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Silverstein ML, Shah JK, Cevallos P, Liu F, Sheckter C, Nazerali R. Associations between prior COVID-19 infection and venous thromboembolism following common plastic surgery operations. J Plast Reconstr Aesthet Surg 2024; 94:198-209. [PMID: 38810360 DOI: 10.1016/j.bjps.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 04/01/2024] [Accepted: 04/05/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION SARS-CoV-2 (COVID-19) infection has been described as a cause of systemic hypercoagulability and a risk factor for the development of venous thromboembolism (VTE). Whereas some multispecialty studies have proposed a link between COVID-19 and postoperative thrombosis, other single-specialty studies have found no such association. We utilized a large national database to determine whether prior COVID-19 infection was associated with the incidence of VTE following common plastic surgery operations. METHODS The Merative™ MarketScan® Research Databases were used to identify female patients who underwent index abdominal panniculectomy, breast reduction, autologous breast reconstruction, or implant-based breast reconstruction procedures between 2020 and 2021. International Classification of Disease, tenth edition (ICD-10) codes were used to identify patients diagnosed with COVID-19 preoperatively and those who experienced a VTE in the 90 days postoperatively. Propensity score matching and multivariable logistic regression were used to determine any independent association between COVID-19 and postoperative VTE. RESULTS Twenty-four thousand two hundred and twenty-eight patients met inclusion criteria. Mean age at time of surgery was 44 years. Six percent carried a preoperative COVID-19 diagnosis, and postoperative VTE occurred in 1.3%. In a propensity-score-matched analysis of 2754 patients, COVID-19 did not significantly correlate with incidence of postoperative VTE (P = 0.463). Compared with a matched prepandemic cohort (14,151 patients), the incidence of VTE did not increase following any of the four studied procedures during the COVID-19 pandemic. CONCLUSION This analysis of a national insurance claims database provides evidence against a link between resolved COVID-19 infection and VTE within 90 days of four common plastic surgery operations.
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Affiliation(s)
- Max L Silverstein
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Jennifer K Shah
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | | | - Farrah Liu
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Clifford Sheckter
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Rahim Nazerali
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
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Degrave R, Murris J, Charles-Nelson A, Hermine O, Porcher R, Ravaud P, Mariette X, Tharaux PL, Resche-Rigon M, Sanchez O, Katsahian S, Arlet JB. Risk factors for thromboembolic events in patients hospitalized for COVID-19 pneumonia in a general ward and requiring treatment with oxygen. Postgrad Med J 2024; 100:120-126. [PMID: 37978265 DOI: 10.1093/postmj/qgad104] [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: 05/01/2023] [Revised: 09/03/2023] [Accepted: 09/13/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE To assess risk factors for arterial and venous thromboses (AVT) in patients hospitalized in general wards for COVID-19 pneumonia and requiring oxygen therapy. METHODS Our study was based on three randomized studies conducted as part of the CORIMUNO-19 platform in France between 27 March and 26 April 2020. Adult inpatients with COVID-19 pneumonia requiring at least 3 l/min of oxygen but not ventilation were randomized to receive standard care alone or standard care plus biologics. Patients were followed up for 3 months, and adverse events were documented. Risk factor for AVT and bleeding was identified by analyzing clinical, laboratory, and treatment data at baseline among the 315 patients with complete datasets. A Fine and Gray model was used to take account of competing events. RESULTS During the 3-month follow-up period, 39 AVT occurred in 38 (10%) of the 388 patients: 26 deep vein thromboses and/or pulmonary embolisms in 25 (6%) patients, and 14 arterial thrombotic events in 13 (3%) patients. A history of diabetes at inclusion [sHR (95% CI) = 2.65 (1.19-5.91), P = .017] and the C-reactive protein (CRP) level (sHR = 1 [1-1.01], P = .049) were significantly associated with an elevated risk of thrombosis. Obesity was not associated with a higher risk of thrombosis (sHR = 1.01 [0.4-2.57], P = .98). The CRP level and diabetes were not risk factors for hemorrhage. CONCLUSION Among patients hospitalized in general wards for COVID-19 pneumonia during the first wave of the epidemic, diabetes (but not obesity) and a high CRP level were risk factors for AVT. The use of higher doses of anticoagulant in these high-risk patients could be considered.
