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Article ; Online: A case report of severe nasal ischemia from cold agglutinin disease and a novel treatment protocol including HBOT.

Kohlert, Scott / McLean, Laurie / Scarvelis, Dimitrios / Thompson, Calvin

Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale

2019 Volume 48, Issue 1, Page(s) 52

Abstract: Cold agglutinin disease (CAD) is a rare condition leading to blood agglutination and autoimmune hemolytic anemia. Cutaneous ischemia resulting from CAD in the head and neck is uncommon. Treatment regimens and outcomes vary widely in the literature and no ...

Abstract	Cold agglutinin disease (CAD) is a rare condition leading to blood agglutination and autoimmune hemolytic anemia. Cutaneous ischemia resulting from CAD in the head and neck is uncommon. Treatment regimens and outcomes vary widely in the literature and no clear protocol exists. This manuscript describes a patient with CAD who developed severe ischemia of the nose that resolved completely without sequellae following a medical regimen of aspirin, low molecular weight heparin, nitroglycerin ointment and hyperbaric oxygen therapy (HBOT). To our knowledge, this is the first reported case where nitroglycerin ointment or HBOT was successfully employed in the treatment of this complication.
MeSH term(s)	Administration, Topical ; Aged, 80 and over ; Anemia, Hemolytic, Autoimmune/complications ; Anticoagulants/therapeutic use ; Combined Modality Therapy ; Enoxaparin/administration & dosage ; Female ; Humans ; Hyperbaric Oxygenation ; Ischemia/drug therapy ; Ischemia/etiology ; Ischemia/therapy ; Nitroglycerin/administration & dosage ; Nose/blood supply ; Ointments ; Vasodilator Agents/administration & dosage
Chemical Substances	Anticoagulants ; Enoxaparin ; Ointments ; Vasodilator Agents ; Nitroglycerin (G59M7S0WS3)
Language	English
Publishing date	2019-10-22
Publishing country	England
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	2434004-2
ISSN	1916-0216 ; 1916-0208 ; 0381-6605
ISSN (online)	1916-0216
ISSN	1916-0208 ; 0381-6605
DOI	10.1186/s40463-019-0369-0
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Zs.A 1130: Show issues

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Article ; Online: Persisting autoimmune heparin-induced thrombocytopenia after elective abdominal aortic aneurysm repair: a case report.

Roberge, Guillaume / Tritschler, Tobias / MacGillivray, Caleb / Dufresne, Laurence / Nagpal, Sudhir Kumar / Scarvelis, Dimitrios

Journal of thrombosis and thrombolysis

2020 Volume 50, Issue 3, Page(s) 674–677

Abstract: Persisting heparin-induced thrombocytopenia (HIT) is characterized by ongoing thrombocytopenia more than 7 days after stopping heparin. It is part of cases referred to as autoimmune HIT (aHIT). In contrast to typical HIT cases, aHIT involves heparin- ... ...

Abstract	Persisting heparin-induced thrombocytopenia (HIT) is characterized by ongoing thrombocytopenia more than 7 days after stopping heparin. It is part of cases referred to as autoimmune HIT (aHIT). In contrast to typical HIT cases, aHIT involves heparin-independent platelet activation mechanism highlighted by a strongly positive functional assay done without heparin. We report the first case of persisting HIT after an elective abdominal aortic aneurysm repair presenting with arterial and venous thrombosis, and describe the potential role of intravenous immunoglobulin in such patients.
MeSH term(s)	Aged ; Anticoagulants/adverse effects ; Anticoagulants/therapeutic use ; Aortic Aneurysm, Abdominal/complications ; Aortic Aneurysm, Abdominal/surgery ; Heparin/adverse effects ; Heparin/therapeutic use ; Humans ; Immunoglobulins, Intravenous/therapeutic use ; Male ; Thrombocytopenia/chemically induced ; Thrombocytopenia/therapy ; Thrombosis/drug therapy ; Thrombosis/etiology
Chemical Substances	Anticoagulants ; Immunoglobulins, Intravenous ; Heparin (9005-49-6)
Language	English
Publishing date	2020-02-14
Publishing country	Netherlands
Document type	Case Reports ; Journal Article
ZDB-ID	1230645-9
ISSN	1573-742X ; 0929-5305
ISSN (online)	1573-742X
ISSN	0929-5305
DOI	10.1007/s11239-020-02062-2
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Article ; Online: Management and outcomes of superficial vein thrombosis: a single-center retrospective study.

