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Ahmed Mohamed S, El- Gohary G, AlGahtani F, Alayoubi F, Abd El-Aziz N. Hematological Findings in COVID-19 and Insights to Stem Cell Therapy: From Bench to Practice. JOURNAL OF SKIN AND STEM CELL 2021; 7. [DOI: 10.5812/jssc.107133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/05/2020] [Accepted: 09/05/2020] [Indexed: 09/02/2023]
Abstract
Context: As the COVID-19 was spreading to all countries, its manifestations were identifying gradually, which were related to several organs. Evidence Acquisition: COVID-19 is associated with distinct hematological changes, increased serum inflammatory markers, and coagulopathy. Most of these changes are related to the patients’ prognosis and mortality, particularly in those with severe disease. Results: Firstly, we discussed the associations between COVID-19 clinical features and complications, and secondly, its hematological findings and coagulopathy are investigated. Conclusions: Such associations not only may shed light on our prognostic view of patients with COVID-19 but also will entail significant therapeutic implications. One of its key implications is to utilize the mesenchymal stem cells (MSCs) to treat patients with COVID-19. Herein, this kind of novel therapy will be discussed, as well.
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The COVID-19 Pandemic: Disproportionate Thrombotic Tendency and Management Recommendations. Trop Med Infect Dis 2021; 6:tropicalmed6010026. [PMID: 33670475 PMCID: PMC7930939 DOI: 10.3390/tropicalmed6010026] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/13/2020] [Accepted: 01/08/2021] [Indexed: 02/06/2023] Open
Abstract
COVID-19 is an infectious disease caused by the SARS COV-2 virus. Patients with COVID-19 are susceptible to thrombosis due to excessive inflammation, platelet activation, endothelial dysfunction, and circulatory stasis, resulting in an increased risk of death due to associated coagulopathies. In addition, many patients receiving antithrombotic therapy for pre-existing thrombotic diseases can develop COVID-19, which can further complicate dose adjustment, choice and laboratory monitoring of antithrombotic treatment. This review summarizes the laboratory findings, the prohemostatic state, incidence of thromboembolic events and some potential therapeutic interventions of COVID-19 associated coagulopathy. We explore the roles of biomarkers of thrombosis and inflammation according to the severity of COVID-19. While therapeutic anticoagulation has been used empirically in some patients with severe COVID-19 but without thrombosis, it may be preferable to provide supportive care based on evidence-based randomized clinical trials. The likely lifting of travel restrictions will accelerate the spread of COVID-19, increasing morbidity and mortality across nations. Many individuals will continue to receive anticoagulation therapy regardless of their location, requiring on-going treatment with low-molecular weight heparin, vitamin K antagonist or direct-acting anticoagulants.
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53
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Berkman SA. Post-hospital discharge venous thromboembolism prophylaxis in medically ill patients. Postgrad Med 2021; 133:51-63. [PMID: 33435758 DOI: 10.1080/00325481.2021.1876387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
There is a widely expressed concern about an unmet need for post hospitalization venous thromboembolism (VTE) prophylaxis in medically ill patients, however, physicians and hospitals have been slow to implement this measure. Recommendations against extended VTE prophylaxis in medical patients from the American Society of Hematology (ASH) in 2018 and the withholding of approval of betrixiban by the European Medicines Agency also in 2018 may have been influential in this regard. Furthermore, rivaroxaban the other drug approved for this indication in the U.S has not yet been approved in Europe. In addition, hospital administrators, those monitoring expenses in the U.S, have been reluctant to support a treatment which will mostly involve outpatients. Internal medicine physicians, hospitalists and nursing home physicians have not shared the fervor for post hospital VTE prophylaxis, whether with anticoagulants or aspirin, that their orthopedic surgery colleagues have, particularly in hip and knee arthroplasty. This is despite an increased risk of post hospital discharge thrombosis in both groups of patients. Enter hospitalized patients with COVID-19, a potentially severe medical illness with high hospitalization related thrombosis risk, and questions arise as to whether these medical patients, who are clearly more hypercoagulable during hospitalization than those in previous studies, should warrant post hospital discharge prophylaxis.
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Affiliation(s)
- Samuel A Berkman
- Department of medicine, Division of hematology/Oncology UCLA, California
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Prevention of Venous Thromboembolism in Acutely Ill Medical Patients: A New Era. Semin Respir Crit Care Med 2021; 42:308-315. [PMID: 33548931 DOI: 10.1055/s-0041-1723018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Venous thromboembolism (VTE) is the leading preventable cause of death in hospitalized patients and data consistently show that acutely ill medical patients remain at increased risk for VTE-related morbidity and mortality in the post-hospital discharge period. Prescribing extended thromboprophylaxis for up to 45 days following an acute hospitalization in key patient subgroups that include more than one-quarter of hospitalized medically-ill patients represents a paradigm shift in the way hospital-based physicians think about VTE prevention. Advances in the field of primary thromboprophylaxis in acutely-ill medical patients using validated VTE and bleeding risk assessment models have established key patient subgroups at high risk of VTE and low risk of bleeding that may benefit from both in-hospital and extended thromboprophylaxis. The direct oral anticoagulants betrixaban and rivaroxaban are now U.S. Food and Drug Administration-approved for in-hospital and extended thromboprophylaxis in medically ill patients and provide net clinical benefit in these key subgroups. Coronavirus disease-2019 may predispose patients to VTE due to excessive inflammation, platelet activation, endothelial dysfunction, and hemostasis. The optimum preventive strategy for these patients requires further investigation. This article aims to review the latest concepts in predicting and preventing VTE and discuss the new era of extended thromboprophylaxis in hospitalized medically ill patients.
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55
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Weber C, Rigby A, Lip GYH. Thrombosis and Haemostasis 2020 Editors' Choice Papers. Thromb Haemost 2021; 121:109-114. [PMID: 33477198 DOI: 10.1055/s-0040-1722171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Christian Weber
- Institute for Cardiovascular Prevention (IPEK), LMU Munich, Munich, Germany.,Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Anne Rigby
- Institute for Cardiovascular Prevention (IPEK), LMU Munich, Munich, Germany
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Girona-Alarcon M, Bobillo-Perez S, Sole-Ribalta A, Hernandez L, Guitart C, Suarez R, Balaguer M, Cambra FJ, Jordan I. The different manifestations of COVID-19 in adults and children: a cohort study in an intensive care unit. BMC Infect Dis 2021; 21:87. [PMID: 33472588 PMCID: PMC7816131 DOI: 10.1186/s12879-021-05786-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/11/2021] [Indexed: 02/06/2023] Open
Abstract
Background The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has collapsed health systems worldwide. In adults, the virus causes severe acute respiratory distress syndrome (ARDS), while in children the disease seems to be milder, although a severe multisystem inflammatory syndrome (MIS-C) has been described. The aim was to describe and compare the characteristics of the severe COVID-19 disease in adults and children. Methods This prospective observational cohort study included the young adults and children infected with SARS-CoV-2 between March–June 2020 and admitted to the paediatric intensive care unit. The two populations were analysed and compared focusing on their clinical and analytical characteristics and outcomes. Results Twenty patients were included. There were 16 adults (80%) and 4 children (20%). No mortality was recorded. All the adults were admitted due to ARDS. The median age was 32 years (IQR 23.3–41.5) and the most relevant previous pathology was obesity (n = 7, 43.7%). Thirteen (81.3%) needed mechanical ventilation, with a median PEEP of 13 (IQR 10.5–14.5). Six (37.5%) needed inotropic support due to the sedation. Eight (50%) developed a healthcare-associated infection, the most frequent of which was central line-associated bloodstream infection (n = 7, 71.4%). One patient developed a partial pulmonary thromboembolism, despite him being treated with heparin. All the children were admitted due to MIS-C. Two (50%) required mechanical ventilation. All needed inotropic support, with a median vasoactive-inotropic score of 27.5 (IQR 17.5–30). The difference in the inotropic requirements between the two populations was statistically significant (37.5% vs. 100%, p < 0.001). The biomarker values were higher in children than in adults: mid-regional pro-adrenomedullin 1.72 vs. 0.78 nmol/L (p = 0.017), procalcitonin 5.7 vs. 0.19 ng/mL (p = 0.023), and C-reactive protein 328.2 vs. 146.9 mg/L (p = 0.005). N-terminal pro-B-type natriuretic peptide and troponins were higher in children than in adults (p = 0.034 and p = 0.039, respectively). Conclusions Adults and children had different clinical manifestations. Adults developed severe ARDS requiring increased respiratory support, whereas children presented MIS-C with greater inotropic requirements. Biomarkers could be helpful in identifying susceptible patients, since they might change depending on the clinical features.
