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Montorfano M, Leoni O, Andreassi A, Ludergnani M, Moroni F, Ancona MB, Landoni G, Ciceri F, Zangrillo A. Chronic anticoagulant treatment and risk of mortality in SARS-Cov2 patients: a large population-based study. Minerva Med 2023; 114:628-633. [PMID: 35191294 DOI: 10.23736/s0026-4806.22.07797-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hypercoagulability is often seen in COVID-19 patients and thromboembolic events appear frequent; antithrombotic treatment has been proposed therefore as part of standard treatment for COVID-19. Under these premises, prior-to-infection antithrombotic treatment may have a protective effect with respect to COVID-19 related thromboembolic events. Aim of the present work was to evaluate the impact of prior-to-infection anticoagulant or antiplatelet treatment on COVID-19 outcomes. METHODS Beneficiaries of the Regional Health Service of the Lombardy region of Italy aged ≥40 years with a COVID-19 diagnosis made between February 21st and July 18th, 2020 were included in the present study. The impact on COVID-19 mortality of pre-existing and chronic therapy with anticoagulant drugs (vitamin-K antagonist or new oral anticoagulants) was evaluated. Analyses were repeated with antiplatelets drugs. RESULTS Among 79,934 SARS-CoV-2 patients beneficiaries of the Regional Healthcare System of the Lombardy Region who received a diagnosis between February 21st and July 18th, 2020, chronic pre-existing anticoagulant assumption was present in 6.0% and antiplatelets in 12.7%. The overall unadjusted mortality rate was 20.6%, with male sex, age category and comorbidity burden being significantly associated to increased mortality risk. Anticoagulant chronic treatment was not associated with a reduction in mortality. Similar results were observed when repeating the analyses for pre-existing oral antiplatelet treatment. CONCLUSIONS In a large population-based study evaluating more than 79,000 COVID-19 patients, pre-existing antithrombotic therapy was not associated to a benefit in terms of mortality. Further studies are needed to evaluate the role of antithrombotic therapy as standard treatment among COVID-19 patients.
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Affiliation(s)
- Matteo Montorfano
- Unit of Interventional Cardiology, IRCCS San Raffaele Scientific Institute, Milan, Italy -
| | - Olivia Leoni
- Welfare Directorate, Regione Lombardia, Milan, Italy
| | | | | | - Francesco Moroni
- Unit of Interventional Cardiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco B Ancona
- Unit of Interventional Cardiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Fabio Ciceri
- Vita-Salute San Raffaele University, Milan, Italy
- Unit of Hematology and Bone Marrow Transplant, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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Alshammary AF, AlQarni HM, Farzan R, Ali Khan I, Vennu V. The risk of venous thromboembolism and blood hyperlactatemia is associated with increased mortality among critically ill patients with Covid-19. THE CLINICAL RESPIRATORY JOURNAL 2023. [PMID: 37144596 DOI: 10.1111/crj.13628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/24/2023] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Coronavirus disease 2019 (Covid-19) following venous thromboembolism (VTE) and blood hyperlactatemia are associated with higher mortality. However, reliable biomarkers for this association remain to be elucidated. This study investigated the associations of VTE risk and blood hyperlactatemia with mortality among critically ill Covid-19 patients admitted to the intensive care unit (ICU). METHODS In this single-centre retrospective study, we included 171 patients aged ≥18 years with confirmed Covid-19 admitted to the ICU at a tertiary healthcare clinic in the Eastern region of Saudi Arabia between 1 March 2020 and 31 January 2021. Patients were divided into two groups: survivor and non-survivor. The survivors have been identified as the patients discharged from the ICU alive. The VTE risk was defined using a Padua prediction score (PPS) >4. The blood lactate concentration (BLC) cut-off value >2 mmol/L was used to determine the blood hyperlactatemia. RESULTS Multi-factor Cox analysis showed that PPS >4 and BLC >2 mmol/L were more likely to be significantly associated with higher odds of ICU mortality in critically ill Covid-19 patients (hazard ratio [HR] = 2.80, 95% confidence interval [CI] = 1.00-8.08, p = 0.050; HR = 3.87, 95% CI = 1.12-13.45, p = 0.033, respectively). The Area under the Curve for VTE and blood hyperlactatemia were 0.62 and 0.85, respectively. CONCLUSION VTE risk and blood hyperlactatemia have been associated with a higher mortality risk in critically ill Covid-19 patients who are hospitalized in the ICU in Saudi Arabia. According to our findings, these people needed more effective VTE prevention strategies based on a personalized assessment of their risk of bleeding. Moreover, persons without diabetes and other groups with a high risk of dying from COVID-19 may be recognized by measuring glucose as having elevated glucose and lactate jointly.
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Affiliation(s)
- Amal F Alshammary
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Hassan M AlQarni
- Clinical Pharmacy Resident, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Raed Farzan
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Imran Ali Khan
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Vishal Vennu
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Hogwood J, Mulloy B, Lever R, Gray E, Page CP. Pharmacology of Heparin and Related Drugs: An Update. Pharmacol Rev 2023; 75:328-379. [PMID: 36792365 DOI: 10.1124/pharmrev.122.000684] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 02/17/2023] Open
Abstract
Heparin has been used extensively as an antithrombotic and anticoagulant for close to 100 years. This anticoagulant activity is attributed mainly to the pentasaccharide sequence, which potentiates the inhibitory action of antithrombin, a major inhibitor of the coagulation cascade. More recently it has been elucidated that heparin exhibits anti-inflammatory effect via interference of the formation of neutrophil extracellular traps and this may also contribute to heparin's antithrombotic activity. This illustrates that heparin interacts with a broad range of biomolecules, exerting both anticoagulant and nonanticoagulant actions. Since our previous review, there has been an increased interest in these nonanticoagulant effects of heparin, with the beneficial role in patients infected with SARS2-coronavirus a highly topical example. This article provides an update on our previous review with more recent developments and observations made for these novel uses of heparin and an overview of the development status of heparin-based drugs. SIGNIFICANCE STATEMENT: This state-of-the-art review covers recent developments in the use of heparin and heparin-like materials as anticoagulant, now including immunothrombosis observations, and as nonanticoagulant including a role in the treatment of SARS-coronavirus and inflammatory conditions.
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Affiliation(s)
- John Hogwood
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, United Kingdom (B.M., E.G., C.P.P.); National Institute for Biological Standards and Control, South Mimms, Hertfordshire, United Kingdom (J.H., E.G.) and School of Pharmacy, University College London, London, United Kingdom (R.L.)
| | - Barbara Mulloy
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, United Kingdom (B.M., E.G., C.P.P.); National Institute for Biological Standards and Control, South Mimms, Hertfordshire, United Kingdom (J.H., E.G.) and School of Pharmacy, University College London, London, United Kingdom (R.L.)
| | - Rebeca Lever
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, United Kingdom (B.M., E.G., C.P.P.); National Institute for Biological Standards and Control, South Mimms, Hertfordshire, United Kingdom (J.H., E.G.) and School of Pharmacy, University College London, London, United Kingdom (R.L.)
| | - Elaine Gray
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, United Kingdom (B.M., E.G., C.P.P.); National Institute for Biological Standards and Control, South Mimms, Hertfordshire, United Kingdom (J.H., E.G.) and School of Pharmacy, University College London, London, United Kingdom (R.L.)
| | - Clive P Page
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, United Kingdom (B.M., E.G., C.P.P.); National Institute for Biological Standards and Control, South Mimms, Hertfordshire, United Kingdom (J.H., E.G.) and School of Pharmacy, University College London, London, United Kingdom (R.L.)
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Hajjar LA, Ancona MB, Filho RK, Tresoldi M, Caldas JG, Monti G, Carnevale FC, De Cobelli F, Moreira de Assis A, Ciceri F, Landoni G, Dijkstra J, Moroni F, Abizaid AAC, Willemann Ungaretti F, Carvalho Carmona MJ, De Backer D, Pompilio CE, de Britto FS, Campos CM, Zangrillo A, Montorfano M. Microvascular lung vessels obstructive thromboinflammatory syndrome in patients with COVID-19: Insights from lung intravascular optical coherence tomography. Front Med (Lausanne) 2023; 10:1050531. [PMID: 36873865 PMCID: PMC9978141 DOI: 10.3389/fmed.2023.1050531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
Background Microvascular lung vessels obstructive thromboinflammatory syndrome has been proposed as a possible mechanism of respiratory failure in COVID-19 patients. However, it has only been observed in post-mortem studies and has never been documented in vivo, probably because of a lack of CT scan sensitivity in small pulmonary arteries. The aim of the present study was to assess the safety, tolerability, and diagnostic value of optical coherence tomography (OCT) for the assessment of patients with COVID-19 pneumonia for pulmonary microvascular thromboinflammatory syndrome. Methods The COVID-OCT trial was a multicenter, open-label, prospective, interventional clinical study. Two cohorts of patients were included in the study and underwent pulmonary OCT evaluation. Cohort A consisted of patients with COVID-19 with a negative CT scan for pulmonary thrombosis and elevated thromboinflammatory markers (D-dimer > 10,000 ng/mL or 5,000 < D-dimer < 10,000 ng/mL and one of: C-reactive Protein > 100 mg/dL, IL-6 > 6 pg/mL, or ferritin > 900 ng/L). Cohort B consisted of patients with COVID-19 and a CT scan positive for pulmonary thrombosis. The primary endpoints of the study were: (i) to evaluate the overall safety of OCT investigation in patients with COVID-19 pneumonia, and (ii) to report on the potential value of OCT as a novel diagnostic tool for the diagnosis of microvascular pulmonary thrombosis in COVID-19 patients. Results A total of 13 patients were enrolled. The mean number of OCT runs performed in each patient was 6.1 ± 2.0, both in ground glass and healthy lung areas, achieving a good evaluation of the distal pulmonary arteries. Overall, OCT runs identified microvascular thrombosis in 8 patients (61.5%): 5 cases of red thrombus, 1 case of white thrombus, and 2 cases of mixed thrombus. In Cohort A, the minimal lumen area was 3.5 ± 4.6 mm2, with stenosis of 60.9 ± 35.9% of the area, and the mean length of thrombus-containing lesions was 5.4 ± 3.0 mm. In Cohort B, the percentage area obstruction was 92.6 ± 2.6, and the mean thrombus-containing lesion length was 14.1 ± 13.9 mm. No peri-procedural complications occurred in any of the 13 patients. Conclusion OCT appears to be a safe and accurate method of evaluating the distal pulmonary arteries in hospitalized COVID-19 patients. Here, it enabled the first in vivo documentation of distal pulmonary arterial thrombosis in patients with elevated thromboinflammatory markers, even when their CT angiogram was negative for pulmonary thrombosis. Clinical trial registration ClinicalTrial.gov, identifier NCT04410549.
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Affiliation(s)
| | - Marco B Ancona
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Kalil Filho
- Heart Institute Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - José Guilherme Caldas
- Department of Interventional Neuroradiology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Giacomo Monti
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francisco Cesar Carnevale
- Interventional Radiology Department, Radiology Institute, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Francesco De Cobelli
- Radiology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - André Moreira de Assis
- Interventional Radiology Department, Radiology Institute, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Fabio Ciceri
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Department of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Jouke Dijkstra
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Francesco Moroni
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Maria José Carvalho Carmona
- Discipline of Anesthesiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Daniel De Backer
- Department of Intensive Care, CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Carlos Eduardo Pompilio
- Department of Intensive Care, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Fábio S de Britto
- Heart Institute Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Carlos M Campos
- Heart Institute Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Alberto Zangrillo
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Talasaz AH, Sadeghipour P, Mehdizadeh K, Khoshnam Rad N, Bikdeli B, Lip GYH, Harenberg J. Knowledge Gaps for Prophylactic Use of Antithrombotic Agents in Patients with COVID-19: Insights into New SARS-CoV-2 Variants, Vaccination Status, and Emerging Oral Antivirals. Thromb Haemost 2022; 123:186-191. [PMID: 36206775 PMCID: PMC9904967 DOI: 10.1055/a-1956-9641] [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] [Indexed: 01/03/2023]
Abstract
Data suggest that coronavirus disease 2019 (COVID-19) results in a prothrombotic state leading to arterial and venous thromboses. Vaccination, novel antiviral drugs, and emerging variants have changed the course of the disease in many ways; however, their effects on the incidence of thrombotic events and the efficacy of preventative antithrombotic agents have not been yet evaluated. A systematic search was conducted to identify studies reported on the incidence of thrombotic events based on vaccination status, use of novel antiviral drugs, and emerging viral variants. Similarly, we screened the ongoing/published randomized trials of preventative antithrombotic therapy in any COVID-19 population to assess whether subgroup-specific results were reported based on any of these variants. Upon searching a total of 3,451 records, only one entry fulfilled the inclusion criteria of our systematic review, which was a self-controlled case series on 29,121,633 vaccinated individuals, the incidence rate ratio of thrombotic complication after breakthrough infection was 13.86 (95% confidence interval [CI]: 12.76-15.05) compared with 1.10 (95% CI: 1.02-1.18) during the 28-day postvaccination. In conclusion, although the mortality benefit of mass vaccination and the early promising results of the new antiviral therapies are well known, we were unable to find clinical evidence on whether vaccination, the use of novel antiviral agents, and emerging viral variants have affected the incidence rate of thrombotic events or impacted the efficacy of prophylactic antithrombotic therapy in patients with COVID-19. Analyses from existing trials and large-scale registries can provide interim knowledge and any findings of relevance should be incorporated in the design of future trials.
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Affiliation(s)
- Azita H. Talasaz
- Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran,Department of Pharmacotherapy and Outcome Sciences, Virginia Commonwealth University, Richmond, Virginia, United States,Address for correspondence Azita H. Talasaz, PharmD, BCPS, BCCP Department of Clinical Pharmacy, Tehran University of Medical Sciences16 Azar St., TehranIran
| | - Parham Sadeghipour
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran,Clinical Trial Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Kasra Mehdizadeh
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Niloofar Khoshnam Rad
- Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnood Bikdeli
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States,Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States,Yale/YNHH Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut, United States,Cardiovascular Research Foundation (CRF), New York, New York, United States
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Job Harenberg
- Ruprecht Karls University, Heidelberg, Germany,Ruperto Carola University of Heidelberg, Heidelberg, Germany,Job Harenberg, MD Department of MedicineDOASENSE GmbH, Waldhofer Strasse 102, 69123 HeidelbergGermany
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6
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Alroomi M, Alsaber A, Al-Bader B, Almutairi F, Malhas H, Pan J, Zhanna KD, Ramadhan M, Saleh MA, Abdullah M, Alotaibi N, AlNasrallah N, Rajan R, Hussein S, Aboelhassan W. In-hospital Mortality Rates in SARS-CoV-2 Patients Treated with Enoxaparin and Heparin. Clin Appl Thromb Hemost 2022; 28:10760296221131802. [PMID: 36285386 PMCID: PMC9608030 DOI: 10.1177/10760296221131802] [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] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES This study aimed to investigate in-hospital mortality rates in patients with coronavirus disease (COVID-19) according to enoxaparin and heparin use. METHODS This retrospective cohort study included 962 patients admitted to two hospitals in Kuwait with a confirmed diagnosis of COVID-19. Cumulative all-cause mortality rate was the primary outcome. RESULTS A total of 302 patients (males, 196 [64.9%]; mean age, 57.2 ± 14.6 years; mean body mass index, 29.8 ± 6.5 kg/m2) received anticoagulation therapy. Patients receiving anticoagulation treatment tended to have pneumonia (n = 275 [91.1%]) or acute respiratory distress syndrome (n = 106 [35.1%]), and high D-dimer levels (median [interquartile range]: 608 [523;707] ng/mL). The mortality rate in this group was high (n = 63 [20.9%]). Multivariable logistic regression, the Cox proportional hazards, and Kaplan-Meier models revealed that the use of therapeutic anticoagulation agents affected the risk of all-cause cumulative mortality. CONCLUSION Age, hypertension, pneumonia, therapeutic anticoagulation, and methylprednisolone use were found to be strong predictors of in-hospital mortality. In elderly hypertensive COVID-19 patients on therapeutic anticoagulation were found to have 2.3 times higher risk of in-hospital mortality. All cause in-hospital mortality rate in the therapeutic anticoagulation group was up to 21%.
