Evaluation of Risk Factors in Individuals with Vascular Thrombosis at High Altitude

Atif Latif; Qurrat-ul- Ain; Muhammad Zaman; Manzoor Qadir; Sajid Ali Shah

doi:10.51253/pafmj.v74i3.8802

Authors

Atif Latif Department of Radiology, Combined Military Hospital Murree/National University of Medical Sciences (NUMS) Pakistan
Qurrat-ul- Ain Department of Pathology, Combined Military Hospital Murree/National University of Medical Sciences (NUMS) Pakistan
Muhammad Zaman Department of Public Health, Armed Forces Post Graduate Medical Institute/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Manzoor Qadir Department of Medicine, Combined Military Hospital Attock/National University of Medical Sciences (NUMS) Pakistan
Sajid Ali Shah Department of Pediatrics, Combined Military Hospital Mardan/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v74i3.8802

Keywords:

Altitude, Embolism, Haemoglobin, Haematocrit veinous thrombosis

Abstract

Objective: To evaluate the risk factors for developing vascular thrombosis at high altitude.

Study Design: Prospective longitudinal study.

Place and Duration of Study: Combined Military Hospital, Skardu Pakistan, from Mar 2018 to Feb 2020.

Methodology: All individuals evacuated from high altitude with suspicion of vascular thrombosis were consecutively inducted and evaluated radiologically. Subjects diagnosed as VT were further categorized on basis of height of evacuation into high altitude, very high altitude and extremely high altitude categories.

Results: Out of 295 individuals evacuated from HA, 54(18.3%) were diagnosed as VT. All patients were males. Mean age was 31+5.3 years. Cerebral venous thrombosis was diagnosed in 19(35%) and was the most frequent followed by pulmonary embolism in 18(33%) and deep venous thrombosis in 14(26%) patients. Risk of VT increased with increase in altitude as 05(10%) cases were from high altitude, 18(33%) were from very high altitude and 31(57%) from extremely high altitude. VT was more frequent in smokers [36 cases (67%), p<0.05] and in cold weather (37 cases (69%), p<0.05). Duration of stay has significant inverse correlation with height of deployment (r= -0.592, p< 0.001). Significant difference was found in duration of stay (p<0.001), haemoglobin (p=0.016) and haematocrit (p=0.012) among different categories of high altitude.

Conclusion: Cases of vascular thrombosis increase with increasing altitude even in shorter period of stay. Increasing haemoglobin and haematocrit with increase in altitude, cold environmental temperature and smoking are important risk factors for development of VT.

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References

Chandler HC, Mellor A. Sudden onset hemiplegia at high altitude. J Roy Army Med Corps 2016; 162(6): 470-472.

https://doi.org/10.1136/jramc-2014-000372

Yamashita Y, Morimoto T, Yoshikawa Y, Yaku H, Sumita Y, Nakai M, et al. Temporal trends in the practice pattern for venous thromboembolism in Japan: insight from JROAD-DPC. J Am Heart Assoc 2020; 9(2): e014582.

https://doi.org/10.1161/JAHA.119.014582

Rocke AS, Paterson GG, Barber MT, Jackson AIR, Main SE, Stannett CE, et al. Thromboelastometry and platelet function during acclimatization to high altitude. J Thromb Haemost 2018; 118(1): 63-71. https://doi.org/10.1160/TH17-02-0138

Algahtani FH, Alqahtany FS, Al-Shehri A, Abdelgader AM. Features and incidence of thromboembolic disease: A

comparative study between high and low altitude dwellers in Saudi Arabia. Saudi J Biol Sci 2020; 27(6): 1632–1636.

https://doi.org/10.1016/j.sjbs.2020.03.004

He Y, Qi X, Ouzhulobu, Liu S, Li J, Zhang H, et al. Blunted nitric oxide regulation in Tibetans under high-altitude hypoxia. Natl. Sci. Rev 2018; 5(4): 516-529.

https://doi.org/10.1093/nsr/nwy037

Zhao Y, Zhang Z, Liu L, Zhang Y, Fan X, Ma L, et al. Associations of high altitude polycythemia with polymorphisms in EPAS1, ITGA6 and ERBB4 in Chinese Han and Tibetan populations. Oncotarget 2017; 8(49): 86736-86746.

https://doi.org/10.18632%2Foncotarget.21420

Syed MJ, Alamgir W, Wasay M. Cerebral venous thrombosis at high altitude. Pak J Neurol Sci 2018; 13(3): 44-51.

