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Gal GL, Agnelli G, Darius H, Kahn SR, Owaidah T, Rocha AT, Zhai Z, Khan I, Djoudi Y, Ponomareva E, Cohen AT. Event rates and risk factors for venous thromboembolism and major bleeding in a population of hospitalized adult patients with acute medical illness receiving enoxaparin thromboprophylaxis. Eur J Intern Med 2024; 121:48-55. [PMID: 38030465 DOI: 10.1016/j.ejim.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND We aimed to describe the event rates and risk-factors for symptomatic venous thromboembolism (VTE) and major bleeding in a population of hospitalized acutely ill medical patients. METHODS Patients ≥40 years old and hospitalized for acute medical illness who initiated enoxaparin prophylaxis were selected from the US Optum research database. Rates of symptomatic VTE and major bleeding at 90-days were estimated via the Kaplan-Meier (KM) method. Risk factors were identified via the Cox proportional hazards model. RESULTS A total of 123,022 patients met the selection criteria. The KM rates of VTE and major bleeding at 90-days were 3.5 % and 2.2 %, respectively. Among subgroups, the risk of VTE varied from 3.0 % in patients with ischemic stroke to 6.9 % in patients with a cancer-related hospitalization, and the risk of major bleeding varied from 1.9 % in patients with inflammatory conditions to 3.6 % in patients with ischemic stroke. Key risk factors for VTE were prior VTE (HR=4.15, 95 % confidence interval [CI] 3.80-4.53), cancer-related hospitalization (HR=2.35, 95 % CI 2.10-2.64), and thrombophilia (HR=1.64, 95 % CI 1.29-2.08). Key risk factors for major bleeding were history of major bleeding (HR=2.17, 95 % CI 1.72-2.74), history of non-major bleeding (HR=2.46, 95 % CI 2.24-2.70), and hospitalization for ischemic stroke (2.42, 95 % CI 2.11-2.78). CONCLUSION There is substantial heterogeneity in the event rates for VTE and major bleeding in acute medically ill patients. History of VTE and cancer related hospitalization represent profiles with a high risk of VTE, where continued VTE prophylaxis may be warranted.
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Affiliation(s)
- Grégoire Le Gal
- Department of Medicine, Ottawa Hospital Research Institute at the University of Ottawa, ON, Canada.
| | | | | | - Susan R Kahn
- McGill University, Montreal, QC, Canada, Jewish General Hospital/Lady Davis Institute, Montreal, QC, Canada
| | - Tarek Owaidah
- King Faisal Specialist Hospital and Research Center, Alfaisal University, Riyadh, Saudi Arabia
| | - Ana Thereza Rocha
- Federal University of Bahia, Salvador, Brazil, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Zhenguo Zhai
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | | | | | | | - Alexander T Cohen
- Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK
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Low serum albumin is associated with mortality and arterial and venous ischemic events in acutely ill medical patients. Results of a retrospective observational study. Thromb Res 2023; 225:1-10. [PMID: 36898171 DOI: 10.1016/j.thromres.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/15/2023] [Accepted: 02/23/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND In general population hypoalbuminemia is associated with poor survival. Aim of this study was to assess the impact of hypoalbuminemia on mortality and venous and arterial ischemic events in hospitalized acutely ill medical patients. PATIENTS AND METHODS Retrospective observational analysis from the "REgistro POliterapie SIMI" (REPOSI). Patients were followed up to 12 months. Serum albumin was obtained in each patient. Mortality and ischemic events were registered throughout the follow-up period. RESULTS In the entire population including 4152 patients, median levels of serum albumin were 3.4 g/dL and 2193 patients (52.8 %) had levels ≤3.4 g/dL. Cases with albumin ≤3.4 g/dL were older, frailer, had more comorbidities and were most frequently underweight than those with serum albumin >3.4 g/dL. During the 12-month follow-up, all-cause mortality was 14.8 % (613 patients), with a higher rate in cases with serum albumin ≤3.4 g/dL (459, 20.9 % vs 154, 7.9 % in those with serum albumin >3.4 g/dL; p < 0.0001). During follow-up 121 ischemic events (2.9 %) were registered, 86 (71.1) arterial and 35 (28.9 %) venous. Proportional hazard analysis showed that patients with albumin ≤3.4 g/dL had a higher chance of dying. Furthermore, patients with albumin ≤3.4 g/dL had a higher likelihood of experiencing ischemic events. CONCLUSIONS Acutely ill hospitalized medical patients with serum levels ≤3.4 g/dL are at higher risk of all-cause mortality and ischemic events, measurement of albumin may help to identify hospitalized patients with a poorer prognosis.
