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Mavropoulou X, Psoma E, Papachristodoulou A, Pyrrou N, Spanou E, Alexandratou M, Sidiropoulou M, Theocharidou A, Rafailidis V, Chrysanthidis T, Prassopoulos P. Gastrointestinal Imaging Findings in the Era of COVID-19: A Pictorial Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1332. [PMID: 37512143 PMCID: PMC10385728 DOI: 10.3390/medicina59071332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023]
Abstract
The potentially fatal COVID-19 pandemic has been associated with a largespectrum of clinical presentations. Beyond the classical pulmonary manifestations, gastrointestinal tract-related symptoms suchas nausea, diarrhea, abdominal distention and pain have been observed in patients, as a consequence of the binding of SARS-CoV-19 to Angiotensin-converting Enzyme 2 (ACE2) receptors in the gastrointestinal (GI) tract. The early recognition ofspecific imaging features, including hepatobiliary involvement, pancreatic involvement, development of solid organ infarcts, ischemic bowel changes and vascular occlusion, plays a key role through the course of the disease. Also, suspicious symptoms, especially in critically ill patients with clinical and biochemical markers of hypovolemia, necessitate timely imaging for bleeding complications. The aim of this pictorial review is to illustrate the spectrum of the GIimaging findings in patients with COVID-19. Awareness of diagnostic imaging hallmarks is crucial to optimize the management of these patients.
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Affiliation(s)
- Xanthippi Mavropoulou
- Department of Clinical Radiology, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece
| | - Elisavet Psoma
- Department of Clinical Radiology, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece
| | - Angeliki Papachristodoulou
- Department of Clinical Radiology, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece
| | - Nikoletta Pyrrou
- Department of Clinical Radiology, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece
| | - Ekaterini Spanou
- Department of Clinical Radiology, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece
| | - Maria Alexandratou
- Department of Clinical Radiology, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece
| | - Maria Sidiropoulou
- Department of Clinical Radiology, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece
| | - Anastasia Theocharidou
- Department of Clinical Radiology, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece
| | - Vasileios Rafailidis
- Department of Clinical Radiology, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece
| | - Theofilos Chrysanthidis
- Infectious Diseases Division, First Internal Medicine Department, School of Medicine, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece
| | - Panos Prassopoulos
- Department of Clinical Radiology, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece
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Alzoubi MN, Salameh I, Shahait AD, Al-zyoud A, Raza S. A Case of Spontaneous Multiple Abdominal Wall Hematomas in a COVID-19 Patient. Cureus 2022; 14:e29647. [DOI: 10.7759/cureus.29647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
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Wifi MN, Morad MA, El Sheemy R, Abdeen N, Afify S, Abdalgaber M, Abdellatef A, Zaghloul M, Alboraie M, El-Kassas M. Hemostatic system and COVID-19 crosstalk: A review of the available evidence. World J Methodol 2022; 12:331-349. [PMID: 36186748 PMCID: PMC9516549 DOI: 10.5662/wjm.v12.i5.331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/17/2022] [Accepted: 07/22/2022] [Indexed: 02/08/2023] Open
Abstract
Since the discovery of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its resultant coronavirus disease 2019 (COVID-19) pandemic, respiratory manifestations have been the mainstay of clinical diagnosis, laboratory evaluations, and radiological investigations. As time passed, other pathological aspects of SARS-CoV-2 have been revealed. Various hemostatic abnormalities have been reported since the rise of the pandemic, which was sometimes superficial, transient, or fatal. Mild thrombocytopenia, thrombocytosis, venous, arterial thromboembolism, and disseminated intravascular coagulation are among the many hemostatic events associated with COVID-19. Venous thromboembolism necessitating therapeutic doses of anticoagulants is more frequently seen in severe cases of COVID-19, especially in patients admitted to intensive care units. Hemorrhagic complications rarely arise in COVID-19 patients either due to a hemostatic imbalance resulting from severe disease or as a complication of over anticoagulation. Although the pathogenesis of coagulation disturbance in SARS-CoV-2 infection is not yet understood, professional societies recommend prophylactic antithrombotic therapy in severe cases, especially in the presence of abnormal coagulation indices. The review article discusses the various available evidence on coagulation disorders, management strategies, outcomes, and prognosis associated with COVID-19 coagulopathy, which raises awareness about the importance of anticoagulation therapy for COVID-19 patients to guard against possible thromboembolic events.
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Affiliation(s)
- Mohamed-Naguib Wifi
- Department of Internal Medicine, Hepatogastro- enterology Unit, Kasr Al-Ainy School of Medicine, Cairo University, Cairo 11451, Egypt
| | - Mohamed Abdelkader Morad
- Clinical Hematology Unit, Department of Internal Medicine, Kasr Al-Ainy, Faculty of Medicine, Cairo University, Cairo 11451, Egypt
| | - Reem El Sheemy
- Department of Tropical Medicine, Minia Faculty of Medicine, Minia University, Minia 61511, Egypt
| | - Nermeen Abdeen
- Department of Tropical Medicine, Faculty of Medicine, Alexandria University, Alexandria 21523, Egypt
| | - Shimaa Afify
- Department of Gastroenterology, National Hepatology and Tropical Medicine, National Hepatology and Tropical Medicine Research Institute, Cairo 11451, Egypt
| | - Mohammad Abdalgaber
- Department of Gastroenterology and Hepatology, Police Authority Hospital, Agoza, Giza 12511, Egypt
| | - Abeer Abdellatef
- Department of Internal Medicine, Hepatogastro- enterology Unit, Kasr Al-Ainy School of Medicine, Cairo University, Cairo 11451, Egypt
| | - Mariam Zaghloul
- Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh 33511, Egypt
| | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo 11884, Egypt
| | - Mohamed El-Kassas
- Department of Endemic Medicine, Faculty of Medicine, Helwan University, Helwan 11731, Egypt
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TUTINO R, BONARIOL L, CARATOZZOLO E, MASSANI M. Biliary complication and spontaneous hemoperitoneum in a coinfected CMV-CoV-2 oncologic patient submitted to major biliary surgery. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.21.05299-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ghosh A, Kar PK, Gautam A, Gupta R, Singh R, Chakravarti R, Ravichandiran V, Ghosh Dastidar S, Ghosh D, Roy S. An insight into SARS-CoV-2 structure, pathogenesis, target hunting for drug development and vaccine initiatives. RSC Med Chem 2022; 13:647-675. [PMID: 35814927 PMCID: PMC9215161 DOI: 10.1039/d2md00009a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/20/2022] [Indexed: 01/27/2023] Open
Abstract
SARS-CoV-2, the virus responsible for the COVID-19 pandemic, has been confirmed to be a new coronavirus having 79% and 50% similarity with SARS-CoV and MERS-CoV, respectively. For a better understanding of the features of the new virus SARS-CoV-2, we have discussed a possible correlation between some unique features of the genome of SARS-CoV-2 in relation to pathogenesis. We have also reviewed structural druggable viral and host targets for possible clinical application if any, as cases of reinfection and compromised protection have been noticed due to the emergence of new variants with increased infectivity even after vaccination. We have also discussed the types of vaccines that are being developed against SARS-CoV-2. In this review, we have tried to give a brief overview of the fundamental factors of COVID-19 research like basic virology, virus variants and the newly emerging techniques that can be applied to develop advanced treatment strategies for the management of COVID-19 disease.
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Affiliation(s)
- Arijit Ghosh
- Department of Natural Products, National Institute of Pharmaceutical Education and Research Kolkata India
- Department of Chemistry, University of Calcutta Kolkata India
- Netaji Subhas Chandra Bose Cancer Research institute 3081, Nayabad Kolkata-700094 India
| | - Paritosh K Kar
- Foundation on Tropical Diseases & Health Research Development, A Mission on Charitable Health Care Unit Balichak CT, Paschim Medinipur West Bengal 721 124 India
| | - Anupam Gautam
- Institute for Bioinformatics and Medical Informatics, University of Tübingen Sand 14 72076 Tübingen Germany
- International Max Planck Research School "From Molecules to Organisms", Max Planck Institute for Biology Tübingen Max-Planck-Ring 5 72076 Tübingen Germany
| | - Rahul Gupta
- Infectious Diseases and Immunology Division, CSIR-Indian Institute of Chemical Biology Kolkata India
| | - Rajveer Singh
- Department of Natural Products, National Institute of Pharmaceutical Education and Research Kolkata India
| | - Rudra Chakravarti
- Department of Natural Products, National Institute of Pharmaceutical Education and Research Kolkata India
| | - Velayutham Ravichandiran
- Department of Natural Products, National Institute of Pharmaceutical Education and Research Kolkata India
| | | | - Dipanjan Ghosh
- Department of Natural Products, National Institute of Pharmaceutical Education and Research Kolkata India
| | - Syamal Roy
- Infectious Diseases and Immunology Division, CSIR-Indian Institute of Chemical Biology Kolkata India
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Marchetti M, Gomez-Rosas P, Russo L, Gamba S, Sanga E, Verzeroli C, Ambaglio C, Schieppati F, Restuccia F, Bonanomi E, Rizzi M, Fagiuoli S, D’Alessio A, Gerotziafas GT, Lorini L, Falanga A. Fibrinolytic Proteins and Factor XIII as Predictors of Thrombotic and Hemorrhagic Complications in Hospitalized COVID-19 Patients. Front Cardiovasc Med 2022; 9:896362. [PMID: 35757331 PMCID: PMC9226333 DOI: 10.3389/fcvm.2022.896362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/09/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction In a prospective cohort of hospitalized COVID-19 patients, an extensive characterization of hemostatic alterations by both global and specific assays was performed to clarify mechanisms underlying the coagulopathy and identify predictive factors for thrombotic and hemorrhagic events during hospitalization. Materials and Methods Intensive care unit (ICU; n = 46) and non-ICU (n = 55) patients were enrolled, and the occurrence of thrombotic and hemorrhagic events was prospectively monitored. At study inclusion, thromboelastometry together with the measurement of specific coagulation proteins and hypercoagulation markers was performed. Results Patients (median age 67 years) showed significantly shorter clot formation time together with greater maximum clot firmness by thromboelastometry, increased levels of F1 + 2 and D-dimer, as biomarkers of hypercoagulability, and of procoagulant factors V, VIII, IX, XI, and fibrinogen, while FXIII was significantly reduced. The concentration of fibrinolytic proteins, tissue plasminogen activator (t-PA) and plasminogen activator inhibitor type 1 (PAI-1) were elevated in the overall cohort of patients. Many of these hemostatic alterations were significantly greater in ICU compared to non-ICU subjects and, furthermore, they were associated with inflammatory biomarker elevation [i.e., interleukin 6 (IL-6), C-reactive protein (CRP), neutrophil to lymphocyte ratio (NLR), and procalcitonin]. After enrollment, 7 thrombosis and 14 major bleedings occurred. Analysis of clinical and biological data identified increased t-PA, PAI-1, and NLR values as independent predictive factors for thrombosis, while lower FXIII levels were associated with bleeding. Conclusion This study demonstrates alterations in all different hemostatic compartments analyzed, particularly in severe COVID-19 conditions, that strongly correlated with the inflammatory status. A potential role of fibrinolytic proteins together with NLR and of FXIII as predictors of thrombotic and hemorrhagic complications, respectively, is highlighted.
