergo CABG, which was carried out in December, In 1995, the patient was readmitted to the hospital for complaints of acute right hypochondriac pain associated with severe nausea and vomiting. A diagnosis of acute calculous cholecystitis was made, and the patient underwent cholecystectomy. During the fifth post-operative day, the patient noticed an acute painful swelling of the left lower limb, which on colour doppler studies proved to be an extensive thrombosis of left internal and external iliac veins. The thrombosis was attributed to be due to the postoperative immobilisation alongwith prevalent atherosclerotic risk factors. The patient was started on heparin cover and was administered warfarin for three months. After three months, repeat studies showed a partial recanalisation of the veins with perforator incompetence. In 1996, the patient developed acute pain in his left lower limb with blackish discoloration of his toes. Except for the left femoral pulse no other pulses were felt in the left lower limb. A colour doppler of the lower limbs showed obstruction of left popliteal artery with poor collateral run-off and a thrombus occluding the left popliteal vein. He was again anticoagulated, this time for six months. He was advised to give up smoking and started on aspirin with dipyridamole alongwith his anti-hypertensive medications. In 1998, he developed severe bilious vomiting with abdominal colic. Within a few hours, the patient had severe abdominal distention and was rushed to the hospital. An urgent exploratory laparotomy was done which revealed a distal small intestinal infarction with gangrene, probably due to thrombosis of the mesenteric artery. The patient then underwent a resection anastomosis and was discharged after nearly three months. From 1998 to 2002, the patient s condition stabilised considerably. He gave-up alcohol completely, significantly reduced his smoking, and ensured strict compliance with his medications. He was on his way to the city of Mumbai when he suffered a severe pontine infarct for which he was admitted in our hospital for the first time. An MRI brain with angiography was subsequently performed, which confirmed a pontine infarct due to an occlusion of the basilar artery. Going through his entire history made us feel that although this patient had multiple risk factors for thrombosis, these were not enough to explain the recurrent episodes of arterial and venous thrombosis. Most of these evident risk factors had been modulated by either lifestyle changes or appropriate medications and still he developed a major basilar artery occlusion. It was at this point of time that we decided to investigate this patient for an underlying thrombophilia. Table I shows the results of the investigations performed on the patient. The patient was then started on warfarin, which he was advised to take life-long. He was asked to follow-up in the out-patients department with regular monitoring of his PT/INR. Discussion Thrombophilic factors predispose an individual for arterial and/or venous thrombosis. Depending on the nature of the factor and the underlying predisposing condition in the patient, the arteries and or the veins can be involved. Table II enlists the different thrombophilic factors and their relative predisposition to involve arteries and/or veins. Activated Protein C (APC) resistance, first reported by Dahlback et al in 1993, is the most common cause of inherited thrombophilia 1. It is said to be present when a patient s plasma fails to demonstrate significant prolongation of the APTT on addition of APC. Bertina and colleagues at the University of Leiden explained this observation in A single point mutation results in the substitution of arginine at position 506 by glutamine. Arg506 is one of several cleavage sites in factor V for the anticoagulant action of APC and the mutation results in loss of the cleavage site. This has been termed the factor V Leiden mutation. Activated protein C is a natural anticoagulant that cleaves two activated coagulant factors factor VIIIa and factor Va. This cleavage inhibits the conversion of factor X to factor Xa and of prothrombin to thrombin. The Arg 506 Gln mutation in the factor V Leiden molecule renders factor Va resistant to breakdown by activated protein C. Population genetics and linkage studies revealed that this mutation was found to be present in about 4-7 per cent of the general Caucasian population. It was subsequently proven to be a common causative factor in venous thrombosis. Recent evidence implicates APC resistance as an important factor in arterial thrombosis as well 2,3. Journal, Indian Academy of Clinical Medicine Vol. 6, No. 3 July-September,
