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Chen X, Zhang S, Liu H, Zhang Q, Chen J, Zheng Q, Guo N, Cai Y, Luo Q, Xu Q, Yang S, Chen X. Effect of anticoagulation on the incidence of venous thromboembolism, major bleeding, and mortality among hospitalized COVID-19 patients: an updated meta-analysis. Front Cardiovasc Med 2024; 11:1381408. [PMID: 38646150 PMCID: PMC11026614 DOI: 10.3389/fcvm.2024.1381408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 03/26/2024] [Indexed: 04/23/2024] Open
Abstract
Objective Anticoagulation is crucial for patients hospitalized with coronavirus disease 2019 (COVID-19) due to the high risk of venous thromboembolism (VTE). However, the optimal anticoagulation regimen needs further exploration. Therefore, we evaluated the efficacy and safety of diverse anticoagulation dosage dosages for COVID-19. Methods An updated meta-analysis was performed to assess the effect of thromboprophylaxis (standard, intermediate, and therapeutic dose) on the incidence of VTE, mortality and major bleeding among COVID-19 patients. Literature was searched via PubMed, EMBASE, Web of Science, and China National Knowledge Infrastructure (CNKI) database. The odds ratio (OR) and 95% confidence interval (CI) were calculated for effect estimates. Results Nineteen studies involving 25,289 participants without VTE history were included. The mean age of patients was 59.3 years old. About 50.96% were admitted to the intensive care unit. In the pooled analysis, both therapeutic-dose and intermediate-dose anticoagulation did not have a significant advantage in reducing VTE risk over standard dosage (OR = 1.09, 95% CI: 0.58-2.02, and OR = 0.89, 95% CI: 0.70-1.12, respectively). Similarly, all-cause mortality was not further decreased in either therapeutic-dose group (OR = 1.12, 95% CI: 0.75-1.67) or intermediate-dose group (OR = 1.34, 95% CI: 0.83-2.17). While the major bleeding risk was significantly elevated in the therapeutic-dose group (OR = 2.59, 95%CI: 1.87-3.57) as compared with the standard-dose regimen. Compared with intermediate dosage, therapeutic anticoagulation did not reduce consequent VTE risk (OR = 0.85, 95% CI: 0.52-1.38) and all-cause mortality (OR = 0.84, 95% CI: 0.60-1.17), but significantly increased major bleeding rate (OR = 2.42, 95% CI: 1.58-3.70). In subgroup analysis of patients older than 65 years, therapeutic anticoagulation significantly lowered the incidence of VTE in comparation comparison with standard thromboprophylaxis, however, at the cost of elevated risk of major bleeding. Conclusion Our results indicated that for most hospitalized patients with COVID-19, standard-dose prophylactic anticoagulation might be the optimal choice. For elderly patients at low risk of bleeding, therapeutic-dose anticoagulation could further reduce VTE risk and should be considered especially when there were other strong risk factors of VTE during hospital stay. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO, identifier, CRD42023388429.
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Affiliation(s)
- Xinwang Chen
- Department of Pulmonary and Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou, China
| | - Suyun Zhang
- Department of Internal Medicine, Fujian Medical University Union Hospital, Fuzhou, China
| | - Haiyu Liu
- Department of Pulmonary and Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qianyuan Zhang
- Department of General Medicine, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jinghan Chen
- Department of Oncology Medicine, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qixian Zheng
- Department of Pulmonary and Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ningjing Guo
- Department of Oncology Medicine, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yuanyuan Cai
- Department of General Medicine, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qiong Luo
- Department of Oncology Medicine, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qian Xu
- Department of Oncology Medicine, Fujian Medical University Union Hospital, Fuzhou, China
| | - Sheng Yang
- Department of Oncology Medicine, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Translational Research in Cancer and Neurodegenerative Diseases, Fuzhou, China
| | - Xiangqi Chen
- Department of Pulmonary and Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Translational Research in Cancer and Neurodegenerative Diseases, Fuzhou, China
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Varlas VN, Borș RG, Plotogea M, Iordache M, Mehedințu C, Cîrstoiu MM. Thromboprophylaxis in Pregnant Women with COVID-19: An Unsolved Issue. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1949. [PMID: 36767320 PMCID: PMC9915713 DOI: 10.3390/ijerph20031949] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
SARS-CoV-2 infection in pregnant women is of growing interest due to controversy over the use of antiplatelet and/or anticoagulant drugs during pregnancy and postpartum. Pregnant women are susceptible to develop severe forms of viral infections due to pregnancy-related immune alterations, changes in lung functions, and hypercoagulability. The association of pregnancy with SARS-CoV-2 infection can cause an increased incidence of thrombotic complications, especially in the case of patients with some genetic variants that favor inflammation and thrombosis. Compared to the general population, pregnant women may be at increased risk of thrombotic complications related to COVID-19. The lack of extensive clinical trials on thromboprophylaxis and extrapolating data from non-pregnant patients lead to major discrepancies in treating pregnant women with COVID-19. Currently, a multidisciplinary team should determine the dose and duration of prophylactic anticoagulant therapy for these patients, depending on the disease severity, the course of pregnancy, and the estimated due date. This narrative review aims to evaluate the protective effect of thromboprophylaxis in pregnant women with COVID-19. It is unknown at this time whether antiplatelet or anticoagulant therapy initiated at the beginning of pregnancy for various diseases (preeclampsia, intrauterine growth restriction, thrombophilia) offers a degree of protection. The optimal scheme for thromboprophylaxis in pregnant women with COVID-19 must be carefully established through an individualized decision concerning gestational age and the severity of the infection.
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Affiliation(s)
- Valentin Nicolae Varlas
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu St., 050451 Bucharest, Romania
| | - Roxana Georgiana Borș
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania
| | - Mihaela Plotogea
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu St., 050451 Bucharest, Romania
- Department of Obstetrics and Gynecology, Nicolae Malaxa Clinical Hospital Bucharest, 022441 Bucharest, Romania
| | - Madalina Iordache
- Doctoral School, “Carol Davila”, University of Medicine and Pharmacy, 4192910 Bucharest, Romania
| | - Claudia Mehedințu
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu St., 050451 Bucharest, Romania
| | - Monica Mihaela Cîrstoiu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu St., 050451 Bucharest, Romania
- Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
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Veenhuis RT, Zeiss CJ. Animal Models of COVID-19 II. Comparative Immunology. ILAR J 2021; 62:17-34. [PMID: 33914873 PMCID: PMC8135340 DOI: 10.1093/ilar/ilab010] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/03/2020] [Accepted: 12/20/2020] [Indexed: 12/22/2022] Open
Abstract
Developing strong animal models is essential for furthering our understanding of how the immune system functions in response to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. The alarming speed at which SARS-CoV-2 has spread, and the high mortality rate of severe Coronavirus Disease 2019 (COVID-19), has required both basic science and clinical research to move at an unprecedented pace. Models previously developed to study the immune response against SARS-CoV have been rapidly deployed to now study SARS-CoV-2. To date, both small and large animal models are remarkably consistent when infected with SARS-CoV-2; however, certain models have proven more useful when answering specific immunological questions than others. Small animal models, such as Syrian hamsters, ferrets, and mice carrying the hACE2 transgene, appear to reliably recapitulate the initial cytokine surge seen in COVID-19 as well as show significant innate and adaptive cell infiltration in to the lung early in infection. Additionally, these models develop strong antibody responses to the virus, are protected from reinfection, and genetically modified versions exist that can be used to ask specific immunological questions. Large animal models such as rhesus and cynomologus macaques and African green monkeys are critical to understanding how the immune system responds to SARS-CoV-2 infection because they are considered to be the most similar to humans. These models are considered the gold standard for assessing vaccine efficacy and protection, and recapitulate the initial cytokine surge, immune cell infiltration into the lung, certain aspects of thrombosis, and the antibody and T-cell response to the virus. In this review, we discuss both small and large animal model studies previously used in SARS-CoV-2 research that may be useful in elucidating the immunological contributions to hallmark syndromes observed with COVID-19.
