Venous duplex and pathologic differences in thrombus characteristics between de novo deep vein thrombi and endovenous heat-induced thrombi

Santin, Brian J.; Lohr, Joanne M.; Panke, Thomas W.; Neville, Patrick; Felinski, Melissa M.; Kuhn, Brian; Recht, Matthew; Muck, Patrick

doi:10.1016/j.jvsv.2014.08.004

Cited by 15 publications

(12 citation statements)

References 14 publications

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“…Venous thromboembolism consists of deep vein thrombosis and pulmonary embolism, and is the third most common cardiovascular disease (CVD) worldwide ( 1 , 2 ). Deep venous thrombus is a CVD and a serious clinical issue that has shown a significantly increasing incidence over the last 20 years leading to pulmonary thromboembolism, and even the death of patients with acute deep venous thrombosis ( 3 ). Deep vein thrombosis is a pathological CVD and is induced by a large number of risk factors including various genetic factors, dietary habits, obesity, pregnancy, aging, drugs, trauma and cancer ( 4 , 5 ).…”

Section: Introductionmentioning

confidence: 99%

Rivaroxaban attenuates thrombosis by targeting the NF-κB signaling pathway in a rat model of deep venous thrombus

Wang

et al. 2017

Int J Mol Med

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Anticoagulant therapy is commonly used for the prevention and treatment of patients with deep venous thrombus. Evidence has shown that rivaroxaban is a potential oral anticoagulant drug for the acute treatment of venous thromboembolism. However, the rivaroxaban-mediated molecular mechanism involved in the progression of deep venous thrombosis has not been investigated. In the present study, we investigated the efficacy of rivaroxaban and the underlying signaling pathways in the prevention and treatment of rats with deep venous thrombosis. A rat model with deep vein thrombus formation was established and received treatment with rivaroxaban or PBS as control. The thrombin-activatable fibrinolysis inhibitor (TAFI) and plasminogen activator inhibitor-1 (PAI-1) were analyzed both in vitro and in vivo. The progression of thrombosis and stroke was evaluated after treatment with rivaroxaban or PBS. Nuclear factor-κB (NF-κB) signaling pathway in venous endothelial cells and in the rat model of deep venous thrombus was assessed. The therapeutic effects of rivaroxaban were evaluated as determined by changes in deep venous thrombosis in the rat model. Our results showed that rivaroxaban markedly inhibited TAFI and PAI-1 expression levels, neutrophils, tissue factor, neutrophil extracellular traps (NETs), myeloperoxidase and macrophages in venous endothelial cells and in the rat model of deep venous thrombus. Expression levels of ADP, PAIs, von Willebrand factor (vWF) and thromboxane were downregulated in vein endothelial cells and in serum from the experimental rats. Importantly, the incidences of inferior vena cava filter thrombus were protected by rivaroxaban during heparin-induced thrombolysis deep venous thrombosis in the rat model. We observed that activity of the NF-κB signaling pathway was inhibited by rivaroxaban in vein endothelial cells both in vitro and in vivo. Notably, immunohistology indicated that rivaroxaban attenuated deep venous thrombosis and the accumulation of inflammatory factors in the lesions in venous thrombus. Matrix metalloproteinase (MMP) expression and activity were downregulated in rivaroxaban-treated rats with deep venous thrombus. Rivaroxaban inhibited the elasticity of the extracellular matrix and collagen-elastin fibers. On the whole, these results indicate that rivaroxaban attenuates deep venous thrombus through MMP-9-mediated NF-κB signaling pathway.

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Section: Introductionmentioning

confidence: 99%

Rivaroxaban attenuates thrombosis by targeting the NF-κB signaling pathway in a rat model of deep venous thrombus

Wang

et al. 2017

Int J Mol Med

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“…The above-mentioned management guidelines adapted for the Lawrence classification are as follows: for classes 1 and 2 only observation and US follow-up are suggested; for class 3 (thrombus up to the level of the femoral venous wall) a decision should be made according to the surgeon's judgement, including the selection of anticoagulant (LMWH) treatment; for classes 4 and 5 anticoagulation with LMWH is proposed; and for class 6 a full therapeutic DVT treatment regimen is recommended [38]. According to the published outcomes of the clinical implementation of the above-mentioned EHIT management protocol, the stable nature of a thrombus, and low progression and embolisation rates allow safe treatment of most patients [38,[42][43][44][45]. Korepta et al identified 70 patients with EHIT in a study of 4799 ablation procedures.…”

Section: Specific Thrombotic Complications After Minimally Invasive Tmentioning

confidence: 99%

A review of the risk of deep vein thrombosis in surgical and minimally invasive treatment of varicose veins