3 Table I: Laboratory investigations and results. Investigation Haemoglobin WBC Count Result 10.8 gm% 6,800 (P-85%, L-15%) Bleeding profile BT/CT 4 minutes/6 minutes PT/APTT PT- 13 (C-12), APTT- 35 (C-32) Absolute platelet count 2,30,000/cmm Renal function Serum lipid profile Lipoprotein (a) Serum homocysteine Fasting blood glucose Anti-cardiolipin antibodies (IgM, IgG) BUN - 60 mg/dl, Creatinine mg/dl Cholesterol- 210 mg/dl, LDL 160 mg/dl, HDL 45 mg/dl. Triglyceride mg/dl 23 mg/dl (normal < 30 mg/dl) 16 mg/dl (normal) 100 mg/dl Negative Protein C activity 62% (N = 70% - 130%) Protein S activity 58.5% (N = 70% - 123%) Activated protein C resistance PCR for factor V Leiden MRI brain Present Positive Pontine infarct with basilar artery obstruction Table II: Thrombophilic factors. Causes of venous Causes of arterial Causes of arterial and thrombosis thrombosis venous thrombosis Protein C deficiency. Atherosclerosis (High serum Activated protein C resistance Protein S deficiency. LDL cholesterol and triglycerides) (Factor V Leiden mutation) Antithrombin III deficiency. Cigarette smoking Antiphospholipid antibody syndrome Prothrombin mutation Hypertension Protein S deficiency (Prothrombin G 20210A). Diabetes Mellitus Oral Contraceptive Pills Oral contraceptives High serum lipoprotein a levels Hyperhomocysteinaemia Malignancy Factor VIII polymorphism (MTHFR enzyme mutation) Immobilisation Infection (Chlamydia, CMV) Surgeries Obesity APC resistance may cause thrombosis, pre-eclampsia, placental abruption, intrauterine growth retardation, and stillbirth 4,5. Females with factor V Leiden who are on oral contraception have considerably higher relative risk of thrombosis. In a study performed in north India, Ahmed et al tested 68 patients who presented with arterial or venous thrombosis for the factor V mutation. 7.3% of patients with venous thrombosis, and 3% of patients with arterial thrombosis tested positive for this molecular defect. In our patient, recurrent episodes of arterial and venous thromboses were repeatedly blamed on prevalent and easily identified risk factors like cigarette smoking, hypertension, and chronic alcoholism. He was Contd. at page Journal, Indian Academy of Clinical Medicine Vol. 6, No. 3 July-September, 2005
4
5
6
7
8
9
10 Contd. from page 246 anticoagulated for short durations of time, after which he would again present with a thrombotic occlusion. Had the underlying genetic predisposition been identified earlier, this patient could have been put on life-long warfarin therapy, saving him all the trouble, which he and his family had to endure. The take home message from this article is that in a case of recurrent thromboses an underlying thrombophilic factor must be pursued, because if identified and treated properly it can significantly reduce mortality and morbidity. References 1. Dahlback B, Carlson M, Svesson PJ. Familial thrombophilia due to previously unrecognised mechanism characterised by poor anticoagulant response to activated protein C: prediction of a co factor to activated protein C. Proc Natl Acad Sci USA 1993; 90: Bertina RM, Koeleman BP, Koster T et al. Mutation in blood coagulation factor V associated with resistance to activated protein C. Nature 1994; 369: Ahmed RP, Gupta PK, Kannan M, Choudhry VP, Saxena R, Factor V Leiden-the commonest molecular defect in arterial and venous thrombophilia in India. Thromb Res 2003; 110 (1): Seligsohn U, Lubetsky A. Medical progress: genetic susceptibility to venous thrombosis. N Engl J Med 2001; 344: Middeldorp S, Meinardi JR, Koopman MM et al. A prospective study of asymptomatic carriers of the factor V Leiden mutation to determine the incidence of venous thromboembolism. Ann Intern Med 2001; 135 (5): Prandoni P, Bilora F, Marchiori A. An association between atherosclerosis and venous thrombosis. N Engl J Med 2003; 348: Journal, Indian Academy of Clinical Medicine Vol. 6, No. 3 July-September,
Thrombophilia. Diagnosis and Management. Kevin P. Hubbard, DO, FACOI
Thrombophilia Diagnosis and Management Kevin P. Hubbard, DO, FACOI Clinical Professor of Medicine Kansas City University of Medicine and Biosciences-College of Osteopathic Medicine Kansas City, Missouri
More informationVENOUS THROMBOEMBOLISM AND CORONARY ARTERY DISEASE: IS THERE A LINK?
VENOUS THROMBOEMBOLISM AND CORONARY ARTERY DISEASE: IS THERE A LINK? Ayman El-Menyar (1), MD, Hassan Al-Thani (2),MD (1)Clinical Research Consultant, (2) Head of Vascular Surgery, Hamad General Hospital
More informationAre there still any valid indications for thrombophilia screening in DVT?