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3
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Loffredo L, Pignatelli P, Pirro M, Ceccarelli G, Oliva A, Maggio E, Cancelli F, D'Ardes D, Amitrano M, Zicari AM, Cinicola BL, Taliani G, Cangemi R, Lichtner M, Falcone M, Orlando F, Pugliese F, Venditti M, Mastroianni CM, Violi F. Association between PaO 2/FiO 2 ratio and thrombotic events in COVID-19 patients. Intern Emerg Med 2023; 18:889-895. [PMID: 36650311 PMCID: PMC9845099 DOI: 10.1007/s11739-023-03196-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/03/2023] [Indexed: 01/19/2023]
Abstract
PaO2/FiO2 (P/F ratio) is considered a marker of hypoxia/hypoxemia and mortality. Several prothrombotic changes are associated with the decrease of P/F ratio. The role of P/F ratio in patients with arterial and venous thrombosis remains unclear. The aim of this study was to assess in patients with coronavirus disease 2019 (COVID-19), the association between P/F ratio and arterial/venous thrombosis. One thousand and four hundred and six COVID-19 patients were recruited; 289 (21%) patients had P/F ratio < 200 and 1117 (79%) ≥ 200. Compared to the patients with P/F ratio ≥ 200, those with P/F ratio < 200 were older and with higher levels of glycemia, D-dimer and lower levels of albumin. Multiple linear regression analysis showed that albumin (standardized coefficient β: 0.156; SE: 0.001; p = 0.0001) and D-dimer (standardized coefficient β: -0.135; SE: 0.0001; p = 0.0001) were associated with P/F ratio. During the hospitalization 159 patients were transferred in intensive care unit (ICU), 253 patients died, 156 patients had arterial or venous thrombotic events. A bivariate logistic analysis was performed to analyze the predictors of thrombosis in COVID-19 patients; P/F ratio < 200 (Odds Ratio: [OR] 1.718, 95% Confidence Interval [CI] 1.085-2.718, p = 0.021), albumin (OR 1.693, 95% CI 1.055-2.716, p = 0.029), D-dimer (OR 3.469, 95% CI 2.110-5.703, p < 0.0001), coronary artery disease (CAD) (OR 1.800, 95% CI 1.086-2.984, p = 0.023) and heart failure (OR 2.410 95% CI 1.385-4.193, p = 0.002) independently predicted thrombotic events in this population. This study suggests that the P/F ratio is associated with thrombotic events by promoting a hypercoagulation state in patients hospitalized for COVID-19.
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Affiliation(s)
- Lorenzo Loffredo
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy.
| | - Pasquale Pignatelli
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Matteo Pirro
- Unit of Internal Medicine, Department of Medicine, University of Perugia, Perugia, Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Enrico Maggio
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Francesca Cancelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Damiano D'Ardes
- Clinica Medica, Department of Medicine and Aging, "G. D'Annunzio, University of Chieti-Pescara, Chieti, Italy
- Mediterranea Cardiocentro-Napoli, Via Orazio, 2, 80122, Naples, Italy
| | - Maria Amitrano
- Internal Medicine Unit, Moscati Hospital, Avellino, Italy
| | - Anna Maria Zicari
- Department of Maternal Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Bianca Laura Cinicola
- Department of Maternal Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Gloria Taliani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Roberto Cangemi
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Miriam Lichtner
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Marco Falcone
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Federica Orlando
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Francesco Pugliese
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Claudio Maria Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Francesco Violi
- Mediterranea Cardiocentro-Napoli, Via Orazio, 2, 80122, Naples, Italy
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Loffredo L, Vidili G, Sciacqua A, Cogliati C, Di Giulio R, Bernardini S, Ciacci P, Pietrangelo A, Orlando F, Paraninfi A, Boddi M, Di Minno G, Falsetti L, Lodigiani C, Santoliquido A, Ettorre E, Pignatelli P, Arezzo MF, Gutu E, Harenberg J, Violi F. Asymptomatic and symptomatic deep venous thrombosis in hospitalized acutely ill medical patients: risk factors and therapeutic implications. Thromb J 2022; 20:72. [PMID: 36451162 PMCID: PMC9709753 DOI: 10.1186/s12959-022-00433-8] [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: 04/28/2022] [Accepted: 11/13/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Acutely ill medical patients experience deep venous thrombosis (DVT) during the hospitalization, however the time course of DVT is still unclear. OBJECTIVES To evaluate risk factors in acutely ill hospitalized medical patients for proximal asymptomatic DVT (ADVT) and symptomatic DVT (SDVT) at admission and discharge. PATIENTS/METHODS In this prospective observational study, consecutive acutely ill medical patients (hospitalized mainly for acute medical disease as infections, neoplasm, anemia, heart failure) underwent compression ultrasonography (CUS) of proximal lower limb veins within 48 h from admission and at discharge to diagnose ADVT and SDVT. Covid-19 patients, anticoagulant therapy, surgical procedures, acute SDVT, and acute pulmonary embolism, were exclusion criteria. Biographical characteristics at hospitalization, D-Dimer (assessed by ELISA)) and DD-improve score. RESULTS Of 2,100 patients (1002 females, 998 males, age 71 ± 16 years) 58 (2.7%) had proximal ADVT at admission. Logistic regression analysis showed that age, and active cancer were independently associated with ADVT at admission. The median length of hospitalization was 10 days [interquartile range: 6-15]. During the hospital stay, 6 patients (0.3%) with a negative CUS at admission experienced DVT (2 SDVT and 4 ADVT). In the subgroup of patients (n = 1118), in whom D-dimer was measured at admission, D-Dimer and IMPROVE-DD score were associated with ADVT at admission (n = 37) and with all DVT (n = 42) at discharge. ROC curve defined an IMPROVE-DD score of 2.5 as the optimal cut-off for discriminating patients with and without thrombotic events. CONCLUSIONS We provide evidence of early development of ADVT in unselected acutely ill medical patients suggesting the need of investigating patients by CUS immediately after hospital admission (within 48 h). Advanced age, active cancer, known thrombophilia and increased IMPROVE-DD score may identify patients at risk. The benefit of anticoagulation needs to be investigated in patients with these specific risk factors and negative CUS at admission. TRIAL REGISTRATION NCT03157843.
