1
|
Krug E, Geckeler KC, Frishman WH. Cardiovascular Manifestations of Long COVID: A Review. Cardiol Rev 2024; 32:402-407. [PMID: 36728728 DOI: 10.1097/crd.0000000000000520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The acute phase of severe acute respiratory syndrome coronavirus 2 [coronavirus disease (COVID)] infection has many well-documented cardiovascular manifestations, however, the long-term sequelae are less understood. In this focused review, we explore the risk factors, character, and rates of cardiovascular events in patients with Long COVID, which is defined as symptoms occurring more than 4 weeks following initial infection. Research has identified increased rates of cerebrovascular disease, dysrhythmias, ischemic and inflammatory heart disease, cardiopulmonary symptoms, and thrombotic events among those with Long COVID, though the risk rates and potential mechanisms behind each cardiovascular event vary. Finally, we discuss the current gaps in the literature as well as how COVID compares to other viral infections when it comes to causing long-term cardiovascular sequelae.
Collapse
Affiliation(s)
- Ethan Krug
- From the Department of Medicine, New York Medical College, Valhalla, NY
| | - Keara C Geckeler
- Department of Medicine, Tufts University School of Medicine, Boston, MA
| | | |
Collapse
|
2
|
Cuevas-Sierra A, Chero-Sandoval L, Higuera-Gómez A, Vargas JA, Martínez-Urbistondo M, Castejón R, Martínez JA. Modulatory role of Faecalibacterium on insulin resistance and coagulation in patients with post-viral long haulers depending on adiposity. iScience 2024; 27:110450. [PMID: 39081294 PMCID: PMC11284562 DOI: 10.1016/j.isci.2024.110450] [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: 03/21/2024] [Revised: 05/05/2024] [Accepted: 07/01/2024] [Indexed: 08/02/2024] Open
Abstract
Patients with Post-viral long hauler encompass lasting symptoms and comorbid complexities, often exacerbated in individuals with excessive body weight. The aim was to study gut microbiota in 130 patients with post-viral long hauler stratified by body mass index (BMI) and the relationship between inflammation and microbiota. Significant higher values were found for anthropometric variables and markers of glucose and dyslipidemia in individuals with higher BMI, as well as elevated levels of C-reactive protein, fibrinogen, IL-6, uric acid, and D-dimer. An interactive association showed an interplay between Faecalibacterium, D-dimer levels, and insulin resistance. This investigation showed that anthropometric, biochemical, and inflammatory variables were impaired in patients with post-viral long haulers with higher BMI. In addition, gut microbiota differences were found between groups and a modification effect on Faecalibacterium abundance regarding insulin resistance and D-dimer. These findings suggest that considering adiposity and gut microbiota structure and composition may improve personalized clinical interventions in patients with chronic inflammation.
Collapse
Affiliation(s)
- Amanda Cuevas-Sierra
- Precision Nutrition and Cardiometabolic Health, IMDEA-Food Institute (Madrid Institute for Advanced Studies), Campus of International Excellence (CEI) UAM+CSIC, 28049 Madrid, Spain
| | - Lourdes Chero-Sandoval
- Precision Nutrition and Cardiometabolic Health, IMDEA-Food Institute (Madrid Institute for Advanced Studies), Campus of International Excellence (CEI) UAM+CSIC, 28049 Madrid, Spain
- Department of Endocrinology and Nutrition of the University Clinical Hospital, University of Valladolid, 47002 Valladolid, Spain
| | - Andrea Higuera-Gómez
- Precision Nutrition and Cardiometabolic Health, IMDEA-Food Institute (Madrid Institute for Advanced Studies), Campus of International Excellence (CEI) UAM+CSIC, 28049 Madrid, Spain
| | - J. Antonio Vargas
- Internal Medicine Service of Puerta de Hierro Majadahonda University Hospital, 2822 Madrid, Spain
| | | | - Raquel Castejón
- Internal Medicine Service of Puerta de Hierro Majadahonda University Hospital, 2822 Madrid, Spain
| | - J. Alfredo Martínez
- Precision Nutrition and Cardiometabolic Health, IMDEA-Food Institute (Madrid Institute for Advanced Studies), Campus of International Excellence (CEI) UAM+CSIC, 28049 Madrid, Spain
- Centro de Medicina y Endocrinología, Universidad de Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
3
|
Marcos-Neira P, Morales-Indiano C, Fernández-Caballero M, Tomasa-Irriguible T, Bordejé-Laguna L, Ruíz-Artola V. Anti-Xa activity below range is related to thrombosis in patients with severe COVID-19. Med Intensiva 2024:S2173-5727(24)00191-7. [PMID: 39054216 DOI: 10.1016/j.medine.2024.07.003] [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: 04/16/2024] [Revised: 06/05/2024] [Accepted: 06/25/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE We aimed to anlayse the relationship between anti-Xa activity below range and thomboembolic events. DESIGN Single center prospective observational longitudinal cohort study (February-November 2021). SETTING Patients admitted to the ICU of a University Hospital. PARTICIPANTS Patients with severe COVID-19 pneumoniae. INTERVENTIONS Enoxaparin was used for prophylactic and therapeutic anticoagulation. Enoxaparin dosing and dose adjustment were based on anti-Xa activity according to the hospital protocol. MAIN VARIABLES OF INTEREST Target: thomboembolic events. PREDICTORS demographics, pharmacotherapy, anti-Xa measurements, clinical data, and laboratory results. Logistic regression was used to identify independent risk factors for thomboembolic events. RESULTS Data were available for 896 serum anti-Xa measurements from 228 subjects. Overall, 71.9% were male, with a median age of 62. Most patients needed invasive mechanical ventilation (87.7%) and mortality was 24.1%. A total of 28.9% new thomboembolic events were diagnosed. There were 27.1% anti-Xa measesurements below range. When multivariable logistic regression analysis was performed anti-Xa activity below range (RR, 4.2; p = 0.000), C-reactive protein (25 mg/L increase) (RR, 1.14; p = 0.005) and D-dimer (1000 ng/L increase) (RR, 1.06; p = 0.002) were the independent factors related to new thomboembolic events in patients with severe COVID-19. CONCLUSIONS Anti-Xa activity below range, C-reactive protein and D-dimer were the independent factors related to thomboembolic events in patients with severe COVID-19. Purposely designed clinical trials should be carried out to confirm the benefit of an anti-Xa monitoring.
Collapse
Affiliation(s)
- Pilar Marcos-Neira
- Intensive Care Unit, Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain.
| | - Cristian Morales-Indiano
- Department of Clinical Analysis and Biochemistry, Laboratori Clínic Metropolitana Nord, Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain.
| | | | | | - Luisa Bordejé-Laguna
- Intensive Care Unit, Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain.
| | - Víctor Ruíz-Artola
- Intensive Care Unit, Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain.
| |
Collapse
|
4
|
Malireddi RKS, Sharma BR, Kanneganti TD. Innate Immunity in Protection and Pathogenesis During Coronavirus Infections and COVID-19. Annu Rev Immunol 2024; 42:615-645. [PMID: 38941608 PMCID: PMC11373870 DOI: 10.1146/annurev-immunol-083122-043545] [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] [Indexed: 06/30/2024]
Abstract
The COVID-19 pandemic was caused by the recently emerged β-coronavirus SARS-CoV-2. SARS-CoV-2 has had a catastrophic impact, resulting in nearly 7 million fatalities worldwide to date. The innate immune system is the first line of defense against infections, including the detection and response to SARS-CoV-2. Here, we discuss the innate immune mechanisms that sense coronaviruses, with a focus on SARS-CoV-2 infection and how these protective responses can become detrimental in severe cases of COVID-19, contributing to cytokine storm, inflammation, long-COVID, and other complications. We also highlight the complex cross talk among cytokines and the cellular components of the innate immune system, which can aid in viral clearance but also contribute to inflammatory cell death, cytokine storm, and organ damage in severe COVID-19 pathogenesis. Furthermore, we discuss how SARS-CoV-2 evades key protective innate immune mechanisms to enhance its virulence and pathogenicity, as well as how innate immunity can be therapeutically targeted as part of the vaccination and treatment strategy. Overall, we highlight how a comprehensive understanding of innate immune mechanisms has been crucial in the fight against SARS-CoV-2 infections and the development of novel host-directed immunotherapeutic strategies for various diseases.
Collapse
Affiliation(s)
- R K Subbarao Malireddi
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA;
| | - Bhesh Raj Sharma
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA;
| | | |
Collapse
|
5
|
Cénat JM, Dromer E, Farahi SMMM, Ndamage CM, Yun A, Zuta H, Mkhatri J, Samson E, Barara R, Labelle PR, Xu Y. Venous thromboembolism in Black COVID-19 patients in a minority context compared to White, Asian and other racialized patients: A systematic review and meta-analysis. Thromb Res 2024; 238:197-205. [PMID: 38733691 DOI: 10.1016/j.thromres.2024.05.007] [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: 03/21/2024] [Revised: 04/26/2024] [Accepted: 05/06/2024] [Indexed: 05/13/2024]
Abstract
IMPORTANCE COVID-19 has disproportionately affected racialized populations, with particular impact among individuals of Black individuals. However, it is unclear whether disparities in venous thromboembolic (VTE) complications exist between Black individuals and those belonging to other racial groups with confirmed SARS-CoV2 infections. OBJECTIVE To summarize the prevalence and moderators associated with VTE among Black COVID-19 patients in minoritized settings, and to compare this to White and Asian COVID-19 patients according to sex, age, and comorbid health conditions (heart failure, cancer, obesity, hypertension). DESIGN SETTING, AND PARTICIPANTS A systematic search of MEDLINE, Embase, CINAHL and CENTRAL for articles or reports published from inception to February 15, 2023. STUDY SELECTION Reports on VTE among Black individuals infected with SARS-CoV2, in countries where Black people are considered a minority population group. DATA EXTRACTION AND SYNTHESIS Study characteristics and results of eligible studies were independently extracted by 2 pairs of reviewers. VTE prevalence was extracted, and risk of bias was assessed. Prevalence estimates of VTE prevalence among Black individuals with COVID19 in each study were pooled. Where studies provided race-stratified VTE prevalence among COVID19 patients, odds ratios were generated using a random-effects model. MAIN OUTCOMES AND MEASURES Prevalence of VTE, comprising of deep vein thrombosis and pulmonary embolism. RESULTS Ten studies with 66,185 Black individuals reporting the prevalence of COVID-19 associated VTE were included. Weighted median age of included studies was 47.60. Pooled prevalence of COVID-19 associated VTE was 7.2 % (95 % CI, 3.8 % - 11.5 %) among Black individuals. Among individuals with SARS-CoV2 infections, Black population had higher risks of VTE compared to their White (OR = 1.79, [95 % CI 1.28-2.53], p < .001) or Asian (OR = 2.01, [95 % CI, 1.14-3.60], p = .017) counterparts, or patients with other racial identities (OR = 2.01, [95 % CI, 1.39, 2.92]; p < .001). CONCLUSIONS AND RELEVANCE Black individuals with COVID-19 had substantially higher risk of VTE compared to White or Asian individuals. Given racial disparities in thrombotic disease burden related to COVID-19, medical education, research, and health policy interventions are direly needed to ensure adequate disease awareness among Black individuals, to facilitate appropriate diagnosis and treatment among Black patients with suspected and confirmed VTE, and to advocate for culturally safe VTE prevention strategies, including pre-existing inequalities to the COVID-19 pandemic that persist after the crisis.
Collapse
Affiliation(s)
- Jude Mary Cénat
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada; Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada; University of Ottawa Research Chair on Black Health, Ottawa, Ontario, Canada.
| | - Elisabeth Dromer
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | - Aiden Yun
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Hannah Zuta
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jihane Mkhatri
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Eden Samson
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Raina Barara
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Yan Xu
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital, Ottawa, Ontario, Canada
| |
Collapse
|
6
|
Bikdeli B, Krishnathasan D, Khairani CD, Bejjani A, Davies J, Porio N, Tristani A, Armero A, Assi AA, Nauffal V, Campia U, Almarzooq Z, Wei E, Ortiz-Rios MD, Zuluaga-Sánchez V, Achanta A, Jesudasen SJ, Tiu B, Merli GJ, Leiva O, Fanikos J, Grandone E, Sharma A, Rizzo S, Pfeferman MB, Morrison RB, Vishnevsky A, Hsia J, Nehler MR, Welker J, Bonaca MP, Carroll B, Goldhaber SZ, Lan Z, Piazza G. Low absolute risk of thrombotic and cardiovascular events in outpatient pregnant women with COVID-19. Thromb Res 2024; 237:209-215. [PMID: 38677791 DOI: 10.1016/j.thromres.2024.02.021] [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: 12/11/2023] [Revised: 02/17/2024] [Accepted: 02/20/2024] [Indexed: 04/29/2024]
Abstract
INTRODUCTION Pregnancy may contribute to an excess risk of thrombotic or cardiovascular events. COVID-19 increases the risk of these events, although the risk is relatively limited among outpatients. We sought to determine whether outpatient pregnant women with COVID-19 are at a high risk for cardiovascular or thrombotic events. MATERIALS & METHODS We analyzed pregnant outpatients with COVID-19 from the multicenter CORONA-VTE-Network registry. The main study outcomes were a composite of adjudicated venous or arterial thrombotic events, and a composite of adjudicated cardiovascular events. Events were assessed 90 days after the COVID-19 diagnosis and reported for non-pregnant women ≤45 years, and for men ≤45 years, as points of reference. RESULTS Among 6585 outpatients, 169 were pregnant at diagnosis. By 90-day follow-up, two pregnant women during the third trimester had lower extremity venous thrombosis, one deep and one superficial vein thrombosis. The cumulative incidence of thrombotic events was 1.20 % (95 % confidence interval [CI]: 0.0 to 2.84 %). Respective rates were 0.47 % (95 % CI: 0.14 % to 0.79 %) among non-pregnant women, and 0.49 % (95 % CI: 0.06 % to 0.91 %) among men ≤45 years. No non-thrombotic cardiovascular events occurred in pregnant women. The rates of cardiovascular events were 0.53 % (95 % CI: 0.18 to 0.87) among non-pregnant women, and 0.68 % (95 % CI: 0.18 to 1.18) in men aged ≤45 years. CONCLUSIONS Thrombotic and cardiovascular events are rare among outpatients with COVID-19. Although a higher event rate among outpatient pregnant women cannot be excluded, the absolute event rates are low and do not warrant population-wide cardiovascular interventions to optimize outcomes.
Collapse
Affiliation(s)
- Behnood Bikdeli
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, USA; YNHH/ Yale Center for Outcomes Research and Evaluation (CORE), New Haven, CT, USA; Cardiovascular Research Foundation (CRF), New York, NY, USA
| | - Darsiya Krishnathasan
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Candrika D Khairani
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Antoine Bejjani
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Julia Davies
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Nicole Porio
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Anthony Tristani
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Andre Armero
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Ali A Assi
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, USA; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Victor Nauffal
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Umberto Campia
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Zaid Almarzooq
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Eric Wei
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Marcos D Ortiz-Rios
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Aditya Achanta
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Sirus J Jesudasen
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Bruce Tiu
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Geno J Merli
- Department of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Orly Leiva
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - John Fanikos
- Department of Pharmacy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elvira Grandone
- Thrombosis and Haemostasis Unit, Fondazione I.R.C.C.S. "Casa Sollievo della Sofferenza", S. Giovanni Rotondo (Foggia), Italy; Department of Obstetrics and Gynecology, First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Aditya Sharma
- Department of Medicine, Cardiovascular Medicine, University of Virginia Health, Charlottesville, VA, USA
| | - Samantha Rizzo
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Mariana B Pfeferman
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Ruth B Morrison
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Alec Vishnevsky
- Department of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Judith Hsia
- CPC Clinical Research, Aurora, CO, USA; Department of Medicine, University of Colorado, Aurora, CO, USA
| | | | - James Welker
- Anne Arundel Research Institute, Annapolis, MD, USA
| | - Marc P Bonaca
- CPC Clinical Research, Aurora, CO, USA; Department of Medicine, University of Colorado, Aurora, CO, USA
| | - Brett Carroll
- Smith Center for Cardiovascular Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Samuel Z Goldhaber
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Zhou Lan
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, USA; Center for Clinical Investigation, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gregory Piazza
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, USA.
| |
Collapse
|
7
|
Jinn A, Kammermayer M, Mabasa VH, Liu T, Paul TS, Phan N. Characterization of the Benefits and Risks of Therapeutic Anticoagulation in Patients Admitted with Severe COVID-19 (CRITAC). Can J Hosp Pharm 2024; 77:e3505. [PMID: 38601129 PMCID: PMC10984258 DOI: 10.4212/cjhp.3505] [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: 06/02/2023] [Accepted: 10/24/2023] [Indexed: 04/12/2024]
Abstract
Background Severe COVID-19 is associated with increased rates of thrombotic complications. Recent provincial recommendations in British Columbia have suggested providing thromboprophylaxis with therapeutic anticoagulation for hospital inpatients with severe COVID-19 who do not have a high risk of bleeding. Objectives To characterize the rates of major bleeding, thrombotic events, complications from COVID-19, and adverse effects among patients with severe COVID-19 treated with therapeutic anticoagulation. Methods This retrospective chart review involved patients with laboratory-confirmed COVID-19 who were admitted to 3 sites within a local health authority between April 1 and December 31, 2021, and received therapeutic anticoagulation for thromboprophylaxis. Results After screening of 1036 patients, 72 patients were included in the study. The mean age of participants was 54 years, 63% (n = 45) were male, and 92% (n = 66) were receiving supplemental oxygen by nasal prongs on admission. The primary outcome, major bleeding, was experienced by 1 patient (1%). Increasing oxygen requirements resulting in progression to high-flow nasal cannula occurred in 11 patients (15%), and 5 patients (7%) required admission to the intensive care unit. One patient (1%) experienced a thrombotic event, and 1 patient (1%) had a minor bleed. The mean duration of hospitalization was 10 (standard deviation 10.8) days. One death occurred during the study period, and no cases of heparin-induced thrombocytopenia were observed. Conclusions In this study of hospital inpatients with severe COVID-19 who were deemed to be at low risk of bleeding and who received therapeutic anticoagulation, there were low rates of both major bleeding and thrombotic events.