Carotid artery stenosis and risk of stroke Are there still any valid indications for thrombophilia screening in DVT? Armando Mansilha MD, PhD, FEBVS Faculty of Medicine of University of Porto Munich, 2016
More informationThrombosis. By Dr. Sara Mohamed Abuelgasim
Thrombosis By Dr. Sara Mohamed Abuelgasim 1 Thrombosis Unchecked, blood coagulation would lead to dangerous occlusion of blood vessels if the protective mechanisms of coagulation factor inhibitors, blood
More informationApproach to Thrombosis
Approach to Thrombosis Theera Ruchutrakool, M.D. Division of Hematology Department of Medicine Siriraj Hospital Faculty of Medicine Mahidol University Approach to Thrombosis Thrombosis: thrombus formation
More informationMabel Labrada, MD Miami VA Medical Center
Mabel Labrada, MD Miami VA Medical Center *1-Treatment for acute DVT with underlying malignancy is for 3 months. *2-Treatment of provoked acute proximal DVT can be stopped after 3months of treatment and
More informationJordan M. Garrison, MD FACS, FASMBS
Jordan M. Garrison, MD FACS, FASMBS Peripheral Arterial Disease (PAD) Near or Complete obstruction of > 1 Peripheral Artery Peripheral Venous reflux Disease Varicose Veins Chronic Venous Stasis Ulcer Disease
More informationArterial Ischemic Stroke with Protein S Deficiency in Pakistan
Case Reports Arterial Ischemic Stroke with Protein S Deficiency in Pakistan Faika Usman, Ali Hassan, Arsalan Ahmad From Section of Neurology, Department of Medicine, Shifa International Hospitals and College
More informationGuidelines for management of stroke in childhood
Guidelines for management of stroke in childhood A clinical syndrome typified by rapidly developing signs of focal or global disturbance of cerebral functions, lasting more than 24 hrs or leading to death,
More informationDISCLOSURE. Presented by: Merav Sendowski, MD Oregon Health and Science University
Thrombophilia! DISCLOSURE Presented by: Merav Sendowski, MD Oregon Health and Science University Created by: Thomas Deloughery, MD Oregon Health and Science University Current Relevant Financial Relationship(s)
More informationChapter. Absolute risk of venous and arterial thrombosis in HIV-infected patients and effects of combination antiretroviral therapy
Chapter Absolute risk of venous and arterial thrombosis in HIV-infected patients and effects of combination antiretroviral therapy Willem M. Lijfering Min Ki ten Kate Herman G. Sprenger Jan van der Meer
More informationCURRENT & FUTURE THERAPEUTIC MANAGEMENT OF VENOUS THROMBOEMBOLISM. Gordon Lowe Professor of Vascular Medicine University of Glasgow
CURRENT & FUTURE THERAPEUTIC MANAGEMENT OF VENOUS THROMBOEMBOLISM Gordon Lowe Professor of Vascular Medicine University of Glasgow VENOUS THROMBOEMBOLISM Common cause of death and disability 50% hospital-acquired
More informationVenous thromboembolism (VTE) consists of deep vein
Clinical Utility of Factor V Leiden (R506Q) Testing for the Diagnosis and Management of Thromboembolic Disorders Richard D. Press, MD, PhD; Kenneth A. Bauer, MD; Jody L. Kujovich, MD; John A. Heit, MD
More informationLearning Objectives for Rotations in Vascular Surgery Year 3 Basic Clerkship
Learning Objectives for Rotations in Vascular Surgery Year 3 Basic Clerkship CLINICAL PROBLEMS IN VASCULAR SURGERY 1. ABDOMINAL AORTIC ANEURYSM A 70 year old man presents in the emergency department with
More informationThursday, February 26, :00 am. Regulation of Coagulation/Disseminated Intravascular Coagulation HEMOSTASIS/THROMBOSIS III
REGULATION OF COAGULATION Introduction HEMOSTASIS/THROMBOSIS III Regulation of Coagulation/Disseminated Coagulation necessary for maintenance of vascular integrity Enough fibrinogen to clot all vessels
More informationDr. Rami M. Adil Al-Hayali Assistant Professor in Medicine
Dr. Rami M. Adil Al-Hayali Assistant Professor in Medicine Venous thromboembolism: pulmonary embolism (PE) deep vein thrombosis (DVT) 1% of all patients admitted to hospital 5% of in-hospital mortality
More informationRECURRENT VENOUS THROMBOEMBOLISM AND MUTATION IN THE GENE FOR FACTOR V
THE RISK OF RECURRENT VENOUS THROMBOEMBOLISM IN PATIENTS WITH AN Arg 506 Gln MUTATION IN THE GENE FOR FACTOR V (FACTOR V LEIDEN) PAOLO SIMIONI, M.D., PAOLO PRANDONI, M.D., PH.D., ANTHONIE W.A. LENSING,
More informationThrombophilia: To test or not to test
Kenneth Bauer, MD Harvard Medical School, Boston, MA Professor of Medicine VA Boston Healthcare System Chief, Hematology Section Beth Israel Deaconess Medical Center, Boston, MA Director, Thrombosis Clinical
More informationOPEN ACCESS TEXTBOOK OF GENERAL SURGERY
OPEN ACCESS TEXTBOOK OF GENERAL SURGERY MESENTERIC ISCHAEMIA P Zwanepoel INTRODUCTION Mesenteric ischaemia results from hypoperfusion of the gut, most commonly due to occlusion, thrombosis or vasospasm.