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Affiliation(s)
- Lorenzo Loffredo
- grid.7841.aDepartment of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Gianpaolo Vidili
- grid.11450.310000 0001 2097 9138Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Angela Sciacqua
- grid.411489.10000 0001 2168 2547Department of Medical and Surgical Sciences, University Magna-Græcia of Catanzaro, Catanzaro, Italy
| | - Chiara Cogliati
- grid.4708.b0000 0004 1757 2822 Department of Biomedical and Clinical Sciences, L.Sacco Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Rosella Di Giulio
- grid.416290.80000 0004 1759 7093Department of Internal Medicine, Internal Medicine Unit, Maggiore Hospital, Bologna, Italy
| | - Sciaila Bernardini
- grid.415207.50000 0004 1760 3756Department of Internal Medicine, AUSL Della Romagna, S. Maria Delle Croci Hospital, 48121 Ravenna, Italy
| | - Paolo Ciacci
- grid.7841.aDepartment of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Antonello Pietrangelo
- grid.413363.00000 0004 1769 5275Department of Internal Medicine 2, University Hospital of Modena, Modena, Italy
| | - Federica Orlando
- grid.7841.aDepartment of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Aurora Paraninfi
- grid.7841.aDepartment of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Maria Boddi
- grid.8404.80000 0004 1757 2304Experimental and Clinical Department, University of Florence, Florence, Italy
| | - Giovanni Di Minno
- grid.4691.a0000 0001 0790 385XDepartment of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Lorenzo Falsetti
- grid.415845.9Internal and Sub-Intensive Medicine Department, A.O.U. “Ospedali Riuniti”, Ancona, Italy
| | - Corrado Lodigiani
- grid.417728.f0000 0004 1756 8807Cardiovascular Department, Thrombosis and Hemorrhagic Diseases Center, Humanitas Research Hospital, Rozzano, Milan Italy
| | - Angelo Santoliquido
- grid.8142.f0000 0001 0941 3192Catholic University of the Sacred Heart, Rome, Italy
| | - Evaristo Ettorre
- grid.7841.aDepartment of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Pasquale Pignatelli
- grid.7841.aDepartment of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Maria Felice Arezzo
- grid.7841.aDepartment of Methods and Models for Economics, Territory and Finance, Sapienza University of Rome, Via del Castro Laurenziano, 9, 00161 Rome, Italy
| | - Evghenii Gutu
- grid.28224.3e0000 0004 0401 27383Rd Department of General Surgery, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, Chisinau, Republic of Moldova
| | - Job Harenberg
- grid.7700.00000 0001 2190 4373Ruprecht-Kalrs University Heidelberg, Heidelberg, Germany
| | - Francesco Violi
- grid.7841.aDepartment of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
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Tini G, Moriconi A, Ministrini S, Zullo V, Venanzi E, Mondovecchio G, Campanella T, Marini E, Bianchi M, Carbone F, Pirro M, De Robertis E, Pasqualini L. Ultrasound screening for asymptomatic deep vein thrombosis in critically ill patients: a pilot trial. Intern Emerg Med 2022; 17:2269-2277. [PMID: 36044159 PMCID: PMC9428380 DOI: 10.1007/s11739-022-03085-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/16/2022] [Indexed: 11/25/2022]
Abstract
Deep vein thrombosis (DVT) in critically ill patients still represents a clinical challenge. The aim of the study was to investigate whether a systematic ultrasound (US) screening might improve the management of the antithrombotic therapy in intensive care unit (ICU). In this non-randomized diagnostic clinical trial, 100 patients consecutively admitted to ICU of the University Hospital of Perugia were allocated either in the screening group or in the control group. Subjects in the screening group underwent US examination of lower limbs 48 h after admission, and again after 5 days. Subjects in the control group underwent US examination according to the standard of care (SOC) of the enrolling institution. Retrospectively registered at ClinicalTrials.gov (NCT05019092) on 24.08.2021. Lower limb DVT was significantly more frequent in the screening group (p < 0.001), as well as the subsequent extension of a pre-existing DVT (p = 0.027). In the control group, DVT of large veins was more frequent (p = 0.038). Major bleedings were reported in 5 patients, 4 in the non-screening group and in 1 in the screening group. Patients in the screening group started the antithrombotic treatment later (p = 0.038), although the frequency, dose and duration of the treatment were not different between the two groups. The duration of stay in ICU was longer in the screening group (p = 0.007). Active screening for DVT is associated with an increased diagnosis of DVT. The screening could be associated with a reduced incidence of proximal DVT and a reduction in the bleeding risk.