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Affiliation(s)
- Rebecca T Veenhuis
- Department of Molecular and Comparative Pathobiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Caroline J Zeiss
- Department of Comparative Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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Incidence, Risk Factors, and Timing of Macrovascular Thrombosis in the Post-COVID-19 Elderly and Assessing the Need and Duration of Extended Thromboprophylaxis: A Prospective Study. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2021. [DOI: 10.5812/archcid.119593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: COVID-19 infection causes a wide spectrum of macrovascular thrombosis, which has contributed significantly to morbidity and mortality in the elderly. Guidelines have recommended extended prophylaxis following discharge from the hospital for variable periods. The risk of thrombosis and the optimal duration of extended anticoagulation remain uncertain. Objectives: This study aimed at determining the overall incidence and timing of macrovascular thrombosis in post-COVID-19 elderly patients. It also aimed at finding out the predictive value of clinical severity, in-hospital anticoagulation, and discharge D-dimer values for the incidence of macrovascular thrombosis and overall mortality within 13 weeks following clinical recovery from acute COVID-19 infection in the elderly. Methods: In this study, 288 elderly patients with symptomatic acute COVID-19 infection discharged between August 1, 2020, and November 30, 2020, were enrolled. Details regarding the incidence of macrovascular thrombosis were collected through a telephone interview after 90 days. Data were tabulated and analyzed with IBM SPSS Statistics for Windows, Version 23.0. (Armonk, NY: IBM Corp.) Results: The number of macrovascular thrombotic events was significantly higher in group C (critical illness) than in the other two groups (17.9 vs. 1.8 and 1.1%, respectively) (P = 0.0005). Three (10.7%) patients died within 13 weeks of discharge in group C, versus one (0.6%) patient in group M (mild to moderate illness) and none in group S (severe illness) (P = 0.0005). There were two macrovascular thrombotic events in the elevated D-dimer group versus one in the reduced D-dimer group (P = 0.135). The number of deaths was high in the elevated D-dimer group [2 (8.3%) vs. 0 (0), P = 0.053]. The cumulative incidence rate of macrovascular events in the post-COVID-19 elderly cohort 13 weeks after discharge was 3.12%. Conclusions: Elderly patients with a critical illness during hospitalization due to COVID-19 and elevated D-dimer values at discharge have the maximum risk of developing macrovascular thrombosis in the post-COVID-19 period. It is reasonable to recommend extended thromboprophylaxis for at least eight weeks in the post-COVID-19 elderly.
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Önal H, Arslan B, Üçüncü Ergun N, Topuz Ş, Yilmaz Semerci S, Kurnaz ME, Molu YM, Bozkurt MA, Süner N, Kocataş A. Treatment of COVID-19 patients with quercetin: a prospective, single center, randomized, controlled trial. Turk J Biol 2021; 45:518-529. [PMID: 34803451 PMCID: PMC8573830 DOI: 10.3906/biy-2104-16] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/02/2021] [Indexed: 12/15/2022] Open
Abstract
Scientific research continues on new preventive and therapeutic strategies against severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2). So far, there is no proven curative treatment, and a valid alternative therapeutic approach needs to be developed. This study is designed to evaluate the effect of quercetin in COVID-19 treatment. This was a single-centre, prospective randomized controlled cohort study. Routine care versus QCB (quercetin, vitamin C, bromelain) supplementation was compared between 429 patients with at least one chronic disease and moderate-to-severe respiratory symptoms. Demographic features, signs, laboratory results and drug administration data of patients were recorded. The endpoint was that QCB supplementation was continued throughout the follow-up period from study baseline to discharge, intubation, or death. The most common complaints at the time of hospital admission were fatigue (62.4%), cough (61.1%), anorexia (57%), thirst (53.7%), respiratory distress (51%) and chills (48.3%). The decrease in CRP and ferritin levels was higher in the QCB group (all Ps were < 0.05). In the QCB group, the increase in platelet and lymphocyte counts was higher (all Ps were < 0.05). QCB did not reduce the risk of events during follow-up. Adjustments for statistically significant parameters, including the lung stage, use of favipiravir and presence of comorbidity did not change the results. While there was no difference between the groups in terms of event frequency, the QCB group had more advanced pulmonary findings. QCB supplement is shown to have a positive effect on laboratory recovery. While there was no difference between the groups in terms of event frequency, QCB supplement group had more advanced pulmonar findings, and QCB supplement is shown to have a positive effect on laboratory recovery/results. Therefore, we conclude that further studies involving different doses and plasma level measurements are required to reveal the dose/response relationship and bioavailability of QCB for a better understanding of the role of QCB in the treatment of SARS CoV-2.
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Affiliation(s)
- Hasan Önal
- Department of Pediatric Nutrition and Metabolism Clinics, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, İstanbul Turkey
| | - Bengü Arslan
- Department of Pediatric Nutrition and Metabolism Clinics, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, İstanbul Turkey
| | - Nurcan Üçüncü Ergun
- Department of Pediatric Nutrition and Metabolism Clinics, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, İstanbul Turkey
| | - Şeyma Topuz
- Department of Pediatric Nutrition and Metabolism Clinics, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, İstanbul Turkey
| | - Seda Yilmaz Semerci
- Department of Neonatology, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, İstanbul Turkey
| | - Mehmet Eren Kurnaz
- Department of Pediatric Nutrition and Metabolism Clinics, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, İstanbul Turkey
| | - Yulet Miray Molu
- Department of Pediatric Nutrition and Metabolism Clinics, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, İstanbul Turkey
| | - Mehmet Abdussamet Bozkurt
- Department of General Surgery, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, İstanbul Turkey
| | - Nurettin Süner
- Department of General Medicine, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, İstanbul Turkey
| | - Ali Kocataş
- Department of General Surgery, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, İstanbul Turkey
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Demelo-Rodriguez P, Galeano-Valle F, Ordieres-Ortega L, Siniscalchi C, Martín Del Pozo M, Fidalgo Á, Gil-Díaz A, Lobo JL, De Ancos C, Monreal M. Validation of a Prognostic Score to Identify Hospitalized Patients with COVID-19 at Increased Risk for Bleeding. Viruses 2021; 13:2278. [PMID: 34835085 PMCID: PMC8621368 DOI: 10.3390/v13112278] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Hospitalized patients with COVID-19 are at increased risk for venous thromboembolism (VTE), but also for bleeding. We previously derived a prognostic score including four variables (elevated D-dimer, elevated ferritin, critical illness, and therapeutic-dose anticoagulation) that identified those at increased risk for major bleeding. METHODS We aimed to validate the score in a subsequent cohort of hospitalized patients with COVID-19 receiving standard-, intermediate- or therapeutic doses of VTE prophylaxis. We evaluated its capacity to predict major bleeding, non-major bleeding, and bleeding-related death. RESULTS The cohort included 972 patients from 29 hospitals, of whom 280 (29%) received standard-; 412 (42%) intermediate-, 157 (16%) therapeutic doses of VTE prophylaxis and 123 (13%) other drugs. Median duration of prophylaxis was 14.7 ± 10.3 days. Major bleeding occurred in 65 patients (6.7%) and non-major bleeding in 67 (6.9%). Thirty patients with major bleeding (46%) died within the first 30 days after bleeding. The prognostic score identified 203 patients (21%) at very low risk, 285 (29%) at low risk, 263 (27%) intermediate-risk and 221 (23%) at high risk for bleeding. Major bleeding occurred in 1.0%, 2.1%, 8.7% and 15.4% of the patients, respectively. Non-major bleeding occurred in 0.5%, 3.5%, 9.5% and 14.2%, respectively. The c-statistics was: 0.74 (95% confidence intervals [CI]: 0.68-0.79) for major bleeding, 0.73 (95% CI: 0.67-0.78) for non-major bleeding and 0.82 (95% CI: 0.76-0.87) for bleeding-related death. CONCLUSIONS In hospitalized patients with COVID-19, we validated that a prognostic score including 4 easily available items may identify those at increased risk for bleeding.