More informationVenous thrombosis is common and often occurs spontaneously, but it also frequently accompanies medical and surgical conditions, both in the community
Venous Thrombosis Venous Thrombosis It occurs mainly in the deep veins of the leg (deep vein thrombosis, DVT), from which parts of the clot frequently embolize to the lungs (pulmonary embolism, PE). Fewer
More informationConsultative Coagulation How to Effectively Answer Common Questions About Hemostasis Testing Session #5000
Consultative Coagulation How to Effectively Answer Common Questions About Hemostasis Testing Session #5000 Dorothy M. (Adcock) Funk, M.D. Karen A. Moser, M.D. Esoterix Coagulation September 20, 2013 Disclosures
More informationSinus and Cerebral Vein Thrombosis
Sinus and Cerebral Vein Thrombosis A Summary Sinus and cerebral vein clots are uncommon. They can lead to severe headaches, confusion, and stroke-like symptoms. They may lead to bleeding into the surrounding
More informationRecurrent Venous Thrombo-Embolism in a Young Adult Female: Case Report with Review of Literature
Cronicon OPEN ACCESS CARDIOLOGY Case Report Recurrent Venous Thrombo-Embolism in a Young Adult Female: Case Report with Review of Literature Ehab M Esheiba 1 *, Ani Purushothaman 2 1 Departments of Cardiology,
More informationStroke 101. Maine Cardiovascular Health Summit. Eileen Hawkins, RN, MSN, CNRN Pen Bay Stroke Program Coordinator November 7, 2013
Stroke 101 Maine Cardiovascular Health Summit Eileen Hawkins, RN, MSN, CNRN Pen Bay Stroke Program Coordinator November 7, 2013 Stroke Statistics Definition of stroke Risk factors Warning signs Treatment
More informationLipid Markers. Independent Risk Factors. Insulin Resistance Score by Lipid Fractionation
Patient: SAMPLE PATIENT DOB: Sex: MRN: 3701 CV Health Plus Genomics - Plasma, Serum & Buccal Swab Methodology: Chemiluminescent, Enzymatic, Immunoturbidimetric, NMR and PCR Lipid Markers Cholesterol LDL-
More informationPotpourri of Hematology Oncology. Jasmine Nabi, M.D. Oncology Associates Hall-Perrine Cancer Center at Mercy
Potpourri of Hematology Oncology Jasmine Nabi, M.D. Oncology Associates Hall-Perrine Cancer Center at Mercy Lifestyle Modifications to Decrease the Risk of Colorectal Cancer Estimates for 2018 American
More informationRecombinant Factor VIIa for Intracerebral Hemorrhage
Recombinant Factor VIIa for Intracerebral Hemorrhage January 24, 2006 Justin Lee Pharmacy Resident University Health Network Outline 1. Introduction to patient case 2. Overview of intracerebral hemorrhage
More informationMolecular mechanisms & clinical consequences. of prothrombin mutations. A.J. Hauer
Molecular mechanisms & clinical consequences of prothrombin mutations A.J. Hauer 07-12-2018 Prothrombin & the coagulation cascade Coagulation factor II, thrombin. Prothrombin is synthesized in the liver
More informationG20210A prothrombin gene mutation identified in patients with venous leg ulcers
J.Cell.Mol.Med. Vol 5, No 4, 2001 pp. 397-401 G20210A prothrombin gene mutation identified in patients with venous leg ulcers Gh. Jebeleanu, Lucia Procopciuc * Department of Medical Biochemistry, University
More informationCover Page. The handle holds various files of this Leiden University dissertation.
Cover Page The handle http://hdl.handle.net/1887/19768 holds various files of this Leiden University dissertation. Author: Langevelde, Kirsten van Title: Are pulmonary embolism and deep-vein thrombosis
More informationLaboratory Evaluation of Venous Thrombosis Risk
Laboratory Evaluation of Venous Thrombosis Risk Dorothy M. Adcock, MD Volume 17, Number 12 December 2003 Objective: The reader will be able to discuss the concepts of risk factor, risk potential and thrombotic
More informationTHROMBOPHILIA TESTING: PROS AND CONS SHANNON CARPENTER, MD MS CHILDREN S MERCY HOSPITAL KANSAS CITY, MO
THROMBOPHILIA TESTING: PROS AND CONS SHANNON CARPENTER, MD MS CHILDREN S MERCY HOSPITAL KANSAS CITY, MO DISCLAIMER I m a pediatrician I will be discussing this issue primarily from a pediatric perspective
More informationCOAGULATION INHIBITORS LABORATORY DIAGNOSIS OF PROTHROMBOTIC STATES REGULATION OF. ANTICOAGULANT PROTEIN DEFICIENCY Disease entities COAGULATION
LABORATORY DIAGNOSIS OF PROTHROMBOTIC COAGULATION INHIBITORS Tissue Factor Pathway Inhibitor (TFPI) Lipoprotein Associated Coagulation Inhibitor (LACI) Extrinsic Pathway Inhibitor (EPI) Complexes with
More information2017/04/21 R1 歐宗頴. Case Discussion
2017/04/21 R1 歐宗頴 Case Discussion Case Demography Name: 18143xxx Age: 14y/o Gender: boy Admission: 2017/04/07 Chief complaint: recurrent fever with RUQ pain for 6 weeks Past History G3P3 full term NSD
More informationVTE in Children: Practical Issues
VTE in Children: Practical Issues Wasil Jastaniah MBBS,FAAP,FRCPC Consultant Pediatric Hem/Onc/BMT May 2012 Top 10 Reasons Why Pediatric VTE is Different 1. Social, ethical, and legal implications. 2.
More informationVenous Thrombo-Embolism (VTE)
Venous Thrombo-Embolism (VTE) Information for service users and carers RDaSH leading the way with care Older People s Mental Health Services Reducing risk of unwanted blood clots whilst in hospital About
More informationUpdates in Medical Management of Pulmonary Embolism and Deep Vein Thrombosis. By: Justin Youtsey, Elliott Reiff, William Montgomery, Grant Finlan
Updates in Medical Management of Pulmonary Embolism and Deep Vein Thrombosis By: Justin Youtsey, Elliott Reiff, William Montgomery, Grant Finlan Objectives Describe the prevalence of PE and DVT as it relates
More informationLOKUN! I got stomach ache!
