Summary
Introduction
Rotation thromboelastometry (ROTEM®) can be used for hypercoagulability evaluation. Cushing's syndrome (CS) is associated with hypercoagulability; however, ROTEM® has never been ...evaluated in this setting.
Objective
To evaluate hypercoagulability in CS using ROTEM® and to correlate these parameters with coagulation markers and with the presence of deep vein thrombosis.
Design and methods
Thirty patients with active CS (26 women) and 30 controls matched for age, sex, body mass index, diabetes mellitus, arterial hypertension, ABO blood group and smoking were included. We measured levels of activated partial thromboplastin time (aPTT), platelets, fibrinogen, D‐dimer, factor VIII (FVIII), von Willebrand factor (vWF) and C‐reactive protein. ROTEM® was used to evaluate the intrinsic (INTEM), extrinsic (EXTEM) and fibrinogen (FIBTEM) pathways. Doppler ultrasonography was performed to search for lower limbs deep vein thrombosis.
Results
INTEM clotting time using ROTEM® was shorter in patients than in controls (P = 0·04). Other ROTEM® parameters were not different. Mean aPTT was shorter in patients than in controls (P = 0·001). The FVIII, vWF and D‐dimer levels were higher in patients than in controls (P = 0·001, 0·001 and 0·02, respectively). Obese CS patients presented higher levels of platelets and alterations in maximum clot formation (MCF), alpha angle and maximum speed of clot formation of INTEM (P = 0·03, 0·02 and 0·02, respectively) and an increase in the MCF of FIBTEM (P = 0·02). No deep vein thrombosis was found.
Conclusions
Although FVIII and vWF were abnormal in CS patients, only the initiation clot formation was different in the ROTEM® methodology and no deep vein thrombosis was found.
Summary
Introduction
Rotation thromboelastometry (ROTEM
®
) can be used for hypercoagulability evaluation. Cushing's syndrome (CS) is associated with hypercoagulability; however, ROTEM
®
has never ...been evaluated in this setting.
Objective
To evaluate hypercoagulability in CS using ROTEM
®
and to correlate these parameters with coagulation markers and with the presence of deep vein thrombosis.
Design and methods
Thirty patients with active CS (26 women) and 30 controls matched for age, sex, body mass index, diabetes mellitus, arterial hypertension, ABO blood group and smoking were included. We measured levels of activated partial thromboplastin time (aPTT), platelets, fibrinogen, D‐dimer, factor VIII (FVIII), von Willebrand factor (vWF) and C‐reactive protein. ROTEM
®
was used to evaluate the intrinsic (INTEM), extrinsic (EXTEM) and fibrinogen (FIBTEM) pathways. Doppler ultrasonography was performed to search for lower limbs deep vein thrombosis.
Results
INTEM clotting time using ROTEM
®
was shorter in patients than in controls (
P
= 0·04). Other ROTEM
®
parameters were not different. Mean aPTT was shorter in patients than in controls (
P
= 0·001). The FVIII, vWF and D‐dimer levels were higher in patients than in controls (
P
= 0·001, 0·001 and 0·02, respectively). Obese CS patients presented higher levels of platelets and alterations in maximum clot formation (MCF), alpha angle and maximum speed of clot formation of INTEM (
P
= 0·03, 0·02 and 0·02, respectively) and an increase in the MCF of FIBTEM (
P
= 0·02). No deep vein thrombosis was found.
Conclusions
Although FVIII and vWF were abnormal in CS patients, only the initiation clot formation was different in the ROTEM
®
methodology and no deep vein thrombosis was found.
Abstract 2555
Poster Board II-532
The purposes of this study were to evaluate the intracranial lesions in adults patients with sickle cell disease (SCD) using magnetic resonance imaging (MRI) and ...magnetic resonance angiography (MRA). The patients were selected from the main hematological hospital of Rio de Janeiro state (HEMORIO). About 187 patients underwent neurological examination and Transcranial Doppler image (TCDi) with microbubbles. Eighty patients were chosen by an aleatory way to perform MRI and MRA, including those symptomatic and asymptomatic ones. MRI and the MRA were evaluated by two different neuroradiologists, in a blind way about the clinical aspects and TCD results. The middle age was 29 years and 81.3% of the patients had the homozygous form of the SCD. In the MRI, 50% of the patients showed intraparenchymatous lesions. Leukoencephalopathy was the most frequent abnormality in 47.5%, encephalomalacia in 16%, lacunar infarctation in 12.5% and atrophy in 12.5%. Of the encephalomalacia cases, the frontal and parietal lobes were the most affected in 85%. In the MRA study, 34% of the patients presented abnormalities, 26% with vascular stenosis and 19% with vascular occlusions. The anterior circulation was the most compromised in the stenotic cases and the carotid was the main affected artery in the occlusions cases. The silent lesions were observed in 45% of the MRI and 24% of the MRA. The prevalence of parenchymatous lesions and vascular stenosis in cases with genotype SS was significant. There was significant statistic relation between the leukoencefalophalopathy and the vascular stenosis with the medium basal hematocrit.
The use of both methods (MRI and TCD image) demonstrated a powerful tool to study vascular lesions in SCD adults patients. The prevalence of silent infarcts in SCD adults patients was higher than previously estimated in literature (55%). This finding reinforces the prophylactic intervention study with TCD Imagining and prophylactic transfusion therapy in early stage of life.
No relevant conflicts of interest to declare.
Abstract 4612
Silent infarcts have been reported in approximately 20% of children with SCD. The prevalence in SCD adult patients has not been studied previously.
We studied 187 patients (mean age 29 ...years) Each of these patients underwent a neurological examination, duplex scan of carotids and TCD image with atoxic contrast (micro bubbles). Eighty of these patients were sorted to perform MRI and MRA to study lacunar infarction, encephalomalacia, leukoencephalopathy, Moya Moya syndrome and aneurysm (measured by number and size).
The overall prevalence of silent infarcts was 52%. Comparing the two methods regarding sensitivity and specificity, obtained respectively 88 and 85%. The positive predictive value of the TCD image with contrast was 80%. There was only one case of intracranial aneurysm, observed by both imaging methods. The other asymptomatic patients with abnormal TCD (low definition of image contrast or absence of flow to TCD image) presented diagnostic criteria of vascular occlusion with secondary collateral (Moya Moya Syndrome).
Use of atoxic contrast (micro bubbles) increases the sensitivity of TCD image for diagnosis of intracranial lesions in SCD adults patients, even in asymptomatic individuals, enabling the diagnosis of silent infarcts.
No relevant conflicts of interest to declare.
Cor triatriatum (CT) is a rare congenital cardiac anomaly that usually becomes symptomatic in the first years of life. If the condition is not associated with other cardiac defects, and depending on ...the degree of communication between the upper chamber and left atrium (LA), patients may reach adulthood. We report a case of an asymptomatic, adult, female patient with CT diagnosed by transthoracic echocardiogram (TTE) and followed-up during pregnancy.
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