Polskie Archiwum Medycyny Wewnętrznej
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Pol. Arch. Med. Wewn. · May 2023
ReviewHow to treat patients with splanchnic vein thrombosis: recent advances.
Splanchnic vein thrombosis (SVT) is an unusual-site venous thromboembolism that includes portal, mesenteric, and splenic vein thrombosis as well as the Budd-Chiari syndrome. SVT is a relatively rare disease (portal vein thrombosis and Budd-Chiari syndrome are, respectively, the most and the least common presentations); roughly one‑third of the cases are detected incidentally, and liver cirrhosis and solid cancer represent the main risk factors. Once SVT is diagnosed, careful patient evaluation should be performed to assess the stage, grade, and extension of the thrombosis, as well as the risks and benefits of the anticoagulation regimen. ⋯ Data on the use of direct oral anticoagulants are increasing and promising. In selected patients and in specialized centers, interventional procedures may be considered in adjunction to anticoagulation in the cases of mesenteric or extensive SVT, intestinal ischemia, or in the patients whose condition deteriorates despite adequate anticoagulant therapy. In this narrative review, we summarize the available data regarding anticoagulation in patients with SVT, identify specific subgroups of patients who may achieve the greatest benefits from anticoagulant therapy, and provide practical advice for clinicians caring for these patients.
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Pol. Arch. Med. Wewn. · May 2023
Observational StudyOutcomes of COVID-19 in patients vaccinated and unvaccinated against SARS-CoV-2 and suffering from pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension.
Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) lead to progressive right heart failure. The mortality rates in PAH and CTEPH patients due to COVID‑19 are high, and vaccination against COVID‑19 is recommended in this group. ⋯ The vaccinated PAH/CTEPH patients suffered from COVID‑19 less frequently than the unvaccinated ones. The mortality rate and hospitalization due to COVID‑19 were higher in the PAH/CTEPH patients than in the general population. All efforts should be made to convince the PAH/CTEPH patients to vaccinate against COVID‑19.
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Pol. Arch. Med. Wewn. · May 2023
Clinical characteristics and 12-month outcomes in MINOCA patients before and during the COVID-19 pandemic.
SARS‑CoV‑2 infection is associated with an increased risk of thromboembolic complications. Thromboembolism is one of the possible causes of myocardial infarction with nonobstructive coronary arteries (MINOCA). ⋯ We observed a lower percentage of MINOCA cases and higher in‑hospital stroke rates in the MINOCA patients treated during the COVID‑19 pandemic (2020). The possible association between worse clinical outcomes of the MINOCA patients treated during the pandemic and the increased risk for thromboembolic complications of SARS‑CoV‑2 infection needs further evaluation.