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Kazi S, Othman M, Khoury R, Bernstein PS, Thachil J, Ciantar E, Ferrara L, Netto M, Abdul-Kadir R, Malinowski AK. Report of the ISTH registry on pregnancy and COVID-19-associated coagulopathy (COV-PREG-COAG). Obstet Med 2024; 17:13-21. [PMID: 38660318 PMCID: PMC11037201 DOI: 10.1177/1753495x231206931] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/16/2023] [Indexed: 04/26/2024] Open
Abstract
Background Concerns about COVID-19-associated coagulopathy (CAC) in pregnant individuals were raised in early pandemic. Methods An ISTH-sponsored COVID-19 coagulopathy in pregnancy (COV-PREG-COAG) international registry was developed to describe incidence of coagulopathy, VTE, and anticoagulation in this group. Results All pregnant patients with COVID-19 from participating centers were entered, providing 430 pregnancies for the first pandemic wave. Isolated abnormal coagulation parameters were seen in 20%; more often with moderate/severe disease than asymptomatic/mild disease (49% vs 15%; p < 0.0001). No one met the ISTH criteria for disseminated intravascular coagulopathy (DIC), though 5/21 (24%) met the pregnancy DIC score. There was no difference in antepartum hemorrhage (APH) with asymptomatic/mild disease versus moderate/severe disease (3.4% vs 7.7%; p = 0.135). More individuals with moderate/severe disease experienced postpartum hemorrhage (PPH) (22.4% vs 9.3%; p = 0.006). There were no arterial thrombotic events. Only one COVID-associated venous thromboembolism (VTE) was reported. Conclusions Low rates of coagulopathy, bleeding, and thrombosis were observed among pregnant people in the first pandemic wave.
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Affiliation(s)
- Sajida Kazi
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Maha Othman
- Queen's University, Kingston, Canada
- St. Lawrence College, School of Baccalaureate Nursing, Kingston, Canada
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Rasha Khoury
- Divisions of Maternal Fetal Medicine and Complex Family Planning, Boston University School of Medicine, Boston, USA
| | - Peter S Bernstein
- Montefiore Medical Center/Albert Einstein College of Medicine, New York, USA
| | | | - Etienne Ciantar
- Leeds Teaching Hospital NHS Trust, Leeds General Infirmary, Leeds, UK
| | | | | | - Rezan Abdul-Kadir
- The Royal Free NHS Foundation Hospital and Institute for Women's Health, University College London, London, UK
| | - A Kinga Malinowski
- Division of Maternal-Fetal Medicine, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
- University of Toronto, Toronto, Canada
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2
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Viswanatha Setty B, Nagarajaiah Setty Raghav G, Rangaswamaiah H. Relating D-Dimer, blood sugars, haemoglobin and liver function among COVID patients with T2DM. Bioinformation 2023; 19:1167-1172. [PMID: 38250528 PMCID: PMC10794759 DOI: 10.6026/973206300191167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/31/2023] [Accepted: 12/31/2023] [Indexed: 01/23/2024] Open
Abstract
It is of interest to evaluate the correlation of D-Dimer, blood sugars, haemoglobin and liver function tests with novel coronavirus in patients with T2DM with and without symptoms. We recruited 200 patients with T2DM and COVID 19 with and without symptoms admitted in Rajarajeshwari Medical College and Hospital, Karnataka. Blood sugars, HbA1c, D-Dimer and also the incidence of T2DM and COVID 19 with and without symptoms were evaluated in all study subjects. There was a significant increased levels of biochemical parameters in T2DM and COVID 19 with symptoms when compared to T2DM and COVID 19 without symptoms (P<0.05). The D-Dimer levels was positively correlated with CT values, (r=0.518, P<0.05). Based on the study findings, the novel coronavirus enhances the insulin resistance, hyper-glycemia, abnormality in the liver and thrombolysis. Additionally, we also suggest that the subjects with T2DM and COVID 19 with and without symptoms require continuous monitoring of D-DIMER and LFT.
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Affiliation(s)
- Balaji Viswanatha Setty
- Department of General Medicine, Rajarajeshwari Medical College and Hospital, Bangalore, Karnataka, India
| | | | - Hareesh Rangaswamaiah
- Department of General Medicine, Rajarajeshwari Medical College and Hospital, Bangalore, Karnataka, India
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Vanassche T, Engelen MM, Orlando C, Vandenbosch K, Gadisseur A, Hermans C, Jochmans K, Minon JM, Motte S, Peperstraete H, Péters P, Sprynger M, Lancellotti P, Dehaene I, Emonts P, Vandenbriele C, Verhamme P, Oury C. The 2023 Belgian clinical guidance on anticoagulation management in hospitalized and ambulatory COVID-19 patients. Acta Clin Belg 2023; 78:497-508. [PMID: 37548503 DOI: 10.1080/17843286.2023.2241692] [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: 02/22/2023] [Accepted: 07/24/2023] [Indexed: 08/08/2023]
Abstract
COVID-19 is associated with an increased risk for thrombotic complications. The trials investigating the optimal thromboprophylactic dose are performed in challenging times and seemingly produce conflicting evidence. The burdensome circumstances, divergent endpoints, and different analytical approaches hamper comparison and extrapolation of available evidence. Most importantly, clinicians should provide thromboprophylaxis in hospitalized COVID-19 patients while (re)assessing bleeding and thrombotic risk frequently. The COVID-19 Thromboprophylaxis Working Group of the BSTH updated its guidance document. It aims to summarize the available evidence critically and to guide clinicians in providing the best possible thromboprophylaxis.
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Affiliation(s)
- Thomas Vanassche
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Matthias M Engelen
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Christelle Orlando
- Department of Haematology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Kristel Vandenbosch
- Department of Laboratory Haematology, CHU University Hospital of Liege, Liege, Belgium
| | - Alain Gadisseur
- Department of Haematology, Antwerp University Hospital, Antwerp, Belgium
| | | | - Kristin Jochmans
- Department of Haematology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jean-Marc Minon
- Department of Laboratory Medicine, Thrombosis-Haemostasis and Transfusion Unit, CHR Citadelle, Liege, Belgium
| | - Serge Motte
- Department of Vascular Diseases, Erasme University Hospital, Brussels, Belgium
| | | | - Pierre Péters
- Department of Laboratory Haematology, CHU University Hospital of Liege, Liege, Belgium
| | - Muriel Sprynger
- Department of Cardiology, CHU University Hospital of Liege, Liege, Belgium
| | | | - Isabelle Dehaene
- Vlaamse Vereniging Voor Obstetrie En Gynaecologie, Universitair Ziekenhuis Gent, Ghent, Belgium
| | - Patrick Emonts
- Groupement des Gynecologues Obstetriciens de Langue Francaise de Belgique, CHU University Hospital of Liege, Liège, Belgium
| | | | - Peter Verhamme
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Cecile Oury
- Laboratory of Cardiology, GIGA Institute, University of Liege, Liege, Belgium
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4
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Kananen L, Molnár C, Ansker F, Kozlowska DJ, Hägg S, Jylhävä J, Religa D, Raaschou P. Anticoagulant treatment and COVID-19 mortality among older adults living in nursing homes in Sweden. Health Sci Rep 2023; 6:e1692. [PMID: 38028709 PMCID: PMC10644256 DOI: 10.1002/hsr2.1692] [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: 09/08/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background Anticoagulants (AC) were introduced in March 2020 as standard of care in nursing home (NH) residents affected with COVID-19 in the Stockholm region, Sweden. ACs are proven to reduce the risk of complications and mortality from COVID-19 among patients of other ages and settings, but there is limited scientific evidence underpinning this practice in the NH setting. Methods This matched cohort study included 182 NH residents in the Stockholm Region diagnosed with COVID-19 in March-May 2020. The main exposure was any AC treatment. Exposed (n = 91), 49% prevalent (pre-COVID-19 diagnosis) AC and 51% incident AC were compared with unexposed controls (n = 91). The outcome was 28-days all-cause mortality after COVID-19 infection. The mortality odds ratios (OR) were assessed using logistic regression, adjusted for age, sex, multimorbidity, and mobility, also stratified by incident or prevalent AC-type, age group, and sex. Results Of the 182 individuals diagnosed with COVID-19 (median age 88 years, 68% women), 39% died within 28 days after diagnosis. Use of either incident or prevalent AC was associated with a reduced, adjusted 28-day mortality (OR[95% CI]: 0.31[0.16-0.62]). In stratified analyses, the association was significant in both age groups: 70-89 (OR: 0.37 [0.15-0.89]) and 90-99 years of age (OR: 0.22 [0.07-0.65]. In sex-stratified analysis, the AC-lowering effect was significant in women only (OR: 0.28[0.11-0.67]). In the analyses stratified by AC type, the mortality-lowering effect was observed for both prevalent AC (OR: 0.35[0.12-0.99]) and incident AC (OR: 0.29[0.11-0.76]). Conclusions Both prevalent and incident use of ACs in prophylactic dosing was associated with reduced 28-day mortality among older individuals with COVID-19 in a NH setting. The effect was seen across age-strata and in women. The findings present new insight in best practice for individuals diagnosed with COVID-19 in the NH setting.
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Affiliation(s)
- Laura Kananen
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetSolnaStockholmSweden
- Faculty of Social Sciences (Health Sciences), and Gerontology Research CenterTampere UniversityTampereFinland
- Faculty of Medicine and Health Technology, and Gerontology Research CenterTampere UniversityTampereFinland
| | - Christian Molnár
- Department of Neurobiology, Care Sciences and Society (NVS)Karolinska InstitutetStockholmSweden
- Familjeläkarna SÄBOFamiljeläkarna i SaltsjöbadenStockholmSweden
| | - Fredrik Ansker
- Familjeläkarna SÄBOFamiljeläkarna i SaltsjöbadenStockholmSweden
| | | | - Sara Hägg
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetSolnaStockholmSweden
| | - Juulia Jylhävä
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetSolnaStockholmSweden
- Faculty of Social Sciences (Health Sciences), and Gerontology Research CenterTampere UniversityTampereFinland
| | - Dorota Religa
- Department of Neurobiology, Care Sciences and Society (NVS)Karolinska InstitutetStockholmSweden
| | - Pauline Raaschou
- Department of Medicine Solna, Clinical Epidemiology Section & Clinical Pharmacology UnitKarolinska InstitutetSolnaStockholmSweden
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Rauch-Kröhnert U, Puccini M, Placzek M, Beyer-Westendorf J, Jakobs K, Friebel J, Hein S, Seidel M, Pieske B, Massberg S, Witzenrath M, Zeiher A, Friede T, Anker SD, Landmesser U. Initial therapeutic anticoagulation with rivaroxaban compared to prophylactic therapy with heparins in moderate to severe COVID-19: results of the COVID-PREVENT randomized controlled trial. Clin Res Cardiol 2023; 112:1620-1638. [PMID: 37407731 PMCID: PMC10584737 DOI: 10.1007/s00392-023-02240-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/30/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND COVID-19 is associated with a prothrombotic state. Current guidelines recommend prophylactic anticoagulation upon hospitalization. METHODS COVID-PREVENT, an open-label, multicenter, randomized, clinical trial enrolled patients (≥ 18 years) with moderate to severe COVID-19 and age-adjusted D-dimers > 1.5 upper limit of normal (ULN). The participants were randomly assigned (1:1) to receive either therapeutic anticoagulation with rivaroxaban 20 mg once daily or thromboprophylaxis with a heparin (SOC) for at least 7 days followed by prophylactic anticoagulation with rivaroxaban 10 mg once daily for 28 days or no thromboprophylaxis. The primary efficacy outcome was the D-dimer level and the co-primary efficacy outcome the 7-category ordinal COVID-19 scale by WHO at 7 days post randomization. The secondary outcome was time to the composite event of either venous or arterial thromboembolism, new myocardial infarction, non-hemorrhagic stroke, all-cause death or progression to intubation and invasive ventilation up to 35 days post randomization. RESULTS The primary efficacy outcome D-dimer at 7 days was not different between patients assigned to therapeutic (n = 55) or prophylactic anticoagulation (n = 56) (1.21 mg/L [0.79, 1.86] vs 1.27 mg/L [0.79, 2.04], p = 0.78). In the whole study population D-dimer was significantly lower at 7 days compared to baseline (1.05 mg/L [0.75, 1.48] vs 1.57 mg/L [1.13, 2.19], p < 0.0001). Therapy with rivaroxaban compared to SOC was not associated an improvement on the WHO 7-category ordinal scale at 7 days (p = 0.085). Rivaroxaban improved the clinical outcome measured by the score in patients with a higher baseline D-dimer > 2.0 ULN (exploratory analysis; 0.632 [0.516, 0.748], p = 0.026). The secondary endpoint occurred in 6 patients (10.9%) in the rivaroxaban group and in 12 (21.4%) in the SOC group (time-to-first occurrence of the components of the secondary outcome: HR 0.5; 95% CI 0.15-1.67; p = 0.264). There was no difference in fatal or non-fatal major or clinically relevant non-major bleeding between the groups. CONCLUSIONS Therapeutic anticoagulation with rivaroxaban compared to prophylactic anticoagulation with a heparin did not improve surrogates of clinical outcome in patients with moderate to severe COVID-19. Whether initial rivaroxaban at therapeutic doses might be superior to thromboprophylaxis in patients with COVID-19 and a high risk as defined by D-dimer > 2 ULN needs confirmation in further studies.
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Affiliation(s)
- Ursula Rauch-Kröhnert
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Deutsches Herzzentrum der Charité, Hindenburgdamm 30, 12203, Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
- Friede Springer Cardiovascular Prevention Center @ Charite Universitätsmedizin Berlin, Berlin, Germany.
| | - Marianna Puccini
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Deutsches Herzzentrum der Charité, Hindenburgdamm 30, 12203, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Marius Placzek
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Jan Beyer-Westendorf
- Department of Medicine I, Universitätsklinikum "Carl Gustav Carus" Dresden, Dresden, Germany
| | - Kai Jakobs
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Deutsches Herzzentrum der Charité, Hindenburgdamm 30, 12203, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Julian Friebel
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Deutsches Herzzentrum der Charité, Hindenburgdamm 30, 12203, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Selina Hein
- Katholisches Klinikum Koblenz-Montabaur, Koblenz, Germany
| | - Mirko Seidel
- BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
| | - Burkert Pieske
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Heart Center Berlin, Berlin, Germany
- Department of Cardiology Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Steffen Massberg
- Department of Medicine I, LMU Klinikum, Ludwig-Maximilians-Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Munich, Germany
| | - Martin Witzenrath
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Zeiher
- Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Rhine-Main, Frankfurt, Germany
| | - Tim Friede
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Stefan D Anker
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Virchow Klinikum, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Deutsches Herzzentrum der Charité, Hindenburgdamm 30, 12203, Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
- Friede Springer Cardiovascular Prevention Center @ Charite Universitätsmedizin Berlin, Berlin, Germany.
