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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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Quiros Ambel H, Crespo-Robledo P, Arribalzaga Juaristi K, Plo-Seco I, Martínez Simón JJ, Pérez Fernández E, Perez Encinas M. Effectiveness of antithrombotic prophylaxis in hospitalised patients with SARS-CoV-2 infection. Eur J Hosp Pharm 2023; 30:264-267. [PMID: 34649964 PMCID: PMC8523220 DOI: 10.1136/ejhpharm-2021-002877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/28/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Antithrombotic prophylaxis in hospitalised patients with SARS-CoV-2 acute infection has increased. Currently, most of the evidence relates to patients in intensive care units; however, there is little information on patients admitted to hospital wards and there is no consensus protocol on thromboprophylaxis during admission and after discharge. OBJECTIVE To assess the effectiveness of antithrombotic prophylaxis in patients admitted with COVID-19 and 30 days after discharge. METHOD A prospective observational study was conducted of patients admitted with COVID-19 in which the hospital thromboprophylaxis protocol was applied, classifying the patients as having a standard or high risk of thrombosis. Pharmacists performed a daily follow-up and actively intervened during admission and at discharge. The main outcome measure was the global incidence of symptomatic venous thromboembolism (VTE) related to hospitalisation. RESULTS A total of 113 patients were included, 98.23% of whom were admitted to a hospital ward. The incidence of hospital-acquired VTE was 1.77%. In 75.22% of the subjects, thromboprophylaxis was adjusted to the protocol during admission. A total of 23 pharmaceutical interventions were conducted, with an adherence of 52.17%. At discharge, 94.28% of the patients who had no haemorrhage and ≥4 points on the Padua Prediction Score required thromboprophylaxis, aligning with the protocol. The global incidence of haemorrhagic events during the follow-up period was 0.88%. CONCLUSION The incidence of hospital-acquired VTE was lower than that described in the literature. Although it cannot be certain that it is directly related to the instituted protocol, the data can show that the management of prevention of VTE is being optimally performed at the hospital. Long-term studies are needed to evaluate the incidence after discharge, as well as to agree on a specific protocol in the COVID-19 population for the prevention of these events during hospitalisation and post-discharge.
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Affiliation(s)
| | | | | | - Isabel Plo-Seco
- Pharmacy, Hospital Universitario Fundacion Alcorcon, Alcorcon, Spain
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Moreno-Ballesteros A, Rebollo-Aguirre ÁC, Bolívar-Roldán I, Busquier T, Sanchez-de Mora E, Jimenez-Heffernan A. Assessment of pulmonary embolism related to active SARS-CoV-2 infection in pregnant women. Rev Esp Med Nucl Imagen Mol 2023; 42:218-222. [PMID: 36758829 PMCID: PMC9904850 DOI: 10.1016/j.remnie.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/20/2022] [Indexed: 02/09/2023]
Abstract
AIM To analyze a sample of pregnant patients who underwent pulmonary perfusion scintigraphy to rule out suspicion of pulmonary embolism (PE) during the acute COVID-19 infection hospitalization period in our hospital. MATERIAL AND METHODS SPECT scintigraphy with a reduced dose (111MBq) of 99mTc-macroaggregated albumin was performed in all the patients (n=5). The images obtained were interpreted by comparing the findings with the radiological images according to the PISAPED criteria. RESULTS Only one of the 5 patients was diagnosed with PE. Two patients showed pathological scintigraphy findings attributable to radiological alterations due to COVID-19 pneumonia, and the other two had normal pulmonary perfusion. CONCLUSION Given the non-specific features of the clinical manifestations and d-dimer values in COVID-19, as well as their similarity to those of PE, pulmonary perfusion scintigraphy plays a crucial role in the screening of PE in these patients due to its high sensitivity and lower irradiation compared to CT. Despite the limited number of patients, the results obtained have special relevance due to the absence of scientific publications in this group of patients within the exceptional context of the COVID-19 pandemic.
