Thrombosis is the formation of a blood clot within the vasculature, and can occur both within the arterial and venous systems. It contributes to a variety of conditions, including myocardial infarction, stroke, pulmonary embolism (PE), and limb ischemia. This specialized issue will cover topics related to thrombosis, largely focused on venous thrombotic conditions.
Venous thromboembolism (VTE) is a condition which includes deep vein thrombosis (DVT) and PE most commonly, but also includes thromboses of other vessels, such as the portal or splenic vein. VTE is a disease process which carries significant morbidity and mortality (1). Acute sequelae include sudden death and complications from anticoagulation. Longer-term sequelae include post-thrombotic syndrome (PTS) in up to 50% of patients and chronic thromboembolic pulmonary hypertension (CTEPH) in approximately 3% (2-4). Despite treatment, recurrence remains high; over 10% of patients recur at 1- and 10-year recurrence rates approach 30% (5,6). VTE also carries a high mortality rate. A recent large cohort study demonstrated 30-day mortality of 3% for DVT and 31% for PE. At 1 year, DVT mortality was 13% and 20% for PE (7).
VTE can be caused by a variety of inherited or acquired conditions which influence coagulation, including inherited coagulopathies, advanced age, obesity, trauma, surgery, infection, malignancy or pregnancy (8-13). After reaching sufficient clinical suspicion for VTE, diagnosis can be confirmed with imaging. Ultrasonography is the standard modality for DVT diagnosis, while computed tomography angiography is recommended for PE. First line treatment generally consists of systemic anticoagulation (14). However, if there are contraindications to anticoagulation, complications or failure of anticoagulation therapy, placement of an inferior vena cava filter is recommended (15). Adjunct therapies may be appropriate in the proper clinical setting. These include systemic lytic therapy, catheter-directed thrombolysis, thrombectomy (pharmacomechanical, aspiration or surgical), and stenting (16-20). Careful risk stratification is needed to determine patients best suited for further interventions beyond systemic anticoagulation (14,21).
Prevention and treatment of thrombosis is also an important concern to maintain patency of stents, fistulas, and grafts. Although drug-eluding stents have decreased the incidence of coronary artery stent thrombosis, the event still carries high mortality of 20–48% and myocardial function rates of 60–70% (22). Proper treatment of arteriovenous fistula thromboses and transjugular intrahepatic portosystemic shunt (TIPS) thromboses is important to preserve function vital to the health and survival of the patient with renal or hepatic failure.
The topic of thrombosis is explored in further detail in this specialized focused issue. Review of thrombus pathogenesis is provided by Monie et al. (23). Stone et al. detail the pathogenesis, diagnosis and management of DVT (24). Catheter-directed treatments are explored for VTE; Fleck et al. perform a review of the literature and practice considerations for catheter-directed thrombolysis of DVT (25), while Naidu et al. discuss the rationale for catheter-directed therapy in PE (26). Exploring the role of cancer and thrombosis, Quencer et al. discuss its incidence, imaging, prognosis and treatment (27). In an original article, Oklu et al. determine that although neutrophil extracellular traps are increased in cancer patients, they are not associated with venous thrombosis (28). This edition also provides updated reviews on rare syndromes such as May-Thurner and Paget-Schroetter Syndome (29). Finally, this edition provides reviews of both in vitro (30) and animal models (31) of thrombosis as ongoing research is needed to further reduce this condition’s morbidity and mortality.
- Behravesh S, Hoang P, Nanda A, et al. Pathogenesis of Thromboembolism and Endovascular Management. Thrombosis 2017;2017:3039713. [Crossref] [PubMed]
- Prandoni P, Kahn SR. Post-thrombotic syndrome: prevalence, prognostication and need for progress. Br J Haematol 2009;145:286-95. [Crossref] [PubMed]
- Cohen AT, Hamilton M, Mitchell SA, et al. Comparison of the Novel Oral Anticoagulants Apixaban, Dabigatran, Edoxaban, and Rivaroxaban in the Initial and Long-Term Treatment and Prevention of Venous Thromboembolism: Systematic Review and Network Meta-Analysis. PLoS One 2015;10:e0144856. [Crossref] [PubMed]
