Journal of Yeungnam Medical Science

Original articles

Incidence and risk factors of deep vein thrombosis and pulmonary thromboembolism after spinal cord disease at a rehabilitation unit: a retrospective study: Yoonhee Kim, Minjae Jeong, Myung Woo Park, Hyun Iee Shin, Byung Chan Lee, Du Hwan Kim; J Yeungnam Med Sci. 2023;40(Suppl):S56-S64. Published online September 20, 2023; DOI: https://doi.org/10.12701/jyms.2023.00689

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Background
Deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) are major complications of spinal cord disease. However, studies of their incidence in Korean patients are limited. Thus, this study investigated the incidence and risk factors of DVT and PTE in Korean patients with spinal cord disease.
Methods
We retrospectively analyzed the medical records of 271 patients with spinal cord disease who were admitted to a rehabilitation unit within 3 months of disease onset at a tertiary hospital. The presence of DVT and PTE was mainly determined using Doppler ultrasonography and chest embolism computed tomography. Risk factor analysis included variables such as sex, age, obesity, completeness of motor paralysis, neurological level of injury, cause of injury, lower extremity fracture, active cancer, and functional ambulation category (FAC) score.
Results
The incidences of DVT and PTE in the patients with spinal cord disease were both 6.3%. Risk factor analysis revealed that age of ≥65 years (p=0.031) and FAC score of ≤1 (p=0.023) were significantly associated with DVT development. Traumatic cause of injury (p=0.028) and DVT (p<0.001) were significant risk factors of PTE.
Conclusion
Patients with spinal cord disease developed DVT and PTE within 3 months of disease onset with incidence rates of 6.3% and 6.3%, respectively. Age of ≥65 years and an FAC of score ≤1 were risk factors for DVT. Traumatic cause of injury and DVT were risk factors for PTE. However, given the inconsistent results of previous studies, the risk factors for DVT and PTE remain inconclusive. Therefore, early screening for DVT and PTE should be performed in patients with acute-to-subacute spinal cord disease regardless of the presence or absence of these risk factors.

Citations

Citations to this article as recorded by

Coagulation parameters correlate to venous thromboembolism occurrence during the perioperative period in patients with spinal fractures
Yong Jiao, Xiaohong Mu
Journal of Orthopaedic Surgery and Research.2023;[Epub] CrossRef

Safety of low-dose anticoagulation in extracorporeal membrane oxygenation using the Permanent Life Support System: a retrospective observational study: Kyungsub Song, Jae Bum Kim; J Yeungnam Med Sci. 2023;40(3):276-282. Published online May 18, 2023; DOI: https://doi.org/10.12701/jyms.2023.00339

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Abstract PDF: Background
Bleeding and thrombosis are major complications associated with high mortality in extracorporeal membrane oxygenation (ECMO) management. Anticoagulant therapy should be adequate to reduce thrombosis. However, related studies are limited.
Methods
We retrospectively reviewed all patients supported with ECMO at a single institution between January 2014 and July 2022 and included those on all types of ECMO using the Permanent Life Support System. Patients were classified into two groups according to their measured mean activated partial thromboplastin time (aPTT) during ECMO management: a high-anticoagulation (AC) group (aPTT, ≥55 seconds; n=52) and a low-AC group (aPTT, <55 seconds; n=79). The primary outcome was thrombotic or bleeding events during ECMO.
Results
We identified 10 patients with bleeding; significantly more of these patients were in the high-AC group (n=8) than in the low-AC group (15.4% vs. 2.5%, p=0.01). However, thrombus events and oxygenator change-free times were not significantly different between the two groups. Four patients in the high-AC group died of bleeding complications (brain hemorrhage, two; hemopericardium, one; and gastrointestinal bleeding, one). One patient in the low-AC group developed a thrombus and died of ECMO dysfunction due to circuit thrombosis.
Conclusion
Heparin did not significantly improve thrombotic outcomes. However, maintaining an aPTT of ≥55 seconds was a significant risk factor for bleeding events, especially those associated with mortality.

