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Granger KL, Paulos T, Boss MK, Guieu L, Shropshire S. Case report: Chronic disseminated intravascular coagulopathy with concurrent paraneoplastic secondary hyperfibrinolysis in a dog with metastatic nasal adenocarcinoma. Front Vet Sci 2024; 11:1375507. [PMID: 38840638 PMCID: PMC11152169 DOI: 10.3389/fvets.2024.1375507] [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: 01/23/2024] [Accepted: 04/26/2024] [Indexed: 06/07/2024] Open
Abstract
In human medicine, hemostatic disorders such as thrombocytopenia, hyperfibrinolysis, and disseminated intravascular coagulopathy (DIC) have been associated with many cancers. Acute hemorrhage secondary to hyperfibrinolysis has been predominantly reported with prostatic adenocarcinoma in human patients. To the author's knowledge, severe bleeding due to paraneoplastic hyperfibrinolysis has not yet been reported in veterinary medicine. The case involves an 8-year-old neutered male Border Collie who was evaluated for progressive and recurrent epistaxis, having a history of 1 year of treatment for metastatic nasal adenocarcinoma. A progressive and severe coagulopathy thought to be related to the known cancer was diagnosed. Advanced coagulation testing was consistent with a chronic DIC and secondary hyperfibrinolysis. Throughout 1 week of hospitalization, the dog was treated with multiple blood products, vitamin K1, and anti-fibrinolytic medications. While the dog was initially discharged home, the dog re-presented the following day and was humanely euthanized due to a perceived poor quality of life. Post-mortem analysis revealed a histopathologic diagnosis of disseminated adenocarcinoma. In dogs with disseminated nasal adenocarcinoma that are experiencing severe bleeding, paraneoplastic secondary hyperfibrinolysis should be considered as a differential. Knowing this association could help guide treatment recommendations for optimal patient management.
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Okazaki E, Barion BG, da Rocha TRF, Di Giacomo G, Ho YL, Rothschild C, Fatobene G, de Carvalho Moraes BDG, Stefanello B, Villaça PR, Rocha VG, Orsi FA. Persistent hypofibrinolysis in severe COVID-19 associated with elevated fibrinolysis inhibitors activity. J Thromb Thrombolysis 2024; 57:721-729. [PMID: 38523179 DOI: 10.1007/s11239-024-02961-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2024] [Indexed: 03/26/2024]
Abstract
Hypercoagulability and reduced fibrinolysis are well-established complications associated with COVID-19. However, the timelines for the onset and resolution of these complications remain unclear. The aim of this study was to evaluate, in a cohort of COVID-19 patients, changes in coagulation and fibrinolytic activity through ROTEM assay at different time points during the initial 30 days following the onset of symptoms in both mild and severe cases. Blood samples were collected at five intervals after symptoms onset: 6-10 days, 11-15 days, 16-20 days, 21-25 days, and 26-30 days. In addition, fibrinogen, plasminogen, PAI-1, and alpha 2-antiplasmin activities were determined. Out of 85 participants, 71% had mild COVID-19. Twenty uninfected individuals were evaluated as controls. ROTEM parameters showed a hypercoagulable state among mild COVID-19 patients beginning in the second week of symptoms onset, with a trend towards reversal after the third week of symptoms. In severe COVID-19 cases, hypercoagulability was observed since the first few days of symptoms, with a tendency towards reversal after the fourth week of symptoms onset. A hypofibrinolytic state was identified in severe COVID-19 patients from early stages and persisted even after 30 days of symptoms. Elevated activity of PAI-1 and alpha 2-antiplasmin was also detected in severe COVID-19 patients. In conclusion, both mild and severe cases of COVID-19 exhibited transient hypercoagulability, reverted by the end of the first month. However, severe COVID-19 cases sustain hypofibrinolysis throughout the course of the disease, which is associated with elevated activity of fibrinolysis inhibitors. Persistent hypofibrinolysis could contribute to long COVID-19 manifestations.
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Affiliation(s)
- Erica Okazaki
- University of Sao Paulo Medical School, Sao Paulo, Brazil
- Hospital das Clínicas da Faculdade de Medicina de Sao Paulo da USP, 255 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil
| | - Bárbara Gomes Barion
- University of Sao Paulo Medical School, Sao Paulo, Brazil
- Hospital das Clínicas da Faculdade de Medicina de Sao Paulo da USP, 255 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil
| | - Tania Rubia Flores da Rocha
- Hospital das Clínicas da Faculdade de Medicina de Sao Paulo da USP, 255 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil
| | - Giovanna Di Giacomo
- Hospital das Clínicas da Faculdade de Medicina de Sao Paulo da USP, 255 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil
| | - Yeh-Li Ho
- Hospital das Clínicas da Faculdade de Medicina de Sao Paulo da USP, 255 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil
| | - Cynthia Rothschild
- Hospital das Clínicas da Faculdade de Medicina de Sao Paulo da USP, 255 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil
| | | | | | - Bianca Stefanello
- Hospital das Clínicas da Faculdade de Medicina de Sao Paulo da USP, 255 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil
| | - Paula Ribeiro Villaça
- Hospital das Clínicas da Faculdade de Medicina de Sao Paulo da USP, 255 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil
| | - Vanderson Geraldo Rocha
- Hospital das Clínicas da Faculdade de Medicina de Sao Paulo da USP, 255 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil
| | - Fernanda Andrade Orsi
- Hospital das Clínicas da Faculdade de Medicina de Sao Paulo da USP, 255 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil.
- Department of Pathology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil.
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Iba T, Helms J, Neal MD, Levy JH. Mechanisms and management of the coagulopathy of trauma and sepsis: trauma-induced coagulopathy, sepsis-induced coagulopathy, and disseminated intravascular coagulation. J Thromb Haemost 2023; 21:3360-3370. [PMID: 37722532 PMCID: PMC10873124 DOI: 10.1016/j.jtha.2023.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/18/2023] [Accepted: 05/12/2023] [Indexed: 09/20/2023]
Abstract
Disseminated intravascular coagulation can occur due to different causes but commonly following sepsis. Trauma-induced coagulopathy (TIC) occurs on hospital arrival in approximately 25% of seriously injured patients who initially presents with impaired hemostasis and a bleeding phenotype that can later progress to a prothrombotic phase. Following traumatic injury, ineffective hemostasis is driven by massive blood loss, tissue damage, and hyperfibrinolysis. This initial impaired hemostasis continues until surgical or other management strategies not only to stop the causes of hemorrhage but also progresses to a prothrombotic and hypofibrinolytic state, also termed fibrinolytic shutdown. Prothrombotic progression is also promoted by inflammatory mediator release, endothelial injury, and platelet dysregulation, which is commonly seen in sepsis with increased mortality. Unlike TIC, the early phase of sepsis is frequently complicated by multiorgan dysfunction described as sepsis-induced coagulopathy (SIC) that lacks a hemorrhagic phase. The phenotypes of SIC and TIC are different, especially in their initial presentations; however, patients who survive TIC may also develop subsequent infections and potentially sepsis and SIC. Although the pathophysiology of SIC and TIC are different, endothelial injury, dysregulated fibrinolysis, and coagulation abnormalities are common. Management includes treatment of the underlying cause, tissue injury vs infection is critical, and supportive therapies, such as hemostatic resuscitation and circulatory support are essential, and adjunct therapies are recommended in guidelines. Based on clinical studies and certain guidelines, additional therapies include tranexamic acid in the limited timing of initial traumatic injury and anticoagulants, such as antithrombin and recombinant thrombomodulin in disseminated intravascular coagulation.