Wołkowski¹,

Urbanek²

2018

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Deep vein thrombosis (DVT) remains one of the most important clinical complications of varicose vein surgery. Despite the fact that procedures employed in the treatment of varicose veins are commonly classified as carrying a low risk of thromboembolism, this risk may vary significantly across different patients due to the presence of individual risk factors. This is a review of the risk of DVT in surgical and minimally invasive treatment of varicose veins. In retrospective studies addressing open varicose vein surgery, the rate of symptomatic DVT has been estimated at approximately 1%, but in prospective imaging-based studies, the risk of DVT in clinical settings seems to be much higher. The role of risk factors for DVT as well as their proper evaluation and individual risk stratification are significant. Because of population aging, a higher incidence of thromboembolic complications can be expected, suggesting the need for an individualised approach to risk stratification and appropriate risk-adjusted prophylaxis in patients who are candidates for varicose vein treatment. The implementation of new treatment modalities, in particular thermal and non-thermal ablation, does not eliminate the risk of DVT completely despite their relatively minimally invasive nature. Moreover, these methods can be related to the occurrence of new types of thrombotic complications, such as endovenous heat-induced thrombosis. The limited number of prospective studies regarding thromboembolism prophylaxis in modern phlebological treatment warrants further research on the importance of patient assessment and evaluation of procedure-related risk factors for venous thromboembolism.

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“…41,42 The data suggest that most EHITs develop within 72 hours, but postprocedure surveillance ultrasound scans have identified an EHIT up to 4 weeks after endovenous ablation. 31,[34][35][36] The diagnostic duplex ultrasound examination can be performed in either the supine or standing position, although there is a greater incidence of false-positive results in the supine position. Therefore, all identified EHITs should be confirmed in the standing position, or supine on a tilt table, to ensure that the thrombus does not retract peripherally into the superficial vein lumen, thereby changing the diagnosis.…”

Section: Best Practice]mentioning

confidence: 99%

“…35 It is currently believed that most EHITs develop within 72 hours, but postprocedure surveillance ultrasound scans may occasionally identify an EHIT after 7 days and even up to 4 weeks after endovenous ablation. 31,[34][35][36] As timing of occurrence is not fully understood, a controversial point is whether an EHIT occurring more than 1 week after ablation should be regarded and treated as an EHIT or as a classic DVT. 37,38 In a prospective study by Lurie and Kistner 31 of patients undergoing RFA of the GSV, levels of C-reactive protein and D-dimer were measured before and after treatment.…”

Section: Introduction and Rationalementioning

confidence: 99%

Classification and treatment of endothermal heat-induced thrombosis: Recommendations from the American Venous Forum and the Society for Vascular Surgery This Practice Guidelines document has been co-published in Phlebology [DOI: 10.1177/0268355520953759] and Journal of Vascular Surgery: Venous and Lymphatic Disorders [DOI: 10.1016/j.jvsv.2020.06.008]. The publications are identical except for minor stylistic and spelling differences in keeping with each journal’s style. The contribution has

et al. 2020

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The American Venous Forum (AVF) and the Society for Vascular Surgery set forth these guidelines for the management of endothermal heat-induced thrombosis (EHIT). The guidelines serve to compile the body of literature on EHIT and to put forth evidence-based recommendations. The guidelines are divided into the following categories: classification of EHIT, risk factors and prevention, and treatment of EHIT. One major feature is to standardize the reporting under one classification system. The Kabnick and Lawrence classification systems are now combined into the AVF EHIT classification system. The novel classification system affords standardization in reporting but also allows continued combined evaluation with the current body of literature. Recommendations codify the use of duplex ultrasound for the diagnosis of EHIT. Risk factor assessments and methods of prevention including mechanical prophylaxis, chemical prophylaxis, and ablation distance are discussed. Treatment guidelines are tailored to the AVF EHIT class (ie, I, II, III, IV). Reference is made to the use of surveillance, antiplatelet therapy, and anticoagulants as deemed indicated, and the recommendations incorporate the use of the novel direct oral anticoagulants. Last, EHIT management as it relates to the great and small saphenous veins is discussed.

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Venous duplex and pathologic differences in thrombus characteristics between de novo deep vein thrombi and endovenous heat-induced thrombi

Cited by 15 publications

References 14 publications

Rivaroxaban attenuates thrombosis by targeting the NF-κB signaling pathway in a rat model of deep venous thrombus

Rivaroxaban attenuates thrombosis by targeting the NF-κB signaling pathway in a rat model of deep venous thrombus

A review of the risk of deep vein thrombosis in surgical and minimally invasive treatment of varicose veins

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