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Affiliation(s)
- Moudhi Alroomi
- Department of Infectious Diseases, Infectious Diseases Hospital, Shuwaikh Medical Area, Kuwait
| | - Ahmad Alsaber
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Bader Al-Bader
- Department of Medicine, Farwaniya Hospital, Farwaniya, Kuwait
| | - Farah Almutairi
- Department of Medicine, Farwaniya Hospital, Farwaniya, Kuwait
| | - Haya Malhas
- Department of Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Jiazhu Pan
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Kobalava D. Zhanna
- Department of Internal Medicine with the Subspecialty of Cardiology and Functional Diagnostics Named after V.S. Moiseev, Institute of Medicine, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russian Federation
| | - Maryam Ramadhan
- Department of Obstetrics and Gynaecology, Maternity Hospital, Shuwaikh Medical Area, Kuwait
| | | | - Mohammed Abdullah
- Department of Infectious Diseases, Infectious Diseases Hospital, Shuwaikh Medical Area, Kuwait
| | - Naser Alotaibi
- Department of Medicine, Al Adan Hospital, Hadiya, Kuwait
| | | | - Rajesh Rajan
- Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Al Amiri Hospital, Kuwait City, Kuwait,Rajesh Rajan, Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Al Amiri Hospital, Kuwait City, Kuwait, 15003.
| | - Soumoud Hussein
- Department of Medicine, Al Amiri Hospital, Kuwait City, Kuwait
| | - Wael Aboelhassan
- Division of Gastroenterology, Department of Medicine, Jaber Al Ahmed Hospital, South Surra, Kuwait
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Approach to Thromboprophylaxis for Prevention of Venous Thromboembolism in COVID-19: Global Updates and Clinical Insights from India. Clin Pract 2022; 12:766-781. [PMID: 36286066 PMCID: PMC9601217 DOI: 10.3390/clinpract12050080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 11/30/2022] Open
Abstract
Venous thromboembolism (VTE) frequently occurs in patients with coronavirus disease-19 (COVID-19) and is associated with increased mortality. Several global guidelines recommended prophylactic-intensity anticoagulation rather than intermediate-intensity or therapeutic-intensity anticoagulation for patients with COVID-19-related acute or critical illness without suspected or confirmed VTE. Even though standard doses of thromboprophylaxis are received, many cases of thrombotic complications are reported; hence, appropriate and adequate thromboprophylaxis is critical for the prevention of VTE in COVID-19. In spite of an increased prevalence of VTE in Indian patients, sufficient data on patient characteristics, diagnosis, and therapeutic approach for VTE in COVID is lacking. In this article, we review the available global literature (search conducted up to 31 May 2021) and provide clinical insights into our approach towards managing VTE in patients with COVID-19. Furthermore, in this review, we summarize the incidence and risk factors for VTE with emphasis on the thromboprophylaxis approach in hospitalized patients and special populations with COVID-19 and assess clinical implications in the Indian context.
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8
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Pre-hospital Aspirin Use and Patient Outcomes in COVID-19: Results from the International Viral Infection and Respiratory Illness Universal Study (VIRUS). Arch Bronconeumol 2022; 58:746-753. [PMID: 36153214 PMCID: PMC9451929 DOI: 10.1016/j.arbres.2022.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/26/2022] [Accepted: 07/26/2022] [Indexed: 12/18/2022]
Abstract
Introduction The goal of this investigation is to assess the association between prehospital use of aspirin (ASA) and patient-centered outcomes in a large global cohort of hospitalized COVID-19 patients. Methods This study utilizes data from the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) Registry. Adult patients hospitalized from February 15th, 2020, to September 30th, 2021, were included. Multivariable regression analyses were utilized to assess the association between pre-hospital use of ASA and the primary outcome of overall hospital mortality. Results 21,579 patients were included from 185 hospitals (predominantly US-based, 71.3%), with 4691 (21.7%) receiving pre-hospital ASA. Patients receiving ASA, compared to those without pre-admission ASA use, were generally older (median 70 vs. 59 years), more likely to be male (58.7 vs. 56.0%), caucasian (57.4 vs. 51.6%), and more commonly had higher rates of medical comorbidities. In multivariable analyses, patients receiving pre-hospital ASA had lower mortality (HR: 0.89, 95% CI 0.82–0.97, p = 0.01) and reduced hazard for progression to severe disease or death (HR: 0.91, 95% CI 0.84–0.99, p = 0.02) and more hospital free days (1.00 days, 95% CI 0.66–1.35, p = 0.01) compared to those without pre-hospital ASA use. The overall direction and significance of the results remained the same in sensitivity analysis, after adjusting the multivariable model for time since pandemic. Conclusions In this large international cohort, pre-hospital use of ASA was associated with a lower hazard for death in hospitalized patients with COVID-19. Randomized controlled trials may be warranted to assess the utility of pre-hospital use of ASA.
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ALGhasab NS, Altamimi LA, Alharbi MS, ALMesned SS, Khetan AK. Venous thromboembolism in COVID-19: A meta-summary of cases. Saudi Med J 2022; 43:979-990. [PMID: 36104055 PMCID: PMC9987652 DOI: 10.15537/smj.2022.43.9.20220316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/13/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To summarize cases of venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT) among coronavirus disease (COVID-19) patients and discuss their symptoms, diagnostic method, clinical features, and prognosis. METHODS All major databases were searched for relevant studies published between December 1, 2019 and May 5, 2021. RESULTS A total of 233 articles were identified, 22 describing 48 patients were included. A total of 79.1% had PE and 20.9% had DVT. Most patients were men, with a mean age of 56 years. Comorbidities were present in 70.8%, and 85.4% had at least one risk factor of VTE. 56.3% had received anticoagulation therapy. Most patients were treated in the general ward. Complications occurred in 27.1% of the patients, and recovery was achieved in 80.4%. CONCLUSION Venous thromboembolism must be suspected even in patients who had received prior anticoagulant regimens or in stable cases, especially in males, the elderly, and patients with comorbidities and high D-dimer levels.
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Affiliation(s)
- Naif Saad ALGhasab
- From the Department of Internal Medicine (ALGhasab), Medical Collage, Ha’il University; from the Department of Medicine (Alharbi), College of Medicine, University of Ha’il, Ha’il; from the College of Medicine (Altamimi), King Saud University, Riyadh; from the Department of Surgery (ALMesned), Medical College, Qassim University, Buraydah, Kingdom of Saudi Arabia; and from the Department of Medicine (ALGhasab, Khetan), McMaster University, Canada.
| | - Leen A. Altamimi
- From the Department of Internal Medicine (ALGhasab), Medical Collage, Ha’il University; from the Department of Medicine (Alharbi), College of Medicine, University of Ha’il, Ha’il; from the College of Medicine (Altamimi), King Saud University, Riyadh; from the Department of Surgery (ALMesned), Medical College, Qassim University, Buraydah, Kingdom of Saudi Arabia; and from the Department of Medicine (ALGhasab, Khetan), McMaster University, Canada.
- Address correspondence and reprint request to: Dr. Leen A. Altamimi, from the College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail: ORCID ID: https://orcid.org/0000-0003-3718-5291
| | - Mohammed Salem Alharbi
- From the Department of Internal Medicine (ALGhasab), Medical Collage, Ha’il University; from the Department of Medicine (Alharbi), College of Medicine, University of Ha’il, Ha’il; from the College of Medicine (Altamimi), King Saud University, Riyadh; from the Department of Surgery (ALMesned), Medical College, Qassim University, Buraydah, Kingdom of Saudi Arabia; and from the Department of Medicine (ALGhasab, Khetan), McMaster University, Canada.
| | - Sulaman S. ALMesned
- From the Department of Internal Medicine (ALGhasab), Medical Collage, Ha’il University; from the Department of Medicine (Alharbi), College of Medicine, University of Ha’il, Ha’il; from the College of Medicine (Altamimi), King Saud University, Riyadh; from the Department of Surgery (ALMesned), Medical College, Qassim University, Buraydah, Kingdom of Saudi Arabia; and from the Department of Medicine (ALGhasab, Khetan), McMaster University, Canada.
| | - Aditya K. Khetan
- From the Department of Internal Medicine (ALGhasab), Medical Collage, Ha’il University; from the Department of Medicine (Alharbi), College of Medicine, University of Ha’il, Ha’il; from the College of Medicine (Altamimi), King Saud University, Riyadh; from the Department of Surgery (ALMesned), Medical College, Qassim University, Buraydah, Kingdom of Saudi Arabia; and from the Department of Medicine (ALGhasab, Khetan), McMaster University, Canada.
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Sato L, Ishikane M, Okumura N, Iwamoto N, Hayakawa K, Iseki K, Hara H, Ohmagari N. A novel anticoagulation treatment protocol using unfractionated heparin for coronavirus disease 2019 patients in Japan, 2022. Glob Health Med 2022; 4:233-236. [PMID: 36119785 PMCID: PMC9420327 DOI: 10.35772/ghm.2022.01030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/30/2022] [Accepted: 07/29/2022] [Indexed: 06/15/2023]
Abstract
Hypercoagulability, which can be induced by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) plays an important role in the pathogenesis of coronavirus disease 2019 (COVID-19). Although anticoagulation therapy is expected to decrease the incidence of thrombosis and mortality in COVID-19 patients, the optimal use of anticoagulation therapy has not been established, especially using unfractionated heparin (UFH). Herein, we suggest a new anticoagulation treatment protocol for the use of UFH in Japanese COVID-19 patients. This protocol considers the safety regarding UFH usage, to lower major bleeding events, and reflects the latest evidence and the current situation regarding anticoagulation therapy in Japan.
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Affiliation(s)
- Lubna Sato
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
- Department of Emergency and Critical Care Medicine, Fukushima Medical University, Fukushima, Japan
| | - Masahiro Ishikane
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Nobumasa Okumura
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Noriko Iwamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kayoko Hayakawa
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Ken Iseki
- Department of Emergency and Critical Care Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hisao Hara
- Department of Cardiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
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11
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Nab L, Groenwold RHH, Klok FA, Bhoelan S, Kruip MJHA, Cannegieter SC. Estimating incidence of venous thromboembolism in COVID-19: Methodological considerations. Res Pract Thromb Haemost 2022; 6:e12776. [PMID: 35992195 PMCID: PMC9376932 DOI: 10.1002/rth2.12776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/24/2022] [Accepted: 07/05/2022] [Indexed: 12/15/2022] Open
Abstract
Background Coagulation abnormalities and coagulopathy are recognized as consequences of severe acute respiratory syndrome coronavirus 2 infection and the resulting coronavirus disease 2019 (COVID-19). Specifically, venous thromboembolism (VTE) has been reported as a frequent complication. By May 27, 2021, at least 93 original studies and 25 meta-analyses investigating VTE incidence in patients with COVID-19 had been published, showing large heterogeneity in reported VTE incidence ranging from 0% to 85%. This large variation complicates interpretation of individual study results as well as comparisons across studies, for example, to investigate changes in incidence over time, compare subgroups, and perform meta-analyses. Objectives This study sets out to provide an overview of sources of heterogeneity in VTE incidence studies in patients with COVID-19, illustrated using examples. Methods The original studies of three meta-analyses were screened and a list of sources of heterogeneity that may explain observed heterogeneity across studies was composed. Results The sources of heterogeneity in VTE incidence were classified as clinical sources and methodologic sources. Clinical sources of heterogeneity include differences between studies regarding patient characteristics that affect baseline VTE risk and protocols used for VTE testing. Methodologic sources of heterogeneity include differences in VTE inclusion types, data quality, and the methods used for data analysis. Conclusions To appreciate reported estimates of VTE incidence in patients with COVID-19 in relation to its etiology, prevention, and treatment, researchers should unambiguously report about possible clinical and methodological sources of heterogeneity in those estimates. This article provides suggestions for that.
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Affiliation(s)
- Linda Nab
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Rolf H. H. Groenwold
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
- Department of Biomedical Data SciencesLeiden University Medical CenterLeidenThe Netherlands
| | - Frederikus A. Klok
- Department of Medicine – Thrombosis and HaemostatisLeiden University Medical CenterLeidenThe Netherlands
| | - Soerajja Bhoelan
- Department of HaematologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | | | - Suzanne C. Cannegieter
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
- Department of Medicine – Thrombosis and HaemostatisLeiden University Medical CenterLeidenThe Netherlands
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12
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Thomas MR, Scully M. Clinical features of thrombosis and bleeding in COVID-19. Blood 2022; 140:184-195. [PMID: 35452509 PMCID: PMC9040438 DOI: 10.1182/blood.2021012247] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/13/2022] [Indexed: 01/08/2023] Open
Abstract
Infection with the SARS-CoV-2 virus, resulting in COVID-19 disease, has presented a unique scenario associated with high rates of thrombosis. The risk of venous thrombosis is some three- to sixfold higher than for patients admitted to a hospital for other indications, and for patients who have thrombosis, mortality appears to increase. Thrombosis may be a presenting feature of COVID-19. Pulmonary thrombi are the most frequent events, some related to deep vein thrombosis, but also to in situ microvascular and macrovascular thrombosis. Other venous thromboses include catheter- and circuit-associated in patients requiring hemofiltration and extracorporeal membrane oxygenation. Arterial thrombosis is less commonly documented, with 3% of patients in intensive care units having major arterial strokes and up to 9% having myocardial infarction, both of which are most likely multifactorial. Risk factors for thrombosis above those already documented in hospital settings include duration of COVID-19 symptoms before admission to the hospital. Laboratory parameters associated with higher risk of thrombosis include higher D-dimer, low fibrinogen, and low lymphocyte count, with higher factor VIII and von Willebrand factor levels indicative of more severe COVID-19 infection. All patients should receive thromboprophylaxis when admitted with COVID-19 infection, but the dose and length of treatment are still debated. Thrombosis continues to be treated according to standard VTE guidelines, but adjustments may be needed depending on other factors relevant to the patient's admission.
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Affiliation(s)
- Mari R Thomas
- Department of Haematology, University College London Hospital (UCLH), London, United Kingdom; and
- Cardiometabolic Programme, National Institute for Health and Care Research (NIHR), UCLH, University College London Biomedical Research Centre (BRC), London, United Kingdom
| | - Marie Scully
- Department of Haematology, University College London Hospital (UCLH), London, United Kingdom; and
- Cardiometabolic Programme, National Institute for Health and Care Research (NIHR), UCLH, University College London Biomedical Research Centre (BRC), London, United Kingdom
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13
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Timpau AS, Miftode RS, Leca D, Timpau R, Miftode IL, Petris AO, Costache II, Mitu O, Nicolae A, Oancea A, Jigoranu A, Tuchilus CG, Miftode EG. A Real Pandora's Box in Pandemic Times: A Narrative Review on the Acute Cardiac Injury Due to COVID-19. LIFE (BASEL, SWITZERLAND) 2022; 12:life12071085. [PMID: 35888173 PMCID: PMC9318707 DOI: 10.3390/life12071085] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 01/08/2023]
Abstract
The intricate relationship between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the cardiovascular system is an extensively studied pandemic topic, as there is an ever-increasing amount of evidence that reports a high prevalence of acute cardiac injury in the context of viral infection. In patients with Coronavirus disease 2019, COVID-19, a significant increase in serum levels of cardiac troponin or other various biomarkers was observed, suggesting acute cardiac injury, thus predicting both a severe course of the disease and a poor outcome. Pathogenesis of acute cardiac injury is not yet completely elucidated, though several mechanisms are allegedly involved, such as a direct cardiomyocyte injury, oxygen supply-demand inequity caused by hypoxia, several active myocardial depressant factors during sepsis, and endothelial dysfunction due to the hyperinflammatory status. Moreover, the increased levels of plasma cytokines and catecholamines and a significantly enhanced prothrombotic environment may lead to the destabilization and rupture of atheroma plaques, subsequently triggering an acute coronary syndrome. In the present review, we focus on describing the epidemiology, pathogenesis, and role of biomarkers in the diagnosis and prognosis of patients with acute cardiac injury in the setting of the COVID-19 pandemic. We also explore some novel therapeutic strategies involving immunomodulatory therapy, as well as their role in preventing a severe form of the disease, with both the short-term outcome and the long-term cardiovascular sequelae being equally important in patients with SARS-CoV-2 induced acute cardiac injury.
