TROMBOSIS VENOSA CEREBRAL LECCIONES DEL ISCVT
|
|
- Hollie Randall
- 6 years ago
- Views:
Transcription
1 TROMBOSIS VENOSA CEREBRAL LECCIONES DEL ISCVT José M. Ferro Department of Neurociences Hospital de Santa Maria, CHLN University of Lisbon Lisboa, Portugal
2 TROMBOSIS VENOSA CEREBRAL ISCVT LECCIONES DEL ISCVT Rational and design Main contributions Advances on cerebral venous thrombosis after ISCVT ISCVT 2 Purpose and design
3 WHY CEREBRAL VENOUS THROMBOSIS?
4 CEREBRAL VENOUS THROMBOSIS A SINGLE CENTRE CASE SERIES 8 cases of CVT Retrospective observational study Data retrieved from file review
5 CEREBRAL VENOUS THROMBOSIS status before ISCVT Variable clinical presentation Difficulty in establishing diagnosis Infection and puerperium important causes Unpredictable prognosis High mortality Management uncertainity and variability
6 VENOPORT National multicentre observational study 142 adult patients with CVT admitted to 20 hospitals in Portugal retrospective series patients prospective series 6/95-6/88 91 patients Mean follow up 12 months (3-36) Ferro et al, Cerebrovasc Dis 2001;11: ;13: ;14: ;15:78-83
7 Incidence and prevalence Autopsies: 1-9% Hospital bases series Portugal: 0.22/ /year (IC 95% = 0-47) Population based studies Netherlands: 1.32/ /year Stroke registries India: 6% of 1014 strokes Pregnancy CEREBRAL VENOUS THROMBOSIS: EPIDEMIOLOGY 11.6/ deliveries in USA Infants & children <18 years in Canada 0.64/
8 CEREBRAL VENOUS THROMBOSIS: UNDERDIAGNOSED?
9 ISCVT: PHRASING THE RESEARCH CLINICAL QUESTION In PATIENTS with cerebral vein and dural sinus thrombosis In a multicentre, multinational, observational, cohort study (DESIGN) Managed following each site best practice (INTERVENTION) What is the OUTCOME, defined as death or dependency at least 6 months after onset
10 INTERNATIONAL STUDY ON CEREBRAL VEIN AND DURAL SINUS THROMBOSIS U.S.A 10 Mexico 53 Canada 5 Peru 1 Chile 6 Belgium 23 France 132 United Kingdom 10 Portugal 126 Spain 39 Uruguay 1 Germany 53 Italy 54 Sweden 11 The Netherlands 30 Austria 8 Luxembourg 2 Brazil 48 India 1 Australia adult cases 89 centres, 21 countries mean age=39, female/male=2,9 79% caucasians median follow up 16 months Ferro et al Stroke 2004 China 3
11 A DIFFICULT BALANCE Internal validity How precise are the definitions and procedures? Reliability Same results under the same circunstances External validity Same results under different circunstances
12 ISCVT DESIGN Diagnosis of CVT by MR, angiography (any type), surgery or autopsy Simple and short admission and follow up forms Diagnostic work up and treatment left to the local investigator Follow up at 6 months and year 1,2 and 3 Main outcome - death and disability (mrs)
13 CVT: PRESENTING SYNDROMES Isolated intracranial hypertension syndrome Headache, nausea/vomiting, papilloedema, visual disturbances, diplopia/vi nerve palsy, tinnitus Isolated headache Focal syndrome Focal deficits: mono/hemiparesis, aphasia Seizures Encephalopathy Multifocal signs Mental status changes Decreased alertness, stupor/coma
14 CVT: LESS COMMON PRESENTING SYNDROMES Cavernous sinus syndrome Subarachnoid haemorrhage Generalised, basal Localised, convexity Pulsating tinnitus Cranial nerve palsies VII Collet-Sicard syndrome
15 CVT: PRESENTING SYMPTOMS & SYNDROMES Variable with: Interval onset-presentation Age of the patient Location of vein or sinus occlusion Parenchymal lesions Underlying disease
16 CVT: TYPE OF PRESENTATION Isolated ICH OTHERS % ACUTE SUBACUTE CHRONIC
17 PRESENTING SYMPTOMS in patients aged 65 or more >64 years <65 years Isolated Intracranial hypertension %; -22 to -5 Mental status disorder %; 20 to 43 GCS< %; 5 to 30 Papilloedema %;-23 to -3 Visual loss %;-14 to 0 Headache %;- 40 to -14 % Ferro et al Stroke 2006
18 CVT: PARENCHYMAL LESIONS Hemorrhage "Infarct" No lesion % I IHS Aphasia Paresis GCS<14 Seizure Straight Sinus Deep Veins Ferro et al 2010
19 VENOUS INFARCTS FLAIR DWI ADC
20 VENOUS INFARCT Increased permeability of the BBB Brain edema Thrombus Collateral circulation ADC Anatomy Thrombosis Lesion Venous Infarction Hemorrhage Destruction of the BBB Inflammation Prothrombotic state and endothelial dysfunction Secondary injury potentiated by physiological processes
21 VENOUS INFARCT hypothesis In CVT, disruption of the BBB is followed by an inflammatory response Elevation of markers of BBB disruption, inflammatory markers and prothrombotic markers is associated with a higher degree of secondary lesion Progression of the parenchymal lesions and functional prognosis is associated with the levels of MMP-9, IL-6 and sp-sel over time Aguiar de Sousa D PhD thesis