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Affiliation(s)
- Toshiaki Iba
- Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Julie Helms
- Strasbourg University (UNISTRA); Strasbourg University Hospital, Medical Intensive Care Unit - NHC; INSERM (French National Institute of Health and Medical Research), Strasbourg, France
| | - Matthew D Neal
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jerrold H Levy
- Department of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, North Carolina, USA. https://twitter.com/JerroldLevy
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Graf J, Pérez R, López R. Increased respiratory dead space could associate with coagulation activation and poor outcomes in COVID-19 ARDS. J Crit Care 2022; 71:154095. [PMID: 35724445 PMCID: PMC9212801 DOI: 10.1016/j.jcrc.2022.154095] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/17/2022] [Accepted: 06/04/2022] [Indexed: 01/08/2023]
Abstract
PURPOSE To determine whether VDPhys/VT is associated with coagulation activation and outcomes. MATERIALS AND METHODS We enrolled patients with COVID-19 pneumonia who were supported by invasive mechanical ventilation and were monitored using volumetric capnography. Measurements were performed during the first 24 h of mechanical ventilation. The primary endpoint was the likelihood of being discharge alive on day 28. RESULTS Sixty patients were enrolled, of which 25 (42%) had high VDPhys/VT (>57%). Patients with high vs. low VDPhys/VT had higher APACHE II (10[8-13] vs. 8[6-9] points, p = 0.002), lower static compliance of the respiratory system (35[24-46] mL/cmH2O vs. 42[37-45] mL/cmH2O, p = 0.005), and higher D-dimer levels (1246[1050-1594] ng FEU/mL vs. 792[538-1159] ng FEU/mL, p = 0.001), without differences in P/F ratio (157[112-226] vs. 168[136-226], p = 0.719). Additionally, D-dimer levels correlated with VDPhys/VT (r = 0.530, p < 0.001), but not with the P/F ratio (r = -0.103, p = 0.433). Patients with high VDPhys/VT were less likely to be discharged alive on day 28 (32% vs. 71%, aHR = 3.393[1.161-9.915], p = 0.026). CONCLUSIONS In critically ill COVID-19 patients, increased VDPhys/VT was associated with high D-dimer levels and a lower likelihood of being discharged alive. Dichotomic VDPhys/VT could help identify a high-risk subgroup of patients neglected by the P/F ratio.
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Affiliation(s)
- Jerónimo Graf
- Departamento de Paciente Crítico, Clínica Alemana de Santiago, Avenida Vitacura 5951, Vitacura, Santiago Zip Code 7650568, Chile,Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Av. Plaza 680, San Carlos de Apoquindo, Las Condes, Santiago Zip Code 7550000, Chile
| | - Rodrigo Pérez
- Departamento de Paciente Crítico, Clínica Alemana de Santiago, Avenida Vitacura 5951, Vitacura, Santiago Zip Code 7650568, Chile,Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Av. Plaza 680, San Carlos de Apoquindo, Las Condes, Santiago Zip Code 7550000, Chile
| | - René López
- Departamento de Paciente Crítico, Clínica Alemana de Santiago, Avenida Vitacura 5951, Vitacura, Santiago Zip Code 7650568, Chile; Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Av. Plaza 680, San Carlos de Apoquindo, Las Condes, Santiago Zip Code 7550000, Chile.
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Amini S, Rezabakhsh A, Hashemi J, Saghafi F, Azizi H, Sureda A, Habtemariam S, Khayat Kashani HR, Hesari Z, Sahebnasagh A. Pharmacotherapy consideration of thrombolytic medications in COVID-19-associated ARDS. J Intensive Care 2022; 10:38. [PMID: 35908022 PMCID: PMC9338522 DOI: 10.1186/s40560-022-00625-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/22/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In late 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which is responsible for coronavirus disease (COVID-19), was identified as the new pathogen to lead pneumonia in Wuhan, China, which has spread all over the world and developed into a pandemic. Despite the over 1 year of pandemic, due to the lack of an effective treatment plan, the morbidity and mortality of COVID-19 remains high. Efforts are underway to find the optimal management for this viral disease. MAIN BODY SARS-CoV-2 could simultaneously affect multiple organs with variable degrees of severity, from mild to critical disease. Overproduction of pro-inflammatory mediators, exacerbated cellular and humoral immune responses, and coagulopathy such as Pulmonary Intravascular Coagulopathy (PIC) contributes to cell injuries. Considering the pathophysiology of the disease and multiple microthrombi developments in COVID-19, thrombolytic medications seem to play a role in the management of the disease. Beyond the anticoagulation, the exact role of thrombolytic medications in the management of patients with COVID-19-associated acute respiratory distress syndrome (ARDS) is not explicit. This review focuses on current progress in underlying mechanisms of COVID-19-associated pulmonary intravascular coagulopathy, the historical use of thrombolytic drugs in the management of ARDS, and pharmacotherapy considerations of thrombolytic therapy, their possible benefits, and pitfalls in COVID-19-associated ARDS. CONCLUSIONS Inhaled or intravenous administration of thrombolytics appears to be a salvage therapy for severe ARDS associated with COVID-19 by prompt attenuation of lung injury. Considering the pathogenesis of COVID-19-related ARDS and mechanism of action of thrombolytic agents, thrombolytics appear attractive options in stable patients without contraindications.
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Affiliation(s)
- Shahideh Amini
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Aysa Rezabakhsh
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Javad Hashemi
- Department of Pathobiology and Laboratory Sciences, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Fatemeh Saghafi
- Department of Clinical Pharmacy, Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Azizi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Antoni Sureda
- Research Group On Community Nutrition and Oxidative Stress, University of the Balearic Islands, Palma, Spain
- CIBEROBN (Physiopathology of Obesity and Nutrition CB12/03/30038), Instituto de Salud Carlos III, Madrid, Spain
| | - Solomon Habtemariam
- Pharmacognosy Research Laboratories and Herbal Analysis Services, University of Greenwich, Central Avenue, Chatham-Maritime, Kent, ME4 4TB UK
| | | | - Zahra Hesari
- Laboratory Sciences Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Adeleh Sahebnasagh
- Clinical Research Center, Department of Internal Medicine, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
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Dimiati H, Widasari N. COVID-19 and Thrombosis Complication in Children. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Since it was discovered in Wuhan in December 2019, most studies on COVID-19 have been centered on symptomatic adults. An expanded pro-inflammatory cytokine reaction, abnormal clot formation, overactive platelets, and hypercoagulable state are among the well-known clinical characteristics of endothelial dysfunction that may arise in patients with COVID-19. These conditions can lead to venous thromboembolism, arterial thrombosis, and pulmonary embolism. To date, the predominance of thromboembolic complications in children infected with severe acute respiratory syndrome coronavirus 2 has not been fully documented, and there is no explicit recommendation for the prevention of thrombosis in children.
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Mihalko EP, Nellenbach K, Krishnakumar M, Moiseiwitsch N, Sollinger J, Cooley BC, Brown AC. Fibrin-specific poly(N-isopropylacrylamide) nanogels for targeted delivery of tissue-type plasminogen activator to treat thrombotic complications are well tolerated in vivo. Bioeng Transl Med 2022; 7:e10277. [PMID: 35600656 PMCID: PMC9115681 DOI: 10.1002/btm2.10277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 12/28/2022] Open
Abstract
Targeted drug delivery for maintaining blood fluidity can reduce the risks associated with systemic anticoagulants that can lead to off-target bleeding. Recently, there has been much interest in targeted delivery of tissue-type plasminogen activator (tPA) for treating thrombotic complications. The work presented here characterizes a fibrin-specific nanogel (FSN) design for targeted delivery of tPA to treat thrombotic complications. Fibrin binding and clot degradation were characterized in vitro, and animal models of thrombosis were used to examine nanogel effects on coagulation parameters. In vitro assays showed tPA-FSNs attach to fibrin in a dose-dependent manner independent of tPA loading. In animal models of thrombosis, including an electrolytic injury to monitor clot properties in real time, and a lipopolysaccharide-induced disseminated intravascular coagulation (DIC) animal model, tPA-FSNs modulated fibrin/fibrinogen and platelet incorporation into clots and at optimized dosing could recover consumptive coagulopathy in DIC. Distribution of unloaded and tPA-loaded FSNs showed potential clearance of tPA-FSNs after 24 h, although unloaded FSNs may be retained at sites of fibrin deposits. Maximum tolerated dose studies showed tPA-FSNs have minimal toxicity up to 20 times the optimized therapeutic dose. Overall, these studies demonstrate the therapeutic efficacy of targeted fibrinolysis for systemic microthrombi and begin to evaluate key translational parameters for tPA-FSN therapeutics, including optimal tPA-FSN dosage in a DIC rodent model and safety of intravenous tPA-FSN therapeutics.