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany.
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6
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Fornazieri MA, da Silva JLB, Gameiro JG, Scussiato HO, Ramos RAMR, Cunha BM, Figueiredo AF, Takahashi EH, Marin GA, Caetano IRDA, Meli TK, Higuchi DI, dos Santos RRP, Rampazzo ACM, Pinna FDR, Voegels RL, Doty RL. Chemosensory Dysfunction 3-Months After COVID-19, Medications and Factors Associated with Complete Recovery. Ann Otol Rhinol Laryngol 2023; 132:1177-1185. [PMID: 36482672 PMCID: PMC9742352 DOI: 10.1177/00034894221138485] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To examine the longitudinal prevalence and recovery of olfactory, gustatory, and oral chemesthetic deficits in a sizable cohort of SARS-CoV-2 infected persons using quantitative testing. To determine whether demographic and clinical factors, mainly the medications used after the COVID-19 diagnosis, influence the test measures. METHODS Prospective cohort in a hospital with primary, secondary, tertiary, and quaternary care. Patients with confirmed COVID-19 were tested during the acute infection phase (within 15 days of initial symptom, n = 187) and one (n = 113) and 3 months later (n = 73). The University of Pennsylvania Smell Identification Test, the Global Gustatory Test, and a novel test for chemesthesis were administered at all visits. RESULTS During the acute phase, 93% were anosmic or microsmic and 29.4% were hypogeusic. No one was ageusic. A deficit in oral chemesthesis was present in 13.4%. By 3 months, taste and chemesthesis had largely recovered, however, some degree of olfactory dysfunction remained in 54.8%. Remarkably, patients who had been treated with anticoagulants tended to have more olfactory improvement. Recovery was greater in men than in women, but was unrelated to disease severity, smoking behavior, or the use of various medications prior to, or during, COVID-19 infection. CONCLUSIONS When using quantitative testing, olfactory disturbances were found in nearly all SARS-CoV-2 infected patients during the acute infection phase. Taste or chemesthetic deficits were low. Olfactory impairment persisted to some degree in over half of the patients at the 3-month follow-up evaluation, being more common in women and less common in those who had been treated earlier with anticoagulants. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Marco Aurélio Fornazieri
- Londrina State University, Londrina, Paraná, Brazil
- Pontifical Catholic University of Paraná, Londrina, Brazil
- University of São Paulo, São Paulo, State of São Paulo, Brazil
- Smell and Taste Center, Department of Otorhinolaryngology, Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Richard L. Doty
- Smell and Taste Center, Department of Otorhinolaryngology, Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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7
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Antony B, Blau H, Casiraghi E, Loomba JJ, Callahan TJ, Laraway BJ, Wilkins KJ, Antonescu CC, Valentini G, Williams AE, Robinson PN, Reese JT, Murali TM. Predictive models of long COVID. EBioMedicine 2023; 96:104777. [PMID: 37672869 PMCID: PMC10494314 DOI: 10.1016/j.ebiom.2023.104777] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 07/24/2023] [Accepted: 08/15/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND The cause and symptoms of long COVID are poorly understood. It is challenging to predict whether a given COVID-19 patient will develop long COVID in the future. METHODS We used electronic health record (EHR) data from the National COVID Cohort Collaborative to predict the incidence of long COVID. We trained two machine learning (ML) models - logistic regression (LR) and random forest (RF). Features used to train predictors included symptoms and drugs ordered during acute infection, measures of COVID-19 treatment, pre-COVID comorbidities, and demographic information. We assigned the 'long COVID' label to patients diagnosed with the U09.9 ICD10-CM code. The cohorts included patients with (a) EHRs reported from data partners using U09.9 ICD10-CM code and (b) at least one EHR in each feature category. We analysed three cohorts: all patients (n = 2,190,579; diagnosed with long COVID = 17,036), inpatients (149,319; 3,295), and outpatients (2,041,260; 13,741). FINDINGS LR and RF models yielded median AUROC of 0.76 and 0.75, respectively. Ablation study revealed that drugs had the highest influence on the prediction task. The SHAP method identified age, gender, cough, fatigue, albuterol, obesity, diabetes, and chronic lung disease as explanatory features. Models trained on data from one N3C partner and tested on data from the other partners had average AUROC of 0.75. INTERPRETATION ML-based classification using EHR information from the acute infection period is effective in predicting long COVID. SHAP methods identified important features for prediction. Cross-site analysis demonstrated the generalizability of the proposed methodology. FUNDING NCATS U24 TR002306, NCATS UL1 TR003015, Axle Informatics Subcontract: NCATS-P00438-B, NIH/NIDDK/OD, PSR2015-1720GVALE_01, G43C22001320007, and Director, Office of Science, Office of Basic Energy Sciences of the U.S. Department of Energy Contract No. DE-AC02-05CH11231.
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Affiliation(s)
- Blessy Antony
- Department of Computer Science, Virginia Polytechnic Institute and State University (Virginia Tech), Blacksburg, VA, 24061, USA
| | - Hannah Blau
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, 06032, USA
| | - Elena Casiraghi
- AnacletoLab, Computer Science Department, Dipartimento di Informatica, Università degli Studi di Milano, Milan, 20133, Italy; Division of Environmental Genomics and Systems Biology, Lawrence Berkeley National Laboratory, Berkeley, CA, 94720, USA; ELLIS - European Laboratory for Learning and Intelligent Systems, Milan Unit, Milan, 20133, Italy
| | - Johanna J Loomba
- Integrated Translational Health Research Institute of Virginia, University of Virginia, Charlottesville, VA, 22904, USA
| | - Tiffany J Callahan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Bryan J Laraway
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Kenneth J Wilkins
- Biostatistics Program, Office of the Director, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, 20814, USA
| | | | - Giorgio Valentini
- AnacletoLab, Computer Science Department, Dipartimento di Informatica, Università degli Studi di Milano, Milan, 20133, Italy; ELLIS - European Laboratory for Learning and Intelligent Systems, Milan Unit, Milan, 20133, Italy
| | - Andrew E Williams
- Institute for Clinical Research and Health Policy Studies, Tufts University School of Medicine, Boston, MA, 02111, USA
| | - Peter N Robinson
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, 06032, USA; Institute for Systems Genomics, University of Connecticut, Farmington, CT, 06269, USA
| | - Justin T Reese
- Division of Environmental Genomics and Systems Biology, Lawrence Berkeley National Laboratory, Berkeley, CA, 94720, USA
| | - T M Murali
- Department of Computer Science, Virginia Polytechnic Institute and State University (Virginia Tech), Blacksburg, VA, 24061, USA.
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8
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Ram MD, Umer M, Trada IJ, Khan SJ, Imran L, Rehan T, Hassan W, Zafar F, Razak S, Laeeq T, Aijaz P, Majid Z. The Role of Anticoagulants and Antiplatelets in Reducing Mortality in COVID-19 Patients: A Systematic Review and Meta-Analysis of Studies Reporting Adjusted Data. Cureus 2023; 15:e45749. [PMID: 37872904 PMCID: PMC10590480 DOI: 10.7759/cureus.45749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/25/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) is associated with prolonged prothrombin time (PT), active partial thromboplastin time (aPTT), and increased D-dimer levels. Therefore, we aim to investigate if anticoagulants (AC) and antiplatelet (AP) therapy play a role in mitigating COVID-19 and its associated thrombosis along with its effect on the mortality rate, the need for mechanical ventilation, and the risk of hospital admission. Electronic databases were searched from their inception to July 19, 2022. The studies were divided into two groups: Group A (any dose of AC/AP versus no AC/AP) and Group B (therapeutic dose of AC (tAC)/AP versus prophylactic dose of AC (pAC)/AP). Review Manager (RevMan) version 5.4.1 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark) was used for all statistical analyses. Adjusted data ratios were extracted from all included studies and pooled using the random effects model. A total of 33 studies were taken for the analysis of two groups (Group A: 285,065 COVID-19-positive patients, Group B: 2,421 COVID-19-positive patients). Overall analysis in Group A showed that the AC/AP group had a low risk of mortality in COVID-19 patients compared to the control group (risk ratio (RR): 0.77, 95% confidence interval (CI): 0.69-0.86). There was no significant difference in the need for mechanical ventilation (RR: 0.80, 95% CI: 0.60-1.08) and hospital admission (RR: 1.12, 95% CI: 0.78-1.59) between the AC/AP and no AC/AP group. Alongside, in Group B, tAC/AP did not demonstrate a significant decrease in mortality as compared to pAC/AP (RR: 0.62, 95% CI: 0.37-1.06). Treatment with AC and AP drugs can significantly decrease the mortality rate in COVID-19-infected patients, while AC also significantly reduces the need for mechanical ventilation.
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Affiliation(s)
| | - Muhammed Umer
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | | | | | - Laiba Imran
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Tayyaba Rehan
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Warda Hassan
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Faiqa Zafar
- General Surgery, New York Institute of Osteopathic Medicine, New York, USA
| | - Sufyan Razak
- Oncology, Johns Hopkins University School of Medicine, Baltimore, USA
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Tooba Laeeq
- Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas (UNLV), Las Vegas, USA
| | - Parisa Aijaz
- Internal Medicine, Charleston Area Medical Center, Charleston, USA
| | - Zainab Majid
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
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9
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Ramadan SE, El-Gizawy SA, Osman MA, Arafa MF. Application of Design of Experiment in the Optimization of Apixaban-Loaded Solid Lipid Nanoparticles: In Vitro and In Vivo Evaluation. AAPS PharmSciTech 2023; 24:167. [PMID: 37552329 DOI: 10.1208/s12249-023-02628-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/25/2023] [Indexed: 08/09/2023] Open
Abstract
Solid lipid nanoparticles (SLnPs) are usually utilized as lipid-based formulations for enhancing oral bioavailability of BCS class IV drugs. Accordingly, the objective of this work was to investigate the effect of formulation and processing variables on the properties of the developed SLnPs for oral delivery of apixaban. Randomized full factorial design (24) was employed for optimization of SLnPs. With two levels for each independent variable, four factors comprising both formulations and processing factors were chosen: the GMS content (A), the Tween 80 content (B), the homogenization time (C), and the content of poloxamer 188 used (D). The modified hot homogenization and sonication method was employed in the formulation of solid lipid nanoparticles loaded with apixaban (APX-SLnPs). The size of APX-SLnPs formulations was measured to lie between 116.7 and 1866 nm, polydispersity index ranged from 0.385 to 1, and zeta potential was discovered to be in the range of - 12.6 to - 38.6 mV. The entrapping efficiency of APX-SLnPs formulations was found to be in the range of 22.8 to 96.7%. The optimized formulation was evaluated in vivo after oral administration to rats. Oral administration of APX-SLnPs resulted in significant prolongation in bleeding time compared with both positive and negative control. This indicates the ability of this system to enhance drug therapeutic effect either by increasing intestinal absorption or trans-lymphatic transport. So, this study highlighted the capability of SLnPs to boost the pharmacological effect of apixaban.
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Affiliation(s)
- Safaa E Ramadan
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Tanta University, Tanta, Egypt.
| | - Sanaa A El-Gizawy
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Tanta University, Tanta, Egypt
| | - Mohamed A Osman
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Tanta University, Tanta, Egypt
| | - Mona F Arafa
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Tanta University, Tanta, Egypt
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10
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Bulanov AY, Bulanova EL, Simarova IB, Bovt EA, Eliseeva OO, Shakhidzhanov SS, Panteleev MA, Roumiantsev AG, Ataullakhanov FI, Karamzin SS. Integral assays of hemostasis in hospitalized patients with COVID-19 on admission and during heparin thromboprophylaxis. PLoS One 2023; 18:e0282939. [PMID: 37267317 DOI: 10.1371/journal.pone.0282939] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/28/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Blood coagulation abnormalities play a major role in COVID-19 pathophysiology. However, the specific details of hypercoagulation and anticoagulation treatment require investigation. The aim of this study was to investigate the status of the coagulation system by means of integral and local clotting assays in COVID-19 patients on admission to the hospital and in hospitalized COVID-19 patients receiving heparin thromboprophylaxis. METHODS Thrombodynamics (TD), thromboelastography (TEG), and standard clotting assays were performed in 153 COVID-19 patients observed in a hospital setting. All patients receiving treatment, except extracorporeal membrane oxygenation (ECMO) patients (n = 108), were administered therapeutic doses of low molecular weight heparin (LMWH) depending on body weight. The ECMO patients (n = 15) were administered unfractionated heparin (UFH). RESULTS On admission, the patients (n = 30) had extreme hypercoagulation by all integral assays: TD showed hypercoagulation in ~75% of patients, while TEG showed hypercoagulation in ~50% of patients. The patients receiving treatment showed a significant heparin response based on TD; 77% of measurements were in the hypocoagulation range, 15% were normal, and 8% remained in hypercoagulation. TEG showed less of a response to heparin: 24% of measurements were in the hypocoagulation range, 59% were normal and 17% remained in hypercoagulation. While hypocoagulation is likely due to heparin treatment, remaining in significant hypercoagulation may indicate insufficient anticoagulation for some patients, which is in agreement with our clinical findings. There were 3 study patients with registered thrombosis episodes, and all were outside the target range for TD parameters typical for effective thromboprophylaxis (1 patient was in weak hypocoagulation, atypical for the LMWH dose used, and 2 patients remained in the hypercoagulation range despite therapeutic LMWH doses). CONCLUSION Patients with COVID-19 have severe hypercoagulation, which persists in some patients receiving anticoagulation treatment, while significant hypocoagulation is observed in others. The data suggest critical issues of hemostasis balance in these patients and indicate the potential importance of integral assays in its control.