Case report

Massive cerebral venous sinus thrombosis secondary to Graves' disease: Hye-Min Son; Yeungnam Univ J Med. 2019;36(3):273-280. Published online September 18, 2019; DOI: https://doi.org/10.12701/yujm.2019.00339

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Abstract PDF

Cerebral venous sinus thrombosis (CVT) is a rare cerebrovascular condition accounting for 0.5–1% of all types of strokes in the general population. Hyperthyroidism is associated with procoagulant and antifibrinolytic activity, thereby precipitating a hypercoagulable state that predisposes to CVT. We report the case of a 31-year-old Korean man with massive CVT and diagnosis of concomitant Graves’ disease at admission. Early diagnosis and prompt treatment of CVT are important to improve prognosis; therefore, CVT should be considered in the differential diagnosis in all patients with hyperthyroidism presenting with neurological symptoms.

Citations

Citations to this article as recorded by

Hyperthyroidism-induced Cerebral Venous Thrombosis Presenting as Chronic Isolated Intracranial Hypertension
Takumi Tashiro, Yuichi Kira, Norihisa Maeda
Internal Medicine.2023; 62(20): 3021. CrossRef
Cerebral Sinus Vein Thrombosis and Gender: A Not Entirely Casual Relationship
Tiziana Ciarambino, Pietro Crispino, Giovanni Minervini, Mauro Giordano
Biomedicines.2023; 11(5): 1280. CrossRef
Insights Into a Hypercoagulable Case of Thyrocardiac Disease and Literature Overview
Pin-Yi Wu, Ruchika Meel
Annals of Internal Medicine: Clinical Cases.2023;[Epub] CrossRef
Cerebral Venous Thrombosis during Thyrotoxicosis: Case Report and Literature Update
Emanuela Maria Raho, Annibale Antonioni, Niccolò Cotta Ramusino, Dina Jubea, Daniela Gragnaniello, Paola Franceschetti, Francesco Penitenti, Andrea Daniele, Maria Chiara Zatelli, Maurizio Naccarato, Ilaria Traluci, Maura Pugliatti, Marina Padroni
Journal of Personalized Medicine.2023; 13(11): 1557. CrossRef
Unprovoked Isolated Pulmonary Embolism and Graves’ Disease in a Patient With Dyspnea: A Case Report
Roshan Bisural, Deepak Acharya, Samaj Adhikari, Baikuntha Chaulagai, Arjun Mainali, Tutul Chowdhury, Nicole Gousy
Cureus.2022;[Epub] CrossRef
Cerebral venous sinus thrombosis caused by traumatic brain injury complicating thyroid storm: a case report and discussion
Shurong Gong, Wenyao Hong, Jiafang Wu, Jinqing Xu, Jianxiang Zhao, Xiaoguang Zhang, Yuqing Liu, Rong-Guo Yu
BMC Neurology.2022;[Epub] CrossRef
Severe headache as a monosymptom of cerebral venous sinus thrombosis: a case report with effective utilization of the SNNOOP10 approach
Garik Yeganyan, Hasmik Sargsyan, Mariam Manukyan, Henrik Schytz, Samson Khachatryan
Armenian Journal of Health & Medical Sciences.2022; : 52. CrossRef
Hyperthyroidism as a Precipitant Factor for Cerebral Venous Thrombosis: A Case Report
Ahmed Elkhalifa Elawad Elhassan, Mohammed Omer Khalil Ali, Amina Bougaila, Mohammed Abdelhady, Hassan Abuzaid
Journal of Investigative Medicine High Impact Case Reports.2020; 8: 232470962094930. CrossRef

Case Report

Acute left main coronary artery thrombosis as an initial presentation of systemic lupus erythematosus: Kang Un Choi, Ung Kim; Yeungnam Univ J Med. 2018;35(2):227-231. Published online December 31, 2018; DOI: https://doi.org/10.12701/yujm.2018.35.2.227

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Abstract PDF: Left main coronary artery (LMCA) thrombosis is rare and the cause should be determined. A previously healthy young man presented with severe chest pain and dyspnea. The electrocardiogram showed typical ST-segment elevation myocardial infarction with clinical instability. Emergency coronary angiography revealed complete LMCA occlusion by thrombosis. After reperfusion, the patient was admitted to the cardiac care unit. He was diagnosed with hemolytic anemia and tested positive for antinuclear antibodies. Systemic lupus erythematosus (SLE) and LMCA disease due to systemic thrombosis were diagnosed. Steroids were started and the patient was discharged without complications. We report this rare case of LMCA thrombosis as an initial presentation of SLE.