Davis C, Hackett P. Advances in the prevention and treatment of high altitude illness. Emerg Med Clin North Am 2017; 35(2): 241-260. https://doi.org/10.1016/j.emc.2017.01.002

Anand AC, Jha SK, Saha A, Sharma V, Adya CM. Thrombosis as a complication of extended stay at high altitude. Natl Med J India 2001; 14(4): 197-201.

Trunk AD, Rondina MT, Kaplan DA. Venous thromboembolism at high altitude: Our Approach to patients at risk. High Alt Med Biol 2012; 20(4): 331-336.

https://doi.org/10.1089/ham.2019.0049

Dash UK, Karmarkar AA, Dangi MS. A Study of High-Altitude-Associated conditions in soldiers less than 50 years of age admitted in the ICU of a tertiary care military hospital operating in a counter insurgency operation area. J Mar Med Soc 2017; 19(2): 138-141. https://doi.org/ 10.4103/jmms.jmms_21_17

Broggi MS, Yoon CJ, Allen J, Maceroli M, Moore T, Schenker M, et al. Higher altitude leads to increased risk of venous thromboembolism after acetabular and pelvic ring injury. J ClinOrthop Trauma 2021; 19(2): 192-195.

https://doi.org/10.1016/j.jcot.2021.05.026

Jones CA, Broggi MS, Holmes JS, Gerlach EB, Goedderz CJ, Ibnamasud SH, et al. High Altitude as a Risk Factor for Venous Thromboembolism in Tibial Plateau Fractures. Cureus;2022: 14(4): e24388. https://doi.org/10.7759/cureus.24388

Damodara D, Vakhariab V, Vakhariac A, Sheua J, Donnally CJ, Levy JC, et al. A higher altitude is an independent risk factor for venous thromboembolisms following total shoulder arthroplasty. J Orthop 2018; 15(4): 1017-1021.

https://doi.org/10.1016/j.jor.2018.09.003

Choudry Q, Iftikhar R, Qadir M, Satti TM, Omair G, Mehmood SK. High altitude and venous thrombosis: frequency and risk factors. Pak Armed Forces Med J 2021; 71(1): 107-111.

https://doi.org/10.51253/pafmj.v71i1.3173

Smallman DP, McBratney CM, Olsen CH, Slogic. Quantification of the 5-year incidence of thromboembolic events in US. Air Force Academy cadets in comparison to the US. Naval and Military Academies. Mil Med 2011; 176(2): 209-213.

https://doi.org/10.7205/MILMED-D-10-00144

Cancienne JM, Diduch DR, Werner BC. High altitude is an independent risk factor for postoperative symptomatic venous thromboembolism after knee arthroscopy: a matched case-control study of Medicare patients. Arthroscopy 2017; 33(2): 422-427. https://doi.org/10.1016/j.arthro.2016.07.031

Vij AG. Effect of prolonged stay at high altitude on platelet aggregation and fibrinogen levels. Platelets 2009; 20(6); 421–427.

https://doi.org/10.1080/09537100903116516

Agnelli G, Verso M. Epidemiology of cerebral vein and sinus thrombosis. Front Neurol Neurosci 2008; 23(2): 16-22.

https://doi.org/10.1159/000111258

Prabhakar A, Chatterjee T, Bajaj N, Tyagi T, Sahu A, Gupta N, et al. Venous thrombosis at altitude presents with distinct biochemical profiles: a comparative study from the Himalayas to the plains. Blood Adv 2019; 3(22): 3713-3723.

https://doi.org/10.1182/bloodadvances.2018024554