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Affiliation(s)
- Giordano Tini
- Internal Medicine, Angiology and Atherosclerosis-Department of Medicine and Surgery, Università Degli Studi Di Perugia, Piazzale Gambuli 1/8, 06124, Perugia, Italy
| | - Amanda Moriconi
- Internal Medicine, Angiology and Atherosclerosis-Department of Medicine and Surgery, Università Degli Studi Di Perugia, Piazzale Gambuli 1/8, 06124, Perugia, Italy
- Medicine Clinic, "S. Lorenzo" Hospital, Viale Vicenza 9, 38051, Borgo Valsugana, TN, Italy
| | - Stefano Ministrini
- Internal Medicine, Angiology and Atherosclerosis-Department of Medicine and Surgery, Università Degli Studi Di Perugia, Piazzale Gambuli 1/8, 06124, Perugia, Italy.
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952, Schlieren, Switzerland.
| | - Valentina Zullo
- Internal Medicine, Angiology and Atherosclerosis-Department of Medicine and Surgery, Università Degli Studi Di Perugia, Piazzale Gambuli 1/8, 06124, Perugia, Italy
| | - Elisa Venanzi
- Internal Medicine, Angiology and Atherosclerosis-Department of Medicine and Surgery, Università Degli Studi Di Perugia, Piazzale Gambuli 1/8, 06124, Perugia, Italy
| | - Giulia Mondovecchio
- Internal Medicine, Angiology and Atherosclerosis-Department of Medicine and Surgery, Università Degli Studi Di Perugia, Piazzale Gambuli 1/8, 06124, Perugia, Italy
| | - Tommaso Campanella
- Internal Medicine, Angiology and Atherosclerosis-Department of Medicine and Surgery, Università Degli Studi Di Perugia, Piazzale Gambuli 1/8, 06124, Perugia, Italy
| | - Ettore Marini
- Internal Medicine, Angiology and Atherosclerosis-Department of Medicine and Surgery, Università Degli Studi Di Perugia, Piazzale Gambuli 1/8, 06124, Perugia, Italy
| | - Maura Bianchi
- Anesthesia, Analgesia and Intensive Care-Department of Medicine and Surgery, Università Degli Studi Di Perugia, Piazzale Gambuli 1/8, 06124, Perugia, Italy
| | - Federico Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine and Medical Specialties, University of Genoa, 6 Viale Benedetto XV, 16132, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, 10 Largo Rosanna Benzi, 16132, Genoa, Italy
| | - Matteo Pirro
- Internal Medicine, Angiology and Atherosclerosis-Department of Medicine and Surgery, Università Degli Studi Di Perugia, Piazzale Gambuli 1/8, 06124, Perugia, Italy
| | - Edoardo De Robertis
- Anesthesia, Analgesia and Intensive Care-Department of Medicine and Surgery, Università Degli Studi Di Perugia, Piazzale Gambuli 1/8, 06124, Perugia, Italy
| | - Leonella Pasqualini
- Internal Medicine, Angiology and Atherosclerosis-Department of Medicine and Surgery, Università Degli Studi Di Perugia, Piazzale Gambuli 1/8, 06124, Perugia, Italy
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AlEidan FAS, AlManea RK, AlMoneef AT, Shalash NA, AlRajhi NA, AlMousa SF, Al Raizah A, Abuelgasim KA. Incidence and Predictors of Recurrence and Mortality Following First Venous Thromboembolism Among the Saudi Population: Single-Center Cohort Study. Int J Gen Med 2022; 15:7559-7568. [PMID: 36199587 PMCID: PMC9527814 DOI: 10.2147/ijgm.s359893] [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: 03/21/2022] [Accepted: 08/09/2022] [Indexed: 11/23/2022] Open
Abstract
Background Little is written about recurrence and mortality rates after a first episode of venous thromboembolism (VTE) among Saudi population. Aim Determine incidence rates and assess predictors of recurrence and mortality following the first VTE event. Patients and Methods A total of 1124 patients aged ≥18 years with symptomatic VTE confirmed by imaging tests were evaluated. The incidence of VTE recurrence and mortality were assessed. The association between patient characteristics, and VTE recurrence and mortality was explored by estimating the hazard ratio (HR) and 95% confidence interval (CI). The difference between cancer-related, provoked and unprovoked VTE in terms of recurrence and mortality was explored using Kaplan–Meier curves. Results The annual incidence rate of the first VTE was 1.7 per 1000 patients. Of 1124 patients with first VTE, 214 (19%) developed recurrent VTE, and 192 (17%) died with overall incidence rates of 15.8 per 100 person-years (95% CI, 13.8–18.0) and 10.0 per 100 person-years (95% CI, 8.7–11.5). Intensive care unit (ICU) admission (HR, 2.15; 95% CI, 1.67–3.10), presence of active cancer (HR, 2.97; 95% CI, 1.87–3.95), immobilization (HR, 2.52; 95% CI, 1.79–3.67), infection (HR, 2.32; 95% CI, 1.94–3.45), and pulmonary embolism ± deep venous thrombosis (HR, 2.22; 95% CI, 1.56–3.16) were found to be independent predictors of recurrent VTE. Recurrence carries a high hazard of mortality (HR, 5.21; 95% CI, 3.61–7.51). The estimated median time to VTE recurrence was lower in cancer-related VTE (18.7 months) compared with provoked (29.0 months) and unprovoked VTE (28.4 months). The estimated survival median time was lower in cancer-related VTE (21.8 months) compared with provoked (30.5 months) and unprovoked VTE (29.8 months). Conclusion Immobilization and presence of active cancer, infection, and PE ± DVT were significant predictors of recurrent VTE. Patients who developed recurrent VTE had a 5.2-fold higher hazard of mortality compared with patients with no VTE recurrence.
