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Vinutha M, Sharma UR, Swamy G, Rohini S, Vada S, Janandri S, Haribabu T, Taj N, Gayathri SV, Jyotsna SK, Mudagal MP. COVID-19-related liver injury: Mechanisms, diagnosis, management; its impact on pre-existing conditions, cancer and liver transplant: A comprehensive review. Life Sci 2024; 356:123022. [PMID: 39214285 DOI: 10.1016/j.lfs.2024.123022] [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: 02/19/2024] [Revised: 08/20/2024] [Accepted: 08/25/2024] [Indexed: 09/04/2024]
Abstract
AIMS This review explores the mechanisms, diagnostic approaches, and management strategies for COVID-19-induced liver injury, with a focus on its impact on patients with pre-existing liver conditions, liver cancer, and those undergoing liver transplantation. MATERIALS AND METHODS A comprehensive literature review included studies on clinical manifestations of liver injury due to COVID-19. Key areas examined were direct viral effects, drug-induced liver injury, cytokine storms, and impacts on individuals with chronic liver diseases, liver transplants, and the role of vaccination. Data were collected from clinical trials, observational studies, case reports, and review literature. KEY FINDINGS COVID-19 can cause a spectrum of liver injuries, from mild enzyme elevations to severe hepatic dysfunction. Injury mechanisms include direct viral invasion, immune response alterations, drug toxicity, and hypoxia-reperfusion injury. Patients with chronic liver conditions (such as alcohol-related liver disease, nonalcoholic fatty liver disease, cirrhosis, and hepatocellular carcinoma) face increased risks of severe outcomes. The pandemic has worsened pre-existing liver conditions, disrupted cancer treatments, and complicated liver transplantation. Vaccination remains crucial for reducing severe disease, particularly in chronic liver patients and transplant recipients. Telemedicine has been beneficial in managing patients and reducing cross-infection risks. SIGNIFICANCE This review discusses the importance of improved diagnostic methods and management strategies for liver injury caused by COVID-19. It emphasizes the need for close monitoring and customized treatment for high-risk groups, advocating for future research to explore long-term effects, novel therapies, and evidence-based approaches to improve liver health during and after the pandemic.
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Affiliation(s)
- M Vinutha
- Department of Pharmacology, Acharya & BM Reddy College of Pharmacy, Acharya Dr. Sarvepalli Radhakrishna Road, Achit Nagar (Post), Soldevanahalli, Bengaluru, India
| | - Uday Raj Sharma
- Department of Pharmacology, Acharya & BM Reddy College of Pharmacy, Acharya Dr. Sarvepalli Radhakrishna Road, Achit Nagar (Post), Soldevanahalli, Bengaluru, India.
| | - Gurubasvaraja Swamy
- Department of Pharmaceutical Chemistry, Acharya & BM Reddy College of Pharmacy, Acharya Dr. Sarvepalli Radhakrishna Road, Achit Nagar (Post), Soldevanahalli, Bengaluru, India
| | - S Rohini
- Department of Pharmacology, Acharya & BM Reddy College of Pharmacy, Acharya Dr. Sarvepalli Radhakrishna Road, Achit Nagar (Post), Soldevanahalli, Bengaluru, India
| | - Surendra Vada
- Department of Pharmacology, Acharya & BM Reddy College of Pharmacy, Acharya Dr. Sarvepalli Radhakrishna Road, Achit Nagar (Post), Soldevanahalli, Bengaluru, India
| | - Suresh Janandri
- Department of Pharmacology, Acharya & BM Reddy College of Pharmacy, Acharya Dr. Sarvepalli Radhakrishna Road, Achit Nagar (Post), Soldevanahalli, Bengaluru, India
| | - T Haribabu
- Department of Pharmacology, Acharya & BM Reddy College of Pharmacy, Acharya Dr. Sarvepalli Radhakrishna Road, Achit Nagar (Post), Soldevanahalli, Bengaluru, India
| | - Nageena Taj
- Department of Pharmacology, Acharya & BM Reddy College of Pharmacy, Acharya Dr. Sarvepalli Radhakrishna Road, Achit Nagar (Post), Soldevanahalli, Bengaluru, India
| | - S V Gayathri
- Department of Pharmacology, Acharya & BM Reddy College of Pharmacy, Acharya Dr. Sarvepalli Radhakrishna Road, Achit Nagar (Post), Soldevanahalli, Bengaluru, India
| | - S K Jyotsna
- Department of Pharmacology, Acharya & BM Reddy College of Pharmacy, Acharya Dr. Sarvepalli Radhakrishna Road, Achit Nagar (Post), Soldevanahalli, Bengaluru, India
| | - Manjunatha P Mudagal
- Department of Pharmacology, Acharya & BM Reddy College of Pharmacy, Acharya Dr. Sarvepalli Radhakrishna Road, Achit Nagar (Post), Soldevanahalli, Bengaluru, India
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2
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Agrawal A, Bajaj S, Bhagat U, Chandna S, Arockiam AD, El Dahdah J, Haroun E, Gupta R, Shekhar S, Raj K, Nayar D, Bajaj D, Chaudhury P, Griffin BP, Wang TKM. Incidence, Predictors, and Outcomes of Venous and Arterial Thrombosis in COVID-19: A Nationwide Inpatient Analysis. Heart Lung Circ 2024:S1443-9506(24)00365-2. [PMID: 38942623 DOI: 10.1016/j.hlc.2024.04.167] [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: 10/26/2023] [Revised: 03/30/2024] [Accepted: 04/08/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is known to increase the risk of venous thromboembolism (VTE) and arterial thromboembolism (ATE). However, the incidence, predictors, and outcomes of clinical thrombosis for inpatients with COVID-19 are not well known. This study aimed to enhance our understanding of clinical thrombosis in COVID-19, its associated factors, and mortality outcomes. METHOD Hospitalised adult (≥18 years of age) patients with COVID-19 in 2020 were retrospectively identified from the US National Inpatient Sample database. Clinical characteristics, incident VTE, ATE, and in-hospital mortality outcomes were recorded. Multivariable logistic regression was performed to identify clinical factors associated with thrombosis and in-hospital mortality in COVID-19 inpatients. RESULTS A total of 1,583,135 adult patients with COVID-19 in the year 2020 were identified from the National Inpatient Sample database; patients with thrombosis were 41% females with a mean age of 65.4 (65.1-65.6) years. The incidence of thrombosis was 6.1% (97,185), including VTE at 4.8% (76,125), ATE at 3.0% (47,790), and the in-hospital mortality rate was 13.4% (212,785). Patients with thrombosis were more likely to have respiratory symptoms of COVID-19 (76.7% vs 75%, p<0.001) compared with patients without thrombosis. The main factors associated with overall thrombosis, VTE, and ATE were paralysis, ventilation, solid tumours without metastasis, metastatic cancer, and acute liver failure. Although all thrombosis categories were associated with higher in-hospital mortality for COVID-19 inpatients in univariable analyses (p<0.001), they were not in multivariable analyses-thrombosis (odds ratio [OR] 1.24; 95% confidence interval [CI] 0.90-1.70; p=0.19), VTE (OR 0.70; 95% CI 0.52-1.00; p=0.05), and ATE (OR 1.07; 95% CI 0.92-1.25; p=0.36). CONCLUSIONS The association of COVID-19 with thrombosis and VTE increases with increasing severity of the COVID-19 disease. Risk stratification of thrombosis is crucial in COVID-19 patients to determine the necessity of thromboprophylaxis.
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Affiliation(s)
- Ankit Agrawal
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Suryansh Bajaj
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Umesh Bhagat
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Sanya Chandna
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Aro Daniela Arockiam
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joseph El Dahdah
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Elio Haroun
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rahul Gupta
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, PA, USA
| | - Shashank Shekhar
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kavin Raj
- Division of Cardiology, Department of Medicine, University of California Riverside School of Medicine, Riverside, CA, USA
| | - Divya Nayar
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Divyansh Bajaj
- Department of Pulmonary, Critical Care, and Sleep Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Pulkit Chaudhury
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brian P Griffin
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tom Kai Ming Wang
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
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3
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Gómez-Moyano E, Pavón-Morón J, Rodríguez-Capitán J, Bardán-Rebollar D, Ramos-Carrera T, Villalobos-Sánchez A, Pérez de Pedro I, Ruiz-García FJ, Mora-Robles J, López-Sampalo A, Pérez-Velasco MA, Bernal-López MR, Gómez-Huelgas R, Jiménez-Navarro M, Romero-Cuevas M, Costa F, Trenas A, Pérez-Belmonte LM. The Role of Heparin in Postural Orthostatic Tachycardia Syndrome and Other Post-Acute Sequelae of COVID-19. J Clin Med 2024; 13:2405. [PMID: 38673677 PMCID: PMC11050777 DOI: 10.3390/jcm13082405] [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: 02/20/2024] [Revised: 04/11/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
The therapeutic management and short-term consequences of the coronavirus disease 2019 (COVID-19) are well known. However, COVID-19 post-acute sequelae are less known and represent a public health problem worldwide. Patients with COVID-19 who present post-acute sequelae may display immune dysregulation, a procoagulant state, and persistent microvascular endotheliopathy that could trigger microvascular thrombosis. These elements have also been implicated in the physiopathology of postural orthostatic tachycardia syndrome, a frequent sequela in post-COVID-19 patients. These mechanisms, directly associated with post-acute sequelae, might determine the thrombotic consequences of COVID-19 and the need for early anticoagulation therapy. In this context, heparin has several potential benefits, including immunomodulatory, anticoagulant, antiviral, pro-endothelial, and vascular effects, that could be helpful in the treatment of COVID-19 post-acute sequelae. In this article, we review the evidence surrounding the post-acute sequelae of COVID-19 and the potential benefits of the use of heparin, with a special focus on the treatment of postural orthostatic tachycardia syndrome.
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Affiliation(s)
- Elisabeth Gómez-Moyano
- Servicio de Dermatología, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain;
| | - Javier Pavón-Morón
- Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain; (J.P.-M.); (M.J.-N.); (M.R.-C.)
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), IBIMA-Plataforma BIONAND, Universidad de Málaga (UMA), 29010 Málaga, Spain;
| | - Jorge Rodríguez-Capitán
- Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain; (J.P.-M.); (M.J.-N.); (M.R.-C.)
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), IBIMA-Plataforma BIONAND, Universidad de Málaga (UMA), 29010 Málaga, Spain;
| | | | | | - Aurora Villalobos-Sánchez
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain (I.P.d.P.); (A.L.-S.); (M.-R.B.-L.); (R.G.-H.)
| | - Iván Pérez de Pedro
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain (I.P.d.P.); (A.L.-S.); (M.-R.B.-L.); (R.G.-H.)
| | | | - Javier Mora-Robles
- Servicio de Cardiología, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
| | - Almudena López-Sampalo
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain (I.P.d.P.); (A.L.-S.); (M.-R.B.-L.); (R.G.-H.)
| | - Miguel A. Pérez-Velasco
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain (I.P.d.P.); (A.L.-S.); (M.-R.B.-L.); (R.G.-H.)
| | - Maria-Rosa Bernal-López
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain (I.P.d.P.); (A.L.-S.); (M.-R.B.-L.); (R.G.-H.)
- Centro de Investigación en Red Fisiopatología de la Obesidad y la Nutrtición (CIBERObn), IBIMA-Plataforma BIONAND, Universidad de Málaga (UMA), 29010 Málaga, Spain
| | - Ricardo Gómez-Huelgas
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain (I.P.d.P.); (A.L.-S.); (M.-R.B.-L.); (R.G.-H.)
- Centro de Investigación en Red Fisiopatología de la Obesidad y la Nutrtición (CIBERObn), IBIMA-Plataforma BIONAND, Universidad de Málaga (UMA), 29010 Málaga, Spain
| | - Manuel Jiménez-Navarro
- Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain; (J.P.-M.); (M.J.-N.); (M.R.-C.)
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), IBIMA-Plataforma BIONAND, Universidad de Málaga (UMA), 29010 Málaga, Spain;
| | - Miguel Romero-Cuevas
- Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain; (J.P.-M.); (M.J.-N.); (M.R.-C.)
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), IBIMA-Plataforma BIONAND, Universidad de Málaga (UMA), 29010 Málaga, Spain;
| | - Francesco Costa
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, A.O.U. Policlinic ‘G. Martino’, Via C. Valeria 1, 98165 Messina, Italy;
| | - Alicia Trenas
- Servicio de Medicina Interna, Área Sanitaria Norte de Málaga, Hospital de Antequera, 29200 Antequera, Spain;
| | - Luis M. Pérez-Belmonte
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), IBIMA-Plataforma BIONAND, Universidad de Málaga (UMA), 29010 Málaga, Spain;
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain (I.P.d.P.); (A.L.-S.); (M.-R.B.-L.); (R.G.-H.)
- Servicio de Medicina Interna, Hospital Helicópteros Sanitarios, 29660 Marbella, Spain
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4
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Nguyen TH, Chen LY, Khan NZ, Lindenbauer A, Bui VC, Zipfel PF, Heinrich D. The Binding of the SARS-CoV-2 Spike Protein to Platelet Factor 4: A Proposed Mechanism for the Generation of Pathogenic Antibodies. Biomolecules 2024; 14:245. [PMID: 38540666 PMCID: PMC10967930 DOI: 10.3390/biom14030245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/25/2024] [Accepted: 01/31/2024] [Indexed: 04/02/2024] Open
Abstract
Pathogenic platelet factor 4 (PF4) antibodies contributed to the abnormal coagulation profiles in COVID-19 and vaccinated patients. However, the mechanism of what triggers the body to produce these antibodies has not yet been clarified. Similar patterns and many comparable features between the COVID-19 virus and heparin-induced thrombocytopenia (HIT) have been reported. Previously, we identified a new mechanism of autoimmunity in HIT in which PF4-antibodies self-clustered PF4 and exposed binding epitopes for other pathogenic PF4/eparin antibodies. Here, we first proved that the SARS-CoV-2 spike protein (SP) also binds to PF4. The binding was evidenced by the increase in mass and optical intensity as observed through quartz crystal microbalance and immunosorbent assay, while the switching of the surface zeta potential caused by protein interactions and binding affinity of PF4-SP were evaluated by dynamic light scattering and isothermal spectral shift analysis. Based on our results, we proposed a mechanism for the generation of PF4 antibodies in COVID-19 patients. We further validated the changes in zeta potential and interaction affinity between PF4 and SP and found that their binding mechanism differs from ACE2-SP binding. Importantly, the PF4/SP complexes facilitate the binding of anti-PF4/Heparin antibodies. Our findings offer a fresh perspective on PF4 engagement with the SARS-CoV-2 SP, illuminating the role of PF4/SP complexes in severe thrombotic events.
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Affiliation(s)
- Thi-Huong Nguyen
- Institute for Bioprocessing and Analytical Measurement Techniques (iba), 37308 Heilbad Heiligenstadt, Germany
- Faculty of Mathematics and Natural Sciences, Technische Universität Ilmenau, 98694 Ilmenau, Germany
| | - Li-Yu Chen
- Institute for Bioprocessing and Analytical Measurement Techniques (iba), 37308 Heilbad Heiligenstadt, Germany
- Institute of Miccrobiology, Friedrich-Schiller-University, 07745 Jena, Germany
| | - Nida Zaman Khan
- Institute for Bioprocessing and Analytical Measurement Techniques (iba), 37308 Heilbad Heiligenstadt, Germany
- Faculty of Mathematics and Natural Sciences, Technische Universität Ilmenau, 98694 Ilmenau, Germany
| | - Annerose Lindenbauer
- Institute for Bioprocessing and Analytical Measurement Techniques (iba), 37308 Heilbad Heiligenstadt, Germany
| | - Van-Chien Bui
- Department of Water Supply and Wastewater Treatment, Eichsfeldwerke GmbH, 37308 Heilbad Heiligenstadt, Germany
| | - Peter F. Zipfel
- Institute of Miccrobiology, Friedrich-Schiller-University, 07745 Jena, Germany
| | - Doris Heinrich
- Institute for Bioprocessing and Analytical Measurement Techniques (iba), 37308 Heilbad Heiligenstadt, Germany
- Faculty of Mathematics and Natural Sciences, Technische Universität Ilmenau, 98694 Ilmenau, Germany
- Fraunhofer Institut für Silicatforschung, Neunerplatz, 97082 Würzburg, Germany
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5
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Kovács A, Hantosi D, Szabó N, Letoha A, Lengyel C, Földesi I, Burián K, Palkó A, Veréb D, Kincses ZT. D-dimer levels to exclude pulmonary embolism and reduce the need for CT angiography in COVID-19 in an outpatient population. PLoS One 2024; 19:e0297023. [PMID: 38232069 DOI: 10.1371/journal.pone.0297023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 12/26/2023] [Indexed: 01/19/2024] Open
Abstract
OBJECTIVES Emerging results indicate that, in COVID-19, thromboembolic complications contribute to the high mortality and morbidity. Previous research showed that the prevalence of pulmonary embolism (PE) is between 25-50% in COVID-19 patients, however, most of these reports are based on data from patients with severe pneumonia, treated in intensive care units. MATERIALS AND METHODS We conducted a retrospective, single-center, observational study to estimate the prevalence of PE in COVID-19 patients who underwent CT angiography and to identify the most important predictors. Adult outpatients with COVID-19, who presented at our COVID Outpatient Clinic between 1st and 31st of March in 2021 and underwent CTA examination were included in this study. Multiple linear regression analysis was used to identify predictors of PE in COVID-19 patients. The predictors were: age, gender, disease duration, CT severity index and log-transformed quantitative D-dimer (logQDDIM) value. RESULTS 843 COVID-19 patients were included into the study. 82.56% (693 patients) of the infected patients had a pulmonary CTA examination and D-dimer levels (mean age: 59.82 years ± 15.66). 7.61% (53 patients) of the patients had PE. 2.02% (14 patients) of the patients had main branch or lobar PE. The multiple regression analysis found that only logQDDIM was a significant predictor. A logQDDIM cut-off value of 0.0169 (1.0171 ug/ml serum D-dimer) predicted PE with 99% sensitivity (p<0.0001, degree-of-freedom = 570, AUC = 0.72). CONCLUSIONS We demonstrated in a large cohort of COVID-19 patients that a cut-off value of QDDIM of 1ug/ml can exclude pulmonary embolism in an outpatient setting, implicating that QDDIM might potentially supersede CTA as a screening approach in COVID-19 outpatient clinics.