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Affiliation(s)
- Marina Marchetti
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
- *Correspondence: Marina Marchetti,
| | - Patricia Gomez-Rosas
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
- Hematology Service, Hospital General Regional Tecamac Instituto Mexicano del Seguro Social (IMSS), Mexico, Mexico
| | - Laura Russo
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Sara Gamba
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Eleonora Sanga
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Cristina Verzeroli
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Chiara Ambaglio
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Francesca Schieppati
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Francesco Restuccia
- Department of Anesthesiology and Critical Care Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Ezio Bonanomi
- Department of Anesthesiology and Critical Care Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Marco Rizzi
- Unit of Infectious Diseases, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Stefano Fagiuoli
- Department of Internal Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Andrea D’Alessio
- Medical Oncology and Internal Medicine, Policlinico San Marco – Gruppo San Donato, Bergamo, Italy
| | - Grigorios T. Gerotziafas
- Sorbonne Université, INSERM UMR_S938, Research Group “Cancer-Hemostasis-Angiogenesis”, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Paris, France
| | - Luca Lorini
- Department of Anesthesiology and Critical Care Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Anna Falanga
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
- School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
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Yoshioka T, Daizumoto K, Tada K, Mima M, Kagawa K, Fukawa T, Yamaguchi K, Takahashi M, Nishioka Y, Kanayama H. Retroperitoneal hemorrhage in a patient with coronavirus disease 2019 (COVID-19):A case report. THE JOURNAL OF MEDICAL INVESTIGATION 2022; 69:148-151. [PMID: 35466138 DOI: 10.2152/jmi.69.148] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Early prophylactic administration of anticoagulants is recommended in patients with coronavirus disease 2019 (COVID-19). A case of retroperitoneal hemorrhage during inpatient treatment for COVID-19 is reported. CASE PRESENTATION A 69-year-old man was diagnosed with COVID-19 6 days after symptom onset. After admission for difficulty of breathing, he was treated with steroid pulse therapy, remdesivir, and heparin sodium. On day 16 after admission, his hemoglobin and blood pressure dropped. Computed tomography showed a left retroperitoneal hematoma and multiple areas of extravasation in bilateral iliopsoas muscles. Anticoagulation therapy was stopped, and blood transfusion therapy was chosen by considering poor general condition caused by severe pneumonia. On day 19, the hemoglobin and blood pressure improved, and blood transfusion was stopped. However, he died on day 25 due to pneumonia. CONCLUSION When retroperitoneal hemorrhage occurs as a complication of COVID-19, appropriate treatment decision, transcatheter arterial embolization or conservative treatment, should be chosen based on patient's condition. J. Med. Invest. 69 : 148-151, February, 2022.
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Affiliation(s)
- Takuya Yoshioka
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Kei Daizumoto
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Kouki Tada
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Masato Mima
- Department of Respiratory Medicine and Rheumatology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Kozo Kagawa
- Department of Respiratory Medicine and Rheumatology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Tomoya Fukawa
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Kunihisa Yamaguchi
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Masayuki Takahashi
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Yasuhiko Nishioka
- Department of Respiratory Medicine and Rheumatology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Hiroomi Kanayama
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
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Brenner B, Ay C, Gal GL, Carrier M, Muñoz AJ, Agnelli G, Rocha ATC, Abdel-Razeq H, Elalamy I, Falanga A. Venous thromboembolism risk, prophylaxis and management in cancer patients with COVID-19: An unmet medical need. THROMBOSIS UPDATE 2022; 6:100098. [PMID: 38620707 PMCID: PMC8743273 DOI: 10.1016/j.tru.2022.100098] [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: 12/06/2021] [Accepted: 01/07/2022] [Indexed: 12/04/2022] Open
Abstract
Cancer patients exhibit an increased risk of venous thromboembolism (VTE), with VTE being the second leading cause of morbidity and mortality in these patients. The implementation of lockdowns following the COVID-19 pandemic has resulted in decreased mobility and delayed access to care, thus further increasing the susceptibility to VTE. Cancer patients may also be at a higher risk of SARS-CoV-2 infection and have been shown to be more likely to experience severe COVID-19 disease compared to patients without cancer. Given that both cancer and COVID-19 exhibit a hypercoagulable state, stasis of blood flow, and endothelial injury, cancer patients with COVID-19 constitute a vulnerable population with a high risk of thrombosis and bleeding. However, to date there are limited studies evaluating whether cancer patients infected with SARS-CoV-2 have a higher VTE incidence than COVID-19 patients without cancer, how to assess the risk of VTE, prophylaxis and treatment in this special population. Herein, we highlight the urgent need for studies in cancer patients with COVID-19 to ensure appropriate patient care and improve clinical outcomes.
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Affiliation(s)
- Benjamin Brenner
- Department of Hematology, Rambam Health Care Campus, Haifa, Israel
- Department of Obstetrics and Gynaecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Cihan Ay
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Comprehensive Cancer Vienna, Medical University of Vienna, Vienna, Austria
- Department of Obstetrics and Gynaecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Grégoire Le Gal
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Marc Carrier
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Andrés J Muñoz
- Medical Oncology Department. Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Giancarlo Agnelli
- Internal Vascular and Emergency Medicine - Stroke Unit, University of Perugia, Perugia, Italy
| | - Ana Thereza Cavalcanti Rocha
- Universidade Federal da Bahia - UFBA, Faculdade de Medicina da Bahia, Departamento de Saúde da FamíliaSalvador, BA, Brazil
| | | | - Ismail Elalamy
- Hematology and Thrombosis Centre, Hôpital Tenon, INSERM U938, Sorbonne Université, AP-HP, Paris, France
- Department of Obstetrics and Gynaecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Anna Falanga
- University of Milano-Bicocca, School of Medicine, Monza, Italy
- Department of Immunohematology and Transfusion Medicine, Thrombosis and Hemostasis Center, Hospital Papa Giovanni XXIII, Bergamo, Italy
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Abdelmohsen MA, Alkandari BM, Gupta VK, Elsebaie N. Gastrointestinal tract imaging findings in confirmed COVID-19 patients: a non-comparative observational study. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [PMCID: PMC7873518 DOI: 10.1186/s43055-021-00433-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Corona virus disease 2019 (COVID-19) pandemic—as declared by the World Health Organization—is a major threatening public health problem. At the time of writing, more than 60,000,000 patients and more than 1,500,000 deaths were recorded worldwide. Besides the classical chest symptoms, gastrointestinal tract-related symptoms were noted, like diarrhea, abdominal distention, and hematochezia, adding more difficulties in the diagnosis of the disease. Although there are many publications evaluated, the thoracic imaging signs and complications of COVID-19, there are few articles—to the best of our knowledge—that evaluated the gastrointestinal tract imaging features and complications related to COVID-19. Results In this retrospective study, positive COVID-19 patients who underwent diagnostic computed tomography (CT) for abdominal complaints along a 3-month duration in a large isolation hospital were evaluated. Strict infection control measures were taken during the CT examinations. The data were reviewed on picture archiving and communications systems with clinical data and laboratory result correlation. Thirty patients (30%) showed gastrointestinal (GI) findings, and 70 patients showed unremarkable or non-related GI findings. The 30 patients were classified into four groups: the ischemic group including 10 patients (10/30: 33.33%), the bleeding group included six patients (6/30: 20%), the inflammatory group included nine patients (9/30: 30%), and fluid-filled bowel group included five patients (5/30: 16.6%). Conclusions COVID-19 should be evaluated as a systemic disease with extra pulmonary highlights. GI imaging should be considered for COVID-19 patients with related suspicious symptoms. Ischemic GI complications were the most common GI findings.