22 Methods Admission Worsening 0 48h 1S 1M 3M CVT Only in patients with parenchymal lesion
23
24 INTEROBSERVER AGREEMENT ON THE LOCALISATION OF CVT High interobserver agreement for the majority of dural sinus and cerebral veins (K > 0,80) Higher diagnostic agreement for the thrombosis of the right jugular vein and lateral sinus than for their left counterparts Low agreement for the diagnosis of cortical vein thrombosis Higher agreement when there are parenchymal lesions located near the occluded veins or sinus Ferro et al Eur J Neurol 2007
25 Idbaih A et al Stroke 2006 MRI: T2*SW SEQUENCES T2*SW cortical vein thrombosis
26 TVC: D-DIMERS Are DD < 500 ng/ml a good screening test for CVT? Meta-analysis of 14 studies with 1134 patients Sensitivity 93.9%; specificity 89.7% Risk factors for false negative D-Dimers Isolated headache Limited extent of CVT Longer duration of symptoms Ongoing M Arnold s (Berne) study D-dimers; FXIII-AP Dentali et al, 2012
27 THE CAUSES OF CVT Associated conditions Condition found in association with CVT Risk factors Condition that increases the risk of CVT Cause Causality requests are fulfilled Necessary Sufficient Contributory
28 CVT ASSOCIATED CONDITIONS 13% no associated condition 44% > 1 associated condition 41% - genetic prothrombotic mutation Nº associated conditions
29 IATROGENIC CVT: ISCVT (11%) Ferro and Canhão, 2013
30 Gouveia and Canhão, 2010; Marjot et al Stroke 2011; Lauw et al, 2014 CVT & THROMBOPHILIA Significant associations OR Prothrombin G20210A 6.1 Factor V Leiden 2.9 Antihtrombin deficiency 3.8 Protein S deficiency 6.5 Protein C deficiency 8.4 High homocystein 3.0
31 Gouveia and Canhão, 2010; Marjot et al Stroke 2011; Lauw et al, 2014 CVT & THROMBOPHILIA Not associated MTHFR polymorphisms PAI-1 polymorphisms Protein Z/G79A Not estimable/uncertain JK-2/V617 (more frequent in MPS with CVT) Factor VIII
32 RISK FACTORS world regions * 50 % * * * * * 0 Contraceptives Only contraceptives Pregnancy Genetic Prothrombotic Haematologic Iatrogenic * p < 0.05
33 CVT: ASSOCIATED CONDITIONS IN A PAKINSTAN-MIDDLE EAST COHORT Prothrombotic state Malignancy 4 7 Infections Pregnancy/puerperium Oral contraceptives PAK-M.EAST ISCVT % Khealani et al Stroke 2008
34 CONTRACEPTIVES (54%) Estrogens OR 5.59 CVT IR/100000/y IRR Levonorgestrel Norgestimate Desogestrel Contraceptive patch Dentali et al, 2006; Jick and Jick, 2006
35 OTHER GENDER SPECIFIC CAUSES Vaginal rings Case reports Emergency (day after) contraception Case report In-vitro fertilization Case report Hormonal replacement therapy
36 CVT ASSOCIATED CONDITIONS Permanent Hereditary thrombophilia Chronic conditions associated with a prothrombotic state (e.g. APS, malignancy) Transient Oral contraceptives Pregnancy/puerperium Infections Both permanent and transient None (cryptogenic CVT)
37 CVT? MR with T2*SW sequences MR-Venography Search the cause... Meningitis? Isolated intracranial hypertension Contraceptives Pregnancy / Puerperium ENT, face & neck infections Systemic inflammatory diseases Malignancy Haematological diseases Other rare causes Prothrombotic screening Lupus anticoagulant Anticardiolipin antibodies Antiβ2 glycoprotein antibd Antithrombin Protein C and S Factor V Leiden Prothrombin G20210 A Homocystein Lumbar puncture
38 CRYPTOGENIC CVT? 13% in ISCVT, 88% with complete prothrombotic screening CVT preciding a systemic disease Anti-phospholip syndrome Essential thrombocythemia and policythemia Inflammatory diseases (IBD, B D) Malignancy
39 OUTCOME AT FINAL FOLLOW UP 624 patients, median follow up: 16 months 79 % 57, ,5 8,3 0,6 1,6 2,9 7,5 death/dependency Compete recovery Rankin 6 Rankin 5 Rankin 4 Rankin 3 Rankin 2 Rankin 1 Rankin 0 Direct f up: 57% Ferro et al Stroke 2004
40 DECLINING MORTALITY IN CVT Coutinho et al, Stroke,2014
41 LAST FOLLOW UP DEATH/DEPENDENCY (n=32) PROGNOSTIC FACTOR HR 95%CI CNS infection Any malignancy Deep venous system thrombosis Haemorrhage on CT/MR GCS score < Mental status disorder Age > Male gender Accuracy: 85% area under the ROC curve 0.79
42 Ferro et al Cerebrovasc Dis 2009 Sensitivity CVT PROGNOSIS External validation Validation sample: VENOPORT and 5 ISCVT centres 1,0 0,8 0,6 ROC Curve Accuracy: 84 and 86% 0,2 Area under the ROC 0,0 curve: 0.69 and ,0 0,2 0,4 0,6 0,8 1,0 1 - Specificity 0,4 Diagonal segments are produced by ties.