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Affiliation(s)
- Amalia-Stefana Timpau
- Department of Infectious Diseases (Internal Medicine II), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (A.-S.T.); (D.L.); (I.-L.M.); (E.-G.M.)
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (A.O.P.); (O.M.); (A.N.); (A.O.); (A.J.)
| | - Radu-Stefan Miftode
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (A.O.P.); (O.M.); (A.N.); (A.O.); (A.J.)
- Correspondence: (R.-S.M.); (I.I.C.)
| | - Daniela Leca
- Department of Infectious Diseases (Internal Medicine II), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (A.-S.T.); (D.L.); (I.-L.M.); (E.-G.M.)
| | - Razvan Timpau
- Department of Radiology and Medical Imaging, St. Spiridon Emergency Hospital, 700115 Iasi, Romania;
| | - Ionela-Larisa Miftode
- Department of Infectious Diseases (Internal Medicine II), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (A.-S.T.); (D.L.); (I.-L.M.); (E.-G.M.)
| | - Antoniu Octavian Petris
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (A.O.P.); (O.M.); (A.N.); (A.O.); (A.J.)
| | - Irina Iuliana Costache
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (A.O.P.); (O.M.); (A.N.); (A.O.); (A.J.)
- Correspondence: (R.-S.M.); (I.I.C.)
| | - Ovidiu Mitu
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (A.O.P.); (O.M.); (A.N.); (A.O.); (A.J.)
| | - Ana Nicolae
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (A.O.P.); (O.M.); (A.N.); (A.O.); (A.J.)
| | - Alexandru Oancea
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (A.O.P.); (O.M.); (A.N.); (A.O.); (A.J.)
| | - Alexandru Jigoranu
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (A.O.P.); (O.M.); (A.N.); (A.O.); (A.J.)
| | - Cristina Gabriela Tuchilus
- Department of Preventive Medicine and Interdisciplinarity (Microbiology), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania;
| | - Egidia-Gabriela Miftode
- Department of Infectious Diseases (Internal Medicine II), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (A.-S.T.); (D.L.); (I.-L.M.); (E.-G.M.)
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14
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Batista DR, Floriano I, Silvinato A, Bacha HA, Barbosa AN, Tanni SE, Bernardo WM. Use of anticoagulants in patients with COVID-19: a living systematic review and meta-analysis. JORNAL BRASILEIRO DE PNEUMOLOGIA : PUBLICACAO OFICIAL DA SOCIEDADE BRASILEIRA DE PNEUMOLOGIA E TISILOGIA 2022; 48:e20220041. [PMID: 35674523 PMCID: PMC9262438 DOI: 10.36416/1806-3756/e20220041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/07/2022] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To answer questions related to the use of anticoagulants in the treatment of COVID-19 patients. METHODS This was a systematic review and meta-analysis of phase 3 randomized controlled trials comparing the use of anticoagulants in non-hospitalized and hospitalized COVID-19 patients. We searched the following databases: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from their inception to January 22, 2022. The risk of bias was assessed by the Cochrane risk-of-bias tool, and the quality of evidence was assessed by the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS A total of 401 studies were initially selected. Of those, 9 met the inclusion criteria and were therefore analyzed (a total of 6,004 patients being analyzed). In non-hospitalized COVID-19 patients, no significant difference was found between post-discharge prophylactic anticoagulation and no intervention regarding venous thromboembolism or bleeding at 30 days. In hospitalized COVID-19 patients, full anticoagulation resulted in a slight reduction in thrombotic events at 30 days (risk difference, -0.03; 95% CI, -0.06 to -0.00; p = 0.04; I2 = 78%), the quality of evidence being moderate. However, no significant difference was found between full anticoagulation and no intervention regarding the risk of major bleeding, the quality of evidence being very low. No significant difference was found between intermediate- and standard-dose prophylactic anticoagulation (risk difference, -0.01; 95% CI, -0.07 to 0.06; p = 0.81; I2 = 0%), the quality of evidence being very low. CONCLUSIONS Therapeutic anticoagulation appears to have no effect on mortality in COVID-19 patients, resulting in a slight reduction in venous thromboembolism in hospitalized patients.
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Affiliation(s)
- Diane R Batista
- . Divisão de Pneumologia, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu (SP) Brasil
| | - Idevaldo Floriano
- . Medicina Baseada em Evidências, Associação Médica Brasileira, São Paulo (SP) Brasil
| | - Antonio Silvinato
- . Medicina Baseada em Evidências, Cooperativa Baixa Mogiana, Mogi-Guaçu (SP) Brasil
| | - Hélio A Bacha
- . Hospital Israelita Albert Einstein, São Paulo (SP) Brasil
| | - Alexandre N Barbosa
- . Departamento de Infectologia, Universidade Estadual Paulista, Botucatu (SP) Brasil
| | - Suzana E Tanni
- . Divisão de Pneumologia, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu (SP) Brasil
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15
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Sabbatinelli J, Matacchione G, Giuliani A, Ramini D, Rippo MR, Procopio AD, Bonafè M, Olivieri F. Circulating biomarkers of inflammaging as potential predictors of COVID-19 severe outcomes. Mech Ageing Dev 2022; 204:111667. [PMID: 35341896 PMCID: PMC8949647 DOI: 10.1016/j.mad.2022.111667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/22/2022] [Accepted: 03/22/2022] [Indexed: 01/10/2023]
Abstract
The COVID-19 pandemic caused by SARS-CoV-2 infection has been of unprecedented clinical and socio-economic worldwide relevance. The case fatality rate for COVID-19 grows exponentially with age and the presence of comorbidities. In the older patients, COVID-19 manifests predominantly as a systemic disease associated with immunological, inflammatory, and procoagulant responses. Timely diagnosis and risk stratification are crucial steps to define appropriate therapies and reduce mortality, especially in the older patients. Chronically and systemically activated innate immune responses and impaired antiviral responses have been recognized as the results of a progressive remodeling of the immune system during aging, which can be described by the words 'immunosenescence' and 'inflammaging'. These age-related features of the immune system were highlighted in patients affected by COVID-19 with the poorest clinical outcomes, suggesting that the mechanisms underpinning immunosenescence and inflammaging could be relevant for COVID-19 pathogenesis and progression. Increasing evidence suggests that senescent myeloid and endothelial cells are characterized by the acquisition of a senescence-associated pro-inflammatory phenotype (SASP), which is considered as the main culprit of both immunosenescence and inflammaging. Here, we reviewed this evidence and highlighted several circulating biomarkers of inflammaging that could provide additional prognostic information to stratify COVID-19 patients based on the risk of severe outcomes.
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Affiliation(s)
- Jacopo Sabbatinelli
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy; Laboratory Medicine, AOU Ospedali Riuniti, Ancona, Italy
| | - Giulia Matacchione
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Angelica Giuliani
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Deborah Ramini
- Center of Clinical Pathology and Innovative Therapy, IRCCS INRCA, Ancona, Italy
| | - Maria Rita Rippo
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Antonio Domenico Procopio
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy; Center of Clinical Pathology and Innovative Therapy, IRCCS INRCA, Ancona, Italy
| | - Massimiliano Bonafè
- Department of Experimental, Diagnostic and Specialty Medicine, Università di Bologna, Bologna, Italy
| | - Fabiola Olivieri
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy; Center of Clinical Pathology and Innovative Therapy, IRCCS INRCA, Ancona, Italy.
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16
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Incidence and prognostic value of pulmonary embolism in COVID-19: A systematic review and meta-analysis. PLoS One 2022; 17:e0263580. [PMID: 35286316 PMCID: PMC8920268 DOI: 10.1371/journal.pone.0263580] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 01/21/2022] [Indexed: 01/08/2023] Open
Abstract
Background Pulmonary embolisms are frequently and prognostically in individuals infected by coronavirus disease 2019 (COVID-19); the incidence of pulmonary embolisms is varied across numerous studies. This study aimed to assess the pooled incidence of pulmonary embolic events and the prognostic value of such events in intensive care unit (ICU) admissions of patients with COVID-19. Methods The Cochrane Library, PubMed, and EmBase were systematically searched for eligible studies published on or before October 20, 2021. The pooled incidence of pulmonary embolism was calculated using the random-effects model. Moreover, the prognostic value was assessed by measuring the sensitivity, specificity, positive and negative likelihood ratio (PLR and NLR), diagnostic odds ratio (DOR), and the area under the receiver operating characteristic curve (AUC). Results Thirty-six studies involving 10,367 COVID-19 patients were selected for the final meta-analysis. The cumulative incidence of pulmonary embolism in patients with COVID-19 was 21% (95% confidence interval [95%CI]: 18−24%; P<0.001), and the incidence of pulmonary embolism in ICU and non-ICU patients was 26% (95%CI: 22−31%; P<0.001) and 17% (95%CI: 14−20%; P<0.001), respectively. The predictive role of pulmonary embolism in ICU admission was also assessed, and the sensitivity, specificity, PLR, NLR, DOR, and AUC were 0.31 (95%CI: 0.21−0.42), 0.84 (95%CI: 0.75−0.90), 1.88 (95%CI: 1.45−2.45), 0.83 (95%CI: 0.75−0.91), 2.25 (95%CI: 1.64−3.08), and 0.61 (95%CI: 0.57−0.65), respectively. Conclusion This study found that the incidence of pulmonary embolism was relatively high in COVID-19 patients, and the incidence of pulmonary embolism in ICU patients was higher than that in non-ICU patients.
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17
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Chiner-Vives E, Cordovilla-Pérez R, de la Rosa-Carrillo D, García-Clemente M, Izquierdo-Alonso JL, Otero-Candelera R, Pérez-de Llano L, Sellares-Torres J, de Granda-Orive JI. Short and Long-Term Impact of COVID-19 Infection on Previous Respiratory Diseases. Arch Bronconeumol 2022; 58 Suppl 1:39-50. [PMID: 35501222 PMCID: PMC9012323 DOI: 10.1016/j.arbres.2022.03.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 03/30/2022] [Indexed: 02/07/2023]
Abstract
On March 11, 2020, the World Health Organization declared Coronavirus Disease 2019 (COVID-19) a pandemic. Till now, it affected 452.4 million (Spain, 11.18 million) persons all over the world with a total of 6.04 million of deaths (Spain, 100,992). It is observed that 75% of hospitalized COVID-19 patients have at least one COVID-19 associated comorbidity. It was shown that people with underlying chronic illnesses are more likely to get it and grow seriously ill. Individuals with COVID-19 who have a past medical history of cardiovascular disorder, cancer, obesity, chronic lung disease, diabetes, or neurological disease had the worst prognosis and are more likely to develop acute respiratory distress syndrome or pneumonia. COVID-19 can affect the respiratory system in a variety of ways and across a spectrum of levels of disease severity, depending on a person's immune system, age and comorbidities. Symptoms can range from mild, such as cough, shortness of breath and fever, to critical disease, including respiratory failure, shock and multi-organ system failure. So, COVID-19 infection can cause overall worsening of these previous respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), interstitial lung disease, etc. This review aims to provide information on the impact of the COVID-19 disease on pre-existing lung comorbidities.
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Affiliation(s)
- Eusebi Chiner-Vives
- Multidisciplinary Sleep Unit, Respiratory Department, Sant Joan University Hospital, Sant Joan d'Alacant, Alicante, Spain
| | - Rosa Cordovilla-Pérez
- Respiratory Department, Salamanca University Hospital, Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | | | - Marta García-Clemente
- Lung Management Area, HUCA, Institute for Health Research of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
| | - José Luis Izquierdo-Alonso
- Department of Medicine and Medical Specialties, University of Alcalá, Madrid, Spain; Respiratory Medicine, University Hospital of Guadalajara, Guadalajara, Spain
| | | | - Luis Pérez-de Llano
- Respiratory Department, Lucus Augusti University Hospital, EOXI Lugo, Monforte, CERVO, Lugo, Spain
| | - Jacobo Sellares-Torres
- Interstitial Lung Diseases Working Group, Respiratory Department, Clinic-University Hospital-IDIBAPS, Barcelona, Spain
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Bhakta S, Erben Y, Sanghavi D, Fortich S, Li Y, Hasan MM, Dong Y, Brigham TJ, Edwards MA, Meschia JF, Franco PM. A Systematic Review and Meta-Analysis on Racial Disparities in Deep Venous Thrombosis and Pulmonary Embolism Events in COVID-19 Hospitalized Patients. J Vasc Surg Venous Lymphat Disord 2022; 10:939-944.e3. [PMID: 35307608 PMCID: PMC8928725 DOI: 10.1016/j.jvsv.2022.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 03/08/2022] [Indexed: 02/09/2023]
Abstract
Objective Coronavirus disease 2019 (COVID-19) is associated with an increased risk of venous thromboembolism (VTE). Recent studies have characterized racial disparities in the incidence of VTE. The aim of our study was to present a systematic review and meta-analysis to assess the association between race and VTE in patients hospitalized with COVID-19. Methods We performed a systematic literature review to evaluate the number of deep vein thrombosis (DVT) and pulmonary embolism (PE) events reported by racial groups in patients hospitalized with COVID-19. For the qualitative analysis, independent reviewers extracted the data from eligible studies, and we used the Newcastle-Ottawa scale to assess the quality of design and content for accurate interpretation. For the quantitative analysis, we pooled the odds ratios with Der Simonian and Laird random effects models. Results The qualitative analysis included 11 studies, with 6 included in the meta-analysis. All studies were observational, retrospective cohort studies, except for one retrospective case-control study. Six studies were eligible for the meta-analysis owing to the high interstudy heterogeneity; thus, the variable reports of racial groups reduced the cohort to Black/African American and White patients (n = 9723) in the analysis. The estimated proportion for DVT and PE events for Black/African American and White patients was 0.07 (95% confidence interval, 0.00-0.10) and 0.04 (95% confidence interval, 0.00-0.07), respectively. The P value of .13 suggested nonsignificant differences in the VTE rates between Black/African American and White patients. Conclusions In our study, the proportion of DVT and PE events between Black/African American and White patients with COVID-19 were comparable. Future COVID-19 studies should include systematic racial group reporting to identify any disparities in the setting of VTE events.
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19
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Maitz T, Parfianowicz D, Vojtek A, Rajeswaran Y, Vyas AV, Gupta R. COVID-19 Cardiovascular Connection: A Review of Cardiac Manifestations in COVID-19 Infection and Treatment Modalities. Curr Probl Cardiol 2022:101186. [PMID: 35351486 PMCID: PMC8957382 DOI: 10.1016/j.cpcardiol.2022.101186] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 03/22/2022] [Indexed: 01/08/2023]
Abstract
The coronavirus pandemic has crippled healthcare system since its outbreak in 2020, and has led to over 2.6 million deaths worldwide. Clinical manifestations of COVID-19 range from asymptomatic carrier to severe pneumonia, to life-threatening acute respiratory distress syndrome (ARDS). The early efforts of the pandemic surrounded treating the pulmonary component of COVID-19, however, there has been robust data surrounding the cardiac complications associated with the virus. This is suspected to be from a marked inflammatory response as well as direct viral injury. Arrhythmias, acute myocardial injury, myocarditis, cardiomyopathy, thrombosis, and myocardial fibrosis are some of the observed cardiac complications. There have been high morbidity and mortality rates in those affected by cardiac conditions associated with COVID-19. Additionally, there have been documented cases of patients presenting with typical cardiac symptoms who are subsequently discovered to have COVID-19 infection. In those who test positive for COVID-19, clinical awareness of the significant cardiac components of the virus is pertinent to prevent morbidity and mortality. Unfortunately, treatment and preventative measures developed for COVID-19 have been shown to be also be associated with cardiac complications. This is a comprehensive review of the cardiac complications and manifestations of COVID-19 infection in addition to those associated with both treatment and vaccination.
