Behcet's Disease as a Model of Venous Thrombosis~!2009-11-07~!2009-12-07~!2010-02-22~!

Regina, Micaela La; Gasparyan, Armen Yuri; Orlandini, Francesco; Prisco, Domenico

doi:10.2174/1874192401004020071

Cited by 12 publications

(6 citation statements)

References 72 publications

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“…The significance of this triad is that it unifies the inflammatory and the coagulation pathways in the genesis of clotting [63][64][65]. One classic example of Virchow's triad explaining thrombosis in vascular disease is the case of Behcet disease where abnormalities in the vessel wall and in the blood flow, as well as of hypercoagulability have been described [66].…”

Section: Virchow's Triad In Covid-19mentioning

confidence: 99%

Thrombosis in Coronavirus disease 2019 (COVID-19) through the prism of Virchow’s triad

2020

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The pathogenesis of Coronavirus disease 2019 (COVID-19) is gradually being comprehended. A high number of thrombotic episodes are reported, along with the mortality benefits of heparin. COVID-19 can be viewed as a prothrombotic disease. We overviewed the available evidence to explore this possibility. We identified various histopathology reports and clinical case series reporting thromboses in COVID-19. Also, multiple coagulation markers support this. COVID-19 can be regarded as a risk factor for thrombosis. Applying the principles of Virchow's triad, we described abnormalities in the vascular endothelium, altered blood flow, and platelet function abnormalities that lead to venous and arterial thromboses in COVID-19. Endothelial dysfunction, activation of the renin-angiotensin-aldosterone system (RAAS) with the release of procoagulant plasminogen activator inhibitor (PAI-1), and hyperimmune response with activated platelets seem to be significant contributors to thrombogenesis in COVID-19. Stratifying risk of COVID-19 thromboses should be based on age, presence of comorbidities, D-dimer, CT scoring, and various blood cell ratios. Isolated heparin therapy may not be sufficient to combat thrombosis in this disease. There is an urgent need to explore newer avenues like activated protein C, PAI-1 antagonists, and tissue plasminogen activators (tPA). These should be augmented with therapies targeting RAAS, antiplatelet drugs, repurposed antiinflammatory, and antirheumatic drugs.

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Section: Virchow's Triad In Covid-19mentioning

confidence: 99%

Thrombosis in Coronavirus disease 2019 (COVID-19) through the prism of Virchow’s triad

2020

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“…Endothelial activation in the lumen of affected vessels may result in vascular inflammation and thrombosis in BD [46, 47]. Many BD patients appeared to be in a generalized hypercoagulable state, based on evidence of increased thrombin formation and decreased fibrinolysis [48, 49]. Arteritis that involves the vascular system in the brain parenchyma may lead to ischemic stroke, aneurysmal dilatation, dissection, and subarachnoid hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Increased ischemic stroke risk in patients with Behçet’s disease: A nationwide population-based cohort study

Chai

et al. 2019

PLoS ONE

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Background Behçet’s disease (BD) is a recurrent, multisystemic, inflammatory disorder that mainly affects blood vessels. Because recurrent inflammation of blood vessels in the brain plays a crucial role in the development of ischemic stroke, we hypothesized that patients with BD might have an elevated risk of ischemic stroke. This potential association has been suggested in a few case reports, but not epidemiological studies. Hence, the present study aimed to examine the relation between BD and subsequent ischemic stroke in Taiwan using a nationwide, population-based database. Methods To establish a study cohort, the longitudinal data of 306 patients newly diagnosed with BD during 2000–2010 were extracted from the National Health Insurance Research Database, Taiwan. For comparison of ischemic stroke incidence, a control cohort of 1224 subjects without BD was established using a frequency-matched ratio of 1:4 for age, sex, and pre-existing comorbidities. Results During the 10-year follow-up, 13 (4.2%) patients with BD and 20 (1.6%) control subjects experienced ischemic stroke. Kaplan–Meier analysis revealed the higher prevalence of ischemic stroke in the BD group (log-rank test, p = 0.001). After adjusting for comorbidities and demographic characteristics, Cox regression analysis revealed that patients with BD had a 2.77-fold risk of ischemic stroke (95% confidence interval, 1.38–5.57) compared to control subjects. Conclusions Patients with BD have an elevated risk of ischemic stroke. Hence, BD may affect the vascular system in the brain, resulting in a stroke event.

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“…Thrombosis in BD is thought to be an inflammation-related model of thrombosis. 24–26 Hence, immunosuppressive drugs (such as corticosteroids, azathioprine, cyclophosphamide or cyclosporine A) are primary therapeutic modalities in such type of thrombosis, targeting to reduce the inflammation of the vessel wall. 27…”

Section: Discussionmentioning

confidence: 99%

Could be serum uric acid a risk factor for thrombosis and/or uveitis in Behcet’s disease?

Avcı

Avci

2018

Vascular

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Introduction Serum uric acid level increases in many inflammatory conditions. Uric acid triggers the vascular inflammation and artery damage, which causes to an increased risk of endothelial dysfunction and atherosclerosis. It is not clear in the literature whether uric acid contributes to uveitis by similar mechanisms. We investigated whether uric acid level increases in Behcet's disease patients with thrombosis or anterior uveitis. Patients and methods We reviewed the medical records of 914 Behcet's disease. After screening for exclusion criteria, there were 50 Behcet's disease patients with thrombotic complication and as the control group 202 BD patients without any vascular complication were included to the study. In the Anterior uveitis group, there were 53 Behcet's disease patients. The Control group consisted of 39 Behçet's disease patients without eye findings. Results Mean uric acid value was 4.96 ± 1.06 mg/dl in Behcet's disease patients with thrombosis whereas 4.08 ± 0.94 mg/dl in controls, indicating a significant difference ( p < 0.001). There was no significant difference between the mean ages of the patients in both groups. The mean age of the BD group without eye findings was 39.31 ± 10.47 years and that of the Behcet's disease with Anterior Uveitis group was 37.72 ± 9.65 years ( p = 0.453). The mean serum UA in the BD group without eye findings was 4.21 ± 1.21 mg/dl, while in the BD with Anterior Uveitis group it was 4.57 ± 1.37 mg/dl ( p = 0.201). Conclusion The extent of increase in uric acid level was greater in Behcet's disease patients that have a thrombotic complication compared to those without thrombotic complication. Uric acid seems to play a role in the pathogenesis of thrombosis. It is concluded that the elevation of serum uric acid level in patients with anterior uveitis with Behcet's disease is not statistically significant.

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Behcet's Disease as a Model of Venous Thrombosis~!2009-11-07~!2009-12-07~!2010-02-22~!

Cited by 12 publications

References 72 publications

Thrombosis in Coronavirus disease 2019 (COVID-19) through the prism of Virchow’s triad

Thrombosis in Coronavirus disease 2019 (COVID-19) through the prism of Virchow’s triad

Increased ischemic stroke risk in patients with Behçet’s disease: A nationwide population-based cohort study

Could be serum uric acid a risk factor for thrombosis and/or uveitis in Behcet’s disease?

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