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Affiliation(s)
- A Moreno-Ballesteros
- Unidad de Medicina Nuclear, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain.
| | - Á C Rebollo-Aguirre
- Unidad de Medicina Nuclear, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - I Bolívar-Roldán
- Unidad de Medicina Nuclear, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - T Busquier
- Unidad de Radiodiagnóstico, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - E Sanchez-de Mora
- Unidad de Medicina Nuclear, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - A Jimenez-Heffernan
- Unidad de Medicina Nuclear, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
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4
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Moreno-Ballesteros A, Rebollo-Aguirre ÁC, Bolívar-Roldán I, Busquier T, Mora ESD, Jimenez-Heffernan A. [Assessment of pulmonary embolism related to active SARS-CoV-2 infection in pregnant women.]. Rev Esp Med Nucl Imagen Mol 2022; 42:S2253-654X(22)00188-3. [PMID: 36533162 PMCID: PMC9742206 DOI: 10.1016/j.remn.2022.11.002] [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: 11/02/2022] [Accepted: 11/20/2022] [Indexed: 12/14/2022]
Abstract
AIM To analyze the sample of pregnant patients who underwent pulmonary perfusion scintigraphy to rule out the pulmonary embolism (PE) suspicion during the acute COVID-19 infection hospitalization period in our hospital. MATERIAL AND METHODS SPECT scintigraphy with a reduced dose (111 MBq) of 99mTc-macroaggregated albumin was performed in all of the patients (n=5). The obtained images were interpreted by comparing the findings with the radiological images according to the PISAPED criteria. RESULTS Only one of the 5 patients was diagnosed with PE. Two patients obtained pathological findings of the scintigraphy attributable to radiological alterations due to COVID-19 pneumonia, and the other two had normal pulmonary perfussion. CONCLUSION Given the non-specific features of the clinical manifestations and D-dimer values in COVID-19, as well as their similarity to those of PE, the pulmonary perfusion scintigraphy plays a crucial role in the screening of PE in these patients due to its high sensitivity and lower irradiation compared to CT. Despite the limited number of patients, the results obtained have special relevance related to the absence of scientific publications on this group of patients within the context of COVID-19 pandemic exceptional situation.
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Affiliation(s)
- Ana Moreno-Ballesteros
- Unidad de Medicina Nuclear. Hospital Universitario Juan Ramón Jiménez. Ronda Norte, s/n, 21005, Huelva, España
| | - Ángel C Rebollo-Aguirre
- Unidad de Medicina Nuclear. Hospital Universitario Juan Ramón Jiménez. Ronda Norte, s/n, 21005, Huelva, España
| | - Isabel Bolívar-Roldán
- Unidad de Medicina Nuclear. Hospital Universitario Virgen Macarena. Avenida Dr Fedriani nº3, 41009, Sevilla, España
| | - Teresa Busquier
- Unidad de Radiodiagnóstico. Hospital Universitario Virgen Macarena. Avenida Dr Fedriani nº3, 41009, Sevilla, España
| | - Elena Sanchez-de Mora
- Unidad de Medicina Nuclear. Hospital Universitario Juan Ramón Jiménez. Ronda Norte, s/n, 21005, Huelva, España
| | - Amelia Jimenez-Heffernan
- Unidad de Medicina Nuclear. Hospital Universitario Juan Ramón Jiménez. Ronda Norte, s/n, 21005, Huelva, España
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Impact of the SARS-CoV-2 Virus Pandemic on Patients with Bronchiectasis: A Multicenter Study. Antibiotics (Basel) 2022; 11:antibiotics11081096. [PMID: 36009967 PMCID: PMC9405473 DOI: 10.3390/antibiotics11081096] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/07/2022] [Accepted: 08/10/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Infection by SARS-CoV-2 has unquestionably had an impact on the health of patients with chronic respiratory airway diseases, such as COPD and asthma, but little information is available about its impact on patients with bronchiectasis. The objective of the present study was to analyze the effect of the SARS-CoV-2 pandemic on the state of health, characteristics, and clinical severity (including the number and severity of exacerbations) of patients with non-cystic fibrosis bronchiectasis. METHODS This study was multicenter, observational, and ambispective (with data collected before and during the SARS-CoV-2 pandemic), and included 150 patients diagnosed with non-cystic fibrosis bronchiectasis. RESULTS A significant drop was observed in the number and severity of the exacerbations (57% in all exacerbations and 50% in severe exacerbations) in the E-FACED and BSI multidimensional scores, in the pandemic, compared with the pre-pandemic period. There was also a drop in the percentage of sputum samples positive for pathogenic microorganisms in general (from 58% to 44.7%) and, more specifically, Pseudomonas aeruginosa (from 23.3% to 13.3%) and Haemophilus influenzae (from 21.3% to 14%). CONCLUSIONS During the SARS-CoV-2 period, a significant reduction was observed in the exacerbations, severity, and isolations of pathogenic microorganisms in patients with bronchiectasis.