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Affiliation(s)
- Theresa Maitz
- Department of Medicine, Lehigh Valley Health Network, Allentown, PA
| | | | - Ashley Vojtek
- Department of Medicine, Lehigh Valley Health Network, Allentown, PA
| | | | - Apurva V Vyas
- Department of Cardiology, Lehigh Valley Health Network, Allentown, PA
| | - Rahul Gupta
- Department of Cardiology, Lehigh Valley Health Network, Allentown, PA.
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Jirak P, van Almsick V, Dimitroulis D, Mirna M, Seelmaier C, Shomanova Z, Wernly B, Semo D, Dankl D, Mahringer M, Lichtenauer M, Hoppe UC, Reinecke H, Pistulli R, Larbig R, Motloch LJ. Dexamethasone Improves Cardiovascular Outcomes in Critically Ill COVID-19, a Real World Scenario Multicenter Analysis. Front Med (Lausanne) 2022; 9:808221. [PMID: 35186995 PMCID: PMC8847392 DOI: 10.3389/fmed.2022.808221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/12/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Severe COVID-19 pneumonia requiring intensive care treatment remains a clinical challenge to date. Dexamethasone was reported as a promising treatment option, leading to a reduction of mortality rates in severe COVID-19 disease. However, the effect of dexamethasone treatment on cardiac injury and pulmonary embolism remains largely elusive. METHODS In total 178 critically ill COVID-19 patients requiring intensive care treatment and mechanical ventilation were recruited in three European medical centres and included in the present retrospective study. One hundred thirteen patients (63.5%) were treated with dexamethasone for a median duration of 10 days (IQR 9-10). Sixty five patients (36.5%) constituted the non-dexamethasone control group. RESULTS While peak inflammatory markers were reduced by dexamethasone treatment, the therapy also led to a significant reduction in peak troponin levels (231 vs. 700% indicated as relative to cut off value, p = 0.001). Similar, dexamethasone resulted in significantly decreased peak D-Dimer levels (2.16 mg/l vs. 6.14 mg/l, p = 0.002) reflected by a significant reduction in pulmonary embolism rate (4.4 vs. 20.0%, p = 0.001). The antithrombotic effect of dexamethasone treatment was also evident in the presence of therapeutic anticoagulation (pulmonary embolism rate: 6 vs. 34.4%, p < 0.001). Of note, no significant changes in baseline characteristics were observed between the dexamethasone and non-dexamethasone group. CONCLUSION In severe COVID-19, anti-inflammatory effects of dexamethasone treatment seem to be associated with a significant reduction in myocardial injury. Similar, a significant decrease in pulmonary embolism, independent of anticoagulation, was evident, emphasizing the beneficial effect of dexamethasone treatment in severe COVID-19.
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Affiliation(s)
- Peter Jirak
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Vincent van Almsick
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Münster, Germany
| | - Dimitrios Dimitroulis
- Division of Cardiology, Hospital Maria Hilf Mönchengladbach, Mönchengladbach, Germany
| | - Moritz Mirna
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Clemens Seelmaier
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Zornitsa Shomanova
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Münster, Germany
| | - Bernhard Wernly
- Department of Anesthesiology, Perioperative Care, and Intensive Care Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
- Center for Public Health and Healthcare Research, Paracelsus Medical University, Salzburg, Austria
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - Dilvin Semo
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Münster, Germany
| | - Daniel Dankl
- Department of Anesthesiology, Perioperative Care, and Intensive Care Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Magdalena Mahringer
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Michael Lichtenauer
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Uta C. Hoppe
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Holger Reinecke
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Münster, Germany
| | - Rudin Pistulli
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Münster, Germany
| | - Robert Larbig
- Division of Cardiology, Hospital Maria Hilf Mönchengladbach, Mönchengladbach, Germany
- Department of Cardiology II - Electrophysiology, University Hospital Münster, Münster, Germany
| | - Lukas J. Motloch
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
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21
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Ahmad H. Thrombosis and Coronavirus Disease-19: A Literature Review. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.7958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
(COVID-19) pandemic, is a respiratory infection-related with the advancement of thromboembolic intricacies and respiratory distress in extreme cases. The expanded danger of pulmonary embolism and thrombosis has been recognized in COVID-19 patients, close by going with rises in likely prognostic biomarkers, including D-dimer, IL-6, and cardiovascular explicit troponins. Methods: Authors conducted a literature search carried out through the PubMed, Science Direct, Medline, and Google Scholar search engines consist of the thrombosis mechanism in COVID-19. Results: Coronavirus infection is portrayed by the communications between hyperactive coagulation and supplement frameworks – incited by hyper-inflammatory conditions, bringing about a supportive of thrombotic state and diffuse tissue injury. There are a few promising prognostic markers of sickness seriousness, with D-dimer the most critical. The presence of thrombocytopenia has all the earmarks of being a critical pointer of patient disintegration. Conclusion: Thrombosis in COVID-19 ought to be overseen as it would be for any sick patient, following the setup training of utilizing thromboembolic prophylaxis for fundamentally not well-hospitalized patients, and standard steady consideration.
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22
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Schultz L, Bungard TJ, Mackay E, Gill P, Guirguis M. Prevalence of Venous Thromboembolism and Anticoagulant Use in Patients with COVID-19 in Alberta, Canada. Can J Hosp Pharm 2022; 75:286-293. [PMID: 36246439 PMCID: PMC9524556 DOI: 10.4212/cjhp.3209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Background COVID-19 causes a hypercoagulable state and increases the risk of venous thromboembolism (VTE). Objectives The primary objective was to identify VTE prevalence among patients with COVID-19 in one Canadian province. Secondary objectives were to identify the prevalence of bleeding, describe anticoagulation prescribing practices, and identify factors contributing to VTE in these patients. Methods Adult patients admitted to Alberta hospitals between March and December 2020 with COVID-19 who had a length of stay of at least 72 hours were included in this retrospective study. VTE, bleeding events, and comorbidities were defined by International Classification of Diseases and Related Health Problems, 10th Revision codes. Cases of VTE and controls (no VTE) were matched on the basis of age older than 60 years, active cancer, and length of stay for the full cohort, as well as for a subgroup of patients with d-dimer data available, to assess for factors associated with VTE. Results A total of 2544 patients were included. Median age was 66 years, 1461 patients (57.4%) were male, median weight was 77.7 kg, and median d-dimer level on admission was 1.00 mg/L. The prevalence of VTE was 3.7% (n = 93) and that of major and clinically relevant non-major bleeding was 4.9% (n = 125). Of the total population, 1224 patients (48.1%) had standard prophylactic-dose anticoagulation, 460 (18.1%) received only higher-dose anticoagulation, 248 (9.7%) received both prophylactic- and higher-dose anticoagulation, and 612 (24.1%) had no anticoagulation data. Logistic regression showed that only the presence of d-dimer above 3 mg/L was associated with a significant odds ratio for VTE (7.04, 95% confidence interval 2.43-20.84). Conclusions VTE prevalence among patients with COVID-19 was higher than baseline prevalence in Alberta. Analysis of prescribing practices demonstrated that a large proportion of patients received higher-dose anticoagulation.
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Affiliation(s)
- Lynnea Schultz
- , PharmD, ACPR, is with the University of Alberta Hospital, Edmonton, Alberta
| | - Tammy J Bungard
- , BSP, PharmD, is with the Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta
| | - Elizabeth Mackay
- , MD, FRCPC, MPH, is with the University of Calgary, Cummings School of Medicine, Peter Lougheed Centre, Calgary, Alberta
| | - Pawandeep Gill
- , PharmD, ACPR, is with Alberta Health Services and Covenant Health, Edmonton, Alberta
| | - Micheal Guirguis
- , BScPharm, PhD, is with the University of Alberta Hospital - Edmonton Zone, Alberta Health Services, Edmonton, Alberta
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Radhwi O, Alkhamesi S, Almohammadi A, Alahwal H, Barefah A, Bahashwan S. Quality of systematic reviews/meta-analyses in coronavirus disease 2019 and venous thromboembolism: An analysis using a measurement tool to assess systematic reviews-2. JOURNAL OF APPLIED HEMATOLOGY 2022. [DOI: 10.4103/joah.joah_34_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Abstract
COVID-19 brought a scientific revolution since its emergence in Wuhan, China, in December 2019. Initially, the SARS-CoV-2 virus came to attention through its effects on the respiratory system. However, its actions in many other organs also have been discovered almost daily. As enzymes are indispensable to uncountable biochemical reactions in the human body, it is not surprising that some enzymes are of relevance to COVID-19 pathophysiology. Past evidence from SARS-CoV and MERS-CoV outbreaks provided hints about the role of enzymes in SARS-CoV-2 infection. In this setting, ACE-2 is an enzyme of great importance since it is the cell entry receptor for SARS-CoV-2. Clinical data elucidate patterns of enzymatic alterations in COVID-19, which could be associated with organ damage, prognosis, and clinical complications. Further, viral mutations can create new disease behaviors, and these effects are related to the activity of enzymes. This review will discuss the main enzymes related to COVID-19, summarizing the findings on their role in viral entry mechanism, the consequences of their dysregulation, and the effects of SARS-CoV-2 mutations on them.
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25
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Castillo-Perez M, Jerjes-Sanchez C, Castro-Varela A, Paredes-Vazquez JG, Vazquez-Garza E, Ramos-Cazares RE, Salinas-Casanova JA, Molina-Rodriguez AM, Martinez-Ibarra AA, Fabiani MA, Flores-Sayavedra YZ, Guajardo-Lozano JA, Lopez-de la Garza H, Betancourt-Del Campo H, Martinez-Magallanes D, Panneflek J. Differences between surviving and non-surviving venous thromboembolism COVID-19 patients: a systematic review. Thromb J 2021; 19:101. [PMID: 34911551 PMCID: PMC8672331 DOI: 10.1186/s12959-021-00346-y] [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: 05/10/2021] [Accepted: 11/14/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To our knowledge, the treatment, outcome, clinical presentation, risk stratification of patients with venous thromboembolism and COVID-19 have not been well characterized. METHODS We searched for systematic reviews, cohorts, case series, case reports, editor letters, and venous thromboembolism COVID-19 patients' abstracts following PRISMA and PROSPERO statements. We analyzed therapeutic approaches and clinical outcomes of venous thromboembolism COVID-19 patients. Inclusion: COVID-19 patients with venous thromboembolism confirmed by an imaging method (venous doppler ultrasound, ventilation-perfusion lung scan, computed tomography pulmonary angiogram, pulmonary angiography). We assessed and reported the original Pulmonary Embolism Severity Index for each pulmonary embolism patient. In addition, we defined major bleedings according to the International Society of Thrombosis and Haemostasis criteria. RESULTS We performed a systematic review from August 9 to August 30, 2020. We collected 1,535 papers from PubMed, Scopus, Web of Science, Wiley, and Opengrey. We extracted data from 89 studies that describe 143 patients. Unfractionated and low-molecular-weight heparin was used as parenteral anticoagulation in 85/143 (59%) cases. The Food and Drug Administration-approved alteplase regimen guided the advanced treatment in 39/143 (27%) patients. The mortality was high (21.6%, CI 95% 15.2-29.3). The incidence of major bleeding complications was 1 (0.9%) in the survival group and 1 (3.2%) in the death group. Pulmonary Embolism Severity Index was class I in 11.6% and II in 22.3% in survivors compared to 0% and 6.5% in non-survivors, respectively. Patients who experienced venous thromboembolism events at home were more likely to live than in-hospital events. CONCLUSIONS We determined a high mortality incidence of pulmonary embolism and a low rate of bleeding. Unfractionated and low-molecular-weight heparin drove parenteral anticoagulation and alteplase the advanced treatment in both groups. The original Pulmonary Embolism Severity Index could be helpful in the risk stratification.
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Affiliation(s)
- Mauricio Castillo-Perez
- Tecnologico de Monterrey. Escuela de Medicina y Ciencias de la Salud., Nuevo Leon, San Pedro Garza Garcia, Mexico
| | - Carlos Jerjes-Sanchez
- Tecnologico de Monterrey. Escuela de Medicina y Ciencias de la Salud., Nuevo Leon, San Pedro Garza Garcia, Mexico.
- Centro de Investigacion Biomedica del Hospital Zambrano Hellion, TecSalud, Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Nuevo Leon, San Pedro Garza Garcia, Mexico.
- Instituto de Cardiologia y Medicina Vascular, TecSalud, Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Batallón San Patricio 112, Real de San Agustin, Nuevo Leon, 66278, San Pedro Garza Garcia, Mexico.
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Av. Ignacio Morones Prieto 3000, N.L., CP, 64718, Monterrey, Mexico.
| | - Alejandra Castro-Varela
- Tecnologico de Monterrey. Escuela de Medicina y Ciencias de la Salud., Nuevo Leon, San Pedro Garza Garcia, Mexico
| | - Jose Gildardo Paredes-Vazquez
- Tecnologico de Monterrey. Escuela de Medicina y Ciencias de la Salud., Nuevo Leon, San Pedro Garza Garcia, Mexico
- Instituto de Cardiologia y Medicina Vascular, TecSalud, Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Batallón San Patricio 112, Real de San Agustin, Nuevo Leon, 66278, San Pedro Garza Garcia, Mexico
| | - Eduardo Vazquez-Garza
- Tecnologico de Monterrey. Escuela de Medicina y Ciencias de la Salud., Nuevo Leon, San Pedro Garza Garcia, Mexico
- Centro de Investigacion Biomedica del Hospital Zambrano Hellion, TecSalud, Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Nuevo Leon, San Pedro Garza Garcia, Mexico
| | - Ray Erick Ramos-Cazares
- Tecnologico de Monterrey. Escuela de Medicina y Ciencias de la Salud., Nuevo Leon, San Pedro Garza Garcia, Mexico
| | | | | | | | - Mario Alejandro Fabiani
- Instituto de Cardiologia y Medicina Vascular, TecSalud, Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Batallón San Patricio 112, Real de San Agustin, Nuevo Leon, 66278, San Pedro Garza Garcia, Mexico
| | - Yoezer Z Flores-Sayavedra
- Tecnologico de Monterrey. Escuela de Medicina y Ciencias de la Salud., Nuevo Leon, San Pedro Garza Garcia, Mexico
| | | | - Hector Lopez-de la Garza
- Tecnologico de Monterrey. Escuela de Medicina y Ciencias de la Salud., Nuevo Leon, San Pedro Garza Garcia, Mexico
| | - Hector Betancourt-Del Campo
- Tecnologico de Monterrey. Escuela de Medicina y Ciencias de la Salud., Nuevo Leon, San Pedro Garza Garcia, Mexico
| | - Daniela Martinez-Magallanes
- Tecnologico de Monterrey. Escuela de Medicina y Ciencias de la Salud., Nuevo Leon, San Pedro Garza Garcia, Mexico
| | - Jathniel Panneflek
- Centro de Investigacion Biomedica del Hospital Zambrano Hellion, TecSalud, Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Nuevo Leon, San Pedro Garza Garcia, Mexico
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Saeed GA, Gaba WH, Kareem Adi AA, Marshoodi RA, Mazrouei SA, Shah AR. Pulmonary thromboembolism in COVID-19 Patients on CT Pulmonary Angiography - A Single-Centre Retrospective Cohort Study in the United Arab Emirates.. [DOI: 10.1101/2021.11.14.21266214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
AbstractPurposeOur aim is to identify the prevalence and distribution of pulmonary thromboembolism in COVID-19 infected patients in our hospital.Materials and MethodsData of all patients with COVID-19 infection either on RT-PCR testing or non-contrast high resolution CT(HRCT) who had CT pulmonary angiography (CTPA) from April to June 2020 were included. 133 patients were initially included in the study, 7 were excluded leaving a total number of 126 patients.ResultsTwenty (15.8%) patients had evidence of pulmonary embolism (PE) on CTPA with mean age of 50 years (ranging 31-85) with 95% males. The mean D-dimer was 5.61mcg/mL among the PE-negative and 14.49 mcg/mL in the PE-positive groups respectively. Among the patients with evidence of pulmonary embolism on CTPA almost half required admission to intensive care unit in comparison to only one-fifth with negative CTPA. One-fourth died among the PE positive group with only 5% died among the PE negative group. There was a 33% reduction in the development of PE in the COVID-19 patients who had received low molecular weight heparin (LMWH) prior to their CTPA study versus those who had not.ConclusionD dimers correlate well with the incidence of pulmonary embolism among COVID-19 patients. Our data suggest that majority of our patients, developed pulmonary embolisms within 5 days into their hospital stay, accounting to almost two thirds of all positive cases diagnosed by CTPA. Those with PE among COVID-19 patients have high chances of ICU admission and mortality. Use of thromboprophylaxis early on might reduce the incidence of PE.