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Affiliation(s)
- Fahad A S AlEidan
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Correspondence: Fahad A S AlEidan, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, Tel +966118011111, Email
| | - Reem K AlManea
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Alyah T AlMoneef
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Nada A Shalash
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Norah A AlRajhi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sarah F AlMousa
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulrahman Al Raizah
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Saudi Society for Bone Marrow Transplant, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Khadega A Abuelgasim
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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7
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Khalil V. Evaluation of oral anticoagulant prescribing patterns and associated hospital acquired complications – a single centre Australian study. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2022. [DOI: 10.1002/jppr.1777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Viviane Khalil
- Senior Pharmacist Peninsula Health Pharmacy Department Frankston Australia
- Assistant Deputy Director of Pharmacy Pharmacy Department Monash Health Clayton Australia
- Lecturer Monash University Melbourne Clayton Australia
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8
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Violi F, Pignatelli P, Vestri A, Spagnoli A, Cipollone F, Ceccarelli G, Oliva A, amitrano M, Pirro M, Taliani G, Cangemi R, Lichtner M, Pugliese F, Falcone M, Venditti M, Mastroianni CM, Loffredo L. THE ADA (AGE-D-DIMER-ALBUMIN) SCORE TO PREDICT THROMBOSIS IN SARS-CoV-2. Thromb Haemost 2022; 122:1567-1572. [DOI: 10.1055/a-1788-7592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV2)-related
pneumonia is associated with venous and arterial thrombosis . Aim of the study was to find-out a
new score for predicting thrombosis in patients with SARS-CoV-2.
Methods: We included a
cohort of 674 patients affected by SARS-CoV-2, not requiring intensive care units, and
followed-up during the hospitalization until discharge. Routinary analyses performed at
in-hospital admission included also serum albumin and D-dimer while arterial and venous
thromboses were the end-points of the study.
Results: During the follow-up thrombotic events
110 were registered; patients with thrombotic events were older and had lower albumin and higher
D-dimer, compared to thrombotic event-free ones. On multivariable logistic regression with step
by stepwise procedure age, serum albumin, D-dimer, were independently associated with thrombotic
events. The linear combination of age, D-dimer, albumin allowed to build-up the ADA score, whose
AUC was 0.752 (95% CI, 0.708-0.795). ADA score was internally validated by bootstrap sampling
procedure giving an AUC of 0.752 (95% CI: 0.708 - 0.794).
Conclusions: Combination of age,
D-dimer, albumin in the ADA score allows identifying SARS-CoV-2 patients at higher risk of
thrombotic events.
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Affiliation(s)
- Francesco Violi
- Policlinico Umberto I, I Clinica Medica, Department of Internal Medicine and Medical Specialties, Sapienza-University of Rome, Roma, Italy
| | | | - Annarita Vestri
- BioMedical Statistics and Clinical Epidemiology Centre, Department of Experimental Medicine, Sapienza University of Rome, Roma, Italy
| | - Alessandra Spagnoli
- Department of Public Health and Infectious Diseases., University of Rome La Sapienza, Rome, Italy
| | | | | | | | - maria amitrano
- Medicine, Azienda Ospedaliera S. G. Moscatti Hospital, avellino, Italy
| | | | | | | | | | | | | | | | | | - Lorenzo Loffredo
- Medicina Interna e Specialità Mediche, Università La Sapienza, Rome, Italy
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9
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Violi F, Cammisotto V, Pignatelli P. Thrombosis in Covid-19 and non-Covid-19 pneumonia: role of platelets. Platelets 2021; 32:1009-1017. [PMID: 34097572 PMCID: PMC8204311 DOI: 10.1080/09537104.2021.1936478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 02/09/2023]
Abstract
Platelets may be a target of bacteria and viruses, which can directly or indirectly activate them so promoting thrombosis. In accordance with this, community-acquired pneumonia (CAP) is complicated by ischemia-related vascular disease (myocardial infarction and stroke) in roughly 10% of patients while the incidence of venous thrombosis is uncertain. In CAP platelet biosynthesis of TxA2 is augmented and associated with myocardial infarction; however, a cause-effect relationship is still unclear as unclear is if platelet activation promotes thrombosis or functional changes of coronary tree such vasospasm. Retrospective studies suggested a potential role of aspirin in reducing mortality but the impact on vascular disease is still unknown. Coronavirus disease 2019 (Covid-19) is complicated by thrombosis in roughly 20% of patients with an almost equivalent localization in arterial and venous circulation. Platelet activation seems to have a pivot role in the thrombotic process in Covid-19 as consistently evidenced by its involvement in promoting Tissue Factor up-regulation via leucocyte interaction. Until now, antiplatelet treatment has been scarcely considered for the treatment of Covid-19; interventional trials, however, are in progress to explore this issue. The aim of this review is 1) to compare the type of vascular diseases complicating CAP and Covid-19 2) to assess the different role of platelets in both diseases and 3) to discuss if antiplatelet treatment is potentially useful to improve clinical outcomes.