Collapse
Affiliation(s)
- Alison Jinn
- , BSc(Pharm), ACPR, was, at the time of this study, a Postgraduate Year 1 Resident with Lower Mainland Pharmacy Services, Fraser Health Authority, Burnaby, British Columbia. She is now a Clinical Pharmacist with the Pharmacy Department, Royal Columbian Hospital, New Westminster, British Columbia
| | - Michael Kammermayer
- , BSc, PharmD, ACPR, was, at the time of this study, a Clinical Pharmacy Specialist - Internal Medicine with the Pharmacy Department, Burnaby Hospital, Burnaby, British Columbia, and is now the Clinical Pharmacy Supervisor with the same department and hospital
| | - Vincent H Mabasa
- , BSc(Pharm), ACPR, PharmD, is the Clinical Pharmacy Coordinator with the Pharmacy Department, Burnaby Hospital, Burnaby, British Columbia
| | - Tracy Liu
- , PharmD, ACPR, is a Clinical Pharmacist with the Pharmacy Department, Burnaby Hospital, Burnaby, British Columbia
| | | | - Nam Phan
- , MD, is a Hospitalist with Burnaby Hospital, Burnaby, British Columbia
| |
Collapse
|
8
|
Kazi S, Othman M, Khoury R, Bernstein PS, Thachil J, Ciantar E, Ferrara L, Netto M, Abdul-Kadir R, Malinowski AK. Report of the ISTH registry on pregnancy and COVID-19-associated coagulopathy (COV-PREG-COAG). Obstet Med 2024; 17:13-21. [PMID: 38660318 PMCID: PMC11037201 DOI: 10.1177/1753495x231206931] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/16/2023] [Indexed: 04/26/2024] Open
Abstract
Background Concerns about COVID-19-associated coagulopathy (CAC) in pregnant individuals were raised in early pandemic. Methods An ISTH-sponsored COVID-19 coagulopathy in pregnancy (COV-PREG-COAG) international registry was developed to describe incidence of coagulopathy, VTE, and anticoagulation in this group. Results All pregnant patients with COVID-19 from participating centers were entered, providing 430 pregnancies for the first pandemic wave. Isolated abnormal coagulation parameters were seen in 20%; more often with moderate/severe disease than asymptomatic/mild disease (49% vs 15%; p < 0.0001). No one met the ISTH criteria for disseminated intravascular coagulopathy (DIC), though 5/21 (24%) met the pregnancy DIC score. There was no difference in antepartum hemorrhage (APH) with asymptomatic/mild disease versus moderate/severe disease (3.4% vs 7.7%; p = 0.135). More individuals with moderate/severe disease experienced postpartum hemorrhage (PPH) (22.4% vs 9.3%; p = 0.006). There were no arterial thrombotic events. Only one COVID-associated venous thromboembolism (VTE) was reported. Conclusions Low rates of coagulopathy, bleeding, and thrombosis were observed among pregnant people in the first pandemic wave.
Collapse
Affiliation(s)
- Sajida Kazi
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Maha Othman
- Queen's University, Kingston, Canada
- St. Lawrence College, School of Baccalaureate Nursing, Kingston, Canada
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Rasha Khoury
- Divisions of Maternal Fetal Medicine and Complex Family Planning, Boston University School of Medicine, Boston, USA
| | - Peter S Bernstein
- Montefiore Medical Center/Albert Einstein College of Medicine, New York, USA
| | | | - Etienne Ciantar
- Leeds Teaching Hospital NHS Trust, Leeds General Infirmary, Leeds, UK
| | | | | | - Rezan Abdul-Kadir
- The Royal Free NHS Foundation Hospital and Institute for Women's Health, University College London, London, UK
| | - A Kinga Malinowski
- Division of Maternal-Fetal Medicine, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
- University of Toronto, Toronto, Canada
| |
Collapse
|
9
|
Hulshof AM, Nab L, van Rosmalen F, de Kok J, Mulder MMG, Hellenbrand D, Sels JWEM, Ten Cate H, Cannegieter SC, Henskens YMC, van Bussel BCT. Rotational thromboelastometry as a biomarker for mortality - The Maastricht Intensive Care COVID cohort. Thromb Res 2024; 234:51-58. [PMID: 38159324 DOI: 10.1016/j.thromres.2023.12.010] [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: 07/18/2023] [Revised: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Patients with severe coronavirus disease 2019 (COVID-19) present with persisting hypercoagulability, hypofibrinolysis and prolonged clot initiation as measured with viscoelastic assays. The objective of this study was to investigate the trajectories of traditional assays of hemostasis, routine and tissue plasminogen activator (tPA) rotational thromboelastometry (ROTEM) in COVID-19 patients and to study their association with mortality. METHODS Patients enrolled within the Maastricht Intensive Care COVID (MaastrICCht) cohort were included. Traditional assays of hemostasis (prothrombin time; PT, fibrinogen and D-dimer) were measured daily and ROTEM EXTEM, FIBTEM and tPA assays were performed weekly. Trajectories of these biomarkers were analyzed over time for survivors and non-survivors using linear mixed-effects models. Additional Fine and Gray competing risk survival analysis was performed for the first available measurement after intubation. RESULTS Of the 138 included patients, 57 (41 %) died in the intensive care unit (ICU). Over 450, 400 and 1900 individual measurements were available for analysis of routine, tPA ROTEM and traditional assays of hemostasis, respectively, with a median [IQR] follow-up of 15 [8-24] days. Non-survivors on average had prolonged CT (clotting time) and increased fibrinogen compared to survivors. MCF (maximum clot firmness), LOT (lysis onset time), LT (lysis time) and PT measurements increased more over time in non-survivors compared to survivors. Associations persisted after adjustment for demographics and disease severity. EXTEM and FIBTEM CT at intubation were associated with increased 45-day ICU mortality. CONCLUSIONS ROTEM measurements demonstrate a further increase of hypercoagulability and (hypo)fibrinolysis parameters in non-survivors throughout ICU admission. Furthermore, prolonged CT at intubation was associated with higher 45-day ICU mortality.
Collapse
Affiliation(s)
- Anne-Marije Hulshof
- Central Diagnostic Laboratory, Maastricht University Medical Centre+, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands.
| | - Linda Nab
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Frank van Rosmalen
- Department of Intensive Care, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Jip de Kok
- Department of Intensive Care, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Mark M G Mulder
- Department of Intensive Care, Maastricht University Medical Centre+, Maastricht, the Netherlands; Department of Anesthesiology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Dave Hellenbrand
- Central Diagnostic Laboratory, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Jan Willem E M Sels
- Department of Intensive Care, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Hugo Ten Cate
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands; Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands; Thrombosis Expert Centre Maastricht, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Suzanne C Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Medicine - Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Yvonne M C Henskens
- Central Diagnostic Laboratory, Maastricht University Medical Centre+, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Bas C T van Bussel
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands; Department of Intensive Care, Maastricht University Medical Centre+, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| |
Collapse
|
10
|
Wang X, Chen W, Guo J, Qiu X, You C, Ma L. Association between antithrombotic therapy and mortality in patients hospitalized for COVID‑19. Thromb J 2024; 22:5. [PMID: 38178082 PMCID: PMC10768353 DOI: 10.1186/s12959-023-00572-6] [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: 06/27/2023] [Accepted: 12/13/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND The prothrombotic state is a common abnormality in patients with coronavirus disease 2019 (COVID-19). However, there is controversy over the use of anticoagulants, especially oral anticoagulants (OAC) due to limited studies. We sought to evaluate the association between antithrombotic therapy on mortality and clinical outcomes in patients hospitalized for COVID-19 through propensity score matching (PSM) analysis. METHODS A retrospective cohort study was performed to include adult patients with COVID-19 in a university hospital. The primary outcome was in-hospital mortality. Secondary outcomes included intensive care unit (ICU) admission, mechanical ventilation, and acute kidney injury (AKI) during hospitalization. PSM was used as a powerful tool for matching patients' baseline characteristics. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were calculated from the models. RESULTS Of 4,881 COVID-19 patients during the study period, 690 (14.1%) patients received antithrombotic therapy and 4,191 (85.9%) patients were under no antithrombotic therapy. After adjustment with multivariate regression analysis, patients receiving OAC, compared with those who did not receive any antithrombotic therapy, had significantly lower odds for in-hospital mortality (aOR: 0.46. 95% CI: 0.24 to 0.87; P= 0.017). PSM analysis observed similar results (aOR: 0.35. 95% CI: 0.19 to 0.61; P< 0.001). Moreover, in critically ill patients who received mechanical ventilation, antithrombotic treatment (aOR: 0.54. 95% CI: 0.32 to 0.89; P= 0.022) was associated with reduced risk of mortality. CONCLUSIONS The application OACs was associated with reduced hospital mortality and mechanical ventilation requirement in COVID-19 patients. Besides, antithrombotic treatment was associated with a reduction in in-hospital mortality among critically ill COVID-19 patients who required mechanical ventilation.
Collapse
Affiliation(s)
- Xing Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wuqian Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiulin Guo
- Information Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xingyu Qiu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lu Ma
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| |
Collapse
|
11
|
Guarino G, Sgromolo N, Giladi AM. Considerations for Perioperative Thromboembolic Risk Mitigation in Actively and Recently COVID-19-Positive Patients Undergoing Hand Surgery. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:103-106. [PMID: 38313610 PMCID: PMC10837296 DOI: 10.1016/j.jhsg.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/18/2023] [Indexed: 02/06/2024] Open
Abstract
Coronavirus Disease 2019 (COVID) induces a hypercoagulable state causing an increased risk of venous and arterial thromboses. Distal limb and microvascular circulation are critical to the success of many hand surgeries, and patients who are actively or recently infected with COVID may be at a higher risk for perioperative thrombotic events. Little information is available regarding how to handle actively or recently infected COVID patients, including preoperative risk assessment, intraoperative decision making, and postoperative considerations regarding thrombotic risk. Our aim was to review the literature to determine how the hand surgeon can best prepare for and manage the actively or recently COVID-positive patients undergoing hand surgeries.
Collapse
Affiliation(s)
- Gianna Guarino
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
| | - Nicole Sgromolo
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
| | - Aviram M. Giladi
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
| |
Collapse
|
12
|
Ferrandis R, Sierra P, Gomez-Luque A. COVID-19 thromboprophylaxis. New evidence. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:34-47. [PMID: 37678450 DOI: 10.1016/j.redare.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/17/2022] [Indexed: 09/09/2023]
Abstract
Recent publications have questioned the efficacy of using therapeutic or intermediate doses of low molecular weight heparin (LMWH) in COVID-19 patients, especially in the most severe patients. In order to update these recommendations, a non-systematic review has been carried out in the main medical databases. A total of 14 randomized clinical trials, 14 meta-analyses and the recommendations of 12 scientific societies were selected, stratified according to the type of patient (outpatient, hospitalized, admitted to critical care or post-discharge). The efficacy of LMWH and other therapeutic approaches (rivaroxaban, apixaban, sulodexide, acetylsalicylic acid and P2Y12 inhibitors) has been analyzed. The findings recommend using standard doses of LMWH as thromboprophylaxis in critically hospitalized COVID-19 patients and therapeutic doses in non-critically hospitalized patients if the risk of bleeding is low. In outpatients and those discharged from the hospital, LMWH could be used at a prophylactic dose if there are thrombotic risk factors, and the bleeding risk is low. It is not recommended to associate antiplatelet agents with LMWH unless previously indicated.
Collapse
Affiliation(s)
- R Ferrandis
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitari i Politècnic La Fe, SEDAR, Valencia, Spain; SEDAR Haemostasis, Transfusion Medicine and Fluid Therapy Division, Valencia, Spain
| | - P Sierra
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Virgen de la Victoria, SEDAR, Málaga, Spain; Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Fundació Puigvert, SEDAR, Barcelona, Spain
| | - A Gomez-Luque
- SEDAR Haemostasis, Transfusion Medicine and Fluid Therapy Division, Valencia, Spain; Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Virgen de la Victoria, SEDAR, Málaga, Spain.
| |
Collapse
|
13
|
Fanelli M, Petrone V, Maracchioni C, Chirico R, Cipriani C, Coppola L, Malagnino V, Teti E, Sorace C, Zordan M, Vitale P, Iannetta M, Balestrieri E, Rasi G, Grelli S, Malergue F, Sarmati L, Minutolo A, Matteucci C. Persistence of circulating CD169+monocytes and HLA-DR downregulation underline the immune response impairment in PASC individuals: the potential contribution of different COVID-19 pandemic waves. CURRENT RESEARCH IN MICROBIAL SCIENCES 2023; 6:100215. [PMID: 38187999 PMCID: PMC10767315 DOI: 10.1016/j.crmicr.2023.100215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
The use of CD169 as a marker of viral infection has been widely discussed in the context of COVID-19, and in particular, its crucial role in the early detection of SARS-CoV-2 infection and its association with the severity and clinical outcome of COVID-19 were demonstrated. COVID-19 patients show relevant systemic alteration and immunological dysfunction that persists in individuals with post-acute sequelae of SARS-CoV-2 infection (PASC). It is critical to implement the characterization of the disease, focusing also on the possible impact of the different COVID-19 waves and the consequent effects found after infection. On this basis, we evaluated by flow cytometry the expression of CD169 and HLA-DR on monocytes from COVID-19 patients and PASC individuals to better elucidate their involvement in immunological dysfunction, also evaluating the possible impact of different pandemic waves. The results confirm CD169 RMFI is a good marker of viral infection. Moreover, COVID-19 patients and PASC individuals showed high percentage of CD169+ monocytes, but low percentage of HLA-DR+ monocytes and the alteration of systemic inflammatory indices. We have also observed alterations of CD169 and HLA-DR expression and indices of inflammation upon different COVID-19 waves. The persistence of specific myeloid subpopulations suggests a role of CD169+ monocytes and HLA-DR in COVID-19 disease and chronic post-infection inflammation, opening new opportunities to evaluate the impact of specific pandemic waves on the immune response impairment and systemic alterations with the perspective to provide new tools to monitoring new variants and diseases associated to emerging respiratory viruses.
Collapse
Affiliation(s)
- Marialaura Fanelli
- Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier, 1 - 00133, Rome, 00133, Italy
| | - Vita Petrone
- Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier, 1 - 00133, Rome, 00133, Italy
| | - Christian Maracchioni
- Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier, 1 - 00133, Rome, 00133, Italy
| | - Rossella Chirico
- Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier, 1 - 00133, Rome, 00133, Italy
| | - Chiara Cipriani
- Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier, 1 - 00133, Rome, 00133, Italy
| | - Luigi Coppola
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, 00133, Italy
- Infectious Diseases Clinic, Policlinic of Tor Vergata, Rome, 00133, Italy
| | - Vincenzo Malagnino
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, 00133, Italy
- Infectious Diseases Clinic, Policlinic of Tor Vergata, Rome, 00133, Italy
| | - Elisabetta Teti
- Infectious Diseases Clinic, Policlinic of Tor Vergata, Rome, 00133, Italy
| | - Chiara Sorace
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, 00133, Italy
- Infectious Diseases Clinic, Policlinic of Tor Vergata, Rome, 00133, Italy
| | - Marta Zordan
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, 00133, Italy
- Infectious Diseases Clinic, Policlinic of Tor Vergata, Rome, 00133, Italy
| | - Pietro Vitale
- Infectious Diseases Clinic, Policlinic of Tor Vergata, Rome, 00133, Italy
| | - Marco Iannetta
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, 00133, Italy
- Infectious Diseases Clinic, Policlinic of Tor Vergata, Rome, 00133, Italy
| | - Emanuela Balestrieri
- Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier, 1 - 00133, Rome, 00133, Italy
| | - Guido Rasi
- Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier, 1 - 00133, Rome, 00133, Italy
| | - Sandro Grelli
- Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier, 1 - 00133, Rome, 00133, Italy
- Virology Unit, Policlinic of Tor Vergata, Rome, 00133, Italy
| | - Fabrice Malergue
- Global Research Organization, Beckman Coulter Life Sciences, Marseille, 13009, France
| | - Loredana Sarmati
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, 00133, Italy
- Infectious Diseases Clinic, Policlinic of Tor Vergata, Rome, 00133, Italy
| | - Antonella Minutolo
- Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier, 1 - 00133, Rome, 00133, Italy
| | - Claudia Matteucci
- Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier, 1 - 00133, Rome, 00133, Italy
| |
Collapse
|
14
|
Fusco F, Krasuski RA, Sadeghi S, Rosenbaum MS, Lewis MJ, Carazo MR, Rodriguez FH, Halpern DG, Feinberg JL, Galilea FA, Baraona F, Cedars AM, Ko JM, Porayette P, Maldonado JR, Frogoudaki AA, Nir A, Chaudhry A, John AS, Karbassi A, Ganame J, Hoskoppal A, Frischhertz BP, Hendrickson B, Rodriguez-Monserrate CP, Broda CR, Tobler D, Gregg D, Martinez-Quintana E, Yeung E, Krieger EV, Ruperti-Repilado FJ, Giannakoulas G, Lui GK, Ephrem G, Singh HS, Hasan A, Bartlett HL, Lindsay I, Grewal J, Nicolarsen J, Araujo JJ, Cramer JW, Bouchardy J, Al Najashi K, Ryan K, Alshawabkeh L, Andrade L, Ladouceur M, Schwerzmann M, Greutmann M, Merás P, Ferrero P, Dehghani P, Tung PP, Garcia-Orta R, Tompkins R, Gendi SM, Cohen S, Klewer SE, Hascoet S, Upadhyay S, Fisher SD, Cook S, Cotts TB, Kovacs AH, Aboulhosn JA, Scognamiglio G, Broberg CS, Sarubbi B. COVID-19-Related Thrombotic and Bleeding Events in Adults With Congenital Heart Disease. JACC. ADVANCES 2023; 2:100701. [PMID: 38938489 PMCID: PMC11198511 DOI: 10.1016/j.jacadv.2023.100701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 08/07/2023] [Accepted: 09/05/2023] [Indexed: 06/29/2024]
Abstract
Background Altered coagulation is a striking feature of COVID-19. Adult patients with congenital heart disease (ACHD) are prone to thromboembolic (TE) and bleeding complications. Objectives The purpose of this study was to investigate the prevalence and risk factors for COVID-19 TE/bleeding complications in ACHD patients. Methods COVID-19-positive ACHD patients were included between May 2020 and November 2021. TE events included ischemic cerebrovascular accident, systemic and pulmonary embolism, deep venous thrombosis, myocardial infarction, and intracardiac thrombosis. Major bleeding included cases with hemoglobin drop >2 g/dl, involvement of critical sites, or fatal bleeding. Severe infection was defined as need for intensive care unit, endotracheal intubation, renal replacement therapy, extracorporeal membrane oxygenation, or death. Patients with TE/bleeding were compared to those without events. Factors associated with TE/bleeding were determined using logistic regression. Results Of 1,988 patients (age 32 [IQR: 25-42] years, 47% male, 59 ACHD centers), 30 (1.5%) had significant TE/bleeding: 12 TE events, 12 major bleeds, and 6 with both TE and bleeding. Patients with TE/bleeding had higher in-hospital mortality compared to the remainder cohort (33% vs 1.7%; P < 0.0001) and were in more advanced physiological stage (P = 0.032) and NYHA functional class (P = 0.01), had lower baseline oxygen saturation (P = 0.0001), and more frequently had a history of atrial arrhythmia (P < 0.0001), previous hospitalization for heart failure (P < 0.0007), and were more likely hospitalized for COVID-19 (P < 0.0001). By multivariable logistic regression, prior anticoagulation (OR: 4.92; 95% CI: 2-11.76; P = 0.0003), cardiac injury (OR: 5.34; 95% CI: 1.98-14.76; P = 0.0009), and severe COVID-19 (OR: 17.39; 95% CI: 6.67-45.32; P < 0.0001) were independently associated with increased risk of TE/bleeding complications. Conclusions ACHD patients with TE/bleeding during COVID-19 infection have a higher in-hospital mortality from the illness. Risk of coagulation disorders is related to severe COVID-19, cardiac injury during infection, and use of anticoagulants.