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Affiliation(s)
- Anita Kovács
- Department of Radiology, Albert Szent-Györgyi Medical Center, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Dóra Hantosi
- Department of Radiology, Albert Szent-Györgyi Medical Center, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Nikoletta Szabó
- Department of Neurology, Albert Szent-Györgyi Medical Center, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Annamária Letoha
- Department of Internal Medicine, Albert Szent-Györgyi Medical Center, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Csaba Lengyel
- Department of Internal Medicine, Albert Szent-Györgyi Medical Center, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Imre Földesi
- Department of Laboratory Medicine, Albert Szent-Györgyi Medical Center, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Katalin Burián
- Department of Medical Microbiology, Albert Szent-Györgyi Medical Center, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - András Palkó
- Department of Radiology, Albert Szent-Györgyi Medical Center, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Dániel Veréb
- Department of Radiology, Albert Szent-Györgyi Medical Center, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Zsigmond Tamás Kincses
- Department of Radiology, Albert Szent-Györgyi Medical Center, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
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Lazzareschi DV, Luo Y, Fong N, Boscardin J, Legrand M, Chen CL. Postoperative thrombotic events following major surgery in patients with a history of COVID-19: a retrospective cohort analysis of commercially insured beneficiaries in the USA. Can J Anaesth 2024; 71:55-65. [PMID: 38102451 PMCID: PMC10858061 DOI: 10.1007/s12630-023-02639-4] [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: 10/02/2022] [Revised: 06/08/2023] [Accepted: 07/21/2023] [Indexed: 12/17/2023] Open
Abstract
PURPOSE We sought to evaluate the synergistic risk of postoperative thrombosis in patients with a history of COVID-19 who undergo major surgery. Major surgery and SARS-CoV-2 infection are independently associated with an increased risk of thrombosis, but the magnitude of additional risk beyond surgery conferred by a COVID-19 history on the development of perioperative thrombotic events has not been clearly elucidated in the literature. METHODS We conducted a retrospective cohort study among commercially insured adults in the USA from March 2020 to June 2021 using the Optum Labs Data Warehouse (OLDW), a longitudinal, real-world data asset containing deidentified administrative claims and electronic health records. We compared patients with prior COVID-19 who underwent surgery with control individuals who underwent surgery without a COVID-19 history and with control individuals who did not undergo surgery with and without a COVID-19 history. We assessed the interaction of surgery and previous COVID-19 on perioperative thrombotic events (venous thromboembolism and major adverse cardiovascular events) within 90 days using multivariable logistic regression and interaction analysis. RESULTS Two million and two-hundred thousand eligible patients were identified from the OLDW. Patients in the surgical cohorts were older and more medically complex than nonsurgical population controls. After adjusting for confounders, only surgical exposure-not COVID-19 history-remained associated with perioperative thrombotic events (adjusted odds ratio [aOR], 4.07; 95% confidence interval [CI], 3.81 to 4.36). The multiplicative interaction term (aOR, 1.25; 95% CI, 0.96 to 1.61) and the synergy index (0.76; 95% CI, 0.56 to 1.04) suggest minimal effect modification of prior COVID-19 on surgery with regards to overall thrombotic risk. CONCLUSIONS We found no evidence of synergistic thrombotic risk from previous COVID-19 in patients who underwent selected major surgery relative to the baseline thrombotic risk from surgery alone.
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Affiliation(s)
- Daniel V Lazzareschi
- San Mateo Division, Anesthesia Care Associates Medical Group (ACAMG), San Mateo, CA, 94010, USA.
- Department of Anesthesia and Perioperative Care, Division of Critical Care Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Yanting Luo
- Department of Anesthesia and Perioperative Care, Division of Critical Care Medicine, University of California, San Francisco, San Francisco, CA, USA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Nicholas Fong
- Department of Anesthesia and Perioperative Care, Division of Critical Care Medicine, University of California, San Francisco, San Francisco, CA, USA
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - John Boscardin
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Matthieu Legrand
- Department of Anesthesia and Perioperative Care, Division of Critical Care Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Catherine L Chen
- Department of Anesthesia and Perioperative Care, Division of Critical Care Medicine, University of California, San Francisco, San Francisco, CA, USA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA
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7
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Matharu SS, Nordmann CS, Ottman KR, Akkem R, Palumbo D, Cruz DRD, Campbell K, Sievert G, Sturgill J, Porterfield JZ, Joshi S, Alfar HR, Peng C, Pokrovskaya ID, Kamykowski JA, Wood JP, Garvy B, Aronova MA, Whiteheart SW, Leapman RD, Storrie B. Deep learning, 3D ultrastructural analysis reveals quantitative differences in platelet and organelle packing in COVID-19/SARSCoV2 patient-derived platelets. Platelets 2023; 34:2264978. [PMID: 37933490 PMCID: PMC10809228 DOI: 10.1080/09537104.2023.2264978] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/20/2023] [Indexed: 11/08/2023]
Abstract
Platelets contribute to COVID-19 clinical manifestations, of which microclotting in the pulmonary vasculature has been a prominent symptom. To investigate the potential diagnostic contributions of overall platelet morphology and their α-granules and mitochondria to the understanding of platelet hyperactivation and micro-clotting, we undertook a 3D ultrastructural approach. Because differences might be small, we used the high-contrast, high-resolution technique of focused ion beam scanning EM (FIB-SEM) and employed deep learning computational methods to evaluate nearly 600 individual platelets and 30 000 included organelles within three healthy controls and three severely ill COVID-19 patients. Statistical analysis reveals that the α-granule/mitochondrion-to-plateletvolume ratio is significantly greater in COVID-19 patient platelets indicating a denser packing of organelles, and a more compact platelet. The COVID-19 patient platelets were significantly smaller -by 35% in volume - with most of the difference in organelle packing density being due to decreased platelet size. There was little to no 3D ultrastructural evidence for differential activation of the platelets from COVID-19 patients. Though limited by sample size, our studies suggest that factors outside of the platelets themselves are likely responsible for COVID-19 complications. Our studies show how deep learning 3D methodology can become the gold standard for 3D ultrastructural studies of platelets.
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Affiliation(s)
- Sagar S Matharu
- Laboratory of Cellular Imaging and Macromolecular Biophysics, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, USA
| | - Cassidy S Nordmann
- Laboratory of Cellular Imaging and Macromolecular Biophysics, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, USA
| | - Kurtis R Ottman
- Laboratory of Cellular Imaging and Macromolecular Biophysics, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, USA
| | - Rahul Akkem
- Laboratory of Cellular Imaging and Macromolecular Biophysics, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, USA
| | - Douglas Palumbo
- Laboratory of Cellular Imaging and Macromolecular Biophysics, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, USA
| | - Denzel R D Cruz
- Laboratory of Cellular Imaging and Macromolecular Biophysics, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, USA
| | - Kenneth Campbell
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Gail Sievert
- Center for Clinical Translational Science, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Jamie Sturgill
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | - James Z Porterfield
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Smita Joshi
- Department of Molecular and Cellular Biochemistry, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Hammodah R Alfar
- Department of Molecular and Cellular Biochemistry, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Chi Peng
- Department of Molecular and Cellular Biochemistry, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Irina D Pokrovskaya
- Department of Physiology and Cell Biology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeffrey A Kamykowski
- Department of Physiology and Cell Biology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeremy P Wood
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Beth Garvy
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Maria A Aronova
- Laboratory of Cellular Imaging and Macromolecular Biophysics, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, USA
| | - Sidney W Whiteheart
- Department of Molecular and Cellular Biochemistry, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Richard D Leapman
- Laboratory of Cellular Imaging and Macromolecular Biophysics, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, USA
| | - Brian Storrie
- Department of Physiology and Cell Biology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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8
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Torkzad MR, Bjørkelund OA, Labruto F. Cerebral venous sinus thrombosis cases detected in on-call CT venographies in Sweden, 2019-2022. J Thromb Thrombolysis 2023; 56:548-554. [PMID: 37598388 DOI: 10.1007/s11239-023-02883-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2023] [Indexed: 08/22/2023]
Abstract
No well-established criteria exist for assessing the risk of cerebral venous sinus thrombosis (CVST). Here, we sought to gain an understanding of CVST cases and associated risk factors, based on the rates of emergency CT venographies (CTVs) performed after hours. Furthermore, we aimed to assess possible correlations between CVST rates and COVID-19, including at the start of the COVID-19 vaccination campaign. We collected reports of emergency CTVs performed after hours at 56 Swedish hospitals between 1/1/2019 and 12/31/2022, and divided them into five groups: (I) from 1/1/2019 to 1/31/2020, before the emergence of COVID-19 cases in Sweden; (II) from 2/1/2020 to 12/26/2020, after the emergence of COVID-19 but before vaccination rollout; (III) from 12/27/2020 to 7/28/2021, from the start of the COVID-19 vaccination campaign until 50% of the adult population in Sweden had been vaccinated; (IV) from 7/29/2021 to 2/1/2022, from when 50% of the adult population was vaccinated until restrictions were lifted; and (V) from 2/2/2022 to 12/31/2022, after restriction measures were suspended. For all included patients, we collected information on demographics and clinical history, including pregnancy, recent partum, and use of oral contraceptives or post-menopausal hormone replacement therapy. In total, we collected 430 reports (92% female, 8% male). The CVST positivity rate was 22.2% in men vs. 2.3% in women. None of the pregnant (n = 49) or postpartum (n = 12) women had CVST positivity. The frequency of CTV examinations was lowest in group 2; during this period, the average time between patients being imaged was 7 days. The frequency of CTV examinations was highest in group IV; during this period, a patient underwent this type of scan every 1.5 days, on average. The frequency of CVST-positive scans was lowest in group II; during this period, a positive case was found every 66 days, on average. The frequency of CVST-positive scans was highest in group IV; during this period, a positive case was found every 62 days, on average, and no statistical difference with respect to group II was observed. Pregnancy and recent partum were not significant risk factors for CVST. The elevated CVST positivity rate observed during the height of the COVID-19 pandemic suggested that patients with less likelihood for positive CVST had fewer emergency visits. The positivity rate did not increase with the start of the COVID-19 pandemic or the rollout of COVID-19 vaccination.
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Affiliation(s)
| | | | - Fausto Labruto
- Australian Telemedicine Clinic Pty Ltd, Sydney, Australia
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9
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Bhoelan S, Codreanu C, Tichelaar V, Borjas Howard J, Meijer K. Exploring heterogeneity in reported venous thromboembolism risk in COVID-19 and comparison to other viral pneumonias: a systematic review and meta-regression. Res Pract Thromb Haemost 2023; 7:102146. [PMID: 37663366 PMCID: PMC10470259 DOI: 10.1016/j.rpth.2023.102146] [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: 02/08/2023] [Revised: 06/18/2023] [Accepted: 06/24/2023] [Indexed: 09/05/2023] Open
Abstract
Background Sources of heterogeneity in venous thromboembolism (VTE) risk in COVID-19 are unclear and comparisons to other viruses are lacking. Objectives To describe VTE risk in patients with COVID-19, explore sources of heterogeneity, and make comparisons with other viral pneumonia. Methods PubMed and Embase data were searched on March 14, 2021, for studies on VTE in adults hospitalized with viral pneumonia. VTE risk estimates were pooled in a random effects meta-analysis stratified by virus type. Heterogeneity in COVID-19 was explored in multivariable meta-regression. Results Seventy studies in COVID-19 (intensive care [ICU] [47] vs ward [23]), 4 studies in seasonal influenza (ICU [3] vs ward [1]), 2 ICU studies in H1N1 and 1 ICU study in SARS-CoV-1 were included. For COVID-19 ICU, pooled VTE risk was 19.6% (95% confidence interval [CI], 16.2%-23.5; I2 = 92.8%) for nonscreening studies and 30.0% (95% CI, 17.9%-45.7%; I2 = 81.9%) for screening studies. For COVID-19 ward, pooled VTE risk was 3.4% (95% CI, 2.4%-4.7%; I2 = 91.3%) and 22.5% (95% CI, 10.2%-42.7%; I2 = 91.6%) for nonscreening and screening studies, respectively. Higher sample size was associated with lower VTE risk. Pooled VTE risk in seasonal influenza and H1N1 at ICU were 9.0% (95% CI, 5.6%-14.2%; I2 = 39.7%) and 29.2% (95% CI, 8.7%-64.2%; I2 = 77.9%), respectively. At ward, VTE risk of seasonal influenza was 2.4% (95% CI, 2.1%-2.7%). In SARS-CoV-1, VTE risk was 47.8% (95% CI, 34.0-62.0). Conclusion Pooled risk estimates in COVID-19 should be interpreted cautiously as a high degree of heterogeneity is present, which hinders comparison to other viral pneumonia. The association of VTE risk in COVID-19 to sample size suggests publication bias.
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Affiliation(s)
- Soerajja Bhoelan
- Department of Haematology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Catalina Codreanu
- Department of Haematology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Vladimir Tichelaar
- Department of Haematology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Jaime Borjas Howard
- Department of Haematology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Karina Meijer
- Department of Haematology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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10
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Cerezo Manchado JJ, Iturbe Hernández T, Martínez Pacheco MDC, Gil Ortega I, Campoy D, Canals Pernas T, Martínez Serra L, Flores Aparco KJ, Velásquez Escandón CA, Martínez Francés A, Olivera P. Impact of atrial fibrillation and anticoagulation on the risk of death, thromboembolic disease and bleeding in patients with COVID-19: the ACO-VID Registry. Curr Med Res Opin 2023; 39:811-817. [PMID: 37189306 DOI: 10.1080/03007995.2023.2204009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To describe the clinical profile, risk of complications and impact of anticoagulation in COVID-19 hospitalized patients, according to the presence of atrial fibrillation (AF). METHODS Multicenter, retrospective, and observational study that consecutively included patients >55 years admitted with COVID-19 from March to October 2020. In AF patients, anticoagulation was chosen based on clinicians' judgment. Patients were followed-up for 90 days. RESULTS A total of 646 patients were included, of whom 75.2% had AF. Overall, mean age was 75 ± 9.1 years and 62.4% were male. Patients with AF were older and had more comorbidities. The most common anticoagulants used during hospitalization in patients with AF were edoxaban (47.9%), low molecular weight heparin (27.0%), and dabigatran (11.7%) and among patients without AF, these numbers were 0%, 93.8% and 0%. Overall, during the study period (68 ± 3 days), 15.2% of patients died, 8.2% of patients presented a major bleeding and 0.9% had a stroke/systemic embolism. During hospitalization, patients with AF had a higher risk of major bleeding (11.3% vs 0.7%; p < .01), COVID-19-related deaths (18.0% vs 4.5%; p = .02), and all-cause deaths (20.6% vs 5.6%; p = .02). Age (HR 1.5; 95% CI 1.0-2.3) and elevated transaminases (HR 3.5; 95% CI 2.0-6.1) were independently associated with all-cause mortality. AF was independently associated with major bleeding (HR 2.2; 95% CI 1.1-5.3). CONCLUSIONS Among patients hospitalized with COVID-19, patients with AF were older, had more comorbidities and had a higher risk of major bleeding. Age and elevated transaminases during hospitalization, but not AF nor anticoagulant treatment increased the risk of all-cause death.
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Affiliation(s)
| | | | | | - Ignacio Gil Ortega
- Department of Cardiology, Hospital Clínico Universitario Santa Lucía, Cartagena, Spain
| | - Desirée Campoy
- Thrombosis and Hemostasis Unit, Department of Hematology, Valld'Hebron University Hospital, Barcelona, Spain
| | - Tania Canals Pernas
- Departament of Hematology, Hospital Universitario Sant Joan de Reus, Reus, Spain
| | - Laia Martínez Serra
- Department of Hematology, University Hospital Sant Joan de Reus, Tarragona, Spain
| | | | | | | | - Pável Olivera
- Thrombosis and Hemostasis Unit, Department of Hematology, Valld'Hebron University Hospital, Barcelona, Spain
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11
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Sahrai H, Hemmati-Ghavshough M, Shahrabi M, Jafari-Rouhi AH, Solduzian M. Thromboprophylaxis for Coagulopathy Related to COVID-19 in Pediatrics: A Narrative Review. Paediatr Drugs 2023:10.1007/s40272-023-00566-x. [PMID: 37142896 PMCID: PMC10158690 DOI: 10.1007/s40272-023-00566-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 05/06/2023]
Abstract
In addition to harming the respiratory system, COVID-19 can affect multiple organs. Children may develop a specific complication of COVID-19 called multisystem inflammatory syndrome in children (MIS-C) which could influence the vascular system of children and cause multiple coagulopathies in the body. Information on the use of thromboprophylaxis in this condition was collected via the review of various articles. In general, different factors in immune system responses can trigger the initiation of thrombotic events. Studies have shown that starting anticoagulant prophylaxis, which contributes to decreased thrombotic events, is dependent on the patient's condition and D-dimer levels. However, further studies on pediatric populations are needed to establish the role of anticoagulants in children with this condition.
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Affiliation(s)
- Hadi Sahrai
- Student research committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Marzieh Shahrabi
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Solduzian
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran.
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12
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Ferrandis R, Escontrela B, Ferrando C, Hernández M, Herrera J, Hidalgo F, Librero J, Llau JV, Martínez A, Pajares A, Tapia B, Arruti E, Bassas E, Blasi A, Calvo A. Effectiveness of thromboprophylaxis with low molecular weight heparin in critically ill patients with COVID-19. An observational prospective, multicenter study. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:129-139. [PMID: 36842685 PMCID: PMC9957653 DOI: 10.1016/j.redare.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 01/09/2022] [Indexed: 04/12/2023]
Abstract
INTRODUCTION COVID-19 induces coagulopathy associated with an increase of thromboembolic events. Due to the lack of agreement on recommendations for thromboprophylactic management, the aim of this study was to study the dosages of LMWH used in critically ill COVID-19 patients assessing the effect on their outcome. METHODS We evaluated data of the Reg-COVID19. According to LMWH dose two groups were analyzed: prophylaxis and treatment. Primary outcome was the relationship of LMWH dosage with mortality. Secondary outcomes included the incidence of thrombotic and bleeding events, length of ICU stay, invasive mechanical ventilation, and thrombotic and inflammatory parameters. RESULTS Data of 720 patients were analyzed, 258 in the prophylaxis group and 462 in the treatment group. C Reactive Protein, invasive mechanical ventilation, tocilizumab and corticosteroid treatments were related with the choice of LMWH dose. Hemorrhagic events (66/720, 9.2%) and thrombotic complications (69/720, 9.6%) were similar in both groups (p = .819 and p = .265), as was the time course of the thrombotic events, earlier than hemorrhagic ones (9 [3-18] and 12 [6-19] days respectively). Mortality was lower in prophylaxis group (25.2% versus 35.1%), but once an inverse probability weighting model was applied, we found no effect of LMWH dose. CONCLUSION We found no benefit or harm with the administration of therapeutic or prophylactic LMWH dose in COVID19 critically ill patients. With a similar rate of hemorrhagic or thrombotic events, the LMWH dose had no influence on mortality. More studies are needed to determine the optimal thromboprophylaxis protocol for critically ill patients.