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Chiner-Vives E, Cordovilla-Pérez R, de la Rosa-Carrillo D, García-Clemente M, Izquierdo-Alonso JL, Otero-Candelera R, Pérez-de Llano L, Sellares-Torres J, de Granda-Orive JI. Short and Long-Term Impact of COVID-19 Infection on Previous Respiratory Diseases. Arch Bronconeumol 2022; 58 Suppl 1:39-50. [PMID: 35501222 PMCID: PMC9012323 DOI: 10.1016/j.arbres.2022.03.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 03/30/2022] [Indexed: 02/07/2023]
Abstract
On March 11, 2020, the World Health Organization declared Coronavirus Disease 2019 (COVID-19) a pandemic. Till now, it affected 452.4 million (Spain, 11.18 million) persons all over the world with a total of 6.04 million of deaths (Spain, 100,992). It is observed that 75% of hospitalized COVID-19 patients have at least one COVID-19 associated comorbidity. It was shown that people with underlying chronic illnesses are more likely to get it and grow seriously ill. Individuals with COVID-19 who have a past medical history of cardiovascular disorder, cancer, obesity, chronic lung disease, diabetes, or neurological disease had the worst prognosis and are more likely to develop acute respiratory distress syndrome or pneumonia. COVID-19 can affect the respiratory system in a variety of ways and across a spectrum of levels of disease severity, depending on a person's immune system, age and comorbidities. Symptoms can range from mild, such as cough, shortness of breath and fever, to critical disease, including respiratory failure, shock and multi-organ system failure. So, COVID-19 infection can cause overall worsening of these previous respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), interstitial lung disease, etc. This review aims to provide information on the impact of the COVID-19 disease on pre-existing lung comorbidities.
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Affiliation(s)
- Eusebi Chiner-Vives
- Multidisciplinary Sleep Unit, Respiratory Department, Sant Joan University Hospital, Sant Joan d'Alacant, Alicante, Spain
| | - Rosa Cordovilla-Pérez
- Respiratory Department, Salamanca University Hospital, Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | | | - Marta García-Clemente
- Lung Management Area, HUCA, Institute for Health Research of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
| | - José Luis Izquierdo-Alonso
- Department of Medicine and Medical Specialties, University of Alcalá, Madrid, Spain; Respiratory Medicine, University Hospital of Guadalajara, Guadalajara, Spain
| | | | - Luis Pérez-de Llano
- Respiratory Department, Lucus Augusti University Hospital, EOXI Lugo, Monforte, CERVO, Lugo, Spain
| | - Jacobo Sellares-Torres
- Interstitial Lung Diseases Working Group, Respiratory Department, Clinic-University Hospital-IDIBAPS, Barcelona, Spain
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Rueda-Camino JA, Sendín-Martín V, Joya-Seijo MD, Angelina-García M, Zamarro-García C, Gimena-Rodríguez FJ, Barba-Martín R. Plasma D-dimer value corrected by inflammatory markers in patients with SARS-CoV-2 infection: Its prognostic value in the diagnosis of venous thromboembolism. Med Clin (Barc) 2022; 158:265-269. [PMID: 34144801 PMCID: PMC8173492 DOI: 10.1016/j.medcli.2021.03.034] [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] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/27/2021] [Accepted: 03/29/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION D-dimer levels are elevated in COVID 19 and they correlate to the levels of other inflammatory markers such us ferritin, fibrinogen and C-reactive protein. It may be possible to correct D-dimer value in function of inflammatory markers, thus identifying patients at higher risk of venous thromboembolism (VTE). Our objectives are estimating a corrected value of plasma D-dimer as a linear function of ferritin, C-reactive protein and fibrinogen and stablishing a cut-off point of high probability of VTE. PATIENTS AND METHODS Age and sex matched case-control study of all patients diagnosed with COVID 19 and VTE between March and May 2020 in a tertiary hospital in Madrid (Spain). Using linear regression, the best predictive model will be estimated and residual D-dimer values will be obtained and analyzed using ROC curves to determine its discriminative performance. RESULTS Thirty-eight cases and seventy-six controls were included. There was 63.2% of men and mean age was 68.2. D-dimer was best predicted by a linear model including fibrinogen, ferritin and C-reactive protein. Using residual values, the optimal cutoff point was 2165ng/mL, with a sensitivity of 57.9% and specificity of 98.7%. CONCLUSION It is possible to estimate a D-dimer corrected value in function of ferritin, C-reactive protein and fibrinogen. Using the observed and estimated value we can obtain a residual value that performs well as a screening method to detect patients who would benefit for further VTE diagnostic testing.
