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LaVasseur C, Mathews R, Wang JSH, Martens K, McMurry HS, Peress S, Sabile J, Kartika T, Oleson I, Lo JO, DeLoughery TG, McCarty OJ, Shatzel JJ. Estrogen-based hormonal therapy and the risk of thrombosis in COVID-19 patients. Eur J Haematol 2023; 111:678-686. [PMID: 37519103 PMCID: PMC11019854 DOI: 10.1111/ejh.14061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE Estrogen-containing contraceptives and hormone replacement therapy are used commonly, however, the risks of venous and arterial thrombosis imparted by such medications during COVID-19 infection or other similar viral infections remain undescribed. METHODS To assess the risk of venous and arterial thrombosis in patients receiving oral estrogen-containing therapy (ECT) with COVID-19 as compared to those receiving non-estrogen-based hormonal therapy, we conducted a multicenter cohort study of 991 patients with confirmed COVID-19 infection, 466 receiving estrogen-containing hormonal therapy, and 525 receiving progestin-only or topical therapy. RESULTS The use of estrogen-containing therapy was found to significantly increase the risk of venous thromboembolism (VTE) following COVID-19 diagnosis after controlling for age (HR 5.46 [95% CI 1.12-26.7, p = .036]). This risk was highest in patients over age 50, with 8.6% of patients receiving estrogen-containing therapy diagnosed with VTE compared to 0.9% of those receiving non-estrogen-based therapies (p = .026). The risk of arterial thrombosis was not significantly associated with oral estrogen use. CONCLUSIONS These results suggest that estrogen-containing therapy is associated with a significantly increased risk of VTE in COVID-19 patients, especially in older individuals. These findings may guide provider counseling and management of patients with COVID-19 on estrogen-containing therapy.
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Affiliation(s)
- Corinne LaVasseur
- Department of Internal Medicine, Oregon Health & Science University, Portland, OR USA
| | - Rick Mathews
- Department of Biomedical Engineering, Oregon Health & Science University, OR USA
| | - Jenny S H Wang
- Department of Biomedical Engineering, Oregon Health & Science University, OR USA
| | - Kylee Martens
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR USA
| | - Hannah Stowe McMurry
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR USA
| | - Shira Peress
- Department of Internal Medicine, Oregon Health & Science University, Portland, OR USA
| | - Jean Sabile
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR USA
| | - Thomas Kartika
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR USA
| | - Ileisa Oleson
- Department of Internal Medicine, Oregon Health & Science University, Portland, OR USA
| | - Jamie O. Lo
- Department of Obstetrics & Gynecology, Oregon Health & Science University, OR USA
| | - Thomas G. DeLoughery
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR USA
| | - Owen J.T. McCarty
- Department of Biomedical Engineering, Oregon Health & Science University, OR USA
| | - Joseph J. Shatzel
- Department of Internal Medicine, Oregon Health & Science University, Portland, OR USA
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR USA
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2
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Bagheri B, Alipour A, Yousefi M, Jalalian R, Moghimi M, Mohammadi M, Hassanpour N, Iranian M. Prevalence of Thromboembolic Events, Including Venous Thromboembolism and Arterial Thrombosis, in Patients with COVID-19: A Systematic Review with Meta-Analysis. J Tehran Heart Cent 2023; 18:154-169. [PMID: 38146412 PMCID: PMC10748660 DOI: 10.18502/jthc.v18i3.14110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/23/2023] [Indexed: 12/27/2023] Open
Abstract
Background Many studies have evaluated thromboembolic events in COVID-19 patients, and most of them have reported a high estimation of the prevalence of such events. The present study sought to evaluate the prevalence of thromboembolic events in patients with COVID-19. Methods This study is a systematic review with meta-analysis that investigated thromboembolic events in patients with COVID-19 from the start of the pandemic to August 31, 2021. The 4 main databases for collecting articles were Medline, Scopus, Google Scholar, and Web of Science. Deep vein thrombosis, pulmonary embolism, arterial thrombosis, and the overall rate of thromboembolic events were considered primary outcomes. Results In a total of 63 studies (104 920 patients with COVID-19), the overall thrombosis rate was 21% (95% CI, 18% to 25%), the rate of deep vein thrombosis was 20% (95% Cl, 16% to 25%), the rate of pulmonary embolism was 8% (95% Cl, 6% to 10%), and the rate of arterial thrombosis was 5% (95% Cl, 3% to 7%). The prevalence of all primary outcomes in critically ill patients admitted to the intensive care unit (ICU) was significantly higher (P<0.05). In older patients, the prevalence of overall thrombosis, pulmonary embolism, or deep vein thrombosis was significantly higher (P<0.05). Conclusion This study showed that COVID-19 increases the risk of thromboembolic events, especially in elderly and critically ill patients admitted to the ICU. Therefore, more strategies are needed to prevent thromboembolic events in patients with COVID-19, especially in ICU-admitted and elderly patients.