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Affiliation(s)
- Raphaël Degrave
- Service de Médecine Interne 2, Hôpital Pitié Salpétrière, Paris, 75013, France
| | - Juliette Murris
- INSERM, Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris Cité, Paris, 75006, France
- Inria, HeKA, PariSantéCampus, Paris, 75015, France
- RWE & Data, Pierre Fabre, Hauts-de-Seine, Boulogne-Billancourt, 92100, France
| | - Anaïs Charles-Nelson
- INSERM, Centre d'Investigation Clinique 1418 Épidémiologie Clinique, Paris, 75015, France
- Unité de Recherche Clinique, AP-HP, Hôpital Européen Georges-Pompidou, Paris, 75015, France
| | - Olivier Hermine
- Service d'hématologie, Hôpital Necker, AP-HP, Paris, 75015, France
- Institut Imagine, Université Paris-Cité, INSERM UMR1183, Paris, 75015, France
| | - Raphaël Porcher
- Center of Research Epidemiology and Statistics (CRESS), Université Paris-Cité, INSERM U1153 , Paris, 75004, France
| | - Philippe Ravaud
- Center of Research Epidemiology and Statistics (CRESS), Université Paris-Cité, INSERM U1153 , Paris, 75004, France
| | - Xavier Mariette
- Service de Rhumatologie, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, 94270, France
- INSERM UMR1184, Université Paris-Saclay, Le Kremlin-Bicêtre, 94270, France
| | - Pierre-Louis Tharaux
- Paris Cardiovascular Center-PARCC, Université de Paris, INSERM, Paris, 75015, France
| | - Matthieu Resche-Rigon
- Université Paris-Cité, ECSTRRA Team-CRESS-UMR 1153, INSERM, Paris, 75010, France
- URC Saint-Louis, AP-HP, Hôpital Saint-Louis, Paris, 75010, France
| | - Olivier Sanchez
- Service de Pneumologie, Université Paris-Cité, Hôpital Européen Georges Pompidou, Paris, 75015, France
| | - Sandrine Katsahian
- INSERM, Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris Cité, Paris, 75006, France
- Inria, HeKA, PariSantéCampus, Paris, 75015, France
- INSERM, Centre d'Investigation Clinique 1418 Épidémiologie Clinique, Paris, 75015, France
- Unité de Recherche Clinique, APHP Centre, AP-HP, Hôpital Européen Georges-Pompidou, Paris, 75015, France
| | - Jean-Benoît Arlet
- Service de Médecine Interne, Hôpital Européen Georges Pompidou, AP-HP, Université Paris-Cité, Paris, 75015, France
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Tholin B, Ghanima W, Selle ML, Stavem K. Incidence and determinants of venous thromboembolism over 90 days in hospitalized and nonhospitalized patients with COVID-19. J Intern Med 2023; 294:721-729. [PMID: 37518983 DOI: 10.1111/joim.13706] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
INTRODUCTION COVID-19 is associated with an increased risk of venous thromboembolism (VTE), but there is great variation among reported incidence rates. Most previous studies have focused on hospitalized patients with COVID-19, and only a few reports are from population-based registries. METHODS We studied the 90-day incidence of VTE, associated risk factors and all-cause mortality in hospitalized and nonhospitalized patients with COVID-19 in a nationwide cohort. Data on hospitalizations and outpatient visits were extracted from two national registries with mandatory reporting linked by a unique national identification number carried by all Norwegian residents. We performed Cox proportional hazards regression to determine risk factors for VTE after infection with SARS-CoV-2. RESULTS Our study included 30,495 patients with positive SARS-CoV-2 polymerase chain reaction with a mean (SD) age of 41.9 (17.3) years, and 53% were males. Only 2081 (6.8%) were hospitalized. The 90-day incidence of VTE was 0.3% (95% CI: 0.21-0.33) overall and 2.9% (95% CI: 2.3-3.7) in hospitalized patients. Age (hazard ratio [HR] 1.28 per decade, 95% CI: 1.11-1.48, p < 0.05), history of previous VTE (HR 4.69, 95% CI: 2.34-9.40, p < 0.05), and hospitalization for COVID-19 (HR 23.83, 95% CI: 13.48-42.13, p < 0.05) were associated with risk of VTE. CONCLUSIONS The 90-day incidence of VTE in hospitalized and nonhospitalized patients with COVID-19 was in the lower end compared with previous reports, with considerably higher rates in hospitalized than nonhospitalized patients. Risk factors for VTE were consistent with previously reported studies.