Collapse
Affiliation(s)
- Flavia Fusco
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Richard A. Krasuski
- Department of Cardiovascular Medicine, Duke University Health System in Durham, Durham, North Carolina, USA
| | - Soraya Sadeghi
- Ahmanson/UCLA Adult Congenital Heart Center, Los Angeles, California, USA
| | - Marlon S. Rosenbaum
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Matthew J. Lewis
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Matthew R. Carazo
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Fred H. Rodriguez
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dan G. Halpern
- Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Jodi L. Feinberg
- Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Francisca A. Galilea
- Instituto Nacional del Tórax - Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Fernando Baraona
- Instituto Nacional del Tórax - Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ari M. Cedars
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jong M. Ko
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Prashob Porayette
- Division of Cardiology, University of Iowa Stead Family Children’s Hospital, Iowa City, Iowa, USA
| | - Jennifer R. Maldonado
- Division of Cardiology, University of Iowa Stead Family Children’s Hospital, Iowa City, Iowa, USA
| | | | - Amiram Nir
- Pediatric Cardiology and Adult Congenital Heart Disease Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Anisa Chaudhry
- Penn State Hershey Heart and Vascular Institute, State College, Pennsylvania, USA
| | - Anitha S. John
- Division of Cardiology, Children’s National Hospital, Washington, District of Columbia, USA
| | | | | | - Arvind Hoskoppal
- UPMC Adult Congenital Heart Disease Program, Pittsburgh, Pennsylvania, USA
| | - Benjamin P. Frischhertz
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Benjamin Hendrickson
- Le Bonheur Heart Institute, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | | | | | - Daniel Tobler
- Division of Cardiology, University Hospital of Basel, Basel, Switzerland
| | - David Gregg
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Efrén Martinez-Quintana
- Cardiology Service, Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Elizabeth Yeung
- Colorado’s Adult and Teen Congenital Heart Program, Colorado University School of Medicine, Aurora, Colorado, USA
| | - Eric V. Krieger
- Division of Cardiology, University of Washington School of Medicine, Seattle, Washington, USA
| | | | | | - George K. Lui
- Division of Cardiovascular Medicine and Pediatric Cardiology, Stanford University School of Medicine, Stanford, California, USA
| | - Georges Ephrem
- Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Harsimran S. Singh
- Department of Medicine & Pediatrics, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Almeneisi Hasan
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Heather L. Bartlett
- Department of Pediatrics and Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Ian Lindsay
- Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah, USA
| | - Jasmine Grewal
- St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeremy Nicolarsen
- Department of Pediatric and Adult Cardiology, Providence Adult and Teen Congenital Heart Program, Spokane, Washington, USA
| | - John J. Araujo
- Department of Pediatric and Adult Congenital Heart Disease, Somer Incare Cardiovascular Center, Rionegro, Colombia
| | - Jonathan W. Cramer
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Judith Bouchardy
- Department of Cardiology and Cardiac Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - Khalid Al Najashi
- Pediatric Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Kristi Ryan
- Adult Congenital Heart Program, OSF Healthcare Children’s Hospital of Illinois, Peoria, Illinois, USA
| | - Laith Alshawabkeh
- Department of Cardiovascular Medicine, University of California-San Diego, La Jolla, California, USA
| | - Lauren Andrade
- Division of Cardiology, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Magalie Ladouceur
- Adult Congenital Heart Disease Unit, Hôpital Européen Georges Pompidou, AP-HP, Université de Paris Cité, Paris, France
| | - Markus Schwerzmann
- Center for Congenital Heart Disease, University Hospital Inselspital, Bern, Switzerland
| | | | - Pablo Merás
- Cardiology Department, University Hospital La Paz, Madrid, Spain
| | - Paolo Ferrero
- Cardiovascular Department, ASST Papa Giovanni XXIII, University of Milano, Bergamo, Italy
| | - Payam Dehghani
- Prairie Vascular Research Network, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Poyee P. Tung
- Division of Adult Congenital Heart Disease, University of Texas at Houston, Houston, Texas, USA
| | - Rocio Garcia-Orta
- Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Rose Tompkins
- The Geurin Family Congenital Heart Program, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Salwa M. Gendi
- Adult Congenital Heart Disease Program, West Virginia University, Morgantown, West Virginia, USA
| | - Scott Cohen
- Adult Congenital Heart Disease Program, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Scott E. Klewer
- Division of Cardiology, University of Arizona, Tucson, Arizona, USA
| | - Sebastien Hascoet
- Department of Pediatric Cardiology and Congenital Heart Disease, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Shailendra Upadhyay
- Division of Pediatric Cardiology, Connecticut Children’s Medical Center, Hartford, Connecticut, USA
| | - Stacy D. Fisher
- Department of Medicine and Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Stephen Cook
- Adult Congenital Heart Center, Helen DeVos Children’s Hospital, Grand Rapids, Michigan, USA
| | - Timothy B. Cotts
- Department of Medicine and Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Adrienne H. Kovacs
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Jamil A. Aboulhosn
- Ahmanson/UCLA Adult Congenital Heart Center, Los Angeles, California, USA
| | | | - Craig S. Broberg
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Berardo Sarubbi
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| |
Collapse
|
15
|
Harte JV, Coleman-Vaughan C, Crowley MP, Mykytiv V. It's in the blood: a review of the hematological system in SARS-CoV-2-associated COVID-19. Crit Rev Clin Lab Sci 2023; 60:595-624. [PMID: 37439130 DOI: 10.1080/10408363.2023.2232010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/27/2023] [Indexed: 07/14/2023]
Abstract
The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to an unprecedented global healthcare crisis. While SARS-CoV-2-associated COVID-19 affects primarily the respiratory system, patients with COVID-19 frequently develop extrapulmonary manifestations. Notably, changes in the hematological system, including lymphocytopenia, neutrophilia and significant abnormalities of hemostatic markers, were observed early in the pandemic. Hematological manifestations have since been recognized as important parameters in the pathophysiology of SARS-CoV-2 and in the management of patients with COVID-19. In this narrative review, we summarize the state-of-the-art regarding the hematological and hemostatic abnormalities observed in patients with SARS-CoV-2-associated COVID-19, as well as the current understanding of the hematological system in the pathophysiology of acute and chronic SARS-CoV-2-associated COVID-19.
Collapse
Affiliation(s)
- James V Harte
- Department of Haematology, Cork University Hospital, Wilton, Cork, Ireland
- School of Biochemistry & Cell Biology, University College Cork, Cork, Ireland
| | | | - Maeve P Crowley
- Department of Haematology, Cork University Hospital, Wilton, Cork, Ireland
- Irish Network for Venous Thromboembolism Research (INViTE), Ireland
| | - Vitaliy Mykytiv
- Department of Haematology, Cork University Hospital, Wilton, Cork, Ireland
| |
Collapse
|
16
|
Hranjec T, Mayhew M, Rogers B, Solomon R, Hurst D, Estreicher M, Augusten A, Nunez A, Green M, Malhotra S, Katz R, Rosenthal A, Hennessy S, Pepe P, Sawyer R, Arenas J. Diagnosis and treatment of coagulopathy using thromboelastography with platelet mapping is associated with decreased risk of pulmonary failure in COVID-19 patients. Blood Coagul Fibrinolysis 2023; 34:508-516. [PMID: 37831624 DOI: 10.1097/mbc.0000000000001259] [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: 10/15/2023]
Abstract
INTRODUCTION Treatment of coronavirus disease 2019 (COVID-19) patients may require antithrombotic and/or anti-inflammatory medications. We hypothesized that individualized anticoagulant (AC) management, based on diagnosis of coagulopathy using thromboelastography with platelet mapping (TEG-PM), would decrease the frequency of pulmonary failure (PF) requiring mechanical ventilation (MV), mitigate thrombotic and hemorrhagic events, and, in-turn, reduce mortality. METHODS Hospital-admitted COVID-19 patients, age 18 or older, with escalating oxygen requirements were included. Prospective and supplemental retrospective chart reviews were conducted during a 2-month period. Patients were stratified into two groups based on clinician-administered AC treatment: TEG-PM guided vs. non-TEG guided. RESULTS Highly-elevated inflammatory markers (D-dimer, C-reactive protein, ferritin) were associated with poor prognosis but did not distinguish coagulopathic from noncoagulopathic patients. TEG-guided AC treatment was used in 145 patients vs. 227 treated without TEG-PM guidance. When managed by TEG-PM, patients had decreased frequency of PF requiring MV (45/145 [31%] vs. 152/227 [66.9%], P < 0.0001), fewer thrombotic events (2[1.4%] vs. 39[17.2%], P = 0.0019) and fewer hemorrhagic events (6[4.1%] vs. 24[10.7%], P = 0.0240), and had markedly reduced mortality (43[29.7%] vs. 142[62.6%], P < 0.0001). Platelet hyperactivity, indicating the need for antiplatelet medications, was identified in 75% of TEG-PM patients. When adjusted for confounders, empiric, indiscriminate AC treatment (not guided by TEG-PM) was shown to be an associated risk factor for PF requiring MV, while TEG-PM guided management was associated with a protective effect (odds ratio = 0.18, 95% confidence interval 0.08-0.4). CONCLUSIONS Following COVID-19 diagnosis, AC therapies based on diagnosis of coagulopathy using TEG-PM were associated with significantly less respiratory decompensation, fewer thrombotic and hemorrhagic complications, and improved likelihood of survival.
Collapse
Affiliation(s)
- Tjasa Hranjec
- Department of Surgery, Bronson Methodist Hospital
- Department of Surgery, Western Michigan University, Homer Stryker MD School of Medicine, Kalamazoo, Michigan
- Department of Surgery, Memorial Regional Hospital, Hollywood
| | - Mackenzie Mayhew
- Florida International University, Miami, Florida
- University of Virginia, Charlottesville, Virginia
| | | | - Rachele Solomon
- Department of Surgery, Memorial Regional Hospital, Hollywood
| | | | | | | | - Aaron Nunez
- Department of Medicine, Memorial Regional Hospital, Hollywood, Florida
| | - Melissa Green
- Department of Medicine, Memorial Regional Hospital, Hollywood, Florida
| | - Shivali Malhotra
- Department of Medicine, Memorial Regional Hospital, Hollywood, Florida
| | | | | | - Sara Hennessy
- Department of Surgery, University of Texas Southwestern Medical Center
| | - Paul Pepe
- Metropolitan Emergency Medical Services, Medical Directors Coalition Global Hdqtrs, Dallas, Texas, USA
| | - Robert Sawyer
- Department of Surgery, Bronson Methodist Hospital
- Department of Surgery, Western Michigan University, Homer Stryker MD School of Medicine, Kalamazoo, Michigan
| | - Juan Arenas
- Department of Surgery, Memorial Regional Hospital, Hollywood
| |
Collapse
|
17
|
Morosin M, Azzu A, Antonopoulos A, Kuhn T, Anandanadesan R, Garfield B, Aw TC, Ledot S, Bianchi P. Safety of tracheostomy during extracorporeal membrane oxygenation support: A single-center experience. Artif Organs 2023; 47:1762-1772. [PMID: 37610348 DOI: 10.1111/aor.14633] [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: 02/15/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Some patients on extracorporeal membrane oxygenation (ECMO) require prolonged mechanical ventilation. An early tracheostomy strategy while on ECMO has appeared to be beneficial for these patients. This study aims to explore the safety of tracheostomy in ECMO patients. METHODS This is a retrospective observational single-center study. RESULTS Hundred and nine patients underwent tracheostomy (76 percutaneous and 33 surgical) during V-V ECMO support over an 8-year period. Patients with a percutaneous tracheostomy showed a significantly shorter ECMO duration [25.5 (17.3-40.1) vs 37.2 (26.5-53.2) days, p = 0.013] and a shorter ECMO-to-tracheostomy time [13.3 (8.5-19.7) vs 27.8 (16.3-36.9) days, p < 0.001] compared to those who underwent a surgical approach. There was no difference between the two strategies regarding both major and minor/no bleeding (p = 0.756). There was no difference in survival rate between patients who underwent percutaneous or surgical tracheostomy (p = 0.173). Patients who underwent an early tracheostomy (within 10 days from ECMO insertion) showed a significantly shorter hospital stay (p < 0.001) and a shorter duration of V-V ECMO support (p < 0.001). Our series includes 24 patients affected by COVID-19, who did not show significantly higher rates of major bleeding when compared to non-COVID-19 patients (p = 0.297). Within the COVID-19 subgroup, there was no difference in major bleeding rates between surgical and percutaneous approach (p = 1.0). CONCLUSIONS Percutaneous and surgical tracheostomy during ECMO have a similar safety profile in terms of bleeding risk and mortality. Percutaneous tracheostomy may favor a shorter duration of ECMO support and hospital stay and can be considered a safe alternative to surgical tracheostomy, even in COVID-19 patients, if relevant clinical expertise is available.
Collapse
Affiliation(s)
- Marco Morosin
- Adult Intensive Care Unit, Royal Brompton Hospital, Royal Brompton & Harefield Hospitals (part of Guy's and St Thomas's Foundation Trust), London, UK
| | - Alessia Azzu
- Adult Intensive Care Unit, Royal Brompton Hospital, Royal Brompton & Harefield Hospitals (part of Guy's and St Thomas's Foundation Trust), London, UK
| | - Alexios Antonopoulos
- Adult Intensive Care Unit, Royal Brompton Hospital, Royal Brompton & Harefield Hospitals (part of Guy's and St Thomas's Foundation Trust), London, UK
| | - Timothy Kuhn
- Adult Intensive Care Unit, Royal Brompton Hospital, Royal Brompton & Harefield Hospitals (part of Guy's and St Thomas's Foundation Trust), London, UK
| | - Rathai Anandanadesan
- Adult Intensive Care Unit, Royal Brompton Hospital, Royal Brompton & Harefield Hospitals (part of Guy's and St Thomas's Foundation Trust), London, UK
| | - Benjamin Garfield
- Adult Intensive Care Unit, Royal Brompton Hospital, Royal Brompton & Harefield Hospitals (part of Guy's and St Thomas's Foundation Trust), London, UK
- Division of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Tuan-Chen Aw
- Department of Anaesthesia, Royal Brompton Hospital, Royal Brompton & Harefield Hospitals (part of Guy's and St Thomas's Foundation Trust), London, UK
| | - Stephane Ledot
- Adult Intensive Care Unit, Royal Brompton Hospital, Royal Brompton & Harefield Hospitals (part of Guy's and St Thomas's Foundation Trust), London, UK
- Division of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Anaesthesia, Royal Brompton Hospital, Royal Brompton & Harefield Hospitals (part of Guy's and St Thomas's Foundation Trust), London, UK
| | - Paolo Bianchi
- Adult Intensive Care Unit, Royal Brompton Hospital, Royal Brompton & Harefield Hospitals (part of Guy's and St Thomas's Foundation Trust), London, UK
- Division of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Anaesthesia, Royal Brompton Hospital, Royal Brompton & Harefield Hospitals (part of Guy's and St Thomas's Foundation Trust), London, UK
| |
Collapse
|
18
|
Erickson R, Huang C, Allen C, Ireland J, Roth G, Zou Z, Lu J, Lafont BAP, Garza NL, Brumbaugh B, Zhao M, Suzuki M, Olano L, Brzostowski J, Fischer ER, Twigg HL, Johnson RF, Sun PD. SARS-CoV-2 infection of human lung epithelial cells induces TMPRSS-mediated acute fibrin deposition. Nat Commun 2023; 14:6380. [PMID: 37821447 PMCID: PMC10567911 DOI: 10.1038/s41467-023-42140-6] [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: 06/09/2022] [Accepted: 09/27/2023] [Indexed: 10/13/2023] Open
Abstract
Severe COVID-associated lung injury is a major confounding factor of hospitalizations and death with no effective treatments. Here, we describe a non-classical fibrin clotting mechanism mediated by SARS-CoV-2 infected primary lung but not other susceptible epithelial cells. This infection-induced fibrin formation is observed in all variants of SARS-CoV-2 infections, and requires thrombin but is independent of tissue factor and other classical plasma coagulation factors. While prothrombin and fibrinogen levels are elevated in acute COVID BALF samples, fibrin clotting occurs only with the presence of viral infected but not uninfected lung epithelial cells. We suggest a viral-induced coagulation mechanism, in which prothrombin is activated by infection-induced transmembrane serine proteases, such as ST14 and TMPRSS11D, on NHBE cells. Our finding reveals the inefficiency of current plasma targeted anticoagulation therapy and suggests the need to develop a viral-induced ARDS animal model for treating respiratory airways with thrombin inhibitors.