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Affiliation(s)
- Babak Bagheri
- Department of Cardiology, Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Abbas Alipour
- Community Medicine Department, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mojtaba Yousefi
- Department of Cardiology, Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Rozita Jalalian
- Department of Cardiology, Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Minoo Moghimi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahsa Mohammadi
- Rajaie Cardiovascular Medical and Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Negar Hassanpour
- Rajaie Cardiovascular Medical and Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Iranian
- Rajaie Cardiovascular Medical and Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Palareti G, Legnani C, Poli D, Ageno W, Pengo V, Testa S, Tosetto A, Prandoni P. COVID-19 pandemic affects the ability of negative D-dimer to identify venous thromboembolism patients at low risk of recurrence: insights from the Apidulcis study. Haematologica 2023; 108:923-925. [PMID: 36420801 PMCID: PMC9973493 DOI: 10.3324/haematol.2022.282130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Indexed: 11/27/2022] Open
Abstract
Not available.
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Affiliation(s)
| | | | | | - Walter Ageno
- UOC Pronto Soccorso, Medicina d'Urgenza e Centro Trombosi ed Emostasi, ASST dei Sette Laghi - Varese
| | - Vittorio Pengo
- Clinica Cardiologica, Azienda Ospedaliera di Padova - Padova - Italy
| | - Sophie Testa
- Centro Emostasi e Trombosi, UUOO Laboratorio Analisi chimico-cliniche e microbiologiche, ASST Cremona - Cremona
| | - Alberto Tosetto
- Divisione di Ematologia, Ospedale S. Bortolo AULSS 8 Berica - Vicenza
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Jennifer K, Shirley SBD, Avi P, Daniella RC, Naama SS, Anat EZ, Miri MR. Post-acute sequelae of COVID-19 infection. Prev Med Rep 2022; 31:102097. [PMID: 36567743 PMCID: PMC9767882 DOI: 10.1016/j.pmedr.2022.102097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 12/18/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
To determine if people infected with SARS-CoV-2 were at higher risk of developing selected medical conditions post-recovery, data were extracted from the database of a large health maintenance organization (HMO) in Israel between March 2020 and May 2021. For each condition, a condition-naïve group prior to COVID-19 (PCR-positive) infection were compared to a condition-naïve, non-COVID-19 infected group, matched by gender, age, socioeconomic status, minority group status and number of months visited primary care physician (PCP) in previous year. Diagnosis and recuperation dates for each COVID-19 infected participant were applied to their matched comparison participant (1:1 ratio). Incidence of each condition was measured between date of recuperation and end of study period for each group and Cox regression models developed to determine hazard ratios by group status, controlling for demographic and health variables. Crude and adjusted incidence rates were higher for the COVID-19 infected group than those not infected with COVID-19 for treatment for depression/anxiety, sleep disturbance, diagnosis of deep venous thrombosis, lung disease and fibromyalgia. Differences in incidence were no longer observed between the two groups for treatment of sleep disturbance, and diagnosis of lung disease when those hospitalized during the acute-phase of illness (any reason) were excluded. No difference was found by COVID-19 infection status for post-acute incidence of diabetes, cerebrovascular accident, myocardial infarction, acute kidney disease, hypertension and ischemic heart disease. Patients post-COVID-19 infection should be evaluated for depression, anxiety, sleep disturbance, DVT, lung disease and fibromyalgia.
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Affiliation(s)
- Kertes Jennifer
- Dept Health Evaluation & Research, Maccabi HealthCare Services, HaMered 27, Tel Aviv 6812509, Israel,Corresponding author.
