Thrombotic superior vena cava syndrome: a national emergency department database study

Mir, Tanveer; Uddin, Mohammed; Shafi, Obeid; Qureshi, Waqas; Kaur, Jasmeet; Zghouzi, Mohamed; Lohia, Prateek; Soubani, Ayman O.; Burket, Mark W.; Sheikh, Mujeeb; Saydain, Ghulam

doi:10.1007/s11239-021-02548-7

Cited by 9 publications

(10 citation statements)

References 17 publications

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“…Patients with age < 18 years at the time of presentation were excluded from the study. A similar methodologic approach was used to our previous studies [ 11 , 12 ].…”

Section: Methodsmentioning

confidence: 99%

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Predictors of Complications Secondary to Infective Endocarditis and Their Associated Outcomes: A Large Cohort Study from the National Emergency Database (2016–2018)

et al. 2021

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Introduction Literature regarding outcomes and predictors of complications secondary to infective endocarditis (IE) is limited. We aimed to study the outcomes and predictors of complications of IE. Methods Data from a national emergency department sample, which constitutes 20% sample of hospital-owned emergency departments in the USA, were analyzed for hospital visits for IE. Complications of endocarditis were obtained by using ICD codes. Multivariable generalized linear method was used to evaluate predictors of in-hospital mortality and complications. Results Out of 255,838 adult IE patients (mean age 60.3 ± 20.1 years, 48.5% females), 97,803 (38.2%) patients developed one or more major complications. The major complications were cardiovascular system complications [57,900 (22.6%)], neurologic [42,851 (16.7%)] complications, and renal [16,236 (6.4%)] complications. These included cardiogenic shock [3873 (1.5%)], septic shock [25,798 (10.1%)], acute heart failure [35,602 (14%)], systemic thromboembolism (STE) [21,390 (8.36%)], heart block [11,430 (4.47%)], in-hospital dialysis [2880 (1.1%)], and disseminated intravascular coagulation (DIC) [2704 (1.1%)]. Patients with complicated IE had risk of mortality (adjusted RR 1.12, 95% CI 1.11–1.13, p < 0.001). The complications strongly associated with mortality were septic shock (RR 1.29, 95% CI 1.27–1.30, p < 0.001), cardiogenic shock (RR 1.24, 95% CI 1.20–1.29, p < 0.001), DIC (RR 1.4, 95% CI 1.35–1.46, p < 0.001), and STE (RR 1.07, 95% CI 1.05–1.08, p < 0.001). Staphylococci were the predominant causative organisms (30.8%) among the complicated IE subgroups with higher associated mortality (42.8%). The main predictors of complications from IE were congenital heart disease, history of congestive heart failure, high Elixhauser comorbidity profile, staphylococcal infection, and fungal infections. The prevalence of cardiogenic shock increased over the study years from 1.13 to 1.98% ( p -trend 0.04). Conclusion Complicated IE is not uncommon and is associated with significant mortality. Staphylococcal infections were associated with high mortality rates. There has been an increasing trend of cardiogenic shock among IE patients across the US. Further research is needed to improve the outcomes of complicated endocarditis. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00563-y.

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“…Patients with age < 18 years at the time of presentation were excluded from the study. A similar methodologic approach was used to our previous studies [ 11 , 12 ].…”

Section: Methodsmentioning

confidence: 99%

“…Pearson’s chi-square test was used to compare categorical variables, and linear regression was used to compare continuous variables. A similar methodologic approach was used as in our previous studies [ 11 , 12 ].…”

Section: Methodsmentioning

confidence: 99%

Predictors of Complications Secondary to Infective Endocarditis and Their Associated Outcomes: A Large Cohort Study from the National Emergency Database (2016–2018)

et al. 2021

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“…SVC syndrome refers to the obstruction of venous flow in the superior vena cavaIntrathoracic, malignancies are responsible for 60-85% of cases of SVC syndrome, and the occurrence of device-related SVC obstruction has increased and accounts for around 20-40% of overall cases [3]. Procedures performed on venous vasculature, resulting in a possible intimal injury or venous stenosis, provoked by transvenous leads, seem to be the most plausible explanation for the observed complication [4].…”

Section: Discussionmentioning

confidence: 99%

Treatment of pacemaker-induced superior vena cava syndrome by direct oral anticoagulant

et al. 2023

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Background The use of cardiac implantable electronic devices has grown substantially over the past two decades, lead-related vascular issues are commonly encountered in clinical practice. Superior vena cava (SVC) syndrome due to pacemaker leads is an uncommon complication. Anticoagulation remains the mainstay of therapy to restore some degree of patency and relieve swelling. However, there are limited clinical trials on direct oral anticoagulants (DOACs). Case presentation We report a case of an 80-year-old man who developed SVC syndrome after transvenous pacemaker implantation with symptoms of obstruction that were significantly relieved after four months of DOACs. His symptoms had completely resolved nine months later. Conclusions DOACs are effective in the treatment of SVC syndrome after pacemaker implantation, representing an important new approach. It is a very good choice for patients who do not want to undergo interventional therapy.

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“…SVC syndrome is an uncommon medical emergency and remains a rare diagnosis in the ED [ 9 ]. There is a risk of cognitive bias resulting in diagnostic error, as occurred in this case.…”

Section: Discussionmentioning

confidence: 99%

Facial Swelling Mimicking Anaphylaxis: A Case of Superior Vena Cava Syndrome in the Emergency Department

Salama¹,

Ukwade²,

Khan³

et al. 2022

Cureus

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Superior vena cava (SVC) syndrome represents clinical manifestations from obstruction of the SVC. It is an uncommon medical emergency that is commonly missed. SVC obstruction is usually caused by extraluminal compression by an intrathoracic mass or intraluminal obstruction from a thrombus. The latter is more common in patients with indwelling central venous catheters and pacemaker leads. Here, we present the case of a 53-year-old woman who presented to the emergency department (ED) with clinical features which were initially diagnosed as anaphylaxis and subsequently diagnosed as a case of SVC syndrome. In this case, diagnostic challenges in the ED and the potential role of cognitive bias are highlighted. In addition, we discuss the clinical manifestations and management of SVC syndrome.

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Thrombotic superior vena cava syndrome: a national emergency department database study

Cited by 9 publications

References 17 publications

Predictors of Complications Secondary to Infective Endocarditis and Their Associated Outcomes: A Large Cohort Study from the National Emergency Database (2016–2018)

Predictors of Complications Secondary to Infective Endocarditis and Their Associated Outcomes: A Large Cohort Study from the National Emergency Database (2016–2018)

Treatment of pacemaker-induced superior vena cava syndrome by direct oral anticoagulant

Facial Swelling Mimicking Anaphylaxis: A Case of Superior Vena Cava Syndrome in the Emergency Department

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