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Affiliation(s)
- Francesco Violi
- I Clinica Medica, Department of Clinical Internal, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Vittoria Cammisotto
- Department of General Surgery and Surgical Specialty Paride Stefanini, Sapienza University of Rome, Rome, Italy
| | - Pasquale Pignatelli
- I Clinica Medica, Department of Clinical Internal, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
- Mediterranea Cardiocentro, Naples, Italy
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10
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Cangemi R, Calvieri C, Falcone M, Cipollone F, Ceccarelli G, Pignatelli P, D'Ardes D, Pirro M, Alessandri F, Lichtner M, D'Ettorre G, Oliva A, Aronica R, Rocco M, Venditti M, Romiti GF, Tiseo G, Taliani G, Menichetti F, Pugliese F, Mastroianni CM, Violi F. Comparison of thrombotic events and mortality in patients with community-acquired pneumonia and COVID-19: a multicentre observational study. Thromb Haemost 2021; 122:257-266. [PMID: 34758488 DOI: 10.1055/a-1692-9939] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND It is still unclear if patients with community-acquired pneumonia (CAP) and coronavirus disease 2019 (COVID-19) have different rate, typology, and impact of thrombosis on survival. METHODS In this multicentre observational cohort study 1.138 patients, hospitalized for CAP (n=559) or COVID-19 (n=579) from 7 clinical centres in Italy, were included in the study. Consecutive adult patients (age ≥18 years) with confirmed COVID-19 related pneumonia, with or without mechanical ventilation, hospitalized from 1st March 2020 to 30 April 2020, were enrolled. Covid-19 was diagnosed based on the WHO interim guidance. Patients were followed-up until discharge or in-hospital death, registering the occurrence of thrombotic events including ischemic/embolic events. RESULTS During the in-hospital stay, 11.4% of CAP and 15.5% of COVID-19 patients experienced thrombotic events (p=0.046). In CAP patients all the events were arterial thromboses, while in COVID-19 patients 8.3% were venous and 7.2% arterial thromboses. During the in-hospital follow-up, 3% of CAP patients and 17% of COVID-19 patients died (p<0.001). The highest mortality rate was found among COVID-19 patients with thrombotic events (47.6% vs 13.4% in thrombotic-event free patients; p<0.001). In CAP, 13.8% of patients experiencing thrombotic events died vs. 1.8% of thrombotic event-free ones (p<0.001). A multivariable COX-regression analysis confirmed a higher risk of death in COVID-19 patients with thrombotic events (HR 2.1; 95% CI: 1.4-3.3; p<0.001). CONCLUSIONS Compared with CAP, COVID-19 is characterized by a higher burden of thrombotic events, different thrombosis typology and higher risk of thrombosis-related in-hospital mortality.
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Affiliation(s)
| | - Camilla Calvieri
- I Clinica Medica, Department of Clinical Internal, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy, Sapienza University of Rome, Rome, Italy
| | | | - Francesco Cipollone
- Department of Medicine and Aging, "G. D'Annunzio" University of Chieti-Pescara, Ita, G. D'Annunzio" University of Chieti-Pescara, Ita, Chieti, Italy
| | | | | | - Damiano D'Ardes
- 3. Department of Medicine and Aging, "G. D'Annunzio" University of Chieti-Pescara, Italy, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | | | | | | | - Gabriella D'Ettorre
- I Clinica Medica, Department of Clinical Internal, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy, Sapienza University of Rome, Rome, Italy
| | - Alessandra Oliva
- I Clinica Medica, Department of Clinical Internal, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy, Sapienza University of Rome, Rome, Italy
| | - Raissa Aronica
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Monica Rocco
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | | | | | | | - Gloria Taliani
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | | | - Francesco Pugliese
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | | | - Francesco Violi
- Policlinico Umberto I, I Clinica Medica, Department of Internal Medicine and Medical Specialties, Sapienza-University of Rome, Roma, Italy
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11
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Barlow B, Barlow A, Breu AC. Things We Do for No Reason™: Universal Venous Thromboembolism Chemoprophylaxis in Low-Risk Hospitalized Medical Patients. J Hosp Med 2021; 16:301-303. [PMID: 33357322 DOI: 10.12788/jhm.3502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 07/08/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Brooke Barlow
- Department of Pharmacy, University of Kentucky HealthCare, Lexington, Kentucky
| | - Ashley Barlow
- Department of Pharmacy, University of Maryland Medical Center, Baltimore, Maryland
| | - Anthony C Breu
- Medical Service, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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12