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Gil-Sala D, Riera C, García-Reyes M, Rodríguez M, Marrero CE, Martínez L, Gil M, Ruiz-Rodríguez JC, Ferrer R, DE Nadal M, Suito-Alcántara MA, Llagostera S, Bellmunt S. Mortality and bleeding complications of COVID-19 critically ill patients with venous thromboembolism. INT ANGIOL 2021; 41:1-8. [PMID: 34751541 DOI: 10.23736/s0392-9590.21.04704-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND VTE disease in COVID-19 patients is a remarkable issue, especially its relationship with bleeding events and mortality. The objective of this study was to describe the outcomes of critically ill patients with COVID-19 hospitalized in ICU in relationship with VTE during their stay. METHODS Prospective cohort study of critically ill COVID-19 patients in two hospitals that underwent a venous ultrasound at the beginning of follow-up of both lower limbs in April 2020. When clinical suspicion of new VTE during the 30-day follow-up, additional ultrasound or thoracic CT were performed. Global VTE frequency, major bleeding events and survival were collected, and their predictors were studied. RESULTS We included 230 patients. After 30 days of follow-up, there were 95 VTE events in 86 patients (37,4%). 13 patients (5,7%) developed major bleeding complications and 42 patients (18,3%) died. None of the comorbidities or previous treatments were related with bleeding events. D-dimer at admission was significantly related with VTE development and mortality. Independent predictors of mortality in the regression model were an older age (>66 years), D-dimer at admission (>1 500ng/mL) and low lymphocyte count (<0,45x109/L) with an AUC in the ROC curve of 0,81 (95%CI: 0,73-0,89). Patients presenting these three conditions presented a mortality of a 100% in the predictive model. CONCLUSIONS VTE frequency in ICU COVID-19 patients is high and risk of major bleeding is low. Comorbidities and laboratory parameters of admission in these patients can be a useful tool to predict mortality.
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Affiliation(s)
- Daniel Gil-Sala
- Angiology and Vascular Surgery Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Department de Cirurgia, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Claudia Riera
- Angiology and Vascular Surgery Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Marvin García-Reyes
- Angiology and Vascular Surgery Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain - .,Department de Cirurgia, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Manuela Rodríguez
- Angiology and Vascular Surgery Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Carlos E Marrero
- Angiology and Vascular Surgery Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Department de Cirurgia, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Lucía Martínez
- Angiology and Vascular Surgery Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Miquel Gil
- Angiology and Vascular Surgery Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Ricard Ferrer
- Intensive Care Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Miriam DE Nadal
- Anesthesiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Secundino Llagostera
- Angiology and Vascular Surgery Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Sergi Bellmunt
- Angiology and Vascular Surgery Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Department de Cirurgia, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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Felsenstein S, Reiff AO. A hitchhiker's guide through the COVID-19 galaxy. Clin Immunol 2021; 232:108849. [PMID: 34563684 PMCID: PMC8461017 DOI: 10.1016/j.clim.2021.108849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 09/04/2021] [Indexed: 01/08/2023]
Abstract
Numerous reviews have summarized the epidemiology, pathophysiology and the various therapeutic aspects of Coronavirus disease 2019 (COVID-19), but a practical guide on "how to treat whom with what and when" based on an understanding of the immunological background of the disease stages remains missing. This review attempts to combine the current knowledge about the immunopathology of COVID-19 with published evidence of available and emerging treatment options. We recognize that the information about COVID-19 and its treatment is rapidly changing, but hope that this guide offers those on the frontline of this pandemic an understanding of the host response in COVID-19 patients and supports their ongoing efforts to select the best treatments tailored to their patient's clinical status.
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Affiliation(s)
- Susanna Felsenstein
- University of Liverpool, Faculty of Health and Life Sciences, Brownlow Hill, Liverpool, L69 3GB, United Kingdom.
| | - Andreas Otto Reiff
- Arthritis & Rheumatic Diseases, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, United States.
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Gavriilaki E, Eftychidis I, Papassotiriou I. Update on endothelial dysfunction in COVID-19: severe disease, long COVID-19 and pediatric characteristics. J LAB MED 2021. [DOI: 10.1515/labmed-2021-0134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Abstract
Objectives
To review current literature on the role of endothelial dysfunction in coronavirus disease-2019 (COVID-19) infection in terms of pathophysiology, laboratory features and markers, clinical phenotype in adults and children, as well as long COVID-19.
Content
We conducted a thorough assessment of the literature and critically analyzed current data, mostly utilizing the PubMed and Medline search engines to find original studies published in the previous decade.
Summary and Outlook
Accumulating evidence suggests that endothelial dysfunction may be a common denominator of severe COVID-19 in adults and children, as well as long COVID-19, implicating mutual pathophysiological pathways. This narrative review summarizes the up-to-date knowledge of endothelial dysfunction caused by COVID-19, including novel aspects of long COVID-19 and pediatric disease. This knowledge is important in order not only to understand the multisystemic attack of COVID-19, but also to improve patient management and prognosis.
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Affiliation(s)
- Eleni Gavriilaki
- Hematology Department – BMT Unit , G. Papanikolaou Hospital , Thessaloniki , Greece
| | - Ioannis Eftychidis
- Hematology Department – BMT Unit , G. Papanikolaou Hospital , Thessaloniki , Greece
| | - Ioannis Papassotiriou
- Department of Clinical Biochemistry , “Aghia Sophia” Children’s Hospital , Athens , Greece
- IFCC Emerging Technologies Division , Emerging Technologies in Pediatric Laboratory Medicine (C-ETPLM) , Milan , Italy
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Barbui T, De Stefano V. Philadelphia-Negative Myeloproliferative Neoplasms Around the COVID-19 Pandemic. Curr Hematol Malig Rep 2021; 16:455-463. [PMID: 34586561 PMCID: PMC8480119 DOI: 10.1007/s11899-021-00647-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW Coronavirus disease 2019 (COVID-19) is associated with a high rate of respiratory failure, thromboembolism, bleeding, and death. Patients with myeloproliferative neoplasms (MPNs) are prone to both thrombosis and bleeding, calling for special care during COVID-19. We reviewed the clinical features of MPN patients with COVID-19, suggesting guidance for treatment. RECENT FINDINGS One study by the European LeukemiaNet collected 175 MPN patients with COVID-19 during the first wave of the pandemic, from February to May 2020. Patients with primary myelofibrosis (PMF) were at higher risk of mortality (48%) in comparison with essential thrombocythemia (ET) (25%) and polycythemia vera (19%); the risk of death was higher in those patients who abruptly discontinued ruxolitinib. In patients followed at home, in regular wards, or in ICU, the thrombosis rate was 1.0%, 2.8%, and 18.4%, respectively. Independent risk factors for thrombosis were ET phenotype, transfer to ICU, and neutrophil/lymphocyte ratio; major bleeding occurred in 4.3% of patients, particularly those with PMF. MPN patients with non-severe COVID-19 treated at home should continue their primary or secondary antithrombotic prophylaxis with aspirin or oral anticoagulants. In the case of hospitalization, patients assuming aspirin should add low molecular weight heparin (LMWH) at standard doses. In contrast, LMWH at intermediate/therapeutic doses should replace oral anticoagulants prescribed for atrial fibrillation or previous venous thromboembolism. Intermediate/high doses of LMWH can also be considered in ICU patients with ET, particularly in the case of a rapid decline in the number of platelets and progressive respiratory failure.
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MESH Headings
- Anticoagulants/therapeutic use
- COVID-19/complications
- COVID-19/diagnosis
- COVID-19/epidemiology
- COVID-19/therapy
- Hemorrhage/epidemiology
- Heparin, Low-Molecular-Weight/therapeutic use
- Humans
- Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative/complications
- Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative/diagnosis
- Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative/epidemiology
- Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative/therapy
- Myeloproliferative Disorders/complications
- Myeloproliferative Disorders/diagnosis
- Myeloproliferative Disorders/epidemiology
- Myeloproliferative Disorders/therapy
- Pandemics
- SARS-CoV-2/physiology
- Thrombosis/epidemiology
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Affiliation(s)
- Tiziano Barbui
- FROM Research Foundation, Papa Giovanni XXIII Hospital, Piazza OMS n. 1, 24127 Bergamo, Italy
| | - Valerio De Stefano
- Section of Hematology, Department of Radiological and Hematological Sciences, Catholic University, Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
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Liu Y, Cai J, Wang C, Jin J, Qu L. A systematic review and meta-analysis of incidence, prognosis, and laboratory indicators of venous thromboembolism in hospitalized patients with coronavirus disease 2019. J Vasc Surg Venous Lymphat Disord 2021; 9:1099-1111.e6. [PMID: 33529719 PMCID: PMC7847192 DOI: 10.1016/j.jvsv.2021.01.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 01/21/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE We have summarized the incidence, anticoagulation panels, laboratory characteristics, and mortality of venous thromboembolism (VTE) in hospitalized patients with coronavirus disease 2019 (COVID-19). METHODS After systematically searching PubMed, Embase, the Cochrane Library, MedRxiv, and BioRxiv, a systematic review and meta-analysis of 18 retrospective, 6 prospective observational, and 2 cross-sectional studies was performed according to the guidelines of the PRISMA (preferred reporting items for systematic reviews and meta-analyses) statement. RESULTS Overall, 4382 hospitalized patients with COVID-19 were included. Men accounted for significantly more patients than did women (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.25-2.02; P < .001). The total incidence of VTE among the patients with COVID-19 was 28.3% (95% CI, 21.6%-35.4%), with an incidence of 38.0% (95% CI, 29.1%-47.4%) and 17.2% (95% CI, 11.4%-23.8%) among those with severe and general COVID-19, respectively. The total incidence of deep vein thrombosis (DVT) of the lower extremities was 18.3% (95% CI, 10.8%-27.2%). The incidence of DVT was 22.1% (95% CI, 11.0%-35.5%) and 12.8% (95% CI, 5.0%-23.3%) in those with severe and general COVID-19, respectively. The total incidence of pulmonary embolism was 17.6% (95% CI, 12.3%-23.5%), with a rate of 21.7% (95% CI, 14.8%-29.3%) in severe cases and 12.5% (95% CI, 6.1%-23.5%) in general cases. When COVID-19 severity was unclassified, the mortality for the patients with VTE was not significantly greater (25.2%; 95% CI, 12.2%-40.5%) than that for those without VTE (10.2%; 95% CI, 3.4%-19.5%; OR, 1.88; 95% CI, 0.46-7.64; P = .377). However, among the patients with severe COVID-19, those who had developed VTE had significantly greater mortality compared with those without VTE (OR, 2.02; 95% CI, 1.15-3.53; P = .014). The patients with COVID-19 and VTE had significantly higher D-dimer levels than did similar patients without VTE in multiple studies. CONCLUSIONS The occurrence of VTE, DVT, and pulmonary embolism has been substantial among hospitalized patients with COVID-19, especially among those with severe COVID-19. Patients with severe COVID-19 and VTE had significantly greater mortality compared with similar patients without VTE. An increased D-dimer level might be an indicator of the occurrence of VTE in patients with COVID-19.
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Affiliation(s)
- Yandong Liu
- Department of Vascular and Endovascular Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Jiawei Cai
- Department of Vascular and Endovascular Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Chao Wang
- Department of Vascular and Endovascular Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Jie Jin
- Department of Vascular and Endovascular Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Lefeng Qu
- Department of Vascular and Endovascular Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China.
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Kollias A, Kyriakoulis KG, Lagou S, Kontopantelis E, Stergiou GS, Syrigos K. Venous thromboembolism in COVID-19: A systematic review and meta-analysis. Vasc Med 2021; 26:415-425. [PMID: 33818197 PMCID: PMC8024143 DOI: 10.1177/1358863x21995566] [Citation(s) in RCA: 123] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Severe coronavirus disease 2019 (COVID-19) is associated with increased risk of venous thromboembolism events (VTE). This study performed a systematic review in PubMed/EMBASE of studies reporting the prevalence of VTE in patients with COVID-19 who were totally screened/assessed for deep vein thrombosis (DVT) and/or for pulmonary embolism (PE). Among 47 candidate studies (n = 6459; 33 in Europe), 17 studies (n = 3973; weighted age 63.0 years, males 60%, intensive care unit (ICU) 16%) reported the prevalence of PE with a pooled estimate of 32% (95% CI: 25, 40%), and 32 studies (n = 2552; weighted age 62.6 years, males 57%, ICU 49%) reported the prevalence of DVT with a pooled estimate of 27% (95% CI: 21, 34%). A total of 36 studies reported the use of at least prophylactic antithrombotic treatment in the majority of their patients. Meta-regression analysis showed that the prevalence of VTE was higher across studies with a higher percentage of ICU patients and higher study population mean D-dimer values, and lower in studies with mixed dosing of anticoagulation in ⩾ 50% of the population compared to studies with standard prophylactic dosing of anticoagulation in < 50% of the population. The pooled odds ratio for death in patients with COVID-19 and VTE versus those without VTE (17 studies, n = 2882) was 2.1 (95% CI: 1.2, 3.6). Hospitalized patients with severe COVID-19 are at high VTE risk despite prophylactic anticoagulation. Further research should investigate the individualized VTE risk of patients with COVID-19 and the optimal preventive antithrombotic therapy. PROSPERO Registration No.: CRD42020185543.
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Affiliation(s)
- Anastasios Kollias
- Third Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Hospital, Athens, Greece
| | - Konstantinos G Kyriakoulis
- Third Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Hospital, Athens, Greece
| | - Styliani Lagou
- Third Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Hospital, Athens, Greece
| | - Evangelos Kontopantelis
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- National Institute for Health Research, School for Primary Care Research, University of Manchester, Manchester, UK
| | - George S Stergiou
- Third Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Hospital, Athens, Greece
| | - Konstantinos Syrigos
- Third Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Hospital, Athens, Greece
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Nassar M, Nso N, Alfishawy M, Novikov A, Yaghi S, Medina L, Toz B, Lakhdar S, Idrees Z, Kim Y, Gurung DO, Siddiqui RS, Zheng D, Agladze M, Sumbly V, Sandhu J, Castillo FC, Chowdhury N, Kondaveeti R, Bhuiyan S, Perez LG, Ranat R, Gonzalez C, Bhangoo H, Williams J, Osman AE, Kong J, Ariyaratnam J, Mohamed M, Omran I, Lopez M, Nyabera A, Landry I, Iqbal S, Gondal AZ, Hassan S, Daoud A, Baraka B, Trandafirescu T, Rizzo V. Current systematic reviews and meta-analyses of COVID-19. World J Virol 2021; 10:182-208. [PMID: 34367933 PMCID: PMC8316876 DOI: 10.5501/wjv.v10.i4.182] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/13/2021] [Accepted: 06/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has left a significant impact on the world's health, economic and political systems; as of November 20, 2020, more than 57 million people have been infected worldwide, with over 1.3 million deaths. While the global spotlight is currently focused on combating this pandemic through means ranging from finding a treatment among existing therapeutic agents to inventing a vaccine that can aid in halting the further loss of life.
