Thrombosis Update最新文献

{"title":"Update on pregnancy-associated venous thromboembolism","authors":"Arielle L. Langer,&nbsp;Nathan T. Connell","doi":"10.1016/j.tru.2022.100107","DOIUrl":"10.1016/j.tru.2022.100107","url":null,"abstract":"<div><p>Venous thromboembolism (VTE) is a major cause of morbidity and mortality in pregnancy. Multiple physiologic changes in pregnancy contribute to the increased risk of VTE. VTE in this setting presents unique challenges for diagnosis and management. Evidence-based diagnostic practices include limiting D-dimer testing, reliance on ultrasound and V/Q scan when possible, and counseling patients and their families on the safe use of CT imaging of the chest when needed. Anticoagulation primarily relies on low molecular weight heparin, but unfractionated heparin and fondaparinux may also be used when needed. Warfarin is a known teratogen and induces an anticoagulant effect in the fetus. Safety data for other anticoagulants is lacking. Thrombolysis should be limited to patients with significant hemodynamic compromise due to the high risk of bleeding with this intervention. For individuals with prior VTE who are no longer on anticoagulation, prophylactic anticoagulation is usually reserved for those with prior estrogen-associated or unprovoked VTE. Future prophylaxis can be limited to additional pregnancies in most individuals. Future exposure to exogenous estrogen should be avoided. Prophylactic anticoagulation on the basis of heritable thrombophilias without a personal history of VTEs is not usually indicated, as risks of bleeding and interference with the use of neuraxial anesthesia outweigh benefits in most instances. Therefore, primary prophylaxis should be limited to only the high risk genotypes.</p></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"8 ","pages":"Article 100107"},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666572722000116/pdfft?md5=05043420ffd8933a8ca8c8d0b2c4f298&pid=1-s2.0-S2666572722000116-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49333721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 vaccine (Ad26.COV2.S), an unlikely culprit of portal vein thrombosis in a middle-aged man","authors":"Dariusz Uczkowski,&nbsp;Arunabh Sekhri","doi":"10.1016/j.tru.2022.100119","DOIUrl":"10.1016/j.tru.2022.100119","url":null,"abstract":"<div><p>While vaccination is the single most effective intervention to prevent spread of COVID-19, rare thromboembolic events have been reported following vaccination with COVID-19 vaccines ChAdOx1 nCOV-19 (AstraZeneca) and Ad26.COV2·S (Johnson &amp; Johnson/Janssen). We present here a case of one such patient who received Ad26.COV2–S (recombinant) JanssenCOVID_19 vaccine.</p><p>A 55-year-old male presented with a two week history of abdominal pain, nausea, vomiting, and distention. He received the Ad26.COV2–S (recombinant) JanssenCOVID_19 vaccine, one month before onset of symptoms. On presentation, lab results revealed hyponatremia, lactic acidosis, and leukocytosis. CT abdomen and pelvis with contrast revealed moderate circumferential bowel wall thickening, prominent mesenteric vessels present, and a portal vein thrombus extending to the superior mesenteric and splenic veins. An extensive hypercoagulable workup was negative. Patient's history revealed he was a frequent airline passenger but was otherwise negative. Additional etiologies were examined before associating the COVID-19 vaccine with thrombosis and the penultimate diagnosis was only reached by exclusion of other causes after initial evaluation and further outpatient follow up.</p></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"8 ","pages":"Article 100119"},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666572722000232/pdfft?md5=85e630a0dc513096353303c8787413e8&pid=1-s2.0-S2666572722000232-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47473929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of low and high factor X concentrations on thrombin generation in vitro","authors":"Ryui Miyashita ,&nbsp;Keiko Shinozawa ,&nbsp;Eisuke Takami ,&nbsp;Koichi Ohkuma ,&nbsp;Kagehiro Amano","doi":"10.1016/j.tru.2022.100111","DOIUrl":"https://doi.org/10.1016/j.tru.2022.100111","url":null,"abstract":"<div><h3>Introduction</h3><p>Plasma factor X (FX) levels may affect the therapeutic effects of bypass hemostatic therapy among patients with hemophilia with inhibitors. This study aimed to reproduce low and high FX level conditions <em>in vitro</em> and analyze changes in coagulation capacity.</p></div><div><h3>Materials and methods</h3><p>To achieve low FX concentrations, FX-deficient plasma was preincubated with anti-factor VIII (FVIII) or anti-factor IX (FIX) antibody. Following this, it was incubated with activated factor VII (FVIIa) or FVIIa/FX mixture in the presence of FX (0.13–0.64 IU/mL). To achieve high FX concentrations, FVIII- or FIX-deficient plasma was preincubated with <em>anti</em>-FVIII or anti-FIX antibody. Next, FX (4–20 IU/mL) was added in the presence of FVIIa (140 IU/mL). Under both conditions, changes in coagulation capacity were assessed by evaluating thrombin generation (TG) and activated partial thromboplastin time (aPTT).