Endovascular retrieval of an inferior vena cava filter penetrating the false lumen of a chronic aortic dissection, with concomitant iliocaval reconstruction

Inferior vena cava filter (IVCF) placement is indicated in patients with acute venous thromboembolism who cannot be adequately anticoagulated or have failed anticoagulation. Prompt IVCF retrieval decreases the risk of complications associated with longer dwell times including fracture, penetration, and further thromboembolic events. Endovascular IVCF retrieval has been performed despite penetration into adjacent structures including the aorta; however, penetration into the false lumen of an aortic dissection is rarely seen. This case report describes endovascular management of an 11 year old IVCF that caused iliocaval thrombosis and penetrated the false lumen of a chronic type B aortic dissection.

Effectiveness and safety of oral anticoagulants in the treatment of acute venous thromboembolism: a comparative cohort study in France

Background RCT evidence has shown that direct oral anti-coagulants (DOACs) are at least as effective and safer in terms of bleeding, compared to vitamin K antagonists (VKAs) in the treatment of acute venous thromboembolism (VTE). Purpose To compare the risks of recurrent VTE and of bleeding leading to hospitalisation, in patients treated with DOACs (each compared with VKAs) for acute VTE in a real-world setting. Methods A retrospective cohort study of treatment-naïve adult patients with VTE (patients with active cancer were excluded) treated with a DOAC (apixaban or rivaroxaban) or VKA, from 2013 to 2018. The French national health data system (SNDS) was used. After propensity score (PS) matching for each DOAC-VKA comparison, risks of bleeding (defined as principal diagnoses of hospital stays), recurrent VTE, and all-cause mortality were compared at 6 months. Cox proportional-hazards regression was used to estimate adjusted hazard ratios of the endpoints. Results 58137 treatment-naïve patients were included: 10775 (18.53%) VKAs, 10440 (17.96%) apixaban, and 36922 (63.51%) rivaroxaban. Patients initiating VKAs were older than those initiating apixaban or rivaroxaban (mean age in years: VKAs, 71; apixaban, 65; rivaroxaban, 60) and had a higher comorbidity burden (mean CCI score: VKAs, 1.55; apixaban, 0.91; rivaroxaban, 0.69). PS matched cohort sizes were: apixaban (n=7503) and rivaroxaban (n=9179). Crude risks of recurrent VTE per 100 patient-year (95% CI) were 4.99 (4.36; 5.70), 3.36 (2.88; 3.92) and 4.33 (4.03; 4.66) for VKAs, apixaban, and rivaroxaban respectively. For bleeding, the respective crude risks were 5.21 (4.57; 5.94), 1.84 (1.49; 2.28), and 2.64 (2.41; 2.90). For all-cause mortality, the respective crude risks were 12.23 (11.26; 13.27), 4.69 (4.11; 5.34), and 2.73 (2.49; 2.99). Adjusted hazard ratios for the endpoints are presented in the table. Conclusions Apixaban was associated with a lower risk of recurrent VTE and bleedings requiring hospitalisation compared with VKAs. Similar trends in risk reduction for these outcomes were observed for rivaroxaban compared with VKAs but without reaching statistical significance. Both DOACs were associated with lower risk of all-cause mortality compared with VKAs. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): BMS/Pfizer alliance

Multiple Sites of Thrombosis Without Thrombocytopenia After a Second Dose of Pfizer-BioNTech COVID-19 Vaccine

BackgroundIn the current international scientific panorama rare cases of venous thrombotic complications following mRNA vaccine administration have been reported, consisting of cerebral sinus thromboses and acute venous thromboembolism. Case presentationThe present paper describes the case of a 75-year-old woman in good health who developed cerebral venous thrombosis (CVT), deep venous thrombosis (DVT) and bilateral pulmonary emboli (PE) after receiving a second dose of Pfizer-BioNTech COVID-19 vaccine. A series of laboratory tests performed during the hospitalization yielded interesting results, allowing us to exclude thrombophilic risk factors and certify the absence of thrombocytopenia in the patient.ConclusionAlthough COVID-19 vaccination is the most important tool in stopping the pandemic, pharmacovigilance is crucial for detecting potential multisystem thrombotic events, even for mRNA vaccines.