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Affiliation(s)
- Mònica Girona-Alarcon
- Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group, Institut de Recerca Hospital Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Sara Bobillo-Perez
- Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain. .,Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group, Institut de Recerca Hospital Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain.
| | - Anna Sole-Ribalta
- Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group, Institut de Recerca Hospital Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain.,Emergency Transport System, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Lluisa Hernandez
- Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group, Institut de Recerca Hospital Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Carmina Guitart
- Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group, Institut de Recerca Hospital Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Ricardo Suarez
- Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group, Institut de Recerca Hospital Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Mònica Balaguer
- Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group, Institut de Recerca Hospital Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Francisco-Jose Cambra
- Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group, Institut de Recerca Hospital Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Iolanda Jordan
- Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group, Institut de Recerca Hospital Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain.,Paediatric Intensive Care Unit, CIBERESP, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
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Hiatt J, Vazquez SR, Witt DM. Provider perceptions of extended venous thromboembolism prophylaxis for hospitalized medically ill patients. THROMBOSIS UPDATE 2021. [DOI: 10.1016/j.tru.2021.100034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Al-Subaie AM. Coagulopathies in novel coronavirus (SARS-CoV-2) pandemic: Emerging evidence for hematologists. Saudi J Biol Sci 2021; 28:956-961. [PMID: 33169062 PMCID: PMC7642728 DOI: 10.1016/j.sjbs.2020.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/30/2020] [Accepted: 11/01/2020] [Indexed: 01/22/2023] Open
Abstract
The coronavirus disease (COVID-19), which is also known as acute respiratory syndrome coronavirus-2 (SARS-CoV2) is a transmissible disease, has phenotypes varying from asymptomatic to Acute Respiratory Distress Syndrome (ARDS) or multiple organ dysfunction syndrome (MODS) and ultimately death in certain cases. Coagulation disorders are being frequently reported amongst these patients and the pathogenesis is still not completely understood. Proposed mechanisms for these coagulopathies comprise a hypercoagulable state with micro- and/or macro-thrombosis in the vessels. A number of changes have been reported or proposed in circulating prothrombotic factors in COVID-19 patients and includes elevation in both factor VIII and fibrinogen, circulating prothrombotic microparticles and hyperviscosity. The COVID-19 patients are showing varied coagulopathies and are at high risk for venous thromboembolism (VTE) which demands an early intervention. This paper reviews the evolving data regarding the evaluation and managing of coagulopathies in patients with COVID-19.
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Affiliation(s)
- Abeer M. Al-Subaie
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Imam AbdulRahman bin Faisal University, P.O. Box: 1982, Dammam 31441, Saudi Arabia
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59
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El-Goly AMM. Lines of Treatment of COVID-19 Infection. COVID-19 INFECTIONS AND PREGNANCY 2021. [PMCID: PMC8298380 DOI: 10.1016/b978-0-323-90595-4.00002-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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60
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Nwajei F, Anand P, Abdalkader M, Andreu Arasa VC, Aparicio HJ, Behbahani S, Curiale G, Daneshmand A, Dasenbrock H, Mayo T, Mian A, Nguyen T, Ong C, Romero JR, Sakai O, Takahashi C, Cervantes-Arslanian AM. Cerebral Venous Sinus Thromboses in Patients with SARS-CoV-2 Infection: Three Cases and a Review of the Literature. J Stroke Cerebrovasc Dis 2020; 29:105412. [PMID: 33254367 PMCID: PMC7571902 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105412] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 09/18/2020] [Accepted: 10/13/2020] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Early studies suggest that acute cerebrovascular events may be common in patients with coronavirus disease 2019 (COVID-19) and may be associated with a high mortality rate. Most cerebrovascular events described have been ischemic strokes, but both intracerebral hemorrhage and rarely cerebral venous sinus thrombosis (CVST) have also been reported. The diagnosis of CVST can be elusive, with wide-ranging and nonspecific presenting symptoms that can include headache or altered sensorium alone. OBJECTIVE To describe the presentation, barriers to diagnosis, treatment, and outcome of CVST in patients with COVID-19. METHODS We abstracted data on all patients diagnosed with CVST and COVID-19 from March 1 to August 9, 2020 at Boston Medical Center. Subsequently, we reviewed the literature and extracted all published cases of CVST in patients with COVID-19 from January 1, 2020 through August 9, 2020 and included all studies with case descriptions. RESULTS We describe the clinical features and management of CVST in 3 women with COVID-19 who developed CVST days to months after initial COVID-19 symptoms. Two patients presented with encephalopathy and without focal neurologic deficits, while one presented with visual symptoms. All patients were treated with intravenous hydration and anticoagulation. None suffered hemorrhagic complications, and all were discharged home. We identified 12 other patients with CVST in the setting of COVID-19 via literature search. There was a female predominance (54.5%), most patients presented with altered sensorium (54.5%), and there was a high mortality rate (36.4%). CONCLUSIONS During this pandemic, clinicians should maintain a high index of suspicion for CVST in patients with a recent history of COVID-19 presenting with non-specific neurological symptoms such as headache to provide expedient management and prevent complications. The limited data suggests that CVST in COVID-19 is more prevalent in females and may be associated with high mortality.
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Affiliation(s)
- Felix Nwajei
- Department of Neurosurgery, Boston University Medical Center, Boston, Massachusetts, USA
| | - Pria Anand
- Department of Neurology, Boston University Medical Center, Boston, Massachusetts, USA
| | - Mohamad Abdalkader
- Department of Radiology, Boston University Medical Center, Boston, Massachusetts, USA
| | - Vanesa C Andreu Arasa
- Department of Radiology, Boston University Medical Center, Boston, Massachusetts, USA
| | - Hugo J Aparicio
- Department of Neurology, Boston University Medical Center, Boston, Massachusetts, USA
| | - Siavash Behbahani
- Department of Radiology, Boston University Medical Center, Boston, Massachusetts, USA
| | - Gioacchino Curiale
- Department of Neurology, Boston University Medical Center, Boston, Massachusetts, USA
| | - Ali Daneshmand
- Department of Neurosurgery, Boston University Medical Center, Boston, Massachusetts, USA; Department of Neurology, Boston University Medical Center, Boston, Massachusetts, USA
| | - Hormuzdiyar Dasenbrock
- Department of Neurosurgery, Boston University Medical Center, Boston, Massachusetts, USA
| | - Thomas Mayo
- Department of Neurology, Boston University Medical Center, Boston, Massachusetts, USA
| | - Asim Mian
- Department of Radiology, Boston University Medical Center, Boston, Massachusetts, USA
| | - Thanh Nguyen
- Department of Neurosurgery, Boston University Medical Center, Boston, Massachusetts, USA; Department of Neurology, Boston University Medical Center, Boston, Massachusetts, USA; Department of Radiology, Boston University Medical Center, Boston, Massachusetts, USA
| | - Charlene Ong
- Department of Neurosurgery, Boston University Medical Center, Boston, Massachusetts, USA; Department of Neurology, Boston University Medical Center, Boston, Massachusetts, USA
| | - J Rafael Romero
- Department of Neurology, Boston University Medical Center, Boston, Massachusetts, USA
| | - Osamu Sakai
- Department of Radiology, Boston University Medical Center, Boston, Massachusetts, USA
| | - Courtney Takahashi
- Department of Neurosurgery, Boston University Medical Center, Boston, Massachusetts, USA; Department of Neurology, Boston University Medical Center, Boston, Massachusetts, USA
| | - Anna M Cervantes-Arslanian
- Department of Neurosurgery, Boston University Medical Center, Boston, Massachusetts, USA; Department of Neurology, Boston University Medical Center, Boston, Massachusetts, USA; Department of Medicine, Boston University Medical Center, Boston, Massachusetts, USA.
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Gerotziafas GT, Catalano M, Colgan MP, Pecsvarady Z, Wautrecht JC, Fazeli B, Olinic DM, Farkas K, Elalamy I, Falanga A, Fareed J, Papageorgiou C, Arellano RS, Agathagelou P, Antic D, Auad L, Banfic L, Bartolomew JR, Benczur B, Bernardo MB, Boccardo F, Cifkova R, Cosmi B, De Marchi S, Dimakakos E, Dimopoulos MA, Dimitrov G, Durand-Zaleski I, Edmonds M, El Nazar EA, Erer D, Esponda OL, Gresele P, Gschwandtner M, Gu Y, Heinzmann M, Hamburg NM, Hamadé A, Jatoi NA, Karahan O, Karetova D, Karplus T, Klein-Weigel P, Kolossvary E, Kozak M, Lefkou E, Lessiani G, Liew A, Marcoccia A, Marshang P, Marakomichelakis G, Matuska J, Moraglia L, Pillon S, Poredos P, Prior M, Salvador DRK, Schlager O, Schernthaner G, Sieron A, Spaak J, Spyropoulos A, Sprynger M, Suput D, Stanek A, Stvrtinova V, Szuba A, Tafur A, Vandreden P, Vardas PE, Vasic D, Vikkula M, Wennberg P, Zhai Z. Guidance for the Management of Patients with Vascular Disease or Cardiovascular Risk Factors and COVID-19: Position Paper from VAS-European Independent Foundation in Angiology/Vascular Medicine. Thromb Haemost 2020; 120:1597-1628. [PMID: 32920811 PMCID: PMC7869052 DOI: 10.1055/s-0040-1715798] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/23/2020] [Indexed: 02/06/2023]
Abstract
COVID-19 is also manifested with hypercoagulability, pulmonary intravascular coagulation, microangiopathy, and venous thromboembolism (VTE) or arterial thrombosis. Predisposing risk factors to severe COVID-19 are male sex, underlying cardiovascular disease, or cardiovascular risk factors including noncontrolled diabetes mellitus or arterial hypertension, obesity, and advanced age. The VAS-European Independent Foundation in Angiology/Vascular Medicine draws attention to patients with vascular disease (VD) and presents an integral strategy for the management of patients with VD or cardiovascular risk factors (VD-CVR) and COVID-19. VAS recommends (1) a COVID-19-oriented primary health care network for patients with VD-CVR for identification of patients with VD-CVR in the community and patients' education for disease symptoms, use of eHealth technology, adherence to the antithrombotic and vascular regulating treatments, and (2) close medical follow-up for efficacious control of VD progression and prompt application of physical and social distancing measures in case of new epidemic waves. For patients with VD-CVR who receive home treatment for COVID-19, VAS recommends assessment for (1) disease worsening risk and prioritized hospitalization of those at high risk and (2) VTE risk assessment and thromboprophylaxis with rivaroxaban, betrixaban, or low-molecular-weight heparin (LMWH) for those at high risk. For hospitalized patients with VD-CVR and COVID-19, VAS recommends (1) routine thromboprophylaxis with weight-adjusted intermediate doses of LMWH (unless contraindication); (2) LMWH as the drug of choice over unfractionated heparin or direct oral anticoagulants for the treatment of VTE or hypercoagulability; (3) careful evaluation of the risk for disease worsening and prompt application of targeted antiviral or convalescence treatments; (4) monitoring of D-dimer for optimization of the antithrombotic treatment; and (5) evaluation of the risk of VTE before hospital discharge using the IMPROVE-D-dimer score and prolonged post-discharge thromboprophylaxis with rivaroxaban, betrixaban, or LMWH.
