Macrovascular thrombosis in critically ill patients with thrombotic micro-angiopathies.
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.
Medical ICU, Clinical Immunology and Hemapheresis Departments, AP-HP, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France.
Laurent
L
Camous
Agnès
A
Veyradier
Michael
M
Darmon
Lionel
L
Galicier
Eric
E
Mariotte
Emmanuel
E
Canet
Nathalie
N
Parquet
Élie
É
Azoulay
D000328:Adult; D000368:Aged; D016638:Critical Illness; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D057049:Thrombotic Microangiopathies / Q000150:complications*; D055815:Young Adult