MyMedR

Fulltext Cerebral Venous Thrombosis following COVID-19 Vaccination

Kow CS, Hasan SS

J Stroke Cerebrovasc Dis, 2021 Oct;30(10):105866.

PMID: 34045111 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105866

Matched MeSH terms: Venous Thrombosis*; Intracranial Thrombosis*

Fulltext Superior masenteric vein thrombosis

Ho CK, Khoo ST, Saw MH

Med J Malaysia, 2002 Jun;57(2):229-32.

PMID: 24326659

A 43 year-old woman presented with severe non-specific abdominal pain of 1-week duration. She was on oral contraceptive pills for the past 6 years. Clinically patient appeared ill with no specific abnormal physical sign. Moderate amount of free fluid in the peritoneal cavity on ultrasound prompted an urgent abdominal computed tomography (CT) scan, which revealed thrombosis of the superior mesenteric vein. Further investigations revealed a hypercoagulable state with protein C deficiency. Patient responded well to anticoagulation and supportive therapy. One month later patient readmitted with vomiting and signs of intestinal obstruction. Barium study revealed a moderately long tight stricture at mid jejunum with proximal dilation. A by-pass surgery was carried out. She was well at 3 months follow-up.

Matched MeSH terms: Thrombosis; Venous Thrombosis*

Fulltext Mechanical Thrombectomy for Life-Threatening Cerebral Venous Thrombosis: A Case Report

Lau KF, Toh TH, Kadir KAA, Tai MS, Tan KS

Case Rep Neurol, 2020 12 14;12(Suppl 1):63-69.

PMID: 33505274 DOI: 10.1159/000507343

Cerebral venous thrombosis (CVT) is a rare cause of stroke worldwide with a wide range of clinical presentations. Anticoagulation therapy has been regarded as the first line of management of CVT to prevent the progression of thrombosis and to re-establish the venous flow. We present a case of severe CVT who did not respond to conventional anticoagulation therapy but responded well to mechanical thrombectomy (MT). This report highlights the features of CVT to consider for early MT.

Matched MeSH terms: Thrombosis; Venous Thrombosis; Intracranial Thrombosis

Fulltext Numerical investigation of the effect of cannula placement on thrombosis

Ong C, Dokos S, Chan B, Lim E, Al Abed A, Bin Abu Osman NA, et al.

Theor Biol Med Model, 2013;10:35.

PMID: 23680359 DOI: 10.1186/1742-4682-10-35

Despite the rapid advancement of left ventricular assist devices (LVADs), adverse events leading to deaths have been frequently reported in patients implanted with LVADs, including bleeding, infection, thromboembolism, neurological dysfunction and hemolysis. Cannulation forms an important component with regards to thrombus formation in assisted patients by varying the intraventricular flow distribution in the left ventricle (LV). To investigate the correlation between LVAD cannula placement and potential for thrombus formation, detailed analysis of the intraventricular flow field was carried out in the present study using a two way fluid structure interaction (FSI), axisymmetric model of a passive LV incorporating an inflow cannula. Three different cannula placements were simulated, with device insertion near the LV apex, penetrating one-fourth and mid-way into the LV long axis. The risk of thrombus formation is assessed by analyzing the intraventricular vorticity distribution and its associated vortex intensity, amount of stagnation flow in the ventricle as well as the level of wall shear stress. Our results show that the one-fourth placement of the cannula into the LV achieves the best performance in reducing the risk of thrombus formation. Compared to cannula placement near the apex, higher vortex intensity is achieved at the one-fourth placement, thus increasing wash out of platelets at the ventricular wall. One-fourth LV penetration produced negligible stagnation flow region near the apical wall region, helping to reduce platelet deposition on the surface of the cannula and the ventricular wall.

Matched MeSH terms: Thrombosis/physiopathology*

Fulltext Anticoagulant approach in COVID-19 patients with cerebral venous thrombosis

Kow CS, Zaihan AF, Hasan SS

J Stroke Cerebrovasc Dis, 2020 12;29(12):105222.