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Affiliation(s)
- Grigoris T. Gerotziafas
- Hematology and Thrombosis Center, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Faculté de Médecine, Sorbonne Université, Paris, France
- Research Group Cancer, Haemostasis and Angiogenesis,” INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France
| | - Mariella Catalano
- Research Center on Vascular Disease & Angiology Unit, Department of Biomedical Science, L Sacco Hospital, University of Milan, Milan, Italy
| | - Mary-Paula Colgan
- Department of Vascular Surgery, St. James's Hospital/Trinity College Dublin, Dublin, Ireland
| | - Zsolt Pecsvarady
- Department of Vascular Medicine, Flor Ferenc Teaching Hospital, Kistarcsa, Hungary
| | - Jean Claude Wautrecht
- Service de Pathologie Vasculaire, Hôpital ERASME, Université Libre de Bruxelle, Brussels, Belgium
| | - Bahare Fazeli
- Immunology Department, Avicenna (Bu-Ali) Research Institute, Mashhad University of Medical Sciences, Iran
| | - Dan-Mircea Olinic
- Medical Clinic No. 1, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Katalin Farkas
- Department of Angiology, St. Imre University Teaching Hospital, Budapest, Hungary
| | - Ismail Elalamy
- Hematology and Thrombosis Center, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Faculté de Médecine, Sorbonne Université, Paris, France
- Research Group Cancer, Haemostasis and Angiogenesis,” INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France
- Department of Obstetrics and Gynecology, I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Anna Falanga
- Department of Immunohematology and Transfusion Medicine, & the Thrombosis and Hemostasis Center, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Jawed Fareed
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois, United States
| | - Chryssa Papageorgiou
- Service Anesthésie, Réanimation et Médecine Périopératoire, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Faculté de médecine, Sorbonne Université, Paris, France
| | | | - Petros Agathagelou
- Department of Inrterventional Cardiology, American Heart Institute of Cyprus, Nicosia, Cyprus
| | - Darco Antic
- Clinic for Hematology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Luciana Auad
- Medicina Vascular, Sanatorio Allende Córdoba, Ciencias Médicas, Universidad Católica de Córdoba, Argentina
| | - Ljiljana Banfic
- University Hospital Center, School of Medicine University of Zagreb, Croatia
| | | | - Bela Benczur
- Balassa Janos County Hospital, University Medical School, Szeged, Hungary
| | | | - Francesco Boccardo
- Department of Cardio-Thoracic-Vascular and Endovascular Surgery, Unit of Lymphatic Surgery, IRCCS S. Martino Hospital, University of Genoa, Italy
| | - Renate Cifkova
- Department of Preventive Cardiology, Thomayer Teaching Hospital, Prague, Czech Republic
| | - Benilde Cosmi
- Angiology and Blood Coagulation, Department of Specialty, Diagnostic and Experimental Medicine, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Sergio De Marchi
- Angiology Unit, Cardiovascular and Thoracic and Medicine Department, Verona University Hospital, Verona, Italy
| | - Evangelos Dimakakos
- Vascular Unit of 3rd Department of Internal Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Meletios A. Dimopoulos
- Hellenic Society of Hematology, Athens, Greece
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Gabriel Dimitrov
- Research Center on Vascular Disease & Angiology Unit, Department of Biomedical Science, L Sacco Hospital, University of Milan, Milan, Italy
| | - Isabelle Durand-Zaleski
- Université de Paris, CRESS, INSERM, INRA, URCEco, AP-HP, Hôpital de l'Hôtel Dieu, Paris, France
| | - Michael Edmonds
- Diabetic Foot Clinic, King's College Hospital, London, United Kingdom
| | | | - Dilek Erer
- Department of Cardiovascular Surgery, Faculty of Medicine, Gazi University, Besevler/Ankara, Turkey
| | - Omar L. Esponda
- Internal Medicine Department, Hospital Perea, Mayaguez, Puerto Rico, United States
| | - Paolo Gresele
- Section of Internal and Cardiovascular Medicine, Department of Medicine, -University of Perugia, Perugia, Italy
| | - Michael Gschwandtner
- MedizinischeUniverstiät Wien, Universitätsklinik für Innere Medizin II, Klinische Abteilung für Angiologie, Vienna, Austria
| | - Yongquan Gu
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing China
| | - Mónica Heinzmann
- Medicina Vascular, Sanatorio Allende Córdoba, Ciencias Médicas, Universidad Católica de Córdoba, Argentina
| | - Naomi M. Hamburg
- The Whitaker Cardiovascular Institute Department of Medicine Boston University School of Medicine, Boston, Massachusetts, United States
| | - Amer Hamadé
- Vascular Medicine Unit, Internal Medicine Department, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Noor-Ahmed Jatoi
- Department Vascular Medicine, Mulhouse Hospital Center, Mulhouse, France
| | - Oguz Karahan
- Department of Cardiovascular Surgery, Medical School of Alaaddin Keykubat University, Alanya/Antalya, Turkey
| | - Debora Karetova
- Second Department of Medicine, Department of Cardiovascular Medicine, Charles University in Prague, Prague, Czech Republic
| | - Thomas Karplus
- Department of Vascular Medicine, Concord Repatriation General Hospital, Sydney, Australia
| | - Peter Klein-Weigel
- Klinik für Angiologie, Zentrum für Innere Medizin II, Ernst von Bergmann Klinikum, Potsdam, Germany
| | - Endre Kolossvary
- Department of Angiology, St. Imre University Teaching Hospital, Budapest, Hungary
| | - Matija Kozak
- Department for Vascular Diseases, Medical Faculty of Ljubljana, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Eleftheria Lefkou
- Board member of the Institute for the Study and Education on Thrombosis and Antithrombotic Therapy, Athens, Greece
| | - Gianfranco Lessiani
- Angiology Unit, Internal Medicine Department., Città Sant' Angelo Hospital, AUSL 03, Pescara, Italy
| | - Aaron Liew
- Portiuncula University Hospital, Soalta University Health Care Group, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Antonella Marcoccia
- Unità di Medicina Vascolare e Autoimmunità, CRIIS-Centro di riferimento interdisciplinare per la Sclerosi Sistemica, Rome, Italy
| | - Peter Marshang
- Department of Internal Medicine, Central Hospital of Bolzano, Bolzano, Italy
| | | | - Jiri Matuska
- MATMED s.r.o., Private Angiology Facility, Hodonin, Czech Republic
| | - Luc Moraglia
- Angiologie Centre Cours du Médoc, Médecine Vasculaire Travail, Bordeaux, France
| | - Sergio Pillon
- UOSD Angiology, San Camillo-Forlanini Hospital, National Health Institute ISS, Rome, Italy
| | - Pavel Poredos
- Medical Association of Slovenia and SMA, Slovenia Academic Research Centre, Slovenian Medical Academy, Ljubljana, Slovenia
| | - Manlio Prior
- Angiology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | | | - Oliver Schlager
- Division of Angiology, Department of Internal Medicine 2, Medical University of Vienna, Vienna, Austria
| | - Gerit Schernthaner
- Division of Angiology, Department of Internal Medicine 2, Medical University of Vienna, Vienna, Austria
| | - Alexander Sieron
- Department of Internal Medicine, Angiology and Physical Medicine, Medical University of Silesia, Katowice, Poland
- Specialist Hospital, Bytom, Jan Długosz University in Częstochowa, Częstochowa, Poland
| | - Jonas Spaak
- Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet, Stockholm, Stockholm County, Sweden
| | - Alex Spyropoulos
- Department of Medicine, Anticoagulation and Clinical Thrombosis Services, Northwell Health at Lenox Hill Hospital, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, The Feinstein Institute for Medical Research, New York, New York, United States
| | - Muriel Sprynger
- Cardiology Department, University Hospital Sart Tilman, Liege, Belgium
| | - Dusan Suput
- Center for Clinical Physiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Agata Stanek
- Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Bytom, Poland
| | - Viera Stvrtinova
- Faculty of Medicine, Comenius University, Bratislava, Slovak Republic
| | - Andrzej Szuba
- Department of Angiology, Hypertension and Diabetology, Wroclaw Medical University, Wroclaw, Poland
| | - Alfonso Tafur
- Vascular Medicine University of Chicago, Northshore Cardiovascular Institute, Skokie, Illinois, US Army
| | - Patrick Vandreden
- Research Group Cancer, Haemostasis and Angiogenesis,” INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France
| | - Panagiotis E. Vardas
- Medical School of Crete, University of Crete and Heart Sector, Hellenic Healthcare Group, Athens, Greece
| | - Dragan Vasic
- Department of Noninvasive vascular laboratory, Clinic of Vascular and Endovascular Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - Miikka Vikkula
- Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium
| | - Paul Wennberg
- Department of Cardiovascular Medicine, Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, United States
| | - Zhenguo Zhai
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Peking University Health Science Center, Capital Medical University, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
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Abdelnabi M, Leelaviwat N, Eshak N, Mekraksakit P, Nugent K, Payne JD. COVID-19 discharge and follow-up recommendations. Proc AMIA Symp 2020; 34:73-75. [PMID: 33456149 PMCID: PMC7785155 DOI: 10.1080/08998280.2020.1834341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/26/2020] [Accepted: 10/01/2020] [Indexed: 12/15/2022] Open
Abstract
Currently, the world is facing a global pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as COVID-19. So far, there are no clear recommendations regarding hospital discharge and aftercare for COVID-19. Here, we briefly discuss the current understanding of recommendations for discharge criteria, discharge treatment regimens, and follow-up.