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Affiliation(s)
- Birgitte Tholin
- Clinic of Internal Medicine, Østfold Hospital, Grålum, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Waleed Ghanima
- Clinic of Internal Medicine, Østfold Hospital, Grålum, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Haematology, Oslo University Hospital, Oslo, Norway
| | - Maria Lie Selle
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Knut Stavem
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
- Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway
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Zysman M, Asselineau J, Saut O, Frison E, Oranger M, Maurac A, Charriot J, Achkir R, Regueme S, Klein E, Bommart S, Bourdin A, Dournes G, Casteigt J, Blum A, Ferretti G, Degano B, Thiébaut R, Chabot F, Berger P, Laurent F, Benlala I. Development and external validation of a prediction model for the transition from mild to moderate or severe form of COVID-19. Eur Radiol 2023; 33:9262-9274. [PMID: 37405504 PMCID: PMC10667132 DOI: 10.1007/s00330-023-09759-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/22/2023] [Accepted: 04/04/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVES COVID-19 pandemic seems to be under control. However, despite the vaccines, 5 to 10% of the patients with mild disease develop moderate to critical forms with potential lethal evolution. In addition to assess lung infection spread, chest CT helps to detect complications. Developing a prediction model to identify at-risk patients of worsening from mild COVID-19 combining simple clinical and biological parameters with qualitative or quantitative data using CT would be relevant to organizing optimal patient management. METHODS Four French hospitals were used for model training and internal validation. External validation was conducted in two independent hospitals. We used easy-to-obtain clinical (age, gender, smoking, symptoms' onset, cardiovascular comorbidities, diabetes, chronic respiratory diseases, immunosuppression) and biological parameters (lymphocytes, CRP) with qualitative or quantitative data (including radiomics) from the initial CT in mild COVID-19 patients. RESULTS Qualitative CT scan with clinical and biological parameters can predict which patients with an initial mild presentation would develop a moderate to critical form of COVID-19, with a c-index of 0.70 (95% CI 0.63; 0.77). CT scan quantification improved the performance of the prediction up to 0.73 (95% CI 0.67; 0.79) and radiomics up to 0.77 (95% CI 0.71; 0.83). Results were similar in both validation cohorts, considering CT scans with or without injection. CONCLUSION Adding CT scan quantification or radiomics to simple clinical and biological parameters can better predict which patients with an initial mild COVID-19 would worsen than qualitative analyses alone. This tool could help to the fair use of healthcare resources and to screen patients for potential new drugs to prevent a pejorative evolution of COVID-19. CLINICAL TRIAL REGISTRATION NCT04481620. CLINICAL RELEVANCE STATEMENT CT scan quantification or radiomics analysis is superior to qualitative analysis, when used with simple clinical and biological parameters, to determine which patients with an initial mild presentation of COVID-19 would worsen to a moderate to critical form. KEY POINTS • Qualitative CT scan analyses with simple clinical and biological parameters can predict which patients with an initial mild COVID-19 and respiratory symptoms would worsen with a c-index of 0.70. • Adding CT scan quantification improves the performance of the clinical prediction model to an AUC of 0.73. • Radiomics analyses slightly improve the performance of the model to a c-index of 0.77.
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Affiliation(s)
- Maéva Zysman
- CHU Bordeaux, 33600, Pessac, France.
- Univ. Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, 33600, Bordeaux, France.
- Centre de Recherche Cardio-Thoracique de Bordeaux (U1045), Centre d'Investigation Clinique, INSERM, Bordeaux Population Health (U1219), (CIC-P 1401), 33600, Pessac, France.