43 CVT: RECOVERY IN THE ELDERLY Elderly patients mrs 0-1 mrs 3-6 Young-middle aged mrs 0-1 mrs disch 6 month last f up disch 6 month last f up Ferro et al Stroke 2006
44 CVT:PROGNOSIS IN WOMEN mrs GSRF GSRF+ GSRF No GSRF Coutinho et al Stroke 2009
45 CVT: PROGNOSIS IN PATIENTS WITH PARENCHYMAL LESIONS mrs 0-2 mrs 3-6 acute death % hemorrhage "infarct" no lesion Ferro et al Cerebrovas Dis 2010
46 ISOLATED HEADACHE: PROGNOSIS 100 CVT patients with isolated headache 52 diagnosed 7 days from onset (early diagnosis) 48 diagnosed > 7 days from onset (delayed diagnosis) Clinical worsening Early diagnosis: 23% Delayed diagnosis: 8% Decreased alerteness, focal defect, seizure, < visual acuity Long-term outcome 89% complete recovery, similar in the 2 groups Gameiro et al, 2012
47 TREATMENTS IN ISCVT Large sample size, wide spectrum of severity, manifestations and risk factors Case series of infrequent treatments (IV thrombolysis, shunting) Treatments choiced by treating MD Variability between centres and countries Non randomised treatment comparisons, adjusted by prognostic factors (steroids, acetazolamide, heparins, AEDs)
48 CVT: COMPLICATIONS OF HEPARIN TREATMENT Low risk of intracranial haemorrhage (8%) Low risk of systemic haemorrage (1.8%) Such haemorrages do not influence outcome Safe to use in patients with intracranial haemorrhages, either intracerebral or subarachnoid
49 IV or LMW Heparin? % France Portugal Italy Mexico Germany Brasil Spain Netherlands Belgium IV Hep LMWH No
50 ISCVT* IV UFH or LMW Heparin? LMW Heparin (28%) vs IV heparin 302 (72%) In favour of LMWH (after adjusting for prognostic factors) More patients independent at 6 months OR 2.4 (95% CI 1.0 to 5.7) Less new intracerebral hemorrhages OR 0.29 (95% CI 0.07 to 1.3) No difference in complete recovery and mortality RCT in India 32 IV heparin vs 34 LMWH Death 6 vs 0, Complete recovery 20 vs 30 LMWH seems preferable over IV UF heparin Coutinho et al (ISCVT) Stroke 2010; Misra et al 2012
51 TREATMENT UNCERTAINTY ACO 12 M ACO 6 M ACO 3 M AED LESION AED LMWH HEPARIN YES % Coutinho J et al, Cerebrovasc 2011
52 ISCVT 2 from observational to experimental studies Safety of anticoagulation in the acute phase Prospective study of decompressive surgery Optimal duration of AC after CVT Effectiveness of AEDs to prevent early and remote seizures after CVT Safety and management of pregnancy after CVT
53 SAFETY OF ANTICOAGULATION IN ACUTE CVT Recent publications raising concerns on the safety of AC in the acute phase Multicentre study with retrospective retrieval of information Centres with CVT registries Follow up cerebral imaging Intracerebral haemorrhage, symptomatic or not Systemic haemorrhage, serious
54 DECOMPRESSIVE SURGERY DECOMPRESS 2: objectives To describe in a prospective registry the vital and functional outcome of CVT patients treated by decompressive surgery To identify subgroups of CVT patients who benefit most from this surgery To describe the psychosocial outcomes after decompressive surgery in acute CVT 18 pt included 9/62 centers To perform an updated systematic review
55 PREVENTION OF RECURRENT VENOUS THROMBOEMBOLISM Risk of recurrence of venous thrombotic events CVT: 2-12% per 100 person-years Other VT: 7-15% per 100 person-years Risk factors for recurrence of venous thrombotic events in adults Male gender Policythemia/thrombocythemia Severe thrombophilia (DVT and PE) Previous VTE EFNS and AHA/ASA Guidelines 3 months (transient risk factors) to lifetime, depending on thrombophilia grading International survey 3 months -13% 6 months 64% 12 months 20% Miranda et al Stroke 2010; Martinelli et al Circulation 2010; Coutinho et al, 2011; Dentali et al 2012
56 PREVENTION OF RECURRENT VENOUS THROMBOEMBOLISM CVT related to a transient risk factor 3 or 3-6 months CVT idiopathic or related to mild thrombophilia 6-12 CVT related to combined, severe thrombophilia or recurrent CVT permanent EFNS guideline (Eur J Neurol 2010) Good practice point AHA/ASA guideline (Stroke 2011) Class IIb, level of evidence C
57 EXCOA-CVT clustered randomised trial To compare the efficacy and safety of a short (3 months to 6 months) and longterm (12 months) oral anticoagulation (any type) policy for the prevention of venous thromboembolic events (VTEs) after 1 st CVT Follow up: 24 months Multicentre, multinational Cluster allocation design
58 EX-COA TRIAL clustered randomised trial AC POLICY ANY ANTICOAGULANT Policy preference 3-6 or 12 months Uncertain? Randomised 3-6 or 12 months
59 Inclusion criteria Patients aged > 18 years with acute symptomatic and confirmed CVT CVT diagnosis <1 month before randomisation Patient must be clinically stable and able to stop parenteral anticoagulation in order to initiate oral anticoagulation Written informed consent
60 Exclusion criteria Systemic life-threatening or major bleeding while on anticoagulants during the acute phase of CVT or during the 6 months prior to randomisation General contraindications for anticoagulant therapy Life expectancy < 2 years due to a pre-existing condition (including any malignancy) Child bearing potential without proper contraceptive measures, pregnancy or breast feeding Other conditions judged by the investigator to be an absolute indication for prolonged oral anticoagulation such as antiphospholipid syndrome, known severe thrombophilia (antithrombin, protein C or protein S deficiency, homozygous factor V Leiden or prothrombin G20210A mutation or combined abnormalities)