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Affiliation(s)
- Pablo Demelo-Rodriguez
- Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28006 Madrid, Spain; (P.D.-R.); (L.O.-O.)
| | - Francisco Galeano-Valle
- Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28006 Madrid, Spain; (P.D.-R.); (L.O.-O.)
| | - Lucía Ordieres-Ortega
- Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28006 Madrid, Spain; (P.D.-R.); (L.O.-O.)
| | - Carmine Siniscalchi
- Department of Angiology, Azienda Ospedaliera Universitaria, 43126 Parma, Italy;
| | - Mar Martín Del Pozo
- Department of Internal Medicine, Hospital Universitario Infanta Sofía, 28703 Madrid, Spain;
| | - Ángeles Fidalgo
- Department of Internal Medicine, Hospital Universitario de Salamanca, 37007 Salamanca, Spain;
| | - Aída Gil-Díaz
- Department of Internal Medicine, Hospital Universitario de Gran Canaria Dr. Negrín, 35010 Las Palmas de Gran Canaria, Spain;
| | - José Luis Lobo
- Department of Pneumonology, Hospital Universitario Araba, 01009 Álava, Spain;
| | - Cristina De Ancos
- Department of Internal Medicine, Hospital Universitario de Fuenlabrada, 28943 Madrid, Spain;
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Germans Trias i Pujol, 08916 Badalona, Spain;
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Barbui T, De Stefano V. Philadelphia-Negative Myeloproliferative Neoplasms Around the COVID-19 Pandemic. Curr Hematol Malig Rep 2021; 16:455-463. [PMID: 34586561 PMCID: PMC8480119 DOI: 10.1007/s11899-021-00647-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW Coronavirus disease 2019 (COVID-19) is associated with a high rate of respiratory failure, thromboembolism, bleeding, and death. Patients with myeloproliferative neoplasms (MPNs) are prone to both thrombosis and bleeding, calling for special care during COVID-19. We reviewed the clinical features of MPN patients with COVID-19, suggesting guidance for treatment. RECENT FINDINGS One study by the European LeukemiaNet collected 175 MPN patients with COVID-19 during the first wave of the pandemic, from February to May 2020. Patients with primary myelofibrosis (PMF) were at higher risk of mortality (48%) in comparison with essential thrombocythemia (ET) (25%) and polycythemia vera (19%); the risk of death was higher in those patients who abruptly discontinued ruxolitinib. In patients followed at home, in regular wards, or in ICU, the thrombosis rate was 1.0%, 2.8%, and 18.4%, respectively. Independent risk factors for thrombosis were ET phenotype, transfer to ICU, and neutrophil/lymphocyte ratio; major bleeding occurred in 4.3% of patients, particularly those with PMF. MPN patients with non-severe COVID-19 treated at home should continue their primary or secondary antithrombotic prophylaxis with aspirin or oral anticoagulants. In the case of hospitalization, patients assuming aspirin should add low molecular weight heparin (LMWH) at standard doses. In contrast, LMWH at intermediate/therapeutic doses should replace oral anticoagulants prescribed for atrial fibrillation or previous venous thromboembolism. Intermediate/high doses of LMWH can also be considered in ICU patients with ET, particularly in the case of a rapid decline in the number of platelets and progressive respiratory failure.
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MESH Headings
- Anticoagulants/therapeutic use
- COVID-19/complications
- COVID-19/diagnosis
- COVID-19/epidemiology
- COVID-19/therapy
- Hemorrhage/epidemiology
- Heparin, Low-Molecular-Weight/therapeutic use
- Humans
- Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative/complications
- Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative/diagnosis
- Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative/epidemiology
- Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative/therapy
- Myeloproliferative Disorders/complications
- Myeloproliferative Disorders/diagnosis
- Myeloproliferative Disorders/epidemiology
- Myeloproliferative Disorders/therapy
- Pandemics
- SARS-CoV-2/physiology
- Thrombosis/epidemiology
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Affiliation(s)
- Tiziano Barbui
- FROM Research Foundation, Papa Giovanni XXIII Hospital, Piazza OMS n. 1, 24127 Bergamo, Italy
| | - Valerio De Stefano
- Section of Hematology, Department of Radiological and Hematological Sciences, Catholic University, Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
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Jalisi S, Chen AD, Gomez E, Chigurupati R, Cauley R, Olbricht S, Lee BT, Lin SJ. A Multidisciplinary Approach and Review of Safety Recommendations for Plastic Surgeons during the COVID-19 Pandemic: Are N95 Masks Enough? Plast Reconstr Surg 2021; 148:467-474. [PMID: 34398101 PMCID: PMC8312336 DOI: 10.1097/prs.0000000000008177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 02/24/2021] [Indexed: 01/08/2023]
Abstract
SUMMARY The novel coronavirus disease of 2019 pandemic presents a unique challenge to the field of plastic and reconstructive surgery. Although plastic surgeons may be postponing elective operations, there are still a number of emergent or urgent procedures that may need to be performed, and surgeons may be facing the reality of returning to a new normalcy of operating with coronavirus disease of 2019. These procedures, consisting of those such as head and neck reconstruction or maxillofacial trauma, largely require a multidisciplinary approach and may be considered of higher risk to health care workers because of the involvement of areas of the body identified as sources for viral transmission. Moreover, viral transmission may potentially extend beyond respiratory secretions, which has been the main focus of most safety precautions. The authors aim to present the scope of these procedures and the means of viral transmission, and to provide safety precaution recommendations for plastic surgery and its related disciplines.
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Affiliation(s)
- Scharukh Jalisi
- From the Divisions of Otolaryngology–Head and Neck Surgery and Plastic Surgery, and the Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School; and the Department of Oral Maxillofacial Surgery, Boston University School of Dental Medicine
| | - Austin D. Chen
- From the Divisions of Otolaryngology–Head and Neck Surgery and Plastic Surgery, and the Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School; and the Department of Oral Maxillofacial Surgery, Boston University School of Dental Medicine
| | - Ernest Gomez
- From the Divisions of Otolaryngology–Head and Neck Surgery and Plastic Surgery, and the Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School; and the Department of Oral Maxillofacial Surgery, Boston University School of Dental Medicine
| | - Radhika Chigurupati
- From the Divisions of Otolaryngology–Head and Neck Surgery and Plastic Surgery, and the Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School; and the Department of Oral Maxillofacial Surgery, Boston University School of Dental Medicine
| | - Ryan Cauley
- From the Divisions of Otolaryngology–Head and Neck Surgery and Plastic Surgery, and the Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School; and the Department of Oral Maxillofacial Surgery, Boston University School of Dental Medicine
| | - Suzanne Olbricht
- From the Divisions of Otolaryngology–Head and Neck Surgery and Plastic Surgery, and the Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School; and the Department of Oral Maxillofacial Surgery, Boston University School of Dental Medicine
| | - Bernard T. Lee
- From the Divisions of Otolaryngology–Head and Neck Surgery and Plastic Surgery, and the Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School; and the Department of Oral Maxillofacial Surgery, Boston University School of Dental Medicine
| | - Samuel J. Lin
- From the Divisions of Otolaryngology–Head and Neck Surgery and Plastic Surgery, and the Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School; and the Department of Oral Maxillofacial Surgery, Boston University School of Dental Medicine
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El Hasbani G, Taher AT. Should we screen Eastern Mediterranean COVID-19 patients for inherited thrombophilia? Med Hypotheses 2021; 152:110621. [PMID: 34116360 PMCID: PMC8176888 DOI: 10.1016/j.mehy.2021.110621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 12/15/2022]
Abstract
The inflammatory component of Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) creates a pro-thrombotic state that necessitates a thrombophylactic strategy for hospitalized patients. Such strategies are difficult to be standardized because certain individuals can have pro-thrombotic conditions, such as inherited thrombophilia, which pre-dispose them to an additional coagulative risk. Whether outside the hospital or when admitted, patients with inherited thrombophilia need special anticoagulant and antiplatelet attention. Identifying such patients, especially in susceptible populations like the eastern Mediterranean (EM) region, will aid primary providers in risk stratification for choosing the optimal anticoagulation or antiplatelet plan.