</p></div><div><h3>Results</h3><p>FX at low concentrations induced concentration-dependent changes in TG. In the presence of FX (0.13 IU/mL), adding FVIIa inadequately restored TG. Further, TG in the plasma was normalized after adding FVIIa/FX (62.5/2 IU/mL), and the FVIIa/FX-added group had a stable TG and aPTT, regardless of FX concentrations (0.13–0.64 IU/mL). The FVIIa-added group exhibited a FX concentration-dependent increase in TG and a decrease in aPTT. Furthermore, TG increased with FX concentrations under high FX concentrations (up to 10 IU/mL).</p></div><div><h3>Conclusions</h3><p>Simultaneous FX supplementation in addition to FVIIa may be effective in promoting hemostasis under low plasma FX levels. Moreover, the risk of overcoagulation might be low even under high plasma FX levels.</p></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"8 ","pages":"Article 100111"},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666572722000153/pdfft?md5=e9250243d96b1412f2c02331c705aabf&pid=1-s2.0-S2666572722000153-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137276197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HELLP syndrome complicated by subcapsular liver hematoma and pulmonary embolism: An extremely rare case report and literature review","authors":"E. Cervilla-Muñoz ,&nbsp;F. Galeano-Valle ,&nbsp;G. Villarreal-Paul ,&nbsp;A. Enríquez-Gómez ,&nbsp;S. De-Santos-Belinchón ,&nbsp;J. Del-Toro-Cervera ,&nbsp;P. Demelo-Rodríguez","doi":"10.1016/j.tru.2022.100115","DOIUrl":"10.1016/j.tru.2022.100115","url":null,"abstract":"<div><p>HELLP syndrome consists of the triad hemolysis, elevated liver enzymes and low platelets count. It is usually developed in pregnant women with preeclampsia. Intrahepatic liver hematoma is an extremely rare complication of HELLP syndrome. Pulmonary embolism (PE) is not a typical complication of HELLP syndrome but it may appear in the setting of prothrombotic status associated to pregnancy. We report a case of HELLP syndrome complicated with subcapsular and parenchymal liver hematoma and pulmonary embolism, which represents a therapeutic challenge because it faces the need to anticoagulate with the risk of bleeding.</p></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"8 ","pages":"Article 100115"},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666572722000190/pdfft?md5=ad1d5ada60812377c30efc4ed2c68378&pid=1-s2.0-S2666572722000190-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46347780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The interplay between inflammation and thrombosis in COVID-19: Mechanisms, therapeutic strategies, and challenges","authors":"Li Ma,&nbsp;Joanne Willey","doi":"10.1016/j.tru.2022.100117","DOIUrl":"10.1016/j.tru.2022.100117","url":null,"abstract":"<div><p>Coronavirus disease 2019 (COVID-19), caused by a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can cause life-threatening pathology characterized by a dysregulated immune response and coagulopathy. While respiratory failure induced by inflammation is the most common cause of death, micro-and macrovascular thrombosis leading to multiple organ failure are also causes of mortality. Dysregulation of systemic inflammation observed in severe COVID-19 patients is manifested by cytokine release syndrome (CRS) - the aberrant release of high levels of proinflammatory cytokines, such as IL-6, IL-1, TNFα, MP-1, as well as complement. CRS is often accompanied by activation of endothelial cells and platelets, coupled with perturbation of the balance between the pro-and antithrombotic mechanisms, resulting in thrombosis. Inflammation and thrombosis form a vicious circle, contributing to morbidity and mortality. Treatment of hyperinflammation has been shown to decrease thrombosis, while anti-thrombotic treatment also downregulates cytokine release. This review highlights the relationship between COVID-19-mediated systemic inflammation and thrombosis, the molecular pathways involved, the therapies targeting these processes, and the challenges currently encountered.</p></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"8 ","pages":"Article 100117"},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666572722000219/pdfft?md5=f79d481acb4ac1194c057376d268f18e&pid=1-s2.0-S2666572722000219-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44333445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Downregulation of thrombomodulin-thrombin-activated protein C pathway as a mechanism for SARS-CoV-2 induced endotheliopathy and microvascular thrombosis","authors":"S. Agarwal ,&nbsp;C.T. Cohen ,&nbsp;M. Zobeck ,&nbsp;P.M. Jacobi ,&nbsp;S.E. Sartain","doi":"10.1016/j.tru.2022.100116","DOIUrl":"10.1016/j.tru.2022.100116","url":null,"abstract":"<div><p>There is emerging evidence of microvascular thrombosis and thrombotic microangiopathy (TMA) induced by COVID-19, presumably from endothelial injury. Thrombomodulin (TM) is an endothelial glycoprotein that plays a dual role in maintaining healthy endothelium-as a natural anticoagulant by binding thrombin to activate protein C (APC) and a negative regulator of the alternate complement pathway (AP). TM is shed into the plasma as soluble TM (sTM) during endothelial injury.