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Affiliation(s)
- Emily P. Mihalko
- Joint Department of Biomedical Engineering of University of North CarolinaChapel Hill and North Carolina State UniversityRaleighNorth CarolinaUSA
- Comparative Medicine InstituteNorth Carolina State UniversityRaleighNorth CarolinaUSA
| | - Kimberly Nellenbach
- Joint Department of Biomedical Engineering of University of North CarolinaChapel Hill and North Carolina State UniversityRaleighNorth CarolinaUSA
- Comparative Medicine InstituteNorth Carolina State UniversityRaleighNorth CarolinaUSA
| | - Manasi Krishnakumar
- Joint Department of Biomedical Engineering of University of North CarolinaChapel Hill and North Carolina State UniversityRaleighNorth CarolinaUSA
| | - Nina Moiseiwitsch
- Comparative Medicine InstituteNorth Carolina State UniversityRaleighNorth CarolinaUSA
| | - Jennifer Sollinger
- Comparative Medicine InstituteNorth Carolina State UniversityRaleighNorth CarolinaUSA
| | - Brian C. Cooley
- Department of Pathology and Laboratory MedicineUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Ashley C. Brown
- Joint Department of Biomedical Engineering of University of North CarolinaChapel Hill and North Carolina State UniversityRaleighNorth CarolinaUSA
- Comparative Medicine InstituteNorth Carolina State UniversityRaleighNorth CarolinaUSA
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Beni AN, Dehghani A, Kianersi F, Ghanbari H, Habibi Z, Memarzadeh E, Beni ZN. Retinal findings of COVID-19 patients using Ocular coherence tomography angiography two to three months after infection: Ocular appearance recovered COVID-19 patient. Photodiagnosis Photodyn Ther 2022; 38:102726. [PMID: 35051664 PMCID: PMC8762816 DOI: 10.1016/j.pdpdt.2022.102726] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/10/2022] [Accepted: 01/14/2022] [Indexed: 02/06/2023]
Abstract
Purpose The aim of this study was to evaluate the ocular disorders in COVID-19 patients, two to three months after infection. Methods In this cross-sectional, historically controlled study, fifty-one COVID-19 patients were compared with thirty-seven age, and gender-matched healthy individuals. After complete ophthalmological examination, all participants underwent peripapillary and macular optical coherence tomography, and optical coherence tomography angiography (OCTA) measurements (OptoVue Inc, Freemont, CA, USA). Results The time between the initial onset of symptoms, and ophthalmologic examination was 63.31±15.21 (40–95 days). Ophthalmic examination of all the recovered COVID-19 patients was within normal range. None of the peripapillary and macular OCTA parameters were significantly different between the two groups with pairwise comparisons, but after adjusting for age, gender, axial length, and signal strength index (SSI), recovered COVID-19 eyes showed a significant increase in peripapillary retinal nerve fiber (RNFL) thickness, superficial, and deep macular vessel densities in parafoveal and perifoveal regions compared with healthy control eyes (p<= 0.05). Inner retinal thickness overall is higher in recovered COVID-19 eyes compared to healthy eyes after adjustment. Conclusion Patients with moderate-intensity SARS-CoV-2 pneumonia had altered peripapillary and macular vessel density compared to healthy subjects. Further investigation is warranted to analyze the correlation of these changes with disease severity as well as evolution of these changes over time.
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Affiliation(s)
- Afsaneh Naderi Beni
- Isfahan Eye Research Center, Department of ophthalmology, Isfahan University of medical sciences, Isfahan, Iran.
| | - Alireza Dehghani
- Isfahan Eye Research Center, Department of ophthalmology, Isfahan University of medical sciences, Isfahan, Iran
| | - Farzan Kianersi
- Isfahan Eye Research Center, Department of ophthalmology, Isfahan University of medical sciences, Isfahan, Iran
| | - Heshmatollah Ghanbari
- Isfahan Eye Research Center, Department of ophthalmology, Isfahan University of medical sciences, Isfahan, Iran
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Cellular and molecular mechanisms in COVID-19 coagulopathy: role of inflammation and endotheliopathy. J Thromb Thrombolysis 2021; 53:282-290. [PMID: 34687400 PMCID: PMC8536904 DOI: 10.1007/s11239-021-02583-4] [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] [Accepted: 10/03/2021] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Coronavirus 2 (CoV-2) infection or coronavirus disease 2019 (COVID-19) is frequently associated with microvascular thrombosis.The microthrombosis in COVID-19 is the result of the interplay between inflammation and endotheliopathy. Elevated interleukin-6 (IL-6) characterizes COVID-19 inflammation resulting in endotheliopathy and coagulopathy marked by elevated D-dimer (DD). Aim of this study is to identify and to describe the coagulation changes in 100 moderate COVID-19 patients having lung involvement and to determine the association of coagulopathy with the severity and prognosis. METHODS Inflammation, endothelial and coagulation molecules were measured in moderate and mild disease. RESULTS IL-6 and tumor necrosis factor-α (TNF-α) and tissue factor (TF), von Willebrand factor (VWF), and tissue factor pathway inhibitor (TFPI) significantly increased in moderate disease as well as D-dimer, thrombin antithrombin complex (TAT), Fibrinogen (Fib), platelet factor-4 (PF4), β-thromboglobulin (β-TG), P-selectin, and platelet adhesion. Shortened clotting time (CT) and clot formation time (CFT), high maximum clot firmness (MCF) and low LY at 30 min were present in 100% of moderate COVID-19 patients compared with mild COVID-19 patients. CONCLUSIONS These findings demonstrate that moderate COVID-19 has a profound inflammation associated with severee ndotheliopathy and intense coagulation activation uncontrolled by TFPI. Attention should be paid to coagulopathy in COVID-19. Closely monitoring of coagulation and application of appropriate anticoagulation may improve the prognosis of moderate COVID-19 and to prevent the progression to severe COVID-19 disease.
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10
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Relationship between serum zinc level and sepsis-induced coagulopathy. Int J Hematol 2021; 115:87-95. [PMID: 34669153 DOI: 10.1007/s12185-021-03225-4] [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: 03/16/2021] [Revised: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND We investigated whether a decrease in the serum zinc level (SZL) among patients with sepsis admitted to the intensive care unit (ICU) was related to sepsis-induced coagulopathy. METHODS All patients (≥20 years) with a diagnosis of sepsis defined by Sepsis-3 criteria, presenting to the ICU between June 2016 and July 2017, were enrolled. Demographic characteristics and the Sequential Organ Failure Assessment (SOFA) and Japanese Association of Acute Medicine (JAAM) disseminated intravascular coagulation (DIC) scores were recorded. Blood samples were collected upon admission and analyzed for SZL. RESULTS One hundred patients with sepsis (median age, 70 years) were enrolled. Patients with SOFA scores ≥8 had a significantly lower SZL compared to those with SOFA scores <8 (p < 0.001). The SZL in the DIC group (JAAM DIC score ≥4) was significantly lower than that in the non-DIC group (JAAM DIC score <4) (p < 0.001). Analysis of receiver operating characteristic (ROC) curves for prediction of sepsis-induced DIC based on SZL in patients with sepsis showed a cut-off value of 25 µg/dL for zinc level and a sensitivity of 63% and a specificity of 72% with AUC of 0.7 (p = 0.0065). CONCLUSION We observed that SZL reflects organ failure, particularly coagulopathy, in patients with sepsis.
