Venous Thromboembolism: Devices, Biomarkers and Selective Stenting
A Vein Chip Model of Covid-19 Thrombosis
A bioengineered microfluidic vein chip reproduced vortex flow seen in venous valve cusps and found cusp endothelial cells behave more anticoagulant than lumen cells, while disturbed shear upregulated Ace2 expression and allowed viral entry, modeling Covid-19 thrombosis beyond mouse models.
Below Knee DVT in Neurosurgical Patients
Among 221 neurosurgical patients with below knee DVT and no early prophylaxis, proximal propagation occurred in only 1.8 percent, pulmonary embolism in 9.5 percent, and smoking predicted PE, supporting duplex surveillance over routine IVC filter placement.
Biomarkers and Selective Stenting Strategies
A Sunset PE trial secondary analysis found the biomarkers Cxcl10 and Pentraxin-3 normalized earlier after thrombolysis than anticoagulation alone, while an ivus based iliofemoral DVT study found residual thrombus burden did not affect outcomes, supporting selective over routine stenting after removal.
ECMO Anticoagulation and Aspiration Thrombectomy
Among Covid-19 patients on venovenous ECMO, heparin kept patients in the target aptt range only about a fifth of the time, while a computer aided 12 French aspiration device achieved 93 percent single session success with half the blood loss of an 8 French system.