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Affiliation(s)
- Andrey Y Bulanov
- Moscow City Clinical Hospital №52 of Healthcare Department, Moscow, Russia
| | | | - Irina B Simarova
- Moscow City Clinical Hospital №52 of Healthcare Department, Moscow, Russia
| | - Elizaveta A Bovt
- Dmitry Rogachev National Medical Research Center Of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
- Center for Theoretical Problems of Physicochemical Pharmacology, Moscow, Russia
| | - Olesya O Eliseeva
- Faculty of Biological and Medical Physics, Moscow Institute of Physics and Technology, Dolgoprudnyi, Russia
| | - Soslan S Shakhidzhanov
- Dmitry Rogachev National Medical Research Center Of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
- Center for Theoretical Problems of Physicochemical Pharmacology, Moscow, Russia
| | - Mikhail A Panteleev
- Dmitry Rogachev National Medical Research Center Of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
- Center for Theoretical Problems of Physicochemical Pharmacology, Moscow, Russia
- Faculty of Biological and Medical Physics, Moscow Institute of Physics and Technology, Dolgoprudnyi, Russia
- Faculty of Physics, Lomonosov Moscow State University, Moscow, Russia
| | - Aleksandr G Roumiantsev
- Dmitry Rogachev National Medical Research Center Of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Fazoil I Ataullakhanov
- Dmitry Rogachev National Medical Research Center Of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
- Center for Theoretical Problems of Physicochemical Pharmacology, Moscow, Russia
- Faculty of Biological and Medical Physics, Moscow Institute of Physics and Technology, Dolgoprudnyi, Russia
- Faculty of Physics, Lomonosov Moscow State University, Moscow, Russia
| | - Sergey S Karamzin
- Center for Theoretical Problems of Physicochemical Pharmacology, Moscow, Russia
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11
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Altaraihi S, Kamstrup P, Eklöf J, Dyrby Johansen N, Biering-Sørensen T, Sivapalan P, Jensen JU. Treatment with prophylactic oral anticoagulants and the risk of mortality in COVID-19 patients: a nationwide cohort study. ERJ Open Res 2023; 9:00644-2022. [PMID: 37228282 PMCID: PMC10204852 DOI: 10.1183/23120541.00644-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/29/2023] [Indexed: 05/27/2023] Open
Abstract
Background Venous thromboembolism has been reported in patients with coronavirus disease 2019 (COVID-19). It remains unclear if premorbid use of prophylactic oral anticoagulation, for reasons other than COVID-19, protects against death in patients with COVID-19. The aim of this study was to estimate if the risk of all-cause mortality, hospital admission or intensive care unit (ICU) admission for individuals with verified SARS-CoV-2 was lower if patients used oral anticoagulant (OAC) therapy prior to a positive COVID-19 status. Methods Data were obtained using national health registries. Cohort entry was the day of a positive SARS-CoV-2 test, and individuals were followed for 14 days or until death or hospital admission. Adjusted Cox proportional hazard regressions and competing risk analyses were used to estimate the risk of all-cause mortality, hospital admission and ICU admission in OAC users compared with patients with no use of OAC. Results In this nationwide cohort study a total of 244 522 individuals were included (median age 35 years (interquartile range 21-52); 124 095 (51%) female), among whom 3710 (1.5%) were OAC users. In the adjusted Cox regression cohort, there was no difference in risk of all-cause mortality in OAC versus non-OAC users. (hazard ratio (HR) 1.13, 95% CI 0.99-1.30). Hospital admission risk (HR 1.11, 95% CI 1.02-1.20) was slightly increased in OAC users, and there was no difference between the groups regarding the risk of ICU admission (HR 0.96, 95% CI 0.74-1.24). Conclusions In individuals with confirmed SARS-CoV-2, pre-existing treatment with OAC was not associated with prophylactic benefits in the prevention of hospital admission, ICU admissions or death. Prescription patterns should remain unchanged.
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Affiliation(s)
- Sarah Altaraihi
- Department of Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Peter Kamstrup
- Department of Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Josefin Eklöf
- Department of Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Niklas Dyrby Johansen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Pradeesh Sivapalan
- Department of Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Jens-Ulrik Jensen
- Department of Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Institute for Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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12
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Kankaria R, Sanina C, Gabr M, Wiley J, Bortnick AE. Extracardiac Prothrombotic Effects of COVID-19. Heart Fail Clin 2023; 19:213-220. [PMID: 36863813 PMCID: PMC9973540 DOI: 10.1016/j.hfc.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
COVID-19 infection triggers a heightened inflammatory response which in turn, increases thrombosis and thromboembolism. Microvascular thrombosis has been detected in various tissue beds which may account for some of the multi-system organ dysfunction associated with COVID-19. Additional research is needed to understand which prophylactic and therapeutic drug regimens are best for the prevention and treatment of thrombotic complications of COVID-19.
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Affiliation(s)
- Rohan Kankaria
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY 10461, USA
| | - Cristina Sanina
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY 10461, USA; Department of Medicine, Division of Cardiology, Montefiore Medical Center, 111 E 210th Street, Bronx, NY 10467 USA
| | - Mohamed Gabr
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY 10461, USA; Department of Medicine, Division of Cardiology, Montefiore Medical Center, 111 E 210th Street, Bronx, NY 10467 USA
| | - Jose Wiley
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY 10461, USA; Department of Medicine, Division of Cardiology, Montefiore Medical Center, 111 E 210th Street, Bronx, NY 10467 USA
| | - Anna E Bortnick
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY 10461, USA; Department of Medicine, Division of Cardiology, Montefiore Medical Center, 111 E 210th Street, Bronx, NY 10467 USA; Division of Geriatrics, Montefiore Medical Center, 111 E 210th Street, Bronx, NY 10467 USA.
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13
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Low Molecular Weight Heparin, Anti-inflammatory/Immunoregulatory and Antiviral Effects, a Short Update. Cardiovasc Drugs Ther 2023; 37:277-281. [PMID: 34460031 PMCID: PMC8403694 DOI: 10.1007/s10557-021-07251-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2021] [Indexed: 01/19/2023]
Abstract
Low molecular weight heparin (LMWH) is a glycosaminoglycan long known for its anticoagulant properties. In recent times, recent evidence has associated this drug with extra pleiotropic anticoagulant effects that have also proven useful in the management of the treatment of COVID-19 infection indicating that heparin may play other roles in the management of the disease in addition to the prevention of thrombosis. Clinical observations and in vitro studies support that heparin has a potential multi-target effect. To date, the molecular mechanisms of these pleiotropic effects are not fully understood. This brief review presents some of the evidence from clinical and animal studies and describes the potential molecular mechanisms by which heparin may exert its anti-inflammatory/immunoregulatory and antiviral effects.
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14
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Patel P, Gaddis M, Xu X, Riviere JE, Kawakami J, Meyer E, Jaberi-Douraki M, Wyckoff GJ. A retrospective study of adverse drug events in anticoagulant administration with relevance to COVID-19. Heliyon 2023; 9:e13763. [PMID: 36855650 PMCID: PMC9951606 DOI: 10.1016/j.heliyon.2023.e13763] [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: 09/06/2022] [Revised: 02/05/2023] [Accepted: 02/10/2023] [Indexed: 03/02/2023] Open
Abstract
Initial studies in COVID-19 patients reported lower mortality rates associated with the use of the drug heparin, a widely used anticoagulant. The objective of this analysis was to determine whether there are adverse events associated with the administration of anticoagulants, and specifically how this might apply in patients known to have COVID-19. Data for this study were obtained from the Food and Drug Administration's Adverse Event Reporting System (FAERS) public database and from the NIH's clinical trials website. Proportional Reporting Ratios (PRR) with lower 95% confidence intervals (lower CI) and empirical Bayes geometric mean (EBGM) scores with lower 95% confidence limits were calculated for data from the FAERS database where the adverse events studied mimicked COVID-19 symptoms.
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Affiliation(s)
- Purva Patel
- Division of Pharmacology and Pharmaceutical Sciences, UMKC School of Pharmacy, UMKC, Kansas City, MO, USA
| | - Monica Gaddis
- Division of Biomedical and Health Informatics, UMKC School of Medicine, UMKC, Kansas City, MO, USA
| | - Xuan Xu
- Mathematics and Data Science, Kansas State University - Olathe, Olathe, KS, USA
| | - Jim E Riviere
- Mathematics and Data Science, Kansas State University - Olathe, Olathe, KS, USA
| | - Jessica Kawakami
- Division of Pharmacology and Pharmaceutical Sciences, UMKC School of Pharmacy, UMKC, Kansas City, MO, USA
| | - Emma Meyer
- Division of Pharmacology and Pharmaceutical Sciences, UMKC School of Pharmacy, UMKC, Kansas City, MO, USA
| | | | - Gerald J Wyckoff
- Division of Pharmacology and Pharmaceutical Sciences, UMKC School of Pharmacy, UMKC, Kansas City, MO, USA
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15
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Jiang L, Zhang T, Lu H, Li S, Lv K, Tuffour A, Zhang L, Ding K, Li JP, Li H, Liu X. Heparin mimetics as potential intervention for COVID-19 and their bio-manufacturing. Synth Syst Biotechnol 2023; 8:11-19. [PMID: 36313216 PMCID: PMC9595387 DOI: 10.1016/j.synbio.2022.10.002] [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: 07/14/2022] [Revised: 09/26/2022] [Accepted: 10/05/2022] [Indexed: 11/07/2022] Open
Abstract
The COVID-19 pandemic has caused severe health problems worldwide and unprecedented decimation of the global economy. Moreover, after more than 2 years, many populations are still under pressure of infection. Thus, a broader perspective in developing antiviral strategies is still of great importance. Inspired by the observed multiple benefits of heparin in the treatment of thrombosis, the potential of low molecular weight heparin (LMWH) for the treatment of COVID-19 have been explored. Clinical applications found that LMWH decreased the level of inflammatory cytokines in COVID-19 patients, accordingly reducing lethality. Furthermore, several in vitro studies have demonstrated the important roles of heparan sulfate in SARS-CoV-2 infection and the inhibitory effects of heparin and heparin mimetics in viral infection. These clinical observations and designed studies argue for the potential to develop heparin mimetics as anti-SARS-CoV-2 drug candidates. In this review, we summarize the properties of heparin as an anticoagulant and the pharmaceutical possibilities for the treatment of virus infection, focusing on the perspectives of developing heparin mimetics via chemical synthesis, chemoenzymatic synthesis, and bioengineered production by microbial cell factories. The ultimate goal is to pave the eminent need for exploring novel compounds to treat coronavirus infection-caused diseases.
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Affiliation(s)
- Lan Jiang
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210093, China,State Key Laboratory of Bioreactor Engineering, East China University of Science and Technology, Shanghai, 200237, China,Corresponding author. Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210093, China
| | - Tianji Zhang
- Division of Chemistry and Analytical Science, Key Laboratory of Chemical Metrology and Applications on Nutrition and Health for State Market Regulation, National Institute of Metrology, Beijing, 100029, China
| | - Hongzhong Lu
- State Key Laboratory of Microbial Metabolism and School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Saijuan Li
- Glycochemistry & Glycobiology Lab, Key Laboratory of Receptor Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China
| | - Kangjie Lv
- State Key Laboratory of Bioreactor Engineering, East China University of Science and Technology, Shanghai, 200237, China
| | - Alex Tuffour
- State Key Laboratory of Bioreactor Engineering, East China University of Science and Technology, Shanghai, 200237, China
| | - Lixin Zhang
- State Key Laboratory of Bioreactor Engineering, East China University of Science and Technology, Shanghai, 200237, China
| | - Kan Ding
- Glycochemistry & Glycobiology Lab, Key Laboratory of Receptor Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China,Corresponding author
| | - Jin-Ping Li
- International Research Center for Soft Matter, Beijing University of Chemical Technology, Beijing, 100029, China,Department of Medical Biochemistry and Microbiology, University of Uppsala, Uppsala, Sweden
| | - Hongmei Li
- Division of Chemistry and Analytical Science, Key Laboratory of Chemical Metrology and Applications on Nutrition and Health for State Market Regulation, National Institute of Metrology, Beijing, 100029, China
| | - Xueting Liu
- State Key Laboratory of Bioreactor Engineering, East China University of Science and Technology, Shanghai, 200237, China,Corresponding author
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16
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Hogwood J, Gray E, Mulloy B. Heparin, Heparan Sulphate and Sepsis: Potential New Options for Treatment. Pharmaceuticals (Basel) 2023; 16:271. [PMID: 37259415 PMCID: PMC9959362 DOI: 10.3390/ph16020271] [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: 11/25/2022] [Revised: 01/22/2023] [Accepted: 02/07/2023] [Indexed: 08/31/2023] Open
Abstract
Sepsis is a life-threatening hyperreaction to infection in which excessive inflammatory and immune responses cause damage to host tissues and organs. The glycosaminoglycan heparan sulphate (HS) is a major component of the cell surface glycocalyx. Cell surface HS modulates several of the mechanisms involved in sepsis such as pathogen interactions with the host cell and neutrophil recruitment and is a target for the pro-inflammatory enzyme heparanase. Heparin, a close structural relative of HS, is used in medicine as a powerful anticoagulant and antithrombotic. Many studies have shown that heparin can influence the course of sepsis-related processes as a result of its structural similarity to HS, including its strong negative charge. The anticoagulant activity of heparin, however, limits its potential in treatment of inflammatory conditions by introducing the risk of bleeding and other adverse side-effects. As the anticoagulant potency of heparin is largely determined by a single well-defined structural feature, it has been possible to develop heparin derivatives and mimetic compounds with reduced anticoagulant activity. Such heparin mimetics may have potential for use as therapeutic agents in the context of sepsis.