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Affiliation(s)
- Mahmoud Abdelnabi
- Cardiology and Angiology Unit, Department of Clinical and Experimental Internal Medicine, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Natnicha Leelaviwat
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nouran Eshak
- Department of Internal Medicine, Texas Tech University Health Science Center, Lubbock, Texas
| | - Poemlarp Mekraksakit
- Department of Internal Medicine, Texas Tech University Health Science Center, Lubbock, Texas
| | - Kenneth Nugent
- Department of Internal Medicine, Texas Tech University Health Science Center, Lubbock, Texas
| | - J. Drew Payne
- Department of Internal Medicine, Texas Tech University Health Science Center, Lubbock, Texas
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63
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Rossi FH. Venous thromboembolism in COVID-19 patients. J Vasc Bras 2020; 19:e20200107. [PMID: 34211527 PMCID: PMC8217998 DOI: 10.1590/1677-5449.200107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/21/2020] [Indexed: 02/06/2023] Open
Abstract
COVID-19 is a potentially serious respiratory disease caused by the SARS-CoV-2 virus that involves an increased risk of venous thromboembolism (VTE). Its pathophysiology is apparently related to an exacerbated inflammatory process and coagulopathy, verified by an increase in D-dimer, fibrinogen, and fibrin degradation products. Occurrence must be monitored, prevented, and treated according to existing recommendations and guidelines. The increased risk of thrombosis, and the association between this phenomenon and the most severe forms of the disease and death have prompted some groups to propose a more aggressive prophylactic and therapeutic approach. However, the risk-benefit profile of this type of conduct has not been defined and cases must be assessed individually, with a multidisciplinary approach. In this study, we review the main studies and evidence available to date on diagnosis, prophylaxis, and treatment of venous thromboembolism in COVID-19 patients.
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Affiliation(s)
- Fabio Henrique Rossi
- Instituto Dante Pazzanese de Cardiologia de São Paulo – IDPC-SP, São Paulo, SP, Brasil.
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Chen EC, Zon RL, Battinelli EM, Connors JM. Approach to the Patient with COVID-19-Associated Thrombosis: A Case-Based Review. Oncologist 2020; 25:e1500-e1508. [PMID: 32881209 PMCID: PMC7461375 DOI: 10.1634/theoncologist.2020-0682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/04/2020] [Indexed: 01/12/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a current global pandemic caused by the novel coronavirus SARS-CoV-2. Alongside its potential to cause severe respiratory illness, studies have reported a distinct COVID-19-associated coagulopathy that is characterized by elevated D-dimer levels, hyperfibrinogenemia, mild thrombocytopenia, and slight prolongation of the prothrombin time. Studies have also reported increased rates of thromboembolism in patients with COVID-19, but variations in study methodologies, patient populations, and anticoagulation strategies make it challenging to distill implications for clinical practice. Here, we present a practical review of current literature and uses a case-based format to discuss the diagnostic approach and management of COVID-19-associated coagulopathy. IMPLICATIONS FOR PRACTICE: Coronavirus disease 2019 (COVID-19)-associated coagulopathy is characterized by elevated D-dimer levels, hyperfibrinogenemia, and increased rates of thromboembolism. Current management guidelines are based on limited evidence from retrospective studies that should be interpreted carefully. At this time, all hospitalized patients with suspected or confirmed COVID-19 should receive coagulation test surveillance and standard doses of prophylactic anticoagulation until prospective randomized controlled trials yield definitive information in support of higher prophylactic doses.
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Affiliation(s)
- Evan C. Chen
- Department of Hematology, Brigham and Women's HospitalBostonMassachusettsUSA
| | - Rebecca L. Zon
- Department of Hematology, Brigham and Women's HospitalBostonMassachusettsUSA
| | | | - Jean M. Connors
- Department of Hematology, Brigham and Women's HospitalBostonMassachusettsUSA
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Orsi FA, De Paula EV, Santos FDO, Teruchkin MM, Campêlo DHC, Mello TT, Chindamo MC, Macedo AVS, Rocha AT, Ramacciotti E, Nascimento ACK, Annichino-Bizzacchi J, Lourenco DM, Guerra JCDC, Rezende SM, Cavalheiro Filho C. Guidance on diagnosis, prevention and treatment of thromboembolic complications in COVID-19: a position paper of the Brazilian Society of Thrombosis and Hemostasis and the Thrombosis and Hemostasis Committee of the Brazilian Association of Hematology, Hemotherapy and Cellular Therapy. Hematol Transfus Cell Ther 2020; 42:300-308. [PMID: 32565232 PMCID: PMC7293502 DOI: 10.1016/j.htct.2020.06.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/03/2020] [Indexed: 12/15/2022] Open
Abstract
Hemostatic abnormalities and thrombotic risk associated with coronavirus disease 2019 (COVID-19) are among the most discussed topics in the management of this disease. The aim of this position paper is to provide the opinion of Brazilian experts on the thromboprophylaxis and management of thrombotic events in patients with suspected COVID-19, in the sphere of healthcare in Brazil. To do so, the Brazilian Society of Thrombosis and Hemostasis (BSTH) and the Thrombosis and Hemostasis Committee of the Brazilian Association of Hematology, Hemotherapy and Cellular Therapy (ABHH) have constituted a panel of experts to carefully review and discuss the available evidence about this topic. The data discussed in this document was reviewed by May 9, 2020. Recommendations and suggestions reflect the opinion of the panel and should be reviewed periodically as new evidence emerges.
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Affiliation(s)
- Fernanda Andrade Orsi
- Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-Unicamp), Campinas, SP, Brazil.
| | - Erich V De Paula
- Centro de Hematologia e Hemoterapia da Universidade Estadual de Campinas (Hemocentro-Unicamp), Campinas, SP, Brazil
| | | | | | | | | | - Maria Chiara Chindamo
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil; Barra D'Or Hospital, Rede D'Or São Luiz, Rio de Janeiro, RJ, Brazil
| | | | - Ana Thereza Rocha
- Faculdade de Medicina da Bahia da Universidade Federal da Bahia (FMB-UFBA), Salvador, BA, Brazil; Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil
| | - Eduardo Ramacciotti
- Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil; Hospital Christóvão da Gama, Grupo Leforte, Santo André, SP, Brazil; Loyola University Medical Center, Maywood, IL, United States
| | | | - Joyce Annichino-Bizzacchi
- Centro de Hematologia e Hemoterapia da Universidade Estadual de Campinas (Hemocentro-Unicamp), Campinas, SP, Brazil
| | | | - João Carlos de Campos Guerra
- Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil; Centro de Hematologia de São Paulo (CHSP), São Paulo, SP, Brazil
| | - Suely Meireles Rezende
- Faculdade de Medicina da Universidade Federal de Minas Gerais (FM/UFMG), Belo Horizonte, MG, Brazil
| | - Cyrillo Cavalheiro Filho
- Hospital Sírio-libanês, São Paulo, SP, Brazil; Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (Incor FMUSP), São Paulo, SP, Brazil
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Abou-Ismail MY, Diamond A, Kapoor S, Arafah Y, Nayak L. The hypercoagulable state in COVID-19: Incidence, pathophysiology, and management. Thromb Res 2020; 194:101-115. [PMID: 32788101 PMCID: PMC7305763 DOI: 10.1016/j.thromres.2020.06.029] [Citation(s) in RCA: 387] [Impact Index Per Article: 96.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/13/2020] [Accepted: 06/17/2020] [Indexed: 02/07/2023]
Abstract
The 2019 coronavirus disease (COVID-19) presents with a large variety of clinical manifestations ranging from asymptomatic carrier state to severe respiratory distress, multiple organ dysfunction and death. While it was initially considered primarily a respiratory illness, rapidly accumulating data suggests that COVID-19 results in a unique, profoundly prothrombotic milieu leading to both arterial and venous thrombosis. Consistently, elevated D-dimer level has emerged as an independent risk factor for poor outcomes, including death. Several other laboratory markers and blood counts have also been associated with poor prognosis, possibly due to their connection to thrombosis. At present, the pathophysiology underlying the hypercoagulable state is poorly understood. However, a growing body of data suggests that the initial events occur in the lung. A severe inflammatory response, originating in the alveoli, triggers a dysfunctional cascade of inflammatory thrombosis in the pulmonary vasculature, leading to a state of local coagulopathy. This is followed, in patients with more severe disease, by a generalized hypercoagulable state that results in macro- and microvascular thrombosis. Of concern, is the observation that anticoagulation may be inadequate in many circumstances, highlighting the need for alternative or additional therapies. Numerous ongoing studies investigating the pathophysiology of the COVID-19 associated coagulopathy may provide mechanistic insights that can direct appropriate interventional strategies.
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Affiliation(s)
- Mouhamed Yazan Abou-Ismail
- University Hospitals, Cleveland Medical Center, Cleveland, OH, United States of America; Case Western Reserve University, Cleveland, OH, United States of America.
| | - Akiva Diamond
- University Hospitals, Cleveland Medical Center, Cleveland, OH, United States of America; Case Western Reserve University, Cleveland, OH, United States of America
| | - Sargam Kapoor
- Alaska Native Medical Center, Anchorage, AK, United States of America
| | - Yasmin Arafah
- University Hospitals, Cleveland Medical Center, Cleveland, OH, United States of America; Case Western Reserve University, Cleveland, OH, United States of America
| | - Lalitha Nayak
- University Hospitals, Cleveland Medical Center, Cleveland, OH, United States of America; Case Western Reserve University, Cleveland, OH, United States of America.