</p><p>We hypothesize that SARS-CoV-2 spike proteins cause direct microvascular endothelial injury, leading to TM shedding, decreased activation of PC, and consequently, microvascular thrombosis in COVID-19. We conducted this study twofold: 1) <em>in vivo</em>, we assessed endothelial injury (by measuring sTM) and AP activation by quantifying Ba (cleavage product of AP component Factor B) in a cohort of critically ill COVID-19 pediatric patients and the implications on clinical outcomes; and 2)<em>in vitro,</em> we investigated endothelial injury (TM shedding) by SARS-COV-2 spike proteins and the subsequent functional consequence in activated PC (APC) levels and Ba levels.</p><p>sTM and Ba in plasma samples from SARS-CoV-2 positive patients admitted to Texas Children's Hospital Pediatric Intensive Care Unit (n = 33) and from healthy controls (n = 38) were measured by ELISA. <em>In vitro,</em> confluent glomerular microvascular endothelial cells (GMVECs) were incubated for 48 h in the presence or absence (control) of purified SARS-CoV-2 spike proteins, S1 and S2. TM from the cell lysates while Ba and APC from the cell supernatants were measured by ELISA. sTM and Ba levels were significantly higher in the COVID-19 pediatric patients compared to healthy controls (p &lt; 0.01 and p &lt; 0.001, respectively). Among the COVID-19 patients, elevated sTM was associated with increased vasopressor use (p = 0.01) and elevated Ba was associated with increased duration of mechanical ventilation (p = 0.04). <em>In vitro</em>, surface bound TM and soluble APC were significantly lower in GMVECs after addition of spike proteins (p &lt; 0.05), while Ba was undetectable in both control and spike proteins exposed GMVECs.</p><p>In conclusion, we provide evidence of endothelial injury in COVID-19 pediatric patients and demonstrate a potential pathway of SARS-CoV-2 induced thrombosis. Decreased surface-bound TM results in lower amount of thrombin-TM complex, hence lesser activation of PC, likely leading to a pro-thrombotic state. These findings in GMVECs could explain the vulnerability of kidneys to COVID-19-induced TMA.</p></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"8 ","pages":"Article 100116"},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666572722000207/pdfft?md5=a1b4b1be35b9b0b7ed8e178dfe19d1d2&pid=1-s2.0-S2666572722000207-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44689326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using weighted harmonic mean for prediction of APTT in the mixing test","authors":"Mitsuhiro Uchiba,&nbsp;Masao Matsuoka","doi":"10.1016/j.tru.2022.100114","DOIUrl":"https://doi.org/10.1016/j.tru.2022.100114","url":null,"abstract":"<div><h3>Background</h3><p>The mixing test of activated partial thromboplastin time (APTT) is used for differentiating factor deficiency (FD), lupus anticoagulant (LAC), and acquired hemophilia A (AHA). However, the interpretation of the mixing test is not fully standardized.</p></div><div><h3>Objectives</h3><p>The aim of this study was to determine whether the weighted harmonic mean predicts the APTT in mixture of a mixing test samples and is useful for the differentiation of FD, LAC, and AHA.</p></div><div><h3>Patients/methods</h3><p>We examined 27 FD, 26 LAC, and 18 AHA samples. Harmonic means of APTT were calculated from the clotting times with and without 2 h incubation. We defined the index of harmonic mean (IHM) as the ratio of the actual APTT to the predicted APTT calculated by the harmonic mean. We defined IHM of the measured immediate after mixing samples and of delayed (after 2 h of incubation) measured samples as IHMi and IHMd respectively.</p></div><div><h3>Results</h3><p>Actual APTT and predicted APTT were correlated in the FD group. Both IHMi and IHMd in the FD group were equal or lower than 1.02, whereas those in the LAC group were higher than 1.02. In the AHA group, the IHMd was higher than 1.02, whereas half of the IHMi were equal or lower than 1.02. Time dependent inhibition evaluated by IHMd/IHMi was not observed in the LAC group, whereas it was observed in 77% of participants in the AHA group.</p></div><div><h3>Conclusions</h3><p>The harmonic mean was potentially useful in predicting APTT in the mixing test, and the IHM calculated from the predicted APTT had differentiation potency for FD and LAC, and for FD and AHA. IHM was also available for partial differentiation of LAC to AHA.