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Affiliation(s)
- John Hogwood
- National Institute for Biological Standards and Control, Blanche Lane, South Mimms EN6 3QG, UK
| | - Elaine Gray
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King’s College London, Stamford St., London SE1 9NH, UK
| | - Barbara Mulloy
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King’s College London, Stamford St., London SE1 9NH, UK
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17
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Chinta S, Rodriguez-Guerra M, Shaban M, Pandey N, Jaquez-Duran M, Vittorio TJ. COVID-19 therapy and vaccination: a clinical narrative review. Drugs Context 2023; 12:dic-2022-7-2. [PMID: 36793450 PMCID: PMC9914077 DOI: 10.7573/dic.2022-7-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/05/2023] [Indexed: 02/08/2023] Open
Abstract
The SARS-CoV-2 pandemic is the most globally impacting health issue our world has faced over the last century. As of January 7, 2022, around 300 million cases have been reported worldwide, with over 5 million deaths. The SARS-CoV-2 infection causes a hyperactive host immune response leading to an excessive inflammatory reaction with the release of many cytokines - cytokine storm - commonly noticed in acute respiratory distress syndrome, sepsis and fulminant multiorgan failure. Since the beginning of the pandemic, the scientific medical community has worked on therapeutic procedures that interfere with the exaggerated immune response. Thromboembolic complications are widespread in patients who are critically ill with COVID-19. Anticoagulant therapy was initially considered a cornerstone in hospitalized patients and even in the early post-discharge period; however, later trials have aborted the clinical benefits except for suspicion of or confirmed thrombosis. Immunomodulatory therapies are still crucial in moderate to severe COVID-19. Immunomodulator therapies include various medications from steroids to hydroxychloroquine, tocilizumab and Anakinra. Anti-inflammatory agents, vitamin supplements and antimicrobial therapy had initial encouraging evidence, but there are limited data to review. Convalescent plasma, immunoglobulins, eculizumab, neutralizing IgG1 monoclonal antibodies and remdesivir have positively impacted inpatient mortality and hospital length of stay. Eventually, wide population vaccination was proven to be the best tool to overcome the SARS-CoV-2 pandemic and help humanity return to regular life. Many vaccines and various strategies have been used since December 2020. This review discusses how the SARS-CoV-2 pandemic has progressed and surged, and summarizes the safety and efficacy of the most used therapies and vaccines in the light of recent evidence.
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Affiliation(s)
- Siddharth Chinta
- Department of Medicine, BronxCare Hospital Center, Icahn School of Medicine at Mt. Sinai, Bronx, NY, USA
| | - Miguel Rodriguez-Guerra
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mohammed Shaban
- Department of Medicine, BronxCare Hospital Center, Icahn School of Medicine at Mt. Sinai, Bronx, NY, USA
| | - Neelanjana Pandey
- Department of Medicine, BronxCare Hospital Center, Icahn School of Medicine at Mt. Sinai, Bronx, NY, USA
| | - Maria Jaquez-Duran
- Department of Medicine, BronxCare Hospital Center, Icahn School of Medicine at Mt. Sinai, Bronx, NY, USA
| | - Timothy J Vittorio
- Division of Cardiology, BronxCare Hospital Center, Icahn School of Medicine at Mt. Sinai, Bronx, NY, USA
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18
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Rizk JG, Gupta A, Lazo JG, Sardar P, Henry BM, Lavie CJ, Effron MB. To Anticoagulate or Not to Anticoagulate in COVID-19: Lessons after 2 Years. Semin Thromb Hemost 2023; 49:62-72. [PMID: 35468641 DOI: 10.1055/s-0042-1744302] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
A hypercoagulable state associated with coronavirus disease 2019 (COVID-19) has been well documented and is believed to be strongly supported by a proinflammatory state. The hypercoagulable state in turn results in increased incidence of arterial and venous thromboembolism (VTE) seen in hospitalized COVID-19 when compared with hospitalized non-COVID-19 patient cohorts. Moreover, patients with arterial or VTE and COVID-19 have higher mortality compared with COVID-19 patients without arterial or VTE. Prevention of arterial or VTE thus remains an essential question in the management of COVID-19 patients, especially because of high rates of reported microvascular and macrovascular thrombosis. This has prompted multiple randomized control trials (RCTs) evaluating different anticoagulation strategies in COVID-19 patients at various stages of the disease. Herein, we review findings from RCTs in the past 2 years of antithrombotic therapy in critically ill hospitalized patients, noncritically ill hospitalized patients, patients postdischarge from the hospital, and outpatients. RCTs in critically ill patients demonstrated therapeutic dose anticoagulation does not improve outcomes and has more bleeding than prophylaxis dose anticoagulant in these patients. Trials in noncritically ill hospitalized patients showed a therapeutic dose anticoagulation with a heparin formulation might improve clinical outcomes. Anticoagulation with a direct oral anticoagulant posthospital discharge may improve outcomes, although there is a large RCT in progress. Nonhospitalized COVID-19 patients have an insufficient burden of events to be candidates for antithrombotic therapy. Anticoagulation in pregnant and lactating patients with COVID-19, as well as antiplatelet therapy for COVID-19, is also reviewed.
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Affiliation(s)
- John G Rizk
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Aashish Gupta
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana
| | - Jose G Lazo
- UCSF Medical Center, University of California, San Francisco, San Francisco, California
| | - Partha Sardar
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana
| | - Brandon Michael Henry
- Cardiac Intensive Care Unit, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Disease Prevention and Intervention & Population Health Programs, Texas Biomedical Research Institute, San Antonio, Texas
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana
| | - Mark B Effron
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana
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19
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Deep Survival Analysis With Clinical Variables for COVID-19. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2023; 11:223-231. [PMID: 36950264 PMCID: PMC10027076 DOI: 10.1109/jtehm.2023.3256966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 01/08/2023] [Accepted: 03/08/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Millions of people have been affected by coronavirus disease 2019 (COVID-19), which has caused millions of deaths around the world. Artificial intelligence (AI) plays an increasing role in all areas of patient care, including prognostics. This paper proposes a novel predictive model based on one dimensional convolutional neural networks (1D CNN) to use clinical variables in predicting the survival outcome of COVID-19 patients. METHODS AND PROCEDURES We have considered two scenarios for survival analysis, 1) uni-variate analysis using the Log-rank test and Kaplan-Meier estimator and 2) combining all clinical variables ([Formula: see text]=44) for predicting the short-term from long-term survival. We considered the random forest (RF) model as a baseline model, comparing to our proposed 1D CNN in predicting survival groups. RESULTS Our experiments using the univariate analysis show that nine clinical variables are significantly associated with the survival outcome with corrected p < 0.05. Our approach of 1D CNN shows a significant improvement in performance metrics compared to the RF and the state-of-the-art techniques (i.e., 1D CNN) in predicting the survival group of patients with COVID-19. CONCLUSION Our model has been tested using clinical variables, where the performance is found promising. The 1D CNN model could be a useful tool for detecting the risk of mortality and developing treatment plans in a timely manner. CLINICAL IMPACT The findings indicate that using both Heparin and Exnox for treatment is typically the most useful factor in predicting a patient's chances of survival from COVID-19. Moreover, our predictive model shows that the combination of AI and clinical data can be applied to point-of-care services through fast-learning healthcare systems.
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Lip GYH, Rigby A, Weber C. A Happy New Year 2023 from Thrombosis and Haemostasis. Thromb Haemost 2023; 123:1-5. [PMID: 36626897 DOI: 10.1055/s-0042-1760264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Anne Rigby
- Institute for Prevention of Cardiovascular Disease , LMU Munich, Munich, Germany
| | - Christian Weber
- Institute for Prevention of Cardiovascular Disease , LMU Munich, Munich, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany.,Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
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21
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Onder AH, Keskin AS, Onder KD, Kizilates F, Heybeli C. Factors associated with development of an acute ischemic event during hospitalization for COVID-19 in cancer and non-cancer patients. Ann Saudi Med 2023; 43:1-9. [PMID: 36739498 PMCID: PMC9899339 DOI: 10.5144/0256-4947.2023.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND COVID-19 and solid cancer are both associated with an increased risk of thromboembolism. OBJECTIVES Assess whether solid cancer is a risk factor for acute ischemic event development among patients with COVID-19. DESIGN Retrospective cohort SETTING: A tertiary training and research hospital PATIENTS AND METHODS: Patients who were hospitalized for COVID-19 for ≥3 days between 15 March 2020 and 30 March 2021 at Antalya Training and Research Hospital, Antalya, Turkiye. were included in the study. Independent predictors of the development of acute ischemic events during hospitalization were determined using multivariable logistic regression analysis. MAIN OUTCOME MEASURES Risk factors for acute ischemic event development. SAMPLE SIZE 538 patients. RESULTS Patients diagnosed with solid cancer comprised 11.3% of the cohort (n=61). Forty-one (7.6%) developed an acute ischemic event at a median of 3 (range, 1-15) days after hospitalization. The presence of a solid cancer (OR 3.80, 95% CI 1.20-12.03, P=.023) along with length of hospital stay (OR 1.05 per day, 95% CI 1.01-1.09, P=.025) were independent predictors of acute ischemic event development during the course of COVID-19. Mortality was reported in 200 (37%) patients at a median of 5 (range, 3-10) days after hospitalization. The presence of solid tumor increased mortality 5.83 times (95% CI 3.19-10.63, P<.001) while this ratio was 4.59 (95% CI 2.29-9.23, P<.001) for patients who experienced an acute ischemic event. CONCLUSION Patients with active cancer carry a significant risk for acute ischemic event development during the course of COVID-19 and such patients may require particular attention in terms of anticoagulation therapy. LIMITATIONS Retrospective design and small sample size. CONFLICT OF INTEREST None.
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Affiliation(s)
- Arif Hakan Onder
- From the Department of Medical Oncology, Antalya Training and Research Hospital, Antalya, Turkiye
| | - Aysegul Seremet Keskin
- From the Department of Infectious Disease and Clinical Microbiology, Antalya Training and Research Hospital, Antalya, Turkiye
| | - Kubra Demir Onder
- From the Department of Infectious Disease and Clinical Microbiology, Antalya Training and Research Hospital, Antalya, Turkiye
| | - Filiz Kizilates
- From the Department of Infectious Diseases and Clinical Microbiology, Health Sciences University, Antalya Training and Research Hospital, Antalya, Turkiye
| | - Cihan Heybeli
- From the Division of Nephrology, Mus State Hospital, Mus, Turkiye
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22
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Said ASA, Hussein RRS, Khalil DM, Fahmy AM, Hassanein AHA, Abdelaty LN. Monotherapy versus polytherapy of enoxaparin and hydroxychloroquine for the treatment of COVID-19: A randomized controlled clinical trial. Pharm Pract (Granada) 2023; 21:2777. [PMID: 37090452 PMCID: PMC10117317 DOI: 10.18549/pharmpract.2023.1.2777] [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: 09/26/2022] [Accepted: 11/03/2022] [Indexed: 04/08/2023] Open
Abstract
Objectives The current study aims to assess the efficacy and safety of Enoxaparin and hydroxychloroquine (HCQ) used as monothrapy or polytherapy versus standard care alone in Coronavirus 2019 (COVID-19) infected patients. Methods The current study included two hundred patients with laboratory confirmed COVID-19 infection. Patients admitted to hospital were randomly allocated into four groups: group I: received standard COVID-19 therapy, group II: received Enoxaparin 40mg/day subcutaneously (SC) plus standard therapy, group III: received 400 mg/day HCQ plus standard therapy & group IV: received a combination of 400 mg/day HCQ and Enoxaparin plus standard COVID-19 therapy. The disease progression was evaluated by duration to a negative polymerase chain reaction (PCR), length of hospital or Intensive Care Unit (ICU) stay, and mortality rate. The safety of treatments was evaluated by measuring adverse effects. Results The length of hospital stay, ICU admission and mortality were significantly decreased in Enoxaparin plus standard COVID-19 therapy group versus other groups. Conclusion These findings suggest that Enoxaparin was safe, effective, and well tolerated and has a role in decreasing the progression of the disease and its complications while HCQ did not discover any evidence of extra therapeutic benefits.
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Affiliation(s)
- Amira S A Said
- PhD. Department of Clinical Pharmacy, College of Pharmacy, Al Ain University, Al Ain, Abu Dhabi, UAE. Department of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Egypt.
| | - Raghda R S Hussein
- PhD. Department of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Egypt. Department of Clinical Pharmacy, Faculty of Pharmacy, October 6 University, Egypt.
| | - Doaa Mahmoud Khalil
- MD. Department of Public Health & Community Medicine, Faculty of Medicine, Beni-Suef University, Egypt.
| | - Alzhraa M Fahmy
- MD. Department of Tropical Medicine & Infectious Diseases, Faculty of Medicine, Beni-Suef University, Egypt.
| | - Ahmed H A Hassanein
- PhD. Phd of Biotechnology, Faculty of Postgraduate Studies for Advanced Science, Beni-Suef University, Egypt.
| | - Lamiaa N Abdelaty
- PhD. Department of Clinical Pharmacy, Faculty of Pharmacy, October 6 University, Egypt.
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Vio R, Giordani AS, Stefil M, Alturki A, Russo V, China P, Gasperetti A, Schiavone M, Čulić V, Biondi-Zoccai G, Themistoclakis S, Lip GY, Proietti R. Therapeutic vs. prophylactic anticoagulation in COVID-19 patients: a systematic review and meta-analysis of real-world studies. Minerva Cardiol Angiol 2022; 70:652-662. [PMID: 36305780 DOI: 10.23736/s2724-5683.22.06230-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Coagulopathy, in the form of either venous or arterial thromboembolism, is one of the most severe sequelae of coronavirus disease (COVID-19) and has been associated with poorer outcomes. However, the role of therapeutic anticoagulation (tAC) or prophylactic anticoagulation (pAC) in COVID-19 patients has not been definitely established. Therefore, the aim of this systematic review and meta-analysis was to gather all the available real-world data in the field and to provide a reliable effect size of the effect on mortality of tAC compared to pAC in COVID-19 patients. EVIDENCE ACQUISITION Real-world studies (RWS) were identified by searching electronic databases from inception to 31st October, 2021. Randomized controlled trials were excluded. Mortality and bleedings were considered as primary and secondary outcomes, respectively. EVIDENCE SYNTHESIS 10 RWS and 5541 patients were included in the analysis. Overall, tAC was associated with lower mortality (HR=0.62, 95% CI: 0.54-0.71). There was asymmetry at the funnel plot suggesting publication bias, that was not confirmed at the Egger test (P=0.07). For the secondary endpoint, there was a non-statistically significant tendency for more bleedings in patients treated with tAC compared to pAC (RR=1.75, 95% CI: 0.81-3.81). CONCLUSIONS Our meta-analysis, based on RWS and adjusted estimates of risk, suggests a survival benefit of tAC over pAC in COVID-19 patients in the real world.
