دانلود رایگان مقاله انگلیسی عوامل خطر آمبولی ترومبوز وریدی در طی عفونت سیتومگالوویروس در افراد دارای ایمنی بدن - اشپرینگر 2018

Abstract

Most of the effects and complications of cytomegalovirus (CMV) infection are still unknown, even though its tropism for the endothelium has been extensively investigated. In fact, CMV is suspected to be a cause of venous thrombo-embolism (VTE) since 1974, but there is still no consensus about the management of CMV-related thrombosis and how to prevent it. Cytomegalovirus-related thrombosis has been reported mostly in immunocompromised patients, rarely in immunocompetent individuals. In order to identify potential risk factors of CMV-related thrombosis, we performed a systematic review of the literature regarding immunocompetent patients with cytomegalovirus infection and thrombosis. We found 115 cases with a mean age of 37.36 years (SD ± 16.43 years). Almost half the female patients were assuming EP contraception at the time of the event, and almost half the patients were affected by a coagulation disorder. Interestingly, just two women and four men had no risk factor for thrombosis other than the CMV infection at the time of the event. In conclusion, coagulation disorders and EP contraception have to be taken into a great deal of consideration in patients with CMV infection, since they could be important risk factors for VTE. Knowing the correlation with coagulation disorders, the use of anticoagulation drugs cannot be considered overtreatment. It was not feasible to determine the usefulness of an antiviral treatment. Further studies, even randomized ones, are required to determine the usefulness of antiviral drugs and the real prevalence of CMV-related VTE.

Conclusion

Our study is affected by the lack of data offered by some of the case-reports included.

We can offer some interesting conclusions:

– CMV-related VTE should be looked for especially in 30– 50-year-old female patients currently undergoing EP contraception

– Coagulation disorders are an important additional risk factor. It is essential to know if the patients are affected by any of these conditions to determine the duration of the anticoagulant therapy

– Anticoagulation is not overtreatment. Even when only small vessels are involved, an anticoagulant therapy should be started, at least till thrombosis resolution

– Antiviral treatment was started only in a minority of patients included in the study, making it impossible to determine about the usefulness of a pharmacological treatment in reducing the symptoms and their duration in immunocompetent patients.

In conclusion, we suggest that CMV should be taken into consideration in all cases of thrombosis with no apparent cause, and that it would probably be reasonable to look for a thrombosis in all symptomatic CMV infections, even more if the patient has at least one other accountable risk factor or any localized pain.

Further studies, also randomized ones, are required to determine about the usefulness of antiviral drugs and the real prevalence of CMV-related VTE.