61 SAFETY OUTCOMES: BLEEDINGS, ALL DEATHS EX-COA TRIAL clustered randomised trial AC POLICY 3-6 MONTHS 12 MONTHS EXCLUSIONS 12 MONTHS TREATMENT 24 MONTHS FOLLOW UP PRIMARY EFFICACY OUTCOME FATAL OR NONFATAL VTE
62 EXCOA-CVT sample size 50% decrease in the risk of recurrent CVT, deep venous thrombosis or pulmonary embolism from a basal risk of 10% to 5% α error of 0.05, 80% power Estimated cluster size (median ISCVT) 7 patients Estimated intracluster correlation coefficient clusters per intervention group (198 centers) 3% dropout rate patients
63 Estimated sample size 1428 patients 198 centers
64 EXCOA-CVT relevant clinical questions What is the most effective and safe duration of AC treatment after CVT? Is it safe to stop AC, one year after CVT? Does AC really prevents TVE in high-risk (excluded) patients? Are NOACs safe and effective after CVT?* Prevention of seizures Outcome of pregnancies *Geisbüsch C et al, 2014
65 PREGNANCY AFTER CVT? 10 studies Case series, only 2 prospective 5 venous thrombotic events/181 pregnancies 2.76% ( ) 2 CVT recurrences/207 pregnancies 0.97% ( ) Low absolute (but uncertain) risks
66 PREGNANCY AFTER CVT ISCVT pregnancy study 10 y follow up of 314 (currently 111) women in fertile age included in ISCVT Outcome of pregnancies (currently 64) Antithrombotic management 51% ISCVT investigators response rate Database to be closed 1st trimester 2015 Results to be presented at EAN Congress Berlin June 2015
67
68 ISCVT A TEAM WORK MG Bousser, J Stam, F Barinagarrementeria Patrícia Canhão Marisa Costa All the ISCVT investigators The patients FCT (Fundação para a Ciência e Tecnologia) Competitive grant
69 ISCVT 2 threats & opportunities Funding (IMM) Low cost study electronic CRF and data transmission EXCOA-CVT cluster design no experimental drug distribution Participating centres Benefits from participation, payment for patient inclusion and follow up, competitive studies Ethics and local administrations
Venous thrombosis in unusual sites
Venous thrombosis in unusual sites Walter Ageno Department of Medicine and Surgery University of Insubria Varese Italy Disclosures Employment Research support Scientific advisory board Consultancy Speakers
More informationCerebral Vein and Dural Sinus Thrombosis in Elderly Patients
Cerebral Vein and Dural Sinus Thrombosis in Elderly Patients José M. Ferro, MD, PhD; Patrícia Canhão, MD; Marie-Germaine Bousser, MD; Jan Stam, MD; Fernando Barinagarrementeria, MD; for the ISCVT Investigators
More informationSinus Venous Thrombosis
Sinus Venous Thrombosis Joseph J Gemmete, MD FACR, FSIR, FAHA Professor Departments of Radiology and Neurosurgery University of Michigan Hospitals Ann Arbor, MI Outline Introduction Medical Treatment Options
More informationVenous Thrombotic Recurrence After Cerebral Venous Thrombosis. A Long-Term Follow-Up Study
Venous Thrombotic Recurrence After Cerebral Venous Thrombosis A Long-Term Follow-Up Study Paola Palazzo, MD, PhD*; Pierre Agius, MD*; Pierre Ingrand, MD; Jonathan Ciron, MD; Matthias Lamy, MD; Aline Berthomet,
More informationEarly Seizures in Cerebral Vein and Dural Sinus Thrombosis Risk Factors and Role of Antiepileptics
Early Seizures in Cerebral Vein and Dural Sinus Thrombosis Risk Factors and Role of Antiepileptics José M. Ferro, MD, PhD; Patrícia Canhão, MD; Marie-Germaine Bousser, MD; Jan Stam, MD; Fernando Barinagarrementeria,
More informationCerebral Venous-Sinus Thrombosis: Risk Factors, Clinical Report, and Outcome. A Prospective Study in the North East of Iran
Caspian Journal of Neurological Sciences http://cjns.gums.ac.ir Cerebral Venous-Sinus Thrombosis: Risk Factors, Clinical Report, and Outcome. A Prospective Study in the North East of Iran Farzadfard Mohammad-Taghi
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 informationCerebral Venous Thrombosis (CVT): Long-Term Vocational Outcome Study. Degree project thesis in Medicine. Erik Lindgren
Cerebral Venous Thrombosis (CVT): Long-Term Vocational Outcome Study Degree project thesis in Medicine Erik Lindgren Turgut Tatlisumak Katarina Jood Department of Neurology, Sahlgrenska University Hospital,
More informationEtiology, clinical profile in cortical venous thrombosis
International Journal of Advances in Medicine Pazare AR et al. Int J Adv Med. 2018 Oct;5(5):xxx-xxx http://www.ijmedicine.com pissn 2349-3925 eissn 2349-3933 Original Research Article DOI: http://dx.doi.org/10.18203/2349-3933.ijam20183365
More informationCerebral venous and sinus thrombosis (CVST) is a relatively
Cerebral Venous and Sinus Thrombosis in Women Jonathan M. Coutinho, MD, MSc; José M. Ferro, MD, PhD; Patrícia Canhão, MD; Fernando Barinagarrementeria, MD; Carlos Cantú, MD; Marie-Germaine Bousser, MD;
More informationYoung Females and Cerebral Venous Thrombosis
Article ID: WMC004294 ISSN 2046-1690 Young Females and Cerebral Venous Thrombosis Corresponding Author: Dr. Ilirjana Zekja, Neurologist, Service of Neurology- University Hospital Center 'Mother Theresa',
More informationCerebral venous thrombosis associated with extracranial tumours: a clinical series
Progress in Neuroscience Vol.1, N. 1-4, 2013 Original article Cerebral venous thrombosis associated with extracranial tumours: a clinical series S. IURLARO, A. SILVANI*, M. MAURI**, G. TRUCI***, S. BERETTA****,
More informationAyman Mahmoud Alboudi MD, MSc Rashid Hospital, Dubai, UAE
Systemic Varicella Zoster Infection Causing Cerebral Venous Thrombosis and Revealing Prothrombotic State Ayman Mahmoud Alboudi MD, MSc Rashid Hospital, Dubai, UAE CVT is a rare disorder with incidence
