State of the art paper Thrombosis associated with acute cytomegalovirus infection: a narrative review

Abstract

Thrombosis associated with acute cytomegalovirus infection has been reported many times in the literature since the mid 1980s – mainly in case reports and in small case series, but also in four controlled studies. Still, many physicians are unaware of this association although acute cytomegalovirus infection diagnosis in a thrombosis patient may warrant antiviral therapy and may affect anticoagulation therapy duration. Accordingly, the clinical characteristics of patients with thrombosis and acute cytomegalovirus infection are reviewed, and the current knowledge concerning this unique association is presented herein. We believe it is time to add acute cytomegalovirus infection to the list of thrombosis triggers.

Cytomegalovirus-Associated Splanchnic Vein Thrombosis in Immunocompetent Patients: Two Case Reports and Literature Review

“…Based on data reported in the literature, it has been suggested to include CMV infection among VTE risk factors/triggers. 4,15,18,19 However, unlike immunosuppressed patients, in whom infection is often the only condition associated with thrombosis, inherited thrombophilia and acquired risk factors for thrombosis often coexist in immunocompetent patients with SVT. 6,18 In a review of case reports and case series on CMVassociated thrombosis in immunocompetent adults, 18 39 patients were described (mean age: 34.9 AE 10.8 years).…”

“…The CMV-IgM seropositivity was independently associated with VTE in multivariable logistic regression analysis (OR: 2.49; 95% CI: 1.53-4.06; p < 0.0001), but it was not associated with arterial thrombosis. 14 Clinical characteristics of CMV-related thrombosis have been reviewed by Sherman et al, 15 who described 78 reports concerning 113 patients. The mean age of patients was 41 AE 14.6 with a female-to-male ratio of 1:1.…”

“…The female-tomale ratio was reanalyzed separately in controlled studies, including consecutive patients, and was 1.6. 15 Recently, Yildiz et al identified 10 patients with synchronous acute CMV infection among 1,007 consecutive patients with VTE. Patients with coexistent VTE and acute CMV infection were younger (37.5 vs. 56.6 years; p ¼ 0.0088) and exhibited a female predominance (90 vs. 56%; p ¼ 0.026) in comparison to the whole cohort.…”

“…17 As regards CMV antiviral therapy, in the recent review by Sherman et al, 15 30.1% of the total population of patients studied were treated with antiviral agents (ganciclovir or valganciclovir) and 73.5% of these had viremia diagnosed by CMV-DNA PCR (deoxyribonucleic acid polymerase chain reaction) or antigen assays. 15 In the meta-analysis by Justo et al, only 17.2% of immunocompetent patients received antiviral agents compared with 51.5% in the immunocompromised group.…”

“…17 As regards CMV antiviral therapy, in the recent review by Sherman et al, 15 30.1% of the total population of patients studied were treated with antiviral agents (ganciclovir or valganciclovir) and 73.5% of these had viremia diagnosed by CMV-DNA PCR (deoxyribonucleic acid polymerase chain reaction) or antigen assays. 15 In the meta-analysis by Justo et al, only 17.2% of immunocompetent patients received antiviral agents compared with 51.5% in the immunocompromised group. 6 In the previously cited literature review, 17 regarding 49 papers with a total of 69 patients with VTE complicating CMV primary infection, only 11 patients (all cases with severe thromboembolic events) received antiviral therapy (ganciclovir and/or valganciclovir).…”