Cerebral and Splanchnic Vein Thrombosis: Advances, Challenges, and Unanswered Questions

Riva, Nicoletta; Ageno, Walter

doi:10.3390/jcm9030743

Cited by 23 publications

(29 citation statements)

References 106 publications

(213 reference statements)

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“…Less frequently, thrombosis affects other veins including upper extremity veins, cerebral venous sinuses, and mesenteric, renal, and hepatic veins. Venous thromboembolism at uncommon sites is discussed in another article of this VTE compendium [4]. For this review, the term DVT will refer to deep-vein thrombosis involving the veins of the lower extremities, including the inferior vena cava.…”

Section: Introductionmentioning

confidence: 99%

Prevention of Venous Thromboembolism in 2020 and Beyond

Nicholson

Chan

Bhagirath

et al. 2020

JCM

120

109

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Venous thromboembolism (VTE) is the third most common cause of vascular mortality worldwide and comprises deep-vein thrombosis (DVT) and pulmonary embolism (PE). In this review, we discuss how an understanding of VTE epidemiology and the results of thromboprophylaxis trials have shaped the current approach to VTE prevention. We will discuss modern thromboprophylaxis as it pertains to genetic risk factors, exogenous hormonal therapies, pregnancy, surgery, medical hospitalization, cancer, and what is known thus far about VTE in COVID-19 infection.

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Section: Introductionmentioning

confidence: 99%

Prevention of Venous Thromboembolism in 2020 and Beyond

Nicholson

Chan

Bhagirath

et al. 2020

JCM

120

109

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“…Critically, a mortality rate of up to 40% has been reported for patients with splanchnic thrombi compared with matched controls. 16 In particular, hematological malignancies such as chronic myeloproliferative neoplasms are strongly associated with splanchnic vein thrombosis. 17 This is underpinned by the high prevalence of the JAK2 V617F mutation in patients with splanchnic thrombus ($52%) compared with other VTE sites.…”

Section: Thrombosis In Cancermentioning

confidence: 99%

Advances in the Management of Cancer-Associated Thrombosis

Dhami

Patmore

O’Sullivan

2021

Semin Thromb Hemost

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The association between cancer and venous thromboembolism (VTE) has been established for more than 150 years. Nevertheless, cancer-associated thrombosis still remains a major clinical challenge and is associated with significant morbidity and mortality for patients with cancer. The clinical presentation of cancer-associated thrombosis can be distinct from that of a patient without an underlying malignancy. Moreover, specific cancer types, including pancreatic cancer and hematological malignancies, as well as advanced stage disease can confer a significant thrombotic risk. This risk is further augmented by specific anticancer treatment modalities. The pathophysiology of cancer-associated thrombosis is complex and multifactorial. However, understanding the biological mechanisms underpinning VTE risk may provide insight into novel targeted prophylaxis in cancer patients. Over the last decade, low-molecular-weight heparin has been the preferred anticoagulant agent for patients with cancer-associated thrombosis due to improved efficacy compared with vitamin K antagonists. However, the advent of direct oral anticoagulants (DOACs) has added to the repertoire of ammunition now at the disposal of clinicians to aid in the management of cancer-associated thrombosis. Several randomized controlled trials have now been published, demonstrating DOAC as a noninferior alternative for both the treatment and prevention of cancer-associated thrombosis. Notwithstanding this, limitations for their widespread use remain, with the potential for increased bleeding risk, drug interactions, and poor DOAC metabolism. This review discusses the evidence base for the incidence and risk factors associated with VTE in cancer, development, and refinement of risk prediction models and novel advances in the therapeutic management of cancer-associated thrombosis.

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“… 90 , 91 , 92 , 93 These treatments may be considered in patients presenting poor response to pharmacological treatment at centres with experience in their use. 56 , 57 , 94 …”

Section: Treatment For Cerebral Venous Sinus Thrombosis In Vaccinated Individualsmentioning

confidence: 99%

Diagnostic and treatment recommendations from the FACME ad-hoc expert working group on the management of cerebral venous sinus thrombosis associated with COVID-19 vaccination

2021

Neurología (English Edition)

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Introduction Cases of cerebral venous sinus thrombosis have been reported in individuals vaccinated against COVID-19 with non-replicating adenoviral vector vaccines. We issue our recommendations on the diagnosis and management of patients presenting this complication. Methods The multidisciplinary working group, led by the Spanish Federation of Medical and Scientific Associations (FACME) and including representatives of several scientific societies, reviewed the available evidence from the literature and reports of the European Medicines Agency. We establish a definition for suspected cases and issue diagnostic and treatment recommendations regarding vaccine-induced immune thrombotic thrombocytopaenia. Results We define suspected cases as those cases of cerebral venous sinus thrombosis occurring between 3 and 21 days after the administration of non-replicating adenoviral vector vaccines, in patients with a platelet count below 150 000/μL or presenting a decrease of 50% with respect to the previous value. Findings suggestive of vaccine-induced immune thrombotic thrombocytopaenia include the presence of antibodies to platelet factor 4, D-dimer levels 4 times greater than the upper limit of normal, and unexplained thrombosis. The recommended treatment includes intravenous administration of non-specific human immunoglobulin or alternatively plasmapheresis, avoiding the use of heparin, instead employing argatroban, bivalirudin, fondaparinux, rivaroxaban, or apixaban for anticoagulation, and avoiding platelet transfusion. Conclusions Non-replicating adenoviral vector vaccines may be associated with cerebral venous sinus thrombosis with thrombocytopaenia; it is important to treat the dysimmune phenomenon and the cerebral venous sinus thrombosis.

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Cerebral and Splanchnic Vein Thrombosis: Advances, Challenges, and Unanswered Questions

Cited by 23 publications

References 106 publications

Prevention of Venous Thromboembolism in 2020 and Beyond

Prevention of Venous Thromboembolism in 2020 and Beyond

Advances in the Management of Cancer-Associated Thrombosis

Diagnostic and treatment recommendations from the FACME ad-hoc expert working group on the management of cerebral venous sinus thrombosis associated with COVID-19 vaccination

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