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Philip AM, George LJ, Saha S, Sadanandan S. Vascular Consequences: A Case Report on Posterior Circulation Infarction as a Sequela of COVID-19. Cureus 2024; 16:e65837. [PMID: 39219954 PMCID: PMC11363812 DOI: 10.7759/cureus.65837] [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] [Accepted: 07/31/2024] [Indexed: 09/04/2024] Open
Abstract
This case report presents a posterior circulation infarction in a previously healthy 39-year-old male, three months post-severe COVID-19. He presented with right-sided homonymous hemianopia and elevated inflammatory markers and D-dimer levels. Imaging revealed an acute left occipital infarct. Such post-COVID-19 posterior circulation strokes are rare. This report discusses the pathophysiology, optimal anticoagulation therapy for COVID-19-related thrombotic complications, and early predictor models. This case underscores the need to recognize thromboembolic events as potential late sequelae in severe COVID-19 cases.
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Affiliation(s)
- Anil M Philip
- Internal Medicine, Kuriakose Chavara Memorial Hospital, Nooranad, IND
| | - Lina J George
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Shubhashis Saha
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
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Escobar C, Bover Freire R, García-Moll Marimón X, González-Juanatey C, Morillas M, Valle Muñoz A, Gómez Doblas JJ. A Delphi consensus on the management of anticoagulation in the COVID-19 pandemic: the MONACO study. Cardiovasc Diagn Ther 2023; 13:777-791. [PMID: 37941839 PMCID: PMC10628427 DOI: 10.21037/cdt-23-76] [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: 02/24/2023] [Accepted: 09/15/2023] [Indexed: 11/10/2023]
Abstract
Background During the COVID-19 pandemic, guideline documents on the management of anticoagulation were rapidly published. However, these documents did not follow a structured methodology, and significant differences existed between the guidelines. The aim of this expert consensus was to provide recommendations on the clinical management of oral anticoagulation in patients in the context of the COVID-19 pandemic. Methods A two-round Delphi study was conducted using an online survey. In the first round, panellists expressed their level of agreement with the items on a 9-point Likert scale. Items were selected if they received approval from ≥66.6% of panellists and if they were agreed by the scientific committee. In the second round, panellists revaluated those items that did not meet consensus in the first round. Results A total of 147 panellists completed the first round, and 144 of them completed the second round. Consensus was reached on 161 items included in five dimensions. These dimensions addressed: (I) management of anticoagulation in patients with atrial fibrillation (AF) without mechanical valves or moderate/severe mitral stenosis during COVID-19 infection; (II) thromboprophylaxis in patients hospitalised for COVID-19; (III) management of anticoagulation at hospital discharge/after COVID-19; (IV) anticoagulation monitoring in the COVID-19 pandemic setting; and (V) role of telemedicine in the management and follow-up of patients with AF in the COVID-19 pandemic setting. Conclusions These areas of collective agreement could specially guide clinicians in making decisions regarding anticoagulation in patients with COVID-19 during hospitalisation and at discharge, where results from clinical trials are still limited and, in some cases, conflicting.
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Affiliation(s)
- Carlos Escobar
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | - Miren Morillas
- Cardiology Department, Hospital de Galdakao, Galdakao, Spain
| | | | - Juan José Gómez Doblas
- Cardiology Department, Hospital Universitario Virgen de la Victoria, CIBERCV, Málaga, Spain
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Platelet dysfunction and thrombus instability in flow conditions in patients with severe COVID-19. Thromb Res 2023; 221:137-148. [PMID: 36376109 PMCID: PMC9642035 DOI: 10.1016/j.thromres.2022.11.004] [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: 09/07/2022] [Revised: 10/21/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022]
Abstract
Severe COVID-19 has been associated with a high rate of thrombotic events but also of bleeding events, particularly when the level of prophylactic anticoagulation was increased. Data on the contribution of platelets to these thrombotic events are discordant between reports, while the involvement of platelets in bleeding events has never been investigated. The objective of the present study was to assess platelet function during the first week of ICU hospitalization in patients with severe COVID-19 pneumonia. A total of 35 patients were prospectively included and blood samples were drawn on day (D) 0, D2 and D7. COVID-19 pneumonia was severe with a median PaO2/FiO2 ratio of 91 [68-119] on D0. Platelets from these patients showed evidence of pre-activation and exhaustion with a significant reduction in the surface expression of GPVI, GPIb and GPIIbIIIa, together with a decrease in serotonin content. Platelets from patients with severe COVID-19 were hyporesponsive with a reduced maximal aggregation response to several platelet agonists and decreased adhesion to immobilized fibrinogen. Aggregation of washed platelets and plasma substitution experiments indicated that a plasma factor was at least partially responsible for this hyporeactivity of platelets. Blood flow experiments showed that severe COVID-19 platelets formed smaller, less stable aggregates on a collagen-coated surface, which could explain why some patients develop bleeding events. These findings should prompt us to carefully evaluate the risks and benefits of high-dose prophylactic anticoagulation, and to decrease the level of anticoagulation once the initial phase of the disease has resolved. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04359992.