Mathieu, Marie-Eve / Duffett, Lisa / Caiano, Lucia / Scarvelis, Dimitri / Code, Catherine / Wells, Philip / Le Gal, Grégoire

Research and practice in thrombosis and haemostasis

2023 Volume 8, Issue 1, Page(s) 102263

Abstract: Background: Guidelines suggest but cannot recommend the optimal management of superficial vein thrombosis (SVT).: Objectives: To identify the prevalence of asymptomatic deep vein thrombosis (DVT) at the time of SVT diagnosis, and to report the ... ...

Abstract	Background: Guidelines suggest but cannot recommend the optimal management of superficial vein thrombosis (SVT). Objectives: To identify the prevalence of asymptomatic deep vein thrombosis (DVT) at the time of SVT diagnosis, and to report the treatment and 3-month complications of patients with only SVT more than 3 cm from deep vein junction (or unknown distance). Methods: We performed a single-center retrospective review of patients referred to the Ottawa Hospital thrombosis unit with ultrasound (US)-diagnosed SVT, and followed patients with only SVT for 3 months. Results: Three hundred sixteen patients with SVT were included. Of the 218 patients without DVT symptoms at presentation, 19 (8.7%; 95% CI, 5.7%-13.2%) were found to have asymptomatic concomitant DVT (11 proximal and 8 distal), and 45 (20.6%) had SVT within 3 cm of the saphenofemoral or saphenopopliteal junctions. Among the 192 patients diagnosed with SVT only, we observed 3-month thrombotic complications in 56 (29.2%; 95% CI, 23.2%-36.0%) patients, with a total of 69 events: 11 (5.7%) DVTs, 2 (1.0%) pulmonary embolisms, 37 (19.2%) SVT extensions, and 19 (9.8%) SVT recurrences. Eighty-two percent (9/11) of the 3-month DVT and pulmonary embolism events occurred in patients who initially received conservative management. Therapeutic treatment doses were most effective. Conclusion: At the time of SVT diagnosis, many patients had asymptomatic DVT and SVT near the deep venous system, supporting the systematic use of initial US in patients clinically diagnosed with SVT. The observed differences in 3-month complication rates, according to the treatment provided, highlight the need for large-scale randomized controlled trials to establish optimal management.
Language	English
Publishing date	2023-11-18
Publishing country	United States
Document type	Journal Article
ISSN	2475-0379
ISSN (online)	2475-0379
DOI	10.1016/j.rpth.2023.102263
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Article ; Online: Therapeutic Plasma Exchange in Vaccine-Induced Immune Thrombotic Thrombocytopenia.

Patriquin, Christopher J / Laroche, Vincent / Selby, Rita / Pendergrast, Jacob / Barth, David / Côté, Benoit / Gagnon, Nathalie / Roberge, Guillaume / Carrier, Marc / Castellucci, Lana A / Scarvelis, Dimitrios / Mack, Johnathan P