PMID: 32891494 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105222

Matched MeSH terms: Venous Thrombosis*

A review of patients with deep vein thrombosis diagnosed at University Hospital, Kuala Lumpur

Liam CK, Ng SC

Ann Acad Med Singap, 1990 Nov;19(6):837-40.

PMID: 2130750

In this retrospective study, 81 patients were diagnosed to have deep vein thrombosis (DVT) at the University Hospital, Kuala Lumpur over a ten year period from 1977 to 1986. Fifty-six patients had their DVT confirmed by venograms. The left side was affected in 79.5% of venographically proven cases of DVT of the lower limbs above the popliteal vein. The incidence of clinically apparent DVT following surgery was 0.21 per 1,000 operations. The incidence of pregnancy-related DVT was 0.039%. DVT was 3 times more frequent in the puerperium than in the antenatal period. The overall incidence of symptomatic pulmonary embolism was 13.6% of the cases of DVT.

Matched MeSH terms: Thrombosis/etiology*; Thrombosis/epidemiology

Fulltext Coeliac artery thrombosis: an uncommon cause of an acute abdomen

Saravana K, Zainal AA, Lee SK

Med J Malaysia, 2011 Aug;66(3):273-5.

PMID: 22111460 MyJurnal

Coeliac artery thrombosis with ischaemia is a rare condition, which usually presents with severe peptic ulcer disease symptoms. It is usually associated with risk factors for thrombosis or embolism. The manifestation is rare because of large number of collaterals between the coeliac and superior mesentery artery. Early detection and intervention is required to prevent the progression of its complications that includes gastric ischaemic necrosis.

Matched MeSH terms: Thrombosis/complications*; Thrombosis/diagnosis*; Thrombosis/therapy

Clinical update on deep vein thrombosis in Singapore

Lee LH

Ann Acad Med Singap, 2002 Mar;31(2):248-52.

PMID: 11957569

Venous thromboembolism (VTE) is thought to be a rare occurrence in Asian patients. The clinical features of VTE are elusive and the disease often unsuspected. Objective testing such as the duplex ultrasound scans and pulmonary imaging are necessary as clinical diagnosis alone is inaccurate. Fatality can occur in untreated patients not suspected of the disease as shown by our post-mortem studies. Indeed VTE is one of the leading causes of maternal mortality in Singapore. There is a rising trend in the incidence of VTE in Asia. Initial studies found an incidence of about 3 per 10,000 hospital admissions in Hong Kong and Malaysia in 1988 and 1990, respectively; rising to 8 and 15.8 per 10,000 hospital admissions in Singapore 1992 and 2000, respectively. The major risk factors for developing deep vein thrombosis (DVT) in our patients are immobilisation, surgery and malignancy. While Factor V Leiden mutation and mutation at position 20,210 in the prothrombin gene are found to be extremely rare in Chinese, the rest of the thrombophilia has not been formally studied. Studies in Singapore reported rates of 3% to 7% of DVT after general surgery, 9.7% after hip surgery and 14% after total knee replacement surgery. It is difficult to compare with studies from other centres because of differences in patient selection and diagnostic criteria. Studies in Singapore showed that the use of prophylactic low molecular weight heparin completely abolished the occurrence of DVT for patients undergoing total knee replacement and colorectal surgery without an increase in bleeding complications. In conclusion, VTE is not an uncommon problem here. Major acquired risk factors do not differ from the Caucasian populations. VTE is a preventable disease and a better understanding of its epidemiology, patient-risk factors and biological factors will allow better management of this condition.

Matched MeSH terms: Venous Thrombosis/diagnosis; Venous Thrombosis/etiology; Venous Thrombosis/epidemiology*

Fulltext Cerebral venous thrombosis as an initial manifestation of acute myeloid leukemia

Tang ASO, Yeo ST, Law WC, Chew LP

Oxf Med Case Reports, 2019 Jan;2019(1):omy118.

PMID: 30697435 DOI: 10.1093/omcr/omy118

Cancer-associated thromboembolism is not an uncommon complication in patients with malignancies. No study has reported the occurrence of thromboembolism prior to the diagnosis of acute myeloid leukemia (AML). Most reports are anectodal and data are scarce on this subject. In this report, we present a case of extensive cerebral venous thrombosis (CVT) that was detected a few weeks before the diagnosis of AML, in which case the patient responded well to chemotherapy and anticoagulation.