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Affiliation(s)
- Charlotte A Bradbury
- Bristol Haematology and Oncology Centre, University of Bristol, Bristol BS2 8ED, UK.
| | - Zoe McQuilten
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Clinical Haematology, Monash Health, Melbourne, VIC, Australia
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Zhang S, Li Y, Liu G, Su B. Intermediate-to-therapeutic versus prophylactic anticoagulation for coagulopathy in hospitalized COVID-19 patients: a systemic review and meta-analysis. Thromb J 2021; 19:91. [PMID: 34819094 PMCID: PMC8611638 DOI: 10.1186/s12959-021-00343-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/04/2021] [Indexed: 02/08/2023] Open
Abstract
Background Anticoagulation in hospitalized COVID-19 patients has been associated with survival benefit; however, the optimal anticoagulant strategy has not yet been defined. The objective of this meta-analysis was to investigate the effect of intermediate-to-therapeutic versus prophylactic anticoagulation for thromboprophylaxis on the primary outcome of in-hospital mortality and other patient-centered secondary outcomes in COVID-19 patients. Methods MEDLINE, EMBASE, and Cochrane databases were searched from inception to August 10th 2021. Cohort studies and randomized clinical trials that assessed the efficacy and safety of intermediate-to-therapeutic versus prophylactic anticoagulation in hospitalized COVID-19 patients were included. Baseline characteristics and relevant data of each study were extracted in a pre-designed standardized data-collection form. The primary outcome was all-cause in-hospital mortality and the secondary outcomes were incidence of thrombotic events and incidence of any bleeding and major bleeding. Pooled analysis with random effects models yielded relative risk with 95 % CIs. Results This meta-analysis included 42 studies with 28,055 in-hospital COVID-19 patients totally. Our pooled analysis demonstrated that intermediate-to-therapeutic anticoagulation was not associated with lower in-hospital mortality (RR=1.12, 95 %CI 0.99-1.25, p=0.06, I2=77 %) and lower incidence of thrombotic events (RR=1.30, 95 %CI 0.79-2.15, p=0.30, I2=88 %), but increased the risk of any bleeding events (RR=2.16, 95 %CI 1.79-2.60, p<0.01, I2=31 %) and major bleeding events significantly (RR=2.10, 95 %CI 1.77-2.51, p<0.01, I2=11 %) versus prophylactic anticoagulation. Moreover, intermediate-to-therapeutic anticoagulation decreased the incidence of thrombotic events (RR=0.71, 95 %CI 0.56-0.89, p=0.003, I2=0 %) among critically ill COVID-19 patients admitted to intensive care units (ICU), with increased bleeding risk (RR=1.66, 95 %CI 1.37-2.00, p<0.01, I2=0 %) and unchanged in-hospital mortality (RR=0.94, 95 %CI 0.79-1.10, p=0.42, I2=30 %) in such patients. The Grading of Recommendation, Assessment, Development, and Evaluation certainty of evidence ranged from very low to moderate. Conclusions We recommend the use of prophylactic anticoagulation against intermediate-to-therapeutic anticoagulation among unselected hospitalized COVID-19 patients considering insignificant survival benefits but higher risk of bleeding in the escalated thromboprophylaxis strategy. For critically ill COVID-19 patients, the benefits of intermediate-to-therapeutic anticoagulation in reducing thrombotic events should be weighed cautiously because of its association with higher risk of bleeding. Trial registration The protocol was registered at PROSPERO on August 17th 2021 (CRD42021273780). Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s12959-021-00343-1.