| | | | - Porath Avi
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Ben Gurion Drive 1, Beer Sheva 8410501, Israel
| | | | - Shamir Stein Naama
- Dept Health Evaluation & Research, Maccabi HealthCare Services, HaMered 27, Tel Aviv 6812509, Israel
| | - Ekka Zohar Anat
- Health Division, Maccabi HealthCare Services, HaMered 27, Tel Aviv 6812509, Israel
| | - Mizrahi-Reuveni Miri
- Health Division, Maccabi HealthCare Services, HaMered 27, Tel Aviv 6812509, Israel
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Fu Z, Bai G, Song B, Wang Y, Song H, Ma M, Zhu J, Zhang Z, Kang Q. Risk factors and mortality of pulmonary embolism in COVID-19 patients: Evidence based on fifty observational studies. Medicine (Baltimore) 2022; 101:e29895. [PMID: 36397410 PMCID: PMC9665895 DOI: 10.1097/md.0000000000029895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND At present, many studies have described acute pulmonary embolism (PE) as a frequent and prognostically relevant complication of coronavirus disease 2019 (COVID-19) infection. Thus we performed the present analysis of 50 studies to evaluate the risk factors and mortality of PE in COVID-19 patients. METHOD Databases including PubMed, Embase, Cochrane Library and Web of Science were searched to October, 2021. Odds ratio (OR), mean difference (MD) or standard MD was used to evaluate the outcomes. The primary outcomes were the difference of mortality between PE and non-PE COVID-19 patients as well as relevant risk factors of PE in COVID-19 patients. All statistical analyses were performed using the standard statistical procedures provided in Review Manager 5.2. RESULT A total of 50 studies including 10053 patients were included in this meta-analysis. Our results indicated that COVID-19 patients with PE experienced significantly higher mortality than non-PE patients (21.9% vs. 10.7%), with a pooled OR of 2.21 (95% CI 1.30 - 3.76; P = .003). In addition, COVID-19 patients with PE also experienced more mechanical ventilation (MV) (OR 2.21; 95% CI 1.30 - 3.75; P = .003) and invasive mechanical ventilation (IMV) (OR 3.58; 95% CI 2.47 - 5.20; P < .0001) respectively. Univariate analysis (UVA) results indicated the Sequential Organ Failure Assessment (SOFA) score, time to deep venous thrombosis (DVT), nonintensive care unit (non-ICU) patients and no anticoagulation as risk factors of PE for COVID-19 patients. In addition, multivariate analysis also found that SOFA score, D-dimer, BMI > 30 kg/m2 and history of PE were risk factors of PE for COVID-19 patients. CONCLUSION The present analysis indicated that PE increased the mortality of COVID-19 patients. Mechanical ventilation, especially invasive mechanical ventilation, is correlated with an increased incidence of PE in patients with COVID-19. The incidence of PE for COVID-19 patients may be multifactorial and further researches focused on risk factors were needed in the future.
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Affiliation(s)
- Zhaoliang Fu
- Department of lnterventional, The Second People’s Hospital of Baiyin City, Baiyin, China
| | - Gengshen Bai
- Department of General Surgery, The Second People’s Hospital of Baiyin City, Baiyin, China
| | - Bingsheng Song
- Department of Respiratory Disease, The Second People’s Hospital of Baiyin City, Baiyin, China
| | - Yongbing Wang
- Department of Respiratory Disease, The Second People’s Hospital of Baiyin City, Baiyin, China
| | - Hui Song
- Department of Respiratory Disease, The Second People’s Hospital of Baiyin City, Baiyin, China
| | - Ming Ma
- Department of lnterventional, The Second People’s Hospital of Baiyin City, Baiyin, China
| | - Junqiang Zhu
- Department of Radiology, The Second People’s Hospital of Baiyin City, Baiyin, China
| | - Zejun Zhang
- Department of Radiology, The Second People’s Hospital of Baiyin City, Baiyin, China
| | - Qinghong Kang
- Department of Respiratory Disease, The Second People’s Hospital of Baiyin City, Baiyin, China
- *Correspondence: Qinghong Kang, Department of Respiratory Disease, The Second People’s Hospital of Baiyin City, No. 509, Park Road, Baiyin District, Baiyin City 730900, China (e-mail: )
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Coagulopathy and Fibrinolytic Pathophysiology in COVID-19 and SARS-CoV-2 Vaccination. Int J Mol Sci 2022; 23:ijms23063338. [PMID: 35328761 PMCID: PMC8955234 DOI: 10.3390/ijms23063338] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/03/2022] [Accepted: 03/15/2022] [Indexed: 02/06/2023] Open
Abstract
Coronavirus Disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is frequently complicated by thrombosis. In some cases of severe COVID-19, fibrinolysis may be markedly enhanced within a few days, resulting in fatal bleeding. In the treatment of COVID-19, attention should be paid to both coagulation activation and fibrinolytic activation. Various thromboses are known to occur after vaccination with SARS-CoV-2 vaccines. Vaccine-induced immune thrombotic thrombocytopenia (VITT) can occur after adenovirus-vectored vaccination, and is characterized by the detection of anti-platelet factor 4 antibodies by enzyme-linked immunosorbent assay and thrombosis in unusual locations such as cerebral venous sinuses and visceral veins. Treatment comprises high-dose immunoglobulin, argatroban, and fondaparinux. Some VITT cases show marked decreases in fibrinogen and platelets and marked increases in D-dimer, suggesting the presence of enhanced-fibrinolytic-type disseminated intravascular coagulation with a high risk of bleeding. In the treatment of VITT, evaluation of both coagulation activation and fibrinolytic activation is important, adjusting treatments accordingly to improve outcomes.
