Background: Bilateral adrenal hemorrhage (BAH) is a rare condition that may lead to life-threatening adrenal insufficiency or adrenal crisis if not addressed appropriately. Case Report: A 54-year-old male with a histo...Background: Bilateral adrenal hemorrhage (BAH) is a rare condition that may lead to life-threatening adrenal insufficiency or adrenal crisis if not addressed appropriately. Case Report: A 54-year-old male with a history of venous thromboembolism (VTE) on warfarin presented to the hospital with nausea, vomiting, and abdominal and flank pain shortly following colonoscopy preparation. Initial imaging of the abdomen and pelvis was notable for hyperdense thickening of the bilateral adrenal glands raising concerns for hemorrhages, and subsequent magnetic resonance imaging (MRI) confirmed BAH. During hospitalization, the patient was placed on prophylactic heparin, and shortly after decompensating, he became tachycardic, hypotensive, and febrile. This led to heparin reversal followed by administration of a single dose of Hydrocortisone 100 mg and Hydrocortisone 50 mg TID due to concern for adrenal insufficiency. The patient also necessitated sepsis work-up and fluid resuscitation. Repeat CT imaging showed no significant change in hemorrhage size bilaterally. Endocrinology, vascular surgery, hematology/oncology, and rheumatology were consulted for the management of adrenal insufficiency, anticoagulation in the presence of hemorrhage, thrombocytopenia, and hypercoagulable state. Towards the end of his hospital course, the patient had asymptomatic diffuse ST elevations, elevated troponin, and an ejection fraction of 10% - 15%, leading to cardiac catheterization and placement of an intra-aortic pump. During subsequent stay in the ICU, the patient developed hemodynamic shock and was transferred to a facility with a higher level of care and medical support therapies. After this transfer, the patient was stabilized from a cardiac standpoint but developed acute respiratory failure suspected to be secondary to diffuse alveolar hemorrhage and immune thrombocytopenic purpura, necessitating platelet transfusion. He was on continued monitoring from rheumatology given his myocarditis believed to be secondary to his antiphospholipid antibodies, and was treated with IVIG, rituximab, and hydroxychloroquine. A repeat echocardiogram revealed an improved ejection fraction of 52% and the patient was then discharged on an enoxaparin bridge to warfarin and a cardiac home event monitor. Discussion: BAH is a life-threatening condition that should be promptly identified and managed in patients presenting with nonspecific symptoms and a history of hypercoagulability or anticoagulation. In these cases, the risk of AH and subsequent adrenal insufficiency is drastically increased, so immediate imaging as well as initiation of steroid therapy is crucial to stabilize patients and prevent adrenal crisis. A multidisciplinary approach, involving endocrinology, hematology, and cardiology as in this case is also imperative to optimize patient outcomes and increase survival. Conclusion: BAH should be considered in patients presenting with a history of VTE and hypercoagulable state when precipitating stressors or predisposing risk factors are present. This case report highlights the importance of clinical awareness of BAH for clinicians to accurately identify and manage it to prevent fatal sequelae and ensure long-term favorable patient outcomes.展开更多
Objective To establish and evaluate a hypercoagulable animal model for the assessment of anticoagulants. Methods Forty mice, thirty-two rats, and twenty-four rabbits were randomly and equally divided into control grou...Objective To establish and evaluate a hypercoagulable animal model for the assessment of anticoagulants. Methods Forty mice, thirty-two rats, and twenty-four rabbits were randomly and equally divided into control group (saline) and three ellagic acid (EA)-treated groups (low, middle, and high doses). In the mice, bleeding time (BT) was estimated with tail transaction, and clotting time (CT) with template method. Prothrombin time (PT) and the activated partial thromboplastin time (APTT) in rats and rabbits were measured by means of Quick's one-stage assay and modified APTT assay respectively. In addition, thrombin activity was estimated in rats with PT assay using a hemagglutination analyzer. The circulating platelet aggregates were de- tected in rabbits through platelet counting and presented as the circulating platelet aggregate ratio (CPAR). Results EA shortened BT and CT in mice, PT and APTT in rats, and increased thrombin activity and CPAR, all in a dose-dependent manner. EA also brought reduction of PT and APTT in rabbits in dose- and time-dependent manners. Conclusion EA could induce hypercoagulable state through activating coagulation system and platelets in mice, rats, and rabbits.展开更多
