Minerva medica
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Upper extremity deep vein thrombosis (UEDVT) represents about 5-10% of all cases of deep vein thrombosis (DVT) with a steadily increasing incidence mostly due to the high prevalence of cancer and frequent use of intravascular devices such as central venous catheters and pacemaker. In primary UEDVT, the venous outflow obstruction and subsequent thrombosis are related to congenital or acquired anatomical abnormalities, whereas secondary UEDVT is often associated with malignancy or indwelling lines. ⋯ Despite sharing many similarities with lower extremity DVT, UEDVT has distinctive features requiring specific diagnostic and therapeutic approaches. The present review discusses the latest evidence on the epidemiology, diagnosis, and treatment of UEDVT, and provides management indications which may help guide clinical decision making.
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The atherosclerotic cardiovascular disease (ASCVD) represents the leading cause of death and disability in the elderly. The study of atherosclerosis and the strategies to control ASCVD are evolving. All strategies emphasize the need to lower LDL cholesterol (LDL-C) through an appropriate lifestyle and the use of lipid-lowering drugs, mainly statins. ⋯ Thus, evidence supporting the benefit of statin therapy for primary and secondary prevention of fatal and nonfatal ASCVD events in adults aged 75 years and older are limited. The pharmacological therapy of dyslipidemia is recommended by guidelines provided by international expert panels in adults, while in the elderly it is still a matter of debate. Statins are generally well tolerated drugs but their use in the elderly, especially in fragile ones or with multi-pathology that take many other drugs, requires a careful evaluation of the risk-benefit ratio and a shared decision- making process between doctor and patient.
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Lemierre Syndrome is a rare form of septic thrombophlebitis of the head and neck veins, most typically of the internal jugular vein, which affects otherwise healthy adolescents and young adults after an oropharyngitis or other local infection. It is characterized by multiple septic embolization. Despite treatment, Lemierre Syndrome displays a high rate of in-hospital complications that include thrombus progression and a new peripheral septic embolization; moreover, it can be fatal or cause disabling sequelae. ⋯ Over the last few years, new observational evidence has improved our knowledge of the clinical epidemiology of this condition and highlighted a number of promising management strategies. We provide an overview of the treatment patterns adopted in the contemporary era, and summarize the arguments proposed so far against or in favor of alternative treatments as well as possible decision rules on the use of anticoagulation. Moreover, we outline the priorities of ongoing and future observational and interventional research.