Original Article

Comparison of symptomatic and asymptomatic pulmonary embolism in proximal deep vein thrombosis: Dong Hun Kim, Young Woo Seo, Gyun Moo Kim, Seung Hyun Ko, Jae Seok Jang, Tae Chang Jang; Yeungnam Univ J Med. 2017;34(2):231-237. Published online December 31, 2017; DOI: https://doi.org/10.12701/yujm.2017.34.2.231

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Abstract PDF: BACKGROUND
Deep vein thrombosis (DVT) and pulmonary embolism (PE) are conditions with significant morbidity and mortality. Proximal DVT has a significant association with PE and possible fatal outcomes. Traditionally, PE is subdivided into symptomatic PE and asymptomatic PE, which have different treatments, preventions and prognoses. The growing utilization of computed tomography pulmonary angiography has led to increased detection of PE in DVT patients. This study examined the clinical characteristics and compared symptomatic PE and asymptomatic PE following proximal DVT. METHODS: The medical records of 258 DVT inpatients from July, 2012 to June, 2015 were reviewed retrospectively. After excluding the patients who did not performed PE evaluation and were not diagnosed with PE, 95 patients diagnosed with PE following proximal DVT were enrolled in this study. They were divided into the symptomatic PE group and asymptomatic PE group. RESULTS: The body weight, body mass index, thrombus size, thrombus length and location were similar in the two groups. The symptomatic PE following proximal DVT group showed an older age, higher incidence of emergency department access (85.0% vs. 38.7%, p < 0.001) and preceding infection (25.0% vs. 1.3%, p < 0.001) as well as a higher incidence of immobilization (45.0% vs 13.3%, p=0.016). In the multivariate logistic regression study, preceding infection and emergency department access showed significant association with symptomatic PE. CONCLUSION: In proximal DVT inpatients, symptomatic PE was associated with emergency department access and preceding infection. The possibility of a symptomatic PE event should be considered in proximal DVT patients, especially those who were admitted through the emergency department and had preceding infection.

Case Reports

Deep vein thrombosis caused by malignant afferent loop obstruction.: Eun Gyu Kang, Chan Kim, Jeungeun Lee, Min Uk Cha, Joo Hoon Kim, Seo Hwa Park, Man Deuk Kim, Do Yun Lee, Sun Young Rha; Yeungnam Univ J Med. 2016;33(2):166-169. Published online December 31, 2016; DOI: https://doi.org/10.12701/yujm.2016.33.2.166

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Abstract PDF: Afferent loop obstruction following gastrectomy is a rare but fatal complication. Clinical features of afferent loop obstruction are mainly gastrointestinal symptoms. A 56-year-old female underwent radical total gastrectomy with Roux-en-Y esophagojejunostomy for treatment of advanced gastric cancer. After fourteen months postoperatively, she showed gradual development of edema of both legs. Computed tomography (CT) scan showed disease progression at the jejunojejunostomy site and consequent dilated afferent loop, which resulted in inferior vena cava (IVC) compression. A drainage catheter was placed percutaneously into the afferent loop through the intrahepatic duct and an IVC filter was placed at the suprarenal IVC, and selfexpanding metal stents were inserted into bilateral common iliac veins. With these procedures, sympotms related with afferent loop obstruction and deep vein thrombosis were improved dramatically. The follow-up abdominal CT scan was taken 3 weeks later and revealed the completely decompressed afferent loop and improved IVC patency. Surgical treatment should be considered as the first choice for afferent loop obstruction; however, because it is more immediate and less invasive, non-surgical modalities, such as percutaneous catheter drainage or stent placement, can be effective alternatives for inoperable cases or risky patients who have severe medical comorbidities.