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11
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Naqvi IH, Alam MT, Rehan M, Mahmood K, Aurangzeb M, Talib A. COVID-19-associated Coagulopathy and Thromboembolism: Determination of their Patterns and Risk Factors as Predictors of Mortality Among Severe COVID-19 Patients. Curr Vasc Pharmacol 2021; 20:77-86. [PMID: 34649490 DOI: 10.2174/1570161119666211014162409] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/27/2021] [Accepted: 09/08/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Corona virus disease 2019 (COVID-19) is associated with coagulopathy (CAC) and venous thromboembolism (VTE). These are well-reported complications of COVID-19 infection. Earlier publications have shown that CAC and thromboembolism are predictors of mortality among COVID-19 patients with severe disease. MATERIAL AND METHODS A prospective study was conducted in the Intensive Care Unit (ICU) where all confirmed COVID-19 patients were enrolled and followed until death or ICU discharge. CAC, VTE, along with all comorbidities were recorded. Predictors of mortality were determined by univariate and multivariate regression. RESULTS Among 261 patients with COVID-19, 48.3% survived and 51.7% died. CAC was present in 53.2% and 76.3% of the survivors and non-survivors, respectively (p<0.001); 89 patients (31.4%) had VTE (p=0.36) and 11 patients (4.2%) had arterial thrombosis (p=0.76) among survivors and non-survivors. Age between 71-80 years (p=0.009), male gender (p=0.045), CAC (p<0.001), comorbidities like chronic kidney disease (CKD, p=0.013), chronic obstructive pulmonary disease (COPD, p=0.001) and asthma (p=0.046), were significant predictors of mortality. CONCLUSION A severe complication of COVID-19 is CAC, such as sepsis-induced coagulopathy, overt disseminated-coagulopathy and VTE. Old age, various comorbidities (e.g. COPD, CKD or asthma), CAC, VTE (pulmonary embolism) and coagulation parameters with critical severity score (D-dimers, platelets, prothrombin time) and the SOFA (Sequential Organ Failure Assessment) score were significant predictors of mortality among COVID-19 patients.
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Affiliation(s)
| | | | - Muhammad Rehan
- Department of Medicine, Dow University of Health Sciences Karachi. Pakistan
| | - Khalid Mahmood
- Department of Medicine, Dow University of Health Sciences Karachi. Pakistan
| | - M Aurangzeb
- Department of Medicine, Dow University of Health Sciences Karachi. Pakistan
| | - Abu Talib
- Department of Medicine, Dow University of Health Sciences Karachi. Pakistan
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12
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Ozdin M, Kaya H, Gulacti U, Lok U, Kafadar H, Yucetas C. The diagnostic value of neutrophil to lymphocyte ratio in determining the severity of COVID-19. IMC JOURNAL OF MEDICAL SCIENCE 2021. [DOI: 10.55010/imcjms.16.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: Changes in hematological parameters play a role in the pathogenesis of coronavirus disease 2019 (COVID-19). We aimed to investigate the significance of neutrophil-lymphocyte ratio (NLR) and hematologic parameters in determining the severity of COVID-19.
Methods: This retrospective cross-sectional study was conducted on adult patients diagnosed with COVID-19 in two pandemic hospitals between 01, April, and 01, July 2020. Using the COVID-19 diagnostic criteria of the world health organization (WHO), the patients were divided into two groups as severe and non-severe. Demographic and clinical characteristics, white blood cell (WBC), neutrophil, lymphocyte and platelet counts, and NLR of all patients were examined at the first admission. Multivariate analyzes were performed to determine the independent predictive data and ROC analysis to test the diagnostic accuracy of the hematological parameters.
Results: Of the 381 patients included in the study, 42 (11%) had severe COVID-19 infection. While the mean NLR was 7.61±7.48 in patients with severe COVID-19, the mean NLR of non-severe patients was 2.97±2.37 (95% CI: 2.294 to 6.984, p<0.001). Long duration of hospital stay, elevated NLR ratio, female gender were predictive variables of severe COVID-19 cases (OR =0.833, 95% CI: 0.744 to 0.934, p=0.002; OR=0.195, 95% CI: 0.057 to 0.6731, p=0.010; OR=0.664, 95% CI: 0.501 to 0.881, p=0.005, respectively). In ROC analysis, NLR ratio had 2.625 optimum cut-off value, 60% specificity (95% CI: 54.7 to 65.4), 86% sensitivity (95% CI: 71.5 to 94.6), positive likelihood ratio (PLR) of 4.2 (95% CI: 2.0 to 8.9) and negative likelihood ratio (NLR) of 0.46 (95% CI: 0.4 to 0.6) for severe COVID-19 cases.
Conclusion: The results of this study revealed that there might be a relationship between elevated NLR and severity in COVID-19 cases.
IMC J Med Sci 2022; 16(1): 001
*Correspondence: Dr. Umut Gulacti, Adiyaman University Training and Research Hospital, Emergency Medicine, Adiyaman, Turkey. E-mail: umutgulacti@gmail.com
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Affiliation(s)
- Mehmet Ozdin
- Sakarya University Training and Research Hospital, Medical Biochemistry Laboratory, Sakarya, Turkey
| | - Hakan Kaya
- Adıyaman University Faculty of Medicine, Department of Cardiology, Adıyaman, Turkey
| | - Umut Gulacti
- Adıyaman University Faculty of Medicine, Department of Emergency Medicine, Adıyaman, Turkey, Adıyaman, Turkey
| | - Uğur Lok
- Adıyaman University Faculty of Medicine, Department of Emergency Medicine, Adıyaman, Turkey, Adıyaman, Turkey
| | - Hüseyin Kafadar
- Adıyaman University Faculty of Medicine, Department of Forensic Medicine, Adıyaman, Turkey
| | - Cem Yucetas
- Adıyaman University Faculty of Medicine, Department of Neurosurgery, Adıyaman, Turkey
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13
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Okeahialam BN. Serine protease inhibitors could be of benefit in the treatment of COVID-19 disease. Ther Adv Infect Dis 2021; 8:20499361211032048. [PMID: 34345429 PMCID: PMC8283214 DOI: 10.1177/20499361211032048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Basil N Okeahialam
- Department of Medicine, Jos University Teaching Hospital, Jos, Plateau 930001, Nigeria
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14
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Iba T, Umemura Y, Wada H, Levy H. The Roles of Coagulation Disorder and Microthrombosis in Sepsis: Pathophysiology, Diagnosis, and Treatment. Arch Med Res 2021; 52:788-797. [PMID: 34344558 DOI: 10.1016/j.arcmed.2021.07.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 06/28/2021] [Accepted: 07/02/2021] [Indexed: 12/23/2022]
Abstract
The diagnostic criteria of overt disseminated intravascular coagulation (DIC) were established by the International Society on Thrombosis and Haemostasis (ISTH) in 2001. Since then, DIC has long been associated with adverse outcomes. However, recent advances in sepsis shed light on the role of coagulation disorders in the progression of sepsis. Currently, inflammation and coagulation are recognized as the two drivers that promote organ dysfunction in sepsis and septic shock. The ISTH has published new diagnostic criteria for improved management, namely sepsis-induced coagulopathy (SIC), in 2017. SIC is a pragmatic scoring system composed of platelet count, prothrombin time, and organ dysfunction score to detect the early-stage of sepsis-associated DIC. Since overt DIC represents an uncompensated coagulation disorder, a two-step approach using SIC and overt DIC criteria is a novel strategy to evaluate the severity and manage this challenging complication. Although there is no globally agreed on anticoagulant therapy for DIC, the Japanese Surviving Sepsis Campaign Guidelines 2020 recommend using antithrombin and recombinant thrombomodulin for sepsis associated DIC. Since research in this area has been previously reported, an international collaborative study is necessary to develop future diagnostic tools and treatment strategies.