AIM To collect all systematic reviews and meta-analyses published related to COVID-19 to better identify available evidence, highlight gaps in knowledge, and elucidate further meta-analyses and umbrella reviews that are yet to be performed.
METHODS We explored studies based on systematic reviews and meta-analyses with the key-terms, including severe acute respiratory syndrome (SARS), SARS virus, coronavirus disease, COVID-19, and SARS coronavirus-2. The included studies were extracted from Embase, Medline, and Cochrane databases. The publication timeframe of included studies ranged between January 01, 2020, to October 30, 2020. Studies that were published in languages other than English were not considered for this systematic review. The finalized full-text articles are freely accessible in the public domain.
RESULTS Searching Embase, Medline, and Cochrane databases resulted in 1906, 669, and 19 results, respectively, that comprised 2594 studies. 515 duplicates were subsequently removed, leaving 2079 studies. The inclusion criteria were systematic reviews or meta-analyses. 860 results were excluded for being a review article, scope review, rapid review, panel review, or guideline that produced a total of 1219 studies. After screening articles were categorized, the included articles were put into main groups of clinical presentation, epidemiology, screening and diagnosis, severity assessment, special populations, and treatment. Subsequently, there was a second subclassification into the following groups: gastrointestinal, cardiovascular, neurological, stroke, thrombosis, anosmia and dysgeusia, ocular manifestations, nephrology, cutaneous manifestations, D-dimer, lymphocyte, anticoagulation, antivirals, convalescent plasma, immunosuppressants, corticosteroids, hydroxychloroquine, renin-angiotensin-aldosterone system, technology, diabetes mellitus, obesity, pregnancy, children, mental health, smoking, cancer, and transplant.
CONCLUSION Among the included articles, it is clear that further research is needed regarding treatment options and vaccines. With more studies, data will be less heterogeneous, and statistical analysis can be better applied to provide more robust clinical evidence. This study was not designed to give recommendations regarding the management of COVID-19.
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Affiliation(s)
- Mahmoud Nassar
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Nso Nso
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Mostafa Alfishawy
- Department of Infectious Diseases, Infectious Diseases Consultants and Academic Researchers of Egypt (IDCARE), Cairo 11221, Outside of the US, Egypt
| | - Anastasia Novikov
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Salim Yaghi
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Luis Medina
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Bahtiyar Toz
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Sofia Lakhdar
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Zarwa Idrees
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Yungmin Kim
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Dawa Ongyal Gurung
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Raheel S Siddiqui
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - David Zheng
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Mariam Agladze
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Vikram Sumbly
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Jasmine Sandhu
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Francisco Cuevas Castillo
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Nadya Chowdhury
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Ravali Kondaveeti
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Sakil Bhuiyan
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Laura Guzman Perez
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Riki Ranat
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Carlos Gonzalez
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Harangad Bhangoo
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - John Williams
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Alaa Eldin Osman
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Joyce Kong
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Jonathan Ariyaratnam
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Mahmoud Mohamed
- Department of Medicine, Division of Nephrology, University of Tennessee Health Science Center, Knoxville City, TN 38103, United States
| | - Ismail Omran
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Mariely Lopez
- Department of Medical, St. George's University, West Indies 38901, Grenada
| | - Akwe Nyabera
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Ian Landry
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Saba Iqbal
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Anoosh Zafar Gondal
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Sameen Hassan
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Ahmed Daoud
- Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo 11221, Egypt
| | - Bahaaeldin Baraka
- Department of Oncology, Broomfiled Hospital, Mid and South Essex NHS Foundation Trust, ESSEX, Chelmsford 12422, United Kingdom
| | - Theo Trandafirescu
- Department of Critical Care Unit, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Vincent Rizzo
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
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Bristogiannis S, Swan D, Thachil J. Thromboprophylaxis in COVID-19 - Rationale and considerations. Adv Biol Regul 2021; 81:100819. [PMID: 34332403 PMCID: PMC8299150 DOI: 10.1016/j.jbior.2021.100819] [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: 05/19/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 12/27/2022]
Abstract
The Corona Virus Disease-2019 (COVID-19) pandemic is associated with a very high incidence of thrombotic complications. The exact mechanisms for this excess risk for clots have not been elucidated although one of the often-quoted pathophysiological entity is immunothrombosis. Recognition of thrombotic complications early on in this pandemic led to an over-explosion of studies which looked at the benefits of anticoagulation to mitigate this risk. In this review, we examine the rationale for thromboprophylaxis in COVID-19 with particular reference to dosing and discuss what may guide the decision-making process to consider anticoagulation. In addition, we explore the rationale for thrombosis prevention measures in special populations including outpatient setting, pregnant females, children, those with high body mass index and those on extracorporeal membrane oxygenation.
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Affiliation(s)
- Sotirios Bristogiannis
- Department of Haematology, NHS Hillingdon Hospital, Pield Health Road, Uxbridge, United Kingdom.
| | - Dawn Swan
- Department of Haematology, University Hospital Galway, Galway, Ireland.
| | - Jecko Thachil
- Department of Haematology, Manchester University Hospitals, Oxford Road, Manchester, United Kingdom.
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Zaffanello M, Piacentini G, Nosetti L, Ganzarolli S, Franchini M. Thrombotic risk in children with COVID-19 infection: A systematic review of the literature. Thromb Res 2021; 205:92-98. [PMID: 34293539 PMCID: PMC8284063 DOI: 10.1016/j.thromres.2021.07.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 01/23/2023]
Abstract
Objective Coagulation and inflammatory parameters are mildly altered in children with SARS-CoV-2 (COVID-19) infection, and laboratory evidence of a proinflammatory and procoagulant state has been noted in multisystem inflammatory syndrome in children (MIS-C). It is not clear whether this pediatric condition is related to thrombotic events. With this study we reviewed the literature for thrombotic complications in children with COVID-19 infection and MIS-C. Data sources We searched the Medline PubMed Advanced Search Builder, Scopus, Web Of Science, and Google Scholar electronic databases (until 1 January 2021) using the medical subject headings (MeSH) terms and text words (their combinations and truncated synonyms): (THROMBOSIS OR THROMBOPHILIA) AND (CHILD OR CHILDREN OR INFANT) AND (COVID-19 OR SARS-CoV-2). Study eligibility criteria Inclusion criteria were children with COVID-19 or SARS-COV-2 infection. The search was limited to articles published in English. Exclusion criteria were: reviews of published studies, studies published only as abstracts, letters or conference proceedings, discussion papers, animal studies, or editorials. Results After screening for duplicates, the initial search yielded 86 records: 12 were case reports involving 19 children; comorbidities were absent or mild in 73.7%. The most common site of thrombosis the lung (21%); the most often used drug was heparin (42%). Two studies were an international survey (n = 337 patients) and a large multicenter study (n = 186 patients with MIS-C). The risk of ischemic stroke in SARS-CoV-2 infection (0.82%) and deep venous thrombosis in MIS-C (4.3%) was lower in children than in adults. Conclusions Thrombodic or thromboembolic events are rare in pediatric patients with COVID-19 infection and MIS-C. Nonetheless, as in adults, a high index of suspicion should be maintained in children with COVID-19 infection or MIS-C, particularly in those with comorbidities predisposing to thrombotic events.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.
| | - Luana Nosetti
- Lombardy Regional SIDS Center, Division of Pediatrics, F. Del Ponte Hospital, University of Insubria, Varese, Italy.
| | - Stefania Ganzarolli
- Pediatric Division, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
| | - Massimo Franchini
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, Mantova, Italy.
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36
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Ravichandran B, Grimm D, Krüger M, Kopp S, Infanger M, Wehland M. SARS-CoV-2 and hypertension. Physiol Rep 2021; 9:e14800. [PMID: 34121359 PMCID: PMC8198473 DOI: 10.14814/phy2.14800] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/19/2021] [Accepted: 02/19/2021] [Indexed: 01/08/2023] Open
Abstract
The objective of this review is to give an overview of the pathophysiological effects of the Coronavirus Disease 2019 (COVID-19) in relation to hypertension (HT), with a focus on the Renin-Angiotensin-Aldosterone System (RAAS) and the MAS receptor. HT is a multifactorial disease and a public health burden, as it is a risk factor for diseases like stroke, coronary artery disease, and heart failure, leading to 10.4 million deaths yearly. Blood pressure is regulated by the RAAS. The system consists of two counter-regulatory axes: ACE/ANG-II/AT1 R and ACE2/ANG-(1-7)/MAS. The main regulatory protein in balancing the RAAS is angiotensin-converting enzyme 2 (ACE2). The protein also functions as the main mediator of endocytosis of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) into the host cell. SARS-CoV-2 is the cause of COVID-19 and has caused a worldwide pandemic; however, the treatment and prophylaxis of COVID-19 are limited. Several drugs and vaccines are currently being tested in clinical trials with a few already approved by EMA and FDA. HT is a major risk factor regarding the severity and fatality of COVID-19, and the RAAS plays an important role in COVID-19 infection since SARS-CoV-2 can lead to a dysregulation of the system by reducing the ACE2 expression. The exact mechanisms of HT in relation to COVID-19 remain uncertain, and more research is needed for further elucidation.
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Affiliation(s)
| | - Daniela Grimm
- Department of Biomedicine, Aarhus University, Aarhus, Denmark.,Department of Microgravity and Translational Regenerative Medicine, University Clinic for Plastic, Aesthetic and Hand Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Marcus Krüger
- Department of Microgravity and Translational Regenerative Medicine, University Clinic for Plastic, Aesthetic and Hand Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Sascha Kopp
- Department of Microgravity and Translational Regenerative Medicine, University Clinic for Plastic, Aesthetic and Hand Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Manfred Infanger
- Department of Microgravity and Translational Regenerative Medicine, University Clinic for Plastic, Aesthetic and Hand Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Markus Wehland
- Department of Microgravity and Translational Regenerative Medicine, University Clinic for Plastic, Aesthetic and Hand Surgery, Otto-von-Guericke University, Magdeburg, Germany
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Corrochano M, Acosta-Isaac R, Mojal S, Miqueleiz S, Rodriguez D, Quijada-Manuitt MÁ, Fraga E, Castillo-Ocaña M, Amaro-Hosey K, Albiol N, Soria JM, Antonijoan RM, Souto JC. Impact of pre-admission antithrombotic therapy on disease severity and mortality in patients hospitalized for COVID-19. J Thromb Thrombolysis 2021; 53:96-102. [PMID: 34138399 PMCID: PMC8210515 DOI: 10.1007/s11239-021-02507-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 12/15/2022]
Abstract
Anticoagulant therapy is a cornerstone treatment for coronavirus disease 2019 (COVID-19) due to the high rates of thromboembolic complications associated with this disease. We hypothesized that chronic antithrombotic therapy could play a protective role in patients hospitalized for COVID-19. Retrospective, observational study of all patients admitted to our hospital for ≥ 24 h from March 1 to May 31, 2020 with SARS-CoV-2. The objective was to evaluate clinical outcomes and mortality in COVID-19 patients receiving chronic anticoagulation (AC) or antiplatelet therapy (AP) prior to hospital admission. A total of 1612 patients were evaluated. The mean (standard deviation; SD) age was 66.5 (17.1) years. Patients were divided into three groups according to the use of antithrombotic therapy prior to admission (AP, AC, or no-antithrombotic treatment). At admission, 9.6% of the patients were taking anticoagulants and 19.1% antiplatelet therapy. The overall mortality rate was 19.3%. On the multivariate analysis there were no significant differences in mortality between the antithrombotic groups (AC or AP) and the no-antithrombotic group (control group). Patients on AC had lower ICU admission rates than the control group (OR: 0.41, 95% CI, 0.18–0.93). Anticoagulation therapy prior to hospitalization for COVID-19 was associated with lower ICU admission rates. However, there were no significant differences in mortality between the patients receiving chronic antithrombotic therapy and patients not taking antithrombotic medications. These findings suggest that chronic anticoagulation therapy at the time of COVID-19 infection may reduce disease severity and thus the need for ICU admission.
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Affiliation(s)
- Mariana Corrochano
- Haemostasis and Thrombosis Unit, Hospital de La Santa Creu I Sant Pau. Carrer de Sant Quintí 89, 08041, Barcelona, Spain.
| | - René Acosta-Isaac
- Haemostasis and Thrombosis Unit, Hospital de La Santa Creu I Sant Pau. Carrer de Sant Quintí 89, 08041, Barcelona, Spain
| | - Sergi Mojal
- Haemostasis and Thrombosis Unit, Hospital de La Santa Creu I Sant Pau. Carrer de Sant Quintí 89, 08041, Barcelona, Spain
| | - Sara Miqueleiz
- Clinical Trials Unit (AGDAC), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Diana Rodriguez
- Clinical Trials Unit (AGDAC), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Marta Castillo-Ocaña
- Clinical Pharmacology Service, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Nil Albiol
- Haemostasis and Thrombosis Unit, Hospital de La Santa Creu I Sant Pau. Carrer de Sant Quintí 89, 08041, Barcelona, Spain
| | - José Manuel Soria
- Unit of Genomics of Complex Diseases, Institut d'Investigació Biomèdica Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Rosa Maria Antonijoan
- Clinical Pharmacology Service, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Drug Research Center, Institut d'Investigació Biomèdica Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Joan Carles Souto
- Haemostasis and Thrombosis Unit, Hospital de La Santa Creu I Sant Pau. Carrer de Sant Quintí 89, 08041, Barcelona, Spain
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Molero-García JM, Arranz-Izquierdo J, Gutiérrez-Pérez MI, Redondo Sánchez JM. [Basic aspects of COVID-19 for management from primary care]. Aten Primaria 2021; 53:101966. [PMID: 33852979 PMCID: PMC7762708 DOI: 10.1016/j.aprim.2020.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 11/23/2022] Open
Abstract
SARS-CoV-2 is transmitted from person to person by inhalation or contact with respiratory droplets and aerosols. The median incubation period is 5.1 days. Fever, dry cough, dyspnea and fatigue are the most common symptoms. Almost half of the cases are asymptomatic. The spectrum of disease varies from mild (81%) to critical (5%). Older age, male gender and comorbidities negatively impact on the severity and mortality of COVID-19. The diagnosis of acute COVID-19 is made with RT-PCR or antigenic detection tests. In hospital patients, remdesivir reduces recovery time. Oral steroids are recommended for severe or critical cases requiring oxygen therapy or mechanical ventilation. Thromboprophylaxis is recommended in all severe and non-severe cases with high thrombotic risk. Antibiotherapy is limited to cases of high suspicion of bacterial superinfection. Mild-moderate and severe cases after discharge from hospital should be clinically monitored for a minimum period of two weeks.