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Piera Carbonell A, Frías Vargas M, García Vallejo O, García Lerín A, Cabrera Ferriols MA, Peiró Morant J, Carrasco Carrasco E. [COVID-19 and thromboprophylaxis: Recommendations for our clinical practice in Primary Care]. Semergen 2020; 46:479-486. [PMID: 33046353 PMCID: PMC7500906 DOI: 10.1016/j.semerg.2020.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/16/2020] [Accepted: 07/30/2020] [Indexed: 12/14/2022]
Abstract
El nuevo coronavirus (SARS-CoV-2) es el responsable de un síndrome respiratorio agudo severo (SARS). Entre sus manifestaciones puede desarrollar una enfermedad trombótica, tanto venosa como arterial, debido a la inflamación excesiva que afecta al sistema vascular, con activación plaquetaria y disfunción endotelial, entre otros mecanismos. La trombosis se asocia a la infección producida por el SARS- CoV-2, aumentando su gravedad y confiriendo un peor pronóstico. Nuestra actuación como Médicos de Familia puede aportar acciones importantes en el manejo y control de esta severa complicación. Teniendo en cuenta que muchos de nuestros pacientes ya reciben terapia antitrombótica o anticoagulante, el hecho de que puedan desarrollar una infección por COVID-19 tendrá implicaciones para la elección, la dosificación y el control en su tratamiento. En este documento, revisamos, con la información actualmente disponible, la relación entre enfermedad producida por el SARS-CoV-2 y trombosis, así como su manejo con un enfoque centrado en Atención Primaria.
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Affiliation(s)
| | | | | | | | - M A Cabrera Ferriols
- Centro de Salud San Vicente del Raspeig, San Vicente del Raspeig, Alicante, España
| | - J Peiró Morant
- Centro de Salud Ponent, Andratx, Mallorca, Illes Balears, España
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68
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Khiali S, Khani E, Entezari‐Maleki T. A Comprehensive Review of Tocilizumab in COVID-19 Acute Respiratory Distress Syndrome. J Clin Pharmacol 2020; 60:1131-1146. [PMID: 32557541 PMCID: PMC7323169 DOI: 10.1002/jcph.1693] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/15/2020] [Indexed: 01/08/2023]
Abstract
Currently, the world is facing the pandemic of a novel strain of beta-coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Acute respiratory distress syndrome (ARDS) is the most devastating complication of SARS-CoV-2. It was indicated that cytokine-release syndrome and dominantly interleukin (IL)-6 play a central role in the pathophysiology of ARDS related to the novel 2019 coronavirus disease (COVID-19). Despite the global emergency of the disease, at this time, there are no proven therapies for the management of the disease. Tocilizumab is a potential recombinant monoclonal antibody against IL-6 and currently is under investigation for the management of ARDS in patients with COVID-19. Given these points, we reviewed the current evidence regarding the potential therapeutic role of tocilizumab and its important clinical issues in the treatment of ARDS related to COVID-19.
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Affiliation(s)
- Sajad Khiali
- Department of Clinical PharmacyFaculty of PharmacyTabriz University of Medical SciencesTabrizIran
| | - Elnaz Khani
- Department of Clinical PharmacyFaculty of PharmacyTabriz University of Medical SciencesTabrizIran
| | - Taher Entezari‐Maleki
- Department of Clinical PharmacyFaculty of PharmacyTabriz University of Medical SciencesTabrizIran
- Cardiovascular Research CenterTabriz University of Medical SciencesTabrizIran
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Moores LK, Tritschler T, Brosnahan S, Carrier M, Collen JF, Doerschug K, Holley AB, Jimenez D, Le Gal G, Rali P, Wells P. Prevention, Diagnosis, and Treatment of VTE in Patients With Coronavirus Disease 2019: CHEST Guideline and Expert Panel Report. Chest 2020; 158:1143-1163. [PMID: 32502594 PMCID: PMC7265858 DOI: 10.1016/j.chest.2020.05.559] [Citation(s) in RCA: 443] [Impact Index Per Article: 110.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/20/2020] [Accepted: 05/26/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Emerging evidence shows that severe coronavirus disease 2019 (COVID-19) can be complicated by a significant coagulopathy, that likely manifests in the form of both microthrombosis and VTE. This recognition has led to the urgent need for practical guidance regarding prevention, diagnosis, and treatment of VTE. METHODS A group of approved panelists developed key clinical questions by using the PICO (Population, Intervention, Comparator, Outcome) format that addressed urgent clinical questions regarding the prevention, diagnosis, and treatment of VTE in patients with COVID-19. MEDLINE (via PubMed or Ovid), Embase, and Cochrane Controlled Register of Trials were systematically searched for relevant literature, and references were screened for inclusion. Validated evaluation tools were used to grade the level of evidence to support each recommendation. When evidence did not exist, guidance was developed based on consensus using the modified Delphi process. RESULTS The systematic review and critical analysis of the literature based on 13 Population, Intervention, Comparator, Outcome questions resulted in 22 statements. Very little evidence exists in the COVID-19 population. The panel thus used expert consensus and existing evidence-based guidelines to craft the guidance statements. CONCLUSIONS The evidence on the optimal strategies to prevent, diagnose, and treat VTE in patients with COVID-19 is sparse but rapidly evolving.
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Affiliation(s)
- Lisa K Moores
- Department of Medicine, F. Edward Hebert School of Medicine at the Uniformed Services University of the Health Sciences, Bethesda, MD.
| | - Tobias Tritschler
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada; Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Shari Brosnahan
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University Langone Health System, New York, NY
| | - Marc Carrier
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Jacob F Collen
- Department of Medicine, F. Edward Hebert School of Medicine at the Uniformed Services University of the Health Sciences, Bethesda, MD; Pulmonary, Critical Care and Sleep Medicine Service, Walter Reed National Military Medical Center, Bethesda, MD
| | - Kevin Doerschug
- Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City, IA
| | - Aaron B Holley
- Department of Medicine, F. Edward Hebert School of Medicine at the Uniformed Services University of the Health Sciences, Bethesda, MD; Pulmonary, Critical Care and Sleep Medicine Service, Walter Reed National Military Medical Center, Bethesda, MD
| | - David Jimenez
- Respiratory Medicine, Ramón y Cajal Hospital (IRYCIS), Madrid, Spain; CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Gregoire Le Gal
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Parth Rali
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Philip Wells
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
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Abstract
Thromboembolism and myocardial injury is common in patients with COVID-19. Low-molecular-weight heparin appears to be associated with a good prognosis in patients with COVID-19 and has the ability to reduce coagulation and inflammation markers. Hospitalized patients with COVID-19 should be placed on thromboprophylaxis with the option of full therapeutic anticoagulation or tissue plasminogen activator in high-risk or mechanically ventilated patients. Thromboprophylaxis should also be considered at hospital discharge for high-risk patients. Clinical judgment should be used to evaluate the bleeding and safety risk of anticoagulation in patients with COVID-19 without confirmed data.
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Chi G, Lee JJ, Jamil A, Gunnam V, Najafi H, Memar Montazerin S, Shojaei F, Marszalek J. Venous Thromboembolism among Hospitalized Patients with COVID-19 Undergoing Thromboprophylaxis: A Systematic Review and Meta-Analysis. J Clin Med 2020; 9:jcm9082489. [PMID: 32756383 PMCID: PMC7463975 DOI: 10.3390/jcm9082489] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/12/2020] [Accepted: 07/27/2020] [Indexed: 01/08/2023] Open
Abstract
Background: Preliminary evidence indicates that prophylactic-dose thromboprophylaxis may be inadequate to control the increased risk of venous thromboembolism (VTE) in patients hospitalized for coronavirus disease 2019 (COVID-19) infection. Additionally, it remains unclear whether the D-dimer measurement is useful for VTE risk stratification among COVID-19 patients. This study aimed to offer benchmark data on the incidence of VTE and to examine the difference in D-dimer levels among anticoagulated COVID-19 patients with and without VTE incident. Methods: A comprehensive literature review of PubMed from inception to May 2020 was performed for original studies that reported the frequency of VTE and death among COVID-19 patients who received thromboprophylaxis on hospitalization. The endpoints included VTE (a composite of pulmonary embolism (PE) or deep vein thrombosis (DVT)), PE, DVT, and mortality. Results: A total of 11 cohort studies were included. Among hospitalized COVID-19 patients, 23.9% (95% confidence interval (CI), 16.2% to 33.7%; I2 = 93%) developed VTE despite anticoagulation. PE and DVT were detected in 11.6% (95% CI, 7.5% to 17.5%; I2 = 92%) and 11.9% (95% CI, 6.3% to 21.3%; I2 = 93%) of patients, respectively. Patients in the intensive care unit (ICU) had a higher risk for VTE (30.4% )95% CI, 19.6% to 43.9%)) than those in the ward (13.0% (95% CI, 5.9% to 26.3%)). The mortality was estimated at 21.3% (95% CI, 17.0% to 26.4%; I2 = 53%). COVID-19 patients who developed VTE had higher D-dimer levels than those who did not develop VTE (mean difference, 2.05 µg/mL; 95% CI, 0.30 to 3.80 µg/mL; P = 0.02). Conclusions: The heightened and heterogeneous risk of VTE in COVID-19 despite prophylactic anticoagulation calls into research on the pathogenesis of thromboembolic complications and strategy of thromboprophylaxis and risk stratification. Prominent elevation of D-dimer may be associated with VTE development and can be used to identify high-risk subsets.
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Affiliation(s)
- Gerald Chi
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (V.G.); (H.N.); (S.M.M.); (F.S.)