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Affiliation(s)
- Toshiaki Iba
- Department of Emergency and Disaster Medicine, Juntendo University Graduate, School of Medicine, Tokyo, Japan.
| | - Yutaka Umemura
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan; Department of Traumatology and Acute Critical Medicine, Osaka, University Graduate School of Medicine, Osaka, Japan
| | - Hideo Wada
- Department of General Medicine, Mie Prefectural General Medical Center, Mie, Japan
| | - H Levy
- Department of Anesthesiology, Critical Care, and Surgery, Duke University, School of Medicine, Durham, NC, USA
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15
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Pathophysiology of Coagulopathy in Hematological Malignancies and in COVID-19. Hemasphere 2021; 5:e571. [PMID: 34095755 PMCID: PMC8171377 DOI: 10.1097/hs9.0000000000000571] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 04/07/2021] [Indexed: 01/08/2023] Open
Abstract
Many severe illnesses with a systemic impact may cause activation of coagulation. While systemic activation of coagulation leads to a coagulopathy that follows many common activation pathways and failure of endogenous regulatory anticoagulant systems, underlying conditions may utilize distinctive pathogenetic routes and may vary in clinical manifestations of the coagulopathy. The coagulation derangement associated with hematological malignancies and the coagulopathy of coronavirus disease 2019 (COVID-19) clearly demonstrate such differences. Malignancies are associated with venous thromboembolism due to the biological effect of malignant cells, frequent medical interventions, or the presence of indwelling vascular catheters. The underlying pathogenesis of cancer-associated coagulopathy relies on tissue factor-mediated activation of coagulation, cytokine-controlled defective anticoagulant pathways, fibrinolytic changes, and dysfunctional endothelium. There is an additional risk caused by anti-cancer agents including chemotherapy and immunotherapy. The underlying pathogenetic factor that contributes to the thrombotic risk associated with chemotherapy is endothelial cell injury (or loss of protection of endothelial integrity, for example, by vascular endothelial growth factor inhibition). In addition, individual anti-cancer agents may have specific prothrombotic effects. One of the remarkable features of severe COVID-19 infections is a coagulopathy that mimics but is not identical to the disseminated intravascular coagulation and thrombotic microangiopathy and has been identified as a strong marker for an adverse outcome. Severe COVID-19 infections cause inflammation-induced changes in coagulation in combination with severe endothelial cell injury. This coagulopathy likely contributes to pulmonary microvascular thrombosis, bronchoalveolar fibrin deposition (which is a hallmark of acute respiratory distress syndrome) and venous thromboembolic complications.
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16
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Wada T, Shiraishi A, Gando S, Yamakawa K, Fujishima S, Saitoh D, Kushimoto S, Ogura H, Abe T, Mayumi T, Sasaki J, Kotani J, Takeyama N, Tsuruta R, Takuma K, Yamashita N, Shiraishi SI, Ikeda H, Shiino Y, Tarui T, Nakada TA, Hifumi T, Okamoto K, Sakamoto Y, Hagiwara A, Masuno T, Ueyama M, Fujimi S, Umemura Y, Otomo Y. Disseminated intravascular coagulation immediately after trauma predicts a poor prognosis in severely injured patients. Sci Rep 2021; 11:11031. [PMID: 34040091 PMCID: PMC8154895 DOI: 10.1038/s41598-021-90492-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/04/2021] [Indexed: 12/12/2022] Open
Abstract
Trauma patients die from massive bleeding due to disseminated intravascular coagulation (DIC) with a fibrinolytic phenotype in the early phase, which transforms to DIC with a thrombotic phenotype in the late phase of trauma, contributing to the development of multiple organ dysfunction syndrome (MODS) and a consequently poor outcome. This is a sub-analysis of a multicenter prospective descriptive cross-sectional study on DIC to evaluate the effect of a DIC diagnosis on the survival probability and predictive performance of DIC scores for massive transfusion, MODS, and hospital death in severely injured trauma patients. A DIC diagnosis on admission was associated with a lower survival probability (Log Rank P < 0.001), higher frequency of massive transfusion and MODS and a higher mortality rate than no such diagnosis. The DIC scores at 0 and 3 h significantly predicted massive transfusion, MODS, and hospital death. Markers of thrombin and plasmin generation and fibrinolysis inhibition also showed a good predictive ability for these three items. In conclusion, a DIC diagnosis on admission was associated with a low survival probability. DIC scores obtained immediately after trauma predicted a poor prognosis of severely injured trauma patients.
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Affiliation(s)
- Takeshi Wada
- Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan.
| | | | - Satoshi Gando
- Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan
- Department of Acute and Critical Care Medicine, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Kazuma Yamakawa
- Department of Emergency Medicine, Osaka Medical College, Osaka, Japan
| | - Seitaro Fujishima
- Center for General Medicine Education, Keio University School of Medicine, Tokyo, Japan
| | - Daizoh Saitoh
- Division of Traumatology, Research Institute, National Defense Medical College, Saitama, Japan
| | - Shigeki Kushimoto
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Toshikazu Abe
- Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Japan
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan
| | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Joji Kotani
- Division of Disaster and Emergency Medicine, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naoshi Takeyama
- Advanced Critical Care Center, Aichi Medical University Hospital, Nagakute, Japan
| | - Ryosuke Tsuruta
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Japan
| | - Kiyotsugu Takuma
- Emergency and Critical Care Center, Kawasaki Municipal Hospital, Kawasaki, Japan
| | - Norio Yamashita
- Department of Emergency and Critical Care Medicine, School of Medicine, Kurume University, Kurume, Japan
| | - Shin-Ichiro Shiraishi
- Department of Emergency and Critical Care Medicine, Aizu Chuo Hospital, Aizuwakamatsu, Japan
| | - Hiroto Ikeda
- Department of Emergency Medicine, Trauma and Resuscitation Center, Teikyo University School of Medicine, Tokyo, Japan
| | - Yasukazu Shiino
- Department of Acute Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Takehiko Tarui
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Taka-Aki Nakada
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Kohji Okamoto
- Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Kitakyushu, Japan
| | - Yuichiro Sakamoto
- Emergency and Critical Care Medicine, Saga University Hospital, Saga, Japan
| | - Akiyoshi Hagiwara
- Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Tomohiko Masuno
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Masashi Ueyama
- Department of Trauma, Critical Care Medicine, and Burn Center, Japan; Community Healthcare Organization, Chukyo Hospital, Nagoya, Japan
| | - Satoshi Fujimi
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Yutaka Umemura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan
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17
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Fournier M, Faille D, Dossier A, Mageau A, Nicaise Roland P, Ajzenberg N, Borie R, Bouadma L, Bunel V, Castier Y, Choquet C, Crestani B, Daugas E, Deconinck L, Descamps D, Descamps V, Dieudé P, Ducrocq G, Faucher N, Goulenok T, Guidoux C, Khalil A, Lavallée P, Lescure FX, Lortat-Jacob B, Mal H, Mutuon P, Pellenc Q, Steg PG, Taille C, Timsit JF, Yazdanpanah Y, Papo T, Sacré K. Arterial Thrombotic Events in Adult Inpatients With COVID-19. Mayo Clin Proc 2021; 96:295-303. [PMID: 33549252 PMCID: PMC7691140 DOI: 10.1016/j.mayocp.2020.11.018] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/21/2020] [Accepted: 11/19/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate the clinical course of and risk factors for arterial thrombotic events in adult inpatients with coronavirus disease 2019 (COVID-19). METHODS All consecutive adult patients admitted for COVID-19 infection in a referral center in France and discharged from the hospital between April 1 and April 30, 2020, were included. All arterial thrombotic events that occurred through discharge were considered for analysis. Epidemiologic, demographic, clinical, laboratory, treatment, and outcome data were extracted from electronic medical records with use of a standardized data collection form. RESULTS Overall, 531 COVID-19+ patients were analyzed. Among them, 30 (5.6%) experienced arterial thrombotic events. Arterial thrombotic events in the setting of COVID-19 infection happened at a median of 11 (5-20) days after the first symptoms of infection; occurred in high-risk patients according to traditional cardiovascular risk factors; had an atypical pattern, such as thrombosis of the aorta, upper limb, or renal arteries or cerebral microvasculopathy in 7 (23.3%) cases; and were associated with an in-hospital mortality rate of 40%. Arterial thrombotic events increased the risk of death by 3-fold in COVID-19+ patients (hazard ratio, 2.96; 95% CI, 1.4 to 4.7; P=.002). A subdistribution survival hazard model showed that a concentration of D-dimer above 1250 ng/mL increased the risk of arterial thrombotic events in COVID-19+ patients by more than 7 (subdistribution hazard ratio, 7.68; 95% CI, 2.9 to 20.6; P<.001). CONCLUSION A dramatically high rate of in-hospital death was observed in patients who suffered arterial thrombotic events in the setting of COVID-19 infection. A D-dimer level above 1250 ng/mL at entry may identify COVID-19+ patients at risk for arterial thrombotic events.