</p></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"8 ","pages":"Article 100114"},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666572722000189/pdfft?md5=6106d24d8777844293cd53466f8e5c56&pid=1-s2.0-S2666572722000189-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137276198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The thrombotic spectrum of B-thalassemia","authors":"Mavra Vasilopoulou,&nbsp;Christos Stafylidis,&nbsp;Marianna Politou","doi":"10.1016/j.tru.2022.100102","DOIUrl":"https://doi.org/10.1016/j.tru.2022.100102","url":null,"abstract":"<div><p>B-thalassemia is one of the most common recessive monogenic disorders, characterized by phenotypic diversity, lifelong treatment and severe complications. Apart from anemia, extramedullary erythropoiesis with skeletal deformities, iron overload and organ damage, hypercoagulability with subsequent thromboembolic events (TEE) has also been recognized as a fundamental feature of the disease. The pathophysiological mechanisms involved in TEE include damaged thalassemic RBC membranes as well as platelet and endothelial activation. Additionally, the fluctuation in the severity of the disease and therapeutic choices seem to influence the hemostatic balance in these patients, as transfusion-independence and splenectomy are documented risk factors for TEE. Insufficient data exist for the management and prevention of thrombotic risk in thalassemia and an imperative need to develop explicit guidelines emerges. In this review, we provide an insight in the pathophysiology of thrombosis in β-thalassemia, further discussing the available clinical evidence for optimal treatment strategies.</p></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"7 ","pages":"Article 100102"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666572722000062/pdfft?md5=07b07d9d8317ee33e8499be053931ec4&pid=1-s2.0-S2666572722000062-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72256305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility study of the Fearon Algorithm in anticoagulation service guided warfarin management","authors":"John Saunders ,&nbsp;Sara R. Vazquez ,&nbsp;Aubrey E. Jones ,&nbsp;J. Michael Fearon ,&nbsp;Paul Wegener ,&nbsp;Aaron Wilson ,&nbsp;Daniel M. Witt","doi":"10.1016/j.tru.2022.100105","DOIUrl":"10.1016/j.tru.2022.100105","url":null,"abstract":"<div><h3>Background</h3><p>Patients receiving warfarin who spend a lower proportion of time in therapeutic international normalized ratio (INR) range (TTR) have a higher risk of both bleeding complications and thromboembolic events. Using warfarin dosing algorithms is one intervention associated with improved INR stability.</p></div><div><h3>Objective</h3><p>To determine the feasibility of an individualized warfarin dosing algorithm (Fearon Algorithm) under anticoagulation management service (AMS) care and compare measures of INR control using the algorithm with standard care.</p></div><div><h3>Methods</h3><p>A pre/post intervention feasibility study consisting of the 12 months prior to patient enrollment (pre-study phase) and 6 months in which patients used the Fearon Algorithm under the supervision of an AMS pharmacist (AMS phase). The primary study outcome was the change in individual TTR.</p></div><div><h3>Results</h3><p>A total of 30 patients were enrolled in the study, 26 (87%) of whom successfully completed the AMS study phase using the Fearon Algorithm. Median corrected individual TTR increased significantly from 53% (IQR: 39%, 64%) during the year prior to enrollment to 63% (IQR: 57%, 73%) during the AMS phase (p &lt; 0.01) The uncorrected TTR also increased significantly from 52% (IQR: 39%, 64%) to 61% (IQR: 57%, 72%) (p &lt; 0.01). The Fearon Algorithm specified a smaller warfarin tablet strength in half the patients.</p></div><div><h3>Conclusion</h3><p>The Fearon Algorithm is feasible for an AMS to implement in patients receiving long-term warfarin therapy and appears to improve TTR.</p></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"7 ","pages":"Article 100105"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666572722000098/pdfft?md5=82b74936348d4288a8176e5ac06a5d19&pid=1-s2.0-S2666572722000098-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45688249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thrombosis post-mRNA-based SARS-CoV-2 vaccination (BNT162b2) – Time to think beyond thrombosis with thrombocytopenia syndrome (TTS)","authors":"Zohaib Yousaf ,&nbsp;Fateen Ata ,&nbsp;Riyadh Ali Mohammed Hammamy","doi":"10.1016/j.tru.2022.100104","DOIUrl":"10.1016/j.tru.2022.100104","url":null,"abstract":"<div><p>The COVID-19 pandemic has affected the global socioeconomic and healthcare infrastructure. Vaccines have been the cornerstone in limiting the global spread of the pandemic. However, the mass scale vaccination has resulted in some unanticipated adverse events. Arguably the most serious of these has been the development of widespread thrombosis with viral-vectored vaccines. We present a case of extensive thrombosis associated with the messenger RNA (m-RNA) vaccine.</p></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"7 ","pages":"Article 100104"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666572722000086/pdfft?md5=7aa4b9e3224a8c5fb865b3c52ec0bc14&pid=1-s2.0-S2666572722000086-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48086436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}