Arterial thrombotic events

Laboratory tests for hypercoagulable states should be done only when the cause of the stroke cannot be determined based on the presence of well-known risk factors. Protein C, protein S, and antithrombin III are best measured in steady state rather than in the acute stage. Antiphospholipid antibodies are of higher yield but should be reserved for patients aged less than 50 years and those who have had multiple venous or arterial thrombotic events or livedo reticularis. 

Although increased plasma von Willebrand factor (vWF) levels have been attributed to increased risk of arterial thrombotic events, no gene polymorphisms in vWF have been identified. 

The initial question must be whether the clinical data point to the emergence of complications of this type. The 1990 International Consensus Meeting found an increase in acute cardiovascular accidents during use of oral contraceptives, but not persisting after they had been discontinued. There is also a great deal of anecdotal evidence, although in view of the massive scale on which oral contraceptives have been used over 40 years, coincidence alone would lead to the accumulation of many reports of adverse events. Other evidence suggesting an increase in arterial thrombotic events has been noted incidentally in... 

Pazopanib (kinase inhibitor) QT prolongation and TdP, congestive heart failure and decreased left ventricular ejection fraction, hypertension, fatal hemorrhagic events, arterial thrombotic events... 

Arterial thrombotic events are the leading cause of MI and have recently been identified as a major contributing factor to plaque progression. The detection of thrombus in a coronary artery is crucially important, as it is used to verily plaque rupture, evaluate the efficacy of thrombolytic therapy, assess the need for thrombectomy and determine the risk for distal embolization and thrombus protrusion through stent struts if percutaneous coronary intervention is warranted [69]. Unfortunately, no FDA-approved technology can accurately detect intraluminal thrombus. 

Morbidity and mortality in HIT are related to thrombotic events. Venous thrombosis occurs most commonly, but occlusion of peripheral or central arteries is not infrequent. If an indwelling catheter is present, the risk of thrombosis is increased in that extremity. Skin necrosis has been described, particularly in individuals treated with warfarin in the absence of a direct thrombin inhibitor, presumably due to acute depletion of the vitamin -dependent anticoagulant protein C occurring in the presence of high levels of procoagulant proteins and an active hypercoagulable state. 

The use of iloprost has been proposed in patients with systemic sclerosis, a disease that is often characterized by pulmonary hypertension and Raynaud s phenomenon. Three patients with systemic sclerosis who were treated with iloprost developed acute thrombotic events (3). In one case, intestinal infarction occurred 1 day after infusion of iloprost. In another patient the left kidney was not perfused 22 days after the last infusion of iloprost because of thrombosis of the left renal artery. The last patient, 9 months after the start of treatment with iloprost, and 5 days after the last infusion, had an anterolateral myocardial infarction. The authors commented that their observations did not allow them to conclude that there is a direct relation between infusion of iloprost and thrombotic events. However, they said that this possibility should be considered, and they suggested that risk factors for thromboembolism should be carefully evaluated in each patient with systemic sclerosis who is receiving iloprost. 

Hardhammar, P.A., van Beusekom, H.M., Emanuelsson, H.U., Elofma, S.E1., Albertsson, P.A., Verdouw, P.D. et al. (1996) Reduction in thrombotic events with heparin-coated Palmaz-Schatz stents in normal porcine coronary arteries. Circulation, 93, 423 130. 

Hardhammar P Van Beusekom H, Emanuelsson H, et al. Reduction in thrombotic events with heparin-coated Palmaz-Schatz stents in normal coronary arteries. Circulation 1996 93 423-430. 

Thrombin is known to play a cracial role in the overall thrombotic events leading to both arterial and venous thrombosis (36). Beside the transformation of fibrinogen to fibrin, this enzyme is claimed to mediate the activation of platelets and macrophages and produces... 

Excessive factor VIII activity in vulnerable arterial beds, for example atherosclerotic vessels, could lead to thrombotic events, such as venous thrombosis or myocardial infarction. In patients with hemophilia A... 

Injectable ibuprofen is contraindicated in the peri-operative period in patients imdergoing coronary artery bypass graft (CABG) simgery secondary to an increased risk of thrombotic events and myocardial infarction. 

Axitinib (Inlyta) VEGFR-1, 2, and 3 2012 CV, CNS, pulmonary, GI 1 gastric emptying TBP, iHR ECG in dog—no effect 6-mraith mouse, 9-month dog Broken teeth (mice), spleen Hypertension, arterial and venous thrombotic events, hemorrhagic events, gastrointestinal perforatirai, hypothyroidism, RPLS, proteinuria, liver enzyme elevation... 

In a patient presenting with symptoms of an acute arterial occlusion, time is critical. If the limb is threatened on physical exam, the patient should proceed to angiography/surgery without noninvasive testing. In a nonthreatened limb with suspected occlusion, ABIs can be performed along with a duplex scan. A duplex scan can help to identify the source of occlusion or confirm a thrombotic event, such as in the territory of a peripheral aneurysm or a stenosis (Fig. 5). 

A 47-year-old woman with schizophrenia was found dead in her apartment. She had been taking lithium and olanzapine. Autopsy showed an acute pulmonary embolus in the left main pulmonary artery, with extension into the lobar branches and an adherent thrombus in the left popliteal vein. There was no evidence of other pathology. Postmortem toxicology confirmed the presence of olanzapine and showed no other substances. There were no other risk factors, such as obesity, a sedentary lifestyle, a history of smoking, recent trauma or immobilization, use of estrogens, or a family history of thrombotic events factor V Leiden and prothrombin mutations were negative. 

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