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Venous Thrombosis during Spaceflight
Open accessAbstract
Venous Thrombosis during SpaceflightTo the Editor: Approximately 2 months into an International Space Station mission, obstructive left internal jugular venous thrombosis was suspected in an astronaut during an ultrasound examination that was performed as part of a vascular research study.The astronaut reported no headache or worsening of the facial plethora that is common in conditions of weightlessness.The astronaut had no personal or family history of venous thromboembolism.The physical examination revealed a prominent ipsilateral external jugular vein.Follow-up ultrasound examination performed by the astronaut, guided in real-time and interpreted by two radiologists on Earth, confirmed the presence of venous thrombosis with subacute characteristics (Fig. S1A in the Supplementary Appendix, available with the full text of this letter at NEJM.org); the contralateral internal jugular vein and the bilateral subclavian, axillary, popliteal, and femoral veins were unremarkable.Multispecialty discussions ensued, weighing the unknown risks of thrombus embolism and retrograde extension into the sinus and cerebral veins against those of anticoagulation.Twenty vials containing 300 mg of enoxaparin each were available in the pharmacy of the space station, but no anticoagulation-reversal agent was available.Treatment with enoxaparin at a dose of 1.5 mg per kilogram of body weight once daily was started; the dose was reduced to 1 mg per kilogram once daily after 33 days to extend therapy until oral apixaban could be delivered to the space station with a supply spacecraft.Protamine and prothrombin complex concentrate were also sent to the space station.Transition to apixaban at a dose of 5 mg twice daily occurred 42 days after the diagnosis of venous thrombo-1.5mg/kg 1.0 mg/kg 5.0 mg 2.5 mg
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“Early in 2020, the first occurrence of venous thrombosis was reported during spaceflight (Aunon-Chancellor et al., 2020).”
From Comprehensive Multi-omics Analysis Reveals Mitochondrial Stress as a Central Biological Hub for Spaceflight Impact (2020) · cites this paper as Aunon-Chancellor et al., 2020
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Cites
Assessment of Jugular Venous Blood Flow Stasis and Thrombosis During Spaceflight
Marshall-Goebel, K. J., Laurie, S. S., Alferova, I. V., Arbeille, P., Auñón-Chancellor, S. M., Ebert, D. J., Lee, S. M. C., Macias, B. R., Martin, D. S., Pattarini, J. M., et al. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.15011 · Cited by 294
Self-citationInternal jugular vein thrombosis: outcome and risk factors
Gbaguidi, X., Janvresse, A., Bénichou, J., Cailleux, N., Levesque, H., & Marié, I. (2010) · QJM · doi:10.1093/qjmed/hcq179 · Cited by 97
Morbidity and Mortality Associated with Internal Jugular Vein Thromboses
Ascher, E., Salles-Cunha, S. X., & Hingorani, A. (2005) · Vascular and Endovascular Surgery · doi:10.1177/153857440503900405 · Cited by 96
Isolated internal jugular vein thrombosis: risk factors and natural history
Sheikh, M. A., Topoulos, A. P., & Deitcher, S. R. (2002) · Vascular Medicine · doi:10.1191/1358863x02vm440oa · Cited by 50
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da Silveira, W. A., Fazelinia, H., Rosenthal, S. B., Laiakis, E. C., Kim, M. S., Meydan, C., Kidane, Y., Rathi, K. S., Smith, S. M., Stear, B., et al. (2020) · Cell · doi:10.1016/j.cell.2020.11.002 · Cited by 402
“Early in 2020, the first occurrence of venous thrombosis was reported during spaceflight (Aunon-Chancellor et al., 2020).”
Human Health during Space Travel: State-of-the-Art Review
Krittanawong, C., Singh, N. K., Scheuring, R. A., Urquieta, E., Bershad, E. M., Macaulay, T. R., Kaplin, S. L., Dunn, C., Kry, S. F., Russomano, T., et al. (2022) · Cells · doi:10.3390/cells12010040 · Cited by 188
Effects of exercise countermeasures on multisystem function in long duration spaceflight astronauts
Scott, J. M., Feiveson, A. H., English, K. L., Spector, E. R., Sibonga, J. D., Dillon, E. L., Ploutz‐Snyder, L. L., & Everett, M. E. (2023) · npj Microgravity · doi:10.1038/s41526-023-00256-5 · Cited by 107
Platelets in Wound Healing: What Happens in Space?
Locatelli, L., Colciago, A., Castiglioni, S., & Maier, J. A. M. (2021) · Frontiers in Bioengineering and Biotechnology · doi:10.3389/fbioe.2021.716184 · Cited by 86
Immobility-associated thromboprotection is conserved across mammalian species from bear to human
Thienel, M., Müller, J., Zhang, Z., Ehreiser, V., Huth, J., Shchurovska, K., Kilani, B., Schweizer, L., Geyer, P. E., Zwiebel, M., et al. (2023) · Science · doi:10.1126/science.abo5044 · Cited by 80
Metadata
- Authors
- Auñón-Chancellor, S. M., Pattarini, J. M., Moll, S., & Sargsyan, A.
- Affiliations
- Louisiana State University (US)
- National Aeronautics and Space Administration (US)
- University of North Carolina at Chapel Hill (US)
- KBR (United States) (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2020-01-02
- Volume
- 382
- Issue
- 1
- Pages
- 89-90
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2996799502
- Cited by
- 179
- References
- 4
- Citations by year
- 2026: 35 · 2025: 37 · 2024: 36 · 2023: 21 · 2022: 21 · 2021: 14 · 2020: 14
- FWCI
- 9.92
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Health Sciences › Medicine › Physiology (medical) › Spaceflight effects on biology
- Health Sciences › Medicine › Clinical Neurology › Cerebral Venous Sinus Thrombosis
- Keywords
- venous thrombosis, spaceflight, International Space Station, internal jugular vein thrombosis, astronauts, enoxaparin, apixaban, anticoagulation, anticoagulant reversal, protamine, prothrombin complex concentrate, venous thromboembolism, microgravity
- MeSH terms
- Aerospace Medicine, Anticoagulants, Drug Administration Schedule, Humans, Jugular Veins, Pyrazoles, Pyridones, Space Flight, Ultrasonography, Weightlessness, Telemedicine, Enoxaparin, Venous Thrombosis
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