Cholesterol crystal embolization caused by anticoagulant therapy

Cortez, Arthur Fernandes; Sakuma, Thais Harumi; Lima, Ricardo Barbosa; Figueiredo, Wagner Martignoni de; Valle, Heliomar de Azevedo; Tolstoy, Fernanda Amorim; Coimbra, Daniel Dal’Asta; Lupi, Omar

doi:10.1111/j.1365-4632.2009.04096.x

Cited by 8 publications

(7 citation statements)

References 7 publications

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“…It is estimated that about 30–85% of CCE patients have a history of invasive vascular procedure in the preceding 3 months, while only 4.3% had cholesterol embolism in age-matched controls that did not have invasive vascular procedure [6,7]. CCE is also a rare complication in patients undergoing the administration of anticoagulants (including heparin, low molecular weight heparin, warfarin, dabigatran) and thrombolytic therapy [2,7,8,9,10]. The incidence of CCE induced by these agents may increase rapidly with their widespread use for artrial fibrillation and acute myocardial infarction in recent years.…”

Section: Etiologymentioning

confidence: 99%

Cholesterol Crystal Embolism and Chronic Kidney Disease

Bayliss

Zhuang

2017

IJMS

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Renal disease caused by cholesterol crystal embolism (CCE) occurs when cholesterol crystals become lodged in small renal arteries after small pieces of atheromatous plaques break off from the aorta or renal arteries and shower the downstream vascular bed. CCE is a multisystemic disease but kidneys are particularly vulnerable to atheroembolic disease, which can cause an acute, subacute, or chronic decline in renal function. This life-threatening disease may be underdiagnosed and overlooked as a cause of chronic kidney disease (CKD) among patients with advanced atherosclerosis. CCE can result from vascular surgery, angiography, or administration of anticoagulants. Atheroembolic renal disease has various clinical features that resemble those found in other kidney disorders and systemic diseases. It is commonly misdiagnosed in clinic, but confirmed by characteristic renal biopsy findings. Therapeutic options are limited, and prognosis is considered to be poor. Expanding knowledge of atheroembolic renal disease due to CCE opens perspectives for recognition, diagnosis, and treatment of this cause of progressive renal insufficiency.

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Section: Etiologymentioning

confidence: 99%

Cholesterol Crystal Embolism and Chronic Kidney Disease

Bayliss

Zhuang

2017

IJMS

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“…CES has been reported in association with the use of anticoagulants such as warfarin. 42 However, in contemporary cohorts of patients with aortic plaques, it remains a very rare event. In three studies including more than 1000 patients, 15,43,44 CES occurred in four patients on warfarin and three patients off warfarin.…”

Section: Case Reportmentioning

confidence: 99%

Antithrombotic therapy in aortic diseases: A narrative review

Anand

2017

Vasc Med

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Aortic diseases are a heterogeneous group of disorders, including atherothrombotic conditions like aortic atheroma, cholesterol embolization syndrome, aortic mural thrombus, thrombus within an aneurysm, and large vessel vasculitis. In this review, we provide a summary of the current evidence regarding atherothrombotic diseases of the aorta, focusing on therapeutic avenues. In patients with previous stroke, aortic arch atheroma is recognized as a strong predictor of recurrent atheroembolism, and antiplatelet therapy alone is still associated with a high (11.1%) residual risk of recurrent stroke. In secondary prevention, the use of dual antiplatelet therapy or moderate intensity anticoagulation with warfarin may lower the risk of recurrent stroke at a cost of increased life-threatening bleeding. Thrombi adherent to the aortic wall are generally associated with underlying atherosclerosis or aneurysmal disease. Primary aortic mural thrombus is a rare condition, sometimes related with systemic prothrombotic or inflammatory diseases. Retrospective studies suggest that anticoagulation is beneficial in patients with mobile mural thrombus. The pathogenesis and consequences of thrombus in an aortic aneurysm, or in an endograft following endovascular aneurysm repair, have been studied, but the role of antiplatelet therapy in those two conditions is still unclear and should be driven by general cardiovascular risk prevention. The benefit of anticoagulation to reduce thrombus load is uncertain. Patients with large vessel vasculitis experience increased cardiovascular events secondary to inflammation-driven atherothrombotic processes. Antiplatelet therapy is recommended as part of the therapy for prevention of cardiovascular disease. Anticoagulation with warfarin has shown limited benefit in few retrospective studies.

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“…They may also prevent protective thrombus formation over an ulcerated plaque. [6] Cardio pulmonary resuscitation may also lead onto AERD. Predisposing factors such as coronary angiogram or thrombolytics were present in three of our patients (37.5%).…”

Section: Discussionmentioning

confidence: 99%

Atheroembolic renal disease: A case series

Prema¹,

Kurien²

2019

Indian J Nephrol

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Atheroembolic renal disease (AERD), a part of systemic cholesterol embolization syndrome, is caused by the occlusion of small arteries in the kidneys by cholesterol crystal emboli from ulcerated atherosclerotic plaques. Kidney is commonly involved because of its proximity to the abdominal aorta and its enormous blood supply. AERD is an under diagnosed condition. We report eight cases of AERD, highlighting the variability in its clinical presentation and the importance of a renal biopsy to arrive at a definitive diagnosis.

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Cholesterol crystal embolization caused by anticoagulant therapy

Cited by 8 publications

References 7 publications

Cholesterol Crystal Embolism and Chronic Kidney Disease

Cholesterol Crystal Embolism and Chronic Kidney Disease

Antithrombotic therapy in aortic diseases: A narrative review

Atheroembolic renal disease: A case series

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