| | | | - Olivier Saut
- "Institut de Mathématiques de Bordeaux" (IMB), UMR5251, CNRS, University of Bordeaux, 351 Cours Libération, 33400, Talence, France
- MONC Team & SISTM Team, INRIA Bordeaux Sud-Ouest, 200 Av Vieille Tour, 33400, Talence, France
| | | | - Mathilde Oranger
- Pôle Des Spécialités Médicales/Département de Pneumologie, Université de Lorraine, Centre Hospitalier Régional Universitaire (CHRU) Nancy, Service de Radiologie Et d'Imagerie, Nancy, France
- Faculté de Médecine de Nancy, Université de Lorraine, Institut National de La Santé Et de La Recherche Médicale (INSERM) Unité Médicale de Recherche (UMR), S 1116, Vandœuvre-Lès-Nancy, France
| | - Arnaud Maurac
- CHU Bordeaux, 33600, Pessac, France
- Univ. Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, 33600, Bordeaux, France
- Centre de Recherche Cardio-Thoracique de Bordeaux (U1045), Centre d'Investigation Clinique, INSERM, Bordeaux Population Health (U1219), (CIC-P 1401), 33600, Pessac, France
| | - Jeremy Charriot
- Department of Respiratory Diseases, Arnaud de Villeneuve Hospital, Montpellier University Hospital, CEDEX 5, 34295, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM U1046, CEDEX 5, 34295, Montpellier, France
| | | | | | | | - Sébastien Bommart
- Department of Respiratory Diseases, Arnaud de Villeneuve Hospital, Montpellier University Hospital, CEDEX 5, 34295, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM U1046, CEDEX 5, 34295, Montpellier, France
| | - Arnaud Bourdin
- Department of Respiratory Diseases, Arnaud de Villeneuve Hospital, Montpellier University Hospital, CEDEX 5, 34295, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM U1046, CEDEX 5, 34295, Montpellier, France
| | - Gael Dournes
- CHU Bordeaux, 33600, Pessac, France
- Univ. Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, 33600, Bordeaux, France
- Centre de Recherche Cardio-Thoracique de Bordeaux (U1045), Centre d'Investigation Clinique, INSERM, Bordeaux Population Health (U1219), (CIC-P 1401), 33600, Pessac, France
| | | | - Alain Blum
- Pôle Des Spécialités Médicales/Département de Pneumologie, Université de Lorraine, Centre Hospitalier Régional Universitaire (CHRU) Nancy, Service de Radiologie Et d'Imagerie, Nancy, France
| | - Gilbert Ferretti
- France Service de Radiologie Diagnostique Et Interventionnelle, Université Grenoble Alpes, CHU Grenoble-Alpes, Grenoble, France
| | - Bruno Degano
- France Service de Radiologie Diagnostique Et Interventionnelle, Université Grenoble Alpes, CHU Grenoble-Alpes, Grenoble, France
| | - Rodolphe Thiébaut
- CHU Bordeaux, 33600, Pessac, France
- Univ. Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, 33600, Bordeaux, France
- Centre de Recherche Cardio-Thoracique de Bordeaux (U1045), Centre d'Investigation Clinique, INSERM, Bordeaux Population Health (U1219), (CIC-P 1401), 33600, Pessac, France
- MONC Team & SISTM Team, INRIA Bordeaux Sud-Ouest, 200 Av Vieille Tour, 33400, Talence, France
| | - Francois Chabot
- Pôle Des Spécialités Médicales/Département de Pneumologie, Université de Lorraine, Centre Hospitalier Régional Universitaire (CHRU) Nancy, Service de Radiologie Et d'Imagerie, Nancy, France
- Faculté de Médecine de Nancy, Université de Lorraine, Institut National de La Santé Et de La Recherche Médicale (INSERM) Unité Médicale de Recherche (UMR), S 1116, Vandœuvre-Lès-Nancy, France
| | - Patrick Berger
- CHU Bordeaux, 33600, Pessac, France
- Univ. Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, 33600, Bordeaux, France
- Centre de Recherche Cardio-Thoracique de Bordeaux (U1045), Centre d'Investigation Clinique, INSERM, Bordeaux Population Health (U1219), (CIC-P 1401), 33600, Pessac, France
| | - Francois Laurent
- CHU Bordeaux, 33600, Pessac, France
- Univ. Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, 33600, Bordeaux, France
- Centre de Recherche Cardio-Thoracique de Bordeaux (U1045), Centre d'Investigation Clinique, INSERM, Bordeaux Population Health (U1219), (CIC-P 1401), 33600, Pessac, France
| | - Ilyes Benlala
- CHU Bordeaux, 33600, Pessac, France
- Univ. Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, 33600, Bordeaux, France
- Centre de Recherche Cardio-Thoracique de Bordeaux (U1045), Centre d'Investigation Clinique, INSERM, Bordeaux Population Health (U1219), (CIC-P 1401), 33600, Pessac, France
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Kenney CL, Nelson AR, Fahey RA, Roubik DJ, How RA, Radowsky JS, Sams VG, Schauer SG, Rizzo JA. EFFECTS OF SARS COVID-19 POSITIVITY STATUS ON VENOUS THROMBOSIS AND PULMONARY EMBOLISM RATES IN TRAUMA PATIENTS. Shock 2023; 59:599-602. [PMID: 36809212 DOI: 10.1097/shk.0000000000002097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