Collapse
Affiliation(s)
- Rachel Erickson
- Laboratory of Immunogenetics, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 5625 Fishers Ln, Rockville, MD, 20852, USA
| | - Chang Huang
- Laboratory of Immunogenetics, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 5625 Fishers Ln, Rockville, MD, 20852, USA
| | - Cameron Allen
- Laboratory of Immunogenetics, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 5625 Fishers Ln, Rockville, MD, 20852, USA
| | - Joanna Ireland
- Laboratory of Immunogenetics, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 5625 Fishers Ln, Rockville, MD, 20852, USA
| | - Gwynne Roth
- Laboratory of Immunogenetics, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 5625 Fishers Ln, Rockville, MD, 20852, USA
| | - Zhongcheng Zou
- Laboratory of Immunogenetics, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 5625 Fishers Ln, Rockville, MD, 20852, USA
| | - Jinghua Lu
- Laboratory of Immunogenetics, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 5625 Fishers Ln, Rockville, MD, 20852, USA
| | - Bernard A P Lafont
- SARS-CoV-2 Virology Core, Laboratory of Viral Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Nicole L Garza
- SARS-CoV-2 Virology Core, Laboratory of Viral Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Beniah Brumbaugh
- Research Technologies Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 903 South 4th Street, Hamilton, MT, 59840, USA
| | - Ming Zhao
- Research Technologies Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 5625 Fishers Ln, Rockville, MD, 20852, USA
| | - Motoshi Suzuki
- Research Technologies Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 5625 Fishers Ln, Rockville, MD, 20852, USA
| | - Lisa Olano
- Research Technologies Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 5625 Fishers Ln, Rockville, MD, 20852, USA
| | - Joseph Brzostowski
- Laboratory of Immunogenetics, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 5625 Fishers Ln, Rockville, MD, 20852, USA
| | - Elizabeth R Fischer
- Research Technologies Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 903 South 4th Street, Hamilton, MT, 59840, USA
| | - Homer L Twigg
- Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine, Indiana University Medical Center, 1120 West Michigan Street, CL 260A, Indianapolis, IN, 46202, USA
| | - Reed F Johnson
- SARS-CoV-2 Virology Core, Laboratory of Viral Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Peter D Sun
- Laboratory of Immunogenetics, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 5625 Fishers Ln, Rockville, MD, 20852, USA.
| |
Collapse
|
19
|
Potere N, Garrad E, Kanthi Y, Di Nisio M, Kaplanski G, Bonaventura A, Connors JM, De Caterina R, Abbate A. NLRP3 inflammasome and interleukin-1 contributions to COVID-19-associated coagulopathy and immunothrombosis. Cardiovasc Res 2023; 119:2046-2060. [PMID: 37253117 PMCID: PMC10893977 DOI: 10.1093/cvr/cvad084] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 01/30/2023] [Accepted: 02/21/2023] [Indexed: 06/01/2023] Open
Abstract
Immunothrombosis-immune-mediated activation of coagulation-is protective against pathogens, but excessive immunothrombosis can result in pathological thrombosis and multiorgan damage, as in severe coronavirus disease 2019 (COVID-19). The NACHT-, LRR-, and pyrin domain-containing protein 3 (NLRP3) inflammasome produces major proinflammatory cytokines of the interleukin (IL)-1 family, IL-1β and IL-18, and induces pyroptotic cell death. Activation of the NLRP3 inflammasome pathway also promotes immunothrombotic programs including release of neutrophil extracellular traps and tissue factor by leukocytes, and prothrombotic responses by platelets and the vascular endothelium. NLRP3 inflammasome activation occurs in patients with COVID-19 pneumonia. In preclinical models, NLRP3 inflammasome pathway blockade restrains COVID-19-like hyperinflammation and pathology. Anakinra, recombinant human IL-1 receptor antagonist, showed safety and efficacy and is approved for the treatment of hypoxaemic COVID-19 patients with early signs of hyperinflammation. The non-selective NLRP3 inhibitor colchicine reduced hospitalization and death in a subgroup of COVID-19 outpatients but is not approved for the treatment of COVID-19. Additional COVID-19 trials testing NLRP3 inflammasome pathway blockers are inconclusive or ongoing. We herein outline the contribution of immunothrombosis to COVID-19-associated coagulopathy, and review preclinical and clinical evidence suggesting an engagement of the NLRP3 inflammasome pathway in the immunothrombotic pathogenesis of COVID-19. We also summarize current efforts to target the NLRP3 inflammasome pathway in COVID-19, and discuss challenges, unmet gaps, and the therapeutic potential that inflammasome-targeted strategies may provide for inflammation-driven thrombotic disorders including COVID-19.
Collapse
Affiliation(s)
- Nicola Potere
- Department of Medicine and Ageing Sciences, ‘G. d’Annunzio’ University, Via Luigi Polacchi 11, Chieti 66100, Italy
| | - Evan Garrad
- Laboratory of Vascular Thrombosis and Inflammation, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
- University of Missouri School of Medicine, Columbia, MO, USA
| | - Yogendra Kanthi
- Laboratory of Vascular Thrombosis and Inflammation, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marcello Di Nisio
- Department of Medicine and Ageing Sciences, ‘G. d’Annunzio’ University, Via Luigi Polacchi 11, Chieti 66100, Italy
| | - Gilles Kaplanski
- Aix-Marseille Université, INSERM, INRAE, Marseille, France
- Division of Internal Medicine and Clinical Immunology, Assistance Publique - Hôpitaux de Marseille, Hôpital Conception, Aix-Marseille Université, Marseille, France
| | - Aldo Bonaventura
- Department of Internal Medicine, Medicina Generale 1, Medical Center, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | - Jean Marie Connors
- Division of Hematology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Raffaele De Caterina
- University Cardiology Division, Pisa University Hospital, Pisa, Italy
- Chair and Postgraduate School of Cardiology, University of Pisa, Pisa, Italy
- Fondazione Villa Serena per la Ricerca, Città Sant’Angelo, Pescara, Italy
| | - Antonio Abbate
- Robert M. Berne Cardiovascular Research Center, Department of Medicine, Division of Cardiovascular Medicine, University of Virginia, 415 Lane Rd (MR5), PO Box 801394, Charlottesville, VA 22903, USA
| |
Collapse
|
20
|
Kumar R, Rivkin MJ, Raffini L. Thrombotic complications in children with Coronavirus disease 2019 and Multisystem Inflammatory Syndrome of Childhood. J Thromb Haemost 2023; 21:2313-2326. [PMID: 37268064 PMCID: PMC10232718 DOI: 10.1016/j.jtha.2023.05.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/04/2023]
Abstract
Coronavirus disease 2019 (COVID-19) associated coagulopathy is multifactorial and involves inflammation driven hypercoagulability, endothelial dysfunction, platelet activation, and impaired fibrinolysis. Hospitalized adults with COVID-19 are at an increased risk of both venous thromboembolism and ischemic stroke, resulting in adverse outcomes, including increased mortality. Although COVID-19 in children follows a less severe course, both arterial and venous thromboses have been reported in hospitalized children with COVID-19. Additionally, some children develop a postinfectious, hyperinflammatory illness termed multisystem inflammatory syndrome of childhood (MIS-C), which is also associated with hypercoagulability and thrombosis. Several randomized trials have evaluated the safety and efficacy of antithrombotic therapy in adults with COVID-19, although similar pediatric data are lacking. In this narrative review, we discuss the postulated pathophysiology of COVID-19 coagulopathy and summarize principal findings of the recently completed adult trials of antithrombotic therapy. We provide an up-to-date summary of pediatric studies investigating the rate of venous thromboembolism and ischemic stroke in COVID-19 and multisystem inflammatory syndrome of childhood in addition to reviewing the findings of the single, nonrandomized pediatric trial investigating the safety of prophylactic anticoagulation. Lastly, we outline adult and pediatric consensus guidelines on the use of antithrombotic therapy in this cohort. A detailed discussion of the practical implementation and current limitations of published data will hopefully address the knowledge deficits surrounding the use of antithrombotic therapy in children with COVID-19 and generate hypotheses for future research.
Collapse
Affiliation(s)
- Riten Kumar
- Dana Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
| | - Michael J Rivkin
- Department of Neurology, Stroke and Cerebrovascular Center, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA
| | - Leslie Raffini
- Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
21
|
Asimakos AT, Vassiliou AG, Keskinidou C, Spetsioti S, Antonoglou A, Vrettou CS, Mourelatos P, Diamantopoulos A, Pratikaki M, Athanasiou N, Jahaj E, Gallos P, Kotanidou A, Dimopoulou I, Orfanos SE, Katsaounou P. Persistent Endothelial Lung Damage and Impaired Diffusion Capacity in Long COVID. J Pers Med 2023; 13:1351. [PMID: 37763119 PMCID: PMC10533128 DOI: 10.3390/jpm13091351] [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: 07/24/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
Since the beginning of the pandemic, both COVID-19-associated coagulopathy biomarkers and a plethora of endothelial biomarkers have been proposed and tested as prognostic tools of severity and mortality prediction. As the pandemic is gradually being controlled, attention is now focusing on the long-term sequelae of COVID-19. In the present study, we investigated the role of endothelial activation/dysfunction in long COVID syndrome. This observational study included 68 consecutive long COVID patients and a healthy age and sex-matched control group. In both groups, we measured 13 endothelial biomarkers. Moreover, in the long COVID patients, we evaluated fatigue and dyspnea severity, lung diffusion capacity (DLCO), and the 6-min walk (6MWT) test as measures of functional capacity. Our results showed that markers of endothelial activation/dysfunction were higher in long COVID patients, and that soluble intracellular adhesion molecule 1 (sICAM-1) and soluble vascular adhesion molecule 1 (sVCAM-1) negatively correlated with lung diffusion and functional capacity (sICAM-1 vs. DLCO, r = -0.306, p = 0.018; vs. 6MWT, r = -0.263, p = 0.044; and sVCAM-1 vs. DLCO, r= -0.346, p = 0.008; vs. 6MWT, r = -0.504, p < 0.0001). In conclusion, evaluating endothelial biomarkers alongside clinical tests might yield more specific insights into the pathophysiological mechanisms of long COVID manifestations.
Collapse
Affiliation(s)
- Andreas T. Asimakos
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.T.A.); (A.G.V.); (C.K.); (S.S.); (A.A.); (C.S.V.); (N.A.); (E.J.); (A.K.); (I.D.); (S.E.O.)
| | - Alice G. Vassiliou
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.T.A.); (A.G.V.); (C.K.); (S.S.); (A.A.); (C.S.V.); (N.A.); (E.J.); (A.K.); (I.D.); (S.E.O.)
| | - Chrysi Keskinidou
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.T.A.); (A.G.V.); (C.K.); (S.S.); (A.A.); (C.S.V.); (N.A.); (E.J.); (A.K.); (I.D.); (S.E.O.)
| | - Stavroula Spetsioti
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.T.A.); (A.G.V.); (C.K.); (S.S.); (A.A.); (C.S.V.); (N.A.); (E.J.); (A.K.); (I.D.); (S.E.O.)
| | - Archontoula Antonoglou
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.T.A.); (A.G.V.); (C.K.); (S.S.); (A.A.); (C.S.V.); (N.A.); (E.J.); (A.K.); (I.D.); (S.E.O.)
| | - Charikleia S. Vrettou
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.T.A.); (A.G.V.); (C.K.); (S.S.); (A.A.); (C.S.V.); (N.A.); (E.J.); (A.K.); (I.D.); (S.E.O.)
| | - Panagiotis Mourelatos
- Department of Endocrinology Diabetes and Metabolism, National Expertise Center for Rare Endocrine Diseases, Evangelismos Hospital, 106 76 Athens, Greece; (P.M.); (A.D.)
| | - Aristidis Diamantopoulos
- Department of Endocrinology Diabetes and Metabolism, National Expertise Center for Rare Endocrine Diseases, Evangelismos Hospital, 106 76 Athens, Greece; (P.M.); (A.D.)
| | - Maria Pratikaki
- Biochemical Department, Evangelismos Hospital, 106 76 Athens, Greece;
| | - Nikolaos Athanasiou
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.T.A.); (A.G.V.); (C.K.); (S.S.); (A.A.); (C.S.V.); (N.A.); (E.J.); (A.K.); (I.D.); (S.E.O.)
| | - Edison Jahaj
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.T.A.); (A.G.V.); (C.K.); (S.S.); (A.A.); (C.S.V.); (N.A.); (E.J.); (A.K.); (I.D.); (S.E.O.)
| | - Parisis Gallos
- Computational Biomedicine Laboratory, Department of Digital Systems, University of Piraeus, 185 34 Piraeus, Greece;
| | - Anastasia Kotanidou
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.T.A.); (A.G.V.); (C.K.); (S.S.); (A.A.); (C.S.V.); (N.A.); (E.J.); (A.K.); (I.D.); (S.E.O.)
| | - Ioanna Dimopoulou
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.T.A.); (A.G.V.); (C.K.); (S.S.); (A.A.); (C.S.V.); (N.A.); (E.J.); (A.K.); (I.D.); (S.E.O.)
| | - Stylianos E. Orfanos
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.T.A.); (A.G.V.); (C.K.); (S.S.); (A.A.); (C.S.V.); (N.A.); (E.J.); (A.K.); (I.D.); (S.E.O.)
| | - Paraskevi Katsaounou
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.T.A.); (A.G.V.); (C.K.); (S.S.); (A.A.); (C.S.V.); (N.A.); (E.J.); (A.K.); (I.D.); (S.E.O.)
| |
Collapse
|
22
|
Hwang YM, Piekos S, Sorensen T, Hood L, Hadlock J. Adoption of a National Prophylactic Anticoagulation Guideline for Hospitalized Pregnant Women With COVID-19: Retrospective Cohort Study. JMIR Public Health Surveill 2023; 9:e45586. [PMID: 37311123 PMCID: PMC10389076 DOI: 10.2196/45586] [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: 01/09/2023] [Revised: 05/05/2023] [Accepted: 06/13/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Both COVID-19 and pregnancy are associated with hypercoagulability. Due to the increased risk for thrombosis, the United States National Institute of Health's recommendation for prophylactic anticoagulant use for pregnant patients has expanded from patients hospitalized for severe COVID-19 manifestation to all patients hospitalized for the manifestation of COVID-19 (no guideline: before December 26, 2020; first update: December 27, 2022; second update: February 24, 2022-present). However, no study has evaluated this recommendation. OBJECTIVE The objective of this study was to characterize prophylactic anticoagulant use among hospitalized pregnant people with COVID-19 from March 20, 2020, to October 19, 2022. METHODS This was a retrospective cohort study in large US health care systems across 7 states. The cohort of interest was pregnant patients who were hospitalized with COVID-19, without previous coagulopathy or contraindication to anticoagulants (n=2767). The treatment group consisted of patients prescribed prophylactic dose anticoagulation between 2 days before and 14 days after COVID-19 treatment onset (n=191). The control group was patients with no anticoagulant exposure between 14 days before and 60 days after COVID-19 treatment onset (n=2534). We ascertained the use of prophylactic anticoagulants with attention to the updates in guidelines and emerging SARS-CoV-2 variants. We propensity score matched the treatment and control group 1:1 on the most important features contributing to the prophylactic anticoagulant administration status classification. Outcome measures included coagulopathy, bleeding, COVID-19-related complications, and maternal-fetal health outcomes. Additionally, the inpatient anticoagulant administration rate was validated in a nationwide population from Truveta, a collective of 700 hospitals across the United States. RESULTS The overall administration rate of prophylactic anticoagulants was 7% (191/2725). It was lowest after the second guideline update (no guideline: 27/262, 10%; first update: 145/1663, 8.72%; second update: 19/811, 2.3%; P<.001) and during the omicron-dominant period (Wild type: 45/549, 8.2%; Alpha: 18/129, 14%; Delta: 81/507, 16%; and Omicron: 47/1551, 3%; P<.001). Models developed on retrospective data showed that the variable most associated with the administration of inpatient prophylactic anticoagulant was comorbidities prior to SARS-CoV-2 infection. The patients who were administered prophylactic anticoagulant were also more likely to receive supplementary oxygen (57/191, 30% vs 9/188, 5%; P<.001). There was no statistical difference in a new diagnosis of coagulopathy, bleeding, or maternal-fetal health outcomes between those who received treatment and the matched control group. CONCLUSIONS Most hospitalized pregnant patients with COVID-19 did not receive prophylactic anticoagulants across health care systems as recommended by guidelines. Guideline-recommended treatment was administered more frequently to patients with greater COVID-19 illness severity. Given the low rate of administration and differences between treated and untreated cohorts, efficacy could not be assessed.
Collapse
Affiliation(s)
- Yeon-Mi Hwang
- Institute for Systems Biology, Seattle, WA, United States
- University of Washington, Seattle, WA, United States
| | | | - Tanya Sorensen
- University of Washington, Seattle, WA, United States
- Swedish Medical Center, Providence Swedish, Seattle, WA, United States
| | - Leroy Hood
- Institute for Systems Biology, Seattle, WA, United States
| | - Jennifer Hadlock
- Institute for Systems Biology, Seattle, WA, United States
- University of Washington, Seattle, WA, United States
| |
Collapse
|
23
|
Kuck KH, Schlüter M, Vogler J, Heeger CH, Tilz RR. Has COVID-19 changed the spectrum of arrhythmias and the incidence of sudden cardiac death? Herz 2023:10.1007/s00059-023-05186-2. [PMID: 37277617 DOI: 10.1007/s00059-023-05186-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 06/07/2023]
Abstract
Arrhythmic manifestations of COVID-19 include atrial arrhythmias such as atrial fibrillation or atrial flutter, sinus node dysfunction, atrioventricular conduction abnormalities, ventricular tachyarrhythmias, sudden cardiac arrest, and cardiovascular dysautonomias including the so-called long COVID syndrome. Various pathophysiological mechanisms have been implicated, such as direct viral invasion, hypoxemia, local and systemic inflammation, changes in ion channel physiology, immune activation, and autonomic dysregulation. The development of atrial or ventricular arrhythmias in hospitalized COVID-19 patients has been shown to portend a higher risk of in-hospital death. Management of these arrhythmias should be based on published evidence-based guidelines, with special consideration of the acuity of COVID-19 infection, concomitant use of antimicrobial and anti-inflammatory drugs, and the transient nature of some rhythm disorders. In view of new SARS-CoV‑2 variants that may evolve, the development and use of newer antiviral and immunomodulator drugs, and the increasing adoption of vaccination, clinicians must remain vigilant for other arrhythmic manifestations that may occur in association with this novel but potentially deadly disease.