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Ng JW, Chong ETJ, Lee PC. An Updated Review on the Role of Single Nucleotide Polymorphisms in COVID-19 Disease Severity: A Global Aspect. Curr Pharm Biotechnol 2022; 23:1596-1611. [DOI: 10.2174/1389201023666220114162347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/09/2021] [Accepted: 12/27/2021] [Indexed: 11/22/2022]
Abstract
Abstract:
Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and recently has become a serious global pandemic. Age, gender, and comorbidities are known to be common risk factors for severe COVID-19 but are not enough to fully explain the magnitude of their effect on the risk of severity of the disease. Single nucleotide polymorphisms (SNPs) in several genes have been reported as a genetic factor contributing to COVID-19 severity. This comprehensive review focuses on the association between SNPs in four important genes and COVID-19 severity in a global aspect. We discuss a total of 39 SNPs in this review: five SNPs in the ABO gene, nine SNPs in the angiotensin-converting enzyme 2 (ACE2) gene, 19 SNPs in the transmembrane protease serine 2 (TMPRSS2) gene, and six SNPs in the toll-like receptor 7 (TLR7) gene. These SNPs data could assist in monitoring an individual's risk of severe COVID-19 disease, and therefore personalized management and pharmaceutical treatment could be planned in COVID-19 patients.
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Affiliation(s)
- Jun Wei Ng
- Biotechnology Programme, Faculty of Science and Natural Resources, Universiti Malaysia, Sabah, Jalan UMS, Kota Kinabalu 88400, Sabah, Malaysia
| | - Eric Tzyy Jiann Chong
- Biotechnology Programme, Faculty of Science and Natural Resources, Universiti Malaysia, Sabah, Jalan UMS, Kota Kinabalu 88400, Sabah, Malaysia
| | - Ping-Chin Lee
- Biotechnology Programme, Faculty of Science and Natural Resources, Universiti Malaysia, Sabah, Jalan UMS, Kota Kinabalu 88400, Sabah, Malaysia;
- Biotechnology Research Institute, Universiti Malaysia Sabah, Jalan UMS, Kota Kinabalu 88400, Sabah, Malaysia
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Mazzaccaro D, Giannetta M, Fancoli F, Milani V, Modafferi A, Malacrida G, Righini P, Marrocco-Trischitta MM, Nano G. COVID and venous thrombosis: systematic review of literature. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 62:548-557. [PMID: 34520137 DOI: 10.23736/s0021-9509.21.12022-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION We aimed to review the prevalence, the risk factors and the outcomes of venous thrombosis (VT) in patients hospitalized for COronaVirus Disease 19 (COVID-19). METHODS Electronic bibliographic databases were searched using the words "COVID venous thrombosis". The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards. RESULTS The search of the Literature retrieved 877 results. After assessment of full texts, 69 papers were included in the qualitative analysis and 23 of them in the quantitative evaluation. The analyzed studies included a total of 106838 patients hospitalized for COVID-19 from 01/2020 to 12/2020. The pooled reported prevalence rate of VT was in median 16.7% (IQR 5.8%-30%), being higher in ICU patients (60.8%-85.4%). VT events were reported in about 75% of cases in the popliteal and calf veins. Signs and symptoms were present in 6.1% of cases. At quantitative evaluation, older age, D-dimer and obesity increased the odds to experience a VT (OR 3.54, 95%CI 0.65-6.43, P=0.01; OR=956.86, 95%CI 225.67-1668.05, P=0.01; OR 1.42, 95%CI 1.01-1.99, P=0.03 respectively). Female sex seemed to be protective against the odds of VT (OR 0.77, 95%CI 0.63-0.93, P=0.007). CONCLUSIONS Among patients hospitalized for COVID-19, VT is a relatively common finding, with higher prevalence rates in ICU patients. VT occurs mostly in the distal regions of the lower limb and is asymptomatic in most cases. Older age, obesity and higher D-dimer values on admission increased the odds of VT, while female sex was protective against the odds of VT.
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Affiliation(s)
- Daniela Mazzaccaro
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy -
| | - Matteo Giannetta
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Fabiana Fancoli
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Valentina Milani
- Scientific Directorate, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Alfredo Modafferi
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Giovanni Malacrida
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Paolo Righini
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Giovanni Nano
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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