AIM To examine the role of soluble fibrin monomer complex(SFMC) in the prediction of hypercoagulable state after gastroenterological surgery.METHODS We collected data on the clinical risk factors and fibrin-related ma...AIM To examine the role of soluble fibrin monomer complex(SFMC) in the prediction of hypercoagulable state after gastroenterological surgery.METHODS We collected data on the clinical risk factors and fibrin-related makers from patients who underwent gastroenterological surgery at Hiroshima University Hospital between April 1, 2014 and March 31, 2015. We investigated the clinical significance of SFMC, which is known to reflect the early plasmatic activation of coagulation, in the view of these fibrin related markers.RESULTS A total of 123 patients were included in the present study. There were no patients with symptomatic VTE. Thirty-five(28%) patients received postoperative anticoagulant therapy. In the multivariate analysis, a high SFMC level on POD 1 was independently associated with D-dimer elevation on POD 7(OR = 4.31, 95%CI: 1.10-18.30, P = 0.03). The cutoff SFMC level was 3.8 μg/ml(AUC = 0.78, sensitivity, 63%, specificity, 89%). The D-dimer level on POD 7 was significantly reduced in high-SFMC patients who received anticoagulant therapy in comparison to highSFMC patients who did not.CONCLUSION The SFMC on POD 1 strongly predicted the hypercoagulable state after gastroenterological surgery than the clinical risk factors and the other fibrin related markers.展开更多
Coronavirus disease has unarguably been the largest pandemic of recent times.Over 150 million cases have occurred worldwide,and more than 3 million have succumbed to the disease.Cardiac manifestations can have varied ...Coronavirus disease has unarguably been the largest pandemic of recent times.Over 150 million cases have occurred worldwide,and more than 3 million have succumbed to the disease.Cardiac manifestations can have varied presentations from an asymptomatic troponin rise to fulminant myocarditis.The pathogenesis of myocardial damage could be direct or indirect,including inflammation,coronary spasm,plaque rupture,and cytokine storm.Thromboembolism is also an important feature of cardiovascular affliction with both arterial and venous systems being affected.Hence,anticoagulation has also been a matter of debate.Fulminant myocarditis is the most severe form and can lead to circulatory shock with a high mortality.Management of cardiac patients with coronavirus disease 2019(COVID-19)infection is not considerably different from non-COVID-19 cardiovascular disease,but interaction between cardiovascular drugs and anti-COVID-19 therapy requires careful attention.More recently,vaccines have emerged as a ray of hope for the disease.But simultaneously,there have been reports of thromboembolism following vaccination.In this review,we discuss the various aspects of coronavirus disease affecting of heart and its management.展开更多
Tuberculosis (TB) remains an infectious disease with a high prevalence worldwide and represents a major public health issue. Although venous thromboembolism (VTE) is a rare complication of this disease, it may be a po...Tuberculosis (TB) remains an infectious disease with a high prevalence worldwide and represents a major public health issue. Although venous thromboembolism (VTE) is a rare complication of this disease, it may be a potentially life-threatening event. A 58-year-old man was admitted due to hematemesis due to inflammation at the anastomosis site after a gastrectomy years ago. After 3 days in-hospital, he showed a peroneal deep vein thrombosis and superficial thrombosis of left cephalic vein. Although reduced mobility and lack of prophylactic heparin could explain vein thrombosis, a simple etiologic workup was performed and active tuberculosis was diagnosed. This case illustrates a rare and unusual presentation form of tuberculosis, a condition that remains now-a-days one of the leading infectious causes of death worldwide. The association between tuberculosis and VTE is rare, but it should be systematically investigated.展开更多
We bring report the case of a young woman who presents with neurological symptoms, and to which the practised investigations led to the discovery in chain of unexpected pathologies. These neurological disorders were r...We bring report the case of a young woman who presents with neurological symptoms, and to which the practised investigations led to the discovery in chain of unexpected pathologies. These neurological disorders were revealing of the picture associating a nephrotic syndrome and a patent foramen ovale. This foramen was the major route of a rain of emboles ring peripheral favored by the nephrotic syndrome towards the cerebral hemispheres.展开更多
