Abstract
The purpose of this study is to assess the incidence and describe the clinical and pathological features of macrovascular thrombosis during the course of thrombotic micro-angiopathy (TMA) in a 6 year retrospective study of all adults with TMA, admitted to a teaching-hospital ICU. Of the 55 patients identified, all had anaemia and thrombocytopenia and 45 (82 %) had renal or neurological impairment. All patients received plasmapheresis, steroids, and strict blood pressure control. Macrovascular venous or arterial thromboses were diagnosed in 28 (51 %) patients; among them, 7 had cerebral artery thrombosis and 21 (including 13 with central venous catheters) had deep vein thrombosis. Median time from plasmapheresis initiation to thrombosis was 7 (4–10) days. Clinical findings were suggestive of deep venous thrombosis in 7 of the 21 patients (33 %) and only one of the 7 patients with stroke had corresponding clinical signs. By multivariate analysis, factors independently associated with macrovascular thrombosis were undetectable ADAMTS13 activity (odds ratio 7.33, 95 % confidence interval 1.3–41.3), cardiac involvement with TMA (odds ratio, 3.46; 95 % confidence interval, 1.1–13.9) and TMA flare (odds ratio 9.03; 95 % confidence interval 1.03–79.4). In conclusion, half of the patients with TMA experience macrovascular thrombosis. Patients with TTP-related ADAMTS13 deficiency and those with cardiac manifestations of TMA are at higher risk for arterial or deep venous thrombosis.
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This work was supported by a grant from the Assistance-Publique Hôpitaux de Paris (AOM 04139).
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Camous, L., Veyradier, A., Darmon, M. et al. Macrovascular thrombosis in critically ill patients with thrombotic micro-angiopathies. Intern Emerg Med 9, 267–272 (2014). https://doi.org/10.1007/s11739-012-0851-4
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DOI: https://doi.org/10.1007/s11739-012-0851-4