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Affiliation(s)
- José Antonio Rueda-Camino
- Internal Medicine Department, Multidisciplinary Venous Thromboembolism Unit, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain.
| | - Vanesa Sendín-Martín
- Internal Medicine Department, Multidisciplinary Venous Thromboembolism Unit, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - María Dolores Joya-Seijo
- Internal Medicine Department, Multidisciplinary Venous Thromboembolism Unit, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - María Angelina-García
- Internal Medicine Department, Multidisciplinary Venous Thromboembolism Unit, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - Celia Zamarro-García
- Pulmonology Department, Multidisciplinary Venous Thromboembolism Unit, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - Francisco Javier Gimena-Rodríguez
- Internal Medicine Department, Multidisciplinary Venous Thromboembolism Unit, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - Raquel Barba-Martín
- Internal Medicine Department, Multidisciplinary Venous Thromboembolism Unit, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
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8
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Rueda-Camino JA, Sendín-Martín V, Joya-Seijo MD, Angelina-García M, Zamarro-García C, Gimena-Rodríguez FJ, Barba-Martín R. Plasma D-dimer value corrected by inflammatory markers in patients with SARS-CoV-2 infection: Its prognostic value in the diagnosis of venous thromboembolism. MEDICINA CLINICA (ENGLISH ED.) 2022; 158:265-269. [PMID: 35492427 PMCID: PMC9034653 DOI: 10.1016/j.medcle.2021.03.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/29/2021] [Indexed: 12/11/2022]
Abstract
Introduction D-dimer levels are elevated in COVID 19 and they correlate to the levels of other inflammatory markers such us ferritin, fibrinogen and C-reactive protein. It may be possible to correct D-dimer value in function of inflammatory markers, thus identifying patients at higher risk of venous thromboembolism (VTE). Our objectives are estimating a corrected value of plasma D-dimer as a linear function of ferritin, C-reactive protein and fibrinogen and stablishing a cut-off point of high probability of VTE. Patients and methods Age and sex matched case-control study of all patients diagnosed with COVID 19 and VTE between March and May 2020 in a tertiary hospital in Madrid (Spain). Using linear regression, the best predictive model will be estimated and residual D-dimer values will be obtained and analyzed using ROC curves to determine its discriminative performance. Results Thirty-eight cases and seventy-six controls were included. There was 63.2% of men and mean age was 68.2. D-dimer was best predicted by a linear model including fibrinogen, ferritin and C-reactive protein. Using residual values, the optimal cutoff point was 2165 ng/mL, with a sensitivity of 57.9% and specificity of 98.7%. Conclusion It is possible to estimate a D-dimer corrected value in function of ferritin, C-reactive protein and fibrinogen. Using the observed and estimated value we can obtain a residual value that performs well as a screening method to detect patients who would benefit for further VTE diagnostic testing.
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Affiliation(s)
- José Antonio Rueda-Camino
- Internal Medicine Department, Multidisciplinary Venous Thromboembolism Unit, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - Vanesa Sendín-Martín
- Internal Medicine Department, Multidisciplinary Venous Thromboembolism Unit, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - María Dolores Joya-Seijo
- Internal Medicine Department, Multidisciplinary Venous Thromboembolism Unit, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - María Angelina-García
- Internal Medicine Department, Multidisciplinary Venous Thromboembolism Unit, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - Celia Zamarro-García
- Pulmonology Department, Multidisciplinary Venous Thromboembolism Unit, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - Francisco Javier Gimena-Rodríguez
- Internal Medicine Department, Multidisciplinary Venous Thromboembolism Unit, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - Raquel Barba-Martín
- Internal Medicine Department, Multidisciplinary Venous Thromboembolism Unit, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
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Cardona Buitrago C, Builes Gutierrez AM, Jiménez Marín D, Aristizábal García C. Mechanical Valve Thrombosis Secondary to Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A Case Report. Cureus 2022; 14:e23358. [PMID: 35475071 PMCID: PMC9018927 DOI: 10.7759/cureus.23358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2022] [Indexed: 12/02/2022] Open
Abstract
