Patients with multiple myeloma are at an increased risk of venous thromboembolism and arterial thrombosis. We assessed the impact of venous and arterial thrombosis on survival in a population-based study of 9,399 multiple myeloma patients diagnosed in Sweden from 1987 to 2005. We found multiple myeloma patients with venous thromboembolism to have a higher mortality at 1-, 5-, and 10-years of follow up compared with those without, with hazard ratios of 2.9 (95% confidence interval (CI) 2.4-3.5), 1.6 (95% CI: 1.5-1.8), and 1.6 (95% CI: 1.4-1.7), respectively. There was an increase in risk of death among multiple myeloma patients with arterial thrombosis, with hazard ratios of 3.4 (95% CI: 3.0-3.8), 2.2 (95% CI: 2.0-2.3), and 2.1 (95% CI: 1.9-2.1), respectively. In landmark analyses at six months, early arterial but not venous thromboembolism was associated with a higher risk of death. Thus, in contrast to prior smaller studies, we found the development of thrombosis to be associated with significantly poorer survival. The prevention of thrombosis in multiple myeloma is an important goal in the management of these patients.
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Maternal death due to thrombosis in a mechanical aortic valve prosthesis during heparin therapy is described. The patient had a normal pregnancy during warfarin therapy. In this pregnancy, warfarin therapy was replaced by subcutaneous heparin injections, and the patient died of massive thrombosis in the valvuloprosthesis at 20 weeks of pregnancy. The effectiveness of heparin therapy and difficulties in the follow-up of heparin treatment during pregnancy are discussed.
Thrombectomy could be an excellent approach on one condition (ie, that all parts of the thrombus are removed). We propose to use a tool (ie, the blower) to complete thrombectomy of the prosthetic mechanical valve. The blower is a vaporizer that mixes air and heparinized saline with regulator of flow and proportion used in beating heart surgery. For thrombectomy, we have modified the air-water mixing part and intensity until we obtained a jet that enabled us to remove the micro thrombus that covered the prosthetic valve and surrounding tissues. The blower completely cleaned the prosthetic valve. With this tool, thrombectomy seems easier, more complete, and more reliable with the advantages of short cross-clamping time.
Major advances in the understanding of myocardial infarction (MI) have been made on animal models of ischemia and infarction. We performed ultrastructural examinations of the hearts of 36 patients who died during the acute phase of MI. Tissue for investigation was obtained by express necropsy immediately after death at the clinic. All components of the microcirculatory system of the heart were damaged during the acute phase of MI. Coronary thrombosis led to arteriolar spasm and intravascular blood coagulation in the vicinity of the damaged artery. Microvessels reduction in ischemic, necrotic, and near-infarct zones was caused by endothelial cell injury and rheological disturbances. Thrombocytes played a decisive role in thrombus formation and arteriolar constriction. Leukocytes nearly always impaired the microhemodynamics in ischemic zones due to their size and rigidity. Microcirculatory disorders seemed to precede myocardial cell injury and death.
Observation on 32,448 salmonellosis patients was carried out. In 653 cases (2.01%) the complicated course of the disease was observed. It was caused by generalized disturbances in blood circulation, or shock, in 0.09% of cases, or by regional disturbances in blood circulation (myocardial infarction in 0.4%, acute disturbances in cerebral circulation in 0.4%, thrombosis of mesenterial vessels in 0.1% of cases). In addition, infectious complications developed in the form of pneumonia (0.5%) and acute renal insufficiency (0.6% of cases). Acute adrenal insufficiency, observed in the past, did not practically occur during the recent 20 years, having lost its importance due to the use of adequate therapy with polyionic crystalloid solutions.
382 Brescia-Cimino type arteriovenous fistulae were created for chronic haemodialysis. Success rate at the first attempt was 73.6% of 281 cases. The most common method of anastomosis was endtoside vein to artery type. Thrombosis was the most frequent complication, other miscellaneous complications were less common.
AIM: To identify prothrombotic risk profiles in children and adolescents referred to a regional coagulation centre in southern Sweden for a first thrombotic event. METHODS: One hundred and twenty-eight consecutive children and adolescents (newborn to 20 y) referred for evaluations of a first episode of venous thrombosis were investigated. Clinical data were collected retrospectively, and the following variables were investigated: protein C, protein S, antithrombin; resistance to activated protein C; the genotypes FV-G1691A, F II-G20210A, MTHFR-C677T, MTHFR- A1298C; coagulation factors VIII and XI. RESULTS: 104/128 subjects (81%) had identifiable acquired risk factors, most often indwelling catheters and hormone therapy. Predisposing genetic factors related to thromboembolic events were revealed in 53/83 (64%) of subjects who agreed to follow-up blood sampling, and 17/83 (20%) had two or more inherited risk factors. Combinations of genetic and acquired risk factors were identified in 45/83 (54%) of the subjects, and 77/83 (93%) had at least one such risk factor. Both sexes had one peak in frequency at less than 1 y of age and then an increase during adolescence, more in females than in males. Plasma values for coagulation factors VIII and XI were age appropriate and showed a normal Gaussian distribution. CONCLUSION: This study identified prothrombotic risk profiles in almost all children and adolescents with venous thrombosis, which underlines the importance of careful evaluation of genetic and acquired risk factors.
Dilated cardiomyopathy with intraventricular thrombosis is a rare disease, most frequently encountered in adults. It rarely occurs in infants. We report here the case of a 2-year-old boy with intraventricular thrombosis due to dilated cardiomyopathy and emphasize the importance of prophylactic anticoagulant therapy in this case.
The authors report statistical data on the spectrum and frequency of fatal thrombotic complications based on the analysis of materials available from the regional bureau of forensic medical examination collected in the period from 2004 to 2007. All lethal cases are categorized in terms of the patients' age, gender, time and clinical characteristics of the injury, time of surgical intervention. Results of the analysis indicate the necessity of examination of fatal cases of thrombotic complications following a standardized protocol.