- Correspondence: ; Tel.: +617-975-9952; Fax: +617-975-9955
| | - Jane J. Lee
- Baim Institute for Clinical Research, Boston, MA 02215, USA;
| | - Adeel Jamil
- Department of Medicine, OSF Saint Francis Medical Center, Peoria, IL 61637, USA;
| | - Vamsikrishna Gunnam
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (V.G.); (H.N.); (S.M.M.); (F.S.)
| | - Homa Najafi
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (V.G.); (H.N.); (S.M.M.); (F.S.)
| | - Sahar Memar Montazerin
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (V.G.); (H.N.); (S.M.M.); (F.S.)
| | - Fahimehalsadat Shojaei
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (V.G.); (H.N.); (S.M.M.); (F.S.)
| | - Jolanta Marszalek
- Department of Neurology, David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, Los Angeles, CA 90095, USA;
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72
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Spyropoulos AC, Levy JH, Ageno W, Connors JM, Hunt BJ, Iba T, Levi M, Samama CM, Thachil J, Giannis D, Douketis JD. Scientific and Standardization Committee communication: Clinical guidance on the diagnosis, prevention, and treatment of venous thromboembolism in hospitalized patients with COVID-19. J Thromb Haemost 2020; 18:1859-1865. [PMID: 32459046 PMCID: PMC7283841 DOI: 10.1111/jth.14929] [Citation(s) in RCA: 533] [Impact Index Per Article: 133.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/15/2020] [Accepted: 05/21/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Alex C Spyropoulos
- Feinstein Institutes for Medical Research and The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, and Department of Medicine, Anticoagulation and Clinical Thrombosis Services, Northwell Health at Lenox Hill Hospital, New York, NY, USA
| | - Jerrold H Levy
- Departments of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Jean Marie Connors
- Hematology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Beverley J Hunt
- Thrombosis and Haemophilia Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Toshiaki Iba
- Department of Emergency and Disaster Medicine, Juntendo University, Tokyo, Japan
| | - Marcel Levi
- Department of Medicine and Cardiometabolic Programme-NIHR UCLH/UCL BRC, University College London Hospitals NHS Foundation Trust, London, UK
| | - Charles Marc Samama
- Department of Anaesthesia, Intensive Care and Perioperative Medicine GHU AP-HP. Centre-Université de Paris-Cochin Hospital, Paris, France
| | - Jecko Thachil
- Department of Haematology, Manchester University Hospitals, Manchester, UK
| | | | - James D Douketis
- Department of Medicine, McMaster University, Hamilton, ON, Canada
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73
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Ali S, Mathew S, Pappachan JM. Acute cor pulmonale from saddle pulmonary embolism in a patient with previous COVID-19: should we prolong prophylactic anticoagulation? Int J Infect Dis 2020; 97:299-302. [PMID: 32544670 PMCID: PMC7293501 DOI: 10.1016/j.ijid.2020.06.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 02/05/2023] Open
Abstract
Severe coronavirus disease 2019 (COVID-19) is known to be associated with a heightened risk of thromboembolism. However, the risk associated with mild and moderate illness from COVID-19 is unknown, and there is no current recommendation for prophylaxis against thromboembolism in patients after hospital treatment, unless there are established thrombophilic risk factors. We report the case of a 52-year-old woman who presented with massive saddle pulmonary embolism 1 week after initial hospital discharge, which was treated successfully with thrombolysis. This case raises the question of whether extended prophylactic anticoagulation should be considered even in low-risk COVID-19 cases.
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Affiliation(s)
- Sadaf Ali
- Department of Medicine and Endocrinology, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Trust, Preston, PR2 9HT, United Kingdom
| | - Smitha Mathew
- Department of Radiology, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Trust, Preston, PR2 9HT, United Kingdom
| | - Joseph M Pappachan
- Department of Medicine and Endocrinology, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Trust, Preston, PR2 9HT, United Kingdom.
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74
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Nicholson M, Chan N, Bhagirath V, Ginsberg J. Prevention of Venous Thromboembolism in 2020 and Beyond. J Clin Med 2020; 9:jcm9082467. [PMID: 32752154 PMCID: PMC7465935 DOI: 10.3390/jcm9082467] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/18/2020] [Accepted: 07/27/2020] [Indexed: 02/06/2023] Open
Abstract
Venous thromboembolism (VTE) is the third most common cause of vascular mortality worldwide and comprises deep-vein thrombosis (DVT) and pulmonary embolism (PE). In this review, we discuss how an understanding of VTE epidemiology and the results of thromboprophylaxis trials have shaped the current approach to VTE prevention. We will discuss modern thromboprophylaxis as it pertains to genetic risk factors, exogenous hormonal therapies, pregnancy, surgery, medical hospitalization, cancer, and what is known thus far about VTE in COVID-19 infection.
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75
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Ramacciotti E, Macedo AS, Biagioni RB, Caffaro RA, Lopes RD, Guerra JC, Orsi FA, Marques MA, Tafur AJ, Caprini JA, Nicolaides A, Carter CA, Filho CC, Fareed J. Evidence-Based Practical Guidance for the Antithrombotic Management in Patients With Coronavirus Disease (COVID-19) in 2020. Clin Appl Thromb Hemost 2020; 26:1076029620936350. [PMID: 32649232 PMCID: PMC7357049 DOI: 10.1177/1076029620936350] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This practical guidance, endorsed by the Brazilian Society of Thrombosis and Hemostasis and The Brazilian Society of Angiology and Vascular Surgery, the International Union of Angiology and the European Venous Forum, aims to provide physicians with clear guidance, based on current best evidence-based data, on clinical strategies to manage antithrombotic strategies in patients with coronavirus disease 2019.
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Affiliation(s)
- Eduardo Ramacciotti
- Hospital Christóvão da Gama, Grupo Leforte, Santo André, São Paulo, Brazil.,Santa Casa de Sao Paulo School of Medical Sciences, São Paulo, São Paulo, Brazil.,Hemostasis & Thrombosis Research Laboratories at Loyola University Medical Center, Maywood, IL, USA
| | | | | | | | - Renato Delascio Lopes
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - João Carlos Guerra
- Hospital Israelita Albert Einstein, São Paulo, Brazil.,Centro de Hematologia de São Paulo, São Paulo, Brazil
| | | | - Marcos Areas Marques
- School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Andrew Nicolaides
- Vascular Screening and Diagnostic Centre and University of Nicosia Medical School, Nicosia, Cyprus
| | - Charles A Carter
- Department of Clinical Research, College of Pharmacy & Health Sciences, Campbell University, NC, USA
| | - Cyrillo Carvalheiro Filho
- Hospital Sirio-Libanês, São Paulo, Brazil.,Heart Institute, University of São Paulo, São Paulo, Brazil
| | - Jawed Fareed
- Hemostasis & Thrombosis Research Laboratories at Loyola University Medical Center, Maywood, IL, USA
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76
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More than Just Pneumonia: Acute Pulmonary Embolism in Two Middle-Aged Patients with COVID-19. Case Rep Med 2020; 2020:4812036. [PMID: 32774385 PMCID: PMC7396098 DOI: 10.1155/2020/4812036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/20/2020] [Indexed: 01/22/2023] Open
Abstract
Background Although severe pneumonia and respiratory compromise have remained the predominant complications of coronavirus disease 19, we are now learning this virus is much more varied in its presentation. In particular, there are increasingly reported cases of thromboembolic events occurring in infected patients. Case Report. In this report, we present two patients, both under the age of 40 with known risk factors for venous thromboembolism, who presented with respiratory distress. Both patients were diagnosed with SARS-CoV-2 pneumonia and pulmonary embolism requiring management with anticoagulation. Both patients were discharged after a short course in the hospital. Conclusion The discussion of a hypercoagulable state induced by coronavirus disease 19 has been well documented; however, the exact mechanisms remain unknown. We suspect that a prothrombotic inflammatory response provoked by coronavirus disease could be the culprit, acting as an additive effect on middle-aged patients with known risk factors for venous thromboembolism. We recommend clinicians closely monitor those with known risk factors for pulmonary embolism.
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77
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Spyropoulos AC, Weitz JI. Hospitalized COVID-19 Patients and Venous Thromboembolism: A Perfect Storm. Circulation 2020; 142:129-132. [PMID: 32658609 DOI: 10.1161/circulationaha.120.048020] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Alex C Spyropoulos
- The Institute for Health Innovations and Outcome Research, The Feinstein Institutes for Medical Research and The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, and Department of Medicine, Anticoagulation and Clinical Thrombosis Services, Northwell Health at Lenox Hill Hospital, New York, NY (A.C.P.)
| | - Jeffrey I Weitz
- McMaster University and the Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada (J.L.W.)
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78
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Terpos E, Ntanasis‐Stathopoulos I, Elalamy I, Kastritis E, Sergentanis TN, Politou M, Psaltopoulou T, Gerotziafas G, Dimopoulos MA. Hematological findings and complications of COVID-19. Am J Hematol 2020; 95:834-847. [PMID: 32282949 PMCID: PMC7262337 DOI: 10.1002/ajh.25829] [Citation(s) in RCA: 1145] [Impact Index Per Article: 286.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 12/15/2022]
Abstract
COVID‐19 is a systemic infection with a significant impact on the hematopoietic system and hemostasis. Lymphopenia may be considered as a cardinal laboratory finding, with prognostic potential. Neutrophil/lymphocyte ratio and peak platelet/lymphocyte ratio may also have prognostic value in determining severe cases. During the disease course, longitudinal evaluation of lymphocyte count dynamics and inflammatory indices, including LDH, CRP and IL‐6 may help to identify cases with dismal prognosis and prompt intervention in order to improve outcomes. Biomarkers, such high serum procalcitonin and ferritin have also emerged as poor prognostic factors. Furthermore, blood hypercoagulability is common among hospitalized COVID‐19 patients. Elevated D‐Dimer levels are consistently reported, whereas their gradual increase during disease course is particularly associated with disease worsening. Other coagulation abnormalities such as PT and aPTT prolongation, fibrin degradation products increase, with severe thrombocytopenia lead to life‐threatening disseminated intravascular coagulation (DIC), which necessitates continuous vigilance and prompt intervention. So, COVID‐19 infected patients, whether hospitalized or ambulatory, are at high risk for venous thromboembolism, and an early and prolonged pharmacological thromboprophylaxis with low molecular weight heparin is highly recommended. Last but not least, the need for assuring blood donations during the pandemic is also highlighted.