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Vergori A, Pianura E, Lorenzini P, D’Abramo A, Di Stefano F, Grisetti S, Vita S, Pinnetti C, Donno DR, Marini MC, Nicastri E, Ianniello S, Antinori A. Spontaneous ilio-psoas haematomas (IPHs): a warning for COVID-19 inpatients. Ann Med 2021; 53:295-301. [PMID: 33491498 PMCID: PMC7877978 DOI: 10.1080/07853890.2021.1875498] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/09/2021] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Critically ill patients with COVID-19 are at increased risk of developing a hypercoagulable state due to haemostatic changes directly related to the SARS-CoV-2 infection or to the consequence of the cytokine storm. Anticoagulation is now recommended to reduce the thrombotic risk. Ilio-psoas haematoma (IPH) is a potentially lethal condition that can arise during the hospitalization, especially in intensive care units (ICUs) and frequently reported as a complication of anticoagulation treatment. MATERIALS AND METHODS We report a case series of seven subjects with SARS-CoV-2 pneumonia complicated by Ilio-psoas haematomas (IPHs) at our COVID-Hospital in Rome, Italy. RESULTS Over the observation period, 925 subjects with confirmed SARS-CoV-2 infection were admitted to our COVID-hospital. Among them, we found seven spontaneous IPHs with an incidence of 7.6 cases per 1000 hospitalization. All the reported cases had a severe manifestation of COVID-19 pneumonia, with at least one comorbidity and 5/7 were on treatment with low weight molecular heparin for micro or macro pulmonary thrombosis. CONCLUSIONS Given the indications to prescribe anticoagulant therapy in COVID-19 and the lack of solid evidences on the optimal dose and duration, it is important to be aware of the iliopsoas haematoma as a potentially serious complication in COVID-19 inpatients. KEY MESSAGE Critically ill patients with COVID-19 are at increased risk of hypercoagulability state and anticoagulation therapy is recommended. Ilio-psoas haematoma (IPH) is found to be a complication of anticoagulation regimen especially in severe COVID-19 cases. An incidence of 7.6 cases per 1000 admission of IPHs was reported. Hypoesthesia of the lower limbs, pain triggered by femoral rotation, hypovolaemia and anaemia are the most common symptoms and signs of IPHs that should alert physician.
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Affiliation(s)
- Alessandra Vergori
- HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Elisa Pianura
- Radiology Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Patrizia Lorenzini
- HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessandra D’Abramo
- Emerging Infectious Diseases Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Federica Di Stefano
- Radiology Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Susanna Grisetti
- HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Serena Vita
- Emerging Infectious Diseases Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Carmela Pinnetti
- HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Davide Roberto Donno
- Severe and Immune-depression Associated Infectious Diseases Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Maria Cristina Marini
- Intensive Care Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Emanuele Nicastri
- Emerging Infectious Diseases Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Stefania Ianniello
- Radiology Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Andrea Antinori
- HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
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Ito Y, Awano N, Uchiyama F, Inomata M, Kuse N, Tone M, Takada K, Fujimoto K, Muto Y, Sagisaka S, Maki K, Yamashita R, Harada A, Nishimura JI, Hayashi M, Izumo T. Spontaneous Muscle Hematoma in Japanese Patients with Severe COVID-19 Treated with Unfractionated Heparin: Two Case Reports. Intern Med 2021; 60:3503-3506. [PMID: 34433713 PMCID: PMC8627824 DOI: 10.2169/internalmedicine.7422-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In hospitalized coronavirus disease 2019 (COVID-19) patients, anticoagulation therapy is administered to prevent thrombosis. However, anticoagulation sometimes causes bleeding complications. We herein report two Japanese cases of severe COVID-19 in which spontaneous muscle hematomas (SMH) developed under therapeutic anticoagulation with unfractionated heparin. Although the activated partial prothrombin time was within the optimal range, contrast-enhanced computed tomography (CECT) revealed SMH in the bilateral iliopsoas muscles in both cases, which required emergent transcatheter embolization. Close monitoring of the coagulation system and the early diagnosis of bleeding complications through CECT are needed in severe COVID-19 patients treated with anticoagulants.
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Affiliation(s)
- Yu Ito
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Japan
| | - Nobuyasu Awano
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Japan
| | - Fumiya Uchiyama
- Department of Interventional Radiology, Japanese Red Cross Medical Center, Japan
| | - Minoru Inomata
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Japan
| | - Naoyuki Kuse
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Japan
| | - Mari Tone
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Japan
| | - Kohei Takada
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Japan
| | - Kazushi Fujimoto
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Japan
| | - Yutaka Muto
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Japan
| | - Shogo Sagisaka
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Medical Center, Japan
| | - Kenro Maki
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Medical Center, Japan
| | - Ryuta Yamashita
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Medical Center, Japan
| | - Akinori Harada
- Department of Interventional Radiology, Japanese Red Cross Medical Center, Japan
| | - Jun-Ichi Nishimura
- Department of Interventional Radiology, Japanese Red Cross Medical Center, Japan
| | - Munehiro Hayashi
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Medical Center, Japan
| | - Takehiro Izumo
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Japan
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12
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Management of Spontaneous Bleeding in COVID-19 Inpatients: Is Embolization Always Needed? J Clin Med 2021; 10:jcm10184119. [PMID: 34575230 PMCID: PMC8469448 DOI: 10.3390/jcm10184119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/02/2021] [Accepted: 09/09/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND critically ill patients with SARS-CoV-2 infection present a hypercoagulable condition. Anticoagulant therapy is currently recommended to reduce thrombotic risk, leading to potentially severe complications like spontaneous bleeding (SB). Percutaneous transcatheter arterial embolization (PTAE) can be life-saving in critical patients, in addition to medical therapy. We report a major COVID-19 Italian Research Hospital experience during the pandemic, with particular focus on indications and technique of embolization. METHODS We retrospectively included all subjects with SB and with a microbiologically confirmed SARS-CoV-2 infection, over one year of pandemic, selecting two different groups: (a) patients treated with PTAE and medical therapy; (b) patients treated only with medical therapy. Computed tomography (CT) scan findings, clinical conditions, and biological findings were collected. RESULTS 21/1075 patients presented soft tissue SB with an incidence of 1.95%. 10/21 patients were treated with PTAE and medical therapy with a 30-days survival of 70%. Arterial blush, contrast late enhancement, and dimensions at CT scan were found discriminating for the embolization (p < 0.05). CONCLUSIONS PTAE is an important tool in severely ill, bleeding COVID-19 patients. The decision for PTAE of COVID-19 patients must be carefully weighted with particular attention paid to the clinical and biological condition, hematoma location and volume.
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13
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Polo Friz H, Gelfi E, Orenti A, Motto E, Primitz L, Donzelli T, Intotero M, Scarpazza P, Vighi G, Cimminiello C, Boracchi P. Acute pulmonary embolism in patients presenting pulmonary deterioration after hospitalisation for non-critical COVID-19. Intern Med J 2021; 51:1236-1242. [PMID: 33834578 PMCID: PMC8251288 DOI: 10.1111/imj.15307] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 03/01/2021] [Accepted: 03/28/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Emerging evidence suggests an association between COVID-19 and acute pulmonary embolism (APE). AIMS To assess the prevalence of APE in patients hospitalised for non-critical COVID-19 who presented clinical deterioration, and to investigate the association of clinical and biochemical variables with a confirmed diagnosis of APE in these subjects. METHODS All consecutive patients admitted to the internal medicine department of a general hospital with a diagnosis of non-critical COVID-19, who performed a computer tomography pulmonary angiography (CTPA) for respiratory deterioration in April 2020, were included in this retrospective cohort study. RESULTS Study populations: 41 subjects, median (interquartile range) age: 71.7 (63-76) years, CPTA confirmed APE = 8 (19.51%, 95% confidence interval (CI): 8.82-34.87%). Among patients with and without APE, no significant differences were found with regards symptoms, comorbidities, treatment, Wells score and outcomes. The optimal cut-off value of d-dimer for predicting APE was 2454 ng/mL, sensitivity (95% CI): 63 (24-91), specificity: 73 (54-87), positive predictive value: 36 (13-65), negative predictive value: 89 (71-98) and AUC: 0.62 (0.38-0.85). The standard and age-adjusted d-dimer cut-offs, and the Wells score ≥2 did not associate with confirmed APE, albeit a cut-off value of d-dimer = 2454 ng/mL showed an relative risk: 3.21; 95% CI: 0.92-13.97; P = 0.073. Heparin at anticoagulant doses was used in 70.73% of patients before performing CTPA. CONCLUSION Among patients presenting pulmonary deterioration after hospitalisation for non-critical COVID-19, the prevalence of APE is high. Traditional diagnostic tools to identify high APE pre-test probability patients do not seem to be clinically useful. These results support the use of a high index of suspicion for performing CTPA to exclude or confirm APE as the most appropriate diagnostic approach in this clinical setting.
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Affiliation(s)
- Hernan Polo Friz
- Internal Medicine, Medical Department, Vimercate Hospital, ASST di Vimercate, Vimercate, Italy
| | - Elia Gelfi
- Internal Medicine, Medical Department, Vimercate Hospital, ASST di Vimercate, Vimercate, Italy
| | - Annalisa Orenti
- Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics Epidemiology and Biometry 'G. A. Maccacaro', University of Milan, Milan, Italy
| | - Elena Motto
- Internal Medicine, Medical Department, Vimercate Hospital, ASST di Vimercate, Vimercate, Italy
| | - Laura Primitz
- Internal Medicine, Medical Department, Vimercate Hospital, ASST di Vimercate, Vimercate, Italy
| | - Tino Donzelli
- Internal Medicine, Medical Department, Vimercate Hospital, ASST di Vimercate, Vimercate, Italy
| | - Marcello Intotero
- Radiology, Diagnostic Department, Vimercate Hospital, ASST Vimercate, Vimercate, Italy
| | - Paolo Scarpazza
- Pulmonology, Medical Department, Vimercate Hospital, ASST Vimercate, Vimercate, Italy
| | - Giuseppe Vighi
- Internal Medicine, Medical Department, Vimercate Hospital, ASST di Vimercate, Vimercate, Italy
| | - Claudio Cimminiello
- Research and Study Center of the Italian Society of Angiology and Vascular Pathology (Società Italiana di Angiologia ePatologia Vascolare, SIAPAV), Milan, Italy
| | - Patrizia Boracchi
- Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics Epidemiology and Biometry 'G. A. Maccacaro', University of Milan, Milan, Italy
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14
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Tutino R, Bonariol L, Caratozzolo E, Massani M. Massive late postoperative bleeding after abdominal surgery in a haematologic patient with postoperative CoV-2 infection. BMJ Case Rep 2021; 14:14/8/e243744. [PMID: 34429289 PMCID: PMC8386227 DOI: 10.1136/bcr-2021-243744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
The role of viral infection in extrapulmonary postoperative complications in CoV-2 patients is still debated. Perioperative bleeding is rare compared with thrombotic events, but can be related to a haemorrhagic CoV-2-associated disseminated intravascular coagulopathy-like syndrome.