The New England journal of medicine

2021 Volume 385, Issue 9, Page(s) 857–859

MeSH term(s)	Anticoagulants/therapeutic use ; COVID-19 Vaccines/adverse effects ; ChAdOx1 nCoV-19 ; Combined Modality Therapy ; Female ; Fibrin Fibrinogen Degradation Products/analysis ; Glucocorticoids/therapeutic use ; Humans ; Immunoglobulins, Intravenous/therapeutic use ; Methylprednisolone/therapeutic use ; Middle Aged ; Plasma Exchange ; Platelet Count ; Prednisone/therapeutic use ; Purpura, Thrombocytopenic, Idiopathic/etiology ; Purpura, Thrombocytopenic, Idiopathic/therapy ; Thrombosis/etiology ; Thrombosis/therapy
Chemical Substances	Anticoagulants ; COVID-19 Vaccines ; Fibrin Fibrinogen Degradation Products ; Glucocorticoids ; Immunoglobulins, Intravenous ; fibrin fragment D ; ChAdOx1 nCoV-19 (B5S3K2V0G8) ; Prednisone (VB0R961HZT) ; Methylprednisolone (X4W7ZR7023)
Language	English
Publishing date	2021-07-07
Publishing country	United States
Document type	Case Reports ; Letter
ZDB-ID	207154-x
ISSN	1533-4406 ; 0028-4793
ISSN (online)	1533-4406
ISSN	0028-4793
DOI	10.1056/NEJMc2109465
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Article ; Online: Outcome of central venous catheter associated upper extremity deep vein thrombosis in cancer patients.

Delluc, Aurélien / Le Gal, Grégoire / Scarvelis, Dimitrios / Carrier, Marc

Thrombosis research

2015 Volume 135, Issue 2, Page(s) 298–302

Abstract: Introduction: Data on efficacy and safety of using low molecular weight heparin in cancer patients with catheter-related upper extremity deep vein thrombosis is scarce and the risk of recurrent venous thromboembolism after discontinuation of ... ...

Abstract	Introduction: Data on efficacy and safety of using low molecular weight heparin in cancer patients with catheter-related upper extremity deep vein thrombosis is scarce and the risk of recurrent venous thromboembolism after discontinuation of anticoagulation is unknown. Material and methods: We conducted a retrospective cohort study including consecutive cancer outpatients assessed for the management of symptomatic central venous catheter-associated proximal upper extremity deep vein thrombosis. Results: Of 99 included patients, 89 were treated with one month of full therapeutic weight-adjusted dose of low molecular weight heparin followed by an intermediate dose. Median duration of anticoagulation was 124 days (range 40 to 1849). No recurrent venous thromboembolism and two major bleeding episodes occurred during the first 3 months of treatment. Eighty patients were followed-up after anticoagulation discontinuation for a median of 632 days (range 6 to 2495). Central venous line was pulled in all patients in remission and in 26 of the 29 patients (89.6%) with active cancer. Five recurrences were observed during follow-up. The cumulative probability of recurrent venous thromboembolism was higher in patients whose cancer was active at the time of anticoagulation discontinuation as compared with those in remission (22.2% (95% CI: 0 to 40.6) vs. 2.3% (95% CI: 0 to 6.7)). Conclusion: The risk of venous thromboembolism recurrence in patients whose central venous catheter has been pulled out and cancer is in remission appears low following anticoagulation discontinuation and after a minimum of 3 months of full/intermediate dose.
MeSH term(s)	Central Venous Catheters/adverse effects ; Cohort Studies ; Female ; Humans ; Male ; Middle Aged ; Neoplasms/complications ; Retrospective Studies ; Treatment Outcome ; Upper Extremity Deep Vein Thrombosis/etiology ; Venous Thromboembolism/etiology ; Warfarin/therapeutic use
Chemical Substances	Warfarin (5Q7ZVV76EI)
Language	English
Publishing date	2015-02
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	121852-9
ISSN	1879-2472 ; 0049-3848
ISSN (online)	1879-2472
ISSN	0049-3848
DOI	10.1016/j.thromres.2014.11.020
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Zs.A 863: Show issues

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Article ; Online: Diagnosis and treatment of deep-vein thrombosis.

Scarvelis, Dimitrios / Wells, Philip S

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne

2006 Volume 175, Issue 9, Page(s) 1087–1092

Abstract: Deep-vein thrombosis (DVT) is a common condition that can lead to complications such as postphlebitic syndrome, pulmonary embolism and death. The approach to the diagnosis of DVT has evolved over the years. Currently an algorithm strategy combining ... ...