Guide wire fracture during percutaneous coronary intervention.: Hak Ro Kim, Tae Hoon Yim, Byung Chul Kim, Ho Jun Lee, Hong Geun Oh, Hyun Sik Ju, Tae Jin Kim, Young Bok Kim; Yeungnam Univ J Med. 2016;33(1):52-55. Published online June 30, 2016; DOI: https://doi.org/10.12701/yujm.2016.33.1.52

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Abstract PDF: Guide wire fracture during percutaneous coronary intervention (PCI) is rare. It can cause fatal complications such as thrombus formation, embolization, and perforation. Guide wire fracture could occur during intervention for severely calcified stenotic lesions, and rarely from distal small branches of stenotic lesions. There are several methods for its management depending on the material character, position, length of the remnant, and the patient's condition. If percutaneous retrieval was not achieved, the surgical procedure should be considered for prevention of potential risks, although the remnant guide wire does not usually cause complications. We experienced a patient with a guide wire fracture during PCI, and managed to prevent its complications through surgical removal of the remnant wire. We report this case here.

Pulmonary thromboembolism combined with intracardiac thrombus occurred during the steroid reduction in nephrotic syndrome patient.: Se Jin Lee, Ji Young Park, Sung Kee Ryu, Jae Woong Choi, Won Young Chae, Hee Yun Ryu, Min Seok Yoo, Yoon Suk Bak; Yeungnam Univ J Med. 2016;33(1):25-28. Published online June 30, 2016; DOI: https://doi.org/10.12701/yujm.2016.33.1.25

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Abstract PDF: Nephrotic syndrome is associated with a hypercoagulable state, which results in thromboembolism as one of its main complications. Various pathogenetic factors that cause the hypercoagulable state in nephrotic syndrome have been recognized. We report on a 19-year-old female with a minimal-change disease who developed pulmonary thromboembolism combined with intracardiac thrombus while on tapering steroid. Our patient showed hypoalbuminemia with an episode of shock, and was successfully treated with thrombolysis and anticoagulation therapy.

Deep Vein Thrombosis Due to Hematoma as a Rare Complication after Femoral Arterial Catheterization.: Minsoo Kim, Jong Young Lee, Cheol Whan Lee, Seung Whan Lee, Soo Jin Kang, Yong Hoon Yoon, Sang Yong Om, Young Hak Kim; Yeungnam Univ J Med. 2013;30(1):31-35. Published online June 30, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.1.31

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Abstract PDF

Hematoma is quite a common complication of femoral arterial catheterization. However, to the best of our knowledge, there have been no previous studies regarding deep vein thrombosis (DVT) caused by compression of a vein due to a hematoma. We report a case of a hematoma developing after femoral arterial catheterization and causing extensive symptomatic DVT. A 59-year-old male was seen in our Emergency Department with right lower leg swelling 15 days after coronary stent implantation performed using right femoral artery access. Computed tomographic (CT) scanning revealed a large hematoma (45 mm in its longest diameter) compressing the common femoral vein and with DVT from the right external iliac vein to the popliteal vein. Due to the extensive DVT involvement, we decided to release the compressed common femoral vein by surgical evacuation of the large hematoma. However, even following evacuation of the hematoma, as the DVT did not resolve soon, further mechanical thrombectomy and catheter-directed thrombolysis were performed. Angiography then showed nearly resolved DVT, and the leg swelling was improved. The patient was discharged with the anticoagulation medication, warfarin.