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Affiliation(s)
- Roberta Tutino
- Chirurgia 1, Azienda ULSS 2 Marca Trevigiana, Ospedale Regionale Treviso, Treviso, Italy .,Dipartimento di discipline chirurgiche, oncologiche e stomatologiche, Università degli Studi di Palermo, Palermo, Italy
| | - Luca Bonariol
- Chirurgia 1, Azienda ULSS 2 Marca Trevigiana, Ospedale Regionale Treviso, Treviso, Italy
| | - Ezio Caratozzolo
- Chirurgia 1, Azienda ULSS 2 Marca Trevigiana, Ospedale Regionale Treviso, Treviso, Italy
| | - Marco Massani
- Chirurgia 1, Azienda ULSS 2 Marca Trevigiana, Ospedale Regionale Treviso, Treviso, Italy
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15
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Abstract
SARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri‐operative or prior SARS‐CoV‐2 were at further increased risk of venous thromboembolism. We conducted a planned sub‐study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS‐CoV‐2 diagnosis was defined as peri‐operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre‐operative anti‐coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS‐CoV‐2; 2.2% (50/2317) in patients with peri‐operative SARS‐CoV‐2; 1.6% (15/953) in patients with recent SARS‐CoV‐2; and 1.0% (11/1148) in patients with previous SARS‐CoV‐2. After adjustment for confounding factors, patients with peri‐operative (adjusted odds ratio 1.5 (95%CI 1.1–2.0)) and recent SARS‐CoV‐2 (1.9 (95%CI 1.2–3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS‐CoV‐2 (1.7 (95%CI 0.9–3.0)). Overall, venous thromboembolism was independently associated with 30‐day mortality (5.4 (95%CI 4.3–6.7)). In patients with SARS‐CoV‐2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri‐operative or recent SARS‐CoV‐2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS‐CoV‐2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.
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16
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Abate V, Casoria A, Rendina D, Muscariello R, Nuzzo V, Vargas M, Servillo G, Venetucci P, Conca P, Tufano A, Galletti F, Di Minno G. Spontaneous Muscle Hematoma in Patients with COVID-19: A Systematic Literature Review with Description of an Additional Case Series. Semin Thromb Hemost 2021; 48:100-108. [PMID: 34388842 DOI: 10.1055/s-0041-1732370] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Coagulation abnormalities, thrombosis, and endothelial dysfunction have been described in COVID-19 patients. Spontaneous muscle hematoma (SMH) is a rare complication in COVID-19. The aims of this study are to: (1) perform a systematic review of the literature to better define the clinical SMH characteristics, (2) describe the prevalence and the clinical characteristics of SMH in COVID-19 patients referring to a Department of Internal Medicine (IM) (Federico II University of Naples), a Department of Sub-Intensive Care Medicine (SIM) (Ospedale Del Mare), and a Department of Intensive Care Unit (ICU) (Federico II University). The systematic review was performed according to PRISMA criteria. The local prevalence of SMH in COVID-19 was evaluated retrospectively. The medical records of all COVID-19 patients referring to IM and ICU from March 11th, 2020, to February 28th, 2021 were examined for SMH occurrence. In our retrospective analysis, we describe 10 cases of COVID-19 patients with SMH not previously reported in literature, with a prevalence of 2.1%. The literature review, inclusive of our case series, describes a total of 50 SMHs in COVID-19 patients (57.4% males; mean age 68.8 ± 10.0 years). The SMH sites were ileo-psoas, vastus intermedius, gluteus, sternocleidomastoid, and pectoralis major muscles. Males developed SMH earlier than females (9.5 ± 7.8 vs. 17.1 ± 9.7 days). Ileo-psoas hematoma was more frequent in males (69.2 vs. 30.8%), while pectoralis major hematoma occurred only in females. The in-hospital mortality rate of SMH in COVID-19 patients was 32.4%. SMH is a rare but severe complication in COVID-19 hospitalized patients, associated with high mortality. A gender difference seems to be present in the clinical presentation of the disorder.
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Affiliation(s)
- Veronica Abate
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
| | - Aniello Casoria
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
| | - Domenico Rendina
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
| | | | - Vincenzo Nuzzo
- Endocrinology and Nutrition Department, Ospedale del Mare, Naples, Italy
| | - Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II," Naples, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II," Naples, Italy
| | - Pietro Venetucci
- Department of Morphological and Functional Diagnostics, Radiotherapy, Forensic Medicine, University of Naples "Federico II," Naples, Italy
| | - Paolo Conca
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
| | - Giovanni Di Minno
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
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17
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Brogna B, Romano A, Tibullo L, Montuori M, Nunziata M, Russo G, Musto LA. Rare findings of spontaneous hemothorax and small subpleural lung hematoma in a COVID-19 patient: A case report. Acta Radiol Open 2021; 10:20584601211028149. [PMID: 34367668 PMCID: PMC8326360 DOI: 10.1177/20584601211028149] [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: 02/08/2021] [Accepted: 06/07/2021] [Indexed: 01/27/2023] Open
Abstract
Hemothorax (HT) and pulmonary hematoma represent rare complications of anticoagulant therapy. We present a rare case of a 53-year-old man with COVID-19 pneumonia who showed, in a follow-up computed tomography (CT) scan 13 days after hospitalization, a left HT and a small hyperdense area in a subpleural location and compatible with a small subpleural hematoma. This patient was being treated with a subcutaneous administration of low-molecular-weight heparin (100UI/kg/BID). No vascular malformations were visualized on the CT pulmonary angiography. Herein, we report the first case of both a spontaneous HT and a lung subpleural hematoma in a COVID-19 patient, probably caused by anticoagulant therapy.
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Affiliation(s)
- Barbara Brogna
- Department of Radiology, San Giuseppe Moscati Hospital Avellino, Avellino, Italy
- Barbara Brogna, Department of Radiology San Giuseppe Moscati Hospital Avellino, National Speciality Hospital San Giuseppe Moscati Neurology and Stroke Unit, Contrada Amoretta, Avellino 83100, Italy.
| | - Annamaria Romano
- Department of Pneumology, San Giuseppe Moscati Hospital Avellino, Avellino, Italy
| | - Loredana Tibullo
- Department of General Medicine, San Giuseppe Moscati Hospital Avellino, Avellino, Italy
| | - Mariagrazia Montuori
- Department of Pneumology, San Giuseppe Moscati Hospital Avellino, Avellino, Italy
| | - Mariagrazia Nunziata
- Department of General Medicine, San Giuseppe Moscati Hospital Avellino, Avellino, Italy
| | - Giuseppe Russo
- Department of Pneumology, San Giuseppe Moscati Hospital Avellino, Avellino, Italy
| | - Lanfranco A Musto
- Department of Radiology, San Giuseppe Moscati Hospital Avellino, Avellino, Italy
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18
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Vaidya T, Nanivadekar A, Patel R. Imaging spectrum of abdominal manifestations of COVID-19. World J Radiol 2021; 13:157-170. [PMID: 34249237 PMCID: PMC8245751 DOI: 10.4329/wjr.v13.i6.157] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/11/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has posed a serious threat to global public health with its rapid spread, high fatality, and severe burden on health care providers all over the world. Although COVID-19 has been established as a respiratory tract infection, it can manifest with gastrointestinal symptoms as a consequence of direct infection by the virus or due to inflammation-mediated cytotoxicity. It has been observed that COVID-19 patients presenting with gastrointestinal symptoms tend to progress to a severe form of disease with increased morbidity and mortality, thus indicating the need for timely management. COVID-19 manifests with a wide spectrum of radiologic findings on gastrointestinal tract imaging, encompassing bowel abnormalities, hepato-biliary and pancreatic involvement, vascular occlusion, and solid organ infarction. Early recognition of these imaging features can facilitate timely treatment of COVID-19 associated gastrointestinal tract complications and may prompt the diagnosis of COVID-19 in patients with atypical disease manifestations. The aim of this article is to provide an overview of the various gastrointestinal imaging manifestations that can be encountered in patients with COVID-19, with an emphasis on early diagnosis of the disease as well as treatment related complications.
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Affiliation(s)
- Tanvi Vaidya
- Department of Radiology, Ruby Hall Clinic, Pune 411001, Maharashtra, India
| | | | - Rajan Patel
- Department of Radiology, Ruby Hall Clinic, Pune 411001, Maharashtra, India
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19
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Sposato B, Croci L, Di Tomassi M, Puttini C, Olivieri C, Alessandri M, Ronchi MC, Donati E, Garcea A, Brazzi A, Migliorini MG, Chigiotti S, Nikiforakis N, Carli T, Canneti E, Strambio F, Cellini C, Nardangeli C, Allegri MP, Bianchi F, Bettini C, Perruzza M, Lanzarone N, Valentini L, Orselli P, Solari M, Cardaci S, Nofri M, Angeli G, Mangani F, Aloia E, Lanari A, Corridi M, Spargi G, Perrella A, Nencioni C. Spontaneous abdominal bleeding associated with SARS-CoV-2 infection: causality or coincidence? ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021199. [PMID: 33988163 PMCID: PMC8182584 DOI: 10.23750/abm.v92i2.10142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 03/29/2021] [Indexed: 01/27/2023]
Abstract
Authors present 6 cases of abdominal bleeding associated with COVID-19, representing 1.35% of all hospitalized COVID-19 patients and hypothesize that there could be, although not very frequently, a relationship between SARS-CoV2 and bleeding. They excluded a side effect of the low molecular weight heparin therapy that all patients underwent during the course of the disease or other possible causes. Alterations of the coagulation state or a weakness of the vascular wall due toa presumed endotheliitis SARS-CoV-2 infection induced, are hypothesized by the authors. Investigation and follow-up for possible hemorrhagic problems in patients with COVID-19 is recommended. In particular, clinicians should be vigilant about retroperitoneal hemorrhage in COVID-19 patients. In addition to the fact that these patients are being treated with anticoagulants, anemia and abdominal pain are the signs that should lead us to suspect this type of haemorrhage. More studies are needed to understand if COVID-19 can be directly associated with bleeding. (www.actabiomedica.it)
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Affiliation(s)
- Bruno Sposato
- Pneumology Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy; Experimental Medicine and Systems, "PhD program" Department of Systems Medicine University of Rome "Tor Vergata".