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Affiliation(s)
- Sirui Zhang
- West China School of Medicine, Sichuan University, 610041, Chengdu, China
| | - Yupei Li
- Department of Nephrology, Med+ Biomaterial Institute, West China Hospital, Sichuan University, 610041, Chengdu, China.,Institute for Disaster Management and Reconstruction, Sichuan University, 610207, Chengdu, China
| | - Guina Liu
- West China School of Medicine, Sichuan University, 610041, Chengdu, China
| | - Baihai Su
- West China School of Medicine, Sichuan University, 610041, Chengdu, China. .,Department of Nephrology, Med+ Biomaterial Institute, West China Hospital, Sichuan University, 610041, Chengdu, China. .,Institute for Disaster Management and Reconstruction, Sichuan University, 610207, Chengdu, China. .,The first People's Hospital of Shuangliu District, 610200, Chengdu, China. .,Med-X Center for Materials, Sichuan University, 610041, Chengdu, China.
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Prévention du risque thromboembolique veineux et surveillance de l’hémostase chez les patients hospitalisés pour COVID-19 : propositions réactualisées (avril 2021). Groupe d’intérêt en hémostase périopératoire (GIHP) et groupe d’étude sur l’hémostase et la thrombose (GFHT). ANESTHÉSIE & RÉANIMATION 2021. [PMCID: PMC8516597 DOI: 10.1016/j.anrea.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Godon A, Tacquard CA, Mansour A, Albaladejo P, Gruel Y, Susen S, Godier A. Reply to the authors of "Age-adjusted D-dimer cut-off levels to exclude venous thromboembolism in COVID-19 patients". Anaesth Crit Care Pain Med 2021; 40:100940. [PMID: 34400387 PMCID: PMC8362657 DOI: 10.1016/j.accpm.2021.100940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Alexandre Godon
- Department of Anaesthesiology and Critical Care, Université Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France.
| | - Charles Ambroise Tacquard
- Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Alexandre Mansour
- Department of Anaesthesiology Critical Care Medicine and Perioperative Medicine, CHU de Rennes, France
| | - Pierre Albaladejo
- Department of Anaesthesiology and Critical Care, Université Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | - Yves Gruel
- Department of Haematology-Haemostasis, Hôpital Universitaire de Tours, France
| | - Sophie Susen
- Department of Haematology and transfusion, Université de Lille, Lille, France
| | - Anne Godier
- Department of Anaesthesia and intensive care, AP-HP, Hôpital Européen Georges Pompidou, and INSERM UMRS-1140, Université de Paris, France
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Godon A, Tacquard CA, Mansour A, Garrigue D, Nguyen P, Lasne D, Testa S, Levy JH, Albaladejo P, Gruel Y, Susen S, Godier A. Prevention of venous thromboembolism and haemostasis monitoring in patients with COVID-19: Updated proposals (April 2021): From the French working group on perioperative haemostasis (GIHP) and the French study group on thrombosis and haemostasis (GFHT), in collaboration with the French society of anaesthesia and intensive care (SFAR). Anaesth Crit Care Pain Med 2021; 40:100919. [PMID: 34182166 PMCID: PMC8233055 DOI: 10.1016/j.accpm.2021.100919] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/16/2021] [Indexed: 12/24/2022]
Affiliation(s)
- Alexandre Godon
- Department of Anaesthesiology and Critical Care, Université Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France.
| | - Charles Ambroise Tacquard
- Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Alexandre Mansour
- Department of Anaesthesiology Critical Care Medicine and Perioperative Medicine, CHU de Rennes, France
| | | | | | - Dominique Lasne
- Department of Haematology Laboratory, Hôpital Necker, AP-HP, Paris, France
| | | | - Jerrold H Levy
- Department of Anaesthesiology, Critical Care, and Surgery, Duke University Hospital, Durham, NC, USA
| | - Pierre Albaladejo
- Department of Anaesthesiology and Critical Care, Université Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | - Yves Gruel
- Department of Haematology-Haemostasis, Hôpital Universitaire de Tours, France
| | - Sophie Susen
- Department of Haematology and Transfusion, Université de Lille, Lille, France
| | - Anne Godier
- Department of Anaesthesia and Intensive Care, AP-HP, Hôpital Européen Georges Pompidou, and INSERM UMRS-1140, Université de Paris, France
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Comparison of Fibrin Monomers and D-dimers to predict thrombotic events in critically ill patients with COVID-19 pneumonia: A retrospective study. Thromb Res 2021; 205:8-10. [PMID: 34224999 PMCID: PMC8213528 DOI: 10.1016/j.thromres.2021.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 11/21/2022]
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