Acute Mesenteric Thrombosis: A Hematologist Perspective

Abstract

Acute vascular insufficiency of intestines (AVI) is a rare cause of severe abdominal pain contributing to 0.09% to 2% of admissions in surgical emergency. Despite its rarity, it needs early recognition because of its high mortality of 40% to 80% requiring timely diagnosis and prompt intervention. Occlusion of mesenteric vessels by arterial embolism (50%) or thrombosis (15% to 25%) and venous thrombosis (5%) are the predominant underlying causes. However, AVI may be nonocclusive in 20% to 30% of the patients. 1,2 Normally intestinal ischemia is prevented by its high perfusion through celiac mesenteric artery, superior mesenteric artery/inferior mesenteric artery, and a parallel system of venous drainage. 3 Therefore, bowel ischemia can occur only when blood supply is markedly reduced to 75% or more leading to a continuum of intestinal necrosis, perforation, infarction, or gangrene stimulating a severe inflammatory response that may be fatal. 4 Recently, activation of Janus kinase/transducer signaling pathway is proposed as an underlying mechanism for mesenteric ischemia. 5 Bowel ischemia is of interest to the clinical hematologist because of its association with thromboembolism. Hematologists are frequently consulted for anticoagulating patients having AVI with or without concomitant bleeding risks. It is important for the hematologists to know the pathophysiology of bowel ischemia, rationale of anticoagulation, preferred anticoagulants, and the selection of patients for thrombophilia screening. This study was conducted to evaluate the clinicopathological spectrum and outcome of thrombosis in acute mesenteric ischemia at

Scoping Review of Clinical Presentations and Outcomes in Patients with Concomitant COVID-19 Infection and Acute Mesenteric Ischaemia

“…Anticoagulation is strongly recommended for all cases of AMI from the time of diagnosis. However, the indication is more robust in the case of venous mesenteric ischaemia than in the other types [ 17 , 18 , 76 , 77 ]. Extended anticoagulation through post-operative and post-discharge is crucial to reduce the incidence of future clots.…”

Carbonization of quercetin into nanogels: a leap in anticoagulant development

“…This finding is crucial, as long-term anticoagulant therapy is often vital for patients with a history of mesenteric ischemia, especially those with conditions like atrial fibrillation or thrombophilia, to prevent life-threatening recurrences. 73 Mesenteric ischemia, commonly caused by thrombosis in an artery supplying the small intestine, necessitates prompt treatment to restore blood flow and prevent irreversible tissue damage and potential organ failure. 74 Without immediate intervention, the condition may rapidly lead to intestinal gangrene, increasing the risk of sepsis and mortality.…”

“…Although conventional anticoagulants can reduce the recurrence of mesenteric ischemia, their associated risks, including gastrointestinal bleeding and intracranial hemorrhage, present significant challenges, particularly in patients with comorbidities or on multiple medications. 73,75 The CNG Qur270 , with its multifaceted anticoagulation properties, shows promise in mitigating these side effects, effectively preventing mesenteric ischemia. Additionally, controlling the carbonization of flavonoids to create carbonized anticoagulants represents a sophisticated approach in anticoagulation therapy.…”