| | - Leonardo Croci
- UOC Malattie Infettive, Ospedale Misericordia di Grosseto.
| | | | | | | | | | | | - Elisa Donati
- UOC Malattie Infettive, Ospedale Misericordia di Grosseto.
| | | | | | | | | | | | - Tiziana Carli
- UOC Malattie Infettive, Ospedale Misericordia di Grosseto.
| | | | | | | | - Claudia Nardangeli
- Pneumology Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | | | - Francesco Bianchi
- Pneumology Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Claudio Bettini
- Pneumology Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy; Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
| | - Marco Perruzza
- Pneumology Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Nicola Lanzarone
- Pneumology Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Lucia Valentini
- Pneumology Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Paolo Orselli
- Pneumology Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Marco Solari
- Cardiology Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Salvatore Cardaci
- Infectious Disease Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Marco Nofri
- Infectious Disease Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Giorgia Angeli
- Infectious Disease Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Francesca Mangani
- Infectious Disease Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Elio Aloia
- Infectious Disease Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Alessandro Lanari
- Infectious Disease Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Marta Corridi
- Intensive Care Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Genni Spargi
- Intensive Care Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Antonio Perrella
- Pneumology Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Cesira Nencioni
- Infectious Disease Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
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20
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Mohammadi A, Boroofeh B, Mousavi-Aghdas SA, Mirza-Aghazadeh-Attari M. Alveolar hemorrhage in the setting of COVID-19: Report of a successful vascular intervention and embolization. Radiol Case Rep 2021; 16:1777-1779. [PMID: 33968288 PMCID: PMC8095242 DOI: 10.1016/j.radcr.2021.04.034] [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: 04/06/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 11/30/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) is characterized by viral pneumonia with mild to moderate symptoms. Emerging studies suggest that some patients may experience uncommon complications, such as thrombotic or hemorrhagic episodes. Here we present a 59-year-old male patient who had a hemorrhage episode from a branch of the pulmonary arteries and was treated by interventional embolization. Our case report demonstrates the importance of early diagnosis of hemorrhagic complications of COVID-19 and the possible benefits of early vascular intervention.
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Affiliation(s)
- Afshin Mohammadi
- Department of Radiology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Behdad Boroofeh
- Department of Internal Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | | | - Mohammad Mirza-Aghazadeh-Attari
- Department of Radiology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran.,Medical Imaging sciences research center, Tabriz University of Medical Sciences, Tabriz, Iran
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21
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Hopp MT, Domingo-Fernández D, Gadiya Y, Detzel MS, Graf R, Schmalohr BF, Kodamullil AT, Imhof D, Hofmann-Apitius M. Linking COVID-19 and Heme-Driven Pathophysiologies: A Combined Computational-Experimental Approach. Biomolecules 2021; 11:biom11050644. [PMID: 33925394 PMCID: PMC8147026 DOI: 10.3390/biom11050644] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 01/08/2023] Open
Abstract
The SARS-CoV-2 outbreak was declared a worldwide pandemic in 2020. Infection triggers the respiratory tract disease COVID-19, which is accompanied by serious changes in clinical biomarkers such as hemoglobin and interleukins. The same parameters are altered during hemolysis, which is characterized by an increase in labile heme. We present two computational–experimental approaches aimed at analyzing a potential link between heme-related and COVID-19 pathophysiologies. Herein, we performed a detailed analysis of the common pathways induced by heme and SARS-CoV-2 by superimposition of knowledge graphs covering heme biology and COVID-19 pathophysiology. Focus was laid on inflammatory pathways and distinct biomarkers as the linking elements. In a second approach, four COVID-19-related proteins, the host cell proteins ACE2 and TMPRSS2 as well as the viral proteins 7a and S protein were computationally analyzed as potential heme-binding proteins with an experimental validation. The results contribute to the understanding of the progression of COVID-19 infections in patients with different clinical backgrounds and may allow for a more individual diagnosis and therapy in the future.
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Affiliation(s)
- Marie-Thérèse Hopp
- Pharmaceutical Biochemistry and Bioanalytics, Pharmaceutical Institute, University of Bonn, An der Immenburg 4, D-53121 Bonn, Germany; (M.-T.H.); (M.S.D.); (R.G.); (B.F.S.)
| | - Daniel Domingo-Fernández
- Department of Bioinformatics, Fraunhofer Institute for Algorithms and Scientific Computing (SCAI), Schloss Birlinghoven, D-53757 Sankt Augustin, Germany; (D.D.-F.); (Y.G.); (A.T.K.)
- Enveda Biosciences, Inc., San Francisco, CA 94080, USA
| | - Yojana Gadiya
- Department of Bioinformatics, Fraunhofer Institute for Algorithms and Scientific Computing (SCAI), Schloss Birlinghoven, D-53757 Sankt Augustin, Germany; (D.D.-F.); (Y.G.); (A.T.K.)
| | - Milena S. Detzel
- Pharmaceutical Biochemistry and Bioanalytics, Pharmaceutical Institute, University of Bonn, An der Immenburg 4, D-53121 Bonn, Germany; (M.-T.H.); (M.S.D.); (R.G.); (B.F.S.)
| | - Regina Graf
- Pharmaceutical Biochemistry and Bioanalytics, Pharmaceutical Institute, University of Bonn, An der Immenburg 4, D-53121 Bonn, Germany; (M.-T.H.); (M.S.D.); (R.G.); (B.F.S.)
| | - Benjamin F. Schmalohr
- Pharmaceutical Biochemistry and Bioanalytics, Pharmaceutical Institute, University of Bonn, An der Immenburg 4, D-53121 Bonn, Germany; (M.-T.H.); (M.S.D.); (R.G.); (B.F.S.)
| | - Alpha T. Kodamullil
- Department of Bioinformatics, Fraunhofer Institute for Algorithms and Scientific Computing (SCAI), Schloss Birlinghoven, D-53757 Sankt Augustin, Germany; (D.D.-F.); (Y.G.); (A.T.K.)
- Causality Biomodels, Kinfra Hi-Tech Park, Kalamassery, Cochin, Kerala 683503, India
| | - Diana Imhof
- Pharmaceutical Biochemistry and Bioanalytics, Pharmaceutical Institute, University of Bonn, An der Immenburg 4, D-53121 Bonn, Germany; (M.-T.H.); (M.S.D.); (R.G.); (B.F.S.)
- Correspondence: (D.I.); (M.H.-A.)
| | - Martin Hofmann-Apitius
- Department of Bioinformatics, Fraunhofer Institute for Algorithms and Scientific Computing (SCAI), Schloss Birlinghoven, D-53757 Sankt Augustin, Germany; (D.D.-F.); (Y.G.); (A.T.K.)
- Correspondence: (D.I.); (M.H.-A.)
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22
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Leentjens J, van Haaps TF, Wessels PF, Schutgens REG, Middeldorp S. COVID-19-associated coagulopathy and antithrombotic agents-lessons after 1 year. LANCET HAEMATOLOGY 2021; 8:e524-e533. [PMID: 33930350 PMCID: PMC8078884 DOI: 10.1016/s2352-3026(21)00105-8] [Citation(s) in RCA: 147] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 03/26/2021] [Accepted: 03/31/2021] [Indexed: 02/06/2023]
Abstract
COVID-19 is associated with a high incidence of thrombotic complications, which can be explained by the complex and unique interplay between coronaviruses and endothelial cells, the local and systemic inflammatory response, and the coagulation system. Empirically, an intensified dose of thrombosis prophylaxis is being used in patients admitted to hospital with COVID-19 and several guidelines on this topic have been published, although the insufficiency of high quality and direct evidence has led to weak recommendations. In this Viewpoint we summarise the pathophysiology of COVID-19 coagulopathy in the context of patients who are ambulant, admitted to hospital, and critically ill or non-critically ill, and those post-discharge from hospital. We also review data from randomised controlled trials in the past year of antithrombotic therapy in patients who are critically ill. These data provide the first high-quality evidence on optimal use of antithrombotic therapy in patients with COVID-19. Pharmacological thromboprophylaxis is not routinely recommended for patients who are ambulant and post-discharge. A first ever trial in non-critically ill patients who were admitted to hospital has shown that a therapeutic dose of low-molecular-weight heparin might improve clinical outcomes in this population. In critically ill patients, this same treatment does not improve outcomes and prophylactic dose anticoagulant thromboprophylaxis is recommended. In the upcoming months we expect numerous data from the ongoing antithrombotic COVID-19 studies to guide clinicians at different stages of the disease.
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Affiliation(s)
- Jenneke Leentjens
- Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands.
| | - Thijs F van Haaps
- Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Pieter F Wessels
- Department of Medical Oncology, University of Pretoria, Pretoria, South Africa; Ampath Laboratories, Pretoria, South Africa
| | - Roger E G Schutgens
- Van Creveldkliniek, University Medical Center Utrecht, University Utrecht, Utrecht, Netherlands
| | - Saskia Middeldorp
- Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
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23
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Abdelmohsen MA, Alkandari BM, Abdel Razek AAK, Tobar AM, Gupta VK, Elsebaie N. Abdominal Computed Tomography Angiography and Venography in Evaluation of Hemorrhagic and Thrombotic lesions in Hospitalized COVID-19 patients. Clin Imaging 2021; 79:12-19. [PMID: 33865171 PMCID: PMC8044556 DOI: 10.1016/j.clinimag.2021.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/27/2021] [Accepted: 04/08/2021] [Indexed: 02/07/2023]
Abstract
Purpose To report imaging findings at computed tomography angiography (CTA) and venography (CTV) of the abdomen and pelvis in evaluation of hemorrhagic and thrombotic lesions in hospitalized patients with COVID-19. Methods In this retrospective observational study, patients admitted to a single tertiary care center from April 1 to July 20, 2020, who tested positive for SARS-CoV-2 and developed acute abdominal pain or decreasing hemoglobin levels over the course of hospitalization were included. Abdominal CTA/CTV imaging studies performed in these patients were reviewed, and acute hemorrhagic or thromboembolic findings were recorded. Results A total of 40 patients (mean age, 59.7 years; 20 men, 20 women) were evaluated. Twenty-five patients (62.5%) required intensive care unit (ICU) admission and 15 patients (37.5%) were treated in the medical ward. Hemorrhagic complications were detected in 19 patients (47.5%), the most common was intramuscular hematoma diagnosed in 17 patients; It involved the iliopsoas compartment unilaterally in 10 patients, bilaterally in 2 patients and the rectus sheath in 5 cases. Pelvic extraperitoneal hemorrhage was found in 3 patients, and mesenteric hematoma in one patient. Thromboembolic events were diagnosed in 8 patients (20%) including; arterial thrombosis (n = 2), venous thrombosis (n = 2), splenic infarct (n = 1), bowel ischemia (n = 1) and multiple sites of thromboembolism (n = 2). Conclusion Our study highlights that both hemorrhagic and thromboembolic complications can be seen in hospitalized patients with COVID-19. It is important that radiologists maintain a high index of suspicion for early diagnosis of these complications.
