Embolie pulmonaire et agénésie de veine cave inférieure : une association inhabituelle

Laethem, S. Van; Peche, Robert; Mercier, Virginie; Moradi, M.; Cauchie, Philippe; Meerhaeghe, Alain Van

doi:10.1016/j.rmr.2019.07.005

Cited by 4 publications

(2 citation statements)

References 9 publications

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“…На сьогоднішній день світовий досвід лікування венозних тромбозів з вродженими аномаліями розвитку НПВ базується на повідомленнях окремих авторів [20,23]. По цій причині відсутні сучасні рекомендації та консенсуси з даного питання.…”

Section: результати обговоренняunclassified

Features of treatment of venous thromboembolism in patients with abnormalities in the development of the vena cava inferior

Khrebtiy¹

2023

Rep. of Vinnytsia Nation. Med. Univ.

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Annotation. In the treatment of venous thromboembolism, a special place is occupied by patients with congenital anomalies of the development of the inferior vena cava (IVC). To date, only single cases of treatment of this pathology have been described in the literature. Studying the experience of treating patients with congenital anomalies of the IVC will allow to improve the results of treatment of this category of patients. We analyzed the results of treatment of 1243 patients with venous thromboembolism from 2010 to 2022. For the diagnosis of venous thromboembolism, we used duplex scanning of the veins of the lower extremities, phlebography by spiral computed tomography (SCT), angiopulmonography, and phlebography. 32 (2.5%) patients had bilateral thrombosis of the ileofemoral venous segment. Congenital anomalies of IVC development were diagnosed in 2 (0.16%) patients. One patient had IVC aplasia, the other had IVC hypoplasia. Both patients had bilateral ileofemoral phlebothrombosis. For the treatment of patients with congenital anomalies of IVC and bilateral ileofemoral deep vein thrombosis, we used anticoagulant therapy and elastic compression of the lower extremities. During the study period, venous thromboembolic complications in the form of pulmonary embolism were not recorded, fatal complications were not diagnosed. Massive bleeding was not diagnosed in this category of patients during the study period. Thus, the conducted analysis allows us to state that the use of anticoagulant therapy allows to obtain satisfactory results of treatment of patients with congenital abnormalities of the development of the IVC.

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Section: результати обговоренняunclassified

Features of treatment of venous thromboembolism in patients with abnormalities in the development of the vena cava inferior

Khrebtiy¹

2023

Rep. of Vinnytsia Nation. Med. Univ.

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“…На сьогодні світовий досвід лікування венозних тромбозів з вродженими аномаліями розвитку нижньої порожнистої вени базується на повідомленнях окремих авторів [21,22]. Через це відсутні сучасні ре-комендації та консенсуси з цього питання.…”

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Treatment of Bilateral Venous Thrombosis in a Patient with Aplasia of the Inferior Vena Cava

Khrebtiy

Tsyhalko²,

Melnychuk³

2022

ujcvs

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The aim. In the treatment of venous thromboembolism, a special place is occupied by patients with congenital anomalies of the development of the inferior vena cava (IVC). To date, only single cases of treatment of this pathology have been described in the literature. Studying the experience of treating patients with congenital anomalies of the IVC will allow to improve the results of treatment of this category of patients. Materials and methods. Patient B., a 36-year-old man, applied to the vascular surgery clinic of the Vinnytsia Regional Pyrohov Clinical Hospital in July 2010 with complaints of pain, swelling, cyanosis of both lower extremities, which bothered the patient for about 10 days. The patient had no history of venous insufficiency of both lower extremities. An objective examination revealed cyanosis and swelling of both lower extremities. A duplex scan of both lower extremities revealed hyperechoic iliofemoral thrombosis of both lower extremities. Aplasia of the IVC was diagnosed. The common iliac veins on both sides formed a collateral that flowed into the left renal vein. The infrarenal segment of the inferior vena cava was absent. Thrombosis spread from tibial to popliteal, femoral, iliac veins with venous collateral thrombosis up to the level of the left renal vein. The patient received enoxaparin at a dose of 1 mg per kg of body weight twice a day for 7 days with subsequent transition to warfarin under the control of international normalized ratio. Warfarin was prescribed from a starting dose of 5 mg with subsequent control of international normalized ratio in the range of 2.0-3.0. Venotonic and anti-inflammatory drugs were also prescribed. In combination with drug therapy, class 2 elastic compression stockings were recommended. After the treatment, the patient’s condition improved, swelling and cyanosis of both lower extremities regressed. Repeated duplex scanning at the discharge of the patient from the hospital after 7 days showed signs of initial recanalization of the affected venous segments and no progression of thrombosis. Conclusions. Thus, this clinical case showed that the use of anticoagulant therapy allows to obtain satisfactory results in the treatment of patients with congenital anomalies of the development of IVC, to avoid the development of pulmonary embolism and other life-threatening conditions. At the same time, such patients need regular follow-up examinations in order to adjust the treatment and prevent the development of IVC syndrome.

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Direct oral anticoagulants after bariatric surgery—What is the evidence?

Leong

Chu

Crowther

et al. 2022

Journal of Thrombosis and Haemostasis

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Background Obesity is a global epidemic and bariatric surgery is used with increasing frequency to treat its complications. The extent to which bariatric surgery alters the efficacy, safety, and pharmacokinetics of direct oral anticoagulants (DOACs) is unknown. Aims In this review, we summarize the evidence supporting the use of DOACs after bariatric surgery and apply our findings to resolve several clinical cases. Materials & Methods We systematically searched MEDLINE, EMBASE, Cochrane Library, CINAHL and http://clinicaltrials.gov from January 1, 2000, to June 15, 2021 for randomized and non‐randomized studies evaluating the use of DOACs for any indication after bariatric surgery. Two reviewers independently screened titles, abstracts, and full‐text articles. Clinical and pharmacokinetic outcomes were pooled by random‐effects meta‐analysis with inverse variance weighting. We used the Newcastle‐Ottawa scale to assess risk of bias in non‐randomized studies and assessed the certainty of evidence with GRADE. Results From 2519 records, we included 28 studies (n = 3229 patients): no randomized trials, 7 cohort studies, 6 case series, and 15 case reports. Incidence rates for arterial thromboembolism, venous thromboembolism and major bleeding were: 0.73 (95% confidence interval [CI]: 0.01–5.10), 2.45 (95% CI: 0.40–7.94), and 3.40 (95% CI: 0.80‐9.36) events per 100 patient‐years, respectively. The pooled proportion of peak direct oral anticoagulant drug levels within the expected range was 58% (95% CI: 39%–74%). Conclusion There appears be substantial risk of DOAC malabsorption after bariatric surgery that could affect clinical outcomes, however the certainty of evidence was very low. PROSPERO: CRD42020202636.

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Embolie pulmonaire et agénésie de veine cave inférieure : une association inhabituelle

Cited by 4 publications

References 9 publications

Features of treatment of venous thromboembolism in patients with abnormalities in the development of the vena cava inferior

Features of treatment of venous thromboembolism in patients with abnormalities in the development of the vena cava inferior

Treatment of Bilateral Venous Thrombosis in a Patient with Aplasia of the Inferior Vena Cava

Direct oral anticoagulants after bariatric surgery—What is the evidence?

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