More informationAHA/ASA Scientific Statement
AHA/ASA Scientific Statement Diagnosis and Management of Cerebral Venous Thrombosis A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association The American
More informationRole of MRI in Evaluation of Cerebral Venous Thrombosis
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 17, Issue 6 Ver. 11 (June. 2018), PP 06-12 www.iosrjournals.org Role of MRI in Evaluation of Cerebral
More informationUnusual Deep Vein Thromboses. Dr. Karl von Kemp Centrum voor Hart- en Vaatziekten UZ Brussel
Unusual Deep Vein Thromboses Dr. Karl von Kemp Centrum voor Hart- en Vaatziekten UZ Brussel Unusual Deep Vein Thromboses Upper extremity deep vein thrombosis Spontaneous Catheter-associated Cerebral venous
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 informationCase Report Delay in Diagnosis of Cerebral Venous and Sinus Thrombosis: Successful Use of Mechanical Thrombectomy and Thrombolysis
Case Reports in Medicine Volume 2011, Article ID 815618, 4 pages doi:10.1155/2011/815618 Case Report Delay in Diagnosis of Cerebral Venous and Sinus Thrombosis: Successful Use of Mechanical Thrombectomy
More informationCerebral venous and dural sinus thrombosis
214 PRACTICAL NEUROLOGY Cerebral venous and dural sinus thrombosis José M. Ferro and Patrícia Canhão Stroke Unit, Department of Neurology, Hospital de Santa Maria, 1649 035 Lisbon, Portugal; E-mail: jmferro@iscvt.com
More informationThrombophilia. 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 informationCase Presentation: A 20-year-old
CLINICIAN UPDATE Cerebral Venous Thrombosis Gregory Piazza, MD, MS Case Presentation: A 20-year-old woman presented with 24 hours of severe left-sided headache associated with nausea, photophobia, and
More informationReview of Patients with Cerebral Venous Sinus Thrombosis (CVST) in a Premier Neuroscience Institute in Nepal
Review of Patients with Cerebral Venous Sinus Thrombosis (CVST) in a Premier Neuroscience Institute in Nepal Abhishek Chaturbedi* 2, Rajeev Shah 2, Rajan Koju 4, Late Upendra P Devkota 1 1Department of
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 informationSaudi Journal of Medicine (SJM)
Saudi Journal of Medicine (SJM) Scholars Middle East Publishers Dubai, United Arab Emirates Website: http://scholarsmepub.com/ ISSN 2518-3389 (Print) ISSN 2518-3397 (Online) Clinical Profile and Radiological
More informationStarting or Resuming Anticoagulation or Antiplatelet Therapy after ICH: A Neurology Perspective
Starting or Resuming Anticoagulation or Antiplatelet Therapy after ICH: A Neurology Perspective Cathy Sila MD George M Humphrey II Professor and Vice Chair of Neurology Director, Comprehensive Stroke Center
More informationThe Importance of Early Recognition of Cerebral Venous Sinus Thrombosis: A Case Report
Case Report PROVISIONAL PDF The Importance of Early Recognition of Cerebral Venous Sinus Thrombosis: A Case Report Kian Guan Goh 1, Viswanathan Shanthi 2 Submitted: 8 Sep 2014 Accepted: 2 Dec 2014 1 Faculty
More informationGuidance for the management of venous thrombosis in unusual sites
J Thromb Thrombolysis (2016) 41:129 143 DOI 10.1007/s19-015-1308-1 Guidance for the management of venous thrombosis in unusual sites Walter Ageno 1 Jan Beyer-Westendorf 2 David A. Garcia 3 Alejandro Lazo-Langner
More informationEvaluation and managment of CVT (Continuum).pdf
University of Toronto From the SelectedWorks of Gustavo Saposnik 2015 Evaluation and managment of CVT (Continuum).pdf Gustavo Saposnik Available at: http://works.bepress.com/gustavo_saposnik/73/ Review
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 informationand a homozygous mutation on the methylenetetrahydrofolate reductase gene, with hyperhomocysteinaemia,
CASE REPORT Port J Nephrol Hypert 2008; 22(1): 49-53 Homozygous C677T mutation of the 5,10-methylenetetrahydrofolate reductase gene with hyperhomocysteinaemia associated with lupus anticoagulant in a chronic
More informationEuropean Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis endorsed by the European Academy of Neurology
GUIDELINES European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis endorsed by the European Academy of Neurology J. M. Ferro a,b, M.-G. Bousser c, P. Canh~ao
More informationIntrasinus Thrombolysis by Mechanical and Urokinase for Severe Cerebral Venous Sinus Thrombosis : A Case Report
122 Intrasinus Thrombolysis by Mechanical and Urokinase for Severe Cerebral Venous Sinus Thrombosis : A Case Report Wen-Sou Lin 1, Hung-Wen Kao 2, Chun-Jen Hsueh 2, Chun-An Cheng 3 Abstract- Purpose: Cerebral
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 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 informationCerebral Sinus Thrombosis with Intracerebral Hemorrhage in Pregnancy: A Case Report
189 Cerebral Sinus Thrombosis with Intracerebral Hemorrhage in Pregnancy: A Case Report Hung-Shih Lin 1, Jui-Feng Lin 1, Cheng-Kuei Chang 1,2, Cheng-Chia Tsai 1, and Shiu-Jau Chen 1 Abstract- A 29-year-old
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 informationCerebral Venous Sinus Thrombosis: Update on Diagnosis and Management
Curr Cardiol Rep (2014) 16:523 DOI 10.1007/s11886-014-0523-2 STROKE (AB SINGHAL, SECTION EDITOR) Cerebral Venous Sinus Thrombosis: Update on Diagnosis and Management José M. Ferro & Patrícia Canhão Published
More informationCover Page. The handle holds various files of this Leiden University dissertation.