ABSTRACT Introduction : COVID-19-induced coagulopathy (CIC) can increase the risk of thromboembolism without underlying clotting disorders, even when compared with other respiratory viruses. Trauma has a known association with hypercoagulability. Trauma patients with concurrent COVID-19 infection potentially have an even greater risk of thrombotic events. The purpose of this study was to evaluate venous thromboembolism (VTE) rates in trauma patients with COVID-19. Methods : This study reviewed all adult patients (≥18 years of age) admitted to the Trauma Service from April through November 2020 for a minimum of 48 hours. Patients were grouped based off COVID-19 status and compared for inpatient VTE chemoprophylaxis regimen, thrombotic complications defined as deep vein thrombosis, pulmonary embolism, myocardial infarction, and cerebrovascular accident, intensive care unit (ICU) length of stay, hospital length of stay, and mortality. Results : A total of 2,907 patients were reviewed and grouped into COVID-19-positive (n = 110) and COVID-19-negative (n = 2,797) groups. There was no difference in terms of receiving deep vein thrombosis chemoprophylaxis or type, but a longer time to initiation in the positive group ( P = 0.0012). VTE occurred in 5 (4.55%) positive and 60 (2.15%) negative patients without a significant difference between the groups, as well as no difference in type of VTE observed. Mortality was higher ( P = 0.009) in the positive group (10.91%). Positive patients had longer median ICU LOS ( P = 0.0012) and total LOS ( P < 0.001). Conclusion : There were no increased rates of VTE complications between COVID-19-positive and -negative trauma patients, despite a longer time to initiation of chemoprophylaxis in the COVID-19-positive group. COVID-19-positive patients had increased ICU LOS, total LOS, and mortality, which are likely due to multifactorial causes but primarily related to their underlying COVID-19 infection.
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Affiliation(s)
| | - Austin R Nelson
- Uniformed Services University of Health Sciences, Bethesda, Maryland
| | - Ryan A Fahey
- Brooke Army Medical Center, Fort Sam Houston, Texas
| | | | | | - Jason S Radowsky
- Uniformed Services University of Health Sciences, Bethesda, Maryland
| | | | | | - Julie A Rizzo
- Uniformed Services University of Health Sciences, Bethesda, Maryland
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DeVries A, Shambhu S, Sloop S, Overhage JM. One-Year Adverse Outcomes Among US Adults With Post-COVID-19 Condition vs Those Without COVID-19 in a Large Commercial Insurance Database. JAMA HEALTH FORUM 2023; 4:e230010. [PMID: 36867420 PMCID: PMC9984976 DOI: 10.1001/jamahealthforum.2023.0010] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Importance Many individuals experience ongoing symptoms following the onset of COVID-19, characterized as postacute sequelae of SARS-CoV-2 or post-COVID-19 condition (PCC). Less is known about the long-term outcomes for these individuals. Objective To quantify 1-year outcomes among individuals meeting a PCC definition compared with a control group of individuals without COVID-19. Design, Setting, and Participants This case-control study with a propensity score-matched control group included members of commercial health plans and used national insurance claims data enhanced with laboratory results and mortality data from the Social Security Administration's Death Master File and Datavant Flatiron data. The study sample consisted of adults meeting a claims-based definition for PCC with a 2:1 matched control cohort of individuals with no evidence of COVID-19 during the time period of April 1, 2020, to July 31, 2021. Exposures Individuals experiencing postacute sequelae of SARS-CoV-2 using a Centers for Disease Control and Prevention-based definition. Main Outcomes and Measures Adverse outcomes, including cardiovascular and respiratory outcomes and mortality, for individuals with PCC and controls assessed over a 12-month period. Results The study population included 13 435 individuals with PCC and 26 870 individuals with no evidence of COVID-19 (mean [SD] age, 51 [15.1] years; 58.4% female). During follow-up, the PCC cohort experienced increased health care utilization for a wide range of adverse outcomes: cardiac arrhythmias (relative risk [RR], 2.35; 95% CI, 2.26-2.45), pulmonary embolism (RR, 3.64; 95% CI, 3.23-3.92), ischemic stroke (RR, 2.17; 95% CI, 1.98-2.52), coronary artery disease (RR, 1.78; 95% CI, 1.70-1.88), heart failure (RR, 1.97; 95% CI, 1.84-2.10), chronic obstructive pulmonary disease (RR, 1.94; 95% CI, 1.88-2.00), and asthma (RR, 1.95; 95% CI, 1.86-2.03). The PCC cohort also experienced increased mortality, as 2.8% of individuals with PCC vs 1.2% of controls died, implying an excess death rate of 16.4 per 1000 individuals. Conclusions and Relevance This case-control study leveraged a large commercial insurance database and found increased rates of adverse outcomes over a 1-year period for a PCC cohort surviving the acute phase of illness. The results indicate a need for continued monitoring for at-risk individuals, particularly in the area of cardiovascular and pulmonary management.