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Affiliation(s)
- Morgane Fournier
- Département de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France
| | - Dorothée Faille
- Département d'Hémostase, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France
| | - Antoine Dossier
- Département de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France
| | - Arthur Mageau
- Département de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France
| | - Pascale Nicaise Roland
- Département d'Immunologie, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France; INSERM UMR 1152, Paris, France
| | - Nadine Ajzenberg
- Département d'Hémostase, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France
| | - Raphael Borie
- Département Pneumologie A, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France
| | - Lila Bouadma
- Département de Réanimation Médicale, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France
| | - Vincent Bunel
- Département de Pneumologie B, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France
| | - Yves Castier
- Département de Chirurgie Vasculaire et Thoracique, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France
| | - Christophe Choquet
- Département des Urgences, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France
| | - Bruno Crestani
- Département Pneumologie A, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France
| | - Eric Daugas
- Département de Néphrologie, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France
| | - Laurene Deconinck
- Département de Maladies Infectieuse, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France
| | - Diane Descamps
- Département de Virologie, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France
| | - Vincent Descamps
- Département de Dermatologie, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France
| | - Philippe Dieudé
- Département de Rhumatologie, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France
| | - Gregory Ducrocq
- Département de Cardiologie, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France
| | - Nathalie Faucher
- Département de Gériatrie, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France
| | - Tiphaine Goulenok
- Département de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France
| | - Céline Guidoux
- Département de Neurologie, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France
| | - Antoine Khalil
- Département de Radiologie, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France
| | - Philippa Lavallée
- Département de Neurologie, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France
| | - François Xavier Lescure
- Département de Maladies Infectieuse, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France
| | - Brice Lortat-Jacob
- Département d'Anesthésie-Réanimation, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France
| | - Hervé Mal
- Département de Pneumologie B, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France
| | - Pierre Mutuon
- Département d'Information Médicale, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France
| | - Quentin Pellenc
- Département de Chirurgie Vasculaire et Thoracique, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France
| | - Philippe Gabriel Steg
- Département de Cardiologie, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France
| | - Camille Taille
- Département Pneumologie A, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France
| | - Jean Francois Timsit
- Département de Réanimation Médicale, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France
| | - Yazdan Yazdanpanah
- Département de Maladies Infectieuse, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France
| | - Thomas Papo
- Département de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France; INSERM U1149, Paris, France
| | - Karim Sacré
- Département de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France; INSERM U1149, Paris, France.
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18
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García-Ortega A, de la Rosa D, Oscullo G, Castillo-Villegas D, López-Reyes R, Martínez-García MÁ. Coagulation disorders and thromboembolic disease in COVID-19: review of current evidence in search of a better approach. J Thorac Dis 2021; 13:1239-1255. [PMID: 33717596 PMCID: PMC7947499 DOI: 10.21037/jtd-20-3062] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/18/2020] [Indexed: 01/08/2023]
Abstract
The new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been an unprecedented global health problem, causing more than 20 million infections and more than 900,000 deaths (September 2020). The SARS-CoV-2 infection, known as COVID-19, has various clinical presentations, from asymptomatic or mild catarrhal processes to severe pneumonia that rapidly progresses to acute respiratory distress syndrome (ARDS) and multiple organ failure. In the last few months, much scientific literature has been devoted to descriptions of different aspects of the coagulation disorders and arterial and venous thrombotic complications associated with COVID-19, particularly venous thromboembolism (VTE). These studies have revealed that SARS-CoV-2 could lead to a prothrombotic state reflecting the high cumulative incidence of associated thrombotic events, particularly in patients admitted to intensive care units (ICUs). As regards the coagulopathy observed in association with SARS-CoV-2 infection, the mechanisms that activate coagulation have been hypothesized as being linked to immune responses, through the release of pro-inflammatory mediators that interact with platelets, stimulate the expression of tissue factor, induce an upregulation of plasminogen activator inhibitor-1, suppress the fibrinolytic system and lead to endothelial dysfunction, triggering thrombogenesis. D-dimer elevation has been recognized as a useful biomarker of poor prognosis, although the best cut-off point for predicting VTE in COVID-19 patients has still not been clarified. This review will try to update all the available scientific information on this important topic with enormous clinical and therapeutic implications.
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Affiliation(s)
- Alberto García-Ortega
- Pneumology Department, Hospital Universitario and Politécnico La Fe, 46026 Valencia, Spain
- Medical Research Institute Hospital La Fe (IISLAFE), 46026 Valencia, Spain
| | - David de la Rosa
- Pneumology Department, Hospital Universitario Santa Creu i Sant Pau, 08041 Barcelona, Spain
| | - Grace Oscullo
- Pneumology Department, Hospital Universitario and Politécnico La Fe, 46026 Valencia, Spain
- Medical Research Institute Hospital La Fe (IISLAFE), 46026 Valencia, Spain
| | | | - Raquel López-Reyes
- Pneumology Department, Hospital Universitario and Politécnico La Fe, 46026 Valencia, Spain
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19
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Iba T, Warkentin TE, Thachil J, Levi M, Levy JH. Proposal of the Definition for COVID-19-Associated Coagulopathy. J Clin Med 2021; 10:jcm10020191. [PMID: 33430431 PMCID: PMC7827226 DOI: 10.3390/jcm10020191] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 12/29/2020] [Accepted: 01/04/2021] [Indexed: 01/08/2023] Open
Abstract
Thrombotic events are common complications in COVID-19 patients that include both thrombus formation in large vessels and the microvasculature of the lung and other organs. COVID-19-associated coagulopathy (CAC) and disseminated intravascular coagulation (DIC) have similarities and differences, and whether CAC is a form of DIC is the subject of debate. Reported mechanisms of CAC include activated coagulation, endotheliopathy, up-regulated innate and adaptive immunity, and activated complement system. Although the clinical features and laboratory findings of CAC and DIC seem different, there are fundamental similarities that should be considered. Basically, the pathological findings of COVID-19 fall within the scope of the definition of DIC, i.e., systemic activation of coagulation caused by or resulting from the microvascular damage. Therefore, we suggest that although CAC differs from usual infection-associated DIC, its various features indicate that it can be considered a thrombotic phenotype DIC. This review summarizes the current knowledge about CAC including differences and similarities with sepsis-associated DIC.