Abstract	Deep-vein thrombosis (DVT) is a common condition that can lead to complications such as postphlebitic syndrome, pulmonary embolism and death. The approach to the diagnosis of DVT has evolved over the years. Currently an algorithm strategy combining pretest probability, D-dimer testing and compression ultrasound imaging allows for safe and convenient investigation of suspected lower-extremity thrombosis. Patients with low pretest probability and a negative D-dimer test result can have proximal DVT excluded without the need for diagnostic imaging. The mainstay of treatment of DVT is anticoagulation therapy, whereas interventions such as thrombolysis and placement of inferior vena cava filters are reserved for special situations. The use of low-molecular-weight heparin allows for outpatient management of most patients with DVT. The duration of anticoagulation therapy depends on whether the primary event was idiopathic or secondary to a transient risk factor. More research is required to optimally define the factors that predict an increased risk of recurrent DVT to determine which patients can benefit from extended anticoagulant therapy.
MeSH term(s)	Algorithms ; Anticoagulants/adverse effects ; Anticoagulants/therapeutic use ; Fibrin Fibrinogen Degradation Products/analysis ; Humans ; Recurrence ; Risk Factors ; Ultrasonography/methods ; Venous Thrombosis/diagnosis ; Venous Thrombosis/drug therapy
Chemical Substances	Anticoagulants ; Fibrin Fibrinogen Degradation Products ; fibrin fragment D
Language	English
Publishing date	2006-10-24
Publishing country	Canada
Document type	Journal Article ; Review
ZDB-ID	215506-0
ISSN	1488-2329 ; 0008-4409 ; 0820-3946
ISSN (online)	1488-2329
ISSN	0008-4409 ; 0820-3946
DOI	10.1503/cmaj.060366
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Article: Embolization of a huge tricuspid valve bacterial vegetation.

Scarvelis, Dimitrios / Malcolm, Ian

Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography

2002 Volume 15, Issue 2, Page(s) 185–187

Abstract: A case of a woman who had tricuspid valve bacterial endocarditis is presented. Her course was complicated by persistent disseminated intravascular coagulation and acute renal failure, followed by pulmonary embolization of the vegetation. Transthoracic ... ...

Abstract	A case of a woman who had tricuspid valve bacterial endocarditis is presented. Her course was complicated by persistent disseminated intravascular coagulation and acute renal failure, followed by pulmonary embolization of the vegetation. Transthoracic echocardiography showed almost complete obstruction of the right pulmonary artery. The case demonstrates the impressive size to which right-sided infective vegetations can progress and the relative paucity of symptoms and hemodynamic derangements with which they may be associated, even in the context of potentially life-threatening complications.
MeSH term(s)	Acute Kidney Injury/complications ; Adult ; Echocardiography ; Endocarditis, Bacterial/complications ; Endocarditis, Bacterial/diagnostic imaging ; Female ; Humans ; Pulmonary Embolism/diagnostic imaging ; Pulmonary Embolism/etiology ; Staphylococcal Infections/complications ; Staphylococcal Infections/diagnostic imaging ; Tricuspid Valve
Language	English
Publishing date	2002-01-28
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	1035622-8
ISSN	1097-6795 ; 0894-7317
ISSN (online)	1097-6795
ISSN	0894-7317
DOI	10.1067/mje.2002.118173
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Zs.A 2638: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Effect of 200μG/day of vitamin K1 on the variability of anticoagulation control in patients on warfarin: a randomized controlled trial.

Majeed, Habeeb / Rodger, Marc / Forgie, Melissa / Carrier, Marc / Taljaard, Monica / Scarvelis, Dimitrios / Gonsalves, Carol / Rodriguez, Rosendo A / Wells, Philip S

Thrombosis research

2013 Volume 132, Issue 3, Page(s) 329–335

Abstract: Background: Controversy exists whether low-dose vitamin K supplementation can improve anticoagulation control in patients with unstable anticoagulation under warfarin. In a single- centre randomized, double-blind, placebo-controlled study, we evaluated ... ...