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Affiliation(s)
- R Ferrandis
- Departamento de Anestesiología y Cuidados Críticos, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
| | - B Escontrela
- Departamento de Anestesiología y Cuidados Críticos, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - C Ferrando
- Departamento de Anestesiología y Cuidados Críticos, Hospital Clínic, Institut d'Investigacions Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, España, CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - M Hernández
- Departamento de Anestesiología y Cuidados Críticos, Hospital Universitario de Cruces, Barakaldo, Vizcaya, Spain
| | - J Herrera
- Departamento de Anestesiología y Cuidados Críticos, Hospital Universitario de Cruces, Barakaldo, Vizcaya, Spain
| | - F Hidalgo
- Departamento de Anestesiología y Cuidados Críticos, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - J Librero
- Navarrabiomed, Complejo Hospitalario de Navarra-Universidad Pública de Navarra, IDISNA, Pamplona, Navarra, Spain
| | - J V Llau
- Departamento de Anestesiología y Cuidados Críticos, Hospital Universitario Doctor Peset, Valencia, Spain
| | - A Martínez
- Jefe de Servicio de Anestesiología y Cuidados Críticos, Hospital Universitario Cruces, Barakaldo, Vizcaya, Spain
| | - A Pajares
- Departamento de Anestesiología y Cuidados Críticos, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - B Tapia
- Departamento de Anestesiología y Cuidados Críticos, Hospital Universitario La Paz, Madrid, Spain
| | - E Arruti
- Innovation and Technology Area, Ubikare SL, Getxo, Vizcaya, Spain
| | - E Bassas
- Departamento de Anestesiología y Cuidados Críticos, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - A Blasi
- Departamento de Anestesiología y Cuidados Críticos, Hospital Clínic, Institut d'Investigacions Biomèdica Agust Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain
| | - A Calvo
- Departamento de Anestesiología y Cuidados Críticos, Hospital Clínic, Institut d'Investigacions Biomèdica Agust Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain
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13
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Vos CG, Gravendeel J, Keller BPJA. Three cases of spontaneous major bleeding in patients with a COVID-19 infection. Acta Chir Belg 2023; 123:72-75. [PMID: 33769205 DOI: 10.1080/00015458.2021.1902092] [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: 02/01/2023]
Abstract
In addition to the respiratory compromise typical for COVID-19 many papers reported on the thromboembolic complications in these often critically ill patients. In this report, three cases of patients that developed spontaneous major bleeding following treatment with therapeutic anticoagulation for thromboembolic complications of COVID-19 were described. Two cases were treated with coil-embolization and one patient could be treated conservatively. These cases illustrate the presence of a relevant bleeding risk against the background of the well-known thromboembolic complications associated with COVID-19. The increased risks of thromboembolic complications in COVID-19 warrant adequate prophylactic anticoagulation. The optimal dose to obtain a significant risk reduction without a significant increase in the incidence of major bleeding requires further research.
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Affiliation(s)
- Cornelis G Vos
- Department of Surgery, Martini Hospital, Groningen, The Netherlands
| | - Joost Gravendeel
- Department of Interventional Radiology, Martini Hospital, Groningen, The Netherlands
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14
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Gabara C, Solarat B, Castro P, Fernández S, Badia JR, Toapanta D, Schulman S, Reverter JC, Soriano A, Moisés J, Aibar J. Anticoagulation strategies and risk of bleeding events in critically ill COVID-19 patients. Med Intensiva 2023; 47:1-8. [PMID: 34345092 PMCID: PMC8321771 DOI: 10.1016/j.medin.2021.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/30/2021] [Accepted: 07/13/2021] [Indexed: 01/04/2023]
Abstract
Objective To evaluate the rate of thrombosis, bleeding and mortality comparing anticoagulant doses in critically ill COVID-19 patients. Design Retrospective observational and analytical cohort study. Setting COVID-19 patients admitted to the intensive care unit of a tertiary hospital between March and April 2020. Patients 201 critically ill COVID-19 patients were included. Patients were categorized into three groups according to the highest anticoagulant dose received during hospitalization: prophylactic, intermediate and therapeutic. Interventions The incidence of venous thromboembolism (VTE), bleeding and mortality was compared between groups. We performed two logistic multivariable regressions to test the association between VTE and bleeding and the anticoagulant regimen. Main variables of interest VTE, bleeding and mortality. Results 78 patients received prophylactic, 94 intermediate and 29 therapeutic doses. No differences in VTE and mortality were found, while bleeding events were more frequent in the therapeutic (31%) and intermediate (15%) dose group than in the prophylactic group (5%) (p < 0.001 and p < 0.05 respectively). The anticoagulant dose was the strongest determinant for bleeding (odds ratio 2.4, 95% confidence interval 1.26-4.58, p = 0.008) but had no impact on VTE. Conclusions Intermediate and therapeutic doses appear to have a higher risk of bleeding without a decrease of VTE events and mortality in critically ill COVID-19 patients.
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Affiliation(s)
- C Gabara
- Internal Medicine Department, Hospital Clínic, IDIBAPS - University of Barcelona, Spain
| | - B Solarat
- Pneumology Department, Hospital Clínic, IDIBAPS - University of Barcelona, Spain
| | - P Castro
- Internal Medicine Department, Hospital Clínic, IDIBAPS - University of Barcelona, Spain
- Medical Intensive Care Unit, Hospital Clínic, IDIBAPS - University of Barcelona, Spain
| | - S Fernández
- Internal Medicine Department, Hospital Clínic, IDIBAPS - University of Barcelona, Spain
- Medical Intensive Care Unit, Hospital Clínic, IDIBAPS - University of Barcelona, Spain
| | - J R Badia
- Pneumology Department, Hospital Clínic, IDIBAPS - University of Barcelona, Spain
| | - D Toapanta
- Liver ICU, Hospital Clínic, IDIBAPS - University of Barcelona, Spain
| | - S Schulman
- Department of Medicine, Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - J C Reverter
- Hematology Department, Hospital Clínic, IDIBAPS - University of Barcelona, Spain
| | - A Soriano
- Infectious Disease Department, Hospital Clínic, IDIBAPS - University of Barcelona, Spain
| | - J Moisés
- Pneumology Department, Hospital Clínic, IDIBAPS - University of Barcelona, Spain
| | - J Aibar
- Internal Medicine Department, Hospital Clínic, IDIBAPS - University of Barcelona, Spain
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15
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Laino ME, Ammirabile A, Motta F, De Santis M, Savevski V, Francone M, Chiti A, Mannelli L, Selmi C, Monti L. Advanced Imaging Supports the Mechanistic Role of Autoimmunity and Plaque Rupture in COVID-19 Heart Involvement. Clin Rev Allergy Immunol 2023; 64:75-89. [PMID: 35089505 PMCID: PMC8796606 DOI: 10.1007/s12016-022-08925-1] [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] [Accepted: 01/11/2022] [Indexed: 01/26/2023]
Abstract
The cardiovascular system is frequently affected by coronavirus disease-19 (COVID-19), particularly in hospitalized cases, and these manifestations are associated with a worse prognosis. Most commonly, heart involvement is represented by myocarditis, myocardial infarction, and pulmonary embolism, while arrhythmias, heart valve damage, and pericarditis are less frequent. While the clinical suspicion is necessary for a prompt disease recognition, imaging allows the early detection of cardiovascular complications in patients with COVID-19. The combination of cardiothoracic approaches has been proposed for advanced imaging techniques, i.e., CT scan and MRI, for a simultaneous evaluation of cardiovascular structures, pulmonary arteries, and lung parenchyma. Several mechanisms have been proposed to explain the cardiovascular injury, and among these, it is established that the host immune system is responsible for the aberrant response characterizing severe COVID-19 and inducing organ-specific injury. We illustrate novel evidence to support the hypothesis that molecular mimicry may be the immunological mechanism for myocarditis in COVID-19. The present article provides a comprehensive review of the available evidence of the immune mechanisms of the COVID-19 cardiovascular injury and the imaging tools to be used in the diagnostic workup. As some of these techniques cannot be implemented for general screening of all cases, we critically discuss the need to maximize the sustainability and the specificity of the proposed tests while illustrating the findings of some paradigmatic cases.
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Affiliation(s)
- Maria Elena Laino
- grid.417728.f0000 0004 1756 8807Artificial Intelligence Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Angela Ammirabile
- grid.417728.f0000 0004 1756 8807Department of Radiology and Nuclear Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Francesca Motta
- grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy ,grid.417728.f0000 0004 1756 8807Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy
| | - Maria De Santis
- grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy ,grid.417728.f0000 0004 1756 8807Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy
| | - Victor Savevski
- grid.417728.f0000 0004 1756 8807Artificial Intelligence Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marco Francone
- grid.417728.f0000 0004 1756 8807Department of Radiology and Nuclear Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Arturo Chiti
- grid.417728.f0000 0004 1756 8807Department of Radiology and Nuclear Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Carlo Selmi
- grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy ,grid.417728.f0000 0004 1756 8807Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy
| | - Lorenzo Monti
- grid.417728.f0000 0004 1756 8807Department of Radiology and Nuclear Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Makani S, Laarje A, Mabrouk M, Zaid Y, Chahid M, Hifdi Z, Azhari M, Elkettani C, Belmir H, Tijani Y. Right atrial thrombus, junctional tachycardia, and critical lower limb ischemia: three rare complications of severe acute respiratory syndrome coronavirus 2 infection. EXPLORATION OF MEDICINE 2022. [DOI: 10.37349/emed.2022.00115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can engender multi-system inflammatory syndrome. Its main symptoms are cardiovascular and thromboembolic problems that can develop into severe complications. The present case is about a 55-year-old patient who was admitted for critical ischemia of the right lower limb and necrosis of the right forefoot. The patient was infected with coronavirus disease 2019 (COVID-19) one month before her admission. The patient also has cardiovascular risks including type 2 diabetes and hypertension. The performance of ultrasounds revealed a thrombus in the right atrium and the pulmonary artery, and arteriography detected an occlusion of the right popliteal joint for which she had an endovascular recanalization and amputation of the right forefoot. This case highlights that SARS-CoV-2 infection could be considered a serious cardiovascular disease requiring cardiovascular explorations to initiate hospital management and avoid severe complications.
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Affiliation(s)
- Said Makani
- Medicine Department, Cheikh Khalifa International University Hospital, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Casablanca 20000, Morocco
| | - Aziza Laarje
- Medicine Department, Cheikh Khalifa International University Hospital, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Casablanca 20000, Morocco
| | - Meryem Mabrouk
- Biology Department, Faculty of Sciences, Mohammed V University, Rabat 10000, Morocco¬¬
| | - Younes Zaid
- Biology Department, Faculty of Sciences, Mohammed V University, Rabat 10000, Morocco¬¬
| | - Malak Chahid
- Medicine Department, Cheikh Khalifa International University Hospital, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Casablanca 20000, Morocco
| | - Zaynab Hifdi
- Medicine Department, Cheikh Khalifa International University Hospital, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Casablanca 20000, Morocco
| | - Meriem Azhari
- Medicine Department, Cheikh Khalifa International University Hospital, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Casablanca 20000, Morocco
| | - Chafik Elkettani
- Medicine Department, Cheikh Khalifa International University Hospital, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Casablanca 20000, Morocco
| | - Hicham Belmir
- Medicine Department, Cheikh Khalifa International University Hospital, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Casablanca 20000, Morocco
| | - Youssef Tijani
- Medicine Department, Cheikh Khalifa International University Hospital, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Casablanca 20000, Morocco
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Mariniello DF, Allocca V, D’Agnano V, Villaro R, Lanata L, Bagnasco M, Aronne L, Bianco A, Perrotta F. Strategies Tackling Viral Replication and Inflammatory Pathways as Early Pharmacological Treatment for SARS-CoV-2 Infection: Any Potential Role for Ketoprofen Lysine Salt? MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27248919. [PMID: 36558048 PMCID: PMC9782495 DOI: 10.3390/molecules27248919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
COVID-19 is an infective disease resulting in widespread respiratory and non-respiratory symptoms prompted by SARS-CoV-2 infection. Interaction between SARS-CoV-2 and host cell receptors prompts activation of pro-inflammatory pathways which are involved in epithelial and endothelial damage mechanisms even after viral clearance. Since inflammation has been recognized as a critical step in COVID-19, anti-inflammatory therapies, including both steroids and non-steroids as well as cytokine inhibitors, have been proposed. Early treatment of COVID-19 has the potential to affect the clinical course of the disease regardless of underlying comorbid conditions. Non-steroidal anti-inflammatory drugs (NSAIDs), which are widely used for symptomatic relief of upper airway infections, became the mainstay of early phase treatment of COVID-19. In this review, we discuss the current evidence for using NSAIDs in early phases of SARS-CoV-2 infection with focus on ketoprofen lysine salt based on its pharmacodynamic and pharmacokinetic features.
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Affiliation(s)
- Domenica Francesca Mariniello
- Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, 80131 Naples, Italy
- U.O.C. Clinica Pneumologica “L. Vanvitelli”, A.O. dei Colli, Ospedale Monaldi, 80131 Naples, Italy
| | - Valentino Allocca
- Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, 80131 Naples, Italy
- U.O.C. Clinica Pneumologica “L. Vanvitelli”, A.O. dei Colli, Ospedale Monaldi, 80131 Naples, Italy
| | - Vito D’Agnano
- Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, 80131 Naples, Italy
- U.O.C. Clinica Pneumologica “L. Vanvitelli”, A.O. dei Colli, Ospedale Monaldi, 80131 Naples, Italy
| | - Riccardo Villaro
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
| | - Luigi Lanata
- Medical Deptartment, Dompé Farmaceutici SpA, 20122 Milan, Italy
| | | | - Luigi Aronne
- Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, 80131 Naples, Italy
- U.O.C. Clinica Pneumologica “L. Vanvitelli”, A.O. dei Colli, Ospedale Monaldi, 80131 Naples, Italy
| | - Andrea Bianco
- Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, 80131 Naples, Italy
- U.O.C. Clinica Pneumologica “L. Vanvitelli”, A.O. dei Colli, Ospedale Monaldi, 80131 Naples, Italy
| | - Fabio Perrotta
- Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, 80131 Naples, Italy
- U.O.C. Clinica Pneumologica “L. Vanvitelli”, A.O. dei Colli, Ospedale Monaldi, 80131 Naples, Italy
- Correspondence:
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Bruni A, Longhini F, Macheda S, Biamonte E, Pasqua P, Neri G, Guzzo ML, Garofalo E. Characteristics of unvaccinated and vaccinated critically ill COVID-19 patients in calabria region (Italy): A retrospective study. Front Med (Lausanne) 2022; 9:1042411. [PMID: 36507545 PMCID: PMC9729689 DOI: 10.3389/fmed.2022.1042411] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/10/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction After the rapid surge of a novel coronavirus (SARS-CoV-2) in 2020 anti-SARS-CoV-2 vaccines have been developed to prevent the development of critical forms of COVID-19 leading to Intensive Care Unit (ICU) admission. The possibility of ICU admission after the first-cycle vaccination has been already reported; however, no data have been published regarding vaccinated patients with a "booster" dose. This retrospective study describes the characteristics of critically ill patients after the implementation of the regional "booster" dose vaccination program in a southern region of Italy. Materials and methods We screened all medical records of critically ill COVID-19 patients in the period between January to April 2022. We collected the demographic characteristics, the presence of comorbidities, the vaccination status, the clinical course (arterial blood gases and type of respiratory support) and outcomes (rate of tracheostomy, ICU length of stay and mortality). Results A total of 272 patients were admitted to ICUs during the study period. 161 patients were unvaccinated, whereas 111 were vaccinated with the complete first-cycle or "booster" dose. The type of respiratory support was similar between groups. Vaccinated patients were characterized by a better oxygenation throughout the whole ICU length of stay. Fourteen unvaccinated and 3 vaccinated patients required tracheostomy (p = 0.045). ICU length of stay was 12.2 (± 7.3) days in unvaccinated patients and 10.4 (± 6.7) days in vaccinated patients (p = 0.036). ICU mortalities were 38.5 and 24.3% in unvaccinated and vaccinated patients, respectively (p = 0.014). Conclusion Vaccinated patients have better clinical course and outcomes as compared to the unvaccinated population.
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Affiliation(s)
- Andrea Bruni
- Anaesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy,*Correspondence: Andrea Bruni,
| | - Federico Longhini
- Anaesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy,Federico Longhini,
| | - Sebastiano Macheda
- Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | - Eugenio Biamonte
- Anaesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | - Pino Pasqua
- Anesthesia and Intensive Care Unit, Annunziata Hospital, Cosenza, Italy
| | - Giuseppe Neri
- Anaesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | - Maria Laura Guzzo
- Anesthesia and Intensive Care Unit, Hospital Pugliese Ciaccio, Catanzaro, Italy
| | - Eugenio Garofalo
- Anaesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
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Fu Z, Bai G, Song B, Wang Y, Song H, Ma M, Zhu J, Zhang Z, Kang Q. Risk factors and mortality of pulmonary embolism in COVID-19 patients: Evidence based on fifty observational studies. Medicine (Baltimore) 2022; 101:e29895. [PMID: 36397410 PMCID: PMC9665895 DOI: 10.1097/md.0000000000029895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND At present, many studies have described acute pulmonary embolism (PE) as a frequent and prognostically relevant complication of coronavirus disease 2019 (COVID-19) infection. Thus we performed the present analysis of 50 studies to evaluate the risk factors and mortality of PE in COVID-19 patients. METHOD Databases including PubMed, Embase, Cochrane Library and Web of Science were searched to October, 2021. Odds ratio (OR), mean difference (MD) or standard MD was used to evaluate the outcomes. The primary outcomes were the difference of mortality between PE and non-PE COVID-19 patients as well as relevant risk factors of PE in COVID-19 patients. All statistical analyses were performed using the standard statistical procedures provided in Review Manager 5.2. RESULT A total of 50 studies including 10053 patients were included in this meta-analysis. Our results indicated that COVID-19 patients with PE experienced significantly higher mortality than non-PE patients (21.9% vs. 10.7%), with a pooled OR of 2.21 (95% CI 1.30 - 3.76; P = .003). In addition, COVID-19 patients with PE also experienced more mechanical ventilation (MV) (OR 2.21; 95% CI 1.30 - 3.75; P = .003) and invasive mechanical ventilation (IMV) (OR 3.58; 95% CI 2.47 - 5.20; P < .0001) respectively. Univariate analysis (UVA) results indicated the Sequential Organ Failure Assessment (SOFA) score, time to deep venous thrombosis (DVT), nonintensive care unit (non-ICU) patients and no anticoagulation as risk factors of PE for COVID-19 patients. In addition, multivariate analysis also found that SOFA score, D-dimer, BMI > 30 kg/m2 and history of PE were risk factors of PE for COVID-19 patients. CONCLUSION The present analysis indicated that PE increased the mortality of COVID-19 patients. Mechanical ventilation, especially invasive mechanical ventilation, is correlated with an increased incidence of PE in patients with COVID-19. The incidence of PE for COVID-19 patients may be multifactorial and further researches focused on risk factors were needed in the future.