Objective:To explore the correlation between peripheral circulating tumor cells and hypercoagulability in patients with lung cancer after surgery.Methods:From January 2017 to December 2021,89 patients with lung cancer...Objective:To explore the correlation between peripheral circulating tumor cells and hypercoagulability in patients with lung cancer after surgery.Methods:From January 2017 to December 2021,89 patients with lung cancer who were treated in the Affiliated Hospital of Hebei University were selected as the research subjects,and a retrospective analysis was conducted to analyze and observe the D-dimer(DD),fibrinogen(FIB),and platelet(PLT)levels in peripheral blood,as well as detect peripheral CTC.Results:There were statistical differences in TMN staging,tumor metastasis,and lymph node metastasis in the clinical data,but there were no statistical differences in gender,smoking history,and pathological classification.After retrospective analysis and comparison of the patients,the DD(mg/ml),FIB(g/L),and PLT(×10^(9)/L)levels of the CTC positive group were 3.41±0.58,3.98±0.87,and 367.26±34.98,respectively;the CTC negative group’s DD(mg/ml),FIB(g/L),and PLT(×10^(9)/L)levels were 0.89±0.49,1.06±0.45,and 234.69±35.69,respectively,and the differences were statistically significant.The factors affecting the prognosis of patients included TMN staging and CTC;the number of CTC positives in the death group was significantly higher than that in the survival group,and there was a statistical difference between the groups.Gender,age,smoking history,pathological type,and surgical resection had no effect on the prognosis of patients.Among the enrolled patients,the survival rate was 71.91%.Conclusion:CTC-positive patients have a higher probability of hypercoagulability after surgery and are prone to tumor metastasis;thus,CTC can be used as a judgment index for the prognosis of patients.展开更多
Introduction:Livedoid vasculopathy is a chronic noninflammatory skin disease secondary to hypercoagulable states.No therapeutic guideline has yet been established for livedoid vasculopathy.We herein report a case of l...Introduction:Livedoid vasculopathy is a chronic noninflammatory skin disease secondary to hypercoagulable states.No therapeutic guideline has yet been established for livedoid vasculopathy.We herein report a case of livedoid vasculopathy secondary to protein C deficiency that was successfully treated with rivaroxaban.Case presentation:A 31-year-old Thai woman who had been diagnosed with livedoid vasculopathy 10 years previously presented with a 2-month history of worsening leg ulcers and failure to respond to aspirin,colchicine,and pentoxifylline.Further investigations confirmed protein C deficiency.Rivaroxaban was initiated,and clinical improvement was achieved in 8 weeks.Discussion:When livedoid vasculopathy is confirmed by skin biopsy,additional investigations for hypercoagulable states should be performed to exclude secondary causes.Identification of the causes of livedoid vasculopathy can direct physicians to therapeutic options based on previously reported cases of successful treatment.Our patient,whose livedoid vasculopathy was caused by protein C deficiency,responded well to rivaroxaban.Conclusion:Protein C deficiency results in a hypercoagulable state,and affected patients can present with livedoid vasculopathy.The anticoagulant rivaroxaban has been beneficial in the treatment of livedoid vasculopathy.展开更多
Background:Hypercoagulability has been shown to act as an important component of ulcerative colitis(UC)pathogenesis and disease activity,and is strongly correlated with the occurrence of venous thromboembolism(VTE).Th...Background:Hypercoagulability has been shown to act as an important component of ulcerative colitis(UC)pathogenesis and disease activity,and is strongly correlated with the occurrence of venous thromboembolism(VTE).This study aimed at providing novel therapeutic clues for hypercoagulable active UC.Methods:The coagulation score model was developed using VTE cohorts,and the predictive performance of this model was evaluated by coagulation subtypes of UC patients,which were clustered by the unsupervised method.Subsequently,the response of UC of distinct coagulation types,as identified by the coagulation scoring model,to different biological agents was evaluated.Immunoinflammatory cells and molecules that were associated with hypercoagulable active UC were explored by employing gene set variation analysis,single-sample gene set enrichment analysis,univariate logistic regression analysis,and immunohistochemistry.Results:A coagulation scoring model was established,which includes five key coagulation factors(ARHGAP35,CD46,BTK,C1QB,and F2R),and accurately distinguished the coagulation subtypes of UC.When comparing anti-TNF-αagents with other biological agents after determining the model,especially golimumab,it showed more effective treatment for hypercoagulable active UC.CXCL8 has been identified as playing an important role in the tightly interconnected network between the immune-inflammatory system and coagulation system in UC.Immunohistochemical analysis showed that the expression of CXCL8,BTK,C1QB,and F2R was upregulated in active UC.Conclusions:Anti-TNF-αagents have significant therapeutic effects on hypercoagulable active UC,and the strong association between CXCL8,hypercoagulation,and disease activity provides a novel therapeutic insight into hypercoagulable active UC.展开更多