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Affiliation(s)
- José María Molero-García
- CS San Andrés, DA CENTRO (SERMAS), Grupo de trabajo de enfermedades infecciosas de SemFYC, Madrid, España.
| | - Javier Arranz-Izquierdo
- Instituto de Investigación Sanitaria de Illes Balears (Idisba), CS Escola Graduada, Ibsalut, Palma de Mallorca, Illes Balears, Grupo de trabajo de enfermedades infecciosas de SemFYC, Illes Balears, España
| | - María Isabel Gutiérrez-Pérez
- CS Delicias I (GAP Oeste) Valladolid, Coordinadora del Grupo de trabajo de enfermedades infecciosas de SemFYC, Valladolid, España
| | - Jesús María Redondo Sánchez
- CS Ramón y Cajal, DA OESTE (SERMAS), Grupo de trabajo de enfermedades infecciosas de SoMaMFyC, Alcorcón, España
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Byttebier G, Belmans L, Alexander M, Saxberg BEH, De Spiegeleer B, De Spiegeleer A, Devreker N, Van Praet JT, Vanhove K, Reybrouck R, Wynendaele E, Fedson DS. Hospital mortality in COVID-19 patients in Belgium treated with statins, ACE inhibitors and/or ARBs. Hum Vaccin Immunother 2021; 17:2841-2850. [PMID: 34047686 PMCID: PMC8171011 DOI: 10.1080/21645515.2021.1920271] [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] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic has disrupted life throughout the world. Newly developed vaccines promise relief to people who live in high-income countries, although vaccines and expensive new treatments are unlikely to arrive in time to help people who live in low-and middle-income countries. The pathogenesis of COVID-19 is characterized by endothelial dysfunction. Several widely available drugs like statins, ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have immunometabolic activities that (among other things) maintain or restore endothelial cell function. For this reason, we undertook an observational study in four Belgian hospitals to determine whether in-hospital treatment with these drugs could improve survival in 959 COVID-19 patients. We found that treatment with statins and ACEIs/ARBs reduced 28-day mortality in hospitalized COVID-19 patients. Moreover, combination treatment with these drugs resulted in a 3-fold reduction in the odds of hospital mortality (OR = 0.33; 95% CI 0.17–0.69). These findings were in general agreement with other published studies. Additional observational studies and clinical trials are needed to convincingly show that in-hospital treatment with statins, ACEIs/ARBs, and especially their combination saves lives.
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Affiliation(s)
| | - Luc Belmans
- Department of R&D, Medaman BV, Geel, Belgium
| | | | | | | | | | - Nick Devreker
- Department of Medical Data Management, AZ Delta, Roeselare, Belgium
| | - Jens T Van Praet
- Department of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
| | - Karolien Vanhove
- Department of Pneumology and Respiratory Oncology, AZ Vesalius, Tongeren, Belgium
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40
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Tsikala Vafea M, Zhang R, Kalligeros M, Mylona EK, Shehadeh F, Mylonakis E. Mortality in mechanically ventilated patients with COVID-19: a systematic review. Expert Rev Med Devices 2021; 18:457-471. [PMID: 33836621 DOI: 10.1080/17434440.2021.1915764] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: The use of mechanical ventilation associated with acute hypoxemic respiratory failure, the most common complication in critically ill COVID-19 patients, defines a high risk population that requires specific consideration of outcomes and treatment practices.Areas covered: This review evaluates existing information about mortality rates and effectiveness of antiviral, immune-modulating, and anticoagulation treatments in COVID-19 patients who received mechanical ventilation. The mortality rate and follow-up periods in patients receiving mechanical ventilation ranged widely. Antivirals, including remdesivir and convalescent plasma, have shown no definitive mortality benefit in this population despite positive results in other COVID-19 patients. Dexamethasone was associated with an absolute reduction in 28-day mortality by 12.3% (95% CI, 6.3 to 17.6), after adjusting for age. Reduced mortality has been demonstrated with tocilizumab use alongside corticosteroids. Evidence is inconclusive for therapeutic anticoagulation, and further studies are needed to determine the comparative benefit of prophylactic anticoagulation.Expert opinion: Significant variation and high mortality rates in mechanically ventilated patients necessitate more standardized outcome measurements, increased consideration of risk factors to reduce intubation, and improved treatment practices. Anticoagulation and dexamethasone should be incorporated in the treatment of patients receiving invasive mechanical ventilation, while more rigorous studies are required for other potential treatments.
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Affiliation(s)
- Maria Tsikala Vafea
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Raina Zhang
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Markos Kalligeros
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Evangelia K Mylona
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Fadi Shehadeh
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Eleftherios Mylonakis
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, RI, USA
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41
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Parisi R, Costanzo S, Di Castelnuovo A, de Gaetano G, Donati MB, Iacoviello L. Different Anticoagulant Regimens, Mortality, and Bleeding in Hospitalized Patients with COVID-19: A Systematic Review and an Updated Meta-Analysis. Semin Thromb Hemost 2021; 47:372-391. [PMID: 33851386 DOI: 10.1055/s-0041-1726034] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We conducted a systematic review and a meta-analysis to assess the association of anticoagulants and their dosage with in-hospital all-cause mortality in COVID-19 patients. Articles were retrieved until January 8, 2021, by searching in seven electronic databases. The main outcome was all-cause mortality occurred during hospitalization. Data were combined using the general variance-based method on the effect estimate for each study. Separate meta-analyses according to type of COVID-19 patients (hospitalized or intensive care unit [ICU] patients), anticoagulants (mainly heparin), and regimens (therapeutic or prophylactic) were conducted. A total of 29 articles were selected, but 23 retrospective studies were eligible for quantitative meta-analyses. No clinical trial was retrieved. The majority of studies were of good quality; however, 34% did not distinguish heparin from other anticoagulants. Meta-analysis on 25,719 hospitalized COVID-19 patients showed that anticoagulant use was associated with 50% reduced in-hospital mortality risk (pooled risk ratio [RR]: 0.50, 95% confidence interval [CI]: 0.40-0.62; I 2: 87%). Both anticoagulant regimens (therapeutic and prophylactic) reduced in-hospital all-cause mortality, compared with no anticoagulation. Particularly in ICU patients, the anticoagulant therapeutic regimen was associated with a reduced in-hospital mortality risk (RR: 0.30, 95% CI: 0.15-0.60; I 2: 58%) compared with the prophylactic one. However, the former was also associated with a higher risk of bleeding (RR: 2.53, 95% CI: 1.60-4.00; I 2: 65%). Anticoagulant use, mainly heparin, reduced all-cause mortality in COVID-19 patients during hospitalization. Due to the higher risk of bleeding at therapeutic doses, the use of prophylactic dosages of anticoagulant is probably to be preferred in noncritically ill COVID-19 patients.
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Affiliation(s)
- Roberta Parisi
- Department of Epidemiology and Prevention. IRCCS Neuromed, via dell'Elettronica, Pozzilli, Isernia, Italy
| | - Simona Costanzo
- Department of Epidemiology and Prevention. IRCCS Neuromed, via dell'Elettronica, Pozzilli, Isernia, Italy
| | | | - Giovanni de Gaetano
- Department of Epidemiology and Prevention. IRCCS Neuromed, via dell'Elettronica, Pozzilli, Isernia, Italy
| | - Maria Benedetta Donati
- Department of Epidemiology and Prevention. IRCCS Neuromed, via dell'Elettronica, Pozzilli, Isernia, Italy
| | - Licia Iacoviello
- Department of Epidemiology and Prevention. IRCCS Neuromed, via dell'Elettronica, Pozzilli, Isernia, Italy.,Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy
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42
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Erben Y, Franco-Mesa C, Gloviczki P, Stone W, Quinones-Hinojoas A, Meltzer AJ, Lin M, Greenway MRF, Hamid O, Devcic Z, Toskich B, Ritchie C, Lamb CJ, De Martino RR, Siegel J, Farres H, Hakaim AG, Sanghavi DK, Li Y, Rivera C, Moreno-Franco P, O'Keefe NL, Gopal N, Marquez CP, Huang JF, Kalra M, Shields R, Prudencio M, Gendron T, McBane R, Park M, Hoyne JB, Petrucelli L, O'Horo JC, Meschia JF. Deep vein thrombosis and pulmonary embolism among hospitalized coronavirus disease 2019-positive patients predicted for higher mortality and prolonged intensive care unit and hospital stays in a multisite healthcare system. J Vasc Surg Venous Lymphat Disord 2021; 9:1361-1370.e1. [PMID: 33836287 PMCID: PMC8023789 DOI: 10.1016/j.jvsv.2021.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 03/18/2021] [Indexed: 01/01/2023]
Abstract
Objective We assessed the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) in hospitalized patients with coronavirus disease 2019 (COVID-19) compared with that in a matched cohort with similar cardiovascular risk factors and the effects of DVT and PE on the hospital course. Methods We performed a retrospective review of prospectively collected data from COVID-19 patients who had been hospitalized from March 11, 2020 to September 4, 2020. The patients were randomly matched in a 1:1 ratio by age, sex, hospital of admission, smoking history, diabetes mellitus, and coronary artery disease with a cohort of patients without COVID-19. The primary end point was the incidence of DVT/PE and the odds of developing DVT/PE using a conditional logistic regression model. The secondary end point was the hospitalization outcomes for COVID-19 patients with and without DVT/PE, including mortality, intensive care unit (ICU) admission, ICU stay, and length of hospitalization (LOH). Multivariable regression analysis was performed to identify the variables associated with mortality, ICU admission, discharge disposition, ICU duration, and LOH. Results A total of 13,310 patients had tested positive for COVID-19, 915 of whom (6.9%) had been hospitalized across our multisite health care system. The mean age of the hospitalized patients was 60.8 ± 17.0 years, and 396 (43.3%) were women. Of the 915 patients, 82 (9.0%) had had a diagnosis of DVT/PE confirmed by ultrasound examination of the extremities and/or computed tomography angiography of the chest. The odds of presenting with DVT/PE in the setting of COVID-19 infection was greater than that without COVID-19 infection (0.6% [5 of 915] vs 9.0% [82 of 915]; odds ratio [OR], 18; 95% confidence interval [CI], 8.0-51.2; P < .001). The vascular risk factors were not different between the COVID-19 patients with and without DVT/PE. Mortality (P = .02), the need for ICU stay (P < .001), duration of ICU stay (P < .001), and LOH (P < .001) were greater in the DVT/PE cohort than in the cohort without DVT/PE. On multivariable logistic regression analysis, the hemoglobin (OR, 0.71; 95% CI, 0.46-0.95; P = .04) and D-dimer (OR, 1.0; 95% CI, 0.33-1.56; P = .03) levels were associated with higher mortality. Higher activated partial thromboplastin times (OR, 1.1; 95% CI, 1.00-1.12; P = .03) and higher interleukin-6 (IL-6) levels (OR, 1.0; 95% CI, 1.01-1.07; P = .05) were associated with a greater risk of ICU admission. IL-6 (OR, 1.0; 95% CI, 1.00-1.02; P = .05) was associated with a greater risk of rehabilitation placement after discharge. On multivariable gamma regression analysis, hemoglobin (coefficient, −3.0; 95% CI, 0.03-0.08; P = .005) was associated with a prolonged ICU stay, and the activated partial thromboplastin time (coefficient, 2.0; 95% CI, 0.003-0.006; P = .05), international normalized ratio (coefficient, −3.2; 95% CI, 0.06-0.19; P = .002) and IL-6 (coefficient, 2.4; 95% CI, 0.0011-0.0027; P = .02) were associated with a prolonged LOH. Conclusions A significantly greater incidence of DVT/PE occurred in hospitalized COVID-19–positive patients compared with a non–COVID-19 cohort matched for cardiovascular risk factors. Patients affected by DVT/PE were more likely to experience greater mortality, to require ICU admission, and experience prolonged ICU stays and LOH compared with COVID-19–positive patients without DVT/PE. Advancements in DVT/PE prevention are needed for patients hospitalized for COVID-19 infection.
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Affiliation(s)
- Young Erben
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, Fla.
| | - Camila Franco-Mesa
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, Fla
| | - Peter Gloviczki
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - William Stone
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Scottsdale, Ariz
| | | | - Andrew J Meltzer
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Scottsdale, Ariz
| | - Michelle Lin
- Department of Neurology, Mayo Clinic, Jacksonville, Fla
| | | | - Osman Hamid
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, Fla
| | - Zlatko Devcic
- Division of Vascular and Interventional Radiology, Mayo Clinic, Jacksonville, Fla
| | - Beau Toskich
- Division of Vascular and Interventional Radiology, Mayo Clinic, Jacksonville, Fla
| | - Charles Ritchie
- Division of Vascular and Interventional Radiology, Mayo Clinic, Jacksonville, Fla
| | | | | | - Jason Siegel
- Department of Neurology, Mayo Clinic, Jacksonville, Fla; Department of Neurosurgery, Mayo Clinic, Jacksonville, Fla; Department of Critical Care, Mayo Clinic, Jacksonville, Fla
| | - Houssan Farres
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, Fla
| | - Albert G Hakaim
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, Fla
| | | | - Yupeng Li
- Department of Political Science and Economics, Rowan University, Glassboro, NJ
| | - Candido Rivera
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Fla
| | | | | | - Neethu Gopal
- Department of Neurology, Mayo Clinic, Jacksonville, Fla
| | | | | | - Manju Kalra
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Raymond Shields
- Division of Vascular Medicine of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn
| | - Mercedes Prudencio
- Department of Neuroscience, Mayo Clinic, Jacksonville, Fla; Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Jacksonville, Fla
| | - Tania Gendron
- Department of Neuroscience, Mayo Clinic, Jacksonville, Fla; Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Jacksonville, Fla
| | - Robert McBane
- Division of Vascular Medicine of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn
| | - Myung Park
- Division of Trauma and Critical Care and General Surgery, Mayo Clinic, Rochester, Minn
| | - Jonathan B Hoyne
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Fla
| | - Leonard Petrucelli
- Department of Neuroscience, Mayo Clinic, Jacksonville, Fla; Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Jacksonville, Fla
| | - John C O'Horo
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minn; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn
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Iba T, Levy JH, Connors JM, Warkentin TE, Thachil J, Levi M. Managing thrombosis and cardiovascular complications of COVID-19: answering the questions in COVID-19-associated coagulopathy. Expert Rev Respir Med 2021; 15:1003-1011. [PMID: 33667146 DOI: 10.1080/17476348.2021.1899815] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The first patients with Coronavirus disease 2019 (COVID-19) emerged at the end of 2019. This novel viral infection demonstrated unique features that include prothrombotic clinical presentations. However, one year after the first occurrence, there remain many unanswered questions. We tried to address some of the important queries in this review. AREAS COVERED We raised the following critical questions. 'Why is COVID-19 so hypercoagulable?', 'Why are most coagulation test results relatively normal?', 'Why is COVID-19-associated coagulopathy more thrombotic than most other infectious diseases?', 'Why is arterial thrombus formed frequently?', 'Is anticoagulant therapy for COVID-19 effective?', and 'Are there racial disparities in thrombosis in COVID-19?' EXPERT OPINION There are commonalities and differences in the pathogeneses and clinical features between COVID-19 and other infectious diseases. Correct understanding will help discussing appropriate anticoagulation prophylaxis or treatment for thromboembolism.
