Recently a diagnosis of deep venous thrombosis (DVT) was made during a long duration ISS mission, which may lead to a potentially fatal pulmonary embolism (PE). While DVTs (Deep Venous Thrombosis) can occur without PEs (Pulmonary Embolism), the latter is almost always preceded by a DVT.
This Topical Team will focus on creating an expert Topical Team in the domains of venous system status, haemodynamics, coagulation physiology, cerebral spinal fluid (CSF) dynamics and the constraints of spaceflight to define a (operationally focused) research and technological/procedural evaluation roadmap. This is to define Venous Thrombo-Embolisms (VTE) pathophysiology, clinical presentation and facilitate the assessment of risk, whilst proposing evaluation of candidate diagnostic, mitigation, and management strategies compatible with human spaceflight.
Publications:
Pathophysiology, risk, diagnosis, and management of venous thrombosis in space: where are we now?
The recent incidental discovery of an asymptomatic venous thrombosis (VT) in the internal jugular vein of an astronaut on the International Space Station prompted a necessary, immediate response from the space medicine community. The European Space Agency formed a topical team to review the pathophysiology, risk and clinical presentation of venous thrombosis and the evaluation of its prevention, diagnosis, mitigation, and management strategies in spaceflight. In this article, we discuss the findings of the ESA VT Topical Team over its 2-year term, report the key gaps as we see them in the above areas which are hindering understanding VT in space. We provide research recommendations in a stepwise manner that build upon existing resources, and highlight the initial steps required to enable further evaluation of this newly identified pertinent medical risk.
Authors: Katie M Harris, Roopen Arya, Antoine Elias, Tobias Weber, David A Green, Danielle K Greaves, Lonnie G Petersen, Lara Roberts, Tovy Haber Kamine, Lucia Mazzolai, Andrej Bergauer, David S Kim, Rik H Olde Engberink, Peter Zu Eulenberg, Bruno Grassi, Lucrezia Zuccarelli, Giovanni Baldassarre, Kevin Tabury, Sarah Baatout, Jens Jordan, Andrew P Blaber, Alexander Choukér, Thais Russomano, Nandu Goswami
Going against the flow: are venous thromboembolism and impaired cerebral drainage critical risks for spaceflight?
Authors: Katie M Harris, Tobias Weber, Danielle Greaves, David Andrew Green, Nandu Goswami, Lonnie G Petersen
Search for Venous Endothelial Biomarkers Heralding Venous Thromboembolism in Space: A Qualitative Systematic Review of Terrestrial Studies
Background: The recent discovery of a venous thrombosis in the internal jugular vein of an astronaut has highlighted the need to predict the risk of venous thromboembolism in otherwise healthy individuals (VTE) in space. Virchow’s triad defines the three classic risk factors for VTE: blood stasis, hypercoagulability, and endothelial disruption/dysfunction. Among these risk factors, venous endothelial disruption/dysfunction remains incompletely understood, making it difficult to accurately predict risk, set up relevant prophylactic measures and initiate timely treatment of VTE, especially in an extreme environment. Methods: A qualitative systematic review focused on endothelial disruption/dysfunction was conducted following the guidelines produced by the Space Biomedicine Systematic Review Group, which are based on Cochrane review guidelines. We aimed to assess the venous endothelial biochemical and imaging markers that may predict increased risk of VTE during spaceflight by surveying the existing knowledge base surrounding these markers in analogous populations to astronauts on the ground. Results: Limited imaging markers related to endothelial dysfunction that were outside the bounds of routine clinical practice were identified. While multiple potential biomarkers were identified that may provide insight into the etiology of endothelial dysfunction and its link to future VTE, insufficient prospective evidence is available to formally recommend screening potential astronauts or healthy patients with any currently available novel biomarker. Conclusion: Our review highlights a critical knowledge gap regarding the role biomarkers of venous endothelial disruption have in predicting and identifying VTE. Future population-based prospective studies are required to link potential risk factors and biomarkers for venous endothelial dysfunction to occurrence of VTE.
Authors: Katie Harris, Jonathan Michael Laws, Antoine Elias, David Andrew Green, Nandu Goswami, Jens Jordan, Tovy Haber Kamine, Lucia Mazzolai, Lonnie G Petersen, Andrew James Winnard, Tobias Weber