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Affiliation(s)
- Mohsen Ahmed Abdelmohsen
- Diagnostic and Interventional Radiology Department, Alexandria Faculty of Medicine, Shamplion Street, Alexandria 21131, Egypt; Medical Imaging Department, Jaber Al Ahmad Hospital, Ministry of Health, Khalid Ben Abdulaziz Street, South Surra, Kuwait City, Kuwait
| | - Buthaina M Alkandari
- Medical Imaging Department, Jaber Al Ahmad Hospital, Ministry of Health, Khalid Ben Abdulaziz Street, South Surra, Kuwait City, Kuwait
| | | | - Ahmed Mohamed Tobar
- Medical Imaging Department, Jaber Al Ahmad Hospital, Ministry of Health, Khalid Ben Abdulaziz Street, South Surra, Kuwait City, Kuwait
| | | | - Nermeen Elsebaie
- Diagnostic and Interventional Radiology Department, Alexandria Faculty of Medicine, Shamplion Street, Alexandria 21131, Egypt.
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24
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Coppola A, Annunziata A, Gioia MR, Fiorentino G. Bleeding events in COVID-19: the other side of the coin? Monaldi Arch Chest Dis 2021; 91. [PMID: 33794592 DOI: 10.4081/monaldi.2021.1739] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/28/2021] [Indexed: 11/23/2022] Open
Abstract
We present three cases of patients affected by severe SARS-CoV-2-related pneumonia treated with a low molecular weight heparin for prevention or treatment of pulmonary embolism, who presented a major bleed, in particular an ileopsoas haematoma that caused severe anaemia; in one case it was fatal. In the recent outbreak of novel coronavirus infection, significantly abnormal coagulation parameters in SARS-CoV-2 infection occur very often, but complications in the opposite direction such as bleeding diathesis are very rare. In these cases, there are different levels of gravity: for one patient the major bleed required the anticoagulant therapy to be stopped until bleeding stabilized, one patient needed interventional radiology and one patient died.
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Affiliation(s)
- Antonietta Coppola
- Department of Respiratory Pathophysiology, Monaldi-Cotugno Hospital, Naples.
| | - Anna Annunziata
- Department of Respiratory Pathophysiology, Monaldi-Cotugno Hospital, Naples.
| | - Maria Rosaria Gioia
- Department of Respiratory Pathophysiology, Monaldi-Cotugno Hospital, Naples.
| | - Giuseppe Fiorentino
- Department of Respiratory Pathophysiology, Monaldi-Cotugno Hospital, Naples.
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25
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Ohn MH, Ng JR, Ohn KM, Luen NP. Double-edged sword effect of anticoagulant in COVID-19 infection. BMJ Case Rep 2021; 14:14/3/e241955. [PMID: 33753396 PMCID: PMC7986783 DOI: 10.1136/bcr-2021-241955] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Coagulation predominant-type coagulopathy such as microthrombosis and macrothrombosis is a well-known recognised complication found in COVID-19 infected critically ill patients. In the context of high incidence of thrombotic events in patients with COVID-19, supplementation with anticoagulant therapy has been routinely recommended and shown to reduce mortality. However, the recommended type, dose, duration and timing of anticoagulant has not been determined yet. Spontaneous retroperitoneal haematoma secondary to anticoagulant therapy is one of the well-known but self-limiting conditions. We report a 51-year-old COVID-19 positive woman, who was taking intermediate-intensity heparin therapy for venous thromboembolism prophylaxis and died from complication of retroperitoneal bleeding. Further studies are needed to verify the risk-benefit ratio of anticoagulant therapy in patients with COVID-19. Although anticoagulant deems appropriate to use in patients with COVID-19, clinicians should be cautious about major bleeding complication such as retroperitoneal haemorrhage even when full therapeutic dosage is not used.
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Affiliation(s)
- May Honey Ohn
- Cardiology Department, Lewisham Hospital NHS Trust, London, UK
| | - Jun Rong Ng
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Khin Maung Ohn
- Surgical Department, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Ng Pey Luen
- Emergency Department, Miri Hospital, Miri, Sarawak, Malaysia
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26
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Singh B, Mechineni A, Kaur P, Reid RJ, Maroules M. COVID-19 and bleeding at unusual locations: Report of four cases. Hematol Transfus Cell Ther 2021; 43:214-218. [PMID: 33681709 PMCID: PMC7919512 DOI: 10.1016/j.htct.2021.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/27/2021] [Indexed: 01/08/2023] Open
Affiliation(s)
- Balraj Singh
- Saint Joseph's University Medical Center, Paterson, NJ, United States.
| | - Ashesha Mechineni
- Saint Joseph's University Medical Center, Paterson, NJ, United States
| | - Parminder Kaur
- Saint Joseph's University Medical Center, Paterson, NJ, United States
| | - Ro-Jay Reid
- Saint Joseph's University Medical Center, Paterson, NJ, United States
| | - Michael Maroules
- Saint Joseph's University Medical Center, Paterson, NJ, United States
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27
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Nakamura H, Ouchi G, Miyagi K, Higure Y, Otsuki M, Nishiyama N, Kinjo T, Nakamatsu M, Tateyama M, Kukita I, Fujita J. Case Report: Iliopsoas Hematoma during the Clinical Course of Severe COVID-19 in Two Male Patients. Am J Trop Med Hyg 2021; 104:1018-1021. [PMID: 33534775 PMCID: PMC7941852 DOI: 10.4269/ajtmh.20-1507] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 12/29/2020] [Indexed: 12/19/2022] Open
Abstract
Anticoagulation plays a major role in reducing the risk of systematic thrombosis in patients with severe COVID-19. Serious hemorrhagic complications, such as intracranial hemorrhage, have also been recognized. However, intra-abdominal hemorrhage is under-recognized because of its rare occurrence, despite high mortality. Here, we discuss two cases of spontaneous iliopsoas hematoma (IPH) likely caused by anticoagulants during the clinical course of COVID-19. We also explored published case reports to identify clinical characteristics of IPH in COVID-19 patients. The use of anticoagulants may increase the risk of lethal IPH among COVID-19 patients becsuse of scarce data on optimal dosage and adequate monitoring of anticoagulant effects. Rapid diagnosis and timely intervention are crucial to ensure good patient outcomes.
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Affiliation(s)
- Hideta Nakamura
- 1Department of Infectious, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Gen Ouchi
- 2Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kazuya Miyagi
- 1Department of Infectious, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yuuri Higure
- 1Department of Infectious, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Mariko Otsuki
- 1Department of Infectious, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Naoya Nishiyama
- 1Department of Infectious, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Takeshi Kinjo
- 1Department of Infectious, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Masashi Nakamatsu
- 1Department of Infectious, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Masao Tateyama
- 1Department of Infectious, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Ichiro Kukita
- 2Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Jiro Fujita
- 1Department of Infectious, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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28
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Rogani S, Calsolaro V, Franchi R, Calabrese AM, Okoye C, Monzani F. Spontaneous muscle hematoma in older patients with COVID-19: two case reports and literature review. BMC Geriatr 2020; 20:539. [PMID: 33353545 PMCID: PMC7755066 DOI: 10.1186/s12877-020-01963-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/14/2020] [Indexed: 12/21/2022] Open
Abstract
Background In late December 2019, a cluster of pneumonia cases due to a novel betacoronavirus, SARS-CoV-2 was reported in China. The so-called COVID 19 is responsible not only for respiratory symptoms, from mild up to pneumonia and even acute respiratory distress syndrome, but also for extrapulmonary involvement. Cases presentation Here we present two cases of spontaneous muscle hematoma in patients with SARS-CoV-2 infection, both on therapeutic LMWH for atrial fibrillation: the first one was an 86-year-old Caucasian female with a history of hypertensive cardiomyopathy and the second one was an 81-year-old Caucasian male with a history of hypertension, diabetes and ischemic heart disease. Blood tests revealed a considerable drop of hemoglobin and alterations of coagulation system. In both cases, embolization of femoral artery was performed. A few other cases of bleeding manifestations are reported in literature, while a lot has been published about the hypercoagulability related to COVID-19. Conclusions Our reports and literature review highlight the need of active surveillance for possible hemorrhagic complications in patients with SARS-CoV-2 infection.
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Affiliation(s)
- Sara Rogani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Valeria Calsolaro
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Riccardo Franchi
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Alessia Maria Calabrese
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Chukwuma Okoye
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy.