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Affiliation(s)
| | | | - Sue Sloop
- Elevance Health, Inc, Indianapolis, Indiana
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Zuin M, Barco S, Giannakoulas G, Engelen MM, Hobohm L, Valerio L, Vandenbriele C, Verhamme P, Vanassche T, Konstantinides SV. Risk of venous thromboembolic events after COVID-19 infection: a systematic review and meta-analysis. J Thromb Thrombolysis 2023; 55:490-498. [PMID: 36652137 PMCID: PMC9845812 DOI: 10.1007/s11239-022-02766-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/29/2022] [Indexed: 01/19/2023]
Abstract
Data regarding the occurrence of venous thromboembolic events (VTE), including acute pulmonary embolism (PE) and deep vein thrombosis (DVT) in recovered COVID-19 patients are scant. We performed a systematic review and meta-analysis to assess the risk of acute PE and DVT in COVID-19 recovered subject. Following the PRIMSA guidelines, we searched Medline and Scopus to locate all articles published up to September 1st, 2022, reporting the risk of acute PE and/or DVT in patients recovered from COVID-19 infection compared to non-infected patients who developed VTE over the same follow-up period. PE and DVT risk were evaluated using the Mantel-Haenszel random effects models with Hazard ratio (HR) as the effect measure with 95% confidence interval (CI) while heterogeneity was assessed using Higgins I2 statistic. Overall, 29.078.950 patients (mean age 50.2 years, 63.9% males), of which 2.060.496 had COVID-19 infection, were included. Over a mean follow-up of 8.5 months, the cumulative incidence of PE and DVT in COVID-19 recovered patients were 1.2% (95% CI:0.9-1.4, I2: 99.8%) and 2.3% (95% CI:1.7-3.0, I2: 99.7%), respectively. Recovered COVID-19 patients presented a higher risk of incident PE (HR: 3.16, 95% CI: 2.63-3.79, I2 = 90.1%) and DVT (HR: 2.55, 95% CI: 2.09-3.11, I2: 92.6%) compared to non-infected patients from the general population over the same follow-up period. Meta-regression showed a higher risk of PE and DVT with age and with female gender, and lower risk with longer follow-up. Recovered COVID-19 patients have a higher risk of VTE events, which increase with aging and among females.
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Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
| | - Stefano Barco
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland ,Center for Thrombosis and Hemostasis, Johannes Gutenberg University, Mainz, Germany
| | - George Giannakoulas
- Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Matthias M Engelen
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Lukas Hobohm
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University, Mainz, Germany
| | - Luca Valerio
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University, Mainz, Germany
| | | | - Peter Verhamme
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Thomas Vanassche
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Stavros V Konstantinides
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University, Mainz, Germany ,Department of Cardiology, Democritus University of Thrace, Thrace, Greece
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Chazova IE, Martynyuk TV, Gorbachevskii SV, Gramovich VV, Danilov NM, Panchenko EP, Chernyavskiy AM, Shmalts AA, Yavelov IS. ["Guiding lights" for the diagnosis of chronic thromboembolic pulmonary hypertension in the flow of patients with pulmonary embolism]. TERAPEVT ARKH 2022; 94:1052-1056. [PMID: 36286754 DOI: 10.26442/00403660.2022.09.201836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
On December 13, 2021, an expert council was held to determine the position of experts of different specialties regarding the reasons for the low level of diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) in real clinical practice in a pandemic of a new coronavirus infection and possible ways to improve detection in patients with pulmonary embolism (PE) ) in history. The reasons for the low level of diagnosis of CTEPH are the insufficient level of knowledge of specialists, especially primary care physicians; lack of clear regulatory documents and expert centers for the management of this category of patients. Primary diagnosis of CTEPH in a pandemic can be strengthened through the widespread use of telemedicine for consultations of primary care physicians with specialists from expert centers; to maximize the role of echocardiography and computed tomography (CT) as differential diagnostic tools for dyspnea, in particular in patients with COVID-19. To increase the detection rate of CTEPH, diagnostic vigilance is required in patients with risk factors and episodes of venous thromboembolism. To improve the screening of CTEPH, it is necessary to create an algorithm for monitoring patients who have had PE; provide educational activities, including through the media; create materials for patients with accessible information. The regulatory documents should designate the circle of responsible specialists who will be engaged in long-term monitoring of patients with PE. Educational programs are needed for primary care physicians, cardiologists, and other physicians who come into the field of view of patients with CTEPH; introduction of a program to create expert centers for monitoring and managing patients with the possibility of performing ventilation-perfusion lung scintigraphy, cardiopulmonary stress test, CT, right heart catheterization. It seems important to build cooperation with the Ministry of Health of Russia in order to create special protocols, procedures for managing patients with PE and CTEPH.