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Affiliation(s)
- Riccardo Vio
- Department of Cardiothoracic, Vascular Medicine and Intensive Care, Dell'Angelo Hospital, Mestre, Venice, Italy -
| | - Andrea S Giordani
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Maria Stefil
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Ahmed Alturki
- Division of Cardiology, McGill University Health Center, Montreal, Canada
| | - Vincenzo Russo
- Department of Medical Translational Sciences, Monaldi Hospital, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Paolo China
- Department of Cardiothoracic, Vascular Medicine and Intensive Care, Dell'Angelo Hospital, Mestre, Venice, Italy
| | - Alessio Gasperetti
- Unit of Cardiology, ASST Fatebenefratelli Sacco-Luigi Sacco University Hospital, Milan, Italy
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marco Schiavone
- Unit of Cardiology, ASST Fatebenefratelli Sacco-Luigi Sacco University Hospital, Milan, Italy
| | - Viktor Čulić
- School of Medicine, University of Split, Split, Croatia
- Department of Cardiology and Angiology, University Hospital Centre Split, Split, Croatia
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Sakis Themistoclakis
- Department of Cardiothoracic, Vascular Medicine and Intensive Care, Dell'Angelo Hospital, Mestre, Venice, Italy
| | - Gregory Y Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Riccardo Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
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24
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Appiah D, Quinn NJ, Messing EG, Veltri KT. Safety and Efficacy Analysis of Apixaban Compared to Heparins in Hospitalized Non-Critically Ill COVID-19 Patients. Hosp Pharm 2022; 57:727-733. [PMID: 36340629 PMCID: PMC9631005 DOI: 10.1177/00185787221095764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
Purpose: Heparin-based regimens are recommended for anticoagulation in hospitalized patients with COVID-19 though a study reported similar mortality with apixaban in critically ill hospitalized COVID-19 patients. Our pilot study sought to determine the differences in all-cause mortality, venous thromboembolism (VTE), and bleeding events between apixaban and therapeutic heparin-based regimens in hospitalized non-critically ill COVID-19 patients. Methods: We conducted a retrospective analysis of non-critically ill COVID-19 patients aged ≥ 18 years admitted to 3 campuses of Montefiore Medical Center during the first (March 2020 to May 2020) and second (January 2021 to February 2021) COVID-19 surges, who received within 48 hours of admission and continued for ≥72 hours a therapeutic dose of low-molecular-weight heparin (LMWH), unfractionated heparin (UFH), or any apixaban dose for VTE prophylaxis. Outcomes data analyzed included mortality, suspected or imaging-confirmed VTE, and bleeding using a defined criteria. Results: Overall, 162 patients met eligibility for analysis. Baseline characteristics were similar between the 2 groups except liver and renal functions. Mortality occurred in 10 (13.3%) patients on apixaban and 23 (26.4%) patients on a heparin-based regimen (P = .059). Confirmed VTE events were not different between the groups (8% vs 13.8%, P = .359), but higher incidence of bleeding occurred in heparin-based group (4% vs 52.9%, P < .001). Conclusion: There were no differences in mortality or confirmed VTE between apixaban and heparin-based regimens except for more bleeding events with the heparins. This study highlights the utility of apixaban in COVID-19.
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Affiliation(s)
- Daniel Appiah
- Roswell Park Comprehensive Cancer
Center, Buffalo, NY, USA
| | | | | | - Keith T. Veltri
- Montefiore Medical Center, Bronx, NY,
USA
- Touro College of Pharmacy, New York,
NY, USA
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Neb H, Talbot SR, Ruskowski K, Brkic D, Sonntagbauer M, Adam EH, von Knethen A, Zacharowski K, Heinicke U. HIGH HEPARANASE LEVEL IN SURVIVORS OF COVID-19 - INDICATOR OF VASCULAR AND PULMONARY RECOVERY? Shock 2022; 58:514-523. [PMID: 36548643 DOI: 10.1097/shk.0000000000002021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ABSTRACT Background: Severe progression of coronavirus disease 2019 (COVID-19) causes respiratory failure and critical illness. Recently, COVID-19 has been associated with heparanase (HPSE)-induced endothelial barrier dysfunction and inflammation, so called endothelitis, and therapeutic treatment with heparin or low-molecular-weight heparin (LMWH) targeting HPSE has been postulated. Because, up to this date, clinicians are unable to measure the severity of endothelitis, which can lead to multiorgan failure and concomitant death, we investigated plasma levels of HPSE and heparin-binding protein (HBP) in COVID-19 intensive care patients to render a possible link between endothelitis and these plasma parameters. Therefore, a prospective prolonged cohort study was conducted, including 47 COVID-19 patients from the intensive care unit. Plasma levels of HPSE, and HBP were measured daily by enzyme-linked immunosorbent assay in survivors (n = 35) and nonsurvivors (n = 12) of COVID-19 from admission until discharge or death. All patients were either treated with heparin or LMWH, aiming for an activated partial thromboplastin time of ≥60 seconds or an anti-Xa level of >0.8 IU/mL using enoxaparin, depending on the clinical status of the patient (patients with extracorporeal membrane oxygenation or >0.1 μg/kg/min noradrenaline received heparin, all others enoxaparin). Results: We found significantly higher plasma levels of HPSE and HBP in survivors and nonsurvivors of COVID-19, compared with healthy controls. Still, interestingly, plasma HPSE levels were significantly higher ( P < 0.001) in survivors compared with nonsurvivors of COVID-19. In contrast, plasma HBP levels were significantly reduced ( P < 0.001) in survivors compared with nonsurvivors of COVID-19. Furthermore, when patients received heparin, they had significantly lower HPSE ( P = 2.22 e - 16) and significantly higher HBP ( P = 0.00013) plasma levels as when they received LMWH. Conclusion: Our results demonstrated that patients, who recover from COVID-19-induced vascular and pulmonary damage and were discharged from the intensive care unit, have significantly higher plasma HPSE level than patients who succumb to COVID-19. Therefore, HPSE is not suitable as marker for disease severity in COVID-19 but maybe as marker for patient's recovery. In addition, patients receiving therapeutic heparin treatment displayed significantly lower heparanse plasma level than upon therapeutic treatment with LMWH.
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Affiliation(s)
- Holger Neb
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Steven R Talbot
- Institute for Laboratory Animal Science, Hannover Medical School, Hannover, Germany
| | - Katharina Ruskowski
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Djurdjina Brkic
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Michael Sonntagbauer
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Elisabeth H Adam
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | | | - Kai Zacharowski
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Ulrike Heinicke
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
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Clinical and laboratory factors associated with mortality among hospitalized patients with COVID-19 infection in Lebanon: A multicenter study. PLoS One 2022; 17:e0278393. [PMID: 36454777 PMCID: PMC9714727 DOI: 10.1371/journal.pone.0278393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/15/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND With the dire economic situation in Lebanon, many of the basic resources of the hospitals needed to help fight COVID-19 infections are not available. In this paper, we studied the possible factors associated with increased mortality in a sample of Lebanese adults enrolled in three hospitals. METHOD In this retrospective cohort study, we analyzed data from 416 adults hospitalized in three institutions for a COVID-19 infection, from the opening of the COVID unit until their closure (period extending from March 2020 to June 2021). We used multivariate analyses to assess potential factors associated with COVID-19 mortality: gender, age, the presence of underlying medical conditions, and some medication taken during hospitalization. RESULTS Using variables related to baseline characteristics entered as independent variables, acute kidney injury (aOR = 4.057) and older age (aOR = 1.053) were associated with a higher probability of death. After adjusting baseline characteristics and factors related to admission entered as independent variables, enoxaparin intake (aOR = 0.435) was significantly associated with a lower probability of death, whereas old age (aOR = 1.049) and ventilation (aOR = 1.2) were significantly associated with higher odds of death. When all variables that showed significance in bivariate analysis were entered, old age (aOR = 1.243) and highest PaCO2 during hospitalization (aOR = 1.192) were significantly associated with higher mortality. With a weak effect, atrial fibrillation, COPD, and higher leucocyte counts on admission were significantly associated with higher odds of death. CONCLUSION These findings could help us prevent severe diseases in patients with several comorbidities and adjust therapeutic care to improve future outcomes. More studies should compare the outcome of different COVID-19 strains as well as the impact of vaccination on those with multiple comorbidities, especially on the mortality rate culminating from disease complications.
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Yu YH, Oh IS, Jeong HE, Platt RW, Douros A, Shin JY, Filion KB. Challenges in evaluating treatments for COVID-19: The case of in-hospital anticoagulant use and the risk of adverse outcomes. Front Pharmacol 2022; 13:1034636. [PMID: 36506517 PMCID: PMC9729259 DOI: 10.3389/fphar.2022.1034636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/10/2022] [Indexed: 11/25/2022] Open
Abstract
Anticoagulants are a potential treatment for the thrombotic complications resulting from COVID-19. We aimed to determine the association between anticoagulant use and adverse outcomes among hospitalized patients with COVID-19. We used data from the COVID-19 International Collaborative Research Project in South Korea from January to June 2020. We defined exposure using an intention-to-treat approach, with person-time classified as use or non-use of anticoagulants at cohort entry, and a time-varying approach. The primary outcome was all-cause, in-hospital mortality; the secondary outcome was a composite including respiratory outcomes, cardiovascular outcomes, venous thromboembolism, major bleeding, and intensive care unit admission. Cox proportional hazards models estimated adjusted hazard ratios (HRs) of the outcomes comparing use versus non-use of anticoagulants. Our cohort included 2,677 hospitalized COVID-19 patients, of whom 24 received anticoagulants at cohort entry. Users were older and had more comorbidities. The crude incidence rate (per 1,000 person-days) of mortality was 5.83 (95% CI: 2.80, 10.72) among anticoagulant users and 1.36 (95% CI: 1.14, 1.59) for non-users. Crude rates of the composite outcome were 3.20 (95% CI: 1.04, 7.47) and 1.80 (95% CI: 1.54, 2.08), respectively. Adjusted HRs for mortality (HR: 1.12, 95% CI: 0.48, 2.64) and the composite outcome (HR: 0.79, 95% CI: 0.28, 2.18) were inconclusive. Although our study was not able to draw conclusions on anticoagulant effectiveness for COVID-19 outcomes, these results can contribute to future knowledge syntheses of this important question. Our study demonstrated that the dynamic pandemic environment may have important implications for observational studies of COVID-19 treatment effectiveness.
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Affiliation(s)
- Ya-Hui Yu
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada,Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| | - In-Sun Oh
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada,Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada,School of Pharmacy Science, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea,Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, Gyeonggi-do, South Kore
| | - Han Eol Jeong
- School of Pharmacy Science, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea,Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, Gyeonggi-do, South Kore
| | - Robert W. Platt
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada,Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada,Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Antonios Douros
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada,Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada,Department of Medicine, McGill University, Montreal, QC, Canada,Institute of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ju-Young Shin
- School of Pharmacy Science, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea,Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, Gyeonggi-do, South Kore,Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Seoul, South Korea
| | - Kristian B. Filion
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada,Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada,Department of Medicine, McGill University, Montreal, QC, Canada,*Correspondence: Kristian B. Filion,
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28
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Shaban M, Elgendy MO, Fahmy AM, Khalil DM, El-Gendy AO, Mahmoud TM, Abdelrahim MEA. The Outcomes of COVID-19 Patients with Spontaneous Intracerebral Hemorrhage Comorbidity and the Efficacy of Enoxaparin in Decreasing the Mortality Rate in Them: Single Egyptian Center Report. J Pers Med 2022; 12:jpm12111822. [PMID: 36579556 PMCID: PMC9699476 DOI: 10.3390/jpm12111822] [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: 09/09/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
Patients with neurological comorbidities are more likely to develop severe COVID-19. We aimed to detect the outcomes of COVID-19 patients with spontaneous intracerebral hemorrhage comorbidity and the role of enoxaparin in decreasing the mortality rate in these cases, even though enoxaparin is a potential cause of intracerebral hemorrhage. The patients were checked on to detect surveillance outcomes, the relationship between mortality and patient characteristics, and the relationship between enoxaparin and study outcomes. Chest condition and GCS improved in 67.9% of participants. Hematoma course increased in 49.1%. Midline-shift, brain-edema, and COVID symptoms improved in 67.9%. There was a non-significant difference in mortality regarding age and gender. There was a significant difference in mortality regarding treatment with enoxaparin; 75% of the patients who did not receive enoxaparin died. 92.6% of the patients who showed decreases in hematoma course were administered enoxaparin. 76.9% of the patients who showed increases in hematoma-course were administered enoxaparin. Most of the patients who were admitted to the neurosurgical unit with spontaneous intracerebral hemorrhage acquired the COVID-19 infection. Most of the cases included in this study did not progress to severe cases. The dying patients showed deterioration in both neurological and COVID-19 symptoms. The anticoagulant properties of enoxaparin given earlier before and throughout the infection can considerably reduce mortality in COVID-19 individuals with spontaneous intracerebral hemorrhage. It is recommended to use enoxaparin for cases with spontaneous intracerebral hemorrhage and COVID-19 regardless of hematoma size because the rate of improvement was greater than the mortality rate after using enoxaparin in this study.