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Affiliation(s)
- Georges El Hasbani
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali T Taher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Trimaille A, Curtiaud A, Matsushita K, Marchandot B, Von Hunolstein JJ, Sato C, Leonard-Lorant I, Sattler L, Grunebaum L, Ohana M, Ohlmann P, Jesel L, Morel O. Acute Pulmonary Embolism in Patients with and without COVID-19. J Clin Med 2021; 10:jcm10102045. [PMID: 34064556 PMCID: PMC8150992 DOI: 10.3390/jcm10102045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/04/2021] [Accepted: 05/07/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction. Acute pulmonary embolism (APE) is a frequent condition in patients with COVID-19 and is associated with worse outcomes. Previous studies suggested an immunothrombosis instead of a thrombus embolism, but the precise mechanisms remain unknown. Objective. To assess the determinants and prognosis of APE during COVID-19. Methods. We retrospectively included all consecutive patients with APE confirmed by computed tomography pulmonary angiography hospitalized at Strasbourg University Hospital from 1 March to 31 May 2019 and 1 March to 31 May 2020. A comprehensive set of clinical, biological, and imaging data during hospitalization was collected. The primary outcome was transfer to the intensive care unit (ICU). Results. APE was diagnosed in 140 patients: 59 (42.1%) with COVID-19, and 81 (57.9%) without COVID-19. A 812% reduction of non-COVID-19 related APE was registered during the 2020 period. COVID-19 patients showed a higher simplified pulmonary embolism severity index (sPESI) score (1.15 ± 0.76 vs. 0.83 ± 0.83, p = 0.019) and were more frequently transferred to the ICU (45.8% vs. 6.2%, p < 0.001). No difference regarding the most proximal thrombus localization, Qanadli score (8.1 ± 6.9 vs. 9.0 ± 7.4, p = 0.45), the proportion of subsegmental (10.2% vs. 11.1%, p = 0.86), and segmental pulmonary embolism (35.6% vs. 24.7%, p = 0.16) was evidenced between COVID-19 and non-COVID-19 APE. In COVID-19 patients with subsegmental or segmental APE, thrombus was, in all cases (27/27 patients), localized in areas with COVID-19-related lung injuries. Marked inflammatory and prothrombotic biological markers were associated with COVID-19 APE. Conclusions. APE patients with COVID-19 have a particular clinico–radiological and biological profile and a dismal prognosis. Our results emphasize the preeminent role of inflammation and a prothrombotic state in these patients.
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Affiliation(s)
- Antonin Trimaille
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France; (A.T.); (A.C.); (K.M.); (B.M.); (J.-J.V.H.); (C.S.); (P.O.); (L.J.)
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, 67000 Strasbourg, France
| | - Anaïs Curtiaud
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France; (A.T.); (A.C.); (K.M.); (B.M.); (J.-J.V.H.); (C.S.); (P.O.); (L.J.)
| | - Kensuke Matsushita
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France; (A.T.); (A.C.); (K.M.); (B.M.); (J.-J.V.H.); (C.S.); (P.O.); (L.J.)
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, 67000 Strasbourg, France
| | - Benjamin Marchandot
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France; (A.T.); (A.C.); (K.M.); (B.M.); (J.-J.V.H.); (C.S.); (P.O.); (L.J.)
| | - Jean-Jacques Von Hunolstein
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France; (A.T.); (A.C.); (K.M.); (B.M.); (J.-J.V.H.); (C.S.); (P.O.); (L.J.)
| | - Chisato Sato
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France; (A.T.); (A.C.); (K.M.); (B.M.); (J.-J.V.H.); (C.S.); (P.O.); (L.J.)
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, 67000 Strasbourg, France
| | - Ian Leonard-Lorant
- Radiology Department, Nouvel Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France; (I.L.-L.); (M.O.)
| | - Laurent Sattler
- Haematology and Haemostasis Laboratory, Centre for Thrombosis and Haemostasis, Nouvel Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France; (L.S.); (L.G.)
| | - Lelia Grunebaum
- Haematology and Haemostasis Laboratory, Centre for Thrombosis and Haemostasis, Nouvel Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France; (L.S.); (L.G.)
| | - Mickaël Ohana
- Radiology Department, Nouvel Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France; (I.L.-L.); (M.O.)
| | - Patrick Ohlmann
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France; (A.T.); (A.C.); (K.M.); (B.M.); (J.-J.V.H.); (C.S.); (P.O.); (L.J.)
| | - Laurence Jesel
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France; (A.T.); (A.C.); (K.M.); (B.M.); (J.-J.V.H.); (C.S.); (P.O.); (L.J.)
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, 67000 Strasbourg, France
| | - Olivier Morel
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France; (A.T.); (A.C.); (K.M.); (B.M.); (J.-J.V.H.); (C.S.); (P.O.); (L.J.)
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, 67000 Strasbourg, France
- Correspondence:
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Practical Recommendations for the Management of Patients with ITP During the COVID-19 Pandemic. Mediterr J Hematol Infect Dis 2021; 13:e2021032. [PMID: 34007420 PMCID: PMC8114883 DOI: 10.4084/mjhid.2021.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/10/2021] [Indexed: 01/08/2023] Open
Abstract
The current COVID-19 pandemic requires revisiting our current approach to major blood disorders, including ITP (Immune Thrombocytopenia), stirring up the production of several disease-specific practical guidelines. This report describes an updated version of consensus-based practical guidelines on the management of ITP, adapted to the Italian health system and social context. It highlights the role of the hematologist in offering guidance for choosing differentiated approaches in relation to specific circumstances and is intended to provide them with a useful tool for sharing the decision-making process with their patients. Probably, the greatest risk to avoid for a patient with suspected, ongoing or relapsed ITP - that is not severe enough to place him or her at risk for major bleeding - is to be infected in non-hospital and hospital healthcare settings. This risk must be carefully considered when adapting the diagnostic and therapeutic approach. More in detail, the document first addresses the appropriate management for COVID-19 negative patients with newly diagnosed ITP or who experience a relapse of previous ITP, according to first and second lines of treatment and then the management of COVID-19 positive patients according to their severity, from paucisymptomatic to those requiring admission to Intensive Cure Units (ICU). The pros and cons of the different treatments required to correct platelet count are discussed, as are some specific situations, including chronic ITP, splenectomy, thromboembolic complication and anti COVID-19 vaccination.