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Affiliation(s)
- Toshiaki Iba
- Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
- Correspondence: ; Tel.: +81-3-3813-3111
| | - Theodore E. Warkentin
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada;
- Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Jecko Thachil
- Department of Haematology, Manchester Royal Infirmary, Manchester M13 9WL, UK;
| | - Marcel Levi
- Department of Medicine, University College London Hospitals NHS Foundation Trust, and Cardio-Metabolic Programme-NIHR UCLH/UCL BRC, London NW1 2BU, UK;
| | - Jerrold H. Levy
- Department of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, NC 27710, USA;
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20
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Hypercoagulability in Patients With Coronavirus Disease (COVID-19): Identification of Arterial and Venous Thromboembolism in the Abdomen, Pelvis, and Lower Extremities. AJR Am J Roentgenol 2021; 216:104-105. [DOI: 10.2214/ajr.20.23617] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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21
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López-Reyes R, Oscullo G, Jiménez D, Cano I, García-Ortega A. [Thrombotic Risk and Covid-19: Review of Current Evidence for a Better Diagnostic and Therapeutic Approach]. Arch Bronconeumol 2021; 57:55-64. [PMID: 34629653 PMCID: PMC7457904 DOI: 10.1016/j.arbres.2020.07.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/10/2020] [Indexed: 01/08/2023]
Abstract
The new SARS-CoV-2 coronavirus has created an unprecedented global health problem, resulting in more than 250,000 confirmed deaths. The disease produced by this virus, called Covid-19, presents with variable clinical manifestations, from practically asymptomatic patients with catarrhal processes to severe pneumonias that rapidly evolve to acute respiratory distress syndrome (ARDS) and multiorgan failure. In recent weeks, papers have been published describing coagulation disorders and arterial and venous thrombotic complications in these patients, mainly among those admitted to intensive care units. The infection triggers an immune response, which causes different inflammatory mediators to be released into the blood. These include cytokines, which interact with platelets and different coagulation proteins, and promote thrombogenesis. One of the most widely studied coagulation markers in Covid-19 is D-dimer (DD), raised levels of which have prognostic implications, although the best cut-off point for the diagnosis of venous thromboembolism (VTE) in this population has not been clarified, nor has its usefulness in determining the intensity of thromboprophylaxis required in these patients. Until sufficiently robust information (preferably from well-designed clinical trials) is available, the recommendations of clinical practice guidelines for the prophylaxis, diagnosis and treatment of VTE should be followed in Covid-19 patients.
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Affiliation(s)
- Raquel López-Reyes
- Servicio de Neumología, Hospital Universitario y Politécnico la Fe, Valencia, España
| | - Grace Oscullo
- Servicio de Neumología, Hospital Universitario y Politécnico la Fe, Valencia, España
- Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, España
| | - David Jiménez
- Servicio de Neumología. Hospital Ramón y Cajal (IRYCIS), Madrid, España
- Departamento de Medicina, Universidad de Alcalá (IRYCIS), Madrid, España
- CIBER Enfermedades Respiratorias (CIBERES), Madrid, España
| | - Irene Cano
- Servicio de Neumología. Hospital Ramón y Cajal (IRYCIS), Madrid, España
| | - Alberto García-Ortega
- Servicio de Neumología, Hospital Universitario y Politécnico la Fe, Valencia, España
- Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, España
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22
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COVID-19 Associated Coagulopathy and Implications for its Treatment. ACTA MEDICA BULGARICA 2020. [DOI: 10.2478/amb-2020-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Abstract
The SARS-CoV-2 coronavirus (COVID-19) pandemic is due to lack of prior immunity and there is no certain management, regarding the complications of this viral illness. The target organ for COVID-19 infection are the lungs. Patients may develop acute lung injury that can be complicated by acute respiratory failure, as well as multiorgan failure. The pathophysiology of COVID-19 infection is characterized with inflammatory changes, associated with coagulopathy. Recent data suggests diffuse bilateral pulmonary inflammation observed in COVID-19 infection that is related to a novel pulmonary-specific vasculopathy, defined as pulmonary intravascular coagulopathy (PIC), distinct from disseminated intravascular coagulopathy (DIC). The coagulopathy associated with COVID-19 is distinguished by initial elevation of D-dimer and fibrin/fibrinogen degradation products. Abnormalities in prothrombin time (PT), partial thromboplastin time (APTT) and platelet counts are not common in the early stages of the infection. This suggests the early screening measurement of D-dimer and fibrinogen. The implications for COVID-19-associated-coagulopathy is the established thromboembolic prophylaxis and standard management for sepsis-induced coagulopathy or DIC. High levels of D-dimer are a marker of higher mortality risk. However, current studies do not show the common use of full therapeutical doses of anticoagulants, unless there are other clinical indications. Bleeding in COVID-19 infection is uncommon, even when a laboratory constellation for DIC is present. However, if it occurs, standard guidelines for DIC management should be followed.
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23
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Levi M. Relevance and diagnosis of disseminated intravascular coagulation associated with cardiovascular disease. Eur J Intern Med 2020; 79:27-28. [PMID: 32768159 DOI: 10.1016/j.ejim.2020.07.021] [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: 07/28/2020] [Accepted: 07/31/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Marcel Levi
- University College London Hospitals NHS Foundation Trust, Department of Medicine (1) and Cardiometabolic Programme-NIHR UCLH/UCL BRC (2), London, UK.
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24
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Xu Y, Liu S, Zhang Y, Zhi Y. Does hereditary angioedema make COVID-19 worse? World Allergy Organ J 2020; 13:100454. [PMID: 32834893 PMCID: PMC7416729 DOI: 10.1016/j.waojou.2020.100454] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/31/2020] [Indexed: 12/19/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has spread rapidly worldwide. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent for COVID-19, enters host cells via angiotensin-converting enzyme 2 (ACE2) and depletes ACE2, which is necessary for bradykinin metabolism. The depletion of ACE2 results in the accumulation of des-Arg (9)-bradykinin and possible bradykinin, both of which bind to bradykinin receptors and induce vasodilation, lung injury, and inflammation. It is well known that an overactivated contact system and excessive production of bradykinin comprise the key mechanisms that drive the pathogenesis of hereditary angioedema (HAE). It is reasonable to speculate that COVID-19 may increase disease activity in patients with HAE and vice versa. In this review, we explore the potential interactions between COVID-19 and HAE in terms of the contact system, the complement system, cytokine release, increased T helper 17 cells, and hematologic abnormalities. We conclude with the hypothesis that comorbidity with HAE might favor COVID-19 progression and may worsen its outcomes, while COVID-19 might in turn aggravate pre-existing HAE and prompt the onset of HAE in asymptomatic carriers of HAE-related mutations. Based on the pathophysiologic links, we suggest that long-term prophylaxis should be considered in patients with HAE at risk of SARS-CoV-2 infection, especially the prophylactic use of C1 inhibitor and lanadelumab and that HAE patients must have medications for acute attacks of angioedema. Additionally, therapeutic strategies employed in HAE should be considered for the treatment of COVID-19, and clinical trials should be performed.
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Key Words
- ACE2
- ADAM metallopeptidase domain 17, ADAM17
- C1 inhibitor, C1–INH
- COVID-19
- Complement system
- Contact system
- Coronavirus disease 2019, COVID-19
- Hereditary angioedema
- Middle East respiratory syndrome coronavirus, MERS-CoV
- acute respiratory distress syndrome, ARDS
- angiotensin-converting enzyme, ACE
- bradykinin receptor B1, B1R
- bradykinin receptor B2, B2R
- bradykinin, BK
- des-Arg(9)-bradykinin, DABK
- granulocyte-colony stimulating factor, GCSF
- granulocyte-macrophage colony stimulating factor, GM-CSF
- hereditary angioedema, HAE
- high-molecular-weight kininogen, HMWK
- interleukin-1, IL-1
- macrophage inflammatory protein, MIP
- mannose-binding lectin associated serine protease, MASP
- mannose-binding lectin, MBL
- severe acute respiratory syndrome coronavirus 2, SARS-CoV-2
- transforming growth factor-β, TGF-β
- transmembrane serine protease, TMPRSS2
- tumor necrosis factor γ, TNF-γ
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Affiliation(s)
- Yingyang Xu
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.,Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment on Allergic Diseases, Beijing, 100730, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, 100730, China.,Centre for Translational Medicine, Peking Union Medical College Hospital, China
| | - Shuang Liu
- School of Clinical Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100005, China
| | - Yan Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Yuxiang Zhi
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.,Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment on Allergic Diseases, Beijing, 100730, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, 100730, China.,Centre for Translational Medicine, Peking Union Medical College Hospital, China
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25
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Abstract
Coagulopathy, a common complication with sepsis, contributes to vascular injury and organ dysfunction. Early detection using diagnostic criteria for sepsis-induced coagulopathy is important to consider for potential clinical management.