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Affiliation(s)
- Zhaoliang Fu
- Department of lnterventional, The Second People’s Hospital of Baiyin City, Baiyin, China
| | - Gengshen Bai
- Department of General Surgery, The Second People’s Hospital of Baiyin City, Baiyin, China
| | - Bingsheng Song
- Department of Respiratory Disease, The Second People’s Hospital of Baiyin City, Baiyin, China
| | - Yongbing Wang
- Department of Respiratory Disease, The Second People’s Hospital of Baiyin City, Baiyin, China
| | - Hui Song
- Department of Respiratory Disease, The Second People’s Hospital of Baiyin City, Baiyin, China
| | - Ming Ma
- Department of lnterventional, The Second People’s Hospital of Baiyin City, Baiyin, China
| | - Junqiang Zhu
- Department of Radiology, The Second People’s Hospital of Baiyin City, Baiyin, China
| | - Zejun Zhang
- Department of Radiology, The Second People’s Hospital of Baiyin City, Baiyin, China
| | - Qinghong Kang
- Department of Respiratory Disease, The Second People’s Hospital of Baiyin City, Baiyin, China
- *Correspondence: Qinghong Kang, Department of Respiratory Disease, The Second People’s Hospital of Baiyin City, No. 509, Park Road, Baiyin District, Baiyin City 730900, China (e-mail: )
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20
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Thromboprophylaxis with standard-dose vs. flexible-dose heparin for hospitalized COVID-19 patients: a target trial emulation. J Clin Epidemiol 2022; 151:96-103. [PMID: 35987402 PMCID: PMC9385269 DOI: 10.1016/j.jclinepi.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 07/19/2022] [Accepted: 08/10/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To compare mortality of hospitalized COVID-19 patients under two low-molecular weight heparin (LMWH) thromboprophylaxis strategies: standard dose and variable dose (standard dose increased to intermediate dose in the presence of laboratory abnormalities indicating an increased thrombosis risk). STUDY DESIGN AND SETTING Target trial emulation using observational data from 2,613 adults admitted with a COVID-19 diagnosis in Madrid, Spain between March 16 and April 15, 2020. RESULTS A total of 1,284 patients were eligible. Among 503 patients without increased baseline thrombotic risk, 28-day mortality risk (95% confidence interval [CI]) was 9.0% (6.6, 11.7) under the standard dose strategy and 5.6% (3.3, 8.3) under the variable dose strategy; risk difference 3.4% (95% CI: -0.24, 6.9); mortality hazard ratio 1.61 (95% CI: 0.97, 2.89). Among 781 patients with increased baseline thrombotic risk, the 28-day mortality risk was 25.8% (22.7, 29.0) under the standard dose strategy and 18.1% (9.3, 28.9) under the intermediate dose strategy; risk difference 7.7% (95% CI: -3.5, 17.2); mortality hazard ratio 1.45 (95% CI: 0.81, 3.17). Major bleeding and LMWH-induced coagulopathy were rare under all strategies. CONCLUSION Escalating anticoagulation intensity after signs of thrombosis risk may increase the survival of hospitalized COVID-19 patients. However, effect estimates were imprecise and additional studies are warranted.
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21
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Anticoagulation strategies and risk of bleeding events in critically ill COVID-19 patients. Med Intensiva 2022. [PMCID: PMC9617640 DOI: 10.1016/j.medine.2021.07.006] [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: 12/01/2022]
Abstract
Objective To evaluate the rate of thrombosis, bleeding and mortality comparing anticoagulant doses in critically ill COVID-19 patients. Design Retrospective observational and analytical cohort study. Setting COVID-19 patients admitted to the intensive care unit of a tertiary hospital between March and April 2020. Patients 201 critically ill COVID-19 patients were included. Patients were categorized into three groups according to the highest anticoagulant dose received during hospitalization: prophylactic, intermediate and therapeutic. Interventions The incidence of venous thromboembolism (VTE), bleeding and mortality was compared between groups. We performed two logistic multivariable regressions to test the association between VTE and bleeding and the anticoagulant regimen. Main variables of interest VTE, bleeding and mortality. Results 78 patients received prophylactic, 94 intermediate and 29 therapeutic doses. No differences in VTE and mortality were found, while bleeding events were more frequent in the therapeutic (31%) and intermediate (15%) dose group than in the prophylactic group (5%) (p < 0.001 and p < 0.05 respectively). The anticoagulant dose was the strongest determinant for bleeding (odds ratio 2.4, 95% confidence interval 1.26–4.58, p = 0.008) but had no impact on VTE. Conclusions Intermediate and therapeutic doses appear to have a higher risk of bleeding without a decrease of VTE events and mortality in critically ill COVID-19 patients.
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22
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Garofalo E, Cammarota G, Neri G, Macheda S, Biamonte E, Pasqua P, Guzzo ML, Longhini F, Bruni A. Bivalirudin vs. Enoxaparin in Intubated COVID-19 Patients: A Pilot Multicenter Randomized Controlled Trial. J Clin Med 2022; 11:jcm11205992. [PMID: 36294312 PMCID: PMC9604898 DOI: 10.3390/jcm11205992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/15/2022] [Accepted: 10/08/2022] [Indexed: 11/23/2022] Open
Abstract
(1) Background: In COVID-19 patients, the occurrence of thromboembolic complications contributes to disease progression and mortality. In patients at increased risk for thrombotic complications, therapeutic enoxaparin should be considered. However, critically ill COVID-19 patients could develop resistance to enoxaparin. Bivalirudin, a thrombin inhibitor, may be an alternative. This pilot multicenter randomized controlled trial aims to ascertain if bivalirudin may reduce the time spent under invasive mechanical ventilation, as compared to enoxaparin. (2) Methods: Intubated COVID-19 patients at risk for thrombo-embolic complications were randomized to receive therapeutic doses of enoxaparin or bivalirudin. We ascertained the time spent under invasive mechanical ventilation during the first 28 days from Intensive Care Unit (ICU) admission. A standardized weaning protocol was implemented in all centers. In addition, we assessed the occurrence of thromboembolic complications, the number of patients requiring percutaneous tracheostomy, the gas exchange, the reintubation rate, the ICU length of stay, the ICU and 28-days mortalities. (3) Results: We enrolled 58 consecutive patients. Bivalirudin did not reduce the time spent under invasive mechanical ventilation as compared to enoxaparin (12 [8; 13] vs. 13 [10; 15] days, respectively; p = 0.078). Thrombotic (p = 0.056) and embolic (p = 0.423) complications, need for tracheostomy (p = 0.423) or reintubation (p = 0.999), the ICU length of stay (p = 0.076) and mortality (p = 0.777) were also similar between treatments. Patients randomized to bivalirudin showed a higher oxygenation at day 7 and 15 after randomization, when compared to enoxaparin group. (4) Conclusions: In intubated COVID-19 patients at increased risk for thromboembolic complications, bivalirudin did not reduce the time spent under invasive mechanical ventilation, nor improved any other clinical outcomes.
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Affiliation(s)
- Eugenio Garofalo
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy
| | - Gianmaria Cammarota
- Department of Anesthesia and Intensive Care Medicine, University of Perugia, 06121 Perugia, Italy
| | - Giuseppe Neri
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy
| | - Sebastiano Macheda
- Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, 89121 Reggio Calabria, Italy
| | - Eugenio Biamonte
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy
| | - Pino Pasqua
- Anesthesia and Intensive Care Unit, Annunziata Hospital, 87100 Cosenza, Italy
| | - Maria Laura Guzzo
- Anesthesia and Intensive Care Unit, “Pugliese Ciaccio” Hospital, 88100 Catanzaro, Italy
| | - Federico Longhini
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy
- Correspondence: ; Tel.: +39-34-7539-5967
| | - Andrea Bruni
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy
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23
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Wifi MN, Morad MA, El Sheemy R, Abdeen N, Afify S, Abdalgaber M, Abdellatef A, Zaghloul M, Alboraie M, El-Kassas M. Hemostatic system and COVID-19 crosstalk: A review of the available evidence. World J Methodol 2022; 12:331-349. [PMID: 36186748 PMCID: PMC9516549 DOI: 10.5662/wjm.v12.i5.331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/17/2022] [Accepted: 07/22/2022] [Indexed: 02/08/2023] Open
Abstract
Since the discovery of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its resultant coronavirus disease 2019 (COVID-19) pandemic, respiratory manifestations have been the mainstay of clinical diagnosis, laboratory evaluations, and radiological investigations. As time passed, other pathological aspects of SARS-CoV-2 have been revealed. Various hemostatic abnormalities have been reported since the rise of the pandemic, which was sometimes superficial, transient, or fatal. Mild thrombocytopenia, thrombocytosis, venous, arterial thromboembolism, and disseminated intravascular coagulation are among the many hemostatic events associated with COVID-19. Venous thromboembolism necessitating therapeutic doses of anticoagulants is more frequently seen in severe cases of COVID-19, especially in patients admitted to intensive care units. Hemorrhagic complications rarely arise in COVID-19 patients either due to a hemostatic imbalance resulting from severe disease or as a complication of over anticoagulation. Although the pathogenesis of coagulation disturbance in SARS-CoV-2 infection is not yet understood, professional societies recommend prophylactic antithrombotic therapy in severe cases, especially in the presence of abnormal coagulation indices. The review article discusses the various available evidence on coagulation disorders, management strategies, outcomes, and prognosis associated with COVID-19 coagulopathy, which raises awareness about the importance of anticoagulation therapy for COVID-19 patients to guard against possible thromboembolic events.
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Affiliation(s)
- Mohamed-Naguib Wifi
- Department of Internal Medicine, Hepatogastro- enterology Unit, Kasr Al-Ainy School of Medicine, Cairo University, Cairo 11451, Egypt
| | - Mohamed Abdelkader Morad
- Clinical Hematology Unit, Department of Internal Medicine, Kasr Al-Ainy, Faculty of Medicine, Cairo University, Cairo 11451, Egypt
| | - Reem El Sheemy
- Department of Tropical Medicine, Minia Faculty of Medicine, Minia University, Minia 61511, Egypt
| | - Nermeen Abdeen
- Department of Tropical Medicine, Faculty of Medicine, Alexandria University, Alexandria 21523, Egypt
| | - Shimaa Afify
- Department of Gastroenterology, National Hepatology and Tropical Medicine, National Hepatology and Tropical Medicine Research Institute, Cairo 11451, Egypt
| | - Mohammad Abdalgaber
- Department of Gastroenterology and Hepatology, Police Authority Hospital, Agoza, Giza 12511, Egypt
| | - Abeer Abdellatef
- Department of Internal Medicine, Hepatogastro- enterology Unit, Kasr Al-Ainy School of Medicine, Cairo University, Cairo 11451, Egypt
| | - Mariam Zaghloul
- Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh 33511, Egypt
| | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo 11884, Egypt
| | - Mohamed El-Kassas
- Department of Endemic Medicine, Faculty of Medicine, Helwan University, Helwan 11731, Egypt
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24
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Petrikov SS, Popugaev KA, Zhuravel’ SV. Intensive Care of Patients with COVID-19. HERALD OF THE RUSSIAN ACADEMY OF SCIENCES 2022; 92:418-424. [PMID: 36091865 PMCID: PMC9447978 DOI: 10.1134/s1019331622040086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/11/2022] [Accepted: 03/17/2022] [Indexed: 06/15/2023]
Abstract
The severe course of COVID-19 requires treatment in emergency and intensive care units. Acute respiratory failure due to the development of pneumonia and acute respiratory distress syndrome is the most common and life-threatening manifestation of the new coronavirus infection. Treatment of patients with severe and extremely severe COVID-19; the use of modern schemes and protocols for drug therapy, mechanical ventilation, and extracorporeal membrane oxygenation; sorption techniques; the use of thermal helium; hemostasis correction; and rehabilitation problems are discussed.
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Affiliation(s)
- S. S. Petrikov
- Sklifosovskii Research Institute for Emergency Medicine, Moscow, Russia
| | - K. A. Popugaev
- Sklifosovskii Research Institute for Emergency Medicine, Moscow, Russia
| | - S. V. Zhuravel’
- Sklifosovskii Research Institute for Emergency Medicine, Moscow, Russia
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25
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Sedaghat F, Vadvala HV, Shan A, McMahon MT, Gawande RS. Incidence of Contrast-Associated Acute Kidney Injury in Renal-Competent COVID-19 Patients Undergoing Computed Chest Angiography. J Comput Assist Tomogr 2022; 46:701-706. [PMID: 35675687 PMCID: PMC9474721 DOI: 10.1097/rct.0000000000001337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/10/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE COVID-19 infection poses a significant risk of both renal injury and pulmonary embolism, producing a clinical challenge, as the criterion standard examination for pulmonary embolism, computed tomography angiography (CTA), requires the use of nephrotoxic iodinated contrast agents.Our investigation evaluated whether symptomatic COVID-19-positive patients without laboratory evidence of renal impairment are at increased risk for developing contrast-associated acute kidney injury (CA-AKI). METHOD All COVID-19-positive patients undergoing noncontrast chest computed tomography and CTA at an apex tertiary medical center between March 1 and December 10, 2020, were retrospectively evaluated. A total of 258 renal-competent (estimated glomerular filtration rate >30) patients with baseline and 48- to 72-hour postexamination creatinine measurements were identified and analyzed for incidence of acute kidney injury (AKI) meeting the criteria for CA-AKI. RESULTS Twenty-five of 191 patients undergoing CTA (13.1%) and 9 of the 67 undergoing noncontrast computed tomography (13.4%) experienced creatinine increases meeting the criteria for CA-AKI. Univariate and multivariate analyses accounting for known AKI risk factors revealed no correlation between iodinated contrast administration and the incidence AKI meeting the criteria for CA-AKI (univariable odds ratio, 0.97 [95% confidence interval, 0.43-2.20]; multivariable odds ratio, 0.97 [95% confidence interval, 0.40-2.36]). CONCLUSIONS Renal-competent COVID-19 patients undergoing chest CTA may not have an increased risk of AKI. Additional studies are needed to confirm this preliminary finding.
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Affiliation(s)
- Farzad Sedaghat
- From the Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD
| | - Harshna V. Vadvala
- From the Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD
| | - Alan Shan
- Cedars-Sinai Medical Center, Los Angeles, CA
| | - Michael T. McMahon
- From the Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD
| | - Rakhee S. Gawande
- From the Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD
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Khan Z, Besis G, Candilio L. COVID-19 Vaccine-Induced Thrombotic Thrombocytopaenia With Venous and Arterial Thrombosis: A Case Report. Cureus 2022; 14:e28535. [PMID: 36185940 PMCID: PMC9518638 DOI: 10.7759/cureus.28535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 11/08/2022] Open
Abstract
Coronavirus disease 19 pandemic has put tremendous pressure on health systems and has caused significant morbidity and mortality throughout the world. Vaccination program against COVID-19 has been effective despite repeated outbreaks across the globe. It was however reported that COVID-19 vaccines in particular, the Oxford-AstraZeneca COVID-19 vaccine (AZD1222) was temporarily suspended by some European countries due to risk of thrombosis. COVID-19 is a prothrombotic condition and is associated with venous thromboembolism mainly. The condition can be challenging to diagnose due to its diagnostic variation. Cases of vaccine-induced thrombotic thrombocytopaenia has been reported in several countries. COVID-19 can also cause vaccine-induced thrombosis without thrombocytopaenia. The thrombotic events can affect different parts of the body including brain, heart, and peripheral vessels. We present a case of 54-year-old patient who presented with chest and abdominal pain for 12 hours and evidence of infero-lateral ST segment elevation on electrocardiogram. Patient received COVID-19 AstraZeneca vaccine 10 days prior to admission. Coronary angiography (CAG) showed occlusion of the proximal to mid part of the right coronary artery (RCA) distal to a large Right Ventricular branch with high thrombotic burden and multiple attempts at aspiration of the thrombus resulted in partial restoration of the flow to right coronary artery.
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Alrashed A, Cahusac P, Mohzari YA, Bamogaddam RF, Alfaifi M, Mathew M, Alrumayyan BF, Alqahtani BF, Alshammari A, AlNekhilan K, Binrokan A, Alamri K, Alshahrani A, Alshahrani S, Alanazi AS, Alhassan BM, Alsaeed A, Almutairi W, Albujaidy A, AlJuaid L, Almalki ZS, Ahmed N, Alajami HN, Aljishi HM, Alsheef M, Alajlan SA, Almutairi F, Alsirhani A, Alotaibi M, Aljaber MA, Bahammam HA, Aldandan H, Almulhim AS, Abraham I, Alamer A. A comparison of three thromboprophylaxis regimens in critically ill COVID-19 patients: An analysis of real-world data. Front Cardiovasc Med 2022; 9:978420. [PMID: 36051287 PMCID: PMC9424612 DOI: 10.3389/fcvm.2022.978420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 07/18/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Thrombotic complications of coronavirus disease 2019 (COVID-19) have received considerable attention. Although numerous conflicting findings have compared escalated thromboprophylaxis doses with a standard dose to prevent thrombosis, there is a paucity of literature comparing clinical outcomes in three different anticoagulation dosing regimens. Thus, we investigated the effectiveness and safety profiles of standard, intermediate, and high-anti-coagulation dosing strategies in COVID-19 critically ill patients. Methodology This retrospective multicenter cohort study of intensive care unit (ICU) patients from the period of April 2020 to August 2021 in four Saudi Arabian centers. Inclusion criteria were age ≥ 18 years, diagnosis with severe or critical COVID-19 infection, and receiving prophylactic anticoagulant dose within 24-48 h of ICU admission. The primary endpoint was a composite of thrombotic events, with mortality rate and minor or major bleeding serving as secondary endpoints. We applied survival analyses with a matching weights procedure to control for confounding variables in the three arms. Results A total of 811 patient records were reviewed, with 551 (standard-dose = 192, intermediate-dose = 180, and high-dose = 179) included in the analysis. After using weights matching, we found that the standard-dose group was not associated with an increase in the composite thrombotic events endpoint when compared to the intermediate-dose group {19.8 vs. 25%; adjusted hazard ratio (aHR) =1.46, [95% confidence of interval (CI), 0.94-2.26]} or when compared to high-dose group [19.8 vs. 24%; aHR = 1.22 (95% CI, 0.88-1.72)]. Also, there were no statistically significant differences in overall in-hospital mortality between the standard-dose and the intermediate-dose group [51 vs. 53.4%; aHR = 1.4 (95% CI, 0.88-2.33)] or standard-dose and high-dose group [51 vs. 61.1%; aHR = 1.3 (95% CI, 0.83-2.20)]. Moreover, the risk of major bleeding was comparable in all three groups [standard vs. intermediate: 4.8 vs. 2.8%; aHR = 0.8 (95% CI, 0.23-2.74); standard vs. high: 4.8 vs. 9%; aHR = 2.1 (95% CI, 0.79-5.80)]. However, intermediate-dose and high-dose were both associated with an increase in minor bleeding incidence with aHR = 2.9 (95% CI, 1.26-6.80) and aHR = 3.9 (95% CI, 1.73-8.76), respectively. Conclusion Among COVID-19 patients admitted to the ICU, the three dosing regimens did not significantly affect the composite of thrombotic events and mortality. Compared with the standard-dose regimen, intermediate and high-dosing thromboprophylaxis were associated with a higher risk of minor but not major bleeding. Thus, these data recommend a standard dose as the preferred regimen.