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12
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Abstract
Die Prävalenz der venösen thromboembolischen (VTE) Ereignisse ist bei Coronavirus diesease 2019 (COVID-19) -Patienten hoch, insbesondere bei schwer Erkrankten. Patienten mit schwerer COVID-19 und VTE haben eine signifikant höhere Mortalität im Vergleich zu Patienten ohne VTE. Die Manifestation einer schweren Infektion mit Severe acute respiratory syndrome coronavirus-2 (SARS-CoV‑2) entspricht einem systemischen proinflammatorischen und prokoagulatorischen Phänotyp, der mit vaskulären Thrombosen nicht nur in den Venen, sondern auch in den Arterien, Kapillaren sowie mit einer Inflammation der Gefäße assoziiert ist. Ein erhöhter D‑Dimer-Spiegel kann als Indikator für VTE bei Patienten mit COVID-19 verwendet werden. Die meisten medizinischen Gesellschaften empfehlen eine VTE-Prophylaxe vorzugsweise mit niedermolekularen Heparinen (LMWH) bei allen stationären Patienten. Weitere Daten von randomisierten kontrollierten Studien (RCTs) über die optimale Antikoagulation und antithrombotische Therapie werden in der nahen Zukunft erwartet.
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Affiliation(s)
- Stanislava Tzaneva
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090 Wien, Österreich
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13
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Jayaweera D, Flume PA, Singer NG, Cohen MS, Lachiewicz AM, Cameron A, Kumar N, Thompson J, Cabrera A, Daudelin D, Shaker R, Bauer PR. Prioritizing studies of COVID-19 and lessons learned. J Clin Transl Sci 2021; 5:e106. [PMID: 34192060 PMCID: PMC8185424 DOI: 10.1017/cts.2021.784] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION COVID-19 altered research in Clinical and Translational Science Award (CTSA) hubs in an unprecedented manner, leading to adjustments for COVID-19 research. METHODS CTSA members volunteered to conduct a review on the impact of CTSA network on COVID-19 pandemic with the assistance from NIH survey team in October 2020. The survey questions included the involvement of CTSAs in decision-making concerning the prioritization of COVID-19 studies. Descriptive and statistical analyses were conducted to analyze the survey data. RESULTS 60 of the 64 CTSAs completed the survey. Most CTSAs lacked preparedness but promptly responded to the pandemic. Early disruption of research triggered, enhanced CTSA engagement, creation of dedicated research areas and triage for prioritization of COVID-19 studies. CTSAs involvement in decision-making were 16.75 times more likely to create dedicated diagnostic laboratories (95% confidence interval [CI] = 2.17-129.39; P < 0.01). Likewise, institutions with internal funding were 3.88 times more likely to establish COVID-19 dedicated research (95% CI = 1.12-13.40; P < 0.05). CTSAs were instrumental in securing funds and facilitating establishment of laboratory/clinical spaces for COVID-19 research. Workflow was modified to support contracting and IRB review at most institutions with CTSAs. To mitigate chaos generated by competing clinical trials, central feasibility committees were often formed for orderly review/prioritization. CONCLUSIONS The lessons learned from the COVID-19 pandemic emphasize the pivotal role of CTSAs in prioritizing studies and establishing the necessary research infrastructure, and the importance of prompt and flexible research leadership with decision-making capacity to manage future pandemics.
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Affiliation(s)
| | | | - Nora G. Singer
- The MetroHealth System at Case Western Reserve University, Cleveland, OH, USA
| | - Myron S. Cohen
- The University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Anne M. Lachiewicz
- The University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Amanda Cameron
- Medical University of South Carolina, Charleston, SC, USA
| | - Naresh Kumar
- University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | | | - Reza Shaker
- Medical College of Wisconsin, Milwaukee, WI, USA
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14
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Deliwala SS, Hussain M, Ponnapalli A, Awuah D, Dawood T, Bachuwa G. Acute confusional state as a prognostic sign of COVID-19 large-vessel occlusion (LVO). BMJ Case Rep 2021; 14:14/2/e240536. [PMID: 33622754 PMCID: PMC7907863 DOI: 10.1136/bcr-2020-240536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
COVID-19 is well known for its respiratory symptoms, but severe presentations can alter haemostasis, causing acute end-organ damage with poor outcomes. Among its various neurological presentations, cerebrovascular events often present as small-vessel strokes. Although uncommon, in predisposed individuals, large-vessel occlusions (LVOs) can occur as a possible consequence of direct viral action (viral burden or antigenic structure) or virus-induced cytokine storm. Subtle presentations and complicated stroke care pathways continue to exist, delaying timely care. We present a unique case of COVID-19 LVO manifesting as an acute confusional state in an elderly man in April 2020. CT angiography revealed 'de novo' occlusions of the left internal carotid artery and proximal right vertebral artery, effectively blocking anterior and posterior circulations. Delirium can lead to inaccurate stroke scale assessments and prolong initiation of COVID-19 stroke care pathways. Future studies are needed to look into the temporal relationship between confusion and neurological manifestations.
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Affiliation(s)
| | - Murtaza Hussain
- Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
| | | | - Dominic Awuah
- Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
| | - Thair Dawood
- Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
| | - Ghassan Bachuwa
- Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
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15
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Barbui T, De Stefano V, Alvarez-Larran A, Iurlo A, Masciulli A, Carobbio A, Ghirardi A, Ferrari A, Cancelli V, Elli EM, Andrade-Campos MM, Kabat MG, Kiladjian JJ, Palandri F, Benevolo G, Garcia-Gutierrez V, Fox ML, Foncillas MA, Morcillo CM, Rumi E, Osorio S, Papadopoulos P, Bonifacio M, Cervantes KSQ, Serrano MS, Carreno-Tarragona G, Sobas MA, Lunghi F, Patriarca A, Elorza BN, Angona A, Mazo EM, Koschmieder S, Carli G, Cuevas B, Hernandez-Boluda JC, Abadia EL, Cirici BX, Guglielmelli P, Garrote M, Cattaneo D, Daffini R, Cavalca F, Bellosillo B, Benajiba L, Curto-Garcia N, Bellini M, Betti S, Harrison C, Rambaldi A, Vannucchi AM. Among classic myeloproliferative neoplasms, essential thrombocythemia is associated with the greatest risk of venous thromboembolism during COVID-19. Blood Cancer J 2021; 11:21. [PMID: 33563901 PMCID: PMC7871138 DOI: 10.1038/s41408-021-00417-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/15/2020] [Accepted: 01/19/2021] [Indexed: 12/12/2022] Open
Abstract
In a multicenter European retrospective study including 162 patients with COVID-19 occurring in essential thrombocythemia (ET, n = 48), polycythemia vera (PV, n = 42), myelofibrosis (MF, n = 56), and prefibrotic myelofibrosis (pre-PMF, n = 16), 15 major thromboses (3 arterial and 12 venous) were registered in 14 patients, of whom all, but one, were receiving LMW-heparin prophylaxis. After adjustment for the competing risk of death, the cumulative incidence of arterial and venous thromboembolic events (VTE) reached 8.5% after 60 days follow-up. Of note, 8 of 12 VTE were seen in ET. Interestingly, at COVID-19 diagnosis, MPN patients had significantly lower platelet count (p < 0.0001) than in the pre-COVID last follow-up.This decline was remarkably higher in ET (-23.3%, p < 0.0001) than in PV (-16.4%, p = 0.1730) and was associated with higher mortality rate (p = 0.0010) for pneumonia. The effects of possible predictors of thrombosis, selected from those clinically relevant and statistically significant in univariate analysis, were examined in a multivariate model. Independent risk factors were transfer to ICU (SHR = 3.73, p = 0.029), neutrophil/lymphocyte ratio (SHR = 1.1, p = 0.001) and ET phenotype (SHR = 4.37, p = 0.006). The enhanced susceptibility to ET-associated VTE and the associated higher mortality for pneumonia may recognize a common biological plausibility and deserve to be delved to tailor new antithrombotic regimens including antiplatelet drugs.