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26
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Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood 2020; 135:2033-2040. [PMID: 32339221 PMCID: PMC7273827 DOI: 10.1182/blood.2020006000] [Citation(s) in RCA: 1645] [Impact Index Per Article: 411.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/27/2020] [Indexed: 02/06/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2, coronavirus disease 2019 (COVID-19)-induced infection can be associated with a coagulopathy, findings consistent with infection-induced inflammatory changes as observed in patients with disseminated intravascular coagulopathy (DIC). The lack of prior immunity to COVID-19 has resulted in large numbers of infected patients across the globe and uncertainty regarding management of the complications that arise in the course of this viral illness. The lungs are the target organ for COVID-19; patients develop acute lung injury that can progress to respiratory failure, although multiorgan failure can also occur. The initial coagulopathy of COVID-19 presents with prominent elevation of D-dimer and fibrin/fibrinogen-degradation products, whereas abnormalities in prothrombin time, partial thromboplastin time, and platelet counts are relatively uncommon in initial presentations. Coagulation test screening, including the measurement of D-dimer and fibrinogen levels, is suggested. COVID-19-associated coagulopathy should be managed as it would be for any critically ill patient, following the established practice of using thromboembolic prophylaxis for critically ill hospitalized patients, and standard supportive care measures for those with sepsis-induced coagulopathy or DIC. Although D-dimer, sepsis physiology, and consumptive coagulopathy are indicators of mortality, current data do not suggest the use of full-intensity anticoagulation doses unless otherwise clinically indicated. Even though there is an associated coagulopathy with COVID-19, bleeding manifestations, even in those with DIC, have not been reported. If bleeding does occur, standard guidelines for the management of DIC and bleeding should be followed.
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Affiliation(s)
- Jean M Connors
- Hematology Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and
| | - Jerrold H Levy
- Department of Anesthesiology
- Division of Critical Care Medicine, and
- Department of Surgery, Division of Cardiothoracic Surgery, Duke University School of Medicine, Durham, NC
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27
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Moore HB, Gando S, Iba T, Kim PY, Yeh CH, Brohi K, Hunt BJ, Levy JH, Draxler DF, Stanworth S, Görlinger K, Neal MD, Schreiber MA, Barrett CD, Medcalf RL, Moore EE, Mutch NJ, Thachil J, Urano T, Thomas S, Scărlătescu E, Walsh M. Defining trauma-induced coagulopathy with respect to future implications for patient management: Communication from the SSC of the ISTH. J Thromb Haemost 2020; 18:740-747. [PMID: 32112533 DOI: 10.1111/jth.14690] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/12/2019] [Accepted: 11/25/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Hunter B Moore
- Department of Surgery, University of Colorado, Denver, CO, USA
| | - Satoshi Gando
- Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
- Department of Acute and Critical Care Medicine, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Toshiaki Iba
- Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Paul Y Kim
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada
| | - Calvin H Yeh
- Department of Medicine, Division of Emergency Medicine, University of Toronto, Toronto, ON,, Canada
| | - Karim Brohi
- Queen Mary University of London, London, UK
- Centre for Trauma Sciences, London, UK
| | | | - Jerrold H Levy
- Department of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Dominik F Draxler
- Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria,, Australia
| | - Simon Stanworth
- Transfusion Medicine, NHS Blood and Transplant, Oxford, UK
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Radcliffe Department of Medicine, NIHR Oxford Biomedical Research Centre,, University of Oxford,, Oxford,, UK
| | - Klaus Görlinger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, Essen, Germany
- TEM Innovations GmbH, Munich, Germany
| | - Matthew D Neal
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Martin A Schreiber
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Christopher D Barrett
- Koch Institute for Integrative Cancer Research, Center for Precision Cancer Medicine, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Acute Care Surgery and Critical Care, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Robert L Medcalf
- Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria,, Australia
| | - Ernest E Moore
- Ernest E. Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA
| | - Nicola J Mutch
- Aberdeen Cardiovascular and Diabetes Centre, School of Medicine, Medical Sciences and Nutrition, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - Jecko Thachil
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - Tetsumei Urano
- Department of Medical Physiology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Scott Thomas
- Beacon Medical Group Trauma and Surgical Research Services, South Bend, IN, USA
| | - Ecaterina Scărlătescu
- Department of Anaesthesia and Intensive Care, Fundeni Clinical Institute, Bucharest, Romania
| | - Mark Walsh
- Beacon Medical Group Trauma and Surgical Research Services, South Bend, IN, USA
- Departments of Emergency and Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, USA
- Indiana University School of Medicine, South Bend Campus, South Bend, IN, USA
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28
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Gando S, Otomo Y. Trauma-induced coagulopathy: The past, present, and future: A comment. J Thromb Haemost 2019; 17:1567-1569. [PMID: 31479181 DOI: 10.1111/jth.14520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 05/21/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Satoshi Gando
- Acute and Critical Care Center, Department of Acute and Critical Care Medicine, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan
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29
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Wada T, Yamakawa K. Trauma-induced coagulopathy: The past, present, and future: A comment. J Thromb Haemost 2019; 17:1571-1574. [PMID: 31479182 DOI: 10.1111/jth.14571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 06/30/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Takeshi Wada
- Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Kazuma Yamakawa
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan
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30
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Kornblith LZ, Moore HB, Cohen MJ. Response to Letter to the Editor submitted by Dr. Wada and Dr. Yamakawa re: Trauma-induced coagulopathy: The past, present, and future. J Thromb Haemost 2019; 17:1574-1576. [PMID: 31479184 PMCID: PMC6727975 DOI: 10.1111/jth.14581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 07/17/2019] [Indexed: 11/29/2022]
Abstract
It is with equal appreciation and enthusiasm that we have the opportunity to participate in these valuable scientific discussions with our respected colleagues Dr. Wada and Dr. Yamakawa, as we did with Dr. Gando and Dr. Otomo on their analogous disseminated-intravascular coagulation (DIC)-centric views of trauma-induced coagulopathy (TIC). We welcome and appreciate Drs Wada and Yamakawa’s expounded descriptions on their areas of their expertise specific to the critical thrombin-specific biologies. We find their additions valuable to the overall framing of the state of the science and controversies that exists in TIC investigations. However, we continue to support that it would be erroneous to continue to force an inflexible view of the complex biology of TIC, thereby failing to acknowledge the various competing mechanisms and mediators described throughout the literature, including the sometimes contradictory biomarker phenotypes that are ‘impaired’ in TIC. In addition, much of our following response to Drs Wada and Yamakawa’s letter will involve referring back to what was already addressed within the manuscript that appears to have been overlooked. However, of absolute importance, we would like to stress that TIC remains open science should therefore be regarded with open minds and without siloed opinions.
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Affiliation(s)
- Lucy Z. Kornblith
- Department of Surgery, Zuckerberg San Francisco General Hospital and the University of California, San Francisco, San Francisco, California, 1001 Potrero Avenue, Building 1, Suite 210, San Francisco, CA 94110
| | - Hunter B. Moore
- Department of Surgery, Denver Health Medical Center and the University of Colorado, Denver, Colorado, 777 Bannock Street. Mail Code 0206, Denver, CO 80203
| | - Mitchell J. Cohen
- Department of Surgery, Denver Health Medical Center and the University of Colorado, Denver, Colorado, 777 Bannock Street. Mail Code 0206, Denver, CO 80203
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