Collapse
Affiliation(s)
- Karl-Heinz Kuck
- Medizinische Klinik II - Kardiologie, Angiologie, Intensivmedizin,Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
- LANS Cardio, Hamburg, Germany.
| | | | - Julia Vogler
- Medizinische Klinik II - Kardiologie, Angiologie, Intensivmedizin,Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Christian Hendrik Heeger
- Medizinische Klinik II - Kardiologie, Angiologie, Intensivmedizin,Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Roland Richard Tilz
- Medizinische Klinik II - Kardiologie, Angiologie, Intensivmedizin,Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| |
Collapse
|
24
|
Vielhauer J, Benesch C, Pernpruner A, Johlke AL, Hellmuth JC, Muenchhoff M, Scherer C, Fink N, Sabel B, Schulz C, Mayerle J, Mahajan UM, Stubbe HC. How to exclude pulmonary embolism in patients hospitalized with COVID-19: a comparison of predictive scores. Thromb J 2023; 21:51. [PMID: 37131204 PMCID: PMC10153021 DOI: 10.1186/s12959-023-00492-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 04/12/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Pulmonary embolism (PE) is an important complication of Coronavirus disease 2019 (COVID-19). COVID-19 is associated with respiratory impairment and a pro-coagulative state, rendering PE more likely and difficult to recognize. Several decision algorithms relying on clinical features and D-dimer have been established. High prevalence of PE and elevated Ddimer in patients with COVID-19 might impair the performance of common decision algorithms. Here, we aimed to validate and compare five common decision algorithms implementing age adjusted Ddimer, the GENEVA, and Wells scores as well as the PEGeD- and YEARS-algorithms in patients hospitalized with COVID-19. METHODS In this single center study, we included patients who were admitted to our tertiary care hospital in the COVID-19 Registry of the LMU Munich. We retrospectively selected patients who received a computed tomography pulmonary angiogram (CTPA) or pulmonary ventilation/perfusion scintigraphy (V/Q) for suspected PE. The performances of five commonly used diagnostic algorithms (age-adjusted D-dimer, GENEVA score, PEGeD-algorithm, Wells score, and YEARS-algorithm) were compared. RESULTS We identified 413 patients with suspected PE who received a CTPA or V/Q confirming 62 PEs (15%). Among them, 358 patients with 48 PEs (13%) could be evaluated for performance of all algorithms. Patients with PE were older and their overall outcome was worse compared to patients without PE. Of the above five diagnostic algorithms, the PEGeD- and YEARS-algorithms performed best, reducing diagnostic imaging by 14% and 15% respectively with a sensitivity of 95.7% and 95.6%. The GENEVA score was able to reduce CTPA or V/Q by 32.2% but suffered from a low sensitivity (78.6%). Age-adjusted D-dimer and Wells score could not significantly reduce diagnostic imaging. CONCLUSION The PEGeD- and YEARS-algorithms outperformed other tested decision algorithms and worked well in patients admitted with COVID-19. These findings need independent validation in a prospective study.
Collapse
Affiliation(s)
- Jakob Vielhauer
- Department of Medicine II, University Hospital LMU Munich, Munich, Germany.
- German Center for Infection Research, Partner Site Munich, Munich, Germany.
| | - Christopher Benesch
- Department of Medicine II, University Hospital LMU Munich, Munich, Germany
- German Center for Infection Research, Partner Site Munich, Munich, Germany
| | - Anna Pernpruner
- Department of Medicine II, University Hospital LMU Munich, Munich, Germany
- German Center for Infection Research, Partner Site Munich, Munich, Germany
| | - Anna-Lena Johlke
- Department of Medicine II, University Hospital LMU Munich, Munich, Germany
- German Center for Infection Research, Partner Site Munich, Munich, Germany
| | - Johannes Christian Hellmuth
- Department of Medicine III, University Hospital LMU Munich, Munich, Germany
- COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, LMU Munich, Munich, Germany
| | - Maximilian Muenchhoff
- German Center for Infection Research, Partner Site Munich, Munich, Germany
- COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, LMU Munich, Munich, Germany
- Max von Pettenkofer Institute and Gene Center, National Reference Center for Retroviruses, Ludwig Maximilian University (LMU) of Munich, Virology, Munich, Germany
| | - Clemens Scherer
- COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, LMU Munich, Munich, Germany
- Department of Medicine I, University Hospital LMU Munich, Munich, Germany
| | - Nicola Fink
- Department of Radiology, Hospital of the LMU Munich, Munich, Germany
| | - Bastian Sabel
- Department of Radiology, Hospital of the LMU Munich, Munich, Germany
| | - Christian Schulz
- Department of Medicine II, University Hospital LMU Munich, Munich, Germany
- German Center for Infection Research, Partner Site Munich, Munich, Germany
| | - Julia Mayerle
- Department of Medicine II, University Hospital LMU Munich, Munich, Germany
| | | | - Hans Christian Stubbe
- Department of Medicine II, University Hospital LMU Munich, Munich, Germany.
- German Center for Infection Research, Partner Site Munich, Munich, Germany.
| |
Collapse
|
25
|
Sayyadi M, Hassani S, Shams M, Dorgalaleh A. Status of major hemostatic components in the setting of COVID-19: the effect on endothelium, platelets, coagulation factors, fibrinolytic system, and complement. Ann Hematol 2023; 102:1307-1322. [PMID: 37074380 PMCID: PMC10115391 DOI: 10.1007/s00277-023-05234-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/14/2023] [Indexed: 04/20/2023]
Abstract
The coagulation, fibrinolytic, anticoagulation, and complement systems are in delicate balance with the vessel wall endothelium ensuring appropriate hemostasis. Coagulopathy in coronavirus disease 2019 (COVID-19) is not a simple disorder of one hemostatic component but a complicated process affecting most of the hemostasis system. COVID-19 disturbs the balance between the procoagulant systems and the regulatory mechanisms. Here, we investigate the effect of COVID-19 on key hemostatic components, including platelets, endothelial cells, coagulation factors, fibrinolytic system, anticoagulant protein system, and complement system, to improve our understanding of the pathophysiological processes underlying COVID-19 coagulopathy based on evidence.
Collapse
Affiliation(s)
- Mohammad Sayyadi
- Department of Medical Laboratory Sciences, School of Allied Medical Sciences, Arak University of Medical Sciences, Arak, Iran
| | - Saeed Hassani
- Department of Medical Laboratory Sciences, School of Allied Medical Sciences, Arak University of Medical Sciences, Arak, Iran.
| | - Mahmood Shams
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | | |
Collapse
|
26
|
Smadja DM, Gendron N, Philippe A, Diehl JL, Ochat N, Bory O, Beauvais A, Mareau A, Jannot AS, Chocron R. Fibrin monomers evaluation during hospitalization for COVID-19 is a predictive marker of in-hospital mortality. Front Cardiovasc Med 2023; 10:1001530. [PMID: 37063947 PMCID: PMC10098364 DOI: 10.3389/fcvm.2023.1001530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 02/28/2023] [Indexed: 04/01/2023] Open
Abstract
BackgroundCoagulopathy is one of the main triggers of severity and worsening of Coronavirus disease 2019 (COVID-19) particularly in critically ill patients. D-dimer has been widely used to detect COVID-19 coagulation disorders and has been correlated with outcomes such as disease severity and in-hospital mortality. Involvement of other fibrin degradation products, particularly fibrin monomers (FM), remains an ongoing question.MethodsWe performed a monocentric study of adult patients with COVID-19, who were admitted either in the medical ward (MW) or in the intensive care unit (ICU) and who had FM measurements performed on them during the first wave of COVID-19 outbreak. We analyzed the positivity of FM levels (FM > 7 µg/mL) to assess the ability of FM monitoring during the first days of hospitalization to predict COVID-19 outcomes.ResultsIn our cohort, 935 FM measurements were performed in 246 patients during their first 9 days of hospitalization. During patient follow-up, the FM levels were higher in patients admitted directly to the ICU than in those admitted to the MW. Moreover, we observed significantly increased levels of FM in patients when the data were stratified for in-hospital mortality. At hospital admission, only 27 (11%) patients displayed a positive value for FM; this subgroup did not differ from other patients in terms of severity (indicated by ICU referral at admission) or in-hospital mortality. When analyzing FM positivity in the first 9 days of hospitalization, we found that 37% of patients had positive FM at least once during hospitalization and these patients had increased in-hospital mortality (p = 0.001). Thus, we used non-adjusted Kaplan–Meier curves for in-hospital mortality according to FM positivity during hospitalization and we observed a statistically significant difference for in-hospital mortality (hazard ratio = 1.48, 95% CI: 1.25–1.76, p < 0.001). However, we compared the AUC of FM positivity associated with a ratio of D-dimer >70% and found that this combined receiver operating characteristic (ROC) curve was superior to the FM positivity ROC curve alone.ConclusionMonitoring of FM positivity in hospitalized patients with COVID-19 could be a reliable and helpful tool to predict the worsening condition and mortality of COVID-19.
Collapse
Affiliation(s)
- David M. Smadja
- Innovative Therapies in Hemostasis, INSERM, University Paris Cité, Paris, France
- Hematology Department, AP-HP.CUP, Georges Pompidou European Hospital, Paris, France
- Correspondence: David M. Smadja
| | - Nicolas Gendron
- Innovative Therapies in Hemostasis, INSERM, University Paris Cité, Paris, France
- Hematology Department, AP-HP.CUP, Georges Pompidou European Hospital, Paris, France
| | - Aurélien Philippe
- Innovative Therapies in Hemostasis, INSERM, University Paris Cité, Paris, France
- Hematology Department, AP-HP.CUP, Georges Pompidou European Hospital, Paris, France
| | - Jean-Luc Diehl
- Innovative Therapies in Hemostasis, INSERM, University Paris Cité, Paris, France
- Intensive Care Unit, AP-HP.CUP, Georges Pompidou European Hospital, Paris, France
| | - Nadège Ochat
- Hematology Department, AP-HP.CUP, Georges Pompidou European Hospital, Paris, France
| | - Olivier Bory
- Emergency Department, AP-HP.CUP, Georges Pompidou European Hospital, Paris, France
| | - Agathe Beauvais
- Emergency Department, AP-HP.CUP, Georges Pompidou European Hospital, Paris, France
| | - Alexis Mareau
- Centre de Recherche des Cordeliers, AP-HP.CUP, Georges Pompidou European Hospital, Medical Informatics, Biostatistics and Public Health Department, European Georges Pompidou Hospital, AP-HP.CUP, University Paris Cité, Paris, France
| | - Anne-Sophie Jannot
- Centre de Recherche des Cordeliers, AP-HP.CUP, Georges Pompidou European Hospital, Medical Informatics, Biostatistics and Public Health Department, European Georges Pompidou Hospital, AP-HP.CUP, University Paris Cité, Paris, France
| | - Richard Chocron
- Emergency Department, AP-HP.CUP, Georges Pompidou European Hospital, Paris, France
- PARCC, INSERM, University Paris Cité, Paris, France
| |
Collapse
|
27
|
Foxley-Marrable M, D’Cruz L, Meredith P, Glaysher S, Beckett AH, Goudarzi S, Fearn C, Cook KF, Loveson KF, Dent H, Paul H, Elliott S, Wyllie S, Lloyd A, Bicknell K, Lumley S, McNicholas J, Prytherch D, Lundgren A, Graur O, Chauhan AJ, Robson SC. Combining viral genomics and clinical data to assess risk factors for severe COVID-19 (mortality, ICU admission, or intubation) amongst hospital patients in a large acute UK NHS hospital Trust. PLoS One 2023; 18:e0283447. [PMID: 36952555 PMCID: PMC10035897 DOI: 10.1371/journal.pone.0283447] [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: 11/11/2022] [Accepted: 03/07/2023] [Indexed: 03/25/2023] Open
Abstract
Throughout the COVID-19 pandemic, valuable datasets have been collected on the effects of the virus SARS-CoV-2. In this study, we combined whole genome sequencing data with clinical data (including clinical outcomes, demographics, comorbidity, treatment information) for 929 patient cases seen at a large UK hospital Trust between March 2020 and May 2021. We identified associations between acute physiological status and three measures of disease severity; admission to the intensive care unit (ICU), requirement for intubation, and mortality. Whilst the maximum National Early Warning Score (NEWS2) was moderately associated with severe COVID-19 (A = 0.48), the admission NEWS2 was only weakly associated (A = 0.17), suggesting it is ineffective as an early predictor of severity. Patient outcome was weakly associated with myriad factors linked to acute physiological status and human genetics, including age, sex and pre-existing conditions. Overall, we found no significant links between viral genomics and severe outcomes, but saw evidence that variant subtype may impact relative risk for certain sub-populations. Specific mutations of SARS-CoV-2 appear to have little impact on overall severity risk in these data, suggesting that emerging SARS-CoV-2 variants do not result in more severe patient outcomes. However, our results show that determining a causal relationship between mutations and severe COVID-19 in the viral genome is challenging. Whilst improved understanding of the evolution of SARS-CoV-2 has been achieved through genomics, few studies on how these evolutionary changes impact on clinical outcomes have been seen due to complexities associated with data linkage. By combining viral genomics with patient records in a large acute UK hospital, this study represents a significant resource for understanding risk factors associated with COVID-19 severity. However, further understanding will likely arise from studies of the role of host genetics on disease progression.
Collapse
Affiliation(s)
- Max Foxley-Marrable
- Institute of Cosmology and Gravitation, University of Portsmouth, Portsmouth, Hampshire, United Kingdom
| | - Leon D’Cruz
- Portsmouth Hospitals University NHS Trust, Portsmouth, Hampshire, United Kingdom
| | - Paul Meredith
- Portsmouth Hospitals University NHS Trust, Portsmouth, Hampshire, United Kingdom
| | - Sharon Glaysher
- Portsmouth Hospitals University NHS Trust, Portsmouth, Hampshire, United Kingdom
| | - Angela H. Beckett
- School of Biological Science, University of Portsmouth, Portsmouth, Hampshire, United Kingdom
- Centre for Enzyme Innovation, University of Portsmouth, Portsmouth, Hampshire, United Kingdom
| | - Salman Goudarzi
- School of Pharmacy and Biomedical Science, University of Portsmouth, Portsmouth, Hampshire, United Kingdom
| | - Christopher Fearn
- School of Pharmacy and Biomedical Science, University of Portsmouth, Portsmouth, Hampshire, United Kingdom
| | - Kate F. Cook
- School of Pharmacy and Biomedical Science, University of Portsmouth, Portsmouth, Hampshire, United Kingdom
| | - Katie F. Loveson
- School of Pharmacy and Biomedical Science, University of Portsmouth, Portsmouth, Hampshire, United Kingdom
| | - Hannah Dent
- School of Pharmacy and Biomedical Science, University of Portsmouth, Portsmouth, Hampshire, United Kingdom
| | - Hannah Paul
- School of Pharmacy and Biomedical Science, University of Portsmouth, Portsmouth, Hampshire, United Kingdom
| | - Scott Elliott
- Portsmouth Hospitals University NHS Trust, Portsmouth, Hampshire, United Kingdom
| | - Sarah Wyllie
- Portsmouth Hospitals University NHS Trust, Portsmouth, Hampshire, United Kingdom
| | - Allyson Lloyd
- Portsmouth Hospitals University NHS Trust, Portsmouth, Hampshire, United Kingdom
| | - Kelly Bicknell
- Portsmouth Hospitals University NHS Trust, Portsmouth, Hampshire, United Kingdom
| | - Sally Lumley
- Portsmouth Hospitals University NHS Trust, Portsmouth, Hampshire, United Kingdom
| | - James McNicholas
- Portsmouth Hospitals University NHS Trust, Portsmouth, Hampshire, United Kingdom
| | - David Prytherch
- Centre for Healthcare Modelling and Informatics, University of Portsmouth, Portsmouth, Hampshire, United Kingdom
| | | | - Andrew Lundgren
- Institute of Cosmology and Gravitation, University of Portsmouth, Portsmouth, Hampshire, United Kingdom
| | - Or Graur
- Institute of Cosmology and Gravitation, University of Portsmouth, Portsmouth, Hampshire, United Kingdom
| | - Anoop J. Chauhan
- Portsmouth Hospitals University NHS Trust, Portsmouth, Hampshire, United Kingdom
| | - Samuel C. Robson
- School of Biological Science, University of Portsmouth, Portsmouth, Hampshire, United Kingdom
- Centre for Enzyme Innovation, University of Portsmouth, Portsmouth, Hampshire, United Kingdom
- School of Pharmacy and Biomedical Science, University of Portsmouth, Portsmouth, Hampshire, United Kingdom
| |
Collapse
|
28
|
Nobili A, D'Avanzo B, Tettamanti M, Galbussera AA, Remuzzi G, Fortino I, Leoni O, Harari S, Mannucci PM. Post-COVID condition: dispensation of drugs and diagnostic tests as proxies of healthcare impact. Intern Emerg Med 2023; 18:801-809. [PMID: 36944811 PMCID: PMC10030070 DOI: 10.1007/s11739-023-03228-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/13/2023] [Indexed: 03/23/2023]
Abstract
With the goal to increase knowledge on the healthcare impact of the post-COVID-19 condition we exploited the administrative claims database of Lombardy, the largest Italian region and the first after China to be heavily hit by the SARS-CoV-2 pandemic in February-May 2020. We chose to employ the dispensation of drugs and diagnostic tests as proxies of the impact of the post-COVID condition in 46,574 cases who recovered from COVID-19 and were negative at PCR testing within June 20, 2020. Data were obtained throughout the 18-month post-negativization period until December 2021 and results on the use of drugs and diagnostic tests were compared with those accrued in the same cases during the pre-COVID period in July-December 2019. After an increase in the first semester after SARS-CoV-2 negativization (July-December 2020), trends in the dispensation of drugs according to the broad ATC classes and of diagnostic tests decreased or remained substantially stable. However, dispensation of drugs for acid related disorders (A02), diabetes (A10), heparins (B01AB), direct oral anticoagulants (B01AP), antipsychotics (N05A), antidepressants (N06A) and for obstructive airways diseases (R03) was still higher than in the pre-COVID period. These findings, based upon drug and diagnostic test dispensation as proxies of the healthcare impact of the post-COVID condition, show that in a substantial proportion of recovered cases the post-COVID condition is active and clinically relevant 18 months after the acute disease. The findings also provide indirect evidence of the body organs and systems more compromised in the post-COVID period.