LOKUN! I got stomach ache! Mr L is a 67year old Chinese gentleman who is a non smoker, social drinker. He has a medical history significant for Hypertension, Hyperlipidemia, Type 2 Diabetes Mellitus, Chronic
More informationHemodynamic Disorders, Thrombosis, and Shock. Richard A. McPherson, M.D.
Hemodynamic Disorders, Thrombosis, and Shock Richard A. McPherson, M.D. Edema The accumulation of abnormal amounts of fluid in intercellular spaces of body cavities. Inflammation and release of mediators
More informationInherited Thrombophilia Testing. George Rodgers, MD, PhD Kristi Smock MD
Inherited Thrombophilia Testing George Rodgers, MD, PhD Kristi Smock MD Prevalence and risk associated with inherited thrombotic disorders Inherited Risk Factor % General Population % Patients w/ Thrombosis
More informationDisclosures. DVT: Diagnosis and Treatment. Questions To Ask. Dr. Susanna Shin - DVT: Diagnosis and Treatment. Acute Venous Thromboembolism (VTE) None
Disclosures DVT: Diagnosis and Treatment None Susanna Shin, MD, FACS Assistant Professor University of Washington Acute Venous Thromboembolism (VTE) Deep Venous Thrombosis (DVT) Pulmonary Embolism (PE)
More informationTHROMBOPHILIA SCREENING
THROMBOPHILIA SCREENING Introduction The regulation of haemostasis Normally, when a clot occurs, it exactly occurs where it has to be and does not grow more than necessary due to the action of the haemostasis
More informationIntroduction. Risk factors of PVD 5/8/2017
PATHOPHYSIOLOGY AND CLINICAL FEATURES OF PERIPHERAL VASCULAR DISEASE Dr. Muhamad Zabidi Ahmad Radiologist and Section Chief, Radiology, Oncology and Nuclear Medicine Section, Advanced Medical and Dental
More informationHEART AND SOUL STUDY OUTCOME EVENT - MORBIDITY REVIEW FORM
REVIEW DATE REVIEWER'S ID HEART AND SOUL STUDY OUTCOME EVENT - MORBIDITY REVIEW FORM : DISCHARGE DATE: RECORDS FROM: Hospitalization ER Please check all that may apply: Myocardial Infarction Pages 2, 3,
More informationWhat are blood clots?
What are blood clots? Dr Matthew Fay GP Principal The Willows Medical Practice- Queensbury GPwSI and Co-Founder Westcliffe Cardiology Service GP Partner Westcliffe Medical Group Created 5/31/18 Dr. Matthew
More informationJOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH How to cite this article: CHOWTA NITHYANANDA K, ARUN S, BIPIN P, FAZIL A. CHRONIC THROMBOEMBOLIC PULMONARY ARTERY HYPERTENSION WITH DEEP VEIN THROMBOSIS DUE
More informationDiagnosis and Treatment of Deep Venous Thrombosis and Pulmonary Embolism
Agency for Healthcare Research and Quality Evidence Report/Technology Assessment Diagnosis and Treatment of Deep Venous Thrombosis and Pulmonary Embolism Summary Number 68 Overview Venous thromboembolism
More informationPrevention and management of deep venous thrombosis (DVT) John Fletcher Wound Care Association of New South Wales
Prevention and management of deep venous thrombosis (DVT) John Fletcher Wound Care Association of New South Wales Merimbula, 6 th November 2010 University of Sydney Department of Surgery Westmead Hospital
More informationPulmonary Embolism Is it the Greatest Danger in Deep Vein Thrombosis?
Difficult issues in Deep Vein Thrombosis: Pulmonary Embolism Is it the Greatest Danger in Deep Vein Thrombosis? Raluca Dulgheru; C Gherghinescu; B Dorobat; H Muresan; R Darabont; M Cinteza; D Vinereanu
More informationDeep vein thrombosis: diagnosis, prevention and treatment
Deep vein thrombosis: diagnosis, prevention and treatment Catherine Bagot BSc, MD, MRCP, FRCPath and Campbell Tait BSc, FRCP, FRCPath Deep vein thrombosis can lead to significant morbidity and has well-recognised
More informationCover Page. The handle holds various files of this Leiden University dissertation.
Cover Page The handle http://hdl.handle.net/1887/19768 holds various files of this Leiden University dissertation. Author: Langevelde, Kirsten van Title: Are pulmonary embolism and deep-vein thrombosis
More informationCardioGenomicPlus Profile
CardioGenomicPlus Profile Patient: SAMPLE PATIENT DOB: Sex: MRN: Apo E Chromosome 19 APOE APO E2: cys / cys APO E3: cys / arg APO E4: arg / arg The two SNPs lead to 3 possible variants for each chromosome,
More informationCoronary Artery Disease Clinical Practice Guidelines
Coronary Artery Disease Clinical Practice Guidelines Guidelines are systematically developed statements to assist patients and providers in choosing appropriate healthcare for specific clinical conditions.