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Le Jeune S, Suhl J, Benainous R, Minvielle F, Purser C, Foudi F, Warzocha U, Dhote R. High prevalence of early asymptomatic venous thromboembolism in anticoagulated COVID-19 patients hospitalized in general wards. J Thromb Thrombolysis 2021; 51:637-641. [PMID: 32812199 PMCID: PMC7433772 DOI: 10.1007/s11239-020-02246-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is associated with coagulation activation and high incidence of venous thromboembolism (VTE) in severe patients despite routine thromboprophylaxis. Conflicting results exist regarding the epidemiology of VTE for unselected anticoagulated COVID-19 patients hospitalized in general wards. The aim of this study was to evaluate the prevalence of asymptomatic deep venous thrombosis (DVT) in unselected patients with COVID-19 recently hospitalized in general wards. We performed a systematic complete doppler ultrasound (CDU) at a median 4 days after admission in 42 consecutive COVID-19 patients hospitalized in general wards of our university hospital, irrespective of D-Dimer level, and retrospectively collected clinical, biological and outcome data from electronic charts. Thromboprophylaxis was systematically applied following a French national proposal. In our population, the prevalence of asymptomatic DVT was 19% (8/42 patients), with distal thrombosis in 7/8 cases and bilateral DVT in 4/8 cases. Symptomatic pulmonary embolism was detected in 4 (9.5%) patients, associated to DVT in one case. Compared to patients without DVT, patients with DVT were older and experienced poorer outcomes. In conclusion, prevalence of asymptomatic DVT is high in the first days of hospitalization of unselected COVID-19 patients in general wards and may be related to poor prognosis. Individualized assessment of thromboprophylaxis and early systematic screening for DVT is warranted in this context.
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Affiliation(s)
- Sylvain Le Jeune
- Service de Médecine Interne, Centre Hospitalo-Universitaire Avicenne, Assistance Publique-Hôpitaux de Paris, 125 rue de Stalingrad, 93000, Bobigny, France.
| | - Jaehyo Suhl
- Service de Médecine Interne, Centre Hospitalo-Universitaire Avicenne, Assistance Publique-Hôpitaux de Paris, 125 rue de Stalingrad, 93000, Bobigny, France
| | - Ruben Benainous
- Service de Médecine Interne, Centre Hospitalo-Universitaire Avicenne, Assistance Publique-Hôpitaux de Paris, 125 rue de Stalingrad, 93000, Bobigny, France
| | - François Minvielle
- Service des Explorations Fonctionnelles, Centre Hospitalo-Universitaire Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Christine Purser
- Service des Explorations Fonctionnelles, Centre Hospitalo-Universitaire Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Farid Foudi
- Service de Médecine Interne, Centre Hospitalo-Universitaire Avicenne, Assistance Publique-Hôpitaux de Paris, 125 rue de Stalingrad, 93000, Bobigny, France
| | - Ursula Warzocha
- Service de Médecine Interne, Centre Hospitalo-Universitaire Avicenne, Assistance Publique-Hôpitaux de Paris, 125 rue de Stalingrad, 93000, Bobigny, France
| | - Robin Dhote
- Service de Médecine Interne, Centre Hospitalo-Universitaire Avicenne, Assistance Publique-Hôpitaux de Paris, 125 rue de Stalingrad, 93000, Bobigny, France
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13
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Violi F, Loffredo L, Pastori D. Anticoagulation in patients with advanced liver disease: an open issue. Intern Emerg Med 2021; 16:61-71. [PMID: 33073317 DOI: 10.1007/s11739-020-02526-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 09/30/2020] [Indexed: 12/14/2022]
Abstract
Liver disease has been long considered as a risk factor for bleeding for the presence of prolongation of global tests of clotting activation and low platelet count. For this reason, the use of anticoagulants in patients with liver disease and an indication to anticoagulation, such as atrial fibrillation of venous thrombosis, has been poorly considered. Furthermore, recent studies underscored the fact that patients with chronic liver disease may experience thrombosis in portal as well as systemic circulation and treatment with anticoagulants should be considered. The introduction of direct oral anticoagulants has increased therapeutic options for thromboprophylaxis; however, evidence on their safety and efficacy in specific populations, such as patients with liver disease, is still scarce and needs further investigation. Thus, atrial fibrillation patients with coexistent liver disease have been excluded from clinical trials with direct oral anticoagulants. Here, we provide an overview on mechanisms of thrombosis in patients with advanced chronic liver disease and a summary of evidence on the use of oral anticoagulants in patients with liver disease and portal vein thrombosis or atrial fibrillation.