Cover Page The handle http://hdl.handle.net/188/20915 holds various files of this Leiden University dissertation. Author: Flinterman, Linda Elisabeth Title: Risk factors for a first and recurrent venous
More informationCOMMITTEE FOR PROPRIETARY MEDICINAL PRODUCTS (CPMP)
The European Agency for the Evaluation of Medicinal Products Evaluation of Medicines for Human Use London, 16 December 1999 COMMITTEE FOR PROPRIETARY MEDICINAL PRODUCTS (CPMP) NOTE FOR GUIDANCE ON CLINICAL
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 informationAneesh T., Hemamalini Gururaj*, Arpitha J. S., Anusha Rao, Vaishnavi Chakravarthy, Abhiman Shetty
International Journal of Research in Medical Sciences Aneesh T et al. Int J Res Med Sci. 2017 Jul;5(7):3023-3028 www.msjonline.org pissn 2320-6071 eissn 2320-6012 Original Research Article DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20172981
More informationPulmonary Embolism. Pulmonary Embolism. Pulmonary Embolism. PE - Clinical
Pulmonary embolus - a practical approach to investigation and treatment Sam Janes Wellcome Senior Fellow and Respiratory Physician, University College London Background Diagnosis Treatment Common: 50 cases
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 informationCEREBRO VASCULAR ACCIDENTS
CEREBRO VASCULAR S MICHAEL OPONG-KUSI, DO MBA MORTON CLINIC, TULSA, OK, USA 8/9/2012 1 Cerebrovascular Accident Third Leading cause of deaths (USA) 750,000 strokes in USA per year. 150,000 deaths in USA
More informationCover Page. The handle holds various files of this Leiden University dissertation
Cover Page The handle http://hdl.handle.net/1887/40114 holds various files of this Leiden University dissertation Author: Exter, Paul L. den Title: Diagnosis, management and prognosis of symptomatic and
More informationClinical Policy Title: Genetic testing for G1691A polymorphism factor V Leiden
Clinical Policy Title: Genetic testing for G1691A polymorphism factor V Leiden Clinical Policy Number: 05.01.03 Effective Date: January 1, 2016 Initial Review Date: July 15, 2015 Most Recent Review Date:
More informationGenetic Tests for the Better Outcome of VTE? 서울대학교병원혈액종양내과윤성수
Genetic Tests for the Better Outcome of VTE? 서울대학교병원혈액종양내과윤성수 Thrombophilia A hereditary or acquired disorder predisposing to thrombosis Questions Why should we test? Who should we test For what disorders?
More informationMalignant isolated cortical vein thrombosis with type II protein S deficiency: a case report
Arai et al. BMC Neurology (2016) 16:69 DOI 10.1186/s12883-016-0597-0 CASE REPORT Open Access Malignant isolated cortical vein thrombosis with type II protein S deficiency: a case report Nobuhiko Arai *,
More informationCerebral vein thrombosis
Intern Emerg Med (2010) 5:27 32 DOI 10.1007/s11739-009-0329-1 IM - REVIEW Cerebral vein thrombosis Francesco Dentali Walter Ageno Received: 24 March 2009 / Accepted: 3 October 2009 / Published online:
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 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 informationFrequency and temporal profile of recanalization after cerebral vein and sinus thrombosis
ORIGINAL ARTICLE Frequency and temporal profile of recanalization after cerebral vein and sinus thrombosis C. Herweh a, M. Griebe b, C. Geisb usch c, K. Szabo b, E. Neumaier-Probst d, M. G. Hennerici b,
More informationStudy of predisposing factors responsible for CVST in Indian population
Original article: Study of predisposing factors responsible for CVST in Indian population 1 Dr Jagadish B Wable, 2 Dr Piyush Ostwal, 3 Dr Govind S. Shiddapur, 4 Dr Satish Nirhale 1 Resident, Department
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 informationLong-term outcome after cerebral venous thrombosis. Hiltunen, Sini
https://helda.helsinki.fi Long-term outcome after cerebral venous thrombosis Hiltunen, Sini 2016-03 Hiltunen, S, Putaala, J, Haapaniemi, E & Tatlisumak, T 2016, ' Long-term outcome after cerebral venous
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 informationAssociation of Hypertension and Cerebral Venous Thrombosis among the Women in the Puerperal Period A Prospective Study
Original article: Association of Hypertension and Cerebral Venous Thrombosis among the Women in the Puerperal Period A Prospective Study 1Dr T Ravikumar, 2 Dr J A vasanthakumar, 3 Dr K Govindarajan, 4
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 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 informationCerebral venous thrombosis: An experience with anticoagulation with low molecular weight heparin
Original Article Cerebral venous thrombosis: An experience with anticoagulation with low molecular weight heparin Lalitha V. Pillai, Dhananjay P. Ambike, Satish Nirhale, S. M. K. Husainy, Satish Pataskar
More informationMenopausal Hormone Therapy & Haemostasis
Menopausal Hormone Therapy & Haemostasis The Haematologist Perspective Dr. Batia Roth-Yelinek Coagulation unit Hadassah MC Menopausal Hormone Therapy & Hemostasis Hemostatic mechanism Mechanism of estrogen