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Affiliation(s)
- Tiziano Barbui
- FROM Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | - Valerio De Stefano
- Section of Hematology, Department of Radiological and Hematological Sciences, Catholic University, Fondazione Policlinico "A. Gemelli" IRCCS, Rome, Italy
| | | | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Arianna Masciulli
- FROM Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Arianna Ghirardi
- FROM Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Alberto Ferrari
- FROM Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Elena Maria Elli
- Hematology Division and Bone Marrow Transplant, San Gerardo Hospital, ASST Monza, Monza, Italy
| | | | | | | | - Francesca Palandri
- Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italia
| | - Giulia Benevolo
- AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | | | - Maria Laura Fox
- Department of Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, C/ Natzaret, 115-117, 08035, Barcelona, Spain
| | | | | | - Elisa Rumi
- Department of molecular medicine, University of Pavia, Pavia, Italy
| | | | | | | | | | | | | | - Marta Anna Sobas
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wrocław, Poland
| | | | | | | | - Anna Angona
- ICO Girona Hospital Josep Trueta, Girona, Spain
| | - Elena Magro Mazo
- Hospital Universitario Principe de Asturias, Alcalà de Henares, Madrid, Spain
| | - Steffen Koschmieder
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | | | | | | | | | - Blanca Xicoy Cirici
- Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Joseo Carreras Leukemia Research Institute, Badalona (Barcelona) Spain, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Paola Guglielmelli
- Center Research and Innovation of Myeloproliferative Neoplasms (CRIMM), Department of Experimental and Clinical Medicine, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | | | - Daniele Cattaneo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Fabrizio Cavalca
- Hematology Division and Bone Marrow Transplant, San Gerardo Hospital, ASST Monza, Monza, Italy
| | | | | | | | | | - Silvia Betti
- Section of Hematology, Department of Radiological and Hematological Sciences, Catholic University, Fondazione Policlinico "A. Gemelli" IRCCS, Rome, Italy
| | | | - Alessandro Rambaldi
- ASST Papa Giovanni XXIII, Bergamo, Italy
- Università degli Studi di Milano, Milano, Italy
| | - Alessandro Maria Vannucchi
- Center Research and Innovation of Myeloproliferative Neoplasms (CRIMM), Department of Experimental and Clinical Medicine, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
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Carrillo Alcalá ME, Minaya Saiz J. [Attending COVID-19 patients during the first wave of the pandemic in a Medium Stay Hospital: Variables associated with mortality in hospitalized patients in an acute situation]. Rev Esp Geriatr Gerontol 2021; 56:334-342. [PMID: 34330544 PMCID: PMC8139233 DOI: 10.1016/j.regg.2021.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/01/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Spain has been one of the countries most affected by the SARS-CoV-2 pandemic. The objective of this study is to describe the characteristics of the patients treated for COVID-19 at Guadarrama Hospital and to identify the associated mortality factors in those admitted in an acute situation. MATERIAL AND METHODS Retrospective observational study of COVID-19 patients admitted from 3/15 to 5/15/2020. Sociodemographic, mental, functional, analytical, clinical, radiological and therapeutic variables were collected. Factors associated with mortality were analysed using a bivariate and multivariate study. RESULTS Two hundred eleven patients were included: 102 (48.3%) in an acute situation and 109 (51.7%) in the convalescent phase, the median (interquartile range) age was 82 (72, 85) years. The most frequent symptoms were fever, cough and respiratory failure. The 89.9% had pneumonia. An acute mortality rate of 26.5% (27/102) was detected and the associated factors were: respiratory failure (P 0.002), Charlson index (ChI)≥3 (P<0.001), CURB≥2 (P 0.011), low SatO2/FiO2 ratio (<0.001), elevated urea (P<0.001) and creatinine (P 0.036), hypoproteinemia (P 0.037) and age (P<0.018). The deceased had a worse functional situation than the survivors (P 0.025). In the multivariate analysis, SatO2/FiO2 ratio (OR: 2.23; 95% CI: 1.07-4.63; P 0.031) and ChI≥3 (OR: 4.25; 95% CI: 1.06-17.04; P 0.041) were independent factors of mortality. CONCLUSIONS The COVID-19 patients treated were mostly severe cases. The variables associated with mortality were age, respiratory failure, comorbidity, kidney failure, and malnutrition. Respiratory failure and comorbidity outweigh age as independent risk factors for mortality.
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D-Dimers Level as a Possible Marker of Extravascular Fibrinolysis in COVID-19 Patients. J Clin Med 2020; 10:jcm10010039. [PMID: 33374487 PMCID: PMC7795726 DOI: 10.3390/jcm10010039] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Host defence mechanisms to counter virus infection include the activation of the broncho-alveolar haemostasis. Fibrin degradation products secondary to extravascular fibrin breakdown could contribute to the marked increase in D-Dimers during COVID-19. We sought to examine the prognostic value on lung injury of D-Dimers in non-critically ill COVID-19 patients without thrombotic events. METHODS This study retrospectively analysed hospitalized COVID-19 patients classified according to a D-Dimers threshold following the COVID-19 associated haemostatic abnormalities (CAHA) classification at baseline and at peak (Stage 1: D-Dimers less than three-fold above normal; Stage 2: D-Dimers three- to six-fold above normal; Stage 3: D-Dimers six-fold above normal). The primary endpoint was the occurrence of critical lung injuries on chest computed tomography. The secondary outcome was the composite of in-hospital death or transfer to the intensive care unit (ICU). RESULTS Among the 123 patients included, critical lung injuries were evidenced in 8 (11.9%) patients in Stage 1, 6 (20%) in Stage 2 and 15 (57.7%) in Stage 3 (p = 0.001). D-Dimers staging at peak was an independent predictor of critical lung injuries regardless of the inflammatory burden assessed by CRP levels (OR 2.70, 95% CI (1.50-4.86); p < 0.001) and was significantly associated with increased in-hospital death or ICU transfer (14.9 % in Stage 1, 50.0% in Stage 2 and 57.7% in Stage 3 (p < 0.001)). D-Dimers staging at peak was an independent predictor of in-hospital death or ICU transfer (OR 2.50, CI 95% (1.27-4.93); p = 0.008). CONCLUSIONS In the absence of overt thrombotic events, D-Dimers quantification is a relevant marker of critical lung injuries and dismal patient outcome.