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29
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Lubansu A, Assamadi M, Barrit S, Dembour V, Yao G, El Hadwe S, De Witte O. COVID-19 Impact on Neurosurgical Practice: Lockdown Attitude and Experience of a European Academic Center. World Neurosurg 2020; 144:e380-e388. [PMID: 32891850 PMCID: PMC7470722 DOI: 10.1016/j.wneu.2020.08.168] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/22/2020] [Accepted: 08/23/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented challenge. Different models of reorganization have been described aiming to preserve resources and ensure optimal medical care. Limited clinical neurosurgical experience with patients with COVID-19 has been reported. We share organizational experience, attitudes, and preliminary data of patients treated at our institution. METHODS Institutional guidelines and patient workflow are described and visualized. A cohort of all neurosurgical patients managed during the lockdown period is presented and analyzed, assessing suspected nosocomial infection risk factors. A comparative surgical subcohort from the previous year was used to investigate the impact on surgical activity. RESULTS A total of 176 patients were admitted in 66 days, 20 of whom tested positive for COVID-19. Patients initially admitted to the neurosurgical ward were less likely to be suspected for a COVID-19 infection compared with patients admitted for critical emergencies, particularly with neurovascular and stroke-related diseases. The mortality of patients with COVID-19 was remarkably high (45%), and even higher in patients who underwent surgical intervention (77%). In addition to the expected decrease in surgical activity (-53%), a decrease in traumatic emergencies was noted. CONCLUSIONS By applying infection prevention and resource-sparing logistics measures shared by the international medical community, we were able to maintain essential neurosurgical care in a pandemic with controlled nosocomial infection risk. Special consideration should be given to medical management and surgical indications in patients infected with severe acute respiratory syndrome coronavirus 2, because they seem to show a problematic hemostatic profile that might result in an unfavorable clinical and surgical outcome.
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Affiliation(s)
- Alphonse Lubansu
- Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Belgium.
| | - Mouhssine Assamadi
- Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Belgium; Department of Neurosurgery, Ibn Tofail Hospital, Université Cadi Ayyad, CHU Mohammed Sixth, Marrakech, Morocco
| | - Sami Barrit
- Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Belgium
| | - Victoria Dembour
- Department of Neurosurgery, Delta Hospital, CHIREC, Brussels, Belgium
| | - Gedeon Yao
- Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Belgium; Department of Neurosurgery, Hospital University of Yopougon, Abidjan, Ivory Coast
| | - Salim El Hadwe
- Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Belgium
| | - Olivier De Witte
- Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Belgium
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30
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Thrombosis at hospital presentation in patients with and without coronavirus disease 2019. J Vasc Surg Venous Lymphat Disord 2020; 9:845-852. [PMID: 33186750 PMCID: PMC7655032 DOI: 10.1016/j.jvsv.2020.11.004] [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] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/01/2020] [Indexed: 01/27/2023]
Abstract
Objective In the present study, we sought to better characterize the patients with coronavirus disease 2019 (COVID-19) most at risk of severe, outpatient thrombosis by defining the patients hospitalized with COVID-19 with arterial or venous thrombosis diagnosed at admission. Methods We conducted a single-center, retrospective analysis of COVID-19 patients. We found a shift in the proportions of thrombosis subtypes from 2019 to 2020, with declines in ST-segment myocardial infarction (from 22.0% to 10.1% of thrombotic events) and stroke (from 48.6% to 37.2%) and an increase in venous thromboembolism (from 29.4% to 52.7%). The patients with COVID-19–associated thrombosis were younger (age, 58 years vs 64 years; P = .043) and were less frequently women (31.3% vs 43.9%; P = .16). However, no differences were found in the body mass index or major comorbidities between those with and without COVID-19. COVID-19–associated thrombosis correlated with greater mortality (15.2% vs 4.3%; P = .016). The biometric profile of patients admitted with COVID-19–associated thrombosis compared with regular thrombosis showed significant changes in the complete blood count, liver function test results, D-dimer levels, C-reactive protein, ferritin, and coagulation panels. Conclusions Outpatients with COVID-19 who developed thrombosis requiring hospitalization had increased mortality compared with outpatients without COVID-19 who developed thrombosis requiring hospitalization. Given the significantly higher inflammatory marker levels, it is possible this is related to different mechanisms of thrombotic disease in these patients. The inflammation could be a therapeutic target to reduce the risk, or aid in the treatment, of thrombosis. We call for more studies elucidating the role that immunothrombosis might be playing in patients with COVID-19.
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31
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Canoglu K, Saylan B. Therapeutic dosing of low-molecular-weight heparin may decrease mortality in patients with severe COVID-19 infection. Ann Saudi Med 2020; 40:462-468. [PMID: 33307734 PMCID: PMC7733641 DOI: 10.5144/0256-4947.2020.462] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/03/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Venous thromboembolism or extensive thrombosis is relatively common in patients with severe COVID-19 infection and has been associated with increased mortality. During the current COVID-19 pandemic, several prophylactic doses and types of low-molecular-weight heparin (LMWH) are being used worldwide; however, there are no high-quality studies or recommendations for an optimal prophylactic LMWH dose. OBJECTIVES Investigate the relationship between coagulation parameters and the LMWH dose, and mortality and ICU admission in hospitalized patients with severe COVID-19 pneumonia. DESIGN Retrospective. SETTING Tertiary care hospital. PATIENTS AND METHODS Data on clinical features, coagulation parameters and anticoagulant medications of inpatients with severe COVID-19 were collected for the period between 11 March 2020 and 31 April 2020. MAIN OUTCOME MEASURES Mortality and ICU admission for prophylactic dose LMWH (0.5 mg/kg twice daily) and therapeutic dose LMWH (1 mg/kg twice daily). SAMPLE SIZE 154 cases. RESULTS Ninety-eight (63.6%) patients were treated with the LMWH prophylactic dose and 56 (36.4%) patients were treated with the therapeutic dose. Forty-four (44.9%) of 98 patients using the prophylactic dose LMWH died, while 10 (17.9%) of 56 patients using the therapeutic dose LMWH died (P=.001). Mortality was 6.4-fold higher in the prophylactic dose LMWH users than in the therapeutic dose LMWH users (OR=6.5, 95% CI: 2.4-17.6, P<.001). CONCLUSIONS Therapeutic dosing of LMWH may decrease mortality in patients with severe COVID-19 infected pneumonia. More aggressive thromboprophylaxis regimens using higher doses of heparin should be evaluated in prospective studies. LIMITATIONS Lack of information about bleeding complications. LMWH was not compared with other anticoagulant therapies. There was no comparison between our two groups on the APACHE score. Used different doses of LMWH in different clinics in our hospital. Single-center, retrospective study. CONFLICT OF INTEREST None.
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Affiliation(s)
- Kadir Canoglu
- From the Department of Pulmonology, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Bengu Saylan
- From the Department of Pulmonology, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
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32
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Chivukula RR, Maley JH, Dudzinski DM, Hibbert K, Hardin CC. Evidence-Based Management of the Critically Ill Adult With SARS-CoV-2 Infection. J Intensive Care Med 2020; 36:18-41. [PMID: 33111601 DOI: 10.1177/0885066620969132] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Human infection by the novel viral pathogen SARS-CoV-2 results in a clinical syndrome termed Coronavirus Disease 2019 (COVID-19). Although the majority of COVID-19 cases are self-limiting, a substantial minority of patients develop disease severe enough to require intensive care. Features of critical illness associated with COVID-19 include hypoxemic respiratory failure, acute respiratory distress syndrome (ARDS), shock, and multiple organ dysfunction syndrome (MODS). In most (but not all) respects critically ill patients with COVID-19 resemble critically ill patients with ARDS due to other causes and are optimally managed with standard, evidence-based critical care protocols. However, there is naturally an intense interest in developing specific therapies for severe COVID-19. Here we synthesize the rapidly expanding literature around the pathophysiology, clinical presentation, and management of COVID-19 with a focus on those points most relevant for intensivists tasked with caring for these patients. We specifically highlight evidence-based approaches that we believe should guide the identification, triage, respiratory support, and general ICU care of critically ill patients infected with SARS-CoV-2. In addition, in light of the pressing need and growing enthusiasm for targeted COVID-19 therapies, we review the biological basis, plausibility, and clinical evidence underlying these novel treatment approaches.
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Affiliation(s)
- Raghu R Chivukula
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, 2348Massachusetts General Hospital, Boston, MA, USA.,Whitehead Institute for Biomedical Research, Cambridge, MA, USA
| | - Jason H Maley
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, 2348Massachusetts General Hospital, Boston, MA, USA
| | - David M Dudzinski
- Corrigan Minehan Heart Center, Division of Cardiology, Department of Medicine, 2348Massachusetts General Hospital, Boston, MA, USA.,Cardiac Intensive Care Unit, Division of Cardiology, Department of Medicine, Massachusetts General, Hospital, Boston, MA, USA
| | - Kathryn Hibbert
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, 2348Massachusetts General Hospital, Boston, MA, USA
| | - C Corey Hardin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, 2348Massachusetts General Hospital, Boston, MA, USA
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33
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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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34
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Kamel AM, Sobhy M, Magdy N, Sabry N, Farid S. Anticoagulation outcomes in hospitalized Covid-19 patients: A systematic review and meta-analysis of case-control and cohort studies. Rev Med Virol 2020; 31:e2180. [PMID: 33022834 PMCID: PMC7646049 DOI: 10.1002/rmv.2180] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 12/14/2022]
Abstract
Background: Coagulopathy and thromboembolic events are common in Covid‐19 patients and are poor prognostic factors. Controversy exists regarding the potential of anticoagulation (AC) to reduce mortality and incidence of thromboembolic events in Covid‐19 patients. The current systematic review and meta‐analysis investigated the association between anticoagulants and mortality in adult hospitalized COVID‐19 patients using the available published non‐randomized studies. Methods: Google Scholar, PubMed, Scopus, the Cochrane Library and Clinical Trials.gov were searched for relevant studies. A meta‐analysis of adjusted and unadjusted estimates was performed. The relative risk was used as a measure of effect. The random‐effects model was used to pool estimates using the generic inverse variance method. Results: Sixteen studies were included in the quantitative data synthesis. Results showed a statistically significant association between AC and mortality (RR = 0.56, 95% CI 0.36; 0.92, p = 0.02). Both therapeutic (Relative risk [RR] = 0.4, 95% CI 0.27; 0.57) and prophylactic AC (RR = 0.54, 95% CI 0.41; 0.71) were associated with lower risk of mortality. Pre‐admission AC was not associated with mortality (RR = 0.84, 95% CI 0.49; 1.43, p > 0.05) while prophylactic AC was associated with higher risk of mortality compared to therapeutic AC (RR = 1.58, 95% CI 1.34; 1.87, p < 0.001). Conclusion: Findings support the association of AC with mortality in Covid‐19 patients. The results, synthesized from mostly low‐quality studies, show that prophylactic and therapeutic AC might reduce mortality in Covid‐19 patients. Findings suggest that therapeutic doses might be associated with better survival compared to prophylactic doses.
