Simmons, Benjamin

Background: Testicular vein thrombosis (TVT) is not currently well-described in the literature. A better understanding of the natural history of TVT will allow for development of optimal management strategies for this little known entity. Methods: The goal of this project was to compare TVT with ovarian vein thrombosis (OVT) and lower extremity deep vein thrombosis (DVT). Patients with TVT, OVT, or DVT between 1995 and 2015 were identified and a chart review was performed. Results: A total of 39 patients with TVT occurring between 1995 and 2015 were identified and compared with 35 patients with OVT and 114 randomly chosen DVT patients. Mean duration of follow-up was 2.9 years (range 0-16.1). Patient demographics can be seen in table 1. Cancer-related (p-value=<0.0001) and idiopathic thrombosis (p-value=0.01) rates were significantly different among the groups. Recurrence rates were similar between TVT and OVT (4.2 vs. 3 per 100 patient-years, p-value = 0.9) as well as TVT and DVT (4.2 vs 2.2 recurrences per 100 patient-years, p-value= 0.37). There were 25 deaths (22%) in DVT patients, 9 (26%) in OVT patients, and 12 (31%) in TVT patients (p-value= 0.541). There was one major bleeding event in both an OVT patient and a TVT patient. Conclusion: Etiology of TVT differs from that of OVT and DVT, specifically in cancer-related and idiopathic thrombosis rate. Our data supports a similar rate of recurrent venous thromboembolism and death in TVT as compared with DVT and OVT.

Introduction Age related declines in oxidative metabolic capacity have been attributed to slowing of O 2 delivery and utilization. While these declines are pronounced in postmenopausal women, it is unclear how these changes compare with age‐matched men. This study aimed to phenotype adjustments of muscle oxy‐ and‐ deoxygenation during transitions of low intensity fixed‐load exercise in postmenopausal women and age‐matched men. Methods Healthy postmenopausal women (PW) and men (M) (N = 7 and 6; age 57 ± 7 and 61 ± 10 years; BMI 26 ± 2 and 27 ± 4 kg/m 2 , respectively, all P >0.05) completed 3 identical 8 min transients of fixed pedal rate (=35) and load (=20W) ergometry wearing bilateral thigh cuffs. After 5 min of rest, exercise began with 3 min without thigh cuff inflation followed by 5 min of exercise+cuff inflation at 90 mm Hg (to provoke locomotor congestion). Deoxy (HHb)‐ and total (Hb tot )‐ hemoglobin were measured by near‐infrared spectroscopy (NIRS) at the right calf. Data were sampled at 1 s intervals and ensemble averaged across 3 transients and binned to 10 s epochs for each participant prior to mono‐exponential modeling: Y B + A [1 − e −(t‐TD)/τ ]; where Y B = baseline value of Y for the 30 s prior to the step transition; τ = time constant; A = asymptote; TD = time delay. Mean response time (MRT) = TD + τ. Kinetics were modelled for the transition from exercise without to exercise+cuff inflation. Results Following the exercise on‐transient, TD was 9±4 vs. 7±3 s (P=0.35) and 8±4 vs. 6±3 s (P=0.28) for PW vs. M prior to the rise in ΔHHb or ΔHb tot , respectively. For PW vs. M, the A representing the rise in ΔHHb was 8±7 vs. 15±7 μM (P=0.04) and for ΔHb tot it was 13±8 vs. 18±8 μM (P=0.17), respectively. The kinetics of HHb following the exercise+cuff onset were similar for PW and M (τ=53±38 vs. 34±9 s, respectively, P=0.36) as well as for Hb tot (τ=43±29 vs. 29±16 s, respectively, P=0.43). The overall time course for the change in HHb (MRT=62±35 vs. 41±8 s, P=0.27) or Hb tot (MRT=51±27 vs. 35±14 s, P=0.31) did not differ for PW and M, respectively. Conclusions Despite age‐matched men demonstrating greater ΔHHb compared with PW, these data do not support the hypothesis that following exercise onset, the rate of locomotor hemodynamic adjustment and O 2 extraction for a given metabolic demand differ between these groups. Thus, as opposed to gross factors of blood flow and O 2 delivery, effects such as slowing of the rate of activation and/or processes regulating oxidative phosphorylation and mitochondrial respiration may play a stronger role in explaining differences in oxidative metabolic capacity between PW and M. Support or Funding Information Funding for this work was supported by National Institutes of Health [RO1‐HL126638 to TPO]; and American Heart Association [16POST30260021 to EHV] and National Institutes of Health [HL138814 to EHV]. This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal .

AbstractBackgroundLow molecular weight heparin (LMWH) is the guideline‐endorsed treatment for cancer‐associated venous thromboembolism (cVTE). Study objectives were to compare the efficacy and safety of rivaroxaban and enoxaparin in cVTE.MethodsUsing a cohort study design, consecutive patients with cVTE (3/1/2013‐7/31/2016), enrolled in the Mayo Thrombophilia Clinic Direct Oral Anticoagulants Registry, were compared to contemporary cancer patients receiving enoxaparin. The cumulative incidence of venous thromboembolism (VTE) recurrence, major and clinically relevant non‐major bleeding, and survival were assessed at 3 and 12 months.ResultsNinety‐eight patients received rivaroxaban (51% female, mean age 63 ± 12 years) and 168 enoxaparin (34.5% female, mean age 62 ± 15 years). The most common cancers included gastrointestinal/pancreatic, genitourinary and hematologic cancers. More than half of patients had pulmonary emboli at presentation. More than half had metastases, and two‐thirds were receiving chemotherapy. At 3 months, there were no differences in VTE recurrence (rivaroxaban 1.0% vs enoxaparin 4.2%; P = .15), major bleeding (rivaroxaban 5.1% vs enoxaparin 3.6%; P = .55), or all‐cause mortality (rivaroxaban 4.1% vs enoxaparin 8.9%; P = .14). At 12 months, these outcomes did not differ by treatment strategy.ConclusionThe results of this “real‐world” experience with cVTE suggest that rivaroxaban may offer a safe and effective alternative to LMWH.

AbstractPurposeTesticular vein thrombosis (TVT) etiology, recurrence, and survival were compared with lower extremity deep vein thrombosis (DVT) in order to determine whether treatment guidelines for DVT could be applied to TVT.Patients and MethodsAn inception cohort of patients with confirmed TVT (January 1995‐October 2015) was compared to a control group of patients with lower extremity DVT matched by age, gender, and diagnosis date.ResultsThirty‐nine men with TVT were identified; 15 (38%) with isolated TVT. Left testicular vein was affected in 77% patients; there were no cases of bilateral TVT. Cancer was over twofold more common in TVT patients (59% vs 28%, P = .01). Most cancers (78%) involved organs in proximity to the testicular vein. Although TVT patients were less frequently treated with anticoagulants (49% vs 97%, P = .0001), recurrence rates were similar to DVT group (TVT 4.2 vs DVT 1.1 per 100 patient‐years, P = .11). Despite higher cancer prevalence, survival rates were similar between groups (31% vs 28%; P = .34). Major bleeding events were rare (one patient per group).ConclusionsIdentifying TVT should prompt a search for a regional malignancy. Despite the high cancer prevalence and low utilization of anticoagulants, recurrent venous thrombosis and mortality rates are similar to DVT patients.