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Affiliation(s)
- Mohamed Shaban
- Neurosurgery Department, Faculty of Medicine, Beni-Suef University, Beni-Suef 62521, Egypt
- Correspondence: (M.S.); (M.O.E.)
| | - Marwa O. Elgendy
- Department of Clinical Pharmacy, Teaching Hospitals of Faculty of Medicine, Faculty of Medicine, Beni-Suef University, Beni-Suef 62521, Egypt
- Department of Clinical Pharmacy, Faculty of Pharmacy, Nahda University (NUB), Beni-Suef 62764, Egypt
- Correspondence: (M.S.); (M.O.E.)
| | - Alzhraa M. Fahmy
- Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Beni-Suef University, Beni-Suef 62521, Egypt
| | - Doaa Mahmoud Khalil
- Public Health and Community Medicine Department, Faculty of Medicine, Beni-Suef University, Beni-Suef 62521, Egypt
| | - Ahmed O. El-Gendy
- Department of Microbiology and Immunology, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62521, Egypt
| | - Tamer M. Mahmoud
- Internal Medicine Department, Faculty of Medicine, Beni-Suef University, Beni-Suef 62521, Egypt
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Alroomi M, Alsaber A, Al-Bader B, Almutairi F, Malhas H, Pan J, Zhanna KD, Ramadhan M, Saleh MA, Abdullah M, Alotaibi N, AlNasrallah N, Rajan R, Hussein S, Aboelhassan W. In-hospital Mortality Rates in SARS-CoV-2 Patients Treated with Enoxaparin and Heparin. Clin Appl Thromb Hemost 2022; 28:10760296221131802. [PMID: 36285386 PMCID: PMC9608030 DOI: 10.1177/10760296221131802] [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: 11/29/2022] Open
Abstract
OBJECTIVES This study aimed to investigate in-hospital mortality rates in patients with coronavirus disease (COVID-19) according to enoxaparin and heparin use. METHODS This retrospective cohort study included 962 patients admitted to two hospitals in Kuwait with a confirmed diagnosis of COVID-19. Cumulative all-cause mortality rate was the primary outcome. RESULTS A total of 302 patients (males, 196 [64.9%]; mean age, 57.2 ± 14.6 years; mean body mass index, 29.8 ± 6.5 kg/m2) received anticoagulation therapy. Patients receiving anticoagulation treatment tended to have pneumonia (n = 275 [91.1%]) or acute respiratory distress syndrome (n = 106 [35.1%]), and high D-dimer levels (median [interquartile range]: 608 [523;707] ng/mL). The mortality rate in this group was high (n = 63 [20.9%]). Multivariable logistic regression, the Cox proportional hazards, and Kaplan-Meier models revealed that the use of therapeutic anticoagulation agents affected the risk of all-cause cumulative mortality. CONCLUSION Age, hypertension, pneumonia, therapeutic anticoagulation, and methylprednisolone use were found to be strong predictors of in-hospital mortality. In elderly hypertensive COVID-19 patients on therapeutic anticoagulation were found to have 2.3 times higher risk of in-hospital mortality. All cause in-hospital mortality rate in the therapeutic anticoagulation group was up to 21%.
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Affiliation(s)
- Moudhi Alroomi
- Department of Infectious Diseases, Infectious Diseases Hospital, Shuwaikh Medical Area, Kuwait
| | - Ahmad Alsaber
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Bader Al-Bader
- Department of Medicine, Farwaniya Hospital, Farwaniya, Kuwait
| | - Farah Almutairi
- Department of Medicine, Farwaniya Hospital, Farwaniya, Kuwait
| | - Haya Malhas
- Department of Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Jiazhu Pan
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Kobalava D. Zhanna
- Department of Internal Medicine with the Subspecialty of Cardiology and Functional Diagnostics Named after V.S. Moiseev, Institute of Medicine, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russian Federation
| | - Maryam Ramadhan
- Department of Obstetrics and Gynaecology, Maternity Hospital, Shuwaikh Medical Area, Kuwait
| | | | - Mohammed Abdullah
- Department of Infectious Diseases, Infectious Diseases Hospital, Shuwaikh Medical Area, Kuwait
| | - Naser Alotaibi
- Department of Medicine, Al Adan Hospital, Hadiya, Kuwait
| | | | - Rajesh Rajan
- Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Al Amiri Hospital, Kuwait City, Kuwait,Rajesh Rajan, Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Al Amiri Hospital, Kuwait City, Kuwait, 15003.
| | - Soumoud Hussein
- Department of Medicine, Al Amiri Hospital, Kuwait City, Kuwait
| | - Wael Aboelhassan
- Division of Gastroenterology, Department of Medicine, Jaber Al Ahmed Hospital, South Surra, Kuwait
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Domínguez-Olmedo JL, Gragera-Martínez Á, Mata J, Pachón V. Age-Stratified Analysis of COVID-19 Outcome Using Machine Learning Predictive Models. Healthcare (Basel) 2022; 10:healthcare10102027. [PMID: 36292474 PMCID: PMC9601713 DOI: 10.3390/healthcare10102027] [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: 09/20/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 11/04/2022] Open
Abstract
Since the emergence of COVID-19, most health systems around the world have experienced a series of spikes in the number of infected patients, leading to collapse of the health systems in many countries. The use of clinical laboratory tests can serve as a discriminatory method for disease severity, defining the profile of patients with a higher risk of mortality. In this paper, we study the results of applying predictive models to data regarding COVID-19 outcome, using three datasets after age stratification of patients. The extreme gradient boosting (XGBoost) algorithm was employed as the predictive method, yielding excellent results. The area under the receiving operator characteristic curve (AUROC) value was 0.97 for the subgroup of patients up to 65 years of age. In addition, SHAP (Shapley additive explanations) was used to analyze the feature importance in the resulting models.
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Affiliation(s)
- Juan L. Domínguez-Olmedo
- I2C Research Group, Higher Technical School of Engineering, University of Huelva, 21007 Huelva, Spain
- Research Center for Technology, Energy and Sustainability (CITES), University of Huelva, 21007 Huelva, Spain
- Correspondence:
| | | | - Jacinto Mata
- I2C Research Group, Higher Technical School of Engineering, University of Huelva, 21007 Huelva, Spain
- Research Center for Technology, Energy and Sustainability (CITES), University of Huelva, 21007 Huelva, Spain
| | - Victoria Pachón
- I2C Research Group, Higher Technical School of Engineering, University of Huelva, 21007 Huelva, Spain
- Research Center for Technology, Energy and Sustainability (CITES), University of Huelva, 21007 Huelva, Spain
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Spyropoulos AC, Connors JM, Douketis JD, Goldin M, Hunt BJ, Kotila TR, Lopes RD, Schulman S. Good practice statements for antithrombotic therapy in the management of COVID-19: Guidance from the SSC of the ISTH. J Thromb Haemost 2022; 20:2226-2236. [PMID: 35906715 PMCID: PMC9349985 DOI: 10.1111/jth.15809] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/14/2022] [Accepted: 07/05/2022] [Indexed: 12/30/2022]
Abstract
Despite the emergence of high quality randomized trial data with the use of antithrombotic agents to reduce the risk of thromboembolism, end-organ failure, and possibly mortality in patients with coronavirus disease 2019 (COVID-19), questions still remain as to optimal patient selection for these strategies, the use of antithrombotics in outpatient settings and in-hospital settings (including critical care units), thromboprophylaxis in special patient populations, and the management of acute thrombosis in hospitalized COVID-19 patients. In October 2021, the International Society on Thrombosis and Haemostasis (ISTH) formed a multidisciplinary and international panel of content experts, two patient representatives, and a methodologist to develop recommendations on treatment with anticoagulants and antiplatelet agents for COVID-19 patients. The ISTH Guideline panel discussed additional topics to be well suited to a non-Grading of Recommendations Assessment, Development, and Evaluation (GRADE) for Good Practice Statements (GPS) to support good clinical care in the antithrombotic management of COVID-19 patients in various clinical settings. The GPS panel agreed on 17 GPS: 3 in the outpatient (pre-hospital) setting, 12 in the hospital setting both in non-critical care (ward) as well as intensive care unit settings, and 2 in the immediate post-hospital discharge setting based on limited evidence or expert opinion that supports net clinical benefit in enacting the statements provided. The antithrombotic therapies discussed in these GPS should be available in low- and middle-income countries.
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Affiliation(s)
- Alex C Spyropoulos
- Institute of Health Systems Science-Feinstein Institutes for Medical Research, Manhasset, New York, USA
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hemptead, New York, USA
- Department of Medicine, Anticoagulation and Clinical Thrombosis Services, Northwell Health at Lenox Hill Hospital, New York, New York, USA
| | - Jean M Connors
- Hematology Division Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - James D Douketis
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Mark Goldin
- Institute of Health Systems Science-Feinstein Institutes for Medical Research, Manhasset, New York, USA
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hemptead, New York, USA
| | - Beverley J Hunt
- Thrombosis & Haemophilia Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Taiwo R Kotila
- Department of Haematology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Renato D Lopes
- Duke University Medical Center, Duke Clinical Research Institute, Department of Medicine, Division of Cardiology, Durham, North Carolina, USA
- Brazilian Clinical Research Institute, Sao Paulo, Brazil
| | - Sam Schulman
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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Incidence, risk factors, and clinical impact of major bleeding in hospitalized patients with COVID-19: a sub-analysis of the CLOT-COVID Study. Thromb J 2022; 20:53. [PMID: 36127738 PMCID: PMC9485792 DOI: 10.1186/s12959-022-00414-x] [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: 04/26/2022] [Accepted: 08/07/2022] [Indexed: 11/10/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) causes extensive coagulopathy and a potential benefit of anticoagulation therapy has been documented for prevention of thromboembolic events. Bleeding events has also been reported as a notable complication; whereas, the incidence, risks, and clinical impact of bleeding remain unclear. Method The CLOT-COVID Study was a nationwide, retrospective, multicenter cohort study on consecutive hospitalized patients with COVID-19 in Japan between April 2021 and September 2021. In this sub-analysis, we compared the characteristics of patients with and without major bleeding; moreover, we examined the risk factors for and clinical impact of bleeding events. Results Among 2882 patients with COVID-19, 57 (2.0%) had major bleeding. The incidence of major bleeding increased with COVID-19 severity as follows: 0.5%, 2.3%, and 12.3% in patients with mild, moderate, and severe COVID-19, respectively. COVID-19 severity, history of major bleeding, and anticoagulant type/dose were independently and additively associated with the bleeding incidence. Compared with patients without major bleeding, those with major bleeding exhibited a longer duration of hospitalization (9 [6–14] vs 28 [19–43] days, P < 0.001) and higher mortality during hospitalization (4.9% vs. 35.1%, P < 0.001). Conclusions In the real-world clinical practice, the incidence of major bleeding was not uncommon, especially in patients with severe COVID-19. Independent risk factors for major bleeding included history of major bleeding, COVID-19 severity, and anticoagulant use, which could be associated with poor clinical outcomes including higher mortality. Precise recognition of the risks for bleeding may be helpful for an optimal use of anticoagulants and for better outcomes in patients with COVID-19.
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Yi J, Miao J, Zuo Q, Owusu F, Dong Q, Lin P, Wang Q, Gao R, Kong X, Yang L. COVID-19 pandemic: A multidisciplinary perspective on the pathogenesis of a novel coronavirus from infection, immunity and pathological responses. Front Immunol 2022; 13:978619. [PMID: 36091053 PMCID: PMC9459044 DOI: 10.3389/fimmu.2022.978619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 08/04/2022] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus2 (SARS-CoV-2), has spread to more than 200 countries and regions, having a huge impact on human health, hygiene, and economic activities. The epidemiological and clinical phenotypes of COVID-19 have increased since the onset of the epidemic era, and studies into its pathogenic mechanisms have played an essential role in clinical treatment, drug development, and prognosis prevention. This paper reviews the research progress on the pathogenesis of the novel coronavirus (SARS-CoV-2), focusing on the pathogenic characteristics, loci of action, and pathogenic mechanisms leading to immune response malfunction of SARS-CoV-2, as well as summarizing the pathological damage and pathological manifestations it causes. This will update researchers on the latest SARS-CoV-2 research and provide directions for future therapeutic drug development.
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Affiliation(s)
- Jia Yi
- College of Traditional Chinese medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jiameng Miao
- College of Traditional Chinese medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Qingwei Zuo
- Research Center for Infectious Diseases, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Felix Owusu
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Qiutong Dong
- College of Traditional Chinese medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Peizhe Lin
- College of Traditional Chinese medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Qilong Wang
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Rui Gao
- Institute of Clinical Pharmacology of Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xianbin Kong
- College of Traditional Chinese medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Long Yang
- Research Center for Infectious Diseases, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Sapir T, Averch Z, Lerman B, Bodzin A, Fishman Y, Maitra R. COVID-19 and the Immune Response: A Multi-Phasic Approach to the Treatment of COVID-19. Int J Mol Sci 2022; 23:ijms23158606. [PMID: 35955740 PMCID: PMC9369212 DOI: 10.3390/ijms23158606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 07/30/2022] [Accepted: 07/30/2022] [Indexed: 12/10/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a viral agent that causes Coronavirus disease 2019 (COVID-19), a disease that causes flu-like symptoms that, when exacerbated, can have life-threatening consequences. COVID-19 has been linked to persistent symptoms, sequelae, and medical complications that can last months after the initial infection. This systematic review aims to elucidate the innate and adaptive immune mechanisms involved and identify potential characteristics of COVID-19 pathology that may increase symptom duration. We also describe he three different stages of COVID-19—viral replication, immune hyperactivation, and post-acute sequelae—as well as each phase’s corresponding immune response. Finally, we use this multiphasic approach to describe different treatment approaches for each of the three stages—antivirals, immunosuppressants and monoclonal antibodies, and continued immunosuppressants—to fully curate the treatment to the stage of disease.
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Abstract
Patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are prone to venous, cerebrovascular, and coronary thrombi, particularly those with severe coronavirus disease 2019 (COVID-19). The pathogenesis is multifactorial and likely involves proinflammatory cascades, development of coagulopathy, and neutrophil extracellular traps, although further investigations are needed. Elevated levels of D-dimers are common in patients with COVID-19 and cannot be used in isolation to predict venous thromboembolism in people with SARS-CoV-2. If given early in hospital admission, therapeutic-dose heparin improves clinical outcomes in patients with moderate COVID-19. To date, antithrombotics have not improved outcomes in patients with severe COVID-19.