文摘Background: Bilateral adrenal hemorrhage (BAH) is a rare condition that may lead to life-threatening adrenal insufficiency or adrenal crisis if not addressed appropriately. Case Report: A 54-year-old male with a history of venous thromboembolism (VTE) on warfarin presented to the hospital with nausea, vomiting, and abdominal and flank pain shortly following colonoscopy preparation. Initial imaging of the abdomen and pelvis was notable for hyperdense thickening of the bilateral adrenal glands raising concerns for hemorrhages, and subsequent magnetic resonance imaging (MRI) confirmed BAH. During hospitalization, the patient was placed on prophylactic heparin, and shortly after decompensating, he became tachycardic, hypotensive, and febrile. This led to heparin reversal followed by administration of a single dose of Hydrocortisone 100 mg and Hydrocortisone 50 mg TID due to concern for adrenal insufficiency. The patient also necessitated sepsis work-up and fluid resuscitation. Repeat CT imaging showed no significant change in hemorrhage size bilaterally. Endocrinology, vascular surgery, hematology/oncology, and rheumatology were consulted for the management of adrenal insufficiency, anticoagulation in the presence of hemorrhage, thrombocytopenia, and hypercoagulable state. Towards the end of his hospital course, the patient had asymptomatic diffuse ST elevations, elevated troponin, and an ejection fraction of 10% - 15%, leading to cardiac catheterization and placement of an intra-aortic pump. During subsequent stay in the ICU, the patient developed hemodynamic shock and was transferred to a facility with a higher level of care and medical support therapies. After this transfer, the patient was stabilized from a cardiac standpoint but developed acute respiratory failure suspected to be secondary to diffuse alveolar hemorrhage and immune thrombocytopenic purpura, necessitating platelet transfusion. He was on continued monitoring from rheumatology given his myocarditis believed to be secondary to his antiphospholipid antibodies, and was treated with IVIG, rituximab, and hydroxychloroquine. A repeat echocardiogram revealed an improved ejection fraction of 52% and the patient was then discharged on an enoxaparin bridge to warfarin and a cardiac home event monitor. Discussion: BAH is a life-threatening condition that should be promptly identified and managed in patients presenting with nonspecific symptoms and a history of hypercoagulability or anticoagulation. In these cases, the risk of AH and subsequent adrenal insufficiency is drastically increased, so immediate imaging as well as initiation of steroid therapy is crucial to stabilize patients and prevent adrenal crisis. A multidisciplinary approach, involving endocrinology, hematology, and cardiology as in this case is also imperative to optimize patient outcomes and increase survival. Conclusion: BAH should be considered in patients presenting with a history of VTE and hypercoagulable state when precipitating stressors or predisposing risk factors are present. This case report highlights the importance of clinical awareness of BAH for clinicians to accurately identify and manage it to prevent fatal sequelae and ensure long-term favorable patient outcomes.
文摘Objective To establish and evaluate a hypercoagulable animal model for the assessment of anticoagulants. Methods Forty mice, thirty-two rats, and twenty-four rabbits were randomly and equally divided into control group (saline) and three ellagic acid (EA)-treated groups (low, middle, and high doses). In the mice, bleeding time (BT) was estimated with tail transaction, and clotting time (CT) with template method. Prothrombin time (PT) and the activated partial thromboplastin time (APTT) in rats and rabbits were measured by means of Quick's one-stage assay and modified APTT assay respectively. In addition, thrombin activity was estimated in rats with PT assay using a hemagglutination analyzer. The circulating platelet aggregates were de- tected in rabbits through platelet counting and presented as the circulating platelet aggregate ratio (CPAR). Results EA shortened BT and CT in mice, PT and APTT in rats, and increased thrombin activity and CPAR, all in a dose-dependent manner. EA also brought reduction of PT and APTT in rabbits in dose- and time-dependent manners. Conclusion EA could induce hypercoagulable state through activating coagulation system and platelets in mice, rats, and rabbits.