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Affiliation(s)
- Evangelos Terpos
- Department of Clinical Therapeutics, School of MedicineNational and Kapodistrian University of Athens Athens Greece
| | | | - Ismail Elalamy
- Hematology and Thrombosis CenterTenon University Hospital, Sorbonne University, INSERM U938, Sorbonne University Paris France
- Department of Obstetrics and Gynaecology, The First I.M. Sechenov Moscow State Medical University Moscow Russia
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, School of MedicineNational and Kapodistrian University of Athens Athens Greece
| | - Theodoros N. Sergentanis
- Department of Clinical Therapeutics, School of MedicineNational and Kapodistrian University of Athens Athens Greece
| | - Marianna Politou
- Hematology Laboratory‐Blood Bank, Aretaieio Hospital, School of MedicineNational and Kapodistrian University of Athens Athens Greece
| | - Theodora Psaltopoulou
- Department of Clinical Therapeutics, School of MedicineNational and Kapodistrian University of Athens Athens Greece
| | - Grigoris Gerotziafas
- Hematology and Thrombosis CenterTenon University Hospital, Sorbonne University, INSERM U938, Sorbonne University Paris France
- Research Group “Cancer, Haemostasis and Angiogenesis,” INSERM U938, Centre de Recherche Saint‐AntoineInstitut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University Paris France
| | - Meletios A. Dimopoulos
- Department of Clinical Therapeutics, School of MedicineNational and Kapodistrian University of Athens Athens Greece
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79
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Antirheumatic drugs for COVID-19 treatment based on the phases of the disease: Current concept. JOURNAL OF POPULATION THERAPEUTICS AND CLINICAL PHARMACOLOGY 2020; 27:e14-e25. [PMID: 32650355 DOI: 10.15586/jptcp.v27isp1.689] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/15/2020] [Indexed: 12/12/2022]
Abstract
COVID-19 disease is the most recent pandemic, since it has affected more than four and a half million people and caused more than 300,000 deaths. It is a very complex systemic disease in terms of pathogenesis, treatment, and prognosis. Pharmacological treatment may include antiviral and antimalarial drugs, antibiotics, monoclonal antibodies, corticosteroids as well as low-molecular-weight heparins to prevent the evolution of the disease from reaching the severe inflammatory phase that can lead to respiratory complications, multiple organ failure, disseminated intravascular coagulation (DIC), and finally death. Therefore, pending the development of the much sought-after vaccine, there needs to be a multidisciplinary approach to tackling this disease, and it is essential to use different medical treatments at the correct pathogenic moment. The aim of this article is to evaluate the rationale and reason behind the use of antirheumatic drugs, by expert point of view, in the various phases of the disease. Another important aspect in the management of the disease is to identify patients at high risk, both to change their lifestyle and to correct the state of their health through non-pharmacological measures for improving their immuno-balance. Our literature review reveals the important role and the therapeutic potential of antirheumatic agents in preventing the progression of the disease and aiding recovery from the disease. However, there is a lack of clinical evidence to support the use of these agents, indicating that further randomized controlled studies are required.
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80
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COVID-19 Pneumonia Hospitalizations Followed by Re-Presentation for Presumed Thrombotic Event. Chest 2020; 158:1665-1668. [PMID: 32589950 PMCID: PMC7309731 DOI: 10.1016/j.chest.2020.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 01/08/2023] Open
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81
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Bikdeli B, Madhavan MV, Jimenez D, Chuich T, Dreyfus I, Driggin E, Nigoghossian CD, Ageno W, Madjid M, Guo Y, Tang LV, Hu Y, Giri J, Cushman M, Quéré I, Dimakakos EP, Gibson CM, Lippi G, Favaloro EJ, Fareed J, Caprini JA, Tafur AJ, Burton JR, Francese DP, Wang EY, Falanga A, McLintock C, Hunt BJ, Spyropoulos AC, Barnes GD, Eikelboom JW, Weinberg I, Schulman S, Carrier M, Piazza G, Beckman JA, Steg PG, Stone GW, Rosenkranz S, Goldhaber SZ, Parikh SA, Monreal M, Krumholz HM, Konstantinides SV, Weitz JI, Lip GYH. COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-Up: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 75:2950-2973. [PMID: 32311448 PMCID: PMC7164881 DOI: 10.1016/j.jacc.2020.04.031] [Citation(s) in RCA: 2114] [Impact Index Per Article: 528.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 02/06/2023]
Abstract
Coronavirus disease-2019 (COVID-19), a viral respiratory illness caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), may predispose patients to thrombotic disease, both in the venous and arterial circulations, because of excessive inflammation, platelet activation, endothelial dysfunction, and stasis. In addition, many patients receiving antithrombotic therapy for thrombotic disease may develop COVID-19, which can have implications for choice, dosing, and laboratory monitoring of antithrombotic therapy. Moreover, during a time with much focus on COVID-19, it is critical to consider how to optimize the available technology to care for patients without COVID-19 who have thrombotic disease. Herein, the authors review the current understanding of the pathogenesis, epidemiology, management, and outcomes of patients with COVID-19 who develop venous or arterial thrombosis, of those with pre-existing thrombotic disease who develop COVID-19, or those who need prevention or care for their thrombotic disease during the COVID-19 pandemic.
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Affiliation(s)
- Behnood Bikdeli
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York; Center for Outcomes Research and Evaluation (CORE), Yale School of Medicine, New Haven, Connecticut; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.
| | - Mahesh V Madhavan
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.
| | - David Jimenez
- Respiratory Department, Hospital Ramón y Cajal and Medicine Department, Universidad de Alcalá (Instituto de Ramón y Cajal de Investigación Sanitaria), Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | - Taylor Chuich
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Isaac Dreyfus
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Elissa Driggin
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | | | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Mohammad Madjid
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Yutao Guo
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Liang V Tang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Hu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jay Giri
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Mary Cushman
- University of Vermont Medical Center, Burlington, Vermont
| | - Isabelle Quéré
- Department of Vascular Medicine, University of Montpellier, Centre Hospitalier Universitaire Montpellier, InnoVTE F-CRIN Network, Montpellier, France
| | - Evangelos P Dimakakos
- Oncology Unit GPP, Sotiria General Hospital Athens School of Medicine, Athens, Greece
| | - C Michael Gibson
- Harvard Medical School, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Giuseppe Lippi
- Laboratory of Clinical Chemistry and Hematology, University Hospital of Verona, Verona, Italy
| | - Emmanuel J Favaloro
- Haematology Laboratory, Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia; Sydney Centres for Thrombosis and Haemostasis, Westmead, New South Wales, Australia
| | - Jawed Fareed
- Loyola University Medical Center, Chicago, Illinois
| | - Joseph A Caprini
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Alfonso J Tafur
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois; Division of Vascular Medicine, Department of Medicine, NorthShore University HealthSystem, Skokie, Illinois
| | - John R Burton
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Dominic P Francese
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Elizabeth Y Wang
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Anna Falanga
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, University of Milan Bicocca, Bergamo, Italy
| | | | | | - Alex C Spyropoulos
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, Hempstead, New York
| | - Geoffrey D Barnes
- Center for Bioethics and Social Science in Medicine, University of Michigan, Ann Arbor, Michigan; Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - John W Eikelboom
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Ido Weinberg
- Harvard Medical School, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts
| | - Sam Schulman
- Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia; McMaster University, Hamilton, Ontario, Canada; Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada
| | - Marc Carrier
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Gregory Piazza
- Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts
| | | | - P Gabriel Steg
- INSERM U1148, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, FACT (French Alliance for Cardiovascular Trials), Paris, France; Université Paris, Paris, France; Royal Brompton Hospital, Imperial College London, London, United Kingdom
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stephan Rosenkranz
- Cologne Cardiovascular Research Center, Heart Center, Department of Cardiology, University of Cologne, Cologne, Germany
| | - Samuel Z Goldhaber
- Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts
| | - Sahil A Parikh
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Universitari Germans Trials i Pujol, Universidad Católica San Antonio de Murcia, Barcelona, Spain
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation (CORE), Yale School of Medicine, New Haven, Connecticut; Department of Health Policy and Administration, Yale School of Public Health, New Haven, Connecticut; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Jeffrey I Weitz
- McMaster University, Hamilton, Ontario, Canada; Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, University of Liverpool, Liverpool, United Kingdom; Aalborg University, Aalborg, Denmark
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82
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Bikdeli B, Madhavan MV, Jimenez D, Chuich T, Dreyfus I, Driggin E, Nigoghossian CD, Ageno W, Madjid M, Guo Y, Tang LV, Hu Y, Giri J, Cushman M, Quéré I, Dimakakos EP, Gibson CM, Lippi G, Favaloro EJ, Fareed J, Caprini JA, Tafur AJ, Burton JR, Francese DP, Wang EY, Falanga A, McLintock C, Hunt BJ, Spyropoulos AC, Barnes GD, Eikelboom JW, Weinberg I, Schulman S, Carrier M, Piazza G, Beckman JA, Steg PG, Stone GW, Rosenkranz S, Goldhaber SZ, Parikh SA, Monreal M, Krumholz HM, Konstantinides SV, Weitz JI, Lip GYH. COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-Up: JACC State-of-the-Art Review. J Am Coll Cardiol 2020. [PMID: 32311448 DOI: 10.1016/j.jacc.2020.04.031:27284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Coronavirus disease-2019 (COVID-19), a viral respiratory illness caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), may predispose patients to thrombotic disease, both in the venous and arterial circulations, because of excessive inflammation, platelet activation, endothelial dysfunction, and stasis. In addition, many patients receiving antithrombotic therapy for thrombotic disease may develop COVID-19, which can have implications for choice, dosing, and laboratory monitoring of antithrombotic therapy. Moreover, during a time with much focus on COVID-19, it is critical to consider how to optimize the available technology to care for patients without COVID-19 who have thrombotic disease. Herein, the authors review the current understanding of the pathogenesis, epidemiology, management, and outcomes of patients with COVID-19 who develop venous or arterial thrombosis, of those with pre-existing thrombotic disease who develop COVID-19, or those who need prevention or care for their thrombotic disease during the COVID-19 pandemic.