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Affiliation(s)
- Ahmed Alrashed
- Administration of Pharmaceutical Services, Main Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Peter Cahusac
- Pharmacology and Biostatistics/Comparative Medicine, Alfaisal University College of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Yahya A. Mohzari
- Clinical Pharmacy Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Reem F. Bamogaddam
- Clinical Pharmacy Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Mashael Alfaifi
- Clinical Pharmacy Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Maya Mathew
- Clinical Pharmacy Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Bashayer F. Alrumayyan
- Administration of Pharmaceutical Services, Main Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Basmah F. Alqahtani
- Administration of Pharmaceutical Services, Main Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Amjad Alshammari
- Administration of Pharmaceutical Services, Main Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Kholud AlNekhilan
- Administration of Pharmaceutical Services, Main Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Aljawharah Binrokan
- Administration of Pharmaceutical Services, Main Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Khalil Alamri
- Administration of Pharmaceutical Services, Main Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdullah Alshahrani
- Administration of Pharmaceutical Services, Main Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Safar Alshahrani
- Administration of Pharmaceutical Services, Main Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ahmad S. Alanazi
- Administration of Pharmaceutical Services, Main Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Batool M. Alhassan
- Department of Clinical Pharmacy, Almoosa Specialist Hospital, Al-Ahasa, Saudi Arabia
| | - Ali Alsaeed
- Department of Neurology, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Asma Albujaidy
- Department of Clinical Pharmacy Service, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Lama AlJuaid
- Pharmacy College, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Ziyad S. Almalki
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Nehad Ahmed
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Hamdan N. Alajami
- Clinical Pharmacy Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Hala M. Aljishi
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed Alsheef
- Medicine Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Saleh A. Alajlan
- Department of Pediatric Dentistry, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Faisal Almutairi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Atheer Alsirhani
- Department of Pharmacy Service, Prince Mutib Bin Abdulaziz Hospital, Sakaka, Saudi Arabia
| | - Manayer Alotaibi
- Department of Pharmacy Service, Prince Mutib Bin Abdulaziz Hospital, Sakaka, Saudi Arabia
| | - Melaf A. Aljaber
- Department of Pharmacy Service, Prince Mutib Bin Abdulaziz Hospital, Sakaka, Saudi Arabia
| | - Hammam A. Bahammam
- Department of Pediatric Dentistry, College of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Abdulaziz S. Almulhim
- Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Ivo Abraham
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tuscon, AZ, United States
| | - Ahmad Alamer
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tuscon, AZ, United States
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Therapeutic anticoagulation using heparin in early phase severe coronavirus disease 2019: A retrospective study. Am J Emerg Med 2022; 58:84-88. [PMID: 35640454 PMCID: PMC9135498 DOI: 10.1016/j.ajem.2022.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/14/2022] [Accepted: 05/18/2022] [Indexed: 11/20/2022] Open
Abstract
Background Although several reports recommend the use of systemic anticoagulation therapy in patients with severe coronavirus disease 2019 (COVID-19) pneumonia, appropriate target population and timing of administration are unknown. We assessed association between therapeutic anticoagulation administration with unfractionated heparin and outcomes in patients with severe COVID-19 pneumonia, assuming that anticoagulant administration effects are influenced by therapy timing. Methods This retrospective observational study included severe COVID-19 patients requiring mechanical ventilation in a tertiary emergency critical care hospital intensive care unit (ICU) in Japan from May 1, 2020 to September 30, 2021. All included patients were divided into early and late-phase administration groups based on therapeutic anticoagulant administration timing (≤5 and >5 days, respectively, after commencing oxygen therapy). Primary outcomes (in-hospital mortality and adverse events related to anticoagulation therapy) and secondary outcomes [veno-venous extracorporeal membrane oxygenation (ECMO), ventilator-free days (VFD), and ICU-free days] were compared between groups using univariate and multivariate models. Results Of 198 included patients 104 (52.5%) and 94 (47.5%) were in early-phase and late-phase administration groups, respectively. Although background characteristics were similar between the groups, the early-phase administration group had a significantly lower in-hospital mortality rate (3.8% vs. 27.7%; p < 0.001), lower adverse event rates (1.9% vs. 12.8%; p < 0.001), significantly longer VFD and ICU-free days, and lower ECMO rates, than the late-phase administration group, in the multivariate model. Conclusions Late administration of therapeutic-dose anticoagulation in patients with severe COVID-19 pneumonia was significantly associated with worse outcomes than early administration.
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Nab L, Groenwold RHH, Klok FA, Bhoelan S, Kruip MJHA, Cannegieter SC. Estimating incidence of venous thromboembolism in COVID-19: Methodological considerations. Res Pract Thromb Haemost 2022; 6:e12776. [PMID: 35992195 PMCID: PMC9376932 DOI: 10.1002/rth2.12776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/24/2022] [Accepted: 07/05/2022] [Indexed: 12/15/2022] Open
Abstract
Background Coagulation abnormalities and coagulopathy are recognized as consequences of severe acute respiratory syndrome coronavirus 2 infection and the resulting coronavirus disease 2019 (COVID-19). Specifically, venous thromboembolism (VTE) has been reported as a frequent complication. By May 27, 2021, at least 93 original studies and 25 meta-analyses investigating VTE incidence in patients with COVID-19 had been published, showing large heterogeneity in reported VTE incidence ranging from 0% to 85%. This large variation complicates interpretation of individual study results as well as comparisons across studies, for example, to investigate changes in incidence over time, compare subgroups, and perform meta-analyses. Objectives This study sets out to provide an overview of sources of heterogeneity in VTE incidence studies in patients with COVID-19, illustrated using examples. Methods The original studies of three meta-analyses were screened and a list of sources of heterogeneity that may explain observed heterogeneity across studies was composed. Results The sources of heterogeneity in VTE incidence were classified as clinical sources and methodologic sources. Clinical sources of heterogeneity include differences between studies regarding patient characteristics that affect baseline VTE risk and protocols used for VTE testing. Methodologic sources of heterogeneity include differences in VTE inclusion types, data quality, and the methods used for data analysis. Conclusions To appreciate reported estimates of VTE incidence in patients with COVID-19 in relation to its etiology, prevention, and treatment, researchers should unambiguously report about possible clinical and methodological sources of heterogeneity in those estimates. This article provides suggestions for that.
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Affiliation(s)
- Linda Nab
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Rolf H. H. Groenwold
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
- Department of Biomedical Data SciencesLeiden University Medical CenterLeidenThe Netherlands
| | - Frederikus A. Klok
- Department of Medicine – Thrombosis and HaemostatisLeiden University Medical CenterLeidenThe Netherlands
| | - Soerajja Bhoelan
- Department of HaematologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | | | - Suzanne C. Cannegieter
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
- Department of Medicine – Thrombosis and HaemostatisLeiden University Medical CenterLeidenThe Netherlands
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Vahdat S. A review of pathophysiological mechanism, diagnosis, and treatment of thrombosis risk associated with COVID-19 infection. IJC HEART & VASCULATURE 2022; 41:101068. [PMID: 35677840 PMCID: PMC9163146 DOI: 10.1016/j.ijcha.2022.101068] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/14/2022] [Accepted: 05/31/2022] [Indexed: 01/08/2023]
Abstract
Severe coronavirus (COVID-19) infection has been reportedly associated with a high risk of thromboembolism. Developing macrovascular thrombotic complications, including myocardial injury/infarction, venous thromboembolism, and stroke have been observed in one-third of severe COVID-19 hospitalized patients, leading to an increase in mortality and morbidity. The diagnosis of COVID-19 associated coagulopathy may be challenging because there are close similarities between pulmonary embolism and severe COVID-19 disease. Therefore, a critical step in improving the clinical outcome of patients with hospitalized COVID-19 is the recognition of coagulation abnormalities and the identification of patients with poor prognoses, prophylactic guidance, or antithrombotic therapy. Prescribing anticoagulants in all patients hospitalized with COVID-19 and 2-6 weeks post-hospital discharge in the absence of contraindications is recommended by most consensus documents published on behalf of professional societies. However, a decision on some variable factors such as intensity and duration of anticoagulation may be made based on an individual case and needs future randomized trial studies. Regarding little information on this subject, this study aims to review how inflammation and thrombosis are related to COVID-19 patients, discuss the types of thrombosis in these patients, and summarize the diagnosis and treatment of thrombosis in COVID19 patients.
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31
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Li H, Chen S, Wang S, Yang S, Cao W, Liu S, Song Y, Li X, Li Z, Li R, Liu X, Wang C, Chen Y, Xie F, He Y, Liu M. Elevated D-dimer and Adverse In-hospital Outcomes in COVID-19 Patients and Synergism with Hyperglycemia. Infect Drug Resist 2022; 15:3683-3691. [PMID: 35855759 PMCID: PMC9288185 DOI: 10.2147/idr.s367012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/08/2022] [Indexed: 01/20/2023] Open
Abstract
Aim One of the most common laboratory findings in COVID-19 patients has been observed to be hypercoagulability with elevated D-dimer levels. An activation of thrombosis may be generated by hyperglycemia. We aimed to explore the association between D-dimer and in-hospital outcomes, and evaluate the synergistic effect between elevated D-dimer and hyperglycemia on COVID-19 prognosis. Methods A retrospective cohort study was undertaken with 2467 COVID-19 inpatients. D-dimer and fasting blood glucose (FBG) on admission and adverse in-hospital outcomes (events of death and aggravated severity) were collected. Cox proportional risk model was performed to assess the association of D-dimer and adverse in-hospital outcomes, and the combined effects of D-dimer and FBG. Results Among these COVID-19 patients, 1100 (44.6%) patients had high D-dimer (≥0.50 mg/L). Patients with high D-dimer were older, with higher FBG (≥7.00 mmol/L), and had significantly higher adjusted risk of adverse in-hospital outcomes when comparing with those who with D-dimer<0.50 mg/L (hazard ratio, 2.73; 95% confidence interval, 1.46–5.11). Moreover, patients with high FBG and D-dimer levels had an increasing risk (hazard ratio, 5.72; 95% confidence interval: 2.65–12.34) than those with normal FBG and D-dimer. Conclusion Risk of adverse in-hospital outcomes is higher among patients with high D-dimer levels. Additionally, this study found for the first time that elevated D-dimer and hyperglycemia had a synergistic effect on COVID-19 prognosis, and this risk was independent of diabetes history.
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Affiliation(s)
- Haowei Li
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, State Key Laboratory of Kidney Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Shimin Chen
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, State Key Laboratory of Kidney Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Shengshu Wang
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, State Key Laboratory of Kidney Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Shanshan Yang
- Department of Disease Prevention and Control, The 1st Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Wenzhe Cao
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, State Key Laboratory of Kidney Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Shaohua Liu
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, State Key Laboratory of Kidney Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yang Song
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, State Key Laboratory of Kidney Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xuehang Li
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, State Key Laboratory of Kidney Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Zhiqiang Li
- Chinese PLA Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Rongrong Li
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, State Key Laboratory of Kidney Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xiong Liu
- Chinese PLA Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Changjun Wang
- Chinese PLA Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Yong Chen
- Chinese PLA Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Fei Xie
- College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yao He
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, State Key Laboratory of Kidney Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Miao Liu
- Graduate School of Chinese PLA General Hospital, Beijing, People's Republic of China
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Poli D, Antonucci E, Ageno W, Prandoni P, Barillari G, Bitti G, Imbalzano E, Bucherini E, Chistolini A, Fregoni V, Galliazzo S, Gandolfo A, Grifoni E, Mastroianni F, Panarello S, Pesavento R, Pedrini S, Sala G, Pignatelli P, Preti P, Simonetti F, Sivera P, Visonà A, Villalta S, Marcucci R, Palareti G. Thromboembolic Complications in COVID-19 Patients Hospitalized in Italian Ordinary Wards: Data from the Multicenter Observational START-COVID Register. TH OPEN 2022; 6:e251-e256. [PMID: 36299804 PMCID: PMC9467691 DOI: 10.1055/a-1878-6806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/21/2022] [Indexed: 11/11/2022] Open
Abstract
Background
Coronavirus disease 2019 (COVID-19) infection causes acute respiratory insufficiency with severe interstitial pneumonia and extrapulmonary complications; in particular, it may predispose to thromboembolic disease. The reported incidence of thromboembolic complications varies from 5 to 30% of cases.
Aim
We conducted a multicenter, Italian, retrospective, observational study on COVID-19 patients admitted to ordinary wards, to describe the clinical characteristics of patients at admission and bleeding and thrombotic events occurring during the hospital stay.
Results
The number of hospitalized patients included in the START-COVID-19 Register was 1,135, and the number of hospitalized patients in ordinary wards included in the study was 1,091, with 653 (59.9%) being males and 71 years (interquartile range 59–82 years) being the median age. During the observation, two (0.2%) patients had acute coronary syndrome episodes and one patient (0.1%) had an ischemic stroke; no other arterial thrombotic events were recorded. Fifty-nine patients had symptomatic venous thromboembolism (VTE) (5.4%) events, 18 (30.5%) deep vein thrombosis (DVT), 39 (66.1%) pulmonary embolism (PE), and 2 (3.4%) DVT+PE. Among patients with DVT, eight (44.4%) were isolated distal DVT and two cases were jugular thrombosis. Among patients with PE, seven (17.9%) events were limited to subsegmental arteries. No fatal PE was recorded. Major bleeding events occurred in nine (1.2%) patients and clinically relevant nonmajor bleeding events in nine (1.2%) patients. All bleeding events occurred among patients receiving thromboprophylaxis, more frequently when treated with subtherapeutic or therapeutic dosages.
Conclusion
Our findings confirm that patients admitted to ordinary wards for COVID-19 infection are at high risk for thromboembolic events. VTE recorded among these patients is mainly isolated PE, suggesting a peculiar characteristic of VTE in these patients.
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Affiliation(s)
- Daniela Poli
- SOD Malattie Aterotrombotiche, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | | | - Walter Ageno
- Dipartimento di Medicina e Chirurgia, Università dell'Insubria, Varese, Italy
| | | | | | | | | | | | - Antonio Chistolini
- Dipartimento di Medicina Traslazionale e di Precisione, Sapienza Università di Roma, Roma, Italy
| | - Vittorio Fregoni
- U.O.C. Medicina Generale, ASST Valtellina e Alto Lario Ospedale di Sondalo, Italy
| | - Silvia Galliazzo
- UOC Medicina Generale, Ospedale San Valentino, Montebelluna (TV), Italy
| | - Alberto Gandolfo
- SC (UCO) Clinica Medica, ASUGI, Ospedale di Cattinara, Trieste, Italy
| | - Elisa Grifoni
- Medicina Interna 2, Ospedale San Giuseppe, Empoli (Fi), Italy
| | - Franco Mastroianni
- UOC Medicina Interna, Covid Unit, EE Ospedale F. Miulli, Acquaviva delle Fonti (Ba), Italy
| | | | | | - Simona Pedrini
- UO, laboratorio Analisi, Fondazione Poliambulanza Brescia, Italy
| | - Girolamo Sala
- UOC Medicina II, Ospedale di Circolo Busto Arsizio (Va), Italy
| | - Pasquale Pignatelli
- I Clinica Medica, Medicina Interna Covid e Centro Trombosi Sapienza, Università di Roma, Roma, Italy
| | - Paola Preti
- Unità di Medicina Interna, Malattie Vascolari e Metaboliche Policlinico San Matteo, Pavia, Italy
| | - Federico Simonetti
- UOC Ematologia Aziendale – Ospedale Versilia –Lido di Camaiore (Lucca), Italy
| | - Piera Sivera
- SCDU Ematologia e terapie cellulari, AO Ordine Mauriziano Umberto 1° Torino, Italy
| | - Adriana Visonà
- UOC Angiologia, Ospedale San Giacomo Apostolo, Castelfranco Veneto (Treviso), Italy
| | - Sabina Villalta
- UOC Medicina Generale, Ospedale San Giacomo Apostolo, Castelfranco Veneto (Treviso), Italy
| | - Rossella Marcucci
- SOD Malattie Aterotrombotiche, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
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Jain A, Reddy A, Murugesan R, Dutta S, Kumbhar U, Savlania A, Vaka SK. Outcomes of Patients With Acute Limb Ischemia in Patients With COVID-19: A Systemic Review and Meta-Analysis. Cureus 2022; 14:e27370. [PMID: 36046311 PMCID: PMC9418627 DOI: 10.7759/cureus.27370] [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] [Accepted: 07/27/2022] [Indexed: 11/05/2022] Open
Abstract
A systemic review and meta-analysis of perioperative outcomes of acute limb ischemia (ALI) in patients with and without coronavirus disease-2019 (COVID-19) to determine the outcomes of ALI and compare the outcomes in patients with and without COVID-19 infection. A literature search of the Medline, Science Direct and Cochrane Library was performed from inception to July 15, 2021. Studies involving ALI in patients with COVID-19 were searched through three electronic databases. The endpoints include limb salvage, re-thrombosis, and mortality, and these outcomes were compared between patients with and without COVID-19 infection and type of management. The primary outcome was early limb salvage (till the patient was discharged from the hospital). The other outcomes assessed were re-thrombosis and mortality. These outcomes were compared between patients with and without COVID-19 infection and the type of management. Pooled estimates were presented as odds ratios (ORs) using a random or fixed effect model based on the results of the chi-square test and calculation of I2. Comparing the ALI outcomes in patients with and without COVID-19 infection, there was no significant difference in limb salvage rate (OR=0.26, 95% CI:0.02-3.09), but there was a significantly higher re-thrombosis (OR=2.65, 95% CI:1.34-5.23) and mortality rate (OR=4.71, 95% CI:1.11-19.99) in patients with COVID-19 infection. On comparing outcomes based on management, intervention group, and anticoagulant alone group, no significant difference was noted concerning limb salvage (OR=1.40, 95% CI:0.27-7.13) and mortality rates (OR=0.2, 95% CI:0.04-1.07). This meta-analysis demonstrates a higher re-thrombosis and mortality in ALI patients with COVID-19 infection when compared to patients without COVID-19 but with similar limb salvage.