More informationPrimary Prevention of Stroke
Primary Prevention of Stroke Dr Chris Ellis Cardiologist Green Lane CVS Service, Auckland City Hospital & Auckland Heart Group, Mercy Hospital, Auckland 67 Pages Long, 735 References 29 Sub-Headings for
More informationHow long to continue anticoagulation after DVT?
How long to continue anticoagulation after DVT? Dr. Nihar Ranjan Pradhan M.S., DNB (Vascular Surgery), FVES(UK) Consultant Vascular Surgeon Apollo Hospital, Jubilee Hills, Hyderabad (Formerly Faculty in
More informationDr. Riaz JanMohamed Consultant Haematologist The Hillingdon Hospital Foundation Trust
MANAGEMENT OF PATIENTS WITH DEEP VEIN THROMBOSIS (DVT) IN THE COMMUNITY SETTING & ANTICOAGULATION CLINICS THE PAST, PRESENT AND THE FUTURE Dr. Riaz JanMohamed Consultant Haematologist The Hillingdon Hospital
More informationComplications of ECLS. Rajasekhar Malyala, MD Assistant Professor, Surgery University of Kentucky
Complications of ECLS Rajasekhar Malyala, MD Assistant Professor, Surgery University of Kentucky Faculty Disclosure No financial Disclosures Education Need/Practice Gap Recommendations and guidelines regarding
More informationCase Study: Chris Arden. Peripheral Arterial Disease
Case Study: Chris Arden Peripheral Arterial Disease Patient Presentation Diane is a 65-year-old retired school teacher She complains of left calf pain when walking 50 metres; the pain goes away after she
More informationDeep Vein Thrombosis
Deep Vein Thrombosis from NHS (UK) guidelines Introduction Deep vein thrombosis (DVT) is a blood clot in one of the deep veins in the body. Blood clots that develop in a vein are also known as venous thrombosis.
More informationTerm-End Examination December, 2009 MCC-006 : CARDIOVASCULAR EPIDEMIOLOGY
MCC-006 POST GRADUATE DIPLOMA IN CLINICAL CARDIOLOGY (PGDCC) 00269 Term-End Examination December, 2009 MCC-006 : CARDIOVASCULAR EPIDEMIOLOGY Time : 2 hours Maximum Marks : 60 Note : There will be multiple
More information4. Which survey program does your facility use to get your program designated by the state?
TRAUMA SURVEY Please complete one survey for each TCD designation you have in your facility. There would be a maximum of three surveys completed if your facility was designated as a trauma, stroke and
More informationEpidemiologia e clinica del tromboembolismo venoso. Maria Ciccone Sezione di Ematologia e Fisiopatologia della Coagulazione
Epidemiologia e clinica del tromboembolismo venoso Maria Ciccone Sezione di Ematologia e Fisiopatologia della Coagulazione Thrombophilia may present clinically as one or more of several thrombotic manifestations
More informationAntiphospholipid antibodies
CARDIOLOGY PATIENT PAGE CARDIOLOGY PATIENT PAGE Antiphospholipid Antibodies Caron P. Misita, PharmD; Stephan Moll, MD Antiphospholipid antibodies (APLAs) are proteins that may be present in the blood and
More informationThrombophilia. Dr. A Sarrafnejad PhD Dep. Immunology School of public health TUMS
Autoimmune Thrombophilia Dr. A Sarrafnejad PhD Dep. Immunology School of public health TUMS Saraf@sina.tums.ac.ir Acquired Thrombophilia HIT PNH Cyckle cell Anemia Myeloproliferative lf Diseases Thrombocytosis
More informationFACTOR Xa AND PAR-1 BLOCKER : ATLAS-2, APPRAISE-2 & TRACER TRIALS
New Horizons In Atherothrombosis Treatment 2012 순환기춘계학술대회 FACTOR Xa AND PAR-1 BLOCKER : ATLAS-2, APPRAISE-2 & TRACER TRIALS Division of Cardiology, Jeonbuk National University Medical School Jei Keon Chae,
More informationIs there an association between atherosclerosis and chronic venous disease?
Is there an association between atherosclerosis and chronic venous disease? Karel Roztocil, IKEM, Praha Hungarian Society of Angiology and Vascular Surgery Congress, Szombathely 2017 Disclosure Nothing
More information1. SCOPE of GUIDELINE:
Page 1 of 35 CLINICAL PRACTICE GUIDELINE: Venous Thromboembolism (VTE) Prevention Guideline: Thromboprophylaxis AUTHORIZATION: VP, Medicine Date Approved: May 17, 2012 Date Revised: Vancouver Coastal Health
More informationDOPPLER ULTRASOUND OF DEEP VENOUS THROMBOSIS
TOKUDA HOSPITAL SOFIA DOPPLER ULTRASOUND OF DEEP VENOUS THROMBOSIS MILENA STANEVA, MD, PhD Department of vascular surgery and angiology Venous thromboembolic disease continues to cause significant morbidity
More informationATHEROSCLEROSIS. Secondary changes are found in other coats of the vessel wall.