Abstract	Background: Controversy exists whether low-dose vitamin K supplementation can improve anticoagulation control in patients with unstable anticoagulation under warfarin. In a single- centre randomized, double-blind, placebo-controlled study, we evaluated the effectiveness of 200 μg/day of vitamin K1 in patients with unstable control under warfarin. Methods: Effectiveness of Vitamin K1 supplementation was primarily assessed by the percentage (%) of Time-in-Therapeutic-Range (TTR) and secondarily by the standard deviation (SD) of the patient's INR values; the proportion of out-of-range INRs; and the number of dose changes on warfarin. Their change scores were obtained by subtracting the mean value in the 6 months pre-randomization from the mean value in the 6 months post-randomization. Multivariable linear-regressions identified factors associated with anticoagulation instability. Results: Fifty out of 54 patients were analyzed (intervention: n=26; placebo: n=24). Most indications (87%) for anticoagulation were venous thromboembolism (VTE). The intervention was associated with a greater reduction in the change scores for the SD of INRs between the pre and post-randomization periods compared with placebo. The mean change score was -0.259±0.307 with the intervention and -0.046±0.345 with placebo (p=0.026). There was no effect on the change scores of the (%) TTR (p=0.98), the number of INRs out-of-range (p=0.58) and the number of dose changes (p=0.604). Factors independently associated with increased variability in the SD of INRs were increased alcoholic drinks/week (p=0.017), dosing errors (p=0.0009) and missed INR appointments (p=0.035). Conclusion: Vitamin K1 supplementation reduces the SD of INRs as an indicator of the variability in anticoagulation control in patients treated with warfarin for VTE.
MeSH term(s)	Anticoagulants/administration & dosage ; Double-Blind Method ; Drug Synergism ; Female ; Genotype ; Humans ; International Normalized Ratio ; Male ; Middle Aged ; Placebos ; Polymorphism, Genetic ; Thrombosis/drug therapy ; Treatment Outcome ; Vitamin K 1/administration & dosage ; Warfarin/administration & dosage
Chemical Substances	Anticoagulants ; Placebos ; Warfarin (5Q7ZVV76EI) ; Vitamin K 1 (84-80-0)
Language	English
Publishing date	2013-09
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	121852-9
ISSN	1879-2472 ; 0049-3848
ISSN (online)	1879-2472
ISSN	0049-3848
DOI	10.1016/j.thromres.2013.07.019
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Article ; Online: Multicenter evaluation of a new quantitative highly sensitive D-dimer assay, the Hemosil D-dimer HS 500, in patients with clinically suspected venous thromboembolism.

Legnani, Cristina / Cini, Michela / Scarvelis, Dimitrios / Toulon, Pierre / Wu, Jogin R / Palareti, Gualtiero

Thrombosis research

2010 Volume 125, Issue 5, Page(s) 398–401

Abstract: Introduction: D-dimer testing is widely used in conjunction with clinical pretest probability (PTP) for venous thromboembolism (VTE) exclusion. We report on a multicenter evaluation of a new, automated, latex enhanced turbidimetric immunoassay [HemosIL ... ...