Collapse
Affiliation(s)
- Alessandro Nobili
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156, Milan, Italy.
| | - Barbara D'Avanzo
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156, Milan, Italy
| | - Mauro Tettamanti
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156, Milan, Italy
| | | | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156, Milan, Italy
| | - Ida Fortino
- Direzione Generale Welfare, Regione Lombardia, Milan, Italy
| | - Olivia Leoni
- Direzione Generale Welfare, Regione Lombardia, Milan, Italy
| | - Sergio Harari
- Department of Clinical Sciences and Community Health, Università Di Milano, Milan, Italy
- Division of Internal Medicine, Multimedica IRCSS, Milan, Italy
| | - Pier Mannuccio Mannucci
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and University of Milan, Milan, Italy
| |
Collapse
|
29
|
Jani CT, Schooley RT, Mckay RR, Lippman SM. Cancer, more than a “COVID-19 co-morbidity”. Front Oncol 2023; 13:1107384. [PMID: 36994197 PMCID: PMC10040761 DOI: 10.3389/fonc.2023.1107384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/13/2023] [Indexed: 03/14/2023] Open
Abstract
Patients with cancer represent a particularly vulnerable population at risk of adverse outcomes related to COVID-19. Collectively, the initial studies, including patients with and without cancer, confirmed that patients with cancer had a higher risk of complications and death related to COVID-19. Subsequent studies on patients with COVID-19 and cancer investigated patient and disease-related factors associated with COVID-19 severity and morality. Multiple interconnected factors include demographics, comorbidities, cancer-associated variables, treatment side effects, and other parameters. However, there is a lack of clarity on the contributions of any one factor. In this commentary, we deconvolute the data of specific risk factors associated with worse outcomes due to COVID-19 in cancer patients and focus on understanding the recommended guidelines to mitigate COVID-19 risk in this vulnerable population. In the first section, we highlight the key parameters, including age and race, cancer status, type of malignancy, cancer therapy, smoking status and comorbidities that impact outcomes for cancer patients with COVID-19. Next, we discuss efforts made at the patient, health system, and population levels to mitigate the effects of the ongoing outbreak for patients with cancer, including (1) screening, barrier and isolation strategies (2), Masking/PPE (3), vaccination, and (4) systemic therapies (e.g., evusheld) to prevent disease onset in patients. In the last section, we discuss optimal treatment strategies for COVID-19, including additional therapies for patients with COVID-19 and cancer. Overall, this commentary focuses on articles with high yield and impact on understanding the evolving evidence of risk factors and management guidelines in detail. We also emphasize the ongoing collaboration between clinicians, researchers, health system administrators and policymakers and how its role will be important in optimizing care delivery strategies for patients with cancer. Creative patient-centered solutions will be critical in the coming years, post the pandemic.
Collapse
Affiliation(s)
- Chinmay T. Jani
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Robert T. Schooley
- Division of Hematology-Oncology, Department of Medicine, University of California San Diego, La Jolla, CA, United States
| | - Rana R. Mckay
- Division of Hematology-Oncology, Department of Medicine, University of California San Diego, La Jolla, CA, United States
- *Correspondence: Rana R. Mckay,
| | - Scott M. Lippman
- Division of Hematology-Oncology, Department of Medicine, University of California San Diego, La Jolla, CA, United States
| |
Collapse
|
30
|
Scharf RE, Anaya JM. Post-COVID Syndrome in Adults-An Overview. Viruses 2023; 15:675. [PMID: 36992384 PMCID: PMC10056158 DOI: 10.3390/v15030675] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023] Open
Abstract
This article provides an overview of various aspects related to post-COVID syndrome. Apart from its prevalence, symptoms and sequelae, risk determinants, and psychosocial implications, the pathogenesis of post-COVID condition is discussed in more detail. A focus on thrombo-inflammation in SARS-CoV-2 infection, the role of neutrophil extracellular traps, and the prevalence of venous thromboembolism is made. Moreover, COVID-19 and post-COVID syndrome in immunocompromising conditions, and the impact of vaccination on the prevention and treatment of post-COVID symptoms are reviewed. Autoimmunity is a hallmark of post-COVID syndrome, and, therefore, is another focus of this article. Thus, misdirected cellular and humoral immune responses can enhance the risk of latent autoimmunity in post-COVID syndrome. Facing the high prevalence of COVID-19 cases worldwide, it can be assumed that autoimmune disorders will increase globally over the next few years. Recent advances in identifying genetically determined variants may open the avenue for a better understanding of the susceptibility to and severity of SARS-CoV-2 infection and post-COVID syndrome.
Collapse
Affiliation(s)
- Rüdiger E. Scharf
- Current Address: Department of Medicine, Division of Cardiology, Angiology, Hemostasis and Internal Intensive Care Medicine, University Medical Center Mannheim, University of Heidelberg, D-68167 Mannheim, Germany
- Harvard Medical School, Program in Cellular and Molecular Medicine, Boston Children’s Hospital, Karp Family Research Laboratories, Boston, MA 02115, USA
- Institute of Transplantation Diagnostics and Cell Therapy, Division of Hemostasis, Hemotherapy and Transfusion Medicine, Heinrich Heine University Medical Center, D-40225 Düsseldorf, Germany
| | - Juan-Manuel Anaya
- Current Affiliation & Address: National Academy of Medicine of Colombia, Bogotá 110221, Colombia
- Health Research and Innovation Center at Coosalud, Cartagena 130001, Colombia
| |
Collapse
|
31
|
COVID-19 and the Response to Antiplatelet Therapy. J Clin Med 2023; 12:jcm12052038. [PMID: 36902825 PMCID: PMC10004309 DOI: 10.3390/jcm12052038] [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: 11/28/2022] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
The coronavirus SARS-CoV2 disease (COVID-19) is connected with significant morbidity and mortality (3.4%), disorders in hemostasis, including coagulopathy, activation of platelets, vascular injury, and changes in fibrinolysis, which may be responsible for an increased risk of thromboembolism. Many studies demonstrated relatively high rates of venous and arterial thrombosis related to COVID-19. The incidence of arterial thrombosis in severe/critically ill intensive care unit-admitted COVID-19 patients appears to be around 1%. There are several ways for the activation of platelets and coagulation that may lead to the formation of thrombi, so it is challenging to make a decision about optimal antithrombotic strategy in patients with COVID-19. This article reviews the current knowledge about the role of antiplatelet therapy in patients with COVID-19.
Collapse
|
32
|
García-Ortega A, Mora VM, Lobo JL. Respiratory Comorbidity and Pulmonary Embolism. Arch Bronconeumol 2023; 59:131-133. [PMID: 36229302 DOI: 10.1016/j.arbres.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/06/2022] [Accepted: 09/12/2022] [Indexed: 11/02/2022]
Affiliation(s)
| | - Víctor Manuel Mora
- Servicio de Neumología, Hospital Universitario Valdecilla, Santander, Spain
| | - José Luis Lobo
- Servicio de Neumología, Hospital Universitario Araba/Organización Sanitaria Integrada ARABA, Vitoria, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
33
|
Incidence of lower limb deep vein thrombosis in patients with COVID-19 pneumonia through different waves of SARS-CoV-2 pandemic: A multicenter prospective study. PLoS One 2023; 18:e0280247. [PMID: 36730264 PMCID: PMC9894444 DOI: 10.1371/journal.pone.0280247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 12/24/2022] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the incidence of deep vein thrombosis (DVT) of the lower limbs in patients hospitalized with COVID-19 pneumonia in a non-ICU setting according to the different waves of the SARS-CoV-2 pandemic. METHODS Multicenter, prospective study of patients with COVID-19 pneumonia admitted to Internal Medicine units in Italy during the first (March-May 2020) and subsequent waves (November 2020 -April 2021) of the pandemic using a serial compression ultrasound (CUS) surveillance to detect DVT of the lower limbs. RESULTS Three-hundred-sixty-three consecutive patients were enrolled. The pooled incidence of DVT was 8%: 13.5% in the first wave, and 4.2% in the subsequent waves (p = 0.002). The proportion of patients with early (< 4 days) detection of DVT was higher in patients during the first wave with respect to those of subsequent waves (8.1% vs 1.9%; p = 0.004). Patients enrolled in different waves had similar clinical characteristics, and thrombotic risk profile. Less patients during the first wave received intermediate/high dose anticoagulation with respect to those of the subsequent waves (40.5% vs 54.5%; p = 0.005); there was a significant difference in anticoagulant regimen and initiation of thromboprophylaxis at home (8.1% vs 25.1%; p<0.001). CONCLUSIONS In acutely ill patients with COVID-19 pneumonia, the incidence of DVT of the lower limbs showed a 3-fold decrease during the first with respect to the subsequent waves of the pandemic. A significant increase in thromboprophylaxis initiation prior to hospitalization, and the increase of the intensity of anticoagulation during hospitalization, likely, played a relevant role to explain this observation.
Collapse
|
34
|
Mykhalchuk DI, Pavlovskyi SA, Pavlovska MO, Drozdov VO, Blagaia AV. FEATURES OF COAGULOPATHY AND SYSTEMIC INFLAMMATION IN PATIENTS AFTER COVID-19 INFECTION. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 75:2907-2914. [PMID: 36723302 DOI: 10.36740/wlek202212103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim: To determine the peculiarities of laboratory data concerning blood coagulation and systemic inflammation in COVID-19 patients in three months after discharge and recovery. The state of coagulation, anticoagulation, and fibrinolytic systems, as well as their prognostic value having been well studied in hospitalized COVID-19 patients, their state three months after hospitalization, are not yet well understood. PATIENTS AND METHODS Materials and methods: Methods of randomization, anthropometry, ECG, standard clinical blood testing, immunoenzymometry, immunoanalysis, and primary statistical analysis were used in the study. Anthropometric measurements of patients (n=20), blood samples, blood serum samples, urine samples, and statistical data were the materials of the study. RESULTS Results: Indices of coagulation and systemic inflammation in studied patients after COVID-19 were obtained (PTT, s ; PATPT, s; Fibrinogen, g/L; Platelets ×109 /L; PCT, ng/mL; DD, μg/L; СRP, mg/L; IL -6, pg/mL; IL -10, pg/mL; Cortisol (nM/L); CIC (IU/mL); Ig A (g/L). CONCLUSION Conclusions: Summing up the results obtained, it is possible to assert micro- and macro-vascular thromboses to be common in COVID-19 cases; they are associated with poor prognosis for diseased patients and are not completely investigated; the role of thromboses in COVID-19 course and complications are to be studied as well as the strategies of fibrinolytic therapies for such condition are to be justified. The presence of specific rheological and serological changes in patients even three months after surviving COVID-19 needs further study to understand the necessity of anti-thrombolytic drug uptake for a relatively long time.
Collapse
Affiliation(s)
| | - Serhij A Pavlovskyi
- PRIVATE INSTITUTION OF HIGHER EDUCATION «KYIV INTERNATIONAL UNIVERSITY», KYIV, UKRAINE
| | - Maryna O Pavlovska
- PRIVATE INSTITUTION OF HIGHER EDUCATION «KYIV INTERNATIONAL UNIVERSITY», KYIV, UKRAINE
| | | | | |
Collapse
|
35
|
Prognostic value of an automated thrombin generation assay in COVID-19 patients entering hospital: A multicentric, prospective observational study. Thromb Res 2023; 222:85-95. [PMID: 36608393 PMCID: PMC9806931 DOI: 10.1016/j.thromres.2022.12.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/16/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The prognostic significance of the thrombin generation assay (TGA) with a thrombomodulin (TM) challenge in patients entering hospital with severe COVID-19 is uncertain. METHODS We prospectively evaluated an automated TGA (aTGA) using the ST-ThromboScreen® assay and ST-Genesia® analyser in 179 patients with severe COVID-19 during their admission to 2 university hospitals. The primary outcome was early survival at Day 28 (D28). Secondary outcomes were late survival at Day 90 (D90), later transfer to an intensive care unit (ICU), and occurrence of any thrombotic complications during hospitalisation. RESULTS Among the 174 patients, 50 were initially admitted to ICUs. Forty-two were transferred to ICUs before D28. Fourteen patients, all in ICUs, died before D28, and 20 before D90, all but 1 in ICUs. None of the aTGA-derived results were associated with vital status either at D28 or D90. Nine patients had a thrombotic event with no association with the aTGA results. Later transfer to the ICU was associated with higher velocity index, thrombin peak height and endogenous thrombin potential (ETP) values of the aTGA performed with TM, and mainly with a lower TM-induced decrease in ETP (odds ratio 15.5 (2.15-132), p = 0.009). CONCLUSIONS aTGA, a global assay supposed to evidence coagulopathy, could predict neither early or late survival, nor thrombotic events, in hospitalised COVID-19 patients. Its clinical justification in that setting is thus unlikely. A relative resistance of the ETP to TM was associated with later transfer to the ICU and deserves further investigation.
Collapse
|
36
|
Zidan A, Noureldin A, Kumar SA, Elsebaie A, Othman M. COVID-19 Vaccine-Associated Immune Thrombosis and Thrombocytopenia (VITT): Diagnostic Discrepancies and Global Implications. Semin Thromb Hemost 2023; 49:9-14. [PMID: 36603593 DOI: 10.1055/s-0042-1759684] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Vaccine-induced immune thrombotic thrombocytopenia (VITT) has been reported in association with the coronavirus disease 2019 preventative adenovirus vector-based vaccines ChAdOx1 nCoV-19 (Oxford/AstraZeneca) and Ad26.COV2.S (Janssen/Johnson & Johnson) in hundreds of recipients across the globe. VITT is characterized by thrombosis, typically at unusual sites, low fibrinogen, and elevated plasma D-dimer, generally manifesting between 4 and 28 days following vaccination. Detection of anti-platelet factor antibodies using an enzyme-linked immunosorbent assay (ELISA) is often confirmatory. Although several similar principles subside in most diagnostic criteria for VITT, the presentation of a positive ELISA assay, use of expert hematology and neurology opinion, and exclusion of possible VITT cases outside the "standard" 4 to 28-day timeframe have contributed a lack of global standardization for defining VITT. Accordingly, the global and regional incidence of VITT differs according to the diagnostic pathway and case definition used. This has influenced the public perception of VITT's severity and the decision to use adenovirus vector-based vaccines for limiting severe acute respiratory syndrome coronavirus 2 infection. We hereby delineate the recognized pathogenic mechanisms, global incidence, discrepancies in diagnostic criteria, recommended treatments, and global implications to vaccine hesitancy from this coagulopathy.
Collapse
Affiliation(s)
- Ali Zidan
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Abdelrahman Noureldin
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Shreya Anil Kumar
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Abdelrahman Elsebaie
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Maha Othman
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada.,Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansura, Egypt.,Department of Nursing, School of Baccalaureate Nursing, St. Lawrence College, Kingston, Ontario, Canada
| |
Collapse
|
37
|
Garg SK, Almurashi AM, Rodriguez E. Virtual Clinics for Diabetes Care. Diabetes Technol Ther 2023; 25:S2-S14. [PMID: 36802190 DOI: 10.1089/dia.2023.2501] [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] [Indexed: 02/23/2023]
Affiliation(s)
- Satish K Garg
- Barbara Davis Center for Diabetes, University of Colorado, Aurora, CO, USA
| | | | - Erika Rodriguez
- Barbara Davis Center for Diabetes, University of Colorado, Aurora, CO, USA
| |
Collapse
|
38
|
Gabrielson K, Myers S, Yi J, Gabrielson E, Jimenez IA. Comparison of Cardiovascular Pathology In Animal Models of SARS-CoV-2 Infection: Recommendations Regarding Standardization of Research Methods. Comp Med 2023; 73:58-71. [PMID: 36731878 PMCID: PMC9948900 DOI: 10.30802/aalas-cm-22-000095] [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: 08/16/2022] [Revised: 10/04/2022] [Accepted: 01/06/2023] [Indexed: 02/04/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged as the viral pathogen that led to the global COVID-19 pandemic that began in late 2019. Because SARS-CoV-2 primarily causes a respiratory disease, much research conducted to date has focused on the respiratory system. However, SARS-CoV-2 infection also affects other organ systems, including the cardiovascular system. In this critical analysis of published data, we evaluate the evidence of cardiovascular pathology in human patients and animals. Overall, we find that the presence or absence of cardiovascular pathology is reported infrequently in both human autopsy studies and animal models of SARS-CoV-2 infection. Moreover, in those studies that have reported cardiovascular pathology, we identified issues in their design and execution that reduce confidence in the conclusions regarding SARS-CoV-2 infection as a cause of significant cardiovascular pathology. Throughout this overview, we expand on these limitations and provide recommendations to ensure a high level of scientific rigor and reproducibility.
Collapse
Affiliation(s)
- Kathleen Gabrielson
- Department of Molecular and Comparative Pathobiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephanie Myers
- School of Veterinary Medicine, Texas Tech University, Amarillo, Texas; and
| | - Jena Yi
- Department of Molecular and Comparative Pathobiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Edward Gabrielson
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Isabel A Jimenez
- Department of Molecular and Comparative Pathobiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
39
|
Rizk JG, Gupta A, Lazo JG, Sardar P, Henry BM, Lavie CJ, Effron MB. To Anticoagulate or Not to Anticoagulate in COVID-19: Lessons after 2 Years. Semin Thromb Hemost 2023; 49:62-72. [PMID: 35468641 DOI: 10.1055/s-0042-1744302] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
A hypercoagulable state associated with coronavirus disease 2019 (COVID-19) has been well documented and is believed to be strongly supported by a proinflammatory state. The hypercoagulable state in turn results in increased incidence of arterial and venous thromboembolism (VTE) seen in hospitalized COVID-19 when compared with hospitalized non-COVID-19 patient cohorts. Moreover, patients with arterial or VTE and COVID-19 have higher mortality compared with COVID-19 patients without arterial or VTE. Prevention of arterial or VTE thus remains an essential question in the management of COVID-19 patients, especially because of high rates of reported microvascular and macrovascular thrombosis. This has prompted multiple randomized control trials (RCTs) evaluating different anticoagulation strategies in COVID-19 patients at various stages of the disease. Herein, we review findings from RCTs in the past 2 years of antithrombotic therapy in critically ill hospitalized patients, noncritically ill hospitalized patients, patients postdischarge from the hospital, and outpatients. RCTs in critically ill patients demonstrated therapeutic dose anticoagulation does not improve outcomes and has more bleeding than prophylaxis dose anticoagulant in these patients. Trials in noncritically ill hospitalized patients showed a therapeutic dose anticoagulation with a heparin formulation might improve clinical outcomes. Anticoagulation with a direct oral anticoagulant posthospital discharge may improve outcomes, although there is a large RCT in progress. Nonhospitalized COVID-19 patients have an insufficient burden of events to be candidates for antithrombotic therapy. Anticoagulation in pregnant and lactating patients with COVID-19, as well as antiplatelet therapy for COVID-19, is also reviewed.