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Affiliation(s)
- Derek V Gibbs
- Division of General Internal Medicine, Department of Medicine, University of Cincinnati School of Medicine, 231 Albert Sabin Way, MSB 6065, Cincinnati, OH 45267, USA
| | - Satya S Shreenivas
- Division of Cardiology, The Christ Hospital, 2139 Auburn Avenue, Cincinnati, OH 45219, USA
| | - Kristin M Hudock
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, University of Cincinnati School of Medicine, 231 Albert Sabin Way, MSB 6053, Cincinnati, OH 45267, USA; Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
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36
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Andersen KM, Joseph CS, Mehta HB, Streiff MB, Betz JF, Bollinger RC, Fisher AM, Gupta A, LeMaistre CF, Robinson ML, Xu Y, Ng DK, Alexander GC, Garibaldi BT. Thromboprophylaxis in people hospitalized with COVID-19: Assessing intermediate or standard doses in a retrospective cohort study. Res Pract Thromb Haemost 2022; 6:e12753. [PMID: 35859579 PMCID: PMC9287673 DOI: 10.1002/rth2.12753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/09/2022] [Accepted: 05/27/2022] [Indexed: 11/08/2022] Open
Abstract
Background and Objectives Current clinical guidelines recommend thromboprophylaxis for adults hospitalized with coronavirus disease 2019 (COVID-19), yet it is unknown whether higher doses of thromboprophylaxis offer benefits beyond standard doses. Methods We studied electronic health records from 50 091 adults hospitalized with COVID-19 in the United States between February 2020 and February 2021. We compared standard (enoxaparin 30 or 40 mg/day, fondaparinux 2.5 mg, or heparin 5000 units twice or thrice per day) versus intermediate (enoxaparin 30 or 40 mg twice daily, or up to 1.2 mg/kg of body weight daily, heparin 7500 units thrice per day or heparin 10 000 units twice or thrice per day) thromboprophylaxis. We separately examined risk of escalation to therapeutic anticoagulation, severe disease (first occurrence of high-flow nasal cannula, noninvasive positive pressure ventilation or invasive mechanical ventilation), and death. To summarize risk, we present hazard ratios (HRs) with 95% confidence intervals (CIs) using adjusted time-dependent Cox proportional hazards regression models. Results People whose first dose was high intensity were younger, more often obese, and had greater oxygen support requirements. Intermediate dose thromboprophylaxis was associated with increased risk of therapeutic anticoagulation (HR, 3.39; 95% CI, 3.22-3.57), severe disease (HR, 1.22; 95% CI, 1.17-1.28), and death (HR, 1.37; 95% CI, 1.21-1.55). Increased risks associated with intermediate-dose thromboprophylaxis persisted in subgroup and sensitivity analyses varying populations and definitions of exposures, outcomes, and covariates. Conclusions Our findings do not support routine use of intermediate-dose thromboprophylaxis to prevent clinical worsening, severe disease, or death among adults hospitalized with COVID-19.
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Affiliation(s)
- Kathleen M Andersen
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA.,Center for Drug Safety and Effectiveness Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Corey S Joseph
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA.,Center for Drug Safety and Effectiveness Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Hemalkumar B Mehta
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA.,Center for Drug Safety and Effectiveness Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Michael B Streiff
- Division of Hematology Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Joshua F Betz
- Department of Biostatistics Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Robert C Bollinger
- Division of Infectious Diseases Johns Hopkins University School of Medicine Baltimore Maryland USA.,Center for Clinical Global Health Education Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Arielle M Fisher
- Sarah Cannon, Genospace, HCA Healthcare Research Institute Nashville Tennessee USA
| | - Amita Gupta
- Division of Infectious Diseases Johns Hopkins University School of Medicine Baltimore Maryland USA.,Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Charles F LeMaistre
- Sarah Cannon, Genospace, HCA Healthcare Research Institute Nashville Tennessee USA
| | - Matthew L Robinson
- Division of Infectious Diseases Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Yanxun Xu
- Department of Applied Mathematics and Statistics Johns Hopkins University Baltimore Maryland USA
| | - Derek K Ng
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - G Caleb Alexander
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA.,Center for Drug Safety and Effectiveness Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA.,Division of General Internal Medicine Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Brian T Garibaldi
- Division of Pulmonary and Critical Care Medicine Johns Hopkins University School of Medicine Baltimore Maryland USA
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Eman A, Balaban O, Süner KÖ, Cırdı Y, Şahin F, Demir G, Pekşen Ö, Musmul A, Erdem AF. The effect of low-dose and high-dose low-molecular-weight-heparin and aspirin thromboprophylaxis on clinical outcome and mortality in critical ill patients with COVID-19: A retrospective cohort study. Saudi Med J 2022; 43:715-722. [PMID: 35830988 PMCID: PMC9749692 DOI: 10.15537/smj.2022.43.7.20220038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/28/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To assess the effect of different thromboprophylaxis regimens on clinical outcomes and mortality of critical ill patients with coronavirus disease -19 (COVID-19). METHODS We investigated the medical records of patients with positive COVID-19 (using polymerase chain reaction test) who were admitted to the intensive care unit (ICU) at Sakarya University Hospital, Sakarya, Turkey, from March 2020 to January 2021. We included patients under anticoagulant therapy in the clinical course. The patients were allocated to 3 groups: Group A - low-dose (prophylactic) low-molecular-weight-heparin (LMWH) therapy, Group B - high-dose (therapeutic) LMWH therapy, and patients that received aspirin additional to the high-dose (therapeutic) LMWH as Group C. Primary outcomes were overall mortality rates and length of stay (LOS) in ICU. Secondary outcomes were rates of major hemorrhagic and thrombotic events. RESULTS Records of 475 patients were reviewed and 164 patients were included. No significant difference was detected in mortality rates between groups (p=0.135). Intensive care unit stay was 13 (9-24.5) days in Group A, 11 (8.75-23) days in Group B, and 13 (9-17) days in Group C without a significant difference (p=0.547). No significant difference was detected between groups in terms of thrombotic (p=0.565) and hemorrhagic events (p=0.615). CONCLUSION A high-dose anticoagulation therapy and addition of aspirin to LMWH therapy did not decrease the mortality rates and LOS in ICU in critical ill COVİD-19 patients. In addition, it did not increase the incidence of major hemorrhage and major thrombotic events.
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Affiliation(s)
- Ali Eman
- From the Department of Anesthesiology and Reanimation (Eman, Balaban, Şahin, Demir, Pekşen, Erdem); from the Department of Intensive Care (Süner), Sakarya Training and Research Hospital; from the Department of Intensive Care (Cırdı), faculty of Medicine, Sakarya University, Sakarya; and from the Department of Medical Services and Techniques (Musmul), Eskisehir Osmangazi University Vocational School of Health Services, Eskisehir, Turkey
| | - Onur Balaban
- From the Department of Anesthesiology and Reanimation (Eman, Balaban, Şahin, Demir, Pekşen, Erdem); from the Department of Intensive Care (Süner), Sakarya Training and Research Hospital; from the Department of Intensive Care (Cırdı), faculty of Medicine, Sakarya University, Sakarya; and from the Department of Medical Services and Techniques (Musmul), Eskisehir Osmangazi University Vocational School of Health Services, Eskisehir, Turkey
| | - Kezban Ö. Süner
- From the Department of Anesthesiology and Reanimation (Eman, Balaban, Şahin, Demir, Pekşen, Erdem); from the Department of Intensive Care (Süner), Sakarya Training and Research Hospital; from the Department of Intensive Care (Cırdı), faculty of Medicine, Sakarya University, Sakarya; and from the Department of Medical Services and Techniques (Musmul), Eskisehir Osmangazi University Vocational School of Health Services, Eskisehir, Turkey
| | - Yaşar Cırdı
- From the Department of Anesthesiology and Reanimation (Eman, Balaban, Şahin, Demir, Pekşen, Erdem); from the Department of Intensive Care (Süner), Sakarya Training and Research Hospital; from the Department of Intensive Care (Cırdı), faculty of Medicine, Sakarya University, Sakarya; and from the Department of Medical Services and Techniques (Musmul), Eskisehir Osmangazi University Vocational School of Health Services, Eskisehir, Turkey
| | - Fatih Şahin
- From the Department of Anesthesiology and Reanimation (Eman, Balaban, Şahin, Demir, Pekşen, Erdem); from the Department of Intensive Care (Süner), Sakarya Training and Research Hospital; from the Department of Intensive Care (Cırdı), faculty of Medicine, Sakarya University, Sakarya; and from the Department of Medical Services and Techniques (Musmul), Eskisehir Osmangazi University Vocational School of Health Services, Eskisehir, Turkey
- Address correspondence and reprint request to: Dr. Fatih Şahin, Department of Anesthesiology and Reanimation, Sakarya University Training and Research Hospital, Sakarya, Turkey. E-mail: ORCID ID: https://orcid.org/0000-0002-8501-0675
| | - Gürkan Demir
- From the Department of Anesthesiology and Reanimation (Eman, Balaban, Şahin, Demir, Pekşen, Erdem); from the Department of Intensive Care (Süner), Sakarya Training and Research Hospital; from the Department of Intensive Care (Cırdı), faculty of Medicine, Sakarya University, Sakarya; and from the Department of Medical Services and Techniques (Musmul), Eskisehir Osmangazi University Vocational School of Health Services, Eskisehir, Turkey
| | - Özge Pekşen
- From the Department of Anesthesiology and Reanimation (Eman, Balaban, Şahin, Demir, Pekşen, Erdem); from the Department of Intensive Care (Süner), Sakarya Training and Research Hospital; from the Department of Intensive Care (Cırdı), faculty of Medicine, Sakarya University, Sakarya; and from the Department of Medical Services and Techniques (Musmul), Eskisehir Osmangazi University Vocational School of Health Services, Eskisehir, Turkey
| | - Ahmet Musmul
- From the Department of Anesthesiology and Reanimation (Eman, Balaban, Şahin, Demir, Pekşen, Erdem); from the Department of Intensive Care (Süner), Sakarya Training and Research Hospital; from the Department of Intensive Care (Cırdı), faculty of Medicine, Sakarya University, Sakarya; and from the Department of Medical Services and Techniques (Musmul), Eskisehir Osmangazi University Vocational School of Health Services, Eskisehir, Turkey
| | - Ali F. Erdem
- From the Department of Anesthesiology and Reanimation (Eman, Balaban, Şahin, Demir, Pekşen, Erdem); from the Department of Intensive Care (Süner), Sakarya Training and Research Hospital; from the Department of Intensive Care (Cırdı), faculty of Medicine, Sakarya University, Sakarya; and from the Department of Medical Services and Techniques (Musmul), Eskisehir Osmangazi University Vocational School of Health Services, Eskisehir, Turkey
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Tandayam A, Syed MHN, Kumar G. Pathophysiology and Management of Hypercoagulation in Infectious Diseases. JOURNAL OF CARDIAC CRITICAL CARE TSS 2022. [DOI: 10.1055/s-0042-1757370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AbstractNumerous systemic infections may have hypercoagulation as one of the complications, which may range from asymptomatic presentation of elevation of biochemical markers of coagulation such as that of fibrin and thrombin generation, to a much severe, symptomatic, life-threatening, disseminated intravascular coagulation (DIC), which results in the formation of thrombi in the microvasculature of various organs. This phenomenon contributes to increase in morbidity and mortality in various infectious diseases. The current review discusses various mechanisms of hypercoagulation during infections such as tissue factor activation, endothelial cell activation, inhibition of physiological anticoagulant pathways, and fibrinolysis inhibition. The review also discusses pathophysiological changes in the coagulation system and its management in the recent pandemic of COVID-19. The article also discusses role of various parenteral and oral anticoagulants in the management of infectious diseases. The review provides clinical data on various anticoagulants used during hospitalization and extended prophylaxis for the management of venous thromboembolism in various infections.
Methodology Because this is a review of published literature and no humans or animals were involved, ethical committee approval was not required and patient consent was not required.
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Affiliation(s)
- Abhishek Tandayam
- Medical Affairs Department, Dr Reddy's Laboratories, Hyderabad, India
| | | | - Gaurav Kumar
- Medical Affairs Department, Dr Reddy's Laboratories, Hyderabad, India
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Factors Associated with Length of Hospital Stay among COVID-19 Patients in Saudi Arabia: A Retrospective Study during the First Pandemic Wave. Healthcare (Basel) 2022; 10:healthcare10071201. [PMID: 35885728 PMCID: PMC9316254 DOI: 10.3390/healthcare10071201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 12/14/2022] Open
Abstract
The COVID-19 pandemic severely affected healthcare systems and tested their preparedness. To date, the length of hospital stay (LoHS) and its factors among COVID-19 patients has not been thoroughly studied. Moreover, it is essential to identify the features of these patients. Adult COVID-19 patients in Saudi Arabia with complete electronic medical records and who were hospitalised for >1 day between 1 May 2020 and 30 July 2020 at one of two hospitals were considered for this retrospective cohort study. Descriptive statistics and multivariate generalized linear models were performed using the data. Of the patients, 34% were ≥50 years old and 80.14% were female. More than 70% had mild-to-moderate symptoms; 45% had either diabetes or hypertension. The median LoHS was 7.00 days (IQR: 3−11). Patients who were females, had either critical or severe disease, were on mechanical ventilation, had diabetes, and administered ceftriaxone had significantly longer LoHS (p < 0.05). Patients administered zinc sulphate had significantly shorter LoHS (p = 0.0008). During the first pandemic wave, COVID-19 patients were hospitalised for 7 days. Healthcare professionals should pay more attention to women, patients with diabetes, and those with severe or critical symptoms. Unnecessary use of ceftriaxone should be minimised, and zinc sulphate can be administered.