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Kanitra JJ, Power AD, Hayward RD, Haouilou JC, Edhayan E. Malfunctioning temporary hemodialysis catheters in patients with novel coronavirus disease 2019. J Vasc Surg 2020; 73:1881-1888.e3. [PMID: 33290813 PMCID: PMC7833410 DOI: 10.1016/j.jvs.2020.11.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 11/27/2020] [Indexed: 01/08/2023]
Abstract
Objective The hypercoagulability seen in patients with novel coronavirus disease 2019 (COVID-19) likely contributes to the high temporary hemodialysis catheter (THDC) malfunction rate. We aim to evaluate prophylactic measures and their association with THDC patency. Methods A retrospective chart review of our institutions COVID-19 positive patients who required placement of a THDC between February 1 to April 30, 2020, was performed. The association between heparin locking, increased dosing of venous thromboembolism (VTE) prophylaxis and systemic anticoagulation on THDC patency was assessed. Proportional hazards modeling was used to perform a survival analysis to estimate the likelihood and timing of THDC malfunction with the three different prophylactic measures. We also determined the mortality, rate of THDC malfunction and its association with d-dimer levels. Results A total of 48 patients with a mortality rate of 71% were identified. THDC malfunction occurred in 31.3% of patients. Thirty-seven patients (77.1%) received heparin locking, 22 (45.8%) received systemic anticoagulation, and 38 (79.1%) received VTE prophylaxis. Overall, the rate of THDC malfunction was lower at a trend level of significance, with heparin vs saline locking (24.3% vs 54.6%; P = .058). The likelihood of THDC malfunction in the heparin locked group is lower than all other groups (hazard ratio [HR], 0.07; 95% confidence interval [CI], 0.01-0.45]; P = .005). The rate of malfunction in patients with subcutaneous heparin (SQH) 7500 U three times daily is significantly lower than of the rate for patients receiving none (HR, 0.03; 95% CI, 0.001-0.74; P = .032). A trend level significant association was found for SQH 5000 U vs none (P = .417) and SQH 7500 vs 5000 U (P = .059). Systemic anticoagulation did not affect the THDC malfunction rate (P = .240). Higher d-dimer levels were related to greater mortality (HR, 3.28; 95% CI, 1.16-9.28; P = .025), but were not significantly associated with THDC malfunction (HR, 1.79; 95% CI, 0.42, 7.71; P = .434). Conclusions Locking THDCs with heparin is associated with a lower malfunction rate. Prospective randomized studies will be needed to confirm these findings to recommend locking THDC with heparin in patients with COVID-19. Increased VTE prophylaxis suggested a possible association with improved THDC patency, although the comparison lacked sufficient statistical power.
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Affiliation(s)
- John J Kanitra
- Department of Surgery, Ascension St. John Hospital, Detroit, Mich
| | | | - R David Hayward
- Department of Surgery, Ascension St. John Hospital, Detroit, Mich.
| | - Jimmy C Haouilou
- Department of Surgery, Ascension St. John Hospital, Detroit, Mich
| | - Elango Edhayan
- Department of Surgery, Ascension St. John Hospital, Detroit, Mich
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19
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Matsushita K, Hess S, Marchandot B, Sato C, Truong DP, Kim NT, Weiss A, Jesel L, Ohlmann P, Morel O. Clinical features of patients with acute coronary syndrome during the COVID-19 pandemic. J Thromb Thrombolysis 2020; 52:95-104. [PMID: 33200333 PMCID: PMC7668406 DOI: 10.1007/s11239-020-02340-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 02/07/2023]
Abstract
Although a reduction in hospital admissions of acute coronary syndromes (ACS) patients has been observed globally during the coronavirus disease 2019 (COVID-19) pandemic, clinical features of those patients have not been fully investigated. The aim of the present analysis is to investigate the incidence, clinical presentation, and outcomes of patients with ACS during the COVID-19 pandemic. We performed a retrospective analysis of consecutive patients who were admitted for ACS at our institution between March 1 and April 20, 2020 and compared with the equivalent period in 2019. Admissions for acute myocardial infarction (AMI) reduced by 39.5% in 2020 compared with the equivalent period in 2019. Owing to the emergency medical services (EMS) of our region, all time components of ST-elevated myocardial infarction care were similar during the COVID-19 outbreak as compared with the previous year’s dataset. Among the 106 ACS patients in 2020, 7 patients tested positive for COVID-19. Higher incidence of type 2 myocardial infarction (29% vs. 4%, p = 0.0497) and elevated D-dimer levels (5650 μg/l [interquartile range (IQR) 1905–13,625 μg/l] vs. 400 μg/l [IQR 270–1050 μg/l], p = 0.02) were observed in COVID-19 patients. In sum, a significant reduction in admission for AMI was observed during the COVID-19 pandemic. COVID-19 patients were characterized by elevated D-dimer levels on admission, reflecting enhanced COVID-19 related thrombogenicity. The prehospital evaluation by EMS may have played an important role for the timely revascularization for STEMI patients.
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Affiliation(s)
- Kensuke Matsushita
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 1 place de l'Hôpital, 67091, Strasbourg cedex, France.,UMR1260 INSERM, Nanomédecine Régénérative, Faculté de Pharmacie, Université de Strasbourg, Illkirch, France
| | - Sebastien Hess
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 1 place de l'Hôpital, 67091, Strasbourg cedex, France
| | - Benjamin Marchandot
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 1 place de l'Hôpital, 67091, Strasbourg cedex, France
| | - Chisato Sato
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 1 place de l'Hôpital, 67091, Strasbourg cedex, France.,UMR1260 INSERM, Nanomédecine Régénérative, Faculté de Pharmacie, Université de Strasbourg, Illkirch, France
| | - Dinh Phi Truong
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 1 place de l'Hôpital, 67091, Strasbourg cedex, France.,Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
| | - Ngoc Thanh Kim
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 1 place de l'Hôpital, 67091, Strasbourg cedex, France.,Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
| | - Anne Weiss
- Centre Hospitalier Universitaire, SAMU 67, Strasbourg, France
| | - Laurence Jesel
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 1 place de l'Hôpital, 67091, Strasbourg cedex, France.,UMR1260 INSERM, Nanomédecine Régénérative, Faculté de Pharmacie, Université de Strasbourg, Illkirch, France
| | - Patrick Ohlmann
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 1 place de l'Hôpital, 67091, Strasbourg cedex, France
| | - Olivier Morel
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 1 place de l'Hôpital, 67091, Strasbourg cedex, France. .,UMR1260 INSERM, Nanomédecine Régénérative, Faculté de Pharmacie, Université de Strasbourg, Illkirch, France.
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20
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Meta-analysis of coagulation parameters associated with disease severity and poor prognosis of COVID-19. Int J Infect Dis 2020; 100:441-448. [PMID: 32947052 PMCID: PMC7490635 DOI: 10.1016/j.ijid.2020.09.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/05/2020] [Accepted: 09/10/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To determine whether abnormal coagulation parameters are associated with disease severity and poor prognosis in patients with 2019 Corona Virus Disease (COVID-19). METHODS A systematic literature search was conducted using the databases PubMed, Embase, and Web of sciences until April 25, 2020. We included a total of 15 studies with 2277 patients. Platelet count (PLT), prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer (D-D), and fibrinogen (FIB) were collected and analyzed. The statistical results were expressed as the effect measured by mean difference (MD) with the related 95% confidence interval (CI). RESULTS The PLT level of severe cases was lower than that of mild cases, while the levels of PT, D-D, and FIB were higher than those of mild cases (P < 0.05). The level of APTT had no statistical difference between two groups (P > 0.05). PT of ICU patients was significantly longer (P < 0.05) than that of non-ICU patients. In non-survivors, PT and D-D were higher, yet PLT was lower than that of survivors (P < 0.05). There was no significant difference in APTT between survivors and non-survivors (P > 0.05). The funnel plot and Egger's regression test demonstrated that there was no publication bias. CONCLUSIONS Our data support the notion that coagulopathy could be considered as a risk factor for disease severity and mortality of COVID-19, which may help clinicians to identify the incidence of poor outcomes in COVID-19 patients.