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Affiliation(s)
- Behnood Bikdeli
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York; Center for Outcomes Research and Evaluation (CORE), Yale School of Medicine, New Haven, Connecticut; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.
| | - Mahesh V Madhavan
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.
| | - David Jimenez
- Respiratory Department, Hospital Ramón y Cajal and Medicine Department, Universidad de Alcalá (Instituto de Ramón y Cajal de Investigación Sanitaria), Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | - Taylor Chuich
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Isaac Dreyfus
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Elissa Driggin
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | | | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Mohammad Madjid
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Yutao Guo
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Liang V Tang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Hu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jay Giri
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Mary Cushman
- University of Vermont Medical Center, Burlington, Vermont
| | - Isabelle Quéré
- Department of Vascular Medicine, University of Montpellier, Centre Hospitalier Universitaire Montpellier, InnoVTE F-CRIN Network, Montpellier, France
| | - Evangelos P Dimakakos
- Oncology Unit GPP, Sotiria General Hospital Athens School of Medicine, Athens, Greece
| | - C Michael Gibson
- Harvard Medical School, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Giuseppe Lippi
- Laboratory of Clinical Chemistry and Hematology, University Hospital of Verona, Verona, Italy
| | - Emmanuel J Favaloro
- Haematology Laboratory, Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia; Sydney Centres for Thrombosis and Haemostasis, Westmead, New South Wales, Australia
| | - Jawed Fareed
- Loyola University Medical Center, Chicago, Illinois
| | - Joseph A Caprini
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Alfonso J Tafur
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois; Division of Vascular Medicine, Department of Medicine, NorthShore University HealthSystem, Skokie, Illinois
| | - John R Burton
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Dominic P Francese
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Elizabeth Y Wang
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Anna Falanga
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, University of Milan Bicocca, Bergamo, Italy
| | | | | | - Alex C Spyropoulos
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, Hempstead, New York
| | - Geoffrey D Barnes
- Center for Bioethics and Social Science in Medicine, University of Michigan, Ann Arbor, Michigan; Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - John W Eikelboom
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Ido Weinberg
- Harvard Medical School, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts
| | - Sam Schulman
- Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia; McMaster University, Hamilton, Ontario, Canada; Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada
| | - Marc Carrier
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Gregory Piazza
- Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts
| | | | - P Gabriel Steg
- INSERM U1148, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, FACT (French Alliance for Cardiovascular Trials), Paris, France; Université Paris, Paris, France; Royal Brompton Hospital, Imperial College London, London, United Kingdom
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stephan Rosenkranz
- Cologne Cardiovascular Research Center, Heart Center, Department of Cardiology, University of Cologne, Cologne, Germany
| | - Samuel Z Goldhaber
- Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts
| | - Sahil A Parikh
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Universitari Germans Trials i Pujol, Universidad Católica San Antonio de Murcia, Barcelona, Spain
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation (CORE), Yale School of Medicine, New Haven, Connecticut; Department of Health Policy and Administration, Yale School of Public Health, New Haven, Connecticut; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Jeffrey I Weitz
- McMaster University, Hamilton, Ontario, Canada; Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, University of Liverpool, Liverpool, United Kingdom; Aalborg University, Aalborg, Denmark
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Scialpi M, Scialpi S, Piscioli I, Battista Scalera G, Longo F. Pulmonary thromboembolism in critical ill COVID-19 patients. Int J Infect Dis 2020; 95:361-362. [PMID: 32339717 PMCID: PMC7180352 DOI: 10.1016/j.ijid.2020.04.056] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 04/19/2020] [Accepted: 04/21/2020] [Indexed: 12/23/2022] Open
Abstract
•COVID-19 in critically ill patients causes death not only from pneumonia but also from multiple organ injuries. •In critically ill COVID-19 patients with pneumonia, pulmonary thromboembolism may be considered. •In critically ill COVID-19 patients, contrast-enhanced computed tomography of the chest is mandatory to assess parenchymal patterns and to diagnose pulmonary thromboembolism.
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Affiliation(s)
- Michele Scialpi
- Division of Diagnostic Imaging, Department of Surgical and Biomedical Sciences, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy.
| | - Sara Scialpi
- Department of Anaesthesia and Intensive Care, University Hospital Pisa, Pisa, Italy
| | | | - Giovanni Battista Scalera
- Division of Radiology 1, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Fernando Longo
- Department of Anaesthesia and Intensive Care, University Hospital Perugia, Perugia, Italy
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84
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Cohoon KP, Mahé G, Tafur AJ, Spyropoulos AC. Emergence of institutional antithrombotic protocols for coronavirus 2019. Res Pract Thromb Haemost 2020; 4:510-517. [PMID: 32542211 PMCID: PMC7267524 DOI: 10.1002/rth2.12358] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- Kevin P. Cohoon
- Division of Cardiovascular MedicineDepartment of MedicineFroedtert and Medical College of WisconsinMilwaukeeWisconsinUSA
| | - Guillaume Mahé
- CHU de Rennes, unité de médecine vasculaireRennesFrance
- Inserm, CIC 1414Univ Rennes, CHU RennesRennesFrance
| | - Alfonso J. Tafur
- Pritzker School of Medicine at the University of ChicagoChicagoIllinoisUSA
- Division of Vascular MedicineDepartment of MedicineNorthShore University HealthSystemSkokieIllinoisUSA
| | - Alex C. Spyropoulos
- Institute for Health Innovations and Outcomes ResearchFeinstein Institutes for Medical Research and Donald and Barbara Zucker School of Medicine at Hofstra/NorthwellManhassetNew YorkUSA
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85
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New Paradigms of Extended Thromboprophylaxis in Medically Ill Patients. J Clin Med 2020; 9:jcm9041002. [PMID: 32252423 PMCID: PMC7230788 DOI: 10.3390/jcm9041002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/18/2020] [Accepted: 03/24/2020] [Indexed: 12/12/2022] Open
Abstract
Extended thromboprophylaxis given to medically ill patients for up to 45 days following an acute hospitalization remains an emerging topic among many hospital-based health care providers. Recent advancements in the field of extended thromboprophylaxis using risk stratification and careful patient selection criteria have led to an improved safety profile of direct oral anticoagulants (DOACs) and established net clinical benefit when given to key patient subgroups at high risk of venous thromboembolism (VTE) and low risk of bleeding. The Food and Drug Administration (FDA) has now approved the DOACs betrixaban and rivaroxaban for both in-hospital and extended thromboprophylaxis in medically ill patients in these key subgroups, which represents more than one-quarter of hospitalized medically ill patients. This has potential to significantly reduce VTE-related morbidity and mortality for these patients. Emerging data also supports reductions in the risk of arterial thromboembolism in medically ill patients with extended thromboprophylaxis post-hospital discharge using DOACs. This article aims to review the most recent concepts of predicting and preventing VTE and to discuss emerging paradigms of extended thromboprophylaxis in hospitalized medically ill patients utilizing an individualized, risk-adapted approach.
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86
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Mezalek ZT, Khibri H, Ammouri W, Bouaouad M, Haidour S, Harmouche H, Maamar M, Adnaoui M. COVID-19 Associated Coagulopathy and Thrombotic Complications. Clin Appl Thromb Hemost 2020; 26:1076029620948137. [PMID: 32795186 PMCID: PMC7430069 DOI: 10.1177/1076029620948137] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The SARS-CoV-2 virus caused a global pandemic within weeks, causing hundreds of thousands of people infected. Many patients with severe COVID-19 present with coagulation abnormalities, including increase D-dimers and fibrinogen. This coagulopathy is associated with an increased risk of death. Furthermore, a substantial proportion of patients with severe COVID-19 develop sometimes unrecognized, venous, and arterial thromboembolic complications. A better understanding of COVID-19 pathophysiology, in particular hemostatic disorders, will help to choose appropriate treatment strategies. A rigorous thrombotic risk assessment and the implementation of a suitable anticoagulation strategy are required. We review here the characteristics of COVID-19 coagulation laboratory findings in affected patients, the incidence of thromboembolic events and their specificities, and potential therapeutic interventions.
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Affiliation(s)
- Zoubida Tazi Mezalek
- Internal Medicine Department, Ibn Sina University Hospital, Rabat, Morocco
- Clinical Hematology Department, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Hajar Khibri
- Internal Medicine Department, Ibn Sina University Hospital, Rabat, Morocco
- Clinical Hematology Department, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Wafaa Ammouri
- Internal Medicine Department, Ibn Sina University Hospital, Rabat, Morocco
- Clinical Hematology Department, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Majdouline Bouaouad
- Clinical Hematology Department, Ibn Sina University Hospital, Rabat, Morocco
| | - Soukaina Haidour
- Clinical Hematology Department, Ibn Sina University Hospital, Rabat, Morocco
| | - Hicham Harmouche
- Internal Medicine Department, Ibn Sina University Hospital, Rabat, Morocco
- Clinical Hematology Department, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Mouna Maamar
- Internal Medicine Department, Ibn Sina University Hospital, Rabat, Morocco
- Clinical Hematology Department, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Mohamed Adnaoui
- Internal Medicine Department, Ibn Sina University Hospital, Rabat, Morocco
- Clinical Hematology Department, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
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87
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SARS-CoV-2 and venous thromboembolic disease. Not everything is new. ANGIOLOGIA 2020. [DOI: 10.20960/angiologia.00173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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