More informationModern Management of ICH
Modern Management of ICH Bradley A. Gross, MD Assistant Professor, Dept of Neurosurgery, University of Pittsburgh October 2018 ICH Background Assessment & Diagnosis Medical Management Surgical Management
More informationVENOUS THROMBOEMBOLISM: DURATION OF TREATMENT
VENOUS THROMBOEMBOLISM: DURATION OF TREATMENT OBJECTIVE: To provide guidance on the recommended duration of anticoagulant therapy for venous thromboembolism (VTE). BACKGROUND: Recurrent episodes of VTE
More informationIschemic Stroke in Critically Ill Patients with Malignancy
Ischemic Stroke in Critically Ill Patients with Malignancy Jeong-Am Ryu 1, Oh Young Bang 2, Daesang Lee 1, Jinkyeong Park 1, Jeong Hoon Yang 1, Gee Young Suh 1, Joongbum Cho 1, Chi Ryang Chung 1, Chi-Min
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 informationSubarachnoid Hemorrhage as a Complication of Cerebral Venous Thrombosis
Mitali Madhusmita et al CASE REPORT 10.5005/jp-journals-10036-1183 Subarachnoid Hemorrhage as a Complication of Cerebral Venous Thrombosis 1 Mitali Madhusmita, 2 Archana Bhate, 3 Anannya Mukherji ABSTRACT
More informationDefinition พ.ญ.ส ธ ดา เย นจ นทร. Epidemiology. Definition 5/25/2016. Seizures after stroke Can we predict? Poststroke seizure
Seizures after stroke Can we predict? พ.ญ.ส ธ ดา เย นจ นทร PMK Epilepsy Annual Meeting 2016 Definition Poststroke seizure : single or multiple convulsive episode(s) after stroke and thought to be related
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 informationCerebral Vein Thrombosis: Screening of Acquired and Hereditary Thrombophilic Risk Factors
ORIGINAL REPORT Cerebral Vein Thrombosis: Screening of Acquired and Hereditary Thrombophilic Risk Factors Payam Sarraf 1, Majid Ghaffarpoor *1, Hosein Poormahmoodian 1, Hosein Harrirchian 1, and Hasan
More informationARTEMIS. ARixtra (fondaparinux) for ThromboEmbolism prevention in. a Medical Indications Study. NV Organon Protocol 63129
ARTEMIS ARixtra (fondaparinux) for ThromboEmbolism prevention in NV Organon Protocol 63129 a Medical Indications Study Objective To demonstrate efficacy and to assess safety of oncedaily subcutaneous (SC)
More informationICSS Safety Results NOT for PUBLICATION. June 2009 ICSS ICSS ICSS ICSS. International Carotid Stenting Study: Main Inclusion Criteria
Safety Results NOT for The following slides were presented to the Investigators Meeting on 22/05/09 and most of them were also presented at the European Stroke Conference on 27/05/09 They are NOT for in
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 informationSWISS SOCIETY OF NEONATOLOGY. Neonatal cerebral infarction
SWISS SOCIETY OF NEONATOLOGY Neonatal cerebral infarction May 2002 2 Mann C, Neonatal and Pediatric Intensive Care Unit, Landeskrankenhaus und Akademisches Lehrkrankenhaus Feldkirch, Austria Swiss Society
More informationthrombosis Auth o r s: Roya B e hrouzi A a nd M a r tin Punte r B ABSTRACT Introduction Clinical features of CVT Key points
Clinical Medicine 2018 Vol 18, No 1: 75 9 CME ACUTE MEDICINE Diagnosis and manage me nt of ce re bral ve nou s thrombosis Auth o r s: Roya B e hrouzi A a nd M a r tin Punte r B ABSTRACT Cerebral venous
More informationDural sinus thrombosis identified by point-of-care ultrasound
https://doi.org/10.15441/ceem.17.237 Dural sinus thrombosis identified by point-of-care ultrasound Laura T. Director, David C. Mackenzie Department of Emergency Medicine, Maine Medical Center, Portland,
More informationIsolated Lateral Sinus Thrombosis A Series of 62 Patients. Mariem Damak, MD; Isabelle Crassard, MD; Valérie Wolff, MD; Marie-Germaine Bousser, MD
Isolated Lateral Sinus Thrombosis A Series of 62 Patients Mariem Damak, MD; Isabelle Crassard, MD; Valérie Wolff, MD; Marie-Germaine Bousser, MD Background and Purpose Isolated lateral sinus thrombosis
More informationControversies in Hemorrhagic Stroke Management. Sarah L. Livesay, DNP, RN, ACNP-BC, ACNS-BC Associate Professor Rush University
Controversies in Hemorrhagic Stroke Management Sarah L. Livesay, DNP, RN, ACNP-BC, ACNS-BC Associate Professor Rush University Disclosures AHA/ASA Outline Blood pressure VTE Coagulopathy Early mobilization
More informationUNIVERSITA DI PADOVA. Un tema particolare (II): Le trombosi venose in pediatria
UNIVERSITA DI PADOVA Un tema particolare (II): Le trombosi venose in pediatria Elena Campello Dipartimento di Medicina Università di Padova Bologna, 6 Novembre 2015 Introduction Pediatric thrombosis: -
More informationClinical Characteristics of Cerebral Venous Thrombosis in a Single Center in Korea
online ML Comm www.jkns.or.kr http://dx.doi.org/10.3340/jkns.2014.56.4.289 J Korean Neurosurg Soc 56 (4) : 289-294, 2014 Print ISSN 2005-3711 On-line ISSN 1598-7876 Copyright 2014 The Korean Neurosurgical
More informationCHAPTER 2 VENOUS THROMBOEMBOLISM
