How I diagnose and treat venous thromboembolism in sickle cell disease - PubMed (original) (raw)

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How I diagnose and treat venous thromboembolism in sickle cell disease

Arun S Shet et al. Blood. 2018.

Abstract

The incidence of venous thromboembolism (VTE) in adult patients with sickle cell disease (SCD) is high. However, overlapping features between the clinical presentation of VTE and SCD complications and a low index of suspicion for thrombosis can influence patient management decisions. VTE in SCD can therefore present management challenges to the clinical hematologist. Herein, we present 3 distinct clinical vignettes that are representative of our clinical practice with SCD patients. These vignettes are discussed with specific reference to the hypercoagulable state in SCD patients, recent VTE diagnosis and anticoagulant therapy guidelines from the general population, and evaluation of the risk of bleeding as a result of long-term exposure to anticoagulant therapy. We examine current diagnostic and treatment options, highlight limitations of the existing clinical prognostic models that offer personalized guidance regarding the duration of anticoagulation, and propose a clinical approach to guide the decision to extend anticoagulation beyond 3 months.

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Conflict of interest statement

Conflict-of-interest disclosure: T.W. is a steering committee member and receives research funding from Janssen and Pfizer. A.S.S. declares no competing financial interests.

Figures

Figure 1.

Figure 1.

Hypercoagulability in SCD. DAMP, damage-associated molecular pattern; IL, interleukin; LPS, lipopolysaccharide; MP, microparticle; NET, neutrophil extracellular trap; TF, tissue factor; TLR, Toll-like receptor; TNF, tumor necrosis factor α; VEGF, vascular endothelial growth factor.

Figure 2.

Figure 2.

Algorithm for diagnosis of SCD patients with an episode of suspected VTE.

References

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