ATHEROSCLEROSIS Atherosclerosis Atherosclerosis is a disease process affecting the intima of the aorta and large and medium arteries, taking the form of focal thickening or plaques of fibrous tissue and
More informationPathophysiology. Tutorial 3 Hemodynamic Disorders
Pathophysiology Tutorial 3 Hemodynamic Disorders ILOs Recall different causes of thrombosis. Explain different types of embolism and their predisposing factors. Differentiate between hemorrhage types.
More informationCausative factors of deep vein thrombosis of lower limb in Indian population
International Surgery Jthisnal Khadilkar R et al. Int Surg J. 18 Jan;(1):3-3 http://www.ijsurgery.com pissn 39-33 eissn 39-9 Original Research Article DOI: http://dx.doi.org/1.183/39-9.isj17919 Causative
More informationA 50-year-old woman with syncope
Hira Shahzad 1, Ali Bin Sarwar Zubairi 2 1 Medical College, Aga Khan University Hospital, Karachi 2 Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan Ali Bin Sarwar Zubairi Associate
More informationIntended Learning Outcomes
2011 Acute Limb Ischemia Definition, Etiology & Pathophysiology Clinical Evaluation Management Ali SABBOUR Prof. of Vascular Surgery, Ain Shams University Acute Limb Ischemia Intended Learning Outcomes
More informationAcute arterial embolism
Acute arterial embolism Definition Thrombus come from heart or blood vessel or other embolus such as tumor,air gas or fat flow with blood stream and occlude distal limb or visceral arteries which causes
More informationINSTITUTE OF NEUROSURGERY & DEPARTMENT OF PICU
CEREBRAL BYPASS An Innovative Treatment for Arteritis INSTITUTE OF NEUROSURGERY & DEPARTMENT OF PICU CASE 1 q 1 year old girl -recurrent seizure, right side limb weakness, excessive cry and irritability.
More informationObjectives. Venous Thromboembolism (VTE) Prophylaxis. Case VTE WHY DO IT? Question: Who Is At Risk?
Objectives Venous Thromboembolism (VTE) Prophylaxis Rishi Garg, MD Department of Medicine Identify patients at risk for VTE Options for VTE prophylaxis Current Recommendations (based on The Seventh ACCP
More informationPathology of pulmonary vascular disease. Dr.Ashraf Abdelfatah Deyab. Assistant Professor of Pathology Faculty of Medicine Almajma ah University
Pathology of pulmonary vascular disease Dr.Ashraf Abdelfatah Deyab Assistant Professor of Pathology Faculty of Medicine Almajma ah University Pulmonary vascular disease Type of pulmonary circulation: Types
More informationDVT Pathophysiology and Prophylaxis in Medically Hospitalized Patients. David Liff MD Oklahoma Heart Institute Vascular Center
DVT Pathophysiology and Prophylaxis in Medically Hospitalized Patients David Liff MD Oklahoma Heart Institute Vascular Center Overview Pathophysiology of DVT Epidemiology and risk factors for DVT in the
More informationUniversity Journal of Medicine and Medical Specialities
University Journal of Medicine and Medical Specialities Volume 1 Issue 1 2015 An unusual case of SADDLE Pulmonary Thrombo Embolism Boopathirajan P Jayanthi R Stanley Medical College Abstract: Pulmonary
More informationPreoperative Management of Patients Receiving Antithrombotics
Preoperative Management of Patients Receiving Antithrombotics Bleeding complications remain an important concern for most surgical procedures. Attempts to minimize the risk of these complications by removing
More informationTHROMBOSIS RISK FACTOR ASSESSMENT
Name: Procedure: Doctor: Date: THROMBOSIS RISK FACTOR ASSESSMENT CHOOSE ALL THAT APPLY EACH RISK FACTOR REPRESENTS 1 POINT Age 41 60 years Minor Surgery Planned History of Prior Major Surgery (< 1 month)
More informationAN INTERESTING CASE OF RESPIRATORY DISTRESS. Dr.V.Akila Devi DNB PG Southern Railway Headquarters Hospital Chennai
AN INTERESTING CASE OF RESPIRATORY DISTRESS Dr.V.Akila Devi DNB PG Southern Railway Headquarters Hospital Chennai 11 month old female infant 1 st born to parents of NC marriage referred from Kolkatta H/O:
More informationPrimary Stroke Center Quality & Performance Measures
Primary Stroke Center Quality & Performance Measures This section of the manual contains information related to the quality performance of Primary Stroke Centers. Brain Attack Coalition Definitions Recognition
More informationResults of Ischemic Heart Disease
Ischemic Heart Disease: Angina and Myocardial Infarction Ischemic heart disease; syndromes causing an imbalance between myocardial oxygen demand and supply (inadequate myocardial blood flow) related to
More informationRisk factors for DVT. Venous thrombosis & pulmonary embolism. Anticoagulation (cont d) Diagnosis 1/5/2018. Ahmed Mahmoud, MD
Risk factors for DVT Venous thrombosis & pulmonary embolism Ahmed Mahmoud, MD Surgery ; post op especially for long cases, pelvic operations (THR), Trauma ; long bone fractures, pelvic fractures (posterior
More informationVenous thrombosis & pulmonary embolism. Ahmed Mahmoud, MD
Venous thrombosis & pulmonary embolism Ahmed Mahmoud, MD Risk factors for DVT Surgery ; post op especially for long cases, pelvic operations (THR), Trauma ; long bone fractures, pelvic fractures (posterior
More informationSimultaneous Acute ST Elevation Myocardial Infarction And Acute Left Subclavian Artery Thrombosis
Simultaneous Acute ST Elevation Myocardial Infarction And Acute Left Subclavian Artery Thrombosis Chee Yang CHIN, MBChB, MRCP(UK) C.W.L. Chin, P.T.L. Chiam, R.S. Tan National Heart Centre Singapore 26
More informationIn which direction, and how aggressively,
Applied Evidence N EW R ESEARCH F INDINGS T HAT A RE C HANGING C LINICAL P RACTICE Evaluating idiopathic venous thromboembolism: What is necessary, what is not Charles F. S. Locke, MD Johns Hopkins Community
More informationComparison of Five Major Recent Endovascular Treatment Trials
Comparison of Five Major Recent Endovascular Treatment Trials Sample size 500 # sites 70 (100 planned) 316 (500 planned) 196 (833 estimated) 206 (690 planned) 16 10 22 39 4 Treatment contrasts Baseline
More informationt. Recommendations for periprocedural anticoagulation are available lhrough the American College of Chest Physicians Clinical Practice Guidelines.
