Histological criteria for age determination of fatal venous thromboembolism

Maffeis, Valeria; Nicolè, Lorenzo; Rago, C.; Fassina, Ambrogio

doi:10.1007/s00414-017-1705-4

Cited by 10 publications

(11 citation statements)

References 42 publications

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“…Subsequently, 10 articles [ 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ] were excluded because they did not meet the inclusion criteria (studies based on experimental animal models). Finally, 4 articles were included for qualitative synthesis ( Figure 1 ) [ 28 , 30 , 43 , 44 ].…”

Section: Resultsmentioning

confidence: 99%

“…The articles were published in English between 2009 and 2019. From the point of view of the type of study, one article was a case report [ 43 ] and three articles were retrospective studies based on the analysis of samples previously collected [ 28 , 30 , 44 ]. A total of 157 DVT and 171 PTE samples were taken.…”

Section: Resultsmentioning

confidence: 99%

“…From the point of view of the population considered, the 187 total subjects consisted of 90 males 97 females, with an age between 35 and 87 years. Thrombotic pathology was found in all cases of the studies considered, while PTE was found only in the autopsy findings related to three studies [ 30 , 43 , 44 ].…”

Section: Resultsmentioning

confidence: 99%

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State-of-Art in the Age Determination of Venous Thromboembolism: A Systematic Review

et al. 2021

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Venous thromboembolism (VTE), consisting of deep vein thrombosis (DVT) and pulmonary embolism (PE), requires a forensic age determination to ascertain their causal relationship with recent events, such as trauma or medical treatment. The main objective of this systematic review is to identify the current state-of-the-art immunohistochemical methods for age determination of fatal VTE. A literature search was performed through different databases, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Within the study, we have selected only cases represented by deceased patients for DVT and/or PTE in which thromboembolic material was collected during an autoptic examination and then subjected to a histological and an immunohistochemical investigation. Studies based on animal models were not included. We assessed bias risk. A database-based search produced a total of 19 articles. After excluding duplicate items from the selection, 14 articles were reviewed. Ten articles were excluded because they did not meet the inclusion criteria. The results have pointed out 4 studies that were included in the present analysis for a total of 157 samples of DVT and 171 PTE samples. These were analyzed using traditional histological and immunohistochemical techniques. The results must be interpreted with a critical eye because of their heterogeneity in terms of time, geography, and study design. The present review highlights the importance of associating specific immunohistochemical markers with a histological analysis for the timing of DVT/PTE fatal events. Further future experiences will hopefully endorse actual knowledge on the subject to increase the accuracy in the assessment of thrombus-embolus age.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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State-of-Art in the Age Determination of Venous Thromboembolism: A Systematic Review

et al. 2021

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“…This study introduces a methodological approach that combines clinical data derived from autopsy and histological analysis; so, it appears to be the first valid approach for the determination of thrombus formation through histological criteria. A recent case report highlighted that although pathology skills are mandatory for an accurate chronological evaluation of fatal PE, histopathology and immunohistochemistry play both a crucial role in the evaluation of PE to the specific case [22]. Therefore, our experience in forensic thanatology [23, 24] reinforces the concept that microscopic observation is at the basis of a correct diagnosis and able to provide informations also for forensic practice and in the specific case in the age-old question of dating [13].…”

Section: Discussionmentioning

confidence: 99%

The dating of thrombus organization in cases of pulmonary embolism: an autopsy study

Mansueto

Costa

Capasso

et al. 2019

BMC Cardiovasc Disord

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BackgroundPulmonary embolism (PE) is associated to high mortality rate worldwide. However, the diagnosis of PE often results inaccurate. Many cases of PE are incorrectly diagnosed or missed and they are often associated to sudden unexpected death (SUD). In forensic practice, it is important to establish the time of thrombus formation in order to determine the precise moment of death. The autopsy remains the gold standard method for the identification of death cause allowing the determination of discrepancies between clinical and autopsy diagnoses. The aim of our study was to verify the morphological and histological criteria of fatal cases of PE and evaluate the dating of thrombus formation considering 5 ranges of time.MethodsPulmonary vessels sections were collected from January 2010 to December 2017. Sections of thrombus sampling were stained with hematoxylin and eosin. The content of infiltrated cells, fibroblasts and collagen fibers were scored using a semi-quantitative three-point scale of range values.ResultsThe 30 autopsies included 19 males (63.3%) and 11 females (36.7%) with an average age of 64.5 ± 12.3 years. The time intervals were as follows: early (≤1 h), recent (> 1 h to 24 h), recent-medium (> 24 h to 48 h), medium (> 48 h to 72 h) and old (> 72 h). In the first hour, we histologically observed the presence of platelet aggregation by immunofluorescence method for factor VIII and fibrinogen. The presence of lymphocytes has been identified from recent thrombus (> 1 h to 24 h) and the fibroblast cells were peripherally located in vascular tissue between 48 and 72 h, whereas they resulted central and copious after 72 h.ConclusionsAfter a macroscopic observation and a good sampling traditional histology, it is important to identify the time of thrombus formation. We identified histologically a range of time in the physiopathology of the thrombus (early, recent, recent-medium, medium, old), allowing to determine the dating of thrombus formation and the exact time of death.Clinical trial numberNCT03887819.Trial registrationThe trial registry is Cliniclatrials.gov, with the unique identifying number NCT03887819. The date of registration was 03/23/2019 and it was “Retrospectively registered”.

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“…The age assessment of a DVT carries special medicolegal significance. Various elaborative histological techniques, including special immunhistochemical methods, have been described to estimate the age of a thrombus [25][26][27][28]. Overall, one may determine whether a thrombus is acute, organizing, or remote.…”

Section: Histological Dating Of the Thrombusmentioning

confidence: 99%

Autopsy and Medicolegal Evaluation in a Case of Sudden Maternal Death from Pulmonary Embolism

Pawan¹,

Karagwal²,

Gilotra³

et al. 2021

Int J Pathol Clin Res

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Pregnancy and the postpartum period carry high risk of thromboembolic phenomenon which increases manifold postpartally. Multiple predisposing risk factors, usually acting in combination, add up to this risk. All three of the Virchow's triad conditions predisposing to vascular thrombosis, i.e., endothelial injury, venous stasis and hypercoagulability, are present in pregnancy. The deaths caused by pulmonary embolism may become the subject of medicolegal investigation due a sudden and unexpected fatal outcome. A thorough dissection, documentation and ancillary investigations pertaining to pulmonary emboli are important components of evaluating such fatalities. The investigation requires a dependable protocol that should include a proper evaluation of the timing of the embolus along with the residual and other thrombi, whenever discovered. Because of the pathophysiology and propagation of thrombus over a range of time period, one may see a broad histological range of thrombosis and organization. The present case pertains to the sudden death of a young female in the postpartum period who suffered a massive pulmonary embolism about 6 weeks after delivery. An extensive dissection of the lower limbs showed multiple deep venous thrombi in the calf and femoral regions while moderate to large coiled emboli were found in the pulmonary arterial vasculature. An additional histopathological dating of the thrombi as well as pulmonary embolus was performed that helped in elucidating the time range of their development.

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Histological criteria for age determination of fatal venous thromboembolism

Cited by 10 publications

References 42 publications

State-of-Art in the Age Determination of Venous Thromboembolism: A Systematic Review

State-of-Art in the Age Determination of Venous Thromboembolism: A Systematic Review

The dating of thrombus organization in cases of pulmonary embolism: an autopsy study

Autopsy and Medicolegal Evaluation in a Case of Sudden Maternal Death from Pulmonary Embolism

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