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Affiliation(s)
- I E Chazova
- Chazov National Medical Research Center of Cardiology
| | - T V Martynyuk
- Chazov National Medical Research Center of Cardiology
- The Russian National Research Medical University named after N.I. Pirogov
| | - S V Gorbachevskii
- Bakoulev Scientific Center for Cardiovascular Surgery
- Russian Medical Academy of Continuous Professional Education
| | - V V Gramovich
- Chazov National Medical Research Center of Cardiology
| | - N M Danilov
- Chazov National Medical Research Center of Cardiology
| | - E P Panchenko
- Chazov National Medical Research Center of Cardiology
| | | | - A A Shmalts
- Bakoulev Scientific Center for Cardiovascular Surgery
- Russian Medical Academy of Continuous Professional Education
| | - I S Yavelov
- National Medical Research Center for Therapy and Preventive Medicine
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9
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The potential role of ischaemia-reperfusion injury in chronic, relapsing diseases such as rheumatoid arthritis, Long COVID, and ME/CFS: evidence, mechanisms, and therapeutic implications. Biochem J 2022; 479:1653-1708. [PMID: 36043493 PMCID: PMC9484810 DOI: 10.1042/bcj20220154] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 02/07/2023]
Abstract
Ischaemia–reperfusion (I–R) injury, initiated via bursts of reactive oxygen species produced during the reoxygenation phase following hypoxia, is well known in a variety of acute circumstances. We argue here that I–R injury also underpins elements of the pathology of a variety of chronic, inflammatory diseases, including rheumatoid arthritis, ME/CFS and, our chief focus and most proximally, Long COVID. Ischaemia may be initiated via fibrin amyloid microclot blockage of capillaries, for instance as exercise is started; reperfusion is a necessary corollary when it finishes. We rehearse the mechanistic evidence for these occurrences here, in terms of their manifestation as oxidative stress, hyperinflammation, mast cell activation, the production of marker metabolites and related activities. Such microclot-based phenomena can explain both the breathlessness/fatigue and the post-exertional malaise that may be observed in these conditions, as well as many other observables. The recognition of these processes implies, mechanistically, that therapeutic benefit is potentially to be had from antioxidants, from anti-inflammatories, from iron chelators, and via suitable, safe fibrinolytics, and/or anti-clotting agents. We review the considerable existing evidence that is consistent with this, and with the biochemical mechanisms involved.
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10
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Rauch-Kröhnert U, Riess H. [Anticoagulation in coronavirus disease 2019 (COVID-19): confirmed and controversial aspects]. Internist (Berl) 2022; 63:453-460. [PMID: 35290499 PMCID: PMC8922984 DOI: 10.1007/s00108-022-01296-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 01/08/2023]
Abstract
Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with a high risk of microvascular immunothrombosis as well as symptomatic and incidental thromboembolisms, predominantly in the venous system but also in the arterial system. This explains among other things the high cardiovascular morbidity and mortality of the patients. The present state of knowledge on the pathophysiology of immunothrombosis and the strategies of anticoagulation in patients with coronavirus disease 2019 (COVID-19) are summarized and illuminated in this article. According to the current guidelines moderately to severely ill patients who are being treated in hospital should receive thrombosis prophylaxis with low molecular weight or unfractionated heparin or alternatively with fondaparinux, as long as there is no clearly increased risk of bleeding. Apart from the established indications for treatment, an intensified or therapeutic dose prophylaxis should be considered very cautiously in these critically ill patients, also due to the increased bleeding complications. The routine continuation of prophylactic anticoagulation after discharge from hospital is currently not recommended.