Although the association of coronavirus disease 2019 (COVID-19) and thromboembolic disease is well known, cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and mechanical valve thrombosis have not been described enough. Mechanical valve thrombosis is a medical emergency that is associated with a great impact on patients' morbidity and mortality. Here, we report a case of a patient with mechanical valve thrombosis secondary to SARS-CoV-2 infections that required valve replacement with satisfactory postoperative recovery. A 52-year old female patient was presented with a previously implanted mechanical prosthesis (type - St. Jude Medical 29 mm; St. Paul, MN: St. Jude Medical, Inc.) eight years ago due to rheumatic fever, under anticoagulation with warfarin and valvular atrial fibrillation (permanent), congenital single kidney (glomerular filtration rate {GFR}: 89.9 mL/min), and hypothyroidism. She was admitted to the hospital with a high level of complexity due to respiratory difficulty and generalized edematous syndrome, and a reverse transcription-polymerase chain reaction (RT-PCR) confirmed COVID-19 infection (20 days before admission); the patient was anticoagulated with warfarin (international normalized ratio {INR} at admission was 2.63 seconds). As per protocol, a CT-chest scan tomography was performed and showed organized pneumonia in the right apical lobe. We performed a transesophageal echocardiogram, which showed a thrombus (20 x 15 x 20 mm) in the lateral disc of the mechanical prosthesis, restricting its mobility. The patient presented signs of hypoperfusion (lactate levels: 4 mmol/L; urine per hour: 1 cc/kg) with associated low cardiac output syndrome, requiring double vasopressor support at the maximum dose (achieving a mean arterial pressure of 72 mmHg) due to the clinical condition and the large size of the thrombus, the cardiovascular surgeon, in agreement with the family, decides to carry out emergency valve replacement surgery with replacement of a mechanical prosthesis replacement (St. Jude No. 29; St. Paul, MN: St. Jude Medical, Inc.). The patient presented a satisfactory postoperative recovery, achieving INR goals, with subsequent discharge and follow-up at two months with transthoracic ultrasound, where normofunctional mitral prosthesis was demonstrated, without evidence of thrombi or intracavitary masses. Mechanical mitral valve thrombosis, secondary to SARS-CoV-2 infection is a serious complication with poor prognosis that requires a high rate of suspicion, and timely diagnostic aids are essential to confirm the diagnosis. Managing this issue should be interdisciplinary and individualized considering the clinical condition of the patient and the associated comorbidities.
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Villar-Álvarez F, Martínez-García MÁ, Jiménez D, Fariñas-Guerrero F, Ortiz de Lejarazu-Leonardo R, López-Campos JL, Blanco-Aparicio M, Royo-Crespo Í, García-Ortega A, Trilla-García A, Trujillo-Reyes JC, Fernández-Prada M, Díaz-Pérez D, Laporta-Hernández R, Valenzuela C, Menéndez R, de la Rosa-Carrillo D. [SEPAR Recommendations for COVID-19 Vaccination in Patients With Respiratory Diseases]. OPEN RESPIRATORY ARCHIVES 2021; 3:100097. [PMID: 38620748 PMCID: PMC7983358 DOI: 10.1016/j.opresp.2021.100097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The Spanish Society of Pneumonology and Thoracic Surgery (SEPAR) has elaborated this document of recommendations for COVID-19 vaccination in patients with respiratory diseases aimed to help healthcare personnel make decisions about how to act in case of COVID-19 vaccination in these patients.The recommendations have been developed by a group of experts in this field after reviewing the materials published up to March 7, 2021, the information provided by different scientific societies, drug agencies and the strategies of the governmental bodies up to this date.We can conclude that COVID-19 vaccines are not only safe and effective, but also prior in vulnerable patients with chronic respiratory diseases. In addition, an active involvement of healthcare professionals, who manage these diseases, in the vaccination strategy is the key to achieve good adherence and high vaccination coverage.
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Affiliation(s)
- Felipe Villar-Álvarez
- Servicio de Neumología, IIS Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, España
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España
| | - Miguel Ángel Martínez-García
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España
- Servicio de Neumología, Hospital Universitario y Politécnico la Fe, Valencia, España
| | - David Jiménez
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España
- Servicio de Neumología, Hospital Ramón y Cajal y Universidad de Alcalá (IRYCIS), Madrid, España
| | | | | | - José Luis López-Campos
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Sevilla, España
| | | | - Íñigo Royo-Crespo
- Dirección Médica, Hospital Universitario San Jorge, Huesca, IIS-Aragón, Aragón, España
| | - Alberto García-Ortega
- Servicio de Neumología, Hospital Universitario y Politécnico la Fe, Valencia, España
- Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, España
| | - Antoni Trilla-García
- Servicio de Medicina Preventiva y Epidemiología, Hospital Clínic – Universidad de Barcelona, Barcelona, España
| | | | - María Fernández-Prada
- Servicio Medicina Preventiva y Salud Pública, Hospital Vital Álvarez Buylla, Mieres, Asturias, España
| | - David Díaz-Pérez
- Servicio de Neumología y Cirugía Torácica, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, España
| | | | - Claudia Valenzuela
- Servicio de Neumología, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, España
| | - Rosario Menéndez
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España
- Servicio de Neumología, Hospital Universitario y Politécnico la Fe, Valencia, España
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