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21
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Fan BE, Ng J, Chan SSW, Christopher D, Tso ACY, Ling LM, Young BE, Wong LJL, Sum CLL, Tan HT, Ang MK, Lim GH, Ong KH, Kuperan P, Chia YW. COVID-19 associated coagulopathy in critically ill patients: A hypercoagulable state demonstrated by parameters of haemostasis and clot waveform analysis. J Thromb Thrombolysis 2020; 51:663-674. [PMID: 33098540 PMCID: PMC7584863 DOI: 10.1007/s11239-020-02318-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 01/22/2023]
Abstract
Patients with COVID-19 are known to be at risk of developing both venous, arterial and microvascular thrombosis, due to an excessive immuno-thrombogenic response to the SARS-CoV-2 infection. Overlapping syndromes of COVID-19 associated coagulopathy with consumptive coagulopathy and microangiopathy can be seen in critically ill patients as well. Blood was collected from 12 Intensive Care Unit (ICU) patients with severe COVID-19 who were on either mechanical ventilation or on high flow oxygen with a PaO2/FiO2 ratio of <300 mmHg. Laboratory tests were performed for parameters of haemostasis, clot waveform analysis and anti-phospholipid antibodies. CWA parameters were raised with elevated aPTT median Min1 (clot velocity) 9.3%/s (IQR 7.1–9.9%/s), elevated PT median Min1 10.3%/s (IQR 7.1–11.1%/s), elevated aPTT median Min2 (clot acceleration) 1.5%/s2 (IQR 1.0–1.6%/s2), elevated PT median Min2 5.2%/s2 (3.6–5.7%/s2), elevated aPTT median Max2 (clot deceleration) 1.3%/s2 (IQR 0.8–1.4%/s2) elevated PT median Max2 3.8%/s2 (IQR 2.6–4.2%/s2), increased aPTT median Delta change (decreased light transmission due to increased clot formation) 87.8% (IQR 70.2–91.8%) and PT median Delta change 33.0%. This together with raised median Factor VIII levels of 262.5%, hyperfibrinogenemia (median fibrinogen levels 7.5 g/L), increased median von Willebrand factor antigen levels 320% and elevated median D-dimer levels 1.7 μg/dl support the diagnosis of COVID-19 associated coagulopathy. A lupus anticoagulant was present in 50% of patients. Our laboratory findings further support the view that severe SARS-CoV-2 infection is associated with a state of hypercoagulability.
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Affiliation(s)
- Bingwen Eugene Fan
- Department of Haematology, Tan Tock Seng Hospital, Singapore, Singapore. .,Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore, Singapore. .,Lee Kong Chian School of Medicine, Singapore, Singapore. .,Yong Loo Lin School of Medicine, Singapore, Singapore.
| | - Jensen Ng
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Singapore, Singapore.,Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Stephrene Seok Wei Chan
- Department of Haematology, Tan Tock Seng Hospital, Singapore, Singapore.,Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Singapore, Singapore.,Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Dheepa Christopher
- Department of Haematology, Tan Tock Seng Hospital, Singapore, Singapore.,Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Singapore, Singapore.,Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Allison Ching Yee Tso
- Department of Haematology, Tan Tock Seng Hospital, Singapore, Singapore.,Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Singapore, Singapore.,Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Li Min Ling
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore.,National Centre for Infectious Diseases, Singapore, Singapore.,Lee Kong Chian School of Medicine, Singapore, Singapore.,Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Barnaby Edward Young
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore.,National Centre for Infectious Diseases, Singapore, Singapore.,Lee Kong Chian School of Medicine, Singapore, Singapore.,Yong Loo Lin School of Medicine, Singapore, Singapore
| | | | | | - Hwee Tat Tan
- Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Mui Kia Ang
- Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Gek Hsiang Lim
- Clinical Research and Innovation Office, Tan Tock Seng Hospital, Singapore, Singapore
| | - Kiat Hoe Ong
- Department of Haematology, Tan Tock Seng Hospital, Singapore, Singapore.,Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Singapore, Singapore.,Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Ponnudurai Kuperan
- Department of Haematology, Tan Tock Seng Hospital, Singapore, Singapore.,Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Singapore, Singapore.,Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Yew Woon Chia
- Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Singapore, Singapore.,Yong Loo Lin School of Medicine, Singapore, Singapore
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22
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Trimaille A, Bonnet G. [COVID-19 and venous thromboembolism]. Ann Cardiol Angeiol (Paris) 2020; 69:370-375. [PMID: 33081917 PMCID: PMC7522640 DOI: 10.1016/j.ancard.2020.09.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 09/18/2020] [Indexed: 01/08/2023]
Abstract
La coronavirus disease 2019 (COVID-19) s’accompagne d’une incidence élevée d’événements thromboemboliques veineux (ETEV). Souvent asymptomatiques, ils ont un impact défavorable sur le pronostic des patients. En plus des facteurs de risque de thrombose veineuse auxquels les formes de COVID-19 nécessitant une hospitalisation exposent (alitement prolongée, hypoxémie, présence de matériel intraveineux), les caractéristiques des patients atteints des formes les plus sévères (âge élevé, obésité) expliquent en partie la fréquence des ETEV. De plus, la COVID-19 entraîne une maladie de l’endothélium vasculaire par une invasion directe des cellules endothéliales, à l’origine d’une endothéliite, et un état prothrombotique secondaire à l’intense réaction inflammatoire. L’ensemble de ces manifestations entraînent une immunothrombose localisée principalement au niveau du lit vasculaire pulmonaire. La stratification du risque thromboembolique veineux pour proposer aux patients un niveau d’anticoagulation adapté apparaît ainsi comme un des piliers du traitement de la COVID-19. Les recommandations émises jusqu’ici se basent sur des avis d’experts dans la mesure où les données sur l’anticoagulation au cours de la COVID-19 proviennent essentiellement d’études observationnelles. Des essais cliniques contrôlés et randomisés sont en cours et permettront d’améliorer la gestion de la maladie thromboembolique veineuse au cours de la COVID-19.
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Affiliation(s)
- A Trimaille
- Pôle d'activité médicochirurgicale cardiovasculaire, nouvel hôpital civil, centre hospitalier régional universitaire de Strasbourg, 67000 Strasbourg, France
| | - G Bonnet
- Unité Inserm U970, Paris centre de recherche cardiovasculaire (PARCC), université de Paris, 75015 Paris, France.
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23
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Thuluva SK, Zhu H, Tan MML, Gupta S, Yeong KY, Cheong Wah ST, Lin L, Yap ES. A 29-Year-Old Male Construction Worker from India Who Presented with Left- Sided Abdominal Pain Due to Isolated Superior Mesenteric Vein Thrombosis Associated with SARS-CoV-2 Infection. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e926785. [PMID: 32970653 PMCID: PMC7521461 DOI: 10.12659/ajcr.926785] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Patient: Male, 29-year-old Final Diagnosis: COVID provoked thromboembolism Symptoms: Abdominal pain Medication:— Clinical Procedure: — Specialty: Infectious Diseases • Radiology
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Affiliation(s)
- Suresh Kumar Thuluva
- Department of Radiology, Ng Teng Fong General Hospital, National University Health System (NUHS), Singapore, Singapore
| | - Hongguang Zhu
- Department of Medicine, Ng Teng Fong General Hospital, National University Health System (NUHS), Singapore, Singapore
| | - Mark M L Tan
- Department of Radiology, Ng Teng Fong General Hospital, National University Health System (NUHS), Singapore, Singapore
| | - Saurav Gupta
- Department of Radiology, Ng Teng Fong General Hospital, National University Health System (NUHS), Singapore, Singapore
| | - Kuan Yuen Yeong
- Department of Radiology, Ng Teng Fong General Hospital, National University Health System (NUHS), Singapore, Singapore
| | - See Toh Cheong Wah
- Department of Radiology, Ng Teng Fong General Hospital, National University Health System (NUHS), Singapore, Singapore
| | - Li Lin
- Department of Medicine, Ng Teng Fong General Hospital, National University Health System (NUHS), Singapore, Singapore
| | - Eng Soo Yap
- Department of Laboratory Medicine, National University Hospital, National University Health System (NUHS), Singapore, Singapore
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