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Affiliation(s)
- Ursula Rauch-Kröhnert
- Klinik für Kardiologie, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Deutschland.
| | - Hanno Riess
- Medizinische Klinik m. S. Hämatologie, Onkologie und Tumorimmunologie, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
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11
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Yet Kwong Horman J, Petrash N, Kraschnewski J, Patel P. Ascending Aortic Thrombus After SARS-CoV-2 Infection. Cureus 2022; 14:e22496. [PMID: 35371695 PMCID: PMC8944936 DOI: 10.7759/cureus.22496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/05/2022] Open
Abstract
A 46-year-old male with a history of SARS-CoV-2 infection one month ago presented to the hospital due to acute onset left flank pain. He was found to have an acute left renal embolic infarction from a large 15mm ascending aortic thrombus, which may have formed due to a transient hypercoagulable state from his recent SARS-CoV-2 infection along with tobacco use. He was medically managed with anticoagulation for six months. Subsequent imaging after three months of therapeutic anticoagulation showed complete resolution of the ascending aortic thrombus.
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12
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Kell DB, Laubscher GJ, Pretorius E. A central role for amyloid fibrin microclots in long COVID/PASC: origins and therapeutic implications. Biochem J 2022; 479:537-559. [PMID: 35195253 PMCID: PMC8883497 DOI: 10.1042/bcj20220016] [Citation(s) in RCA: 103] [Impact Index Per Article: 51.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 12/15/2022]
Abstract
Post-acute sequelae of COVID (PASC), usually referred to as 'Long COVID' (a phenotype of COVID-19), is a relatively frequent consequence of SARS-CoV-2 infection, in which symptoms such as breathlessness, fatigue, 'brain fog', tissue damage, inflammation, and coagulopathies (dysfunctions of the blood coagulation system) persist long after the initial infection. It bears similarities to other post-viral syndromes, and to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Many regulatory health bodies still do not recognize this syndrome as a separate disease entity, and refer to it under the broad terminology of 'COVID', although its demographics are quite different from those of acute COVID-19. A few years ago, we discovered that fibrinogen in blood can clot into an anomalous 'amyloid' form of fibrin that (like other β-rich amyloids and prions) is relatively resistant to proteolysis (fibrinolysis). The result, as is strongly manifested in platelet-poor plasma (PPP) of individuals with Long COVID, is extensive fibrin amyloid microclots that can persist, can entrap other proteins, and that may lead to the production of various autoantibodies. These microclots are more-or-less easily measured in PPP with the stain thioflavin T and a simple fluorescence microscope. Although the symptoms of Long COVID are multifarious, we here argue that the ability of these fibrin amyloid microclots (fibrinaloids) to block up capillaries, and thus to limit the passage of red blood cells and hence O2 exchange, can actually underpin the majority of these symptoms. Consistent with this, in a preliminary report, it has been shown that suitable and closely monitored 'triple' anticoagulant therapy that leads to the removal of the microclots also removes the other symptoms. Fibrin amyloid microclots represent a novel and potentially important target for both the understanding and treatment of Long COVID and related disorders.
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Affiliation(s)
- Douglas B. Kell
- Department of Biochemistry and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 7ZB, U.K
- The Novo Nordisk Foundation Centre for Biosustainability, Technical University of Denmark, Kemitorvet 200, 2800 Kgs Lyngby, Denmark
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch Private Bag X1 Matieland, 7602, South Africa
| | | | - Etheresia Pretorius
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch Private Bag X1 Matieland, 7602, South Africa
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13
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Whiteley MS, Holdstock JM. Non-thrombotic superficial venous phlebitis secondary to Covid-19 vaccine or subsequent Covid-19 infection. SAGE Open Med Case Rep 2022; 10:2050313X221124378. [PMID: 36128512 PMCID: PMC9478630 DOI: 10.1177/2050313x221124378] [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: 01/05/2022] [Accepted: 08/18/2022] [Indexed: 11/24/2022] Open
Abstract
A 43-year-old woman presented with localised areas of prominent, tender superficial veins
in her right arm and both legs, and chest pain, following the second dose of AstraZeneca
vaccine and possible contemporaneous Covid-19 infection. Electrocardiogram, troponin and
d-dimer had all been normal. However, a venous duplex ultrasound scan showed a
perivenous inflammation without thrombosis in the areas of her limbs with prominent tender
veins, but not elsewhere. We suggest that patients may present with prominent and tender
superficial veins secondary to non-thrombotic phlebitis following Covid-19 infection or
the AstraZeneca vaccine, which appears to be self-limiting. In addition, this case raises
the possibility that Covid-19 infection or the AstraZeneca vaccine may directly affect
cells in the vein wall, resulting in phlebitis without any evidence of thrombosis or
microthrombosis. This phenomenon appears to be transient and self-limiting.
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