文摘AIM To examine the role of soluble fibrin monomer complex(SFMC) in the prediction of hypercoagulable state after gastroenterological surgery.METHODS We collected data on the clinical risk factors and fibrin-related makers from patients who underwent gastroenterological surgery at Hiroshima University Hospital between April 1, 2014 and March 31, 2015. We investigated the clinical significance of SFMC, which is known to reflect the early plasmatic activation of coagulation, in the view of these fibrin related markers.RESULTS A total of 123 patients were included in the present study. There were no patients with symptomatic VTE. Thirty-five(28%) patients received postoperative anticoagulant therapy. In the multivariate analysis, a high SFMC level on POD 1 was independently associated with D-dimer elevation on POD 7(OR = 4.31, 95%CI: 1.10-18.30, P = 0.03). The cutoff SFMC level was 3.8 μg/ml(AUC = 0.78, sensitivity, 63%, specificity, 89%). The D-dimer level on POD 7 was significantly reduced in high-SFMC patients who received anticoagulant therapy in comparison to highSFMC patients who did not.CONCLUSION The SFMC on POD 1 strongly predicted the hypercoagulable state after gastroenterological surgery than the clinical risk factors and the other fibrin related markers.
文摘Coronavirus disease has unarguably been the largest pandemic of recent times.Over 150 million cases have occurred worldwide,and more than 3 million have succumbed to the disease.Cardiac manifestations can have varied presentations from an asymptomatic troponin rise to fulminant myocarditis.The pathogenesis of myocardial damage could be direct or indirect,including inflammation,coronary spasm,plaque rupture,and cytokine storm.Thromboembolism is also an important feature of cardiovascular affliction with both arterial and venous systems being affected.Hence,anticoagulation has also been a matter of debate.Fulminant myocarditis is the most severe form and can lead to circulatory shock with a high mortality.Management of cardiac patients with coronavirus disease 2019(COVID-19)infection is not considerably different from non-COVID-19 cardiovascular disease,but interaction between cardiovascular drugs and anti-COVID-19 therapy requires careful attention.More recently,vaccines have emerged as a ray of hope for the disease.But simultaneously,there have been reports of thromboembolism following vaccination.In this review,we discuss the various aspects of coronavirus disease affecting of heart and its management.
文摘Tuberculosis (TB) remains an infectious disease with a high prevalence worldwide and represents a major public health issue. Although venous thromboembolism (VTE) is a rare complication of this disease, it may be a potentially life-threatening event. A 58-year-old man was admitted due to hematemesis due to inflammation at the anastomosis site after a gastrectomy years ago. After 3 days in-hospital, he showed a peroneal deep vein thrombosis and superficial thrombosis of left cephalic vein. Although reduced mobility and lack of prophylactic heparin could explain vein thrombosis, a simple etiologic workup was performed and active tuberculosis was diagnosed. This case illustrates a rare and unusual presentation form of tuberculosis, a condition that remains now-a-days one of the leading infectious causes of death worldwide. The association between tuberculosis and VTE is rare, but it should be systematically investigated.
文摘We bring report the case of a young woman who presents with neurological symptoms, and to which the practised investigations led to the discovery in chain of unexpected pathologies. These neurological disorders were revealing of the picture associating a nephrotic syndrome and a patent foramen ovale. This foramen was the major route of a rain of emboles ring peripheral favored by the nephrotic syndrome towards the cerebral hemispheres.