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Affiliation(s)
- Ankit Jain
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Abhinaya Reddy
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Rajeswari Murugesan
- Biostatistics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Souradeep Dutta
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Uday Kumbhar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Ajay Savlania
- Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Sivaranjit K Vaka
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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Overton PM, Toshner M, Mulligan C, Vora P, Nikkho S, de Backer J, Lavon BR, Klok FA. Pulmonary thromboembolic events in COVID-19-A systematic literature review. Pulm Circ 2022; 12:e12113. [PMID: 35942076 PMCID: PMC9349961 DOI: 10.1002/pul2.12113] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/28/2022] [Accepted: 07/10/2022] [Indexed: 11/15/2022] Open
Abstract
Pulmonary thromboembolic events have been linked to coronavirus disease 2019 (COVID-19), but their incidence and long-term sequelae remain unclear. We performed a systematic literature review to investigate the incidence of pulmonary embolism (PE), microthrombi, thrombosis in situ (thromboinflammatory disease), and chronic thromboembolic pulmonary hypertension (CTEPH) during and after COVID-19. PubMed and the World Health Organization Global Research Database were searched on May 7, 2021. Hospital cohort and database studies reporting data for ≥1000 patients and autopsy studies reporting data for ≥20 patients were included. Results were summarized descriptively. We screened 1438 records and included 41 references (32 hospital/database studies and 9 autopsy studies). The hospital/database studies reported the incidence of PE but not CTEPH, microthrombi, or thromboinflammatory disease. PE incidence varied widely (0%-1.1% of outpatients, 0.9%-8.2% of hospitalized patients, and 1.8%-18.9% of patients in intensive care). One study reported PE events occurring within 45 days after hospital discharge (incidence in discharged patients: 0.2%). Segmental arteries were generally the most common location for PE. In autopsy studies, PE, thromboinflammatory disease, and microthrombi were reported in 6%-23%, 43%-100%, and 45%-84% of deceased patients, respectively. Overall, the included studies mostly focused on PE during the acute phase of COVID-19. The results demonstrate the challenges of identifying and characterizing vascular abnormalities using current protocols (e.g., visual computed tomography reads). Further research is needed to detect subtle pulmonary vascular abnormalities, distinguish thromboinflammatory disease from PE, optimize treatment, and assess the incidence of long-term sequelae after COVID-19.
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Affiliation(s)
| | - Mark Toshner
- Department of Medicine, School of Clinical MedicineUniversity of CambridgeCambridgeUK
| | | | | | | | | | | | - Frederikus A. Klok
- Department of Medicine–Thrombosis and HemostasisLeiden University Medical CenterLeidenthe Netherlands
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Bais B, Sozio E, De Silvestri D, Volpetti S, Zannier ME, Filì C, Bassi F, Alcaro L, Cotrufo M, Pagotto A, Giacinta A, Patruno V, Da Porto A, Sbrojavacca R, Curcio F, Tascini C, Sechi LA, Colussi G. Effect of heparin treatment on pulmonary embolism and in-hospital death in unvaccinated COVID-19 patients without overt deep vein thrombosis. Thromb J 2022; 20:34. [PMID: 35725464 PMCID: PMC9207168 DOI: 10.1186/s12959-022-00393-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 06/09/2022] [Indexed: 11/15/2022] Open
Abstract
Background Pulmonary embolism (PE) without overt deep vein thrombosis (DVT) was common in hospitalized coronavirus-induced disease (COVID)-19 patients and represented a diagnostic, prognostic, and therapeutic challenge. The aim of this study was to analyze the prognostic role of PE on mortality and the preventive effect of heparin on PE and mortality in unvaccinated COVID-19 patients without overt DVT. Methods Data from 401 unvaccinated patients (age 68 ± 13 years, 33% females) consecutively admitted to the intensive care unit or the medical ward were included in a retrospective longitudinal study. PE was documented by computed tomography scan and DVT by compressive venous ultrasound. The effect of PE diagnosis and any heparin use on in-hospital death (primary outcome) was analyzed by a classical survival model. The preventive effect of heparin on either PE diagnosis or in-hospital death (secondary outcome) was analyzed by a multi-state model after having reclassified patients who started heparin after PE diagnosis as not treated. Results Median follow-up time was 8 days (range 1–40 days). PE cumulative incidence and in-hospital mortality were 27% and 20%, respectively. PE was predicted by increased D-dimer levels and COVID-19 severity. Independent predictors of in-hospital death were age (hazards ratio (HR) 1.05, 95% confidence interval (CI) 1.03–1.08, p < 0.001), body mass index (HR 0.93, 95% CI 0.89–0.98, p = 0.004), COVID-19 severity (severe versus mild/moderate HR 3.67, 95% CI 1.30–10.4, p = 0.014, critical versus mild/moderate HR 12.1, 95% CI 4.57–32.2, p < 0.001), active neoplasia (HR 2.58, 95% CI 1.48–4.50, p < 0.001), chronic obstructive pulmonary disease (HR 2.47; 95% CI 1.15–5.27, p = 0.020), respiratory rate (HR 1.06, 95% CI 1.02–1.11, p = 0.008), heart rate (HR 1.03, 95% CI 1.01–1.04, p < 0.001), and any heparin treatment (HR 0.35, 95% CI 0.18–0.67, p = 0.001). In the multi-state model, preventive heparin at prophylactic or intermediate/therapeutic dose, compared with no treatment, reduced PE risk and in-hospital death, but it did not influence mortality of patients with a PE diagnosis. Conclusions PE was common during the first waves pandemic in unvaccinated patients, but it was not a negative prognostic factor for in-hospital death. Heparin treatment at any dose prevented mortality independently of PE diagnosis, D-dimer levels, and disease severity.
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Affiliation(s)
- Bruno Bais
- Thrombosis Prevention Unit, Division of Internal Medicine, Academic Hospital of Udine (ASUFC), 33100, Udine, UD, Italy
| | - Emanuela Sozio
- Infectious Diseases Clinic, Department of Medicine, University of Udine, 33100, Udine, Italy
| | - Daniele De Silvestri
- Thrombosis Prevention Unit, Division of Internal Medicine, Academic Hospital of Udine (ASUFC), 33100, Udine, UD, Italy
| | - Stefano Volpetti
- Hematology and Bone Marrow Transplantation, Department of Medicine, University of Udine, 33100, Udine, Italy
| | - Maria Elena Zannier
- Hematology and Bone Marrow Transplantation, Department of Medicine, University of Udine, 33100, Udine, Italy
| | - Carla Filì
- Hematology and Bone Marrow Transplantation, Department of Medicine, University of Udine, 33100, Udine, Italy
| | - Flavio Bassi
- Department of Anesthesia and Intensive Care Medicine, Academic Hospital of Udine (ASUFC), 33100, Udine, Italy
| | - Lucia Alcaro
- Internal Medicine, Department of Medicine, University of Udine, 33100, Udine, Italy
| | - Marco Cotrufo
- Infectious Diseases Clinic, Department of Medicine, University of Udine, 33100, Udine, Italy
| | - Alberto Pagotto
- Infectious Diseases Clinic, Department of Medicine, University of Udine, 33100, Udine, Italy
| | - Alessandro Giacinta
- Infectious Diseases Clinic, Department of Medicine, University of Udine, 33100, Udine, Italy
| | - Vincenzo Patruno
- Division of Pulmonary Medicine, Academic Hospital of Udine (ASUFC), 33100, Udine, Italy
| | - Andrea Da Porto
- Internal Medicine, Department of Medicine, University of Udine, 33100, Udine, Italy
| | - Rodolfo Sbrojavacca
- Infectious Diseases Clinic, Department of Medicine, University of Udine, 33100, Udine, Italy
| | - Francesco Curcio
- Department of Laboratory Medicine, University of Udine, 33100, Udine, Italy
| | - Carlo Tascini
- Infectious Diseases Clinic, Department of Medicine, University of Udine, 33100, Udine, Italy
| | | | - GianLuca Colussi
- Internal Medicine, Department of Medicine, University of Udine, 33100, Udine, Italy.
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Zaini M, Abu Farha R, Abutayeh R, Alsaud W, Hammoudeh A, Al-Shudifat AE, Al-Kharabsheh T. Assessment of Jordanian physicians’ knowledge about venous thromboembolism risk and management among COVID-19 patients. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2022. [DOI: 10.1093/jphsr/rmac021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objectives
The aim of this study was to assess Jordanian physicians’ awareness about venous thromboembolism (VTE) risk among COVID-19 patients and its treatment protocol.
Methods
This was a cross-sectional-based survey that was conducted in Jordan in 2020. During the study period, a convenience sample of physicians working in various Jordanian hospitals were invited to participate in this study. Physicians’ knowledge was evaluated and physicians gained one point for each correct answer. Then, a knowledge score out of 23 was calculated for each.
Key findings
In this study, 102 physicians were recruited. Results from this study showed that most of the physicians realize that all COVID-19 patients need VTE risk assessment (n = 69, 67.6%). Regarding VTE prophylaxis, the majority of physicians (n = 91, 89.2%) agreed that low molecular weight heparin (LMWH) is the best prophylactic option for mild-moderate COVID-19 patients with high VTE risk. Regarding severe/critically ill COVID-19 patients, 75.5% of physicians (n = 77) recognized that LMWH is the correct prophylactic option in this case, while 80.4% of them (n = 82) knew that mechanical prevention is the preferred prophylactic option for severe/critically ill COVID-19 patients with high bleeding risk. Moreover, 77.5% of physicians (n = 79) knew that LMWH is the treatment of choice for COVID-19 patients diagnosed with VTE. Finally, linear regression analysis showed that consultants had an overall higher knowledge score about VTE prevention and treatment in COVID-19 patients compared with residents (P = 0.009).
Conclusion
All physicians knew about VTE risk factors for COVID-19 patients. However, consultants showed better awareness of VTE prophylaxis and treatment compared with residents. We recommend educational workshops be conducted to enhance physicians’ knowledge and awareness about VTE thromboprophylaxis and management in COVID-19 patients.
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Affiliation(s)
- Mohammad Zaini
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University , Amman , Jordan
| | - Rana Abu Farha
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University , Amman , Jordan
| | - Reem Abutayeh
- Pharmaceutical Chemistry and Pharmacognosy Department, Faculty of Pharmacy, Applied Science Private University , Amman , Jordan
| | - Wesam Alsaud
- Scientific Office Manager, Jordanian Pharmaceutical Company , Amman , Jordan
| | - Ayman Hammoudeh
- Interventional Cardiologist, Istishari Hospital , Amman , Jordan
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Marchioni C, Esposito G, Calci M, Bais B, Colussi G. Effect of intermediate/high versus low dose heparin on the thromboembolic and hemorrhagic risk of unvaccinated COVID-19 patients in the emergency department. BMC Emerg Med 2022; 22:107. [PMID: 35698054 PMCID: PMC9192337 DOI: 10.1186/s12873-022-00668-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background The optimal prophylactic dose of heparin in patients with coronavirus-associated disease 2019 (COVID-19) in the emergency department (ED) is debated. This study aimed to analyze different thromboprophylaxis approaches in unvaccinated COVID-19 patients admitted to ED without initial venous thromboembolism. Methods Retrospectively, the effect of intermediate/high versus low dose heparin treatment was evaluated from December 2020 to July 2021 in a tertiary Academic Hospital in northeast Italy. The primary outcome comprised arterial or venous thromboembolism or all-cause death within 30 days. Secondary outcomes comprised each single primary outcome component or major hemorrhagic event. Cox regression was used to determine predictors of the primary outcome and propensity score weights to balance the effect of heparin treatment on all outcomes. Results Data of 144 consecutive patients (age 70 ± 13, 33% females) were included in the study. High-dose prophylactic heparin was used in 69%, intermediate in 15%, and low in 17% of patients. The primary outcome occurred in 48 patients. Independent predictors of the primary outcome were COVID-19 severity (hazards ratio (HR) 1.96, 95% confidence interval (CI) 1.05–3.65, p = 0.035) and D-dimer levels (HR each log ng/dl 1.38, 95% CI 1.04–1.84, p = 0.026). Intermediate/high dose heparin did not affect the risk of the primary outcome compared with the low dose (weighted HR 1.39, 95% CI 0.75–2.56, p = 0.292). Intermediate/high heparin increased the risk of major hemorrhagic events (weighted HR 5.92, 95% CI 1.09–32, p = 0.039). Conclusions In unvaccinated COVID-19 patients admitted to ED, prophylaxis with heparin at the intermediate/high dose did not reduce primary outcome compared with the low dose but increased the risk of major hemorrhagic events.
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Affiliation(s)
- Claudia Marchioni
- Division of Internal Medicine and Emergency Medicine Residency Program, Department of Medicine, University of Udine, 33100, Udine, Italy
| | - Gaetano Esposito
- Department of Emergency Medicine, ASUFC University Hospital of Udine, 33100, Udine, Italy
| | - Mario Calci
- Department of Emergency Medicine, ASUFC University Hospital of Udine, 33100, Udine, Italy
| | - Bruno Bais
- Thrombosis Prevention Unit, 2nd Division of Internal Medicine, Department of Medicine, ASUFC University Hospital of Udine, 33100, Udine, Italy
| | - GianLuca Colussi
- Division of Internal Medicine and Emergency Medicine Residency Program, Department of Medicine, University of Udine, 33100, Udine, Italy.
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Glise Sandblad K, Rosengren A, Sörbo J, Jern S, Hansson P. Pulmonary embolism and deep vein thrombosis—comorbidities and temporary provoking factors in a register‐based study of 1.48 million people. Res Pract Thromb Haemost 2022; 6:e12714. [PMID: 35677029 PMCID: PMC9166387 DOI: 10.1002/rth2.12714] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/28/2022] [Accepted: 04/10/2022] [Indexed: 12/03/2022] Open
Abstract
Background Knowledge on differences in patients who present with deep vein thrombosis (DVT) and those with pulmonary embolism (PE) is incomplete. Objective To determine comorbidities and temporary provoking factors in patients with a first‐time PE or DVT. Methods This was a nationwide Swedish registry‐based, retrospective, case‐control study including 298 172 patients with first‐time venous thromboembolism (VTE) and 1 185 079 controls matched for age, sex, and county of residence, free of VTE at the time of matching. Results Patients with PE were older than those with DVT (mean age, 69 vs 66 years) and included slightly more women (PE, 53.4% vs DVT, 52.1%). After multivariable adjustment for comorbidities (within 7 years) and temporary provoking factors (within 3 months), heart failure (PE: adjusted odds ratio [aOR], 2.64 [99% confidence interval [CI], 2.55‐2.73]; DVT: aOR, 1.66 [99% CI, 1.60‐1.72]), ischemic heart disease (PE: aOR, 1.51 [99% CI, 1.47‐1.56]; DVT: aOR, 1.01 [99% CI, 0.98‐1.04]), and chronic obstructive pulmonary disease (PE: aOR, 2.51 [99% CI, 2.40‐2.63]; DVT, 1.54 [99% CI, 1.47‐1.62]) were among diseases that showed higher odds ratios in patients with PE than in those with DVT, compared with controls. Comorbidities registered within 6 months were associated with higher aORs than those within 7 years. The highest population attributable risks for PE were for cancer (13.0%) and heart failure (11.7%). Conclusion Cardiopulmonary diseases, particularly with recent onset, imply a higher risk for PE, whereas orthopedic surgery and lower‐extremity fractures carry a higher risk of DVT.
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Affiliation(s)
- Katarina Glise Sandblad
- Department of Medicine, Geriatrics and Emergency Medicine Östra Region Västra Götaland Sahlgrenska University Hospital Gothenburg Sweden
- Department of Molecular and Clinical Medicine Institute of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Annika Rosengren
- Department of Medicine, Geriatrics and Emergency Medicine Östra Region Västra Götaland Sahlgrenska University Hospital Gothenburg Sweden
- Department of Molecular and Clinical Medicine Institute of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Jan Sörbo
- Department of Clinical Physiology Region Västra Götaland Sahlgrenska University Hospital Gothenburg Sweden
| | - Sverker Jern
- The Wallenberg Laboratory for Cardiovascular Research Institute of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Per‐Olof Hansson
- Department of Medicine, Geriatrics and Emergency Medicine Östra Region Västra Götaland Sahlgrenska University Hospital Gothenburg Sweden
- Department of Molecular and Clinical Medicine Institute of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
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Duhailib ZA, Oczkowski S, Polok K, Fronczek J, Szczeklik W, Piticaru J, Mammen MJ, Alshamsi F, Eikelboom J, Belley-Cote E, Alhazzani W. Venous and arterial thrombosis in COVID-19: An updated narrative review. J Infect Public Health 2022; 15:689-702. [PMID: 35643053 PMCID: PMC9106398 DOI: 10.1016/j.jiph.2022.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 04/29/2022] [Accepted: 05/08/2022] [Indexed: 01/08/2023] Open
Abstract
Hospitalized patients with coronavirus disease 2019 (COVID-19), particularly those admitted to the intensive care unit (ICU) are at high risk of morbidity and mortality. Several observational studies have described hemostatic derangements and thrombotic complications in patients with COVID-19. The aim of this review article is to summarize the current evidence on pathologic findings, pathophysiology, coagulation and hemostatic abnormalities, D-dimer's role in prognostication epidemiology and risk factors of thrombotic complications, and the role of prophylactic and therapeutic anticoagulation in patients with COVID-19. While existing evidence is limited in quality, COVID-19 appears to increase micro-and macro-vascular thrombosis rates in hospitalized and critically ill patients, which may contribute to the burden of disease. D-dimer can be used for risk stratification of hospitalized patients, but its role to guide anticoagulation therapy remains unclear. Evidence of higher quality is needed to address the role of therapeutic anticoagulation or high-intensity venous thromboembolism prophylaxis in COVID-19 patients. TAKE-HOME POINTS.
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Affiliation(s)
- Zainab Al Duhailib
- Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
| | - Simon Oczkowski
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kamil Polok
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub Fronczek
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Szczeklik
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Joshua Piticaru
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Manoj J Mammen
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Rochester, USA
| | - Fayez Alshamsi
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - John Eikelboom
- Population Health Research Institute, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Emilie Belley-Cote
- Population Health Research Institute, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Waleed Alhazzani
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Critical Care, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Alahyari S, Moradi M, Rajaeinejad M, Jalaeikhoo H. Post-COVID-19 hematologic complications: a systematic review. Expert Rev Hematol 2022; 15:539-546. [PMID: 35584541 DOI: 10.1080/17474086.2022.2080051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION COVID-19 crisis continues around the world. Some patients developed complications after the disease, which have been reported in limited studies. The aim of this study is to comprehensively assess the post-COVID hematologic complications in patients. AREAS COVERED We searched PubMed, Scopus and Google Scholar between January 2020 and August 2021 using related keywords. Evaluation of the articles was performed by two independent researchers. The extracted data included number of patients, age, type of hematological complication, duration of follow-up, response to treatment and prognosis. EXPERT OPINION Sixty five articles reported post-COVID hematologic complications. The most frequent hematologic complication in COVID-19 patients is thromboembolic events, which often occur in two forms: deep vein thrombosis (DVT) and pulmonary emboli (PE). In a group of patients after the diagnosis of COVID-19, a significant decrease in platelets was observed, which was attributed to the ITP induced by COVID-19. Hemolytic anemia and aplastic anemia have also been reported rarely in patients. Finally, post-COVID hematologic complications appear to go beyond thromboembolic events. Although these complications have been reported rarely, searching for methods to identify susceptible patients and prevent these complications could be the subject of future research.