CHAPTER 2 VENOUS THROMBOEMBOLISM Objectives Venous Thromboembolism (VTE) Prevalence Patho-physiology Risk Factors Diagnosis Pulmonary Embolism (PE) Management of DVT/PE Prevention VTE Patho-physiology
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 informationElevation of Blood Plasminogen Activator Inhibitor Level in Patients With Cerebral Venous Thrombosis
Original Article J Neurol Res. 2018;8(1-2):4-9 Elevation of Blood Plasminogen Activator Inhibitor Level in Patients With Cerebral Venous Thrombosis Suzan Bindal a, Ozlem Coskun b, Bulent Alioglu c, Levent
More informationCT and MR findings of systemic lupus erythematosus involving the brain: Differential diagnosis based on lesion distribution
CT and MR findings of systemic lupus erythematosus involving the brain: Differential diagnosis based on lesion distribution Poster No.: C-2723 Congress: ECR 2010 Type: Educational Exhibit Topic: Neuro
More informationCEREBRAL VENOUS THROMBOSIS AFTER A CESAREAN DELIVERY
CASE REPORT CEREBRAL VENOUS THROMBOSIS AFTER A CESAREAN DELIVERY Edvard Ehler 1, Aleš Kopal 1, Milan Mrklovský 2, Milan Košťál 3 Pardubice Regional Hospital, Pardubice, Czech Republic: Department of Neurology
More informationChallenges in Anticoagulation and Thromboembolism
Challenges in Anticoagulation and Thromboembolism Ethan Cumbler M.D. Assistant Professor of Medicine Hospitalist Medicine Section University of Colorado Denver May 2010 No Conflicts of Interest Objectives
More informationDVT - initial management NSCCG
Background information Information resources for patients and carers Updates to this care map Synonyms Below knee DVT and bleeding risks Patient with confirmed DVT Scan confirms superficial thrombophlebitis
More informationInferior Venacaval Filters Valuable vs. Dangerous Valuable Annie Kulungowski. Department of Surgery Grand Rounds March 24, 2008
Inferior Venacaval Filters Valuable vs. Dangerous Valuable Annie Kulungowski Department of Surgery Grand Rounds March 24, 2008 History of Vena Cava Filters Virchow-1846-Proposes PE originate from veins
More informationAntithrombotic therapy in patients with transient ischemic attack / stroke (acute phase <48h)
Antithrombotic therapy in patients with transient ischemic attack / stroke (acute phase
More informationThrombophilia. Stephan Moll, MD Medicine, Heme-Coag UNC Chapel Hill, NC. GASCO Atlanta Sept 8 th, Disclosures. Conflicts of interest: NONE
LA APLA 1 3 ACA Anti-ß2-GP I 2 45 Thrombophilia Stephan Moll, MD Medicine, Heme-Coag UNC Chapel Hill, NC GASCO Atlanta Sept 8 th, 2017 Disclosures Conflicts of interest: NONE Off-label product use discussion:
More informationClinical Policy Title: Genetic testing for G1691A polymorphism factor V Leiden
Clinical Policy Title: Genetic testing for G1691A polymorphism factor V Leiden Clinical Policy Number: 05.01.03 Effective Date: January 1, 2016 Initial Review Date: July 15, 2015 Most Recent Review Date:
More informationDave Duddleston, MD VP and Medical Director Southern Farm Bureau Life
Dave Duddleston, MD VP and Medical Director Southern Farm Bureau Life Sources of Risk for Venous Diseases Pulmonary embolism (thrombus) Bleeding from anticoagulation Mortality from underlying disease Chronic
More informationTechnology appraisal guidance Published: 17 December 2014 nice.org.uk/guidance/ta327
Dabigatran an etexilate for the treatment and secondary prevention ention of deep vein thrombosis and/or pulmonary embolism Technology appraisal guidance Published: 17 December 2014 nice.org.uk/guidance/ta327
More informationΜακροχρόνια παρακολούθηση ασθενών με πνευμονική εμβολή
Μακροχρόνια παρακολούθηση ασθενών με πνευμονική εμβολή Ευφροσύνη Δ. Μάναλη Λέκτορας Β Πανεπιστημιακή Πνευμονολογική Κλινική ΓΝΑ «Αττικόν» Εθνικό και Καποδιστριακό Πανεπιστήμιο Αθηνών Existing guidelines
More informationHandbook for Venous Thromboembolism
Handbook for Venous Thromboembolism Gregory Piazza Benjamin Hohlfelder Samuel Z. Goldhaber Handbook for Venous Thromboembolism Gregory Piazza Cardiovascular Division Harvard Medical School Brigham and
More information41 year old female with headache. Elena G. Violari MD and Leo Wolansky MD
41 year old female with headache Elena G. Violari MD and Leo Wolansky MD ? Dural Venous Sinus Thrombosis with Hemorrhagic Venous Infarct Acute intraparenchymal hematoma measuring ~3 cm in diameter centered
More informationShould infants with perinatal thrombosis be screened for thrombophilia and treated by anticoagulants?
Should infants with perinatal thrombosis be screened for thrombophilia and treated by anticoagulants? Shoshana Revel-Vilk, MD MSc Pediatric Hematology Center, Pediatric Hematology/Oncology Department,
More informationSAS Journal of Medicine ISSN SAS J. Med., Volume-3; Issue-7 (Jul, 2017); p Available online at
SAS Journal of Medicine ISSN 2454-5112 SAS J. Med., Volume-3; Issue-7 (Jul, 2017); p-140-146 Available online at http://sassociety.com/sasjm/ Original Research Article Clinical Profile of Cerebral Venous
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 information