Abstract	Introduction: D-dimer testing is widely used in conjunction with clinical pretest probability (PTP) for venous thromboembolism (VTE) exclusion. We report on a multicenter evaluation of a new, automated, latex enhanced turbidimetric immunoassay [HemosIL D-Dimer HS 500, Instrumentation Laboratory (IL)]. Materials and methods: 747 consecutive outpatients with suspected proximal deep vein thrombosis (DVT, n=401) or pulmonary embolism (PE, n=346) were evaluated at four university hospitals in a management study with a 3 month follow-up. Samples were tested at each center using the new D-dimer assay on an automated coagulation analyzer [ACL TOP (IL)], with clinical cut-off for VTE at 500 ng/mL (FEU). Results: The sensitivity and negative predictive value (NPV) were 100% for all PTP subgroups (no false negative results); for both sensitivity and NPV the lower limit of the 95% CI in patients with moderate/low PTP was higher than 95%. The overall specificity was 45.1% (95%CI: 41.1-49.3%). Higher specificity value was recorded in the low PTP subgroup [49.2% (95%CI: 41.7-56.7)]. No significant differences were found between patients suspected of having DVT or PE; sensitivity and NPV were 100%. The reproducibility of the assay was good, being the total CVs% less than 10% for D-dimer concentration near the clinical cut-off. Conclusions: The new, highly sensitive D-dimer assay proved to be accurate when used for VTE diagnostic work-up in outpatients. Based on 100% sensitivity and NPV and lower limit of the 95% CI higher than 95%, the assay can be used as a stand-alone test in patients with non high PTP.
MeSH term(s)	Adolescent ; Adult ; Aged ; Blood Chemical Analysis/instrumentation ; Diagnosis, Computer-Assisted/instrumentation ; Equipment Design ; Equipment Failure Analysis ; Female ; Fibrin Fibrinogen Degradation Products/analysis ; Humans ; Immunoassay/instrumentation ; Internationality ; Male ; Middle Aged ; Nephelometry and Turbidimetry/instrumentation ; Reproducibility of Results ; Sensitivity and Specificity ; Venous Thromboembolism/blood ; Venous Thromboembolism/diagnosis ; Young Adult
Chemical Substances	Fibrin Fibrinogen Degradation Products ; fibrin fragment D
Language	English
Publishing date	2010-05
Publishing country	United States
Document type	Evaluation Studies ; Journal Article ; Multicenter Study
ZDB-ID	121852-9
ISSN	1879-2472 ; 0049-3848
ISSN (online)	1879-2472
ISSN	0049-3848
DOI	10.1016/j.thromres.2009.07.013
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Article ; Online: Hospital mortality due to pulmonary embolism and an evaluation of the usefulness of preventative interventions.

Scarvelis, Dimitrios / Anderson, Josdalyne / Davis, Laurie / Forgie, Melissa / Lee, James / Petersson, Linn / Ramsay, Tim / Wells, Philip S

Thrombosis research

2010 Volume 125, Issue 2, Page(s) 166–170

Abstract: Background: Mortality rates due to pulmonary embolism (PE) are difficult to estimate often due to the presence of comorbid disease.: Objectives: To determine the accuracy of hospital records in identifying PE cases, PE-related mortality, and the ... ...

Abstract	Background: Mortality rates due to pulmonary embolism (PE) are difficult to estimate often due to the presence of comorbid disease. Objectives: To determine the accuracy of hospital records in identifying PE cases, PE-related mortality, and the number of PE-related deaths which are potentially preventable. Methods: Retrospective chart review of PE cases hospitalized at The Ottawa Hospital over an 8 year period. Cases were reviewed to determine accuracy of coding, as well as the certainty with which PE was the cause of death. In PE-related deaths, a determination was made as to whether any interventions may have been life-saving. Results: 498 cases of 612 (81%) cases coded as PE were correctly coded. 111 (22%) died during hospitalization, 63% of deaths were attributed to PE. The presence of a cardiorespiratory comorbidity or cancer was independently associated with an increased rate of death due to PE. 54% of PE-related deaths were determined to be potentially preventable, most commonly by appropriate DVT prophylaxis. A significantly higher number of cancer patients as compared to non-cancer patients may have potentially had their death due to PE prevented by an inferior vena cava filter (IVCF). Systemic thrombolysis was deemed to be potentially life-saving in 1/38 PE-related deaths. Conclusion: Hospital mortality due to clinically recognized PE can be determined by chart review of PE cases identified using the ICD coding system. Death due to PE is often potentially preventable; in the subgroup with cancer and DVT/PE, an IVCF may be a potentially useful intervention to prevent death due to PE. Prospective studies are needed to confirm these results.
MeSH term(s)	Aged ; Canada ; Cause of Death ; Cohort Studies ; Comorbidity ; Female ; Hospital Mortality ; Humans ; Male ; Neoplasms/epidemiology ; Practice Guidelines as Topic ; Pulmonary Embolism/epidemiology ; Pulmonary Embolism/mortality ; Pulmonary Embolism/prevention & control ; Records as Topic/standards ; Retrospective Studies ; Vena Cava Filters/adverse effects ; Venous Thrombosis/prevention & control
Language	English
Publishing date	2010-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	121852-9
ISSN	1879-2472 ; 0049-3848
ISSN (online)	1879-2472
ISSN	0049-3848
DOI	10.1016/j.thromres.2009.06.025
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