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Affiliation(s)
- Ahmed M. Kamel
- Clinical Pharmacy DepartmentCollege of PharmacyCairo UniversityCairoEgypt
| | - Mona Sobhy
- Clinical Pharmacy DepartmentCollege of PharmacyCairo UniversityCairoEgypt
| | - Nada Magdy
- Clinical Pharmacy DepartmentCollege of PharmacyCairo UniversityCairoEgypt
| | - Nirmeen Sabry
- Clinical Pharmacy DepartmentCollege of PharmacyCairo UniversityCairoEgypt
| | - Samar Farid
- Clinical Pharmacy DepartmentCollege of PharmacyCairo UniversityCairoEgypt
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Abdelmohsen MA, Alkandari BM, Gupta VK, ElBeheiry AA. Diagnostic value of abdominal sonography in confirmed COVID-19 intensive care patients. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [PMCID: PMC7522184 DOI: 10.1186/s43055-020-00317-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background In December 2019, a large outbreak of a novel coronavirus infection occurred in Wuhan, China. The pneumonic disease caused by this virus is called coronavirus disease 2019 (COVID-19) by the World Health Organization (WHO). As case numbers have increased worldwide, gastro-intestinal symptoms like diarrhea, constipation, abdominal pain, and vomiting have been increased, these symptoms associated with positive laboratory results including abnormal liver function tests, renal function tests, and D-Dimer levels. Although there are multiple articles evaluated the imaging findings in HRCT of COVID-19 patients that helped in understanding the disease course and potential complications in the chest, yet there are—to our knowledge—limited data about the abdominal imaging findings of the course and potential abdominal complications of COVID-19 notably in the intensive care units (ICU). Results Forty-one sonographic examinations were done for 30 confirmed COVID-intensive care patients presented with abdominal symptoms. Of the 30 patients, 26 were males (86.66%), and 4 were females (13.3%), the average age of the patients was 57.7 years old. The most common sonographic observation was hepatomegaly (n, 23/41, 56%) and biliary system disease (n, 17/41, 41.4%); the imaging findings were correlated with the clinical and laboratory data. CT examination when indicated (in our study to assess hematomas for active extravasation and to assess bowel obstruction and its level). Conclusion Abdominal sonographic imaging was often performed for inpatients with COVID-19. Hepatobiliary dysfunction as well as nephropathy was the most common imaging findings.
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36
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Karki S, Rawal SB, Malla S, Rayamajhi J, Thapa BB. A case report on spontaneous hemoperitoneum in COVID-19 patient. Int J Surg Case Rep 2020; 75:211-213. [PMID: 32959008 PMCID: PMC7489338 DOI: 10.1016/j.ijscr.2020.09.078] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 09/10/2020] [Accepted: 09/10/2020] [Indexed: 12/21/2022] Open
Abstract
Young adult COVID-19 patient presented with acute abdomen. Evaluation of patient revealed splenomegaly, splenic rupture and hemoperitoneum. Patient recover with conservative management.
Introduction Coronavirus disease (COVID-19) is a global a pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients commonly present with respiratory tract symptoms and fever. However two third are asymptomatic and unusual presentation is evolving. This has cause management dilemma among physicians. Presentation of case A 35 year young otherwise healthy male presented to emergency department of this institute with fever of 103 °F, abdominal pain, and pancytopenia with progressive fall in hemoglobin level was tested positive for COVID-19. Contrast enhance computed tomography of the patient revealed hemoperitoneum with splenic infarct. He was admitted in intensive care unit and managed with supportive treatment. Discussion Respiratory and gastrointestinal symptoms with hematological abnormalities like lymphopenia, thrombocytopenia are common presentation of COVID-19. Although coagulopathy and vasculitis has been a well-documented entity in patients with COIVD-19, visceral infarction leading to spontaneous hemoperitoeum was unusual and rare clinical presentation. Conclusion A high degree of clinical suspicion and thorough evaluation helps in the diagnosis of COVID-19 and related complications. The management of cases with unusual presentation requires judicious and careful approach.
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Affiliation(s)
- Saurab Karki
- Department of Surgery, Nepalese Army Institute of Health Sciences, College of Medicine, Kathmandu, Nepal.
| | - Sushil Bahadur Rawal
- Department of Surgery, Nepalese Army Institute of Health Sciences, College of Medicine, Kathmandu, Nepal.
| | - Srijan Malla
- Department of Surgery, Nepalese Army Institute of Health Sciences, College of Medicine, Kathmandu, Nepal.
| | - Jyoti Rayamajhi
- Department of Surgery, Nepalese Army Institute of Health Sciences, College of Medicine, Kathmandu, Nepal.
| | - Bikash Bikram Thapa
- Department of Surgery, Nepalese Army Institute of Health Sciences, College of Medicine, Kathmandu, Nepal.
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Murgo S, Lheureux O, Taccone F, Vouche M, Golzarian J. Haemoptysis treated by bronchial artery embolisation in severe acute respiratory syndrome coronavirus 2: case report. CVIR Endovasc 2020; 3:61. [PMID: 32889589 PMCID: PMC7474304 DOI: 10.1186/s42155-020-00154-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/25/2020] [Indexed: 01/15/2023] Open
Abstract
Background We found no data in the literature on the embolization of the bronchial arteries in the context of hemoptysis associated with severe acute respiratory syndrome coronavirus 2. We therefore decided to share this experience. Case presentation A 62-year-old patient with no significant medical history was admitted with acute respiratory distress. Chest computed tomography showed diffuse bilateral ground-glass opacities with limited consolidations. Diagnostic tests confirmed severe acute respiratory syndrome coronavirus 2 infection. The severity of respiratory failure required the implantation of veno-venous extracorporeal membrane oxygenation. The patient developed severe haemoptysis, which was successfully treated by bronchial artery embolisation. Conclusions In the case of coronavirus-19 pneumonia, our experience suggests that the treatment of severe haemoptysis by bronchial artery embolisation is feasible and effective. The survival benefit should be assessed in the future.
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Affiliation(s)
- Salvatore Murgo
- Erasme Hospital, ULB, route de Lennik, 808, 1070, Brussels, Belgium.
| | - Olivier Lheureux
- Erasme Hospital, ULB, route de Lennik, 808, 1070, Brussels, Belgium
| | - Fabio Taccone
- Erasme Hospital, ULB, route de Lennik, 808, 1070, Brussels, Belgium
| | - Michael Vouche
- Erasme Hospital, ULB, route de Lennik, 808, 1070, Brussels, Belgium
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Pagano MB, Cataife G, Fertrin KY, Gernsheimer T, R Hess J, Staley E, Clark C, Senn N, Tuott E, C Tsang H. Blood use and transfusion needs at a large health care system in Washington state during the SARS-CoV-2 pandemic. Transfusion 2020; 60:2859-2866. [PMID: 32856307 DOI: 10.1111/trf.16051] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND This report evaluates hospital blood use trends during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, and identifies factors associated with the need for transfusion and risk of death in patients with coronavirus 2019 (COVID-19). METHODS Overall hospital blood use and medical records of adult patients with COVID-19 were extracted for two institutions. Multivariate logistic regression models were conducted to estimate associations between the outcomes transfusion and mortality and patient factors. RESULTS Daily blood use decreased compared to pre-COVID-19 levels; the effect was more significant for platelets (29% and 34%) compared to red blood cells (25% and 20%) at the two institutions, respectively. Surgical and oncologic services had a decrease in average daily use of platelets of 52% and 30%, and red blood cells of 39% and 25%, respectively. A total of 128 patients with COVID-19 were hospitalized, and 13 (10%) received at least one transfusion due to anemia secondary to chronic illness (n = 7), recent surgery (n = 3), and extracorporeal membrane oxygenation (n = 3). Lower baseline platelet count and admission to the intensive care unit were associated with increased risk of transfusion. The blood group distribution in patients with COVID-19 was 37% group O, 40% group A, 18% group B, and 5% group AB. Non-type O was not associated with increased risk of mortality. CONCLUSION The response to the SARS-CoV-2 pandemic included changes in routine hospital operations that allowed for the provision of a sufficient level of care for patients with and without COVID-19. Although blood type may play a role in COVID-19 susceptibility, it did not seem to be associated with patient mortality.
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Affiliation(s)
- Monica B Pagano
- Transfusion Medicine Division, Laboratory Medicine, University of Washington, Seattle, Washington, USA.,Hematology Division, Medicine, University of Washington, Seattle, Washington, USA
| | - Guido Cataife
- Impaq International LLC, Health Division, Columbia, Maryland, USA
| | | | - Terry Gernsheimer
- Transfusion Medicine Division, Laboratory Medicine, University of Washington, Seattle, Washington, USA.,Hematology Division, Medicine, University of Washington, Seattle, Washington, USA
| | - John R Hess
- Transfusion Medicine Division, Laboratory Medicine, University of Washington, Seattle, Washington, USA.,Hematology Division, Medicine, University of Washington, Seattle, Washington, USA
| | - Elizabeth Staley
- Transfusion Medicine Division, Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Christine Clark
- Transfusion Medicine Division, Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Nina Senn
- Transfusion Medicine Division, Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Erin Tuott
- Transfusion Medicine Division, Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Hamilton C Tsang
- Transfusion Medicine Division, Laboratory Medicine, University of Washington, Seattle, Washington, USA
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