Warfarin anticoagulation before angioplasty relieves thrombus burden in Budd-Chiari syndrome caused by inferior vena cava anatomic obstruction

Li, Tianxiao; Zhang, Wayne W.; Bai, Weixing; Zhai, Shengli; Pang, Zhigang

doi:10.1016/j.jvs.2010.05.098

Cited by 18 publications

(9 citation statements)

References 21 publications

(26 reference statements)

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“…Due to necessity of intravenous administration, the practical utility of thrombin-inhibiting NPs would be focused to acute use, but a number of important indications exist for emergent application, including acute vascular syndromes, angioplasty [3], microangiopathy [30], acute kidney injury [31], and arteriovenous fistula and/or graft maintenance [32]. Given the success of thrombin inhibiting particles featuring functional moieties with distinctive properties (either PPACK or bivalirudin), the formation of an antithrombotic layer appears to be the critical feature in the success of the nanoparticle strategy in mouse models.…”

Section: Discussionmentioning

confidence: 99%

Thrombin-inhibiting nanoparticles rapidly constitute versatile and detectable anticlotting surfaces

Myerson¹,

He²,

Allen³

et al. 2014

Nanotechnology

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Restoring an antithrombotic surface to suppress ongoing thrombosis is an appealing strategy for treatment of acute cardiovascular disorders such as erosion of atherosclerotic plaque. An antithrombotic surface would present an alternative to systemic anticoagulation with attendant risks of bleeding. We have designed thrombin-targeted nanoparticles that bind to sites of active clotting to extinguish local thrombin activity and inhibit platelet deposition while exhibiting only transient systemic anticoagulant effects. Perfluorocarbon nanoparticles (PFC NP) were functionalized with thrombin inhibitors (either PPACK or bivalirudin) by covalent attachment of more than 15,000 inhibitors to each PFC NP. Fibrinopeptide A ELISA demonstrated that thrombin-inhibiting NPs prevented cleavage of fibrinogen by both free and clot-bound thrombin. Magnetic resonance imaging confirmed that a layer of thrombin-inhibiting NPs prevented growth of clots in vitro. Thrombin-inhibiting NPs were administered in vivo to C57BL6 mice subjected to laser injury of the carotid artery. NPs significantly delayed thrombotic occlusion of the artery, whereas an equivalent bolus of free inhibitor was ineffective. For thrombin-inhibiting NPs, only a short-lived (~10 minutes) systemic effect on bleeding time was observed, despite prolonged clot inhibition. Imaging and quantification of in vivo antithrombotic NP layers was demonstrated by magnetic resonance imaging (MRI) of the PFC NP. 19F MRI confirmed colocalization of particles with arterial thrombi, and quantitative 19F spectroscopy demonstrated specific binding and retention of thrombin-inhibiting NPs in injured arteries. The ability to rapidly form and image a new antithrombotic surface in acute vascular syndromes while minimizing risks of bleeding would permit a safer method of passivating active lesions than current systemic anticoagulant regimes.

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Section: Discussionmentioning

confidence: 99%

Thrombin-inhibiting nanoparticles rapidly constitute versatile and detectable anticlotting surfaces

Myerson¹,

He²,

Allen³

et al. 2014

Nanotechnology

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“…However, a massive fresh thrombus in IVC is a contraindication [11,12]. Some clinicians prefer to suppress the thrombosis first and then to rupture the membrane.…”

Section: Discussionmentioning

confidence: 99%

Applicability of Different Endovascular Methods for Treatment of Refractory Budd–Chiari Syndrome

Gao¹,

Chen²,

Yu³

2011

Cell Biochem Biophys

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The study's objective was to evaluate the applicability of different endovascular methods for treatment of refractory type of Budd-Chiari syndrome (BCS) under specific scenarios frequently encountered in patients. The treatment methods were evaluated in 197 patients with the following four types of refractory BCS: lesions of the inferior vena cava (IVC) including a special shape diaphragm (e.g., a knife- or a vertically shaped diaphragm, etc.), occlusion of the long segment of IVC, IVC obstruction combined with thrombosis, and occlusion of the hepatic vein. The choice of endovascular treatment depended on the degree of difficulty to puncture the membrane after spatial orientation. There was a need to adjust the curvature of the device to fit the natural angle of IVC. When IVC lesions were combined with thrombosis, the treatment was adjusted depending on the freshness of the thrombus. Different routes were used to rupture the membrane and expand the lesion. The majority of patients recovered without complications. The few complications observed were the following: 1 case of death due to a postoperative stress ulcer, 1 case of a successfully treated pericardial tamponade, 1 case of stent migration, and 3 cases of failure to stent and re-occlusion that occurred in the follow-up period. To conclude, BCS is preferably treated via endovascular intervention; however, the particular choice depends on individual circumstances.

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“…5 IVC thrombosis was once considered a contraindication to endovascular therapy because of the risk of potentially fatal pulmonary embolism from dislodgement of the thrombus after opening the blocked IVC. However, in recent years, many therapeutic approaches to treating BCS with IVC thrombosis have been advanced: anticoagulation therapy, 6,7 thrombolytic therapy, 8 large lumen catheter aspiration, 5,9 stent press thrombus, 10,11 agitation thrombolysis, 12 pre-dilation therapy, 13 retrieval stent filter placement, 14e16 and direct large balloon dilation. 11,17 However, optimal treatment methods for BCS with IVC thrombosis have not been defined, and the numbers of reported cases are insufficient to permit reliable assessment of long-term outcome.…”

Section: Introductionmentioning

confidence: 99%

An Individualised Strategy and Long-Term Outcomes of Endovascular Treatment of Budd–Chiari Syndrome Complicated by Inferior Vena Cava Thrombosis

Ding

Han

et al. 2018

European Journal of Vascular and Endovascular Surgery

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Warfarin anticoagulation before angioplasty relieves thrombus burden in Budd-Chiari syndrome caused by inferior vena cava anatomic obstruction

Abstract: Spontaneous fibrinolysis of IVC thrombus occurs within 1 year in the majority of the patients treated with warfarin. Pre-treatment with warfarin prevents PE after PTBA in the patients with BCS with IVC membranous or segmental occlusion and large thrombus.

Cited by 18 publications

References 21 publications

Thrombin-inhibiting nanoparticles rapidly constitute versatile and detectable anticlotting surfaces

Thrombin-inhibiting nanoparticles rapidly constitute versatile and detectable anticlotting surfaces

Applicability of Different Endovascular Methods for Treatment of Refractory Budd–Chiari Syndrome

An Individualised Strategy and Long-Term Outcomes of Endovascular Treatment of Budd–Chiari Syndrome Complicated by Inferior Vena Cava Thrombosis

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