Citations

Citations to this article as recorded by

Femoral Vein Thrombosis Following Femoral Access Cardiac Catheterisation – A Rare Complication
Laurence Disler, Mathew Disler, Dayle Disler Biddle, Camilla Friedman, Janet Couper-Smith
Cardiovascular Revascularization Medicine.2023; 53: S224. CrossRef
A Case of Puncture-Site Giant Pseudoaneurysm Following Recanalization Therapy for Acute Ischemic Stroke: Marked Growth and Rupture of a Femoral Artery Pseudoaneurysm
Noriaki Matsubara, Yusuke Fukuo, Kohei Yoshimura, Hideki Kashiwagi, Gen Futamura, Yangtae Park, Toshihiko Kuroiwa, Masahiko Wanibuchi
Journal of Neuroendovascular Therapy.2021; 15(6): 366. CrossRef
Deep Vein Thrombosis after Femoral Arterial Access: Pathophysiologic and Therapeutic Challenges
Evan Harmon, Yoo Jin Lee, Sula Mazimba, Kanwar Singh, Aditya Sharma, Younghoon Kwon
Case Reports in Cardiology.2019; 2019: 1. CrossRef
Treatment of pulmonary thromboembolism using Arrow-Trerotola percutaneous thrombolytic device
Tae Kyun Kim, Ji Young Park, Jun Ho Bae, Jae Woong Choi, Sung Kee Ryu, Min-Jung Kim, Jun Bong Kim, Jang Won Sohn
Yeungnam University Journal of Medicine.2014; 31(1): 28. CrossRef

A Case of Essential Thrombocythemia Presenting as Esophageal Varix Bleeding and Multiple Thrombosis.: So Yeon Yoon, Jun Hyeok Choi, Sun Mi Kang, Jung Nam Cho, Sung Hwa Bae, Hun Mo Ryoo; Yeungnam Univ J Med. 2011;28(1):99-104. Published online June 30, 2011; DOI: https://doi.org/10.12701/yujm.2011.28.1.99

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Abstract PDF: Essential thrombocythemia (ET), a subcategory of chronic myeloproliferative disorder, is characterized by absolute thrombocytosis due to excessive clonal proliferation of platelets, hyperaggregability of platelets, and increased incidence of thrombosis and hemorrhage. We consider a diagnosis of ET when an unexplained and persistent thrombocytosis is observed. It is difficult to consider ET first when we meet a patient with esophageal varix bleeding or unusual multiple thromboses like mesenteric vein, splenic vein, and portal vein. This article reports a patient who presented initially with esophageal varix bleeding and unusual multiple thromboses, thereafter, she was diagnosed with ET after testing positive for the Janus Tyrosine Kinase 2 (JAK2) V617F mutation. In conclusion, in patients with varix bleeding and unusual multiple thromboses, myeloproliferative disorders like essential thrombocythemia should be considered as a potential cause and testing for the JAK2 mutation is warranted.

Neuro-Behcet's Disease Presented with Cerebral Venous Sinus Thrombosis: A Case Report.: Yun Kyung Lee, Mee Young Park, Seung Hyun Lee, Sung Gyun Joo, Yong Kook Cho; Yeungnam Univ J Med. 2004;21(1):96-100. Published online June 30, 2004; DOI: https://doi.org/10.12701/yujm.2004.21.1.96

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Abstract PDF: Behcet's disease is a chronic, relapsing multisystem disorder, that may develop into variable neurological manifestations. They include vascular and parenchymal involvement. Vascular involvement is dominated by cerebral venous sinus thrombosis marked by benign intracranial hypertension. Cerebral venous sinus thrombosis can present with all the classical criteria for idiopathic intracranial hypertension, including normal brain CT findings with normal CSF content. But brain MRI is a useful diagnostic method in this situation to confirm the presence of cerebral venous sinus thrombosis. We experienced a case of raised intracranial pressure in a 21-year-old man, caused by cerebral venous sinus thrombosis. We disclosed his symptoms and signs thus fulfilling the diagnostic criteria for Behcet's disease.

A Case of Superior Mesenteric Venous Thrombosis after Endoscopic Sclerotherapy.: Won Duck Kim, Kwang Hae Choi, Jeong Ok Hah; Yeungnam Univ J Med. 2001;18(2):297-301. Published online December 31, 2001; DOI: https://doi.org/10.12701/yujm.2001.18.2.297

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Abstract PDF: The efficacy of injection sclerotherapy for treatment of acute esophageal variceal bleeding is well established. But several complications of endoscopic sclerotherapy have been reported. One of the complications is mesenteric venous thrombosis which develops when vasopressin is user for the sclerotherapy. We report a case of superior mesenteric venous thrombosis with developed after endoscopic sclerotherapy for control of esophageal variceal bleeding.

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