基金Baoding Science and Technology Project(Project Number:18ZF134)Youth Fund of Affiliated Hospital of Hebei University(Project Number:2017Q018)。
文摘Objective:To explore the correlation between peripheral circulating tumor cells and hypercoagulability in patients with lung cancer after surgery.Methods:From January 2017 to December 2021,89 patients with lung cancer who were treated in the Affiliated Hospital of Hebei University were selected as the research subjects,and a retrospective analysis was conducted to analyze and observe the D-dimer(DD),fibrinogen(FIB),and platelet(PLT)levels in peripheral blood,as well as detect peripheral CTC.Results:There were statistical differences in TMN staging,tumor metastasis,and lymph node metastasis in the clinical data,but there were no statistical differences in gender,smoking history,and pathological classification.After retrospective analysis and comparison of the patients,the DD(mg/ml),FIB(g/L),and PLT(×10^(9)/L)levels of the CTC positive group were 3.41±0.58,3.98±0.87,and 367.26±34.98,respectively;the CTC negative group’s DD(mg/ml),FIB(g/L),and PLT(×10^(9)/L)levels were 0.89±0.49,1.06±0.45,and 234.69±35.69,respectively,and the differences were statistically significant.The factors affecting the prognosis of patients included TMN staging and CTC;the number of CTC positives in the death group was significantly higher than that in the survival group,and there was a statistical difference between the groups.Gender,age,smoking history,pathological type,and surgical resection had no effect on the prognosis of patients.Among the enrolled patients,the survival rate was 71.91%.Conclusion:CTC-positive patients have a higher probability of hypercoagulability after surgery and are prone to tumor metastasis;thus,CTC can be used as a judgment index for the prognosis of patients.
文摘Introduction:Livedoid vasculopathy is a chronic noninflammatory skin disease secondary to hypercoagulable states.No therapeutic guideline has yet been established for livedoid vasculopathy.We herein report a case of livedoid vasculopathy secondary to protein C deficiency that was successfully treated with rivaroxaban.Case presentation:A 31-year-old Thai woman who had been diagnosed with livedoid vasculopathy 10 years previously presented with a 2-month history of worsening leg ulcers and failure to respond to aspirin,colchicine,and pentoxifylline.Further investigations confirmed protein C deficiency.Rivaroxaban was initiated,and clinical improvement was achieved in 8 weeks.Discussion:When livedoid vasculopathy is confirmed by skin biopsy,additional investigations for hypercoagulable states should be performed to exclude secondary causes.Identification of the causes of livedoid vasculopathy can direct physicians to therapeutic options based on previously reported cases of successful treatment.Our patient,whose livedoid vasculopathy was caused by protein C deficiency,responded well to rivaroxaban.Conclusion:Protein C deficiency results in a hypercoagulable state,and affected patients can present with livedoid vasculopathy.The anticoagulant rivaroxaban has been beneficial in the treatment of livedoid vasculopathy.
基金supported by the Zhejiang Chinese Medicine University Postgraduate Scientific Research Fund Project[grant number 2022YKJ02]Medical Scientific Research Foundation of Guangdong Province of China[grant number A2021433]+2 种基金Guangdong Basic and Applied Basic Research Foundation[grant numbers 2021A1515010280,2022A1515012170,and 2024A1515011242]China Postdoctoral Science Foundation[grant number 2023M730743]National Natural Science Foundation of China[grant number 82470422].
文摘Background:Hypercoagulability has been shown to act as an important component of ulcerative colitis(UC)pathogenesis and disease activity,and is strongly correlated with the occurrence of venous thromboembolism(VTE).This study aimed at providing novel therapeutic clues for hypercoagulable active UC.Methods:The coagulation score model was developed using VTE cohorts,and the predictive performance of this model was evaluated by coagulation subtypes of UC patients,which were clustered by the unsupervised method.Subsequently,the response of UC of distinct coagulation types,as identified by the coagulation scoring model,to different biological agents was evaluated.Immunoinflammatory cells and molecules that were associated with hypercoagulable active UC were explored by employing gene set variation analysis,single-sample gene set enrichment analysis,univariate logistic regression analysis,and immunohistochemistry.Results:A coagulation scoring model was established,which includes five key coagulation factors(ARHGAP35,CD46,BTK,C1QB,and F2R),and accurately distinguished the coagulation subtypes of UC.When comparing anti-TNF-αagents with other biological agents after determining the model,especially golimumab,it showed more effective treatment for hypercoagulable active UC.CXCL8 has been identified as playing an important role in the tightly interconnected network between the immune-inflammatory system and coagulation system in UC.Immunohistochemical analysis showed that the expression of CXCL8,BTK,C1QB,and F2R was upregulated in active UC.Conclusions:Anti-TNF-αagents have significant therapeutic effects on hypercoagulable active UC,and the strong association between CXCL8,hypercoagulation,and disease activity provides a novel therapeutic insight into hypercoagulable active UC.