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Affiliation(s)
- Sam Alahyari
- Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Milad Moradi
- Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Rajaeinejad
- AJA Cancer Epidemiology Research and Treatment Center (AJA- CERTC), AJA University of Medical Sciences, Tehran, Iran
| | - Hasan Jalaeikhoo
- AJA Cancer Epidemiology Research and Treatment Center (AJA- CERTC), AJA University of Medical Sciences, Tehran, Iran
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Morici N, Podda G, Birocchi S, Bonacchini L, Merli M, Trezzi M, Massaini G, Agostinis M, Carioti G, Saverio Serino F, Gazzaniga G, Barberis D, Antolini L, Grazia Valsecchi M, Cattaneo M. Enoxaparin for thromboprophylaxis in hospitalized COVID-19 patients: The X-COVID-19 Randomized Trial. Eur J Clin Invest 2022; 52:e13735. [PMID: 34958123 DOI: 10.1111/eci.13735] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND It is uncertain whether higher doses of anticoagulants than recommended for thromboprophylaxis are necessary in COVID-19 patients hospitalized in general wards METHODS: This is a multicentre, open-label, randomized trial performed in 9 Italian centres, comparing 40 mg b.i.d. versus 40 mg o.d. enoxaparin in COVID-19 patients, between April 30 2020 and April 25 2021. Primary efficacy outcome was in-hospital incidence of venous thromboembolism (VTE): asymptomatic or symptomatic proximal deep vein thrombosis (DVT) diagnosed by serial compression ultrasonography (CUS), and/or symptomatic pulmonary embolism (PE) diagnosed by computed tomography angiography (CTA). Secondary endpoints included each individual component of the primary efficacy outcome and a composite of death, VTE, mechanical ventilation, stroke, myocardial infarction, admission to ICU. Safety outcomes included major bleeding. RESULTS The study was interrupted prematurely due to slow recruitment. We included 183 (96%) of the 189 enrolled patients in the primary analysis (91 in b.i.d., 92 in o.d.). Primary efficacy outcome occurred in 6 patients (6.5%, 0 DVT, 6 PE) in the o.d. group and 0 in the b.id. group (ARR 6.5, 95% CI: 1.5-11.6). The absence of concomitant DVT and imaging characteristics suggests that most pulmonary artery occlusions were actually caused by local thrombi rather than PE. Statistically nonsignificant differences in secondary and safety endpoints were observed, with two major bleeding events in each arm. CONCLUSIONS No DVT developed in COVID-19 patients hospitalized in general wards, independently of enoxaparin dosing used for thromboprophylaxis. Pulmonary artery occlusions developed only in the o.d. group. Our trial is underpowered and with few events.
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Affiliation(s)
- Nuccia Morici
- Intensive Coronary Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - GianMarco Podda
- Unità di Medicina 2, ASST Santi Paolo e Carlo, Milan, Italy.,Dipartimento di Scienze della Salute, Università Degli Studi di Milano, Milan, Italy
| | | | - Luca Bonacchini
- Emergency Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marco Merli
- Divisione di Malattie Infettive, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Michele Trezzi
- Struttura Operativa Complessa (SOC) Malattie Infettive II, AUSL Toscana Centro, Ospedale San Jacopo, Pistoia, Italy
| | - Gianluca Massaini
- Struttura Operativa Semplice (SOS) Chirurgia vascolare, AUSL Toscana Centro, Ospedale San Jacopo, Pistoia, Italy
| | - Marco Agostinis
- Emergency Department, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo, Milano, Italy
| | - Giulia Carioti
- Emergency Department, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo, Milano, Italy
| | | | - Gianluca Gazzaniga
- Postgraduate School of Clinical Pharmacology and Toxicology, Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Daniela Barberis
- Intensive Coronary Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Laura Antolini
- Center of Bioinformatics, Biostatistics and Bioimaging, School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Maria Grazia Valsecchi
- Center of Bioinformatics, Biostatistics and Bioimaging, School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Marco Cattaneo
- Unità di Medicina 2, ASST Santi Paolo e Carlo, Milan, Italy.,Dipartimento di Scienze della Salute, Università Degli Studi di Milano, Milan, Italy
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Jamiruddin MR, Meghla BA, Islam DZ, Tisha TA, Khandker SS, Khondoker MU, Haq MA, Adnan N, Haque M. Microfluidics Technology in SARS-CoV-2 Diagnosis and Beyond: A Systematic Review. Life (Basel) 2022; 12:649. [PMID: 35629317 PMCID: PMC9146058 DOI: 10.3390/life12050649] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 12/22/2022] Open
Abstract
With the progression of the COVID-19 pandemic, new technologies are being implemented for more rapid, scalable, and sensitive diagnostics. The implementation of microfluidic techniques and their amalgamation with different detection techniques has led to innovative diagnostics kits to detect SARS-CoV-2 antibodies, antigens, and nucleic acids. In this review, we explore the different microfluidic-based diagnostics kits and how their amalgamation with the various detection techniques has spearheaded their availability throughout the world. Three other online databases, PubMed, ScienceDirect, and Google Scholar, were referred for articles. One thousand one hundred sixty-four articles were determined with the search algorithm of microfluidics followed by diagnostics and SARS-CoV-2. We found that most of the materials used to produce microfluidics devices were the polymer materials such as PDMS, PMMA, and others. Centrifugal force is the most commonly used fluid manipulation technique, followed by electrochemical pumping, capillary action, and isotachophoresis. The implementation of the detection technique varied. In the case of antibody detection, spectrometer-based detection was most common, followed by fluorescence-based as well as colorimetry-based. In contrast, antigen detection implemented electrochemical-based detection followed by fluorescence-based detection, and spectrometer-based detection were most common. Finally, nucleic acid detection exclusively implements fluorescence-based detection with a few colorimetry-based detections. It has been further observed that the sensitivity and specificity of most devices varied with implementing the detection-based technique alongside the fluid manipulation technique. Most microfluidics devices are simple and incorporate the detection-based system within the device. This simplifies the deployment of such devices in a wide range of environments. They can play a significant role in increasing the rate of infection detection and facilitating better health services.
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Affiliation(s)
| | - Bushra Ayat Meghla
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; (B.A.M.); (D.Z.I.); (T.A.T.)
| | - Dewan Zubaer Islam
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; (B.A.M.); (D.Z.I.); (T.A.T.)
| | - Taslima Akter Tisha
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; (B.A.M.); (D.Z.I.); (T.A.T.)
| | - Shahad Saif Khandker
- Gonoshasthaya-RNA Molecular Diagnostic & Research Center, Dhanmondi, Dhaka 1205, Bangladesh; (S.S.K.); (M.A.H.)
| | - Mohib Ullah Khondoker
- Department of Community Medicine, Gonoshasthaya Samaj Vittik Medical College, Savar, Dhaka 1344, Bangladesh;
| | - Md. Ahsanul Haq
- Gonoshasthaya-RNA Molecular Diagnostic & Research Center, Dhanmondi, Dhaka 1205, Bangladesh; (S.S.K.); (M.A.H.)
| | - Nihad Adnan
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; (B.A.M.); (D.Z.I.); (T.A.T.)
| | - Mainul Haque
- The Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sugai Besi, Kuala Lumpur 57000, Malaysia
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43
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Yoshioka T, Daizumoto K, Tada K, Mima M, Kagawa K, Fukawa T, Yamaguchi K, Takahashi M, Nishioka Y, Kanayama H. Retroperitoneal hemorrhage in a patient with coronavirus disease 2019 (COVID-19):A case report. THE JOURNAL OF MEDICAL INVESTIGATION 2022; 69:148-151. [PMID: 35466138 DOI: 10.2152/jmi.69.148] [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] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Early prophylactic administration of anticoagulants is recommended in patients with coronavirus disease 2019 (COVID-19). A case of retroperitoneal hemorrhage during inpatient treatment for COVID-19 is reported. CASE PRESENTATION A 69-year-old man was diagnosed with COVID-19 6 days after symptom onset. After admission for difficulty of breathing, he was treated with steroid pulse therapy, remdesivir, and heparin sodium. On day 16 after admission, his hemoglobin and blood pressure dropped. Computed tomography showed a left retroperitoneal hematoma and multiple areas of extravasation in bilateral iliopsoas muscles. Anticoagulation therapy was stopped, and blood transfusion therapy was chosen by considering poor general condition caused by severe pneumonia. On day 19, the hemoglobin and blood pressure improved, and blood transfusion was stopped. However, he died on day 25 due to pneumonia. CONCLUSION When retroperitoneal hemorrhage occurs as a complication of COVID-19, appropriate treatment decision, transcatheter arterial embolization or conservative treatment, should be chosen based on patient's condition. J. Med. Invest. 69 : 148-151, February, 2022.
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Affiliation(s)
- Takuya Yoshioka
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Kei Daizumoto
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Kouki Tada
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Masato Mima
- Department of Respiratory Medicine and Rheumatology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Kozo Kagawa
- Department of Respiratory Medicine and Rheumatology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Tomoya Fukawa
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Kunihisa Yamaguchi
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Masayuki Takahashi
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Yasuhiko Nishioka
- Department of Respiratory Medicine and Rheumatology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Hiroomi Kanayama
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
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Prével R, Dupont A, Labrouche-Colomer S, Garcia G, Dewitte A, Rauch A, Goutay J, Caplan M, Jozefowicz E, Lanoix JP, Poissy J, Rivière E, Orieux A, Malvy D, Gruson D, Garçon L, Susen S, James C. Plasma Markers of Neutrophil Extracellular Trap Are Linked to Survival but Not to Pulmonary Embolism in COVID-19-Related ARDS Patients. Front Immunol 2022; 13:851497. [PMID: 35371025 PMCID: PMC8968169 DOI: 10.3389/fimmu.2022.851497] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/23/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Coronavirus disease 2019 (COVID-19) can cause life-threatening acute respiratory distress syndrome (ARDS). Recent data suggest a role for neutrophil extracellular traps (NETs) in COVID-19-related lung damage partly due to microthrombus formation. Besides, pulmonary embolism (PE) is frequent in severe COVID-19 patients, suggesting that immunothrombosis could also be responsible for increased PE occurrence in these patients. Here, we evaluate whether plasma levels of NET markers measured shorty after admission of hospitalized COVID-19 patients are associated with clinical outcomes in terms of clinical worsening, survival, and PE occurrence. Patients and Methods Ninety-six hospitalized COVID-19 patients were included, 50 with ARDS (severe disease) and 46 with moderate disease. We collected plasma early after admission and measured 3 NET markers: total DNA, myeloperoxidase (MPO)–DNA complexes, and citrullinated histone H3. Comparisons between survivors and non-survivors and patients developing PE and those not developing PE were assessed by Mann–Whitney test. Results Analysis in the whole population of hospitalized COVID-19 patients revealed increased circulating biomarkers of NETs in patients who will die from COVID-19 and in patients who will subsequently develop PE. Restriction of our analysis in the most severe patients, i.e., the ones who enter the hospital for COVID-19-related ARDS, confirmed the link between NET biomarker levels and survival but not PE occurrence. Conclusion Our results strongly reinforce the hypothesis that NETosis is an attractive therapeutic target to prevent COVID-19 progression but that it does not seem to be linked to PE occurrence in patients hospitalized with COVID-19.
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Affiliation(s)
- Renaud Prével
- CHU Bordeaux, Medical Intensive Care Unit, Pessac, France.,Univ. Bordeaux, INSERM, U1045, Centre de Recherche Cardio-Thoracique de Bordeaux, Pessac, France
| | - Annabelle Dupont
- Univ. Lille, INSERM, CHU Lille, Department of Hematology and Transfusion, Pôle de Biologie Pathologie Génétique, Institut Pasteur de Lille, UMR1011-EGID, Lille, France
| | - Sylvie Labrouche-Colomer
- Univ. Bordeaux, INSERM, UMR1034, Biology of Cardiovascular Diseases, Pessac, France.,CHU Bordeaux, Laboratory of Hematology, Pessac, France
| | - Geoffrey Garcia
- Laboratoire d'Hématologie, CHU Amiens, EA4666 HEMATIM, UPJV, Amiens, France
| | - Antoine Dewitte
- CHU Bordeaux, Department of Anaesthesia and Critical Care, Magellan Medico-Surgical Centre, Bordeaux, France.,Univ. Bordeaux, CNRS, UMR 5164, INSERM ERL1303, Immunology from Concept and Experiments to Translation (ImmunoConcEpT), Bordeaux, France
| | - Antoine Rauch
- Univ. Lille, INSERM, CHU Lille, Department of Hematology and Transfusion, Pôle de Biologie Pathologie Génétique, Institut Pasteur de Lille, UMR1011-EGID, Lille, France
| | - Julien Goutay
- Centre Hospitalier Universitaire Lille, Intensive Care Department, Pôle de Réanimation, Lille, France
| | - Morgan Caplan
- Centre Hospitalier Universitaire Lille, Intensive Care Department, Pôle de Réanimation, Lille, France
| | - Elsa Jozefowicz
- Centre Hospitalier Universitaire Lille, Surgical Critical Care, Department of Anesthesiology and Critical Care, Lille, France
| | - Jean-Philippe Lanoix
- CHU Amiens-Picardie, Infectious Diseases Department, Amiens, France.,EA4294, Université Picardie Jules Verne, Amiens, France
| | - Julien Poissy
- Univ. Lille, INSERM U1285, CHU Lille, Pôle de réanimation, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France
| | - Etienne Rivière
- Univ. Bordeaux, INSERM, UMR1034, Biology of Cardiovascular Diseases, Pessac, France.,CHU Bordeaux, Internal Medicine and Infectious Diseases Unit, Pessac, France
| | - Arthur Orieux
- CHU Bordeaux, Medical Intensive Care Unit, Pessac, France
| | - Denis Malvy
- Department for Infectious and Tropical diseases, University Hospital Centre and INSERM 1219, University of Bordeaux, Bordeaux, France
| | - Didier Gruson
- CHU Bordeaux, Medical Intensive Care Unit, Pessac, France.,Univ. Bordeaux, INSERM, U1045, Centre de Recherche Cardio-Thoracique de Bordeaux, Pessac, France
| | - Loic Garçon
- Laboratoire d'Hématologie, CHU Amiens, EA4666 HEMATIM, UPJV, Amiens, France
| | - Sophie Susen
- Univ. Lille, INSERM, CHU Lille, Department of Hematology and Transfusion, Pôle de Biologie Pathologie Génétique, Institut Pasteur de Lille, UMR1011-EGID, Lille, France
| | - Chloé James
- Univ. Bordeaux, INSERM, UMR1034, Biology of Cardiovascular Diseases, Pessac, France.,CHU Bordeaux, Laboratory of Hematology, Pessac, France
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45
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Mohammed Y, Goodlett DR, Cheng MP, Vinh DC, Lee TC, Mcgeer A, Sweet D, Tran K, Lee T, Murthy S, Boyd JH, Singer J, Walley KR, Patrick DM, Quan C, Ismail S, Amar L, Pal A, Bassawon R, Fesdekjian L, Gou K, Lamontagne F, Marshall J, Haljan G, Fowler R, Winston BW, Russell JA. Longitudinal Plasma Proteomics Analysis Reveals Novel Candidate Biomarkers in Acute COVID-19. J Proteome Res 2022; 21:975-992. [PMID: 35143212 PMCID: PMC8864781 DOI: 10.1021/acs.jproteome.1c00863] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Indexed: 12/15/2022]
Abstract
The host response to COVID-19 pathophysiology over the first few days of infection remains largely unclear, especially the mechanisms in the blood compartment. We report on a longitudinal proteomic analysis of acute-phase COVID-19 patients, for which we used blood plasma, multiple reaction monitoring with internal standards, and data-independent acquisition. We measured samples on admission for 49 patients, of which 21 had additional samples on days 2, 4, 7, and 14 after admission. We also measured 30 externally obtained samples from healthy individuals for comparison at baseline. The 31 proteins differentiated in abundance between acute COVID-19 patients and healthy controls belonged to acute inflammatory response, complement activation, regulation of inflammatory response, and regulation of protein activation cascade. The longitudinal analysis showed distinct profiles revealing increased levels of multiple lipid-associated functions, a rapid decrease followed by recovery for complement activation, humoral immune response, and acute inflammatory response-related proteins, and level fluctuation in the regulation of smooth muscle cell proliferation, secretory mechanisms, and platelet degranulation. Three proteins were differentiated between survivors and nonsurvivors. Finally, increased levels of fructose-bisphosphate aldolase B were determined in patients with exposure to angiotensin receptor blockers versus decreased levels in those exposed to angiotensin-converting enzyme inhibitors. Data are available via ProteomeXchange PXD029437.
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Affiliation(s)
- Yassene Mohammed
- Genome BC Proteomics Centre, University
of Victoria, Victoria V8Z 5N3, British Columbia,
Canada
- Center for Proteomics and Metabolomics,
Leiden University Medical Center, Leiden 2333 ZA,
Netherlands
| | - David R. Goodlett
- Genome BC Proteomics Centre, University
of Victoria, Victoria V8Z 5N3, British Columbia,
Canada
- Department of Biochemistry and Microbiology,
University of Victoria, Victoria V8W 2Y2, British Columbia,
Canada
- International Centre for Cancer Vaccine Science,
University of Gdansk, Gdansk 80-822, European Union,
Poland
| | - Matthew P. Cheng
- Division of Infectious Diseases (Department of
Medicine), Division of Medical Microbiology (Department of Pathology and Laboratory
Medicine), McGill University Health Centre, Montreal H4A 3J1,
Quebec, Canada
| | - Donald C. Vinh
- Division of Infectious Diseases (Department of
Medicine), Division of Medical Microbiology (Department of Pathology and Laboratory
Medicine), McGill University Health Centre, Montreal H4A 3J1,
Quebec, Canada
| | - Todd C. Lee
- Department of Medicine, McGill
University, Montreal H4A 3J1, Quebec, Canada
| | - Allison Mcgeer
- Mt. Sinai Hospital and University of
Toronto, University Avenue, Toronto M5G 1X5, Ontario,
Canada
| | - David Sweet
- Division of Critical Care Medicine, Department of
Emergency Medicine, Vancouver General Hospital and University of British
Columbia, Vancouver V5Z 1M9, British Columbia,
Canada
| | - Karen Tran
- Division of General Internal Medicine,
Vancouver General Hospital and University of British
Columbia, Vancouver V5Z 1M9, British Columbia,
Canada
| | - Terry Lee
- Centre for Health Evaluation and Outcome Science
(CHEOS), St. Paul’s Hospital, University of British
Columbia, 1081 Burrard Street, Vancouver V6Z 1Y6, British Columbia,
Canada
| | - Srinivas Murthy
- BC Children’s Hospital,
University of British Columbia, Vancouver V6H 3N1, British Columbia,
Canada
| | - John H. Boyd
- Centre for Heart Lung Innovation, St.