Collapse
Affiliation(s)
- John G Rizk
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Aashish Gupta
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana
| | - Jose G Lazo
- UCSF Medical Center, University of California, San Francisco, San Francisco, California
| | - Partha Sardar
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana
| | - Brandon Michael Henry
- Cardiac Intensive Care Unit, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Disease Prevention and Intervention & Population Health Programs, Texas Biomedical Research Institute, San Antonio, Texas
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana
| | - Mark B Effron
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana
| |
Collapse
|
40
|
Goudswaard LJ, Williams CM, Khalil J, Burley KL, Hamilton F, Arnold D, Milne A, Lewis PA, Heesom KJ, Mundell SJ, Davidson AD, Poole AW, Hers I. Alterations in platelet proteome signature and impaired platelet integrin α IIbβ 3 activation in patients with COVID-19. J Thromb Haemost 2023; 21:1307-1321. [PMID: 36716966 PMCID: PMC9883069 DOI: 10.1016/j.jtha.2023.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 01/30/2023]
Abstract
BACKGROUND Patients with COVID-19 are at increased risk of thrombosis, which is associated with altered platelet function and coagulopathy, contributing to excess mortality. OBJECTIVES To characterize the mechanism of altered platelet function in COVID-19 patients. METHODS The platelet proteome, platelet functional responses, and platelet-neutrophil aggregates were compared between patients hospitalized with COVID-19 and healthy control subjects using tandem mass tag proteomic analysis, Western blotting, and flow cytometry. RESULTS COVID-19 patients showed a different profile of platelet protein expression (858 altered of the 5773 quantified). Levels of COVID-19 plasma markers were enhanced in the platelets of COVID-19 patients. Gene ontology pathway analysis demonstrated that the levels of granule secretory proteins were raised, whereas those of platelet activation proteins, such as the thrombopoietin receptor and protein kinase Cα, were lowered. Basally, platelets of COVID-19 patients showed enhanced phosphatidylserine exposure, with unaltered integrin αIIbβ3 activation and P-selectin expression. Agonist-stimulated integrin αIIbβ3 activation and phosphatidylserine exposure, but not P-selectin expression, were decreased in COVID-19 patients. COVID-19 patients had high levels of platelet-neutrophil aggregates, even under basal conditions, compared to controls. This association was disrupted by blocking P-selectin, demonstrating that platelet P-selectin is critical for the interaction. CONCLUSIONS Overall, our data suggest the presence of 2 platelet populations in patients with COVID-19: one of circulating platelets with an altered proteome and reduced functional responses and another of P-selectin-expressing neutrophil-associated platelets. Platelet-driven thromboinflammation may therefore be one of the key factors enhancing the risk of thrombosis in COVID-19 patients.
Collapse
Affiliation(s)
- Lucy J Goudswaard
- School of Physiology, Pharmacology and Neuroscience, Biomedical Sciences Building, University Walk, Bristol, BS8 1TD, UK; Population Health Sciences, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK. https://twitter.com/lucygoudswaard
| | - Christopher M Williams
- School of Physiology, Pharmacology and Neuroscience, Biomedical Sciences Building, University Walk, Bristol, BS8 1TD, UK
| | - Jawad Khalil
- School of Physiology, Pharmacology and Neuroscience, Biomedical Sciences Building, University Walk, Bristol, BS8 1TD, UK
| | - Kate L Burley
- School of Physiology, Pharmacology and Neuroscience, Biomedical Sciences Building, University Walk, Bristol, BS8 1TD, UK
| | - Fergus Hamilton
- Population Health Sciences, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK; Department of Infection Sciences, North Bristol NHS Trust, Bristol, BS10 5NB, UK
| | - David Arnold
- Academic Respiratory Unit, North Bristol NHS Trust, Bristol, BS10 5NB, UK
| | - Alice Milne
- Academic Respiratory Unit, North Bristol NHS Trust, Bristol, BS10 5NB, UK
| | - Phil A Lewis
- Proteomics Facility, Faculty of Life Sciences, University Walk, University of Bristol, Bristol, BS8 1TD, UK
| | - Kate J Heesom
- Proteomics Facility, Faculty of Life Sciences, University Walk, University of Bristol, Bristol, BS8 1TD, UK
| | - Stuart J Mundell
- School of Physiology, Pharmacology and Neuroscience, Biomedical Sciences Building, University Walk, Bristol, BS8 1TD, UK
| | - Andrew D Davidson
- School of Cellular and Molecular Medicine, Biomedical Sciences Building, University Walk, Bristol, BS8 1TD, UK
| | - Alastair W Poole
- School of Physiology, Pharmacology and Neuroscience, Biomedical Sciences Building, University Walk, Bristol, BS8 1TD, UK
| | - Ingeborg Hers
- School of Physiology, Pharmacology and Neuroscience, Biomedical Sciences Building, University Walk, Bristol, BS8 1TD, UK.
| |
Collapse
|
41
|
Volod O, Bunch CM, Miller J, Moore EE, Moore HB, Kwaan HC, Patel SS, Wiarda G, Aboukhaled M, Thomas SG, Fulkerson D, Erdman L, Tincher A, Walsh MM. Reply to Bareille et al. Are Viscoelastometric Assays of Old Generation Ready for Disposal? Comment on "Volod et al. Viscoelastic Hemostatic Assays: A Primer on Legacy and New Generation Devices. J. Clin. Med. 2022, 11, 860". J Clin Med 2023; 12:jcm12020478. [PMID: 36675408 PMCID: PMC9862366 DOI: 10.3390/jcm12020478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/16/2022] [Accepted: 12/27/2022] [Indexed: 01/11/2023] Open
Abstract
We are pleased to see that Bareille et al. have written a Commentary: "Are viscoelastometric assays of old generation ready for disposal?" [...].
Collapse
Affiliation(s)
- Oksana Volod
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Correspondence:
| | - Connor M. Bunch
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI 48402, USA
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA
| | - Joseph Miller
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI 48402, USA
| | - Ernest E. Moore
- Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, University of Colorado Health Sciences Center, Denver, CO 80204, USA
| | - Hunter B. Moore
- Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, University of Colorado Health Sciences Center, Denver, CO 80204, USA
| | - Hau C. Kwaan
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Shivani S. Patel
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA
| | - Grant Wiarda
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA
| | - Michael Aboukhaled
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA
| | - Scott G. Thomas
- Department of Trauma Surgery, Memorial Leighton Trauma Center, Beacon Health System, South Bend, IN 46601, USA
| | - Daniel Fulkerson
- Department of Trauma Surgery, Memorial Leighton Trauma Center, Beacon Health System, South Bend, IN 46601, USA
| | - Lee Erdman
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA
| | - Anna Tincher
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA
| | - Mark M. Walsh
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA
| |
Collapse
|
42
|
Zlojutro B, Jandric M, Momcicevic D, Dragic S, Kovacevic T, Djajic V, Stojiljkovic MP, Skrbic R, Djuric DM, Kovacevic P. Dynamic changes in coagulation, hematological and biochemical parameters as predictors of mortality in critically ill COVID-19 patients: A prospective observational study. Clin Hemorheol Microcirc 2023; 83:137-148. [PMID: 36373312 DOI: 10.3233/ch-221583] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION This study was created to analyze dynamic alterations in coagulation, hematological and biochemical parameters and their association with mortality of COVID-19 patients. To identify the most sensitive biomarkers as predictors of mortality more research is required. METHODS The present study was a prospective, one-year-long observational study conducted on all critically ill, COVID-19 patients with respiratory failure. The following data were collected: demographic and clinical characteristics of the study population, comorbidities, coagulation, biochemical and hematological parameters. The primary outcome was the proportion of patients who died. RESULTS 91 patients with median age 60 (50-67), 76.9% male, met the acute respiratory distress syndrome criteria. It was tested whether dynamic change (delta-Δ) of parameters that were found to be predictors of mortality is independently associated with poor outcome. Adjusted (multivariate) analysis was used, where tested parameters were corrected for basic and clinical patients characteristics. The only inflammatory parameter which dynamic change had statistically significant odds ratio was ΔCRP (p < 0.005), while among coagulation parameters statistically significant OR was found for Δ fibrinogen (p < 0.005) in predicting mortality. CONCLUSION Monitoring of coagulation, hematological and biochemical parameters abnormalities and their dynamical changes can potentially improve management and predict mortality in critically ill COVID -19 patients.
Collapse
Affiliation(s)
- Biljana Zlojutro
- University Clinical Centre of the Republic of Srpska, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina
| | - Milka Jandric
- University Clinical Centre of the Republic of Srpska, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina
| | - Danica Momcicevic
- University Clinical Centre of the Republic of Srpska, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina.,Faculty of Medicine, University of Banja Luka, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina
| | - Sasa Dragic
- University Clinical Centre of the Republic of Srpska, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina.,Faculty of Medicine, University of Banja Luka, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina
| | - Tijana Kovacevic
- University Clinical Centre of the Republic of Srpska, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina.,Faculty of Medicine, University of Banja Luka, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina
| | - Vlado Djajic
- University Clinical Centre of the Republic of Srpska, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina.,Faculty of Medicine, University of Banja Luka, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina
| | - Milos P Stojiljkovic
- Center for Biomedical Research, Faculty of Medicine, University of Banja Luka, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina
| | - Ranko Skrbic
- Center for Biomedical Research, Faculty of Medicine, University of Banja Luka, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina
| | - Dragan M Djuric
- Institute of Medical Physiology "Richard Burian", Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Pedja Kovacevic
- University Clinical Centre of the Republic of Srpska, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina.,Faculty of Medicine, University of Banja Luka, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina
| |
Collapse
|
43
|
Impact of Paxlovid on international normalized ratio among patients on chronic warfarin therapy. Blood 2022; 140:2757-2759. [PMID: 36240439 PMCID: PMC9906278 DOI: 10.1182/blood.2022017433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/23/2022] [Accepted: 09/06/2022] [Indexed: 12/30/2022] Open
|
44
|
Cognasse F, Hamzeh-Cognasse H, Rosa M, Corseaux D, Bonneaudeau B, Pierre C, Huet J, Arthaud CA, Eyraud MA, Prier A, Duchez AC, Ebermeyer T, Heestermans M, Audoux-Caire E, Philippot Q, Le Voyer T, Hequet O, Fillet AM, Chavarin P, Legrand D, Richard P, Pirenne F, Gallian P, Casanova JL, Susen S, Morel P, Lacombe K, Bastard P, Tiberghien P. Inflammatory markers and auto-Abs to type I IFNs in COVID-19 convalescent plasma cohort study. EBioMedicine 2022; 87:104414. [PMID: 36535107 PMCID: PMC9758484 DOI: 10.1016/j.ebiom.2022.104414] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 11/10/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND COVID-19 convalescent plasma (CCP) contains neutralising anti-SARS-CoV-2 antibodies that may be useful as COVID-19 passive immunotherapy in patients at risk of developing severe disease. Such plasma from convalescent patients may also have additional immune-modulatory properties when transfused to COVID-19 patients. METHODS CCP (n = 766) was compared to non-convalescent control plasma (n = 166) for soluble inflammatory markers, ex-vivo inflammatory bioactivity on endothelial cells, neutralising auto-Abs to type I IFNs and reported adverse events in the recipients. FINDINGS CCP exhibited a statistically significant increase in IL-6 and TNF-alpha levels (0.531 ± 0.04 vs 0.271 ± 0.04; (95% confidence interval [CI], 0.07371-0.4446; p = 0.0061) and 0.900 ± 0.07 vs 0.283 ± 0.07 pg/mL; (95% [CI], 0.3097-0.9202; p = 0.0000829) and lower IL-10 (0.731 ± 0.07 vs 1.22 ± 0.19 pg/mL; (95% [CI], -0.8180 to -0.1633; p = 0.0034) levels than control plasma. Neutralising auto-Abs against type I IFNs were detected in 14/766 (1.8%) CCPs and were not associated with reported adverse events when transfused. Inflammatory markers and bioactivity in CCP with or without auto-Abs, or in CCP whether or not linked to adverse events in transfused patients, did not differ to a statistically significant extent. INTERPRETATION Overall, CCP exhibited moderately increased inflammatory markers compared to the control plasma with no discernible differences in ex-vivo bioactivity. Auto-Abs to type I IFNs detected in a small fraction of CCP were not associated with reported adverse events or differences in inflammatory markers. Additional studies, including careful clinical evaluation of patients treated with CCP, are required in order to further define the clinical relevance of these findings. FUNDING French National Blood Service-EFS, the Association "Les Amis de Rémi" Savigneux, France, the "Fondation pour la Recherche Médicale (Medical Research Foundation)-REACTing 2020".
Collapse
Affiliation(s)
- Fabrice Cognasse
- Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France,Univ Jean Monnet, Mines Saint-Étienne, INSERM, U 1059 Sainbiose, 42023, Saint-Étienne, France,Corresponding author. Etablissement Français du Sang Auvergne-Rhône-Alpes, INSERM U1059, Campus Santé Innovation - 10 rue de la Marandière, 42270, Saint-Priest-en-Jarez, France.
| | - Hind Hamzeh-Cognasse
- Univ Jean Monnet, Mines Saint-Étienne, INSERM, U 1059 Sainbiose, 42023, Saint-Étienne, France
| | - Mickael Rosa
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, CNRS, U1011- EGID, F-59000 Lille, France,Centre National de la Recherche Scientifique (National Scientific Research Centre), Surgical Critical Care, Department of Anaesthesiology and Critical Care, U1019 - Unité Mixte de Recherche 9017 (Mixed Research Unit 9017) – Lille Centre for Infection and Immunity, France
| | - Delphine Corseaux
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, CNRS, U1011- EGID, F-59000 Lille, France,Centre National de la Recherche Scientifique (National Scientific Research Centre), Surgical Critical Care, Department of Anaesthesiology and Critical Care, U1019 - Unité Mixte de Recherche 9017 (Mixed Research Unit 9017) – Lille Centre for Infection and Immunity, France
| | | | - Chloe Pierre
- Etablissement Français du Sang, La Plaine, St Denis, France
| | - Julie Huet
- Etablissement Français du Sang, La Plaine, St Denis, France
| | - Charles Antoine Arthaud
- Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France,Univ Jean Monnet, Mines Saint-Étienne, INSERM, U 1059 Sainbiose, 42023, Saint-Étienne, France
| | - Marie Ange Eyraud
- Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France,Univ Jean Monnet, Mines Saint-Étienne, INSERM, U 1059 Sainbiose, 42023, Saint-Étienne, France
| | - Amélie Prier
- Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France,Univ Jean Monnet, Mines Saint-Étienne, INSERM, U 1059 Sainbiose, 42023, Saint-Étienne, France
| | - Anne Claire Duchez
- Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France,Univ Jean Monnet, Mines Saint-Étienne, INSERM, U 1059 Sainbiose, 42023, Saint-Étienne, France
| | - Theo Ebermeyer
- Univ Jean Monnet, Mines Saint-Étienne, INSERM, U 1059 Sainbiose, 42023, Saint-Étienne, France
| | - Marco Heestermans
- Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France,Univ Jean Monnet, Mines Saint-Étienne, INSERM, U 1059 Sainbiose, 42023, Saint-Étienne, France
| | - Estelle Audoux-Caire
- Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France,Univ Jean Monnet, Mines Saint-Étienne, INSERM, U 1059 Sainbiose, 42023, Saint-Étienne, France
| | - Quentin Philippot
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale U1163 (National Institute for Health and Medical Research), Necker Hospital for Sick Children, Paris, France,University of Paris, Imagine Institute, Paris, France
| | - Tom Le Voyer
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale U1163 (National Institute for Health and Medical Research), Necker Hospital for Sick Children, Paris, France,University of Paris, Imagine Institute, Paris, France
| | - Olivier Hequet
- Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France
| | | | - Patricia Chavarin
- Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France
| | - Dominique Legrand
- Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France
| | | | - France Pirenne
- Univ Paris Est Creteil, INSERM U955, Institut Mondor de Recherche Biomédicale (Mondor Biomedical Research Institute) (IMRB), Creteil, France & Laboratory of Excellence GR-Ex, Paris, France
| | - Pierre Gallian
- Etablissement Français du Sang, La Plaine, St Denis, France,UMR “Unité des Virus Emergents” (Emerging Virus Unit), Aix-Marseille University - IRD 190 - INSERM 1207 - IRBA - EFS - IHU Méditerranée Infection, Marseille, France
| | - Jean Laurent Casanova
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale U1163 (National Institute for Health and Medical Research), Necker Hospital for Sick Children, Paris, France,University of Paris, Imagine Institute, Paris, France,St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA,Howard Hughes Medical Institute, New York, NY, USA
| | - Sophie Susen
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, CNRS, U1011- EGID, F-59000 Lille, France,Centre National de la Recherche Scientifique (National Scientific Research Centre), Surgical Critical Care, Department of Anaesthesiology and Critical Care, U1019 - Unité Mixte de Recherche 9017 (Mixed Research Unit 9017) – Lille Centre for Infection and Immunity, France
| | - Pascal Morel
- Etablissement Français du Sang, La Plaine, St Denis, France
| | - Karine Lacombe
- Sorbonne University, Inserm IPLESP, Infectious Diseases Department, Saint-Antoine Hospital, APHP (University Hospital Trust), Paris, France
| | - Paul Bastard
- Etablissement Français du Sang, La Plaine, St Denis, France,Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale U1163 (National Institute for Health and Medical Research), Necker Hospital for Sick Children, Paris, France,St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
| | - Pierre Tiberghien
- Etablissement Français du Sang, La Plaine, St Denis, France,UMR RIGHT U1098, INSERM, Etablissement Français du Sang, University of Franche-Comté, Besançon, France
| |
Collapse
|
45
|
Uzun G, Althaus K, Hammer S, Bakchoul T. Assessment and Monitoring of Coagulation in Patients with COVID-19: A Review of Current Literature. Hamostaseologie 2022; 42:409-419. [PMID: 35477118 DOI: 10.1055/a-1755-8676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Coagulation abnormalities are common in patients with COVID-19 and associated with high morbidity and mortality. It became a daily challenge to navigate through these abnormal laboratory findings and deliver the best possible treatment to the patients. The unique character of COVID-19-induced coagulopathy necessitates not only a dynamic follow-up of the patients in terms of hemostatic findings but also the introduction of new diagnostic methods to determine the overall function of the coagulation system in real time. After the recognition of the high risk of thromboembolism in COVID-19, several professional societies published their recommendations regarding anticoagulation in patients with COVID-19. This review summarizes common hemostatic findings in COVID-19 patients and presents the societal recommendations regarding the use of coagulation laboratory findings in clinical decision-making. Although several studies have investigated coagulation parameters in patients with COVID-19, the methodological shortcomings of published studies as well as the differences in employed anticoagulation regimens that have changed over time, depending on national and international guidelines, limit the applicability of these findings in other clinical settings. Accordingly, evidence-based recommendations for diagnostics during acute COVID-19 infection are still lacking. Future studies should verify the role of coagulation parameters as well as viscoelastic methods in the management of patients with COVID-19.