Matched MeSH terms: Venous Thrombosis; Intracranial Thrombosis

A probable case of vaccine-induced immune thrombotic thrombocytopenia secondary to Pfizer Comirnaty COVID-19 vaccine

Goh Cy C, Teng Keat C, Su Kien C, Ai Sim G

J R Coll Physicians Edinb, 2022 Jun;52(2):113-116.

PMID: 36146992 DOI: 10.1177/14782715221103660

The accelerated development of various vaccines against COVID-19 was a global effort to curb the COVID-19 pandemic. As a result, several unique vaccine-related adverse events were observed. Vaccine-induced immune thrombotic thrombocytopenia (VITT) has been recognised as a clinically distinct entity with a predisposition for thrombosis at unusual sites with laboratory features of consumptive coagulopathy in addition to anti-PF4 assay seropositivity. The majority of cases reported were associated with adenoviral-based vectors such as ChAdOx1 nCoV-19 (Oxford-AstraZeneca) and Janssen Ad26.COV2.S (Johnson & Johnson). In our online search, we have not found any reports to date of VITT associated with Pfizer-BioNTech Comirnaty mRNA vaccine. We report a case of a previously healthy 76-year-old man who received his first-dose Pfizer Comirnaty vaccine on 11 October 2021 who developed left upper limb swelling on day 2 post-vaccination, which progressively worsened on day 4 post-vaccination. He was confirmed to have left axillary vein thrombosis on computer tomography arteriography/computed tomography venography of left upper limb on day 5 post-vaccination with new onset aphasia with unilateral limb weakness on day 8 post-vaccination. Magnetic resonance imaging/magnetic resonance angiography of the brain confirmed acute left middle cerebral artery thrombosis with infarction. Blood investigations showed thrombocytopenia, elevated D-dimer, hypofibrinogenemia in addition to his unusual sites of thrombosis involving both arterial and venous circulation. His IgG ELISA assay for anti-PF4 antibody was positive.

Matched MeSH terms: Thrombosis*

Fulltext Atrial septal defect with Crochetage sign presenting with pulmonary artery thrombosis

Kaisbain N, Lim WJ, Kim HS

BMJ Case Rep, 2021 Jul 27;14(7).

PMID: 34315750 DOI: 10.1136/bcr-2021-244180

Atrial septal defect (ASD) is the most common congenital heart disease observed in adult. Several ECG findings are considered sensitive for the diagnosis of ASD. We describe a 50 years old man who displayed Crochetage sign, incomplete right bundle branch block (IRBBB) and right ventricular strain pattern on ECG. Crochetage sign is highly specific for ASD and it correlates with shunt severity. The diagnostic specificity for ASD increases if the R waves have both Crochetage patterns and IRBBB. It is important not to confuse Crochetage signs with IRBBB abnormalities on ECG. Our patient was ultimately diagnosed with a large ASD measuring 3 cm with bidirectional shunt and concomitant pulmonary thrombosis. This illustrates that high suspicion of the ASD with the use of good-old ECG signs remains relevant in this modern era. This also reminds us that patients with Eisenmenger syndrome are at higher risk for pulmonary thrombosis.

Matched MeSH terms: Venous Thrombosis*

Fulltext Renal vein thrombosis and the nephrotic syndrome

Segasothy M, Kamal A, Pang KS

Med J Malaysia, 1983 Jun;38(2):114-7.

PMID: 6621439

A 31 year old Chinese man developed the nephrotic syndrome, and wasfound to have some of the clinical features of renal vein thrombosis such as a rapid deterioration in renal function and great variability in proteinuria. Radiological studies confirmed the diagnosis of bilateral renal vein thrombosis. The clinical features and pathogenesis of renal vein thrombosis are discussed.

Matched MeSH terms: Thrombosis/complications*; Thrombosis/diagnosis

Cerebral venous thrombosis associated with antithrombin III deficiency

Lee MK, Ng SC

Aust N Z J Med, 1991 Oct;21(5):772-3.