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Affiliation(s)
- Toshiaki Iba
- Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Jerrold H Levy
- Department of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Jean Marie Connors
- Hematology Division Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Theodore E Warkentin
- Department of Pathology and Molecular Medicine, and Department of Medicine, McMaster University, Hamilton, Canada
| | - Jecko Thachil
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - Marcel Levi
- Department of Medicine, University College London Hospitals NHS Foundation Trust, and Cardio-metabolic Programme-NIHR UCLH/UCL BRC London, UK
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Longchamp G, Manzocchi-Besson S, Longchamp A, Righini M, Robert-Ebadi H, Blondon M. Proximal deep vein thrombosis and pulmonary embolism in COVID-19 patients: a systematic review and meta-analysis. Thromb J 2021; 19:15. [PMID: 33750409 PMCID: PMC7942819 DOI: 10.1186/s12959-021-00266-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/01/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND COVID-19 appears to be associated with a high risk of venous thromboembolism (VTE). We aimed to systematically review and meta-analyze the risk of clinically relevant VTE in patients hospitalized for COVID-19. METHODS This meta-analysis included original articles in English published from January 1st, 2020 to June 15th, 2020 in Pubmed/MEDLINE, Embase, Web of science, and Cochrane. Outcomes were major VTE, defined as any objectively diagnosed pulmonary embolism (PE) and/or proximal deep vein thrombosis (DVT). Primary analysis estimated the risk of VTE, stratified by acutely and critically ill inpatients. Secondary analyses explored the separate risk of proximal DVT and of PE; the risk of major VTE stratified by screening and by type of anticoagulation. RESULTS In 33 studies (n = 4009 inpatients) with heterogeneous thrombotic risk factors, VTE incidence was 9% (95%CI 5-13%, I2 = 92.5) overall, and 21% (95%CI 14-28%, I2 = 87.6%) for patients hospitalized in the ICU. Proximal lower limb DVT incidence was 3% (95%CI 1-5%, I2 = 87.0%) and 8% (95%CI 3-14%, I2 = 87.6%), respectively. PE incidence was 8% (95%CI 4-13%, I2 = 92.1%) and 17% (95%CI 11-25%, I2 = 89.3%), respectively. Screening and absence of anticoagulation were associated with a higher VTE incidence. When restricting to medically ill inpatients, the VTE incidence was 2% (95%CI 0-6%). CONCLUSIONS The risk of major VTE among COVID-19 inpatients is high but varies greatly with severity of the disease. These findings reinforce the need for the use of thromboprophylaxis in all COVID-19 inpatients and for clinical trials testing different thromboprophylaxis regimens in subgroups of COVID-19 inpatients. TRIAL REGISTRATION The review protocol was registered in PROSPERO International Prospective Register of Systematic Reviews ( CRD42020193369 ).
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Affiliation(s)
- Gregoire Longchamp
- Department of Visceral Surgery, Faculty of Medicine and Geneva University Hospitals, Geneva, Switzerland
| | - Sara Manzocchi-Besson
- Division of Angiology and Haemostasis, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
- Department of Vascular Surgery, Centre Hospitalier du Valais Romand de l'Hôpital du Valais (site de Sion), Sion, Switzerland
| | - Alban Longchamp
- Department of Vascular Surgery, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
- Department of Biomedical Sciences, University of Lausanne, Lausanne, Switzerland
| | - Marc Righini
- Division of Angiology and Haemostasis, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Helia Robert-Ebadi
- Division of Angiology and Haemostasis, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Marc Blondon
- Division of Angiology and Haemostasis, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
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Gratz J, Wiegele M, Maleczek M, Herkner H, Schöchl H, Chwala E, Knöbl P, Schaden E. Risk of Clinically Relevant Venous Thromboembolism in Critically Ill Patients With COVID-19: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8:647917. [PMID: 33768106 PMCID: PMC7985162 DOI: 10.3389/fmed.2021.647917] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/01/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Early during the course of the ongoing COVID-19 pandemic, reports suggested alarmingly high incidences for thromboembolic events in critically ill patients with COVID-19. However, the clinical relevance of these events was not reported in several studies. Additionally, more recent research showed contradictory results and suggested substantially lower rates of venous thromboembolism. Thus, the aim of the present study was to summarize evidence on the incidence of clinically relevant venous thromboembolism (VTE)—defined as VTE excluding isolated subsegmental pulmonary embolism (PE) and distal deep vein thrombosis (DVT)—in adult critically ill patients with COVID-19. Methods: We performed a systematic review of studies reporting the incidence of clinically relevant PE and/or DVT in critically ill patients with COVID-19. Scientific reports published in the English language between January and October 2020 were included. We conducted a random-effects model meta-analysis to calculate incidence estimates of clinically relevant VTE and bleeding events. We also performed exploratory meta-regression and subgroup analyses of different diagnostic approaches and additional factors that possibly influenced the incidence of these outcomes. Results: Fifty-four articles (5,400 patients) fulfilled the predefined inclusion criteria, of which 41 had a high risk of bias. The majority of included patients were male, > 60 years, and overweight. Twenty-one studies reported the use of prophylactic doses of heparin. Pooled incidences for clinically relevant PE were estimated at 8% (95% CI, 4–11%), for proximal DVT at 14% (95% CI, 9–20%), and—after exclusion of studies with a high risk of bias—for the composite outcome of VTE at 18% (95% CI, 13–24%). Clinically relevant bleeding occurred at a rate of 6% (95% CI, 2–9%). Conclusions: We summarized currently available data on the rate of clinically relevant VTE in critically ill patients with COVID-19. Pooled incidence estimates were lower than those reported by previous review articles. In the absence of evidence-based anticoagulation guidelines for critically ill patients with COVID-19, the results of our study provide clinically important information for an individual risk-benefit assessment in this context. Registration: The study protocol was prospectively registered in PROSPERO on June 22, 2020 (CRD42020193353; https://www.crd.york.ac.uk/prospero).
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Affiliation(s)
- Johannes Gratz
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Marion Wiegele
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Mathias Maleczek
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Herbert Schöchl
- Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria.,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Centre, Vienna, Austria
| | - Eva Chwala
- University Library, Medical University of Vienna, Vienna, Austria
| | - Paul Knöbl
- Division of Hematology and Hemostasis, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Eva Schaden
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
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46
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Tomo S, Kumar KP, Roy D, Sankanagoudar S, Purohit P, Yadav D, Banerjee M, Sharma P, Misra S. Complement activation and coagulopathy - an ominous duo in COVID19. Expert Rev Hematol 2021; 14:155-173. [PMID: 33480807 DOI: 10.1080/17474086.2021.1875813] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION COVID-19 has similarities to the Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) outbreaks, as severe patients and non-survivors have frequently shown abnormal coagulation profiles. Immune-mediated pathology is a key player in this disease; hence, the role of the complement system needs assessment. The complement system and the coagulation cascade share an intricate network, where multiple mediators maintain a balance between both pathways. Coagulopathy in COVID-19, showing mixed features of complement-mediated and consumption coagulopathy, creates a dilemma in diagnosis and management. AREAS COVERED Pathophysiology of coagulopathy in COVID-19 patients, with a particular focus on D-dimer and its role in predicting the severity of COVID-19 has been discussed. A comprehensive search of the medical literature on PubMed was done till May 30th, 2020 with the keywords 'COVID-19', 'SARS-CoV-2', 'Coronavirus', 'Coagulopathy', and 'D-dimer'. Twenty-two studies were taken for weighted pooled analysis of D-dimer. EXPERT OPINION A tailored anticoagulant regimen, including intensification of standard prophylactic regimens with low-molecular-weight heparin is advisable for COVID-19 patients. Atypical manifestations and varying D-dimer levels seen in different populations bring forth the futility of uniform recommendations for anticoagulant therapy. Further, direct thrombin inhibitors and platelet inhibitors in a patient-specific manner should also be considered.
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Affiliation(s)
- Sojit Tomo
- Department of Biochemistry, AIIMS Jodhpur, Jodhpur, Rajasthan, India
| | - Kiran Pvsn Kumar
- Department of Biochemistry, AIIMS Jodhpur, Jodhpur, Rajasthan, India
| | - Dipayan Roy
- Department of Biochemistry, AIIMS Jodhpur, Jodhpur, Rajasthan, India
| | | | - Purvi Purohit
- Department of Biochemistry, AIIMS Jodhpur, Jodhpur, Rajasthan, India
| | - Dharamveer Yadav
- Department of Biochemistry, AIIMS Jodhpur, Jodhpur, Rajasthan, India
| | - Mithu Banerjee
- Department of Biochemistry, AIIMS Jodhpur, Jodhpur, Rajasthan, India
| | - Praveen Sharma
- Department of Biochemistry, AIIMS Jodhpur, Jodhpur, Rajasthan, India
| | - Sanjeev Misra
- Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Ahmed HY, Papali A, Haile T, Shrestha GS, Schultz MJ, Lundeg G, Akrami KM, For The Covid-Lmic Task Force. Pragmatic Recommendations for the Management of Anticoagulation and Venous Thrombotic Disease for Hospitalized Patients with COVID-19 in Low- and Middle-Income Countries. Am J Trop Med Hyg 2021; 104:99-109. [PMID: 33432908 PMCID: PMC7957232 DOI: 10.4269/ajtmh.20-1305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/23/2020] [Indexed: 12/19/2022] Open
Abstract
New studies of COVID–19 are constantly updating best practices in clinical care. Often, it is impractical to apply recommendations based on high-income country investigations to resource limited settings in low- and middle-income countries (LMICs). We present a set of pragmatic recommendations for the management of anticoagulation and thrombotic disease for hospitalized patients with COVID-19 in LMICs. In the absence of contraindications, we recommend prophylactic anticoagulation with either low molecular weight heparin (LMWH) or unfractionated heparin (UFH) for all hospitalized COVID-19 patients in LMICs. If available, we recommend LMWH over UFH for venous thromboembolism (VTE) prophylaxis to minimize risk to healthcare workers. We recommend against the use of aspirin for VTE prophylaxis in hospitalized COVID-19 and non–COVID-19 patients in LMICs. Because of limited evidence, we suggest against the use of “enhanced” or “intermediate” prophylaxis in COVID-19 patients in LMICs. Based on current available evidence, we recommend against the initiation of empiric therapeutic anticoagulation without clinical suspicion for VTE. If contraindications exist to chemical prophylaxis, we recommend mechanical prophylaxis with intermittent pneumatic compression (IPC) devices or graduated compression stockings (GCS) for hospitalized COVID-19 patients in LMICs. In LMICs, we recommend initiating therapeutic anticoagulation for hospitalized COVID-19 patients, in accordance with local clinical practice guidelines, if there is high clinical suspicion for VTE, even in the absence of testing. If available, we recommend LMWH over UFH or Direct oral anticoagulants for treatment of VTE in LMICs to minimize risk to healthcare workers. In LMIC settings where continuous intravenous UFH or LMWH are unavailable or not feasible to use, we recommend fixed dose heparin, adjusted to body weight, in hospitalized COVID-19 patients with high clinical suspicion of VTE. We suggest D-dimer measurement, if available and affordable, at the time of admission for risk stratification, or when clinical suspicion for VTE is high. For hospitalized COVID-19 patients in LMICs, based on current available evidence, we make no recommendation on the use of serial D-dimer monitoring for the initiation of therapeutic anticoagulation. For hospitalized COVID-19 patients in LMICs receiving intravenous therapeutic UFH, we recommend serial monitoring of partial thromboplastin time or anti-factor Xa level, based on local laboratory capabilities. For hospitalized COVID-19 patients in LMICs receiving LMWH, we suggest against serial monitoring of anti-factor Xa level. We suggest serial monitoring of platelet counts in patients receiving therapeutic anticoagulation for VTE, to assess risk of bleeding or development of heparin induced thrombocytopenia.
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Affiliation(s)
- Hanan Y Ahmed
- Division of Pulmonary and Critical Care Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alfred Papali
- Division of Pulmonary and Critical Care Medicine, Atrium Health, Charlotte, North Carolina
| | - Tewodros Haile
- Division of Pulmonary and Critical Care Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gentle S Shrestha
- Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Marcus J Schultz
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand.,Department of Clinical Tropical Medicine, Mahidol University, Bangkok, Thailand.,Department of Intensive Care, Amsterdam University Medical Centers, Location 'Academic Medical Center', Amsterdam, The Netherlands
| | - Ganbold Lundeg
- Critical Care and Anaesthesia Department, Mongolian National University of Medical Sciences, Ulan Bator, Mongolia
| | - Kevan M Akrami
- Divisions of Infectious Disease and Critical Care Medicine, University of California San Diego, San Diego, California.,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
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48
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Han YJ, Lee KH, Yoon S, Nam SW, Ryu S, Seong D, Kim JS, Lee JY, Yang JW, Lee J, Koyanagi A, Hong SH, Dragioti E, Radua J, Smith L, Oh H, Ghayda RA, Kronbichler A, Effenberger M, Kresse D, Denicolò S, Kang W, Jacob L, Shin H, Shin JI. Treatment of severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and coronavirus disease 2019 (COVID-19): a systematic review of in vitro, in vivo, and clinical trials. Am J Cancer Res 2021; 11:1207-1231. [PMID: 33391531 PMCID: PMC7738873 DOI: 10.7150/thno.48342] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/22/2020] [Indexed: 02/06/2023] Open
Abstract
Rationale: Coronavirus disease 2019 (COVID-19) has spread worldwide and poses a threat to humanity. However, no specific therapy has been established for this disease yet. We conducted a systematic review to highlight therapeutic agents that might be effective in treating COVID-19. Methods: We searched Medline, Medrxiv.org, and reference lists of relevant publications to identify articles of in vitro, in vivo, and clinical studies on treatments for severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and COVID-19 published in English until the last update on October 11, 2020. Results: We included 36 studies on SARS, 30 studies on MERS, and 10 meta-analyses on SARS and MERS in this study. Through 12,200 title and 830 full-text screenings for COVID-19, eight in vitro studies, 46 randomized controlled trials (RCTs) on 6,886 patients, and 29 meta-analyses were obtained and investigated. There was no therapeutic agent that consistently resulted in positive outcomes across SARS, MERS, and COVID-19. Remdesivir showed a therapeutic effect for COVID-19 in two RCTs involving the largest number of total participants (n = 1,461). Other therapies that showed an effect in at least two RCTs for COVID-19 were sofosbuvir/daclatasvir (n = 114), colchicine (n = 140), IFN-β1b (n = 193), and convalescent plasma therapy (n = 126). Conclusions: This review provides information to help establish treatment and research directions for COVID-19 based on currently available evidence. Further RCTs are required.
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Affiliation(s)
- Young Joo Han
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Keum Hwa Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sojung Yoon
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seoung Wan Nam
- Department of Rheumatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Seohyun Ryu
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dawon Seong
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Seok Kim
- Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Jun Young Lee
- Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Jae Won Yang
- Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Jinhee Lee
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Ai Koyanagi
- Research and development unit, Parc Sanitari Sant Joan de Déu/CIBERSAM, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.,ICREA, Pg. Lluis Companys 23, 08010, Barcelona, Spain
| | - Sung Hwi Hong
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, USA
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Joaquim Radua
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Mental Health Research Networking Center (CIBERSAM), Barcelona, Spain.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Centre for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Hans Oh
- School of Social Work, University of Southern California, CA, USA
| | - Ramy Abou Ghayda
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, USA.,Division of Urology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Andreas Kronbichler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Maria Effenberger
- Department of Internal Medicine I (Gastroenterology, Hepatology, Endocrinology & Metabolism), Medical University Innsbruck, Innsbruck, Austria
| | - Daniela Kresse
- Department of Internal Medicine, St. Johann County Hospital, St. Johann in Tirol, Austria
| | - Sara Denicolò
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Woosun Kang
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Louis Jacob
- Research and development unit, Parc Sanitari Sant Joan de Déu/CIBERSAM, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.,Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Hanwul Shin
- Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea.,✉ Corresponding author: Dr. Jae Il Shin MD PhD, 50-1 Yonsei-ro, Seodaemun-gu, Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea. Tel: 82-2-2228-2050, Fax: 82-2-393-9118, E-mail:
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49
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Ashraf O, Virani A, Cheema T. COVID-19: An Update on the Epidemiological, Clinical, Preventive, and Therapeutic Management of 2019 Novel Coronavirus Disease. Crit Care Nurs Q 2020; 44:128-137. [PMID: 33234866 PMCID: PMC7724996 DOI: 10.1097/cnq.0000000000000346] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) remains a serious issue for global health, given widespread infectivity and a high contagion rate. A tremendous amount of data has been generated since it was first identified in December 2019. It is vital to keep up with these data from across the world at a time of uncertainty and continuously evolving guidelines and clinical practice. This review provides an update on recent developments concerning epidemiology, clinical presentation, treatment options, and scientific advancements to combat the COVID-19 pandemic.
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Affiliation(s)
- Obaid Ashraf
- Division of Pulmonary Critical Care Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Ahmed Virani
- Division of Pulmonary Critical Care Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Tariq Cheema
- Division of Pulmonary Critical Care Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania
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