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Jugular Vein Thrombosis and Anticoagulation Therapy in Lemierre’s Syndrome—A Post Hoc Observational and Population-Based Study of 82 Patients
BACKGROUND: Lemierre’s syndrome is typically caused by Fusobacterium necrophorum where an oropharyngeal infection is followed by septic internal jugular vein thrombophlebitis with subsequent septic embolization. Yet, the pathogenesis of septic thrombophlebitis, differences dependent on the presence...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7793455/ https://www.ncbi.nlm.nih.gov/pubmed/33447643 http://dx.doi.org/10.1093/ofid/ofaa585 |
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author | Nygren, David Elf, Johan Torisson, Gustav Holm, Karin |
author_facet | Nygren, David Elf, Johan Torisson, Gustav Holm, Karin |
author_sort | Nygren, David |
collection | PubMed |
description | BACKGROUND: Lemierre’s syndrome is typically caused by Fusobacterium necrophorum where an oropharyngeal infection is followed by septic internal jugular vein thrombophlebitis with subsequent septic embolization. Yet, the pathogenesis of septic thrombophlebitis, differences dependent on the presence of jugular vein thrombosis, and the role of anticoagulant therapy are insufficiently understood. METHODS: Patients with invasive infection with F. necrophorum and Lemierre’s syndrome who had been investigated for jugular vein thrombosis were included from a previous population-based observational study in Sweden. Medical records were reviewed and compared in patients with and without jugular vein thrombosis. Then, patients with jugular vein thrombosis were compared by exposure to therapeutic, prophylactic, or no anticoagulation. Outcomes examined were thrombosis progression, early or late peripheral septic complications, chronic major sequelae, 30-day mortality, and major bleeding. RESULTS: Fifty-one of 82 (62%) radiologically investigated patients with Lemierre’s syndrome had jugular vein thrombosis. Patients with jugular vein thrombosis had lower platelet levels (median, 76 vs 112 ×10(9)/L; P = .04) on presentation and more days to defervesence (12 vs 7 days; P = .03) yet similar rates of major sequelae and 30-day mortality. No significant differences in outcomes were seen between patients with jugular vein thrombosis exposed to therapeutic, prophylactic, or no anticoagulation therapy, yet study outcomes were rare. CONCLUSIONS: Patients with Lemierre’s syndrome with jugular vein thrombosis were more severely affected, yet had similar prognosis. Most patients with jugular vein thrombosis recovered well without therapeutic anticoagulation therapy, though adverse events were similarly rare in anticoagulated patients. The observational design and rarity of study outcomes require cautious interpretation. |
format | Online Article Text |
id | pubmed-7793455 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-77934552021-01-13 Jugular Vein Thrombosis and Anticoagulation Therapy in Lemierre’s Syndrome—A Post Hoc Observational and Population-Based Study of 82 Patients Nygren, David Elf, Johan Torisson, Gustav Holm, Karin Open Forum Infect Dis Major Articles BACKGROUND: Lemierre’s syndrome is typically caused by Fusobacterium necrophorum where an oropharyngeal infection is followed by septic internal jugular vein thrombophlebitis with subsequent septic embolization. Yet, the pathogenesis of septic thrombophlebitis, differences dependent on the presence of jugular vein thrombosis, and the role of anticoagulant therapy are insufficiently understood. METHODS: Patients with invasive infection with F. necrophorum and Lemierre’s syndrome who had been investigated for jugular vein thrombosis were included from a previous population-based observational study in Sweden. Medical records were reviewed and compared in patients with and without jugular vein thrombosis. Then, patients with jugular vein thrombosis were compared by exposure to therapeutic, prophylactic, or no anticoagulation. Outcomes examined were thrombosis progression, early or late peripheral septic complications, chronic major sequelae, 30-day mortality, and major bleeding. RESULTS: Fifty-one of 82 (62%) radiologically investigated patients with Lemierre’s syndrome had jugular vein thrombosis. Patients with jugular vein thrombosis had lower platelet levels (median, 76 vs 112 ×10(9)/L; P = .04) on presentation and more days to defervesence (12 vs 7 days; P = .03) yet similar rates of major sequelae and 30-day mortality. No significant differences in outcomes were seen between patients with jugular vein thrombosis exposed to therapeutic, prophylactic, or no anticoagulation therapy, yet study outcomes were rare. CONCLUSIONS: Patients with Lemierre’s syndrome with jugular vein thrombosis were more severely affected, yet had similar prognosis. Most patients with jugular vein thrombosis recovered well without therapeutic anticoagulation therapy, though adverse events were similarly rare in anticoagulated patients. The observational design and rarity of study outcomes require cautious interpretation. Oxford University Press 2020-11-29 /pmc/articles/PMC7793455/ /pubmed/33447643 http://dx.doi.org/10.1093/ofid/ofaa585 Text en © The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Major Articles Nygren, David Elf, Johan Torisson, Gustav Holm, Karin Jugular Vein Thrombosis and Anticoagulation Therapy in Lemierre’s Syndrome—A Post Hoc Observational and Population-Based Study of 82 Patients |
title | Jugular Vein Thrombosis and Anticoagulation Therapy in Lemierre’s Syndrome—A Post Hoc Observational and Population-Based Study of 82 Patients |
title_full | Jugular Vein Thrombosis and Anticoagulation Therapy in Lemierre’s Syndrome—A Post Hoc Observational and Population-Based Study of 82 Patients |
title_fullStr | Jugular Vein Thrombosis and Anticoagulation Therapy in Lemierre’s Syndrome—A Post Hoc Observational and Population-Based Study of 82 Patients |
title_full_unstemmed | Jugular Vein Thrombosis and Anticoagulation Therapy in Lemierre’s Syndrome—A Post Hoc Observational and Population-Based Study of 82 Patients |
title_short | Jugular Vein Thrombosis and Anticoagulation Therapy in Lemierre’s Syndrome—A Post Hoc Observational and Population-Based Study of 82 Patients |
title_sort | jugular vein thrombosis and anticoagulation therapy in lemierre’s syndrome—a post hoc observational and population-based study of 82 patients |
topic | Major Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7793455/ https://www.ncbi.nlm.nih.gov/pubmed/33447643 http://dx.doi.org/10.1093/ofid/ofaa585 |
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