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Affiliation(s)
- Francesco Violi
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, I Clinica Medica, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
- Mediterranea Cardiocentro, via Orazio 2, 80122, Naples, Italy.
| | - Lorenzo Loffredo
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, I Clinica Medica, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Daniele Pastori
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, I Clinica Medica, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
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14
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Pizzolo F, Rigoni AM, De Marchi S, Friso S, Tinazzi E, Sartori G, Stefanoni F, Nalin F, Montagnana M, Pilotto S, Milella M, Azzini AM, Tacconelli E, Marchi G, Girelli D, Olivieri O, Martinelli N. Deep vein thrombosis in SARS-CoV-2 pneumonia-affected patients within standard care units: Exploring a submerged portion of the iceberg. Thromb Res 2020; 194:216-219. [PMID: 33074107 PMCID: PMC7409796 DOI: 10.1016/j.thromres.2020.08.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/31/2020] [Accepted: 08/05/2020] [Indexed: 01/08/2023]
Abstract
An association between COVID-19 and venous thromboembolism (VTE) is now recognized. The prevalence of VTE is high in COVID-19 patients hospitalized in standard care units. The prevalence of VTE is high even though thromboprophylaxis and in patients estimated at low risk. A high index of suspicion for VTE is crucial in patients with SARS-CoV-2 infection.
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Affiliation(s)
| | | | | | | | - Elisa Tinazzi
- Department of Medicine, University of Verona, Verona, Italy
| | - Giulia Sartori
- Department of Medicine, University of Verona, Verona, Italy
| | | | | | | | - Sara Pilotto
- Department of Medicine, University of Verona, Verona, Italy
| | | | | | | | - Giacomo Marchi
- Department of Medicine, University of Verona, Verona, Italy
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15
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Violi F, Pastori D, Cangemi R, Pignatelli P, Loffredo L. Hypercoagulation and Antithrombotic Treatment in Coronavirus 2019: A New Challenge. Thromb Haemost 2020; 120:949-956. [PMID: 32349133 PMCID: PMC7295290 DOI: 10.1055/s-0040-1710317] [Citation(s) in RCA: 154] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/13/2020] [Indexed: 02/07/2023]
Abstract
The novel coronavirus 2019 (COVID-19) is clinically characterized by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is responsible for a high number of patients needing mechanical ventilation or intensive care units treatment and for the elevated mortality risk. A link between COVID-19 and multiorgan failure may be dependent on the fact that most COVID-19 patients are complicated by pneumonia, which is known to be associated with early changes of clotting and platelet activation and artery dysfunction; these changes may implicate in thrombotic-related events such as myocardial infarction and ischemic stroke. Recent data showed that myocardial injury compatible with coronary ischemia may be detectable in SARS-CoV-2 patients and laboratory data exploring clotting system suggest the presence of a hypercoagulation state. Thus, we performed a systematic review of COVID-19 literature reporting measures of clotting activation to assess if changes are detectable in this setting and their relationship with clinical severity. Furthermore, we discussed the biologic plausibility of the thrombotic risk in SARS-CoV-2 and the potential use of an antithrombotic treatment.
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Affiliation(s)
- Francesco Violi
- Department of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - Daniele Pastori
- Department of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - Roberto Cangemi
- Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Pasquale Pignatelli
- Department of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - Lorenzo Loffredo
- Department of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Italy
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16
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Cattaneo M, Bertinato EM, Birocchi S, Brizio C, Malavolta D, Manzoni M, Muscarella G, Orlandi M. Pulmonary Embolism or Pulmonary Thrombosis in COVID-19? Is the Recommendation to Use High-Dose Heparin for Thromboprophylaxis Justified? Thromb Haemost 2020; 120:1230-1232. [PMID: 32349132 PMCID: PMC7516356 DOI: 10.1055/s-0040-1712097] [Citation(s) in RCA: 216] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Marco Cattaneo
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.,Medicina II, ASST Santi Paolo e Carlo-Ospedale San Paolo, Milan, Italy
| | - Elena M Bertinato
- Medicina II, ASST Santi Paolo e Carlo-Ospedale San Paolo, Milan, Italy
| | - Simone Birocchi
- Medicina II, ASST Santi Paolo e Carlo-Ospedale San Paolo, Milan, Italy
| | - Carolina Brizio
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.,Medicina II, ASST Santi Paolo e Carlo-Ospedale San Paolo, Milan, Italy
| | - Daniele Malavolta
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.,Medicina II, ASST Santi Paolo e Carlo-Ospedale San Paolo, Milan, Italy
| | - Marco Manzoni
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.,Medicina II, ASST Santi Paolo e Carlo-Ospedale San Paolo, Milan, Italy
| | - Gesualdo Muscarella
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.,Medicina II, ASST Santi Paolo e Carlo-Ospedale San Paolo, Milan, Italy
| | - Michela Orlandi
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.,Medicina II, ASST Santi Paolo e Carlo-Ospedale San Paolo, Milan, Italy
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17
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Castelli R, Gidaro A. Abnormal Hemostatic Parameters and Risk of Thromboembolism Among Patients With COVID-19 Infection. J Hematol 2020; 9:1-4. [PMID: 32362977 PMCID: PMC7188381 DOI: 10.14740/jh636] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 01/09/2023] Open
Affiliation(s)
- Roberto Castelli
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Antonio Gidaro
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital, Milan, Italy
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