Collapse
Affiliation(s)
- Günalp Uzun
- Center for Clinical Transfusion Medicine, University Hospital of Tuebingen, Tuebingen, Germany
| | - Karina Althaus
- Center for Clinical Transfusion Medicine, University Hospital of Tuebingen, Tuebingen, Germany.,Medical Faculty of Tuebingen, Institute for Clinical and Experimental Transfusion Medicine, Tuebingen, Germany
| | - Stefanie Hammer
- Center for Clinical Transfusion Medicine, University Hospital of Tuebingen, Tuebingen, Germany
| | - Tamam Bakchoul
- Center for Clinical Transfusion Medicine, University Hospital of Tuebingen, Tuebingen, Germany.,Medical Faculty of Tuebingen, Institute for Clinical and Experimental Transfusion Medicine, Tuebingen, Germany
| |
Collapse
|
46
|
Yepes M. Neurological Complications of SARS-CoV-2 Infection and COVID-19 Vaccines: From Molecular Mechanisms to Clinical Manifestations. Curr Drug Targets 2022; 23:1620-1638. [PMID: 36121081 DOI: 10.2174/1389450123666220919123029] [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: 02/04/2022] [Revised: 05/31/2022] [Accepted: 07/26/2022] [Indexed: 01/25/2023]
Abstract
Coronavirus Disease 2019 (COVID-19) is an infectious disease, caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), that reached pandemic proportions in 2020. Despite the fact that it was initially characterized by pneumonia and acute respiratory distress syndrome, it is now clear that the nervous system is also compromised in one third of these patients. Indeed, a significant proportion of COVID-19 patients suffer nervous system damage via a plethora of mechanisms including hypoxia, coagulopathy, immune response to the virus, and the direct effect of SARS-CoV-2 on endothelial cells, neurons, astrocytes, pericytes and microglia. Additionally, a low number of previously healthy individuals develop a variety of neurological complications after receiving COVID-19 vaccines and a large proportion of COVID-19 survivors experience longlasting neuropsychiatric symptoms. In conclusion, COVID-19 is also a neurological disease, and the direct and indirect effects of the virus on the nervous system have a significant impact on the morbidity and mortality of these patients. Here we will use the concept of the neurovascular unit, assembled by endothelial cells, basement membrane, perivascular astrocytes, neurons and microglia, to review the effects of SARS-CoV-2 in the nervous system. We will then use this information to review data published to this date on the neurological manifestations of COVID-19, the post- COVID syndrome and COVID-19 vaccines.
Collapse
Affiliation(s)
- Manuel Yepes
- Division of Neuropharmacology and Neurologic Diseases, Yerkes National Primate Research Center, Atlanta, GA, USA.,Department of Neurology & Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA.,Department of Neurology, Veterans Affairs Medical Center, Atlanta, GA, USA
| |
Collapse
|
47
|
Eikelboom JW, Jolly SS, Belley-Cote EP, Whitlock RP, Rangarajan S, Xu L, Heenan L, Bangdiwala SI, Luz Diaz M, Diaz R, Yusufali A, Kumar Sharma S, Tarhuni WM, Hassany M, Avezum A, Harper W, Wasserman S, Almas A, Drapkina O, Felix C, Lopes RD, Berwanger O, Lopez-Jaramillo P, Anand SS, Bosch J, Choudhri S, Farkouh ME, Loeb M, Yusuf S. Colchicine and the combination of rivaroxaban and aspirin in patients hospitalised with COVID-19 (ACT): an open-label, factorial, randomised, controlled trial. THE LANCET. RESPIRATORY MEDICINE 2022; 10:1169-1177. [PMID: 36228641 PMCID: PMC9635892 DOI: 10.1016/s2213-2600(22)00298-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND COVID-19 disease is accompanied by a dysregulated immune response and hypercoagulability. The Anti-Coronavirus Therapies (ACT) inpatient trial aimed to evaluate anti-inflammatory therapy with colchicine and antithrombotic therapy with the combination of rivaroxaban and aspirin for prevention of disease progression in patients hospitalised with COVID-19. METHODS The ACT inpatient, open-label, 2 × 2 factorial, randomised, controlled trial was done at 62 clinical centres in 11 countries. Patients aged at least 18 years with symptomatic, laboratory confirmed COVID-19 who were within 72 h of hospitalisation or worsening clinically if already hospitalised were randomly assigned (1:1) to receive colchicine 1·2 mg followed by 0·6 mg 2 h later and then 0·6 mg twice daily for 28 days versus usual care; and in a second (1:1) randomisation, to the combination of rivaroxaban 2·5 mg twice daily plus aspirin 100 mg once daily for 28 days versus usual care. Investigators and patients were not masked to treatment allocation. The primary outcome, assessed at 45 days in the intention-to-treat population, for the colchicine randomisation was the composite of the need for high-flow oxygen, mechanical ventilation, or death; and for the rivaroxaban plus aspirin randomisation was the composite of major thrombosis (myocardial infarction, stroke, acute limb ischaemia, or pulmonary embolism), the need for high-flow oxygen, mechanical ventilation, or death. The trial is registered at www. CLINICALTRIALS gov, NCT04324463 and is ongoing. FINDINGS Between Oct 2, 2020, and Feb 10, 2022, at 62 sites in 11 countries, 2749 patients were randomly assigned to colchicine or control and the combination of rivaroxaban and aspirin or to the control. 2611 patients were included in the analysis of colchicine (n=1304) versus control (n=1307); 2119 patients were included in the analysis of rivaroxaban and aspirin (n=1063) versus control (n=1056). Follow-up was more than 98% complete. Overall, 368 (28·2%) of 1304 patients allocated to colchicine and 356 (27·2%) of 1307 allocated to control had a primary outcome (hazard ratio [HR] 1·04, 95% CI 0·90-1·21, p=0·58); and 281 (26·4%) of 1063 patients allocated to the combination of rivaroxaban and aspirin and 300 (28·4%) of 1056 allocated to control had a primary outcome (HR 0·92, 95% CI 0·78-1·09, p=0·32). Results were consistent in subgroups defined by vaccination status, disease severity at baseline, and timing of randomisation in relation to onset of symptoms. There was no increase in the number of patients who had at least one serious adverse event for colchicine versus control groups (87 [6·7%] of 1304 vs 90 [6·9%] of 1307) or with rivaroxaban and aspirin versus control groups (85 [8·0%] vs 91 [8·6%]). Among patients assigned to colchicine, 8 (0·61%) had adverse events that led to discontinuation of study drug, mostly gastrointestinal in nature. 17 (1·6%) patients assigned to the combination of rivaroxaban and aspirin had bleeding compared with seven (0·66%) of those allocated to control (p=0·042); the number of serious bleeding events was two (0·19%) versus six (0·57%), respectively (p=0·18). No patients assigned to rivaroxaban and aspirin had serious adverse events that led to discontinuation of study drug. INTERPRETATION Among patients hospitalised with COVID-19, neither colchicine nor the combination of rivaroxaban and aspirin prevent disease progression or death. FUNDING Canadian Institutes for Health Research, Bayer, Population Health Research Institute, Hamilton Health Sciences Research Institute, Thistledown Foundation. TRANSLATIONS For the Portuguese, Russian and Spanish translations of the abstract see Supplementary Materials section.
Collapse
Affiliation(s)
- John W Eikelboom
- Population Health Research Institute, McMaster University and Hamilton Health Sciences Hamilton, Canada,Department of Medicine, McMaster University, Hamilton, ON, Canada,Correspondence to: Prof John W Eikelboom, Population Health Research Institute, Hamilton, ON L8L 2X2, Canada
| | - Sanjit S Jolly
- Population Health Research Institute, McMaster University and Hamilton Health Sciences Hamilton, Canada,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Emilie P Belley-Cote
- Population Health Research Institute, McMaster University and Hamilton Health Sciences Hamilton, Canada,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Richard P Whitlock
- Population Health Research Institute, McMaster University and Hamilton Health Sciences Hamilton, Canada,Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences Hamilton, Canada
| | - Lizhen Xu
- Population Health Research Institute, McMaster University and Hamilton Health Sciences Hamilton, Canada
| | - Laura Heenan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences Hamilton, Canada
| | - Shrikant I Bangdiwala
- Population Health Research Institute, McMaster University and Hamilton Health Sciences Hamilton, Canada
| | - Maria Luz Diaz
- Estudios Clínicos Latino América, Instituto Cardiovascular de Rosario, Rosario, Argentina
| | - Rafael Diaz
- Estudios Clínicos Latino América, Instituto Cardiovascular de Rosario, Rosario, Argentina
| | - Afzalhussein Yusufali
- Hatta Hospital, Dubai Medical College, Dubai Health Authority, Dubai, United Arab Emirates
| | | | - Wadea M Tarhuni
- Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada,Department of Medicine, Western University, Clinical Skills Building London, ON, Canada,Windsor Cardiac Centre, Windsor, ON, Canada
| | - Mohamed Hassany
- National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Alvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - William Harper
- Population Health Research Institute, McMaster University and Hamilton Health Sciences Hamilton, Canada
| | - Sean Wasserman
- Wellcome Centre for Infectious Diseases Research in Africa, Institute for Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa,Division of Infectious Diseases and HIV Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Aysha Almas
- Section of Internal Medicine, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Oxana Drapkina
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia
| | - Camilo Felix
- Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Ecuador
| | - Renato D Lopes
- Division of Cardiology, Duke University Medical Center, Duke Clinical Research Institute, NC, USA
| | | | | | - Sonia S Anand
- Population Health Research Institute, McMaster University and Hamilton Health Sciences Hamilton, Canada,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jackie Bosch
- Population Health Research Institute, McMaster University and Hamilton Health Sciences Hamilton, Canada,School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | | | - Michael E Farkouh
- Peter Munk Cardiac Centre, University of Toronto, Toronto, ON, Canada
| | - Mark Loeb
- Departments of Pathology and Molecular Medicine and Health Evidence Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences Hamilton, Canada,Department of Surgery, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
48
|
Hayashi H, Izumiya Y, Fukuda D, Wakita F, Mizobata Y, Fujii H, Yachi S, Takeyama M, Nishimoto Y, Tsujino I, Nakamura J, Yamamoto N, Nakata H, Ikeda S, Umetsu M, Aikawa S, Satokawa H, Okuno Y, Iwata E, Ogihara Y, Ikeda N, Kondo A, Iwai T, Yamada N, Ogawa T, Kobayashi T, Mo M, Yamashita Y. Real-World Management of Pharmacological Thromboprophylactic Strategies for COVID-19 Patients in Japan: From the CLOT-COVID Study. JACC. ASIA 2022; 2:897-907. [PMID: 36536621 PMCID: PMC9753959 DOI: 10.1016/j.jacasi.2022.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/06/2022] [Accepted: 09/06/2022] [Indexed: 12/23/2022]
Abstract
Background Data on prophylactic anticoagulation are important in understanding the current issues, unmet needs, and optimal management of Japanese COVID-19 patients. Objectives This study aimed to investigate the clinical management strategies for prophylactic anticoagulation of COVID-19 patients in Japan. Methods The CLOT-COVID study was a multicenter observational study that enrolled 2,894 consecutive hospitalized patients with COVID-19. The study population consisted of 2,889 patients (after excluding 5 patients with missing data); it was divided into 2 groups: patients with pharmacological thromboprophylaxis (n = 1,240) and those without (n = 1,649). Furthermore, we evaluated the 1,233 patients who received prophylactic anticoagulation-excluding 7 patients who could not be classified based on the intensity of their anticoagulants-who were then divided into 2 groups: patients receiving prophylactic anticoagulant doses (n = 889) and therapeutic anticoagulant doses (n = 344). Results The most common pharmacological thromboprophylaxis anticoagulant was unfractionated heparin (68.2%). The severity of COVID-19 at admission was a predictor of the implementation of pharmacological thromboprophylaxis in the multivariable analysis (moderate vs mild: OR: 16.6; 95% CI:13.2-21.0; P < 0.001, severe vs mild: OR: 342.6, 95% CI: 107.7-1090.2; P < 0.001). It was also a predictor of the usage of anticoagulants of therapeutic doses in the multivariable analysis (moderate vs mild: OR: 2.10; 95% CI: 1.46-3.02; P < 0.001, severe vs mild: OR: 5.96; 95% CI: 3.91-9.09; P < 0.001). Conclusions In the current real-world Japanese registry, pharmacological thromboprophylaxis, especially anticoagulants at therapeutic doses, was selectively implemented in COVID-19 patients with comorbidities and severe COVID-19 status at admission.
Collapse
Affiliation(s)
- Hiroya Hayashi
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan,Address for correspondence: Dr Hiroya Hayashi, Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka 545-8585, Japan
| | - Yasuhiro Izumiya
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Daiju Fukuda
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Fumiaki Wakita
- Department of Traumatology and Critical Care Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Yasumitsu Mizobata
- Department of Traumatology and Critical Care Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hiromichi Fujii
- Department of Intensive Care Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Sen Yachi
- Japan Community Health Care Organization Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Makoto Takeyama
- Japan Community Health Care Organization Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Yuji Nishimoto
- Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | | | | | | | | | - Satoshi Ikeda
- Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | | | | | | | - Eriko Iwata
- Nankai Medical Center Japan Community Health Care Organization, Saiki, Japan
| | | | | | - Akane Kondo
- Shikoku Medical Center for Children and Adults, Zentsuji, Japan
| | | | | | | | | | - Makoto Mo
- Yokohama Minami Kyosai Hospital, Yokohama, Japan
| | | | | |
Collapse
|
49
|
Sugimoto MA, Perucci LO, Tavares LP, Teixeira MM, Sousa LP. Fibrinolysis in COVID-19: Impact on Clot Lysis and Modulation of Inflammation. Curr Drug Targets 2022; 23:1578-1592. [PMID: 36221881 DOI: 10.2174/1389450123666221011102250] [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: 04/29/2022] [Revised: 08/26/2022] [Accepted: 09/14/2022] [Indexed: 01/25/2023]
Abstract
COVID-19 is a multisystem disease caused by SARS-CoV-2 and is associated with an imbalance between the coagulation and fibrinolytic systems. Overall, hypercoagulation, hypofibrinolysis and fibrin-clot resistance to fibrinolysis predispose patients to thrombotic and thromboembolic events. In the lungs, the virus triggers alveolar and interstitial fibrin deposition, endothelial dysfunction, and pulmonary intravascular coagulation, all events intrinsically associated with the activation of inflammation and organ injury. Adding to the pathogenesis of COVID-19, there is a positive feedback loop by which local fibrin deposition in the lungs can fuel inflammation and consequently dysregulates coagulation, a process known as immunothrombosis. Therefore, fibrinolysis plays a central role in maintaining hemostasis and tissue homeostasis during COVID-19 by cleaning fibrin clots and controlling feed-forward products of coagulation. In addition, components of the fibrinolytic system have important immunomodulatory roles, as evidenced by studies showing the contribution of Plasminogen/Plasmin (Plg/Pla) to the resolution of inflammation. Herein, we review clinical evidence for the dysregulation of the fibrinolytic system and discuss its contribution to thrombosis risk and exacerbated inflammation in severe COVID-19. We also discuss the current concept of an interplay between fibrinolysis and inflammation resolution, mirroring the well-known crosstalk between inflammation and coagulation. Finally, we consider the central role of the Plg/Pla system in resolving thromboinflammation, drawing attention to the overlooked consequences of COVID-19-associated fibrinolytic abnormalities to local and systemic inflammation.
Collapse
Affiliation(s)
- Michelle A Sugimoto
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Division of Medicine, University College London, London, UK.,Signaling in Inflammation Laboratory, Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Luiza O Perucci
- Signaling in Inflammation Laboratory, Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.,Nucleus of Research on Biological Sciences, Institute of Exact and Biological Sciences, Federal University of Ouro Preto, Ouro Preto, Brazil.,Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Luciana P Tavares
- Signaling in Inflammation Laboratory, Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.,Pulmonary and Critical Care Medicine Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Mauro M Teixeira
- Department of Biochemistry and Immunology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Lirlândia P Sousa
- Signaling in Inflammation Laboratory, Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| |
Collapse
|
50
|
Urano T, Yasumoto A, Yokoyama K, Horiuchi H, Morishita E, Suzuki Y. COVID-19 and Thrombosis: Clinical Aspects. Curr Drug Targets 2022; 23:1567-1572. [PMID: 36200150 DOI: 10.2174/1389450123666221005092350] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/30/2022] [Accepted: 09/09/2022] [Indexed: 01/25/2023]
Abstract
In coronavirus disease 2019 (COVID-19), thrombus formation is related to the pathogenesis of acute respiratory distress syndrome (ARDS) and the progression of clinical symptoms. Severe damage to vascular endothelial cells and the associated cytokine storm after SARS-CoV-2 infection cause thrombogenesis and contribute to the development of more severe and unique thromboses compared to other infectious diseases. Thromboses occur more often in critically ill patients. In addition to pulmonary thromboembolism (PE) and deep vein thrombosis, acute myocardial infarction, peripheral arterial thrombosis, and aortic thrombosis have also been reported. In PE, thrombi develop in both pulmonary arteries and alveolar capillaries. These, together with intraalveolar fibrin deposition, interfere with effective gaseous exchange in the lungs and exacerbate the clinical symptoms of ARDS in patients with COVID-19. Pharmacological thromboprophylaxis is recommended for all hospitalized patients to prevent both thrombosis and aggravation of ARDS, and other organ failures. Although the pediatric population is mostly asymptomatic or develops mild disease after SARS-CoV-2 infection, a new inflammatory disorder affecting the cardiovascular system, multisystem inflammatory syndrome in children (MIS-C), has been reported. Similar to Kawasaki disease, acute myocarditis, coronary vasculitis, and aneurysms are typically seen in MISC, although these two are now considered distinct entities. A similar acute myocarditis is also observed in young male adults, in which a hyperinflammatory state after SARS-CoV-2 infection seems to be involved. Several side effects following vaccination against COVID-19 have been reported, including vaccine-induced immune thrombotic thrombocytopenia and acute myocarditis. Although these could be serious and life-threatening, the cases are very rare, thus, the benefits of immunization still outweigh the risks.
Collapse
Affiliation(s)
- Tetsumei Urano
- Department of Medical Physiology, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Atsushi Yasumoto
- Department of Hematology, Faculty of Medicine, Hokkaido University, Sappero, Japan
| | - Kenji Yokoyama
- Department of Hematology/Oncology, Tokai University, Tokyo, Japan
| | - Hisanori Horiuchi
- Department of Molecular and Cellular Biology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Eriko Morishita
- Department of Clinical Laboratory Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Faculty of Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Yuko Suzuki
- Department of Medical Physiology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| |
Collapse
|