PMID: 1759929

Matched MeSH terms: Intracranial Embolism and Thrombosis/blood*; Intracranial Embolism and Thrombosis/etiology

Therapeutic Suppression of Nonsense Mutation: An Emerging Target in Multiple Diseases and Thrombotic Disorders

Asiful Islam M, Alam F, Kamal MA, Gan SH, Wong KK, Sasongko TH

Curr Pharm Des, 2017;23(11):1598-1609.

PMID: 27875971 DOI: 10.2174/1381612823666161122142950

Nonsense mutations contribute to approximately 10-30% of the total human inherited diseases via disruption of protein translation. If any of the three termination codons (UGA, UAG and UAA) emerges prematurely [known as premature termination codon (PTC)] before the natural canonical stop codon, truncated nonfunctional proteins or proteins with deleterious loss or gain-of-function activities are synthesized, followed by the development of nonsense mutation-mediated diseases. In the past decade, PTC-associated diseases captured much attention in biomedical research, especially as molecular therapeutic targets via nonsense suppression (i.e. translational readthrough) regimens. In this review, we highlighted different treatment strategies of PTC targeting readthrough therapeutics including the use of aminoglycosides, ataluren (formerly known as PTC124), suppressor tRNAs, nonsense-mediated mRNA decay, pseudouridylation and CRISPR/Cas9 system to treat PTC-mediated diseases. In addition, as thrombotic disorders are a group of disease with major burdens worldwide, 19 potential genes containing a total of 705 PTCs that cause 21 thrombotic disorders have been listed based on the data reanalysis from the 'GeneCards® - Human Gene Database' and 'Human Gene Mutation Database' (HGMD®). These PTC-containing genes can be potential targets amenable for different readthrough therapeutic strategies in the future.

Matched MeSH terms: Thrombosis/drug therapy*; Thrombosis/genetics*

Tranexamic Acid in Patients Undergoing Noncardiac Surgery

Devereaux PJ, Marcucci M, Painter TW, Conen D, Lomivorotov V, Sessler DI, et al.

N Engl J Med, 2022 May 26;386(21):1986-1997.

PMID: 35363452 DOI: 10.1056/NEJMoa2201171

BACKGROUND: Perioperative bleeding is common in patients undergoing noncardiac surgery. Tranexamic acid is an antifibrinolytic drug that may safely decrease such bleeding.

METHODS: We conducted a trial involving patients undergoing noncardiac surgery. Patients were randomly assigned to receive tranexamic acid (1-g intravenous bolus) or placebo at the start and end of surgery (reported here) and, with the use of a partial factorial design, a hypotension-avoidance or hypertension-avoidance strategy (not reported here). The primary efficacy outcome was life-threatening bleeding, major bleeding, or bleeding into a critical organ (composite bleeding outcome) at 30 days. The primary safety outcome was myocardial injury after noncardiac surgery, nonhemorrhagic stroke, peripheral arterial thrombosis, or symptomatic proximal venous thromboembolism (composite cardiovascular outcome) at 30 days. To establish the noninferiority of tranexamic acid to placebo for the composite cardiovascular outcome, the upper boundary of the one-sided 97.5% confidence interval for the hazard ratio had to be below 1.125, and the one-sided P value had to be less than 0.025.

RESULTS: A total of 9535 patients underwent randomization. A composite bleeding outcome event occurred in 433 of 4757 patients (9.1%) in the tranexamic acid group and in 561 of 4778 patients (11.7%) in the placebo group (hazard ratio, 0.76; 95% confidence interval [CI], 0.67 to 0.87; absolute difference, -2.6 percentage points; 95% CI, -3.8 to -1.4; two-sided P<0.001 for superiority). A composite cardiovascular outcome event occurred in 649 of 4581 patients (14.2%) in the tranexamic acid group and in 639 of 4601 patients (13.9%) in the placebo group (hazard ratio, 1.02; 95% CI, 0.92 to 1.14; upper boundary of the one-sided 97.5% CI, 1.14; absolute difference, 0.3 percentage points; 95% CI, -1.1 to 1.7; one-sided P = 0.04 for noninferiority).

