Histological age determination of venous thrombosis: A neglected forensic task in fatal pulmonary thrombo-embolism

Fineschi, Vittorio; Turillazzi, Emanuela; Neri, Margherita; Pomara, Cristoforo; Riezzo, Irene

doi:10.1016/j.forsciint.2009.01.006

Cited by 104 publications

(115 citation statements)

References 13 publications

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“…When forensic pathologists encounter cases of DVT-related PTE, they are always required to estimate how old the venous thrombi are, as well as skin wound age determination. Immunohistochemical techniques are widely used in the forensic research fields to estimate the age of skin wounds or brain contusions [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]; however, there are only a few forensic studies on thrombus age estimation [19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Immunohistochemical detection of MMP-2 and MMP-9 in a stasis-induced deep vein thrombosis model and its application to thrombus age estimation

et al. 2010

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We immunohistochemically examined the expression of matrix metalloproteinase (MMP)-2 and MMP-9 using venous thrombi developed by ligation of the inferior vena cava (IVC) in mice. Both MMP-2- and MMP-9- positive cells could be detected in the whole course of thrombus formation after IVC ligation. Morphometrically, their number was greatest 14 days after IVC ligation and thereafter, gradually decreased at 21 days. The number of MMP-9-positive cells was significantly higher than that of MMP-2-positive cells at 1 to 7 days. The average ratio of MMP-9 to MMP-2 (MMP-9/MMP-2 ratio) was >2.0 in all thrombus samples at 1-5 days. After 7 days, the MMP-9/MMP-2 ratio was less than 2.0. These observations implied that an MMP-9/MMP-2 ratio markedly exceeding 2.0 strongly indicates an age of 5 days or less. Furthermore, an MMP-9/MMP-2 ratio of <2.0 probably indicates an age of more than 7 days. The present study demonstrated that the immunohistochemical detection of intrathrombotic MMP-2 and MMP-9 was suitable to estimate the age of venous thrombi.

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Section: Introductionmentioning

confidence: 99%

Immunohistochemical detection of MMP-2 and MMP-9 in a stasis-induced deep vein thrombosis model and its application to thrombus age estimation

et al. 2010

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“…The results are somewhat surprising, because one could expect that Zahn lines do not occur often in the venous system where the flow regime is laminar (30,31). However, because post mortem accumulations of platelets can occur only on the exposed surface of venous thrombi (17), the Zahn lines in the core of the venous thrombi cannot be dismissed as an artifact.…”

Section: Discussionmentioning

confidence: 95%

“…The first part was subjected to prompt examination by MRI during thrombolysis, while the second part was analyzed by immunohistochemical staining to platelets, fibrin, and RBCs. According to the histological age determination all samples qualified to the phase I thrombotic material (17).…”

Section: Venous Thrombimentioning

confidence: 99%

An MRI study of the differences in the rate of thrombolysis between red blood cell‐rich and platelet‐rich components of venous thrombi ex vivo

Vidmar

Blinc

Kralj³

et al. 2011

Magnetic Resonance Imaging

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Purpose: To test whether T 1 -weighted MRI can detect the differences in the rate of thrombolysis induced by recombinant tissue plasminogen activator (rt-PA) between platelet-rich regions and red blood cell (RBC)-rich regions of venous thrombi ex vivo. Materials and Methods:Each of 21 venous thrombi ex vivo (8 pulmonary emboli and 13 in situ thrombi) was dissected along the longitudinal axis. Half of it was analyzed for the presence of platelet, fibrin, and RBC components by immunohistochemistry and the other half was imaged serially by high-resolution T 1 -weighted three-dimensional MRI to assess the progression of thrombolysis. The MR images were analyzed for proportions of the remaining platelet-rich and RBC-rich regions.Results: Laminated platelet-rich regions, corresponding to Zahn lines, were confirmed immunohistochemically and by MRI in 18/21 venous thrombi. In T 1 -weighted MR images (TE/TR ¼ 10/105 ms) the mean signal intensity of platelet-rich regions was on average 2.3 higher than that of RBC-rich regions. The rate of thrombolysis in plateletrich regions was on average 30% lower than in RBC-rich regions. After 120 min of thrombolysis the proportion of lysed platelet-rich regions was 0.27 6 0.04 versus 0.40 6 0.08 in RBC regions, which resulted in 1.4% decrease of lysed thrombus volume per 1% increase of platelet-rich content.Conclusion: Venous thrombi are most often composed of interspersed platelet-rich and RBC-rich regions. T 1 -weighted MRI is capable of noninvasive discrimination between those two components of venous thrombi ex vivo which have a different susceptibility to thrombolysis by rt-PA.

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“…In the case we describe, however, the period of time in which the thrombus originated may be determined owing to the immobilisation of the patient. As the assessment of the histological age of thromboses and pulmonary embolisms is mandatory for medical liability purposes, we took into account some of the criteria proposed by Irninger [4], Leu [5], Fineschi et al [6] and Nosaka et al [7,8].…”

Section: Autopsy Findingsmentioning

confidence: 99%

“…New technologies have enhanced interest in this field [1][2][3]. As regards with thrombus age estimation, the use of conventional histopathological methods was proposed by Irninger in the 1960s [4] and by Leu [5] in the 1980s, while more recent studies have focused on immunohistochemical methods [6][7][8]. In the case we describe here, the criteria for the age determination of venous thrombi were applied to a case of fatal thromboembolism during physical restraint in a patient suffering from schizophrenia.…”

Section: Introductionmentioning

confidence: 99%

Fatal thromboembolism following physical restraint in a patient with schizophrenia

Cecchi

Lazzaro²,

Catanese

et al. 2012

Int J Legal Med

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Fatal thromboembolism during physical restraint in patients suffering from psychotic disorders is a very rare occurrence. In the case we present here, the criteria used in forensic pathology for the age determination of venous thrombi are applied to a case of pulmonary embolism in a patient suffering from schizophrenia who died after physical restraint. The possible association between conventional antipsychotic drugs and deep venous thrombosis, followed by pulmonary embolism, in a man with no predisposing risk factors, as well as the question concerning the appropriateness of medical care, are discussed.

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Histological age determination of venous thrombosis: A neglected forensic task in fatal pulmonary thrombo-embolism

Cited by 104 publications

References 13 publications

Immunohistochemical detection of MMP-2 and MMP-9 in a stasis-induced deep vein thrombosis model and its application to thrombus age estimation

Immunohistochemical detection of MMP-2 and MMP-9 in a stasis-induced deep vein thrombosis model and its application to thrombus age estimation

An MRI study of the differences in the rate of thrombolysis between red blood cell‐rich and platelet‐rich components of venous thrombi ex vivo

Fatal thromboembolism following physical restraint in a patient with schizophrenia

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