Paul’s Hospital, University of British Columbia, 1081 Burrard
Street, Vancouver V6Z 1Y6, British Columbia, Canada
- Division of Critical Care Medicine, St.
Paul’s Hospital, University of British Columbia, 1081 Burrard
Street, Vancouver V6Z 1Y6, British Columbia, Canada
| | - Joel Singer
- Centre for Health Evaluation and Outcome Science
(CHEOS), St. Paul’s Hospital, University of British
Columbia, 1081 Burrard Street, Vancouver V6Z 1Y6, British Columbia,
Canada
| | - Keith R. Walley
- Centre for Heart Lung Innovation, St.
Paul’s Hospital, University of British Columbia, 1081 Burrard
Street, Vancouver V6Z 1Y6, British Columbia, Canada
- Division of Critical Care Medicine, St.
Paul’s Hospital, University of British Columbia, 1081 Burrard
Street, Vancouver V6Z 1Y6, British Columbia, Canada
| | - David M. Patrick
- British Columbia Centre for Disease
Control (BCCDC) and University of British Columbia, Vancouver V5Z 4R4,
British Columbia, Canada
| | - Curtis Quan
- Department of Medicine, McGill
University, Montreal H4A 3J1, Quebec, Canada
| | - Sara Ismail
- Department of Medicine, McGill
University, Montreal H4A 3J1, Quebec, Canada
| | - Laetitia Amar
- Department of Medicine, McGill
University, Montreal H4A 3J1, Quebec, Canada
| | - Aditya Pal
- Department of Medicine, McGill
University, Montreal H4A 3J1, Quebec, Canada
| | - Rayhaan Bassawon
- Department of Medicine, McGill
University, Montreal H4A 3J1, Quebec, Canada
| | - Lara Fesdekjian
- Department of Medicine, McGill
University, Montreal H4A 3J1, Quebec, Canada
| | - Karine Gou
- Department of Medicine, McGill
University, Montreal H4A 3J1, Quebec, Canada
| | | | - John Marshall
- Department of Surgery, St.
Michael’s Hospital, Toronto M5B 1W8, Ontario,
Canada
| | - Greg Haljan
- Division of Critical Care, Surrey
Memorial Hospital and University of British Columbia, Surrey V3V 1Z2,
British Columbia, Canada
| | - Robert Fowler
- Sunnybrook Health Sciences
Centre, Toronto M4N 3M5, Ontario, Canada
| | - Brent W. Winston
- Departments of Critical Care Medicine, Medicine and
Biochemistry and Molecular Biology, University of Calgary,
Calgary T2N 4N1, Alberta, Canada
| | - James A. Russell
- Centre for Heart Lung Innovation, St.
Paul’s Hospital, University of British Columbia, 1081 Burrard
Street, Vancouver V6Z 1Y6, British Columbia, Canada
- Division of Critical Care Medicine, St.
Paul’s Hospital, University of British Columbia, 1081 Burrard
Street, Vancouver V6Z 1Y6, British Columbia, Canada
| | - ARBs CORONA I
- Genome BC Proteomics Centre, University
of Victoria, Victoria V8Z 5N3, British Columbia,
Canada
- Center for Proteomics and Metabolomics,
Leiden University Medical Center, Leiden 2333 ZA,
Netherlands
- Department of Biochemistry and Microbiology,
University of Victoria, Victoria V8W 2Y2, British Columbia,
Canada
- International Centre for Cancer Vaccine Science,
University of Gdansk, Gdansk 80-822, European Union,
Poland
- Department of Medicine, McGill
University, Montreal H4A 3J1, Quebec, Canada
- Mt. Sinai Hospital and University of
Toronto, University Avenue, Toronto M5G 1X5, Ontario,
Canada
- Division of Critical Care Medicine, Department of
Emergency Medicine, Vancouver General Hospital and University of British
Columbia, Vancouver V5Z 1M9, British Columbia,
Canada
- Division of General Internal Medicine,
Vancouver General Hospital and University of British
Columbia, Vancouver V5Z 1M9, British Columbia,
Canada
- Centre for Health Evaluation and Outcome Science
(CHEOS), St. Paul’s Hospital, University of British
Columbia, 1081 Burrard Street, Vancouver V6Z 1Y6, British Columbia,
Canada
- BC Children’s Hospital,
University of British Columbia, Vancouver V6H 3N1, British Columbia,
Canada
- Centre for Heart Lung Innovation, St.
Paul’s Hospital, University of British Columbia, 1081 Burrard
Street, Vancouver V6Z 1Y6, British Columbia, Canada
- Division of Critical Care Medicine, St.
Paul’s Hospital, University of British Columbia, 1081 Burrard
Street, Vancouver V6Z 1Y6, British Columbia, Canada
- British Columbia Centre for Disease
Control (BCCDC) and University of British Columbia, Vancouver V5Z 4R4,
British Columbia, Canada
- University of Sherbrooke,
Sherbrooke J1K 2R1, Quebec, Canada
- Department of Surgery, St.
Michael’s Hospital, Toronto M5B 1W8, Ontario,
Canada
- Division of Critical Care, Surrey
Memorial Hospital and University of British Columbia, Surrey V3V 1Z2,
British Columbia, Canada
- Sunnybrook Health Sciences
Centre, Toronto M4N 3M5, Ontario, Canada
- Departments of Critical Care Medicine, Medicine and
Biochemistry and Molecular Biology, University of Calgary,
Calgary T2N 4N1, Alberta, Canada
- Division of Infectious Diseases (Department of
Medicine), Division of Medical Microbiology (Department of Pathology and Laboratory
Medicine), McGill University Health Centre, Montreal H4A 3J1,
Quebec, Canada
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Battistoni I, Francioni M, Morici N, Rubboli A, Podda GM, Pappalardo A, Abdelrahim MEA, Elgendy MO, Elgendy SO, Khalaf AM, Hamied AAM, Garcés HH, Abdelhamid OES, Tawfik KAM, Zeduri A, Bassi G, Pongetti G, Angelini L, Giovinazzo S, Garcia PM, Serino FS, Polistina GE, Fiorentino G, Barbati G, Toniolo A, Fabbrizioli A, Belenguer-Muncharaz A, Porto I, Ocak S, Minuz P, Bernal F, Hermosilla I, Borovac JA. Pre- and in-hospital anticoagulation therapy in coronavirus disease 2019 patients: a propensity-matched analysis of in-hospital outcomes. J Cardiovasc Med (Hagerstown) 2022; 23:264-271. [PMID: 34878430 DOI: 10.2459/jcm.0000000000001284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To estimate if chronic anticoagulant (CAC) treatment is associated with morbidity and mortality outcomes of patients hospitalized for SARS-CoV-2 infection. METHODS In this European multicentric cohort study, we included 1186 patients of whom 144 were on CAC (12.1%) with positive coronavirus disease 2019 testing between 1 February and 30 July 2020. The average treatment effect (ATE) analysis with a propensity score-matching (PSM) algorithm was used to estimate the impact of CAC on the primary outcomes defined as in-hospital death, major and minor bleeding events, cardiovascular complications (CCI), and acute kidney injury (AKI). We also investigated if different dosages of in-hospital heparin were associated with in-hospital survival. RESULTS In unadjusted populations, primary outcomes were significantly higher among CAC patients compared with non-CAC patients: all-cause death (35% vs. 18% P < 0.001), major and minor bleeding (14% vs. 8% P = 0.026; 25% vs. 17% P = 0.014), CCI (27% vs. 14% P < 0.001), and AKI (42% vs. 19% P < 0.001). In ATE analysis with PSM, there was no significant association between CAC and primary outcomes except for an increased incidence of AKI (ATE +10.2%, 95% confidence interval 0.3-20.1%, P = 0.044). Conversely, in-hospital heparin, regardless of dose, was associated with a significantly higher survival compared with no anticoagulation. CONCLUSIONS The use of CAC was not associated with the primary outcomes except for the increase in AKI. However, in the adjusted survival analysis, any dose of in-hospital anticoagulation was associated with significantly higher survival compared with no anticoagulation.
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Affiliation(s)
- Ilaria Battistoni
- S.O.D. Cardiologia-Emodinamica-UTIC, Dipartimento di Scienze Cardiovascolari, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona
| | - Matteo Francioni
- S.O.D. Cardiologia-Emodinamica-UTIC, Dipartimento di Scienze Cardiovascolari, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona
| | - Nuccia Morici
- Unità di Cure Intensive Cardiologiche and De Gasperis Cardio-Center, ASST Grande Ospedale Metropolitano Niguarda
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan
| | - Andrea Rubboli
- Division of Cardiology, Laboratory of Interventional Cardiology, Ospedale Maggiore, Bologna
| | - Gian Marco Podda
- Unità di Medicina 2, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan
| | - Andrea Pappalardo
- Cardiology Unit, University Hospital Policlinico 'Paolo Giaccone', University of Palermo, Palermo, Italy
| | | | - Marwa O Elgendy
- Clinical Pharmacy Department, Teaching Hospital of Faculty of Medicine, Faculty of Medicine, Beni-Suef University
- Clinical Pharmacy Department, Faculty of Pharmacy, Nahda University (NUB)
| | - Sara O Elgendy
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Ahmed M Khalaf
- Internal Medicine Department, Faculty of Medicine, Beni-Suef University
| | | | | | | | - Karim A M Tawfik
- General Surgery Department, Ministry of Health, Beni-Suef, Egypt
| | | | - Gabriele Bassi
- Intensive Care Unit. SST Grande Ospedale Metropolitano Niguarda, Milan
| | - Giulia Pongetti
- S.O.D. Cardiologia-Emodinamica-UTIC, Dipartimento di Scienze Cardiovascolari, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona
| | - Luca Angelini
- S.O.D. Cardiologia-Emodinamica-UTIC, Dipartimento di Scienze Cardiovascolari, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona
| | - Stefano Giovinazzo
- Cardiothoracic and Vascular Department (DICATOV), IRCCS San Martino Hospital, Genoa, Italy
| | | | - Francesco Saverio Serino
- Internal Medicine Department, U.O. Infectious Disease-Jesolo Hospital- ASL 4 Veneto Orientale, San Donà di Piave
| | | | - Giuseppe Fiorentino
- Sub-Intensive Care Unit and Respiratory, Physiopathology Department, Cotugno - Monaldi Hospital, Naples
| | | | - Anna Toniolo
- UOC Anestesia e Rianimazione, Ospedale San Bortolo, Vicenza
| | - Azzurra Fabbrizioli
- Operative Unit of ICCU and Cardiology Hospital 'S.Maria della Misericordia', ASUR Marche, Urbino
| | | | - Italo Porto
- Cardiothoracic and Vascular Department (DICATOV), IRCCS San Martino Hospital, Genoa, Italy
- Department of Internal Medicine and Medical Specialties (Di.M.I), Cardiovascular Diseases Chair, University of Genoa, Genoa Italy
| | - Sibel Ocak
- Department of Internal Medicine University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Pietro Minuz
- Department of Medicine, Section of Internal Medicine C, University of Verona, Verona, Italy
| | | | | | - Josip A Borovac
- Department of Pathophysiology, University of Split School of Medicine, Split, Croatia
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47
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Yueniwati Y, Syaban MFR, Purnomo AF, Kinesya E, Mannagalli Y, Pasaribu EA, Lutfiana NC, Purnomo AS. Low Molecular Weight Heparin Doses and Ventilator Airway Necessity in the COVID-19 Patients: Systematic Review and Meta-analysis. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Anticoagulant therapy is recommendation for COVID-19 infection. However, the mechanical ventilation needed for COVID-19 is still high.
AIM: The aim of the study was to determine comparison therapeutic and prophylactic dose LMWH for mechanical necessity in COVID-19 infection.
METHODS: A systematic literature search articles online from studies published between 2020 and 2021 that met our inclusion criteria and were retrieved from scientific databases such as Cochrane, ProQuest, and PubMed. The primary measure was a composite bad outcome, which included mechanical ventilation, mortality. and bleeding risk.
RESULTS: There were 3432 patients from seven study included in this meta-analysis for necessity of mechanical ventilation in COVID-19 patients that used prophylactic and therapeutic anticoagulants. Prophylactic dose of anticoagulant showed no difference for the need for mechanical ventilation necessity for COVID-19 patients (RR = 0.54; 95% CI = 0.20–1.48; p = 0.23). However, prophylactic anticoagulant showed more safe for bleeding incidence (RR = 0.27; 95% CI = 0.18–0.39; p = <0.00001) and reduce mortality (RR = 0.52; 95% CI = 0.46-0.58; p = <0.00001).
CONCLUSION: LMWH anticoagulant dose not associated with reduce mechanical ventilation necessity but prophylactic dose prefers rather than therapeutic dose for reduce mortality and risk of bleeding.
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48
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Marquini GV, Martins SB, Oliveira LM, Dias MM, Takano CC, Sartori MGF. Effects of the COVID-19 Pandemic on Gynecological Health: An Integrative Review. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:194-200. [PMID: 35213918 PMCID: PMC9948067 DOI: 10.1055/s-0042-1742294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To analyze the existing scientific literature to find out if the coronavirus disease 2019 (COVID-19) pandemic has an effect on gynecological health. SEARCH STRATEGY We performed an integrative review of articles published between April 2020 and April 2021 on the PubMed, SciELO, and LILACS databases, using COVID-19 and the following relevant terms: Menstrual change; Ovarian function; Violence against women; Contraception; HPV; Mental health; and Urogynecology. SELECTION CRITERIA Among the eligible studies found, editorials and primary research articles, which describe the dynamics between severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection (the cause of the COVID-19 pandemic) and gynecological health, were included. DATA COLLECTION AND ANALYSIS Through qualitative synthesis, data were extracted from the included publications and from guidelines of national and international societies of gynecology. MAIN RESULTS The 34 publications included in the present study showed that some factors of the SARS-CoV-2 infection, and, consequently, the COVID-19 pandemic, might be associated with menstrual abnormalities, effects on contraception, alterations in steroid hormones, changes in urogynecological care, effects on women's mental health, and negative impact on violence against women. CONCLUSION The COVID-19 pandemic has significantly impacted the health of women. The scientific community encourages the development of recommendations for specialized care for women and strategies to prevent and respond to violence during and after the COVID-19 pandemic.
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Affiliation(s)
- Gisele Vissoci Marquini
- Departament of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Sérgio Brasileiro Martins
- Departament of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Letícia Maria Oliveira
- Departament of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Márcia Maria Dias
- Departament of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Claudia Cristina Takano
- Departament of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Afshar ZM, Barary M, Babazadeh A, Hosseinzadeh R, Alijanpour A, Miri SR, Sio TT, Sullman MJM, Carson-Chahhoud K, Langer F, Ebrahimpour S. SARS-CoV-2-related and Covid-19 vaccine-induced thromboembolic events: A comparative review. Rev Med Virol 2022; 32:e2327. [PMID: 35112763 DOI: 10.1002/rmv.2327] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 01/01/2023]
Abstract
Since the start of the pandemic, thrombotic events have been a well-known and severe complication associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Nevertheless, the initiation of vaccination programs brought another rare yet highly fatal thrombotic event, vaccine-induced immune thrombotic thrombocytopaenia, which has caused extensive debate regarding the safety of vaccines. This review defines the thromboembolic events following infection and vaccination, identifies their risk factors, describes their pathophysiology, and discusses their management, treatment, and prevention.
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Affiliation(s)
- Zeinab Mohseni Afshar
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Barary
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran.,Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Arefeh Babazadeh
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Rezvan Hosseinzadeh
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | | | - Seyed Rouhollah Miri
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Science, Tehran, Iran
| | - Terence T Sio
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Mark J M Sullman
- Department of Social Sciences, University of Nicosia, Nicosia, Cyprus.,Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | | | - Florian Langer
- Zentrum für Onkologie, II. Medizinische Klinik und Poliklinik, Universitätsklinikum Eppendorf, Hamburg, Germany
| | - Soheil Ebrahimpour
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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Kory P, Meduri GU, Iglesias J, Varon J, Cadegiani FA, Marik PE. "MATH+" Multi-Modal Hospital Treatment Protocol for COVID-19 Infection: Clinical and Scientific Rationale. J Clin Med Res 2022; 14:53-79. [PMID: 35317360 PMCID: PMC8912998 DOI: 10.14740/jocmr4658] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/08/2022] [Indexed: 11/17/2022] Open
Abstract
In December 2019, coronavirus disease 2019 (COVID-19), a severe respiratory illness caused by the new coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China. The greatest impact that COVID-19 had was on intensive care units (ICUs), given that approximately 20% of hospitalized cases developed acute respiratory failure (ARF) requiring ICU admission. Based on the assumption that COVID-19 represented a viral pneumonia and no anti-coronaviral therapy existed, nearly all national and international health care societies recommended "supportive care only" avoiding other therapies outside of randomized controlled trials, with a specific prohibition against the use of corticosteroids in treatment. However, early studies of COVID-19-associated ARF reported inexplicably high mortality rates, with frequent prolonged durations of mechanical ventilation (MV), even from centers expert in such supportive care strategies. These reports led the authors to form a clinical expert panel called the Front-Line COVID-19 Critical Care Alliance (www.flccc.net). The panel collaboratively reviewed the emerging clinical, radiographic, and pathological reports of COVID-19 while initiating multiple discussions among a wide clinical network of front-line clinical ICU experts from initial outbreak areas in China, Italy, and New York. Based on the shared early impressions of "what was working and what wasn't working", the increasing medical journal publications and the rapidly accumulating personal clinical experiences with COVID-19 patients, a treatment protocol was created for the hospitalized patients based on the core therapies of methylprednisolone, ascorbic acid, thiamine, heparin and non-antiviral co-interventions (MATH+). This manuscript reviews the scientific and clinical rationale behind MATH+ based on published in-vitro, pre-clinical, and clinical data in support of each medicine, with a special emphasis of studies supporting their use in the treatment of patients with viral syndromes and COVID-19 specifically.
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Affiliation(s)
- Pierre Kory
- Front Line Critical Care Consortium (FLCCC.org), Washington DC, USA
| | | | - Jose Iglesias
- Jersey Shore University Medical Center, Hackensack School of Medicine at Seton Hall, NJ, USA
| | - Joseph Varon
- University of Texas Health Science Center, Houston, TX, USA
| | | | - Paul E. Marik
- Front Line Critical Care Consortium (FLCCC.org), Washington DC, USA
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