CONCLUSIONS: Among patients undergoing noncardiac surgery, the incidence of the composite bleeding outcome was significantly lower with tranexamic acid than with placebo. Although the between-group difference in the composite cardiovascular outcome was small, the noninferiority of tranexamic acid was not established. (Funded by the Canadian Institutes of Health Research and others; POISE-3 ClinicalTrials.gov number, NCT03505723.).

Matched MeSH terms: Thrombosis/chemically induced; Thrombosis/drug therapy

Neonatal aortic thrombosis: A life threatening complication of umbilical artery catheterisation

Thay WY, Aisha Fadhilah AA, Faizah MJ, Zainudin Z

Med J Malaysia, 2020 03;75(2):173-174.

PMID: 32281603

Umbilical artery catheterisation is considered the standard of care for arterial access in neonatal intensive care unit. It is routinely used for blood sampling and blood pressure monitoring. Unfortunately, an indwelling umbilical catheter have been associated with thrombotic complication which may result in either partial or complete occlusion of the aorta. We report here our experience in the diagnosis and treatment of a neonate with this condition.

Matched MeSH terms: Thrombosis/drug therapy*

Fulltext Imaging findings of an isolated deep cerebral venous thrombosis in the absence of superficial sinus thrombosis

Sabrilhakim Sidek, Kartini Rahmat, Norlisah Ramli

Neurology Asia, 2015;20(2):191-195.

MyJurnal

Thrombosis of the deep cerebral venous system in the absence of superficial sinus thrombosis is a very rare disease. The clinical and radiological findings can be diagnostically challenging due to the subtle appearances on computed tomography (CT) scan. Magnetic resonance imaging (MRI) examination is a preferred imaging modality to complement the CT findings for an accurate diagnosis of venous sinus thrombosis. We present a case of this unusual condition which present as unilateral thalamic lesion on CT scan and the role of contrast enhanced MRI with fast spoiled gradient echo (FSPGR) sequence and 3D reconstruction which led to the diagnosis of thrombosis in the deep cerebral venous system.

Matched MeSH terms: Sinus Thrombosis, Intracranial; Thrombosis

Thrombosis of the renal veins

MUIR CS

Med J Malaya, 1957 Mar;11(3):242-6.

PMID: 13477002

Matched MeSH terms: Thrombosis*

Fulltext Recurrent cavernous sinus thrombosis: a rare complication of Cushing disease

Tong CV, Tee CK

BMJ Case Rep, 2021 Jun 22;14(6).

PMID: 34158336 DOI: 10.1136/bcr-2021-243786

A 14-year-old girl who presented in 2017 with headache, unilateral right eye ptosis and secondary amenorrhoea had an initial workup consistent with non-functioning pituitary macroadenoma. She underwent debulking of pituitary tumour in October 2017. Postoperatively, she developed recurrent cavernous sinus thrombosis. In view of recurrent thrombosis, she was reinvestigated and was found to have adrenocorticotropic hormone-dependent Cushing. Follow-up MRI 1 year after initial presentation showed that there was structural recurrence of pituitary macroadenoma. She subsequently underwent a petrosal craniotomy for debulking of tumour. Postsurgery she remained biochemically Cushingnoid. MRI 5 months after second surgery showed an enlarging pituitary mass which was deemed inoperable. A multidisciplinary meeting discussion consensus for treatment included radiotherapy and somatostatin analogue, pasireotide. She completed 30 cycles of radiotherapy and MRI post radiotherapy showed reduction in the size of the macroadenoma. Currently, she is waiting for pasereotide initiation.

Matched MeSH terms: Cavernous Sinus Thrombosis*

Fulltext Rare cause of lower limb deep venous thrombosis: a case report

Khang NC, Hanif H, Zainal Ariffin A

Med J Malaysia, 2014 Jun;69(3):144-5.

PMID: 25326359 MyJurnal

deep venous thrombosis (dVT) in lower limbs caused by abdominal aortic aneurysm (AAA) is rare. A combination of anatomical obstruction with surrounding inflammatory tissue and reduced blood flow in venous limb were probably the main reasons for the occurrence of the dVT. we report a case of infra-renal AAA presented as lower limb dVT and symptomatic pulmonary embolism.

Matched MeSH terms: Venous Thrombosis

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