Name or Policy: Policy Number: 3364-133-116 Department: Approving Officer: Responsible Agent: cope: x Management of Anticoagulation with Invasive Procedures Pharmacy Chief Operating Officer Director of
More informationHemostasis. PHYSIOLOGICAL BLOOD CLOTTING IN RESPONSE TO INJURY OR LEAK no disclosures
Hemostasis PHYSIOLOGICAL BLOOD CLOTTING IN RESPONSE TO INJURY OR LEAK no disclosures Disorders of Hemostasis - Hemophilia - von Willebrand Disease HEMOPHILIA A defect in the thrombin propagation phase
More informationManagement of intracranial atherosclerotic stenosis (ICAS)/intracranial atherosclerosis
Management of intracranial atherosclerotic stenosis (ICAS)/intracranial atherosclerosis Tim Mikesell, D.O. Oct 22, 2016 Stroke facts Despite progress in decreasing stroke incidence and mortality, stroke
More informationSindrome da anticorpi antifosfolipidi: clinica e terapia. Vittorio Pengo Clinical Cardiology, Padova, Italy
Sindrome da anticorpi antifosfolipidi: clinica e terapia Vittorio Pengo Clinical Cardiology, Padova, Italy Revised Classification Criteria for the Antiphospholipid Syndrome J Thromb Haemost 2006;4:295-306
More informationSession Chair: Andrew I. Schafer, MD Speakers: Mary Cushman, MD, MSc; Paolo Prandoni, MD, PhD; and Thomas L. Ortel, MD, PhD
Thrombosis II Session Chair: Andrew I. Schafer, MD Speakers: Mary Cushman, MD, MSc; Paolo Prandoni, MD, PhD; and Thomas L. Ortel, MD, PhD Inherited Risk Factors for Venous Thrombosis Mary Cushman Venous
More informationOriginal Policy Date
MP 2.04.71 Genetic Testing for Inherited Thrombophilia Medical Policy Section Medicine Issue 12:2013 Original Policy Date 12:2013 Last Review Status/Date Created with literature search12:2013 Return to
More informationNursing Process Focus: Patients Receiving Heparin
Obtain complete heath history including allergies, drug history and possible drug Assess baseline coagulation studies and CBC. Assess for history of bleeding disorders, GI bleeding, cerebral bleed, recent
More informationVenous Thromboembolism. Prevention
Venous Thromboembolism Prevention August 2010 Venous Thromboembloism Prevention 1 1 Expected Practice Assess all patients upon admission to the ICU for risk factors of venous thromboembolism (VTE) and
More informationHeparin-Induced Thrombocytopenia. Steven Baroletti, PharmD., M.B.A., BCPS Brigham and Women s Hospital
Heparin-Induced Thrombocytopenia Steven Baroletti, PharmD., M.B.A., BCPS Brigham and Women s Hospital Heparin-induced thrombocytopenia (HIT) A serious concern associated with thrombosis development following
More informationAnticoagulants and Head Injuries. Asaad Shujaa,MD,FRCPC,FAAEM Assistant Professor,weill Corneal Medicne Senior Consultant,HMC Qatar
Anticoagulants and Head Injuries Asaad Shujaa,MD,FRCPC,FAAEM Assistant Professor,weill Corneal Medicne Senior Consultant,HMC Qatar Common Anticoagulants and Indications Coumadin (warfarin) indicated for
More informationCase Report Simultaneous Left Ventricular and Deep Vein Thrombi Caused by Protein C Deficiency
Hindawi Case Reports in Medicine Volume 217, Article ID 424959, 4 pages https://doi.org/1.15/217/424959 Case Report Simultaneous Left Ventricular and Deep Vein Thrombi Caused by Protein C Deficiency Harufumi
More information