- Tapson VF, Humbert M. Incidence and prevalence of chronic thromboembolic pulmonary hypertension: from acute to chronic pulmonary embolism. Proc Am Thorac Soc 2006;3:564-7. [Crossref] [PubMed]
- Heit JA, Mohr DN, Silverstein MD, et al. Predictors of recurrence after deep vein thrombosis and pulmonary embolism: a population-based cohort study. Arch Intern Med 2000;160:761-8. [Crossref] [PubMed]
- Eichinger S, Heinze G, Jandeck LM, et al. Risk assessment of recurrence in patients with unprovoked deep vein thrombosis or pulmonary embolism: the Vienna prediction model. Circulation 2010;121:1630-6. [Crossref] [PubMed]
- Søgaard KK, Schmidt M, Pedersen L, et al. 30-year mortality after venous thromboembolism: a population-based cohort study. Circulation 2014;130:829-36. [Crossref] [PubMed]
- Hotoleanu C. Genetic Risk Factors in Venous Thromboembolism. Adv Exp Med Biol 2017;906:253-72. [Crossref] [PubMed]
- Engbers MJ, van Hylckama Vlieg A, Rosendaal FR. Venous thrombosis in the elderly: incidence, risk factors and risk groups. J Thromb Haemost 2010;8:2105-12. [Crossref] [PubMed]
- Stein PD, Beemath A, Olson RE. Obesity as a risk factor in venous thromboembolism. Am J Med 2005;118:978-80. [Crossref] [PubMed]
- Goldhaber SZ, Bounameaux H. Pulmonary embolism and deep vein thrombosis. Lancet 2012;379:1835-46. [Crossref] [PubMed]
- James AH. Venous Thromboembolism in Pregnancy. Arterioscler Thromb Vasc Biol 2009;29:326-31. [Crossref] [PubMed]
- Elyamany G, Alzahrani AM, Bukhary E. Cancer-Associated Thrombosis: An Overview. Clinical Medicine Insights Oncology 2014;8:129-37. [Crossref] [PubMed]
- Kearon C, Akl EA, Ornelas J, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest 2016;149:315-52. [Crossref] [PubMed]
- DeYoung E, Minocha J. Inferior Vena Cava Filters: Guidelines, Best Practice, and Expanding Indications. Semin Intervent Radiol 2016;33:65-70. [Crossref] [PubMed]
- Wang TF, Squizzato A, Dentali F, et al. The role of thrombolytic therapy in pulmonary embolism. Blood 2015;125:2191-9. [Crossref] [PubMed]
- Yoo JW, Choi HC, Lee SJ, et al. Comparison between systemic and catheter thrombolysis in patients with pulmonary embolism. Am J Emerg Med 2016;34:985-8. [Crossref] [PubMed]
- Coleman DM, Obi A, Henke PK. Update in venous thromboembolism pathophysiology, diagnosis, and treatment for surgical patients. Curr Probl Surg 2015;52:233-59. [Crossref] [PubMed]
- Zarghouni M, Charles HW, Maldonado TS, et al. Catheter-directed interventions for pulmonary embolism. Cardiovasc Diagn Ther 2016;6:651-61. [Crossref] [PubMed]
- Oklu R, Wicky S. Catheter-directed thrombolysis of deep venous thrombosis. Semin Thromb Hemost 2013;39:446-51. [Crossref] [PubMed]
- Vedantham S, Piazza G, Sista AK, et al. Guidance for the use of thrombolytic therapy for the treatment of venous thromboembolism. J Thromb Thrombolysis 2016;41:68-80. [Crossref] [PubMed]
- Iakovou I, Kadota K, Papamentzelopoulos S, et al. Is there a higher risk of stent thrombosis in bifurcation lesion or is it related to the technique? EuroIntervention 2010;6 Suppl J:J107-11.
- Monie DD, DeLoughery EP. Pathogenesis of thrombosis: cellular and pharmacogenetic contributions. Cardiovasc Diagn Ther 2017;7:S291-8.
- Stone J, Hangge P, Albadawi H, et al. Deep vein thrombosis: pathogenesis, diagnosis, and medical management. Cardiovasc Diagn Ther 2017;7:S276-84.
- Fleck D, Albadawi H, Shamoun F, et al. Catheter-directed thrombolysis of deep vein thrombosis: literature review and practice considerations. Cardiovasc Diagn Ther 2017;7:S228-37.
- Naidu SG, Knuttinen MG, Kriegshauser JS, et al. Rationale for catheter directed therapy in pulmonary embolism. Cardiovasc Diagn Ther 2017;7:S320-8.
- Quencer KB, Friedman T, Sheth R, et al. Tumor thrombus: incidence, imaging, prognosis and treatment. Cardiovasc Diagn Ther 2017;7:S165-77.
- Oklu R, Sheth RA, Wong KH, et al. Neutrophil extracellular traps are increased in cancer patients but does not associate with venous thrombosis. Cardiovasc Diagn Ther 2017;7:S140-9.
- Hangge P, Rotellini-Coltvet L, Deipolyi AR, et al. Paget-Schroetter syndrome: treatment of venous thrombosis and outcomes. Cardiovasc Diagn Ther 2017;7:S285-90.
- Zhang YS, Oklu R, Albadawi H. Bioengineered in vitro models of thrombosis: methods and techniques. Cardiovasc Diagn Ther 2017;7:S329-35.
- Albadawi H, Witting AA, Pershad Y, et al. Animal models of venous thrombosis. Cardiovasc Diagn Ther 2017;7:S197-206.