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Volteas P, Drakos P, Alkadaa LN, Cleri NA, Asencio AA, Oganov A, Giannopoulos S, Saadon JR, Mikell CB, Rubano JA, Labropoulos N, Tassiopoulos AK, Mofakham S, Bannazadeh M. Low-Molecular-Weight Heparin Compared to Unfractionated Heparin in Critically Ill COVID-19 Patients. J Vasc Surg Venous Lymphat Disord 2022; 10:1128-1136. [PMID: 35716998 PMCID: PMC9212478 DOI: 10.1016/j.jvsv.2022.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/05/2022] [Accepted: 04/26/2022] [Indexed: 11/30/2022]
Abstract
Background Thrombosis in COVID-19 worsens mortality. In our study, we sought to investigate how the dose and type of anticoagulation (AC) can influence patient outcomes. Methods This is a single-center retrospective analysis of critically ill intubated patients with COVID-19, comparing low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) at therapeutic and prophylactic doses. Of 218 patients, 135 received LMWH (70 prophylactic, 65 therapeutic) and 83 UFH (11 prophylactic, 72 therapeutic). The primary outcome was mortality. Secondary outcomes were thromboembolic complications confirmed on imaging and major bleeding complications. Cox proportional-hazards regression models were used to determine whether the type and dose of AC were independent predictors of survival. We performed Kaplan-Meier survival analysis to compare the cumulative survivals. Results Overall, therapeutic AC, with either LMWH (65% vs 79%, P = .09) or UFH (32% vs 46%, P = .73), conveyed no survival benefit over prophylactic AC. UFH was associated with a higher mortality rate than LMWH (66% vs 28%, P = .001), which was also evident in the multivariable analysis (LMWH vs UFH mortality, hazard ratio: 0.47, P = .001) and in the Kaplan-Meier survival analysis. Thrombotic and bleeding complications did not depend on the AC type (prophylactic LMWH vs UFH: thrombosis P = .49, bleeding P = .075; therapeutic LMWH vs UFH: thrombosis P = .5, bleeding P = .17). When comparing prophylactic with therapeutic AC, the rate of both thrombotic and bleeding complications was higher with the use of LMWH compared with UFH. In addition, transfusion requirements were significantly higher with both therapeutic LMWH and UFH. Conclusions Among intubated critically ill COVID-19 intensive care unit patients, therapeutic AC, with either LMWH or UFH, conveyed no survival benefit over prophylactic AC. AC with LMWH was associated with higher cumulative survival compared with AC with UFH.
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Affiliation(s)
- Panagiotis Volteas
- Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Panagiotis Drakos
- Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Leor N Alkadaa
- Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Nathaniel A Cleri
- Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Anthony A Asencio
- Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Anthony Oganov
- Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Stefanos Giannopoulos
- Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA; Division of Vascular Surgery, Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Jordan R Saadon
- Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Charles B Mikell
- Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Jerry A Rubano
- Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Nicos Labropoulos
- Division of Vascular Surgery, Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Apostolos K Tassiopoulos
- Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA; Division of Vascular Surgery, Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Sima Mofakham
- Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, USA.
| | - Mohsen Bannazadeh
- Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA; Division of Vascular Surgery, Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA.
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Caird R, Williamson M, Yusuf A, Gogoi D, Casey M, McElvaney NG, Reeves EP. Targeting of Glycosaminoglycans in Genetic and Inflammatory Airway Disease. Int J Mol Sci 2022; 23:ijms23126400. [PMID: 35742845 PMCID: PMC9224208 DOI: 10.3390/ijms23126400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/02/2022] [Accepted: 06/05/2022] [Indexed: 12/10/2022] Open
Abstract
In the lung, glycosaminoglycans (GAGs) are dispersed in the extracellular matrix (ECM) occupying the interstitial space between the capillary endothelium and the alveolar epithelium, in the sub-epithelial tissue and in airway secretions. In addition to playing key structural roles, GAGs contribute to a number of physiologic processes ranging from cell differentiation, cell adhesion and wound healing. Cytokine and chemokine–GAG interactions are also involved in presentation of inflammatory molecules to respective receptors leading to immune cell migration and airway infiltration. More recently, pathophysiological roles of GAGs have been described. This review aims to discuss the biological roles and molecular interactions of GAGs, and their impact in the pathology of chronic airway diseases, such as cystic fibrosis and chronic obstructive pulmonary disease. Moreover, the role of GAGs in respiratory disease has been heightened by the current COVID-19 pandemic. This review underlines the essential need for continued research aimed at exploring the contribution of GAGs in the development of inflammation, to provide a better understanding of their biological impact, as well as leads in the development of new therapeutic agents.
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Silva BRO, Rodrigues WF, Abadia DGP, Alves da Silva DA, Andrade e Silva LE, Desidério CS, Farnesi-de-Assunção TS, Costa-Madeira JC, Barbosa RM, Bernardes e Borges AV, Hortolani Cunha ACC, Pereira LQ, Helmo FR, Lemes MR, Barbosa LM, Trevisan RO, Obata MMS, Bueno GF, Mundim FV, Oliveira-Scussel ACM, Monteiro IB, Ferreira YM, Machado GH, Ferreira-Paim K, Moraes-Souza H, da Silva MV, Rodrigues Júnior V, Oliveira CJF. Clinical-Epidemiology Aspect of Inpatients With Moderate or Severe COVID-19 in a Brazilian Macroregion: Disease and Countermeasures. Front Cell Infect Microbiol 2022; 12:899702. [PMID: 35669120 PMCID: PMC9164138 DOI: 10.3389/fcimb.2022.899702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
COVID-19, also known as coronavirus disease 2019, is an infectious viral disease caused by SARS-CoV-2, a novel coronavirus. Since its emergence, its epidemiology has been explored; however, for some regions of the world, COVID-19’s behavior, incidence, and impact remain unclear. In continental nations like Brazil, this lack of knowledge results in nonuniform control, prevention, and treatment measures, which can be controversial in some locations. This study aimed to describe the epidemiological profile of patients with COVID-19 in the macroregion of Triângulo Sul in the state of Minas Gerais (MG), Brazil. Between March 25 and October 21, 2020, data were collected and statistically analyzed from 395 hospitalized patients in the city of Uberaba, MG, suspected to have moderate or severe forms of the disease. Of the 395 suspected cases, 82% were confirmed to be positive for COVID-19. The mean age of positive patients was 58.4 years, and 60.76% were male. Following these patients throughout their hospitalization, a mortality rate of 31.3% was observed. In the population positive for COVID-19, the risk of death increased by 4% for each year of the patient’s age. Likewise, the older the patient, the longer their hospitalization and the higher the risk of developing acute respiratory failure. Among the treatments tested in patients, heparin was associated with protection against mortality, and the absence of anticoagulant use was linked to a more than six times greater risk of death. Finally, comorbidities in patients with COVID-19 were positively correlated with increased hospitalization time. In summary, this study revealed that age, presence of comorbidities, length of hospitalization, and drug treatment considerably altered COVID-19’s lethality. To understand infection rates and the factors involved in COVID-19’s lethality, knowledge of the local epidemiology is necessary.
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Affiliation(s)
| | - Wellington Francisco Rodrigues
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba, Brazil
- *Correspondence: Wellington Francisco Rodrigues,
| | - Daniela Gomes Pires Abadia
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Djalma A. Alves da Silva
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Leonardo E. Andrade e Silva
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Chamberttan S. Desidério
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | | | - Juliana C. Costa-Madeira
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Rafaela M. Barbosa
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Anna V. Bernardes e Borges
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | | | - Loren Q. Pereira
- Laboratory of Hematological Research of the Federal University of Triângulo Mineiro and Regional Blood Center of Uberaba - Hemominas Foundation, Uberaba, Brazil
| | - Fernanda R. Helmo
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Marcela Rezende Lemes
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Laís M. Barbosa
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Rafael O. Trevisan
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Malu Mateus Santos Obata
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Giovanna F. Bueno
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Fabiano V. Mundim
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | | | - Ivan B. Monteiro
- UNIMED São Domingos Hospital, Uberaba, MG, Brazil. José Alencar Gomes da Silva Regional Hospital, Uberaba, Brazil
- José Alencar Gomes da Silva Regional Hospital, Uberaba, Brazil
| | | | | | - Kennio Ferreira-Paim
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Hélio Moraes-Souza
- Laboratory of Hematological Research of the Federal University of Triângulo Mineiro and Regional Blood Center of Uberaba - Hemominas Foundation, Uberaba, Brazil
| | - Marcos Vinicius da Silva
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Virmondes Rodrigues Júnior
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Carlo José Freire Oliveira
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba, Brazil
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Guaní-Guerra E, Torres-Murillo B, Muñoz-Corona C, Rodríguez-Jiménez JC, Macías AE, Scavo-Montes DA, Alvarez JA. Diagnostic Accuracy of the RDW for Predicting Death in COVID-19. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58050613. [PMID: 35630030 PMCID: PMC9144906 DOI: 10.3390/medicina58050613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/15/2022] [Accepted: 04/17/2022] [Indexed: 01/10/2023]
Abstract
Background and Objectives: An association between high red blood cell distribution width (RDW) and mortality has been found in several diseases, including infection and sepsis. Some studies have aimed at determining the association of elevated RDW with adverse prognosis in COVID-19, but its usefulness has not been well established. The objective of this study was to determine the accuracy of the RDW, measured at hospital admission and discharge, for predicting death in patients with COVID-19. Materials andMethods: An observational, retrospective, longitudinal, and analytical study was conducted in two different COVID-19 reference centers in the state of Guanajuato, Mexico. A total of 323 patients hospitalized by COVID-19 were included. Results: We found higher RDW levels at the time of hospital admission in the non-survivors group compared to levels in survivors (median = 13.6 vs. 13.0, p < 0.001). Final RDW levels were even higher in the deceased group when compared with those of survivors (median = 14.6 [IQR, 12.67−15.6] vs. 12.9 [IQR, 12.2−13.5], p < 0.001). For patients who died, an RDW > 14.5% was more common at the time of death than for patients who survived at the time of discharge (81 vs. 13 patients, p < 0.001; RR = 2.3, 95% CI 1.89−2.81). Conclusions: The RDW is an accessible and economical parameter that, together with other characteristics of the presentation and evolution of patients with COVID-19, can be helpful in determining the prognosis. An RDW that increases during hospitalization could be a more important mortality predictor than the RDW at hospital admission.
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Affiliation(s)
- Eduardo Guaní-Guerra
- Department of Research, Hospital Regional de Alta Especialidad del Bajío, San Carlos La Roncha, León P.C. 37660, Guanajuato, Mexico;
- Department of Medicine, University of Guanajuato, San Carlos La Roncha, León P.C. 37660, Guanajuato, Mexico;
| | - Brenda Torres-Murillo
- Department of Medicine, University of Guanajuato, San Carlos La Roncha, León P.C. 37660, Guanajuato, Mexico;
| | - Carolina Muñoz-Corona
- General Directorate of Quality and Health Education, Ministry of Health, Mexico City P.C. 11410, Mexico;
| | - José Carlos Rodríguez-Jiménez
- Department of Internal Medicine, Hospital Regional de Alta Especialidad del Bajío, San Carlos La Roncha, León P.C. 37660, Guanajuato, Mexico;
| | - Alejandro E. Macías
- Microbiology Laboratory, Department of Medicine and Nutrition, University of Guanajuato, León P.C. 37000, Guanajuato, Mexico;
| | | | - Jose A. Alvarez
- Department of Research, Hospital Regional de Alta Especialidad del Bajío, San Carlos La Roncha, León P.C. 37660, Guanajuato, Mexico;
- Microbiology Laboratory, Department of Medicine and Nutrition, University of Guanajuato, León P.C. 37000, Guanajuato, Mexico;
- Correspondence:
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Xiang M, Jing H, Wang C, Novakovic VA, Shi J. Persistent Lung Injury and Prothrombotic State in Long COVID. Front Immunol 2022; 13:862522. [PMID: 35464473 PMCID: PMC9021447 DOI: 10.3389/fimmu.2022.862522] [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: 01/26/2022] [Accepted: 03/17/2022] [Indexed: 12/19/2022] Open
Abstract
Lung injury may persist during the recovery period of COVID-19 as shown through imaging, six-minute walk, and lung function tests. The pathophysiological mechanisms leading to long COVID have not been adequately explained. Our aim is to investigate the basis of pulmonary susceptibility during sequelae and the possibility that prothrombotic states may influence long-term pulmonary symptoms of COVID-19. The patient’s lungs remain vulnerable during the recovery stage due to persistent shedding of the virus, the inflammatory environment, the prothrombotic state, and injury and subsequent repair of the blood-air barrier. The transformation of inflammation to proliferation and fibrosis, hypoxia-involved vascular remodeling, vascular endothelial cell damage, phosphatidylserine-involved hypercoagulability, and continuous changes in serological markers all contribute to post-discharge lung injury. Considering the important role of microthrombus and arteriovenous thrombus in the process of pulmonary functional lesions to organic lesions, we further study the possibility that prothrombotic states, including pulmonary vascular endothelial cell activation and hypercoagulability, may affect long-term pulmonary symptoms in long COVID. Early use of combined anticoagulant and antiplatelet therapy is a promising approach to reduce the incidence of pulmonary sequelae. Essentially, early treatment can block the occurrence of thrombotic events. Because impeded pulmonary circulation causes large pressure imbalances over the alveolar membrane leading to the infiltration of plasma into the alveolar cavity, inhibition of thrombotic events can prevent pulmonary hypertension, formation of lung hyaline membranes, and lung consolidation.
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Affiliation(s)
- Mengqi Xiang
- Department of Hematology, First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Haijiao Jing
- Department of Hematology, First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Chengyue Wang
- Department of Hematology, First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Valerie A Novakovic
- Department of Research, Veterans Affairs Boston Healthcare System, Harvard Medical School, Boston, MA, United States
| | - Jialan Shi
- Department of Hematology, First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China.,Department of Research, Veterans Affairs Boston Healthcare System, Harvard Medical School, Boston, MA, United States.,Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
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Development of Evidence-Based COVID-19 Management Guidelines for Local Context: The Methodological Challenges. Glob Health Epidemiol Genom 2022; 2022:4240378. [PMID: 35492871 PMCID: PMC9020141 DOI: 10.1155/2022/4240378] [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: 01/03/2022] [Accepted: 03/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has presented as a therapeutic challenge for clinicians worldwide due to its rapid spread along with evolving evidence and understanding of the disease. Internationally, recommendations to guide the management of COVID-19 have been created and updated continuously by the WHO and CDC, which have been locally adapted by different countries. Similarly, Pakistan's National Command Operation Center (NCOC), in its national COVID-19 management strategy, generated guidelines for national implementation. Keeping the guidelines updated has proved challenging globally and locally. Here, we present a summary of the process to assess the evidence, including a time-restricted systematic review based on NCOC Clinical Management Guidelines for COVID-19 Infections v4 published on 11th December 2020 version, correlating it with current recommendations and with input one of the guidelines authors, particularly noting the methodological challenges. Methods We conducted a systematic review synthesizing global research on treatment options for COVID-19 hospitalized patients, limiting it to pharmacological interventions for hospitalized COVID-19 patients included in Pakistan's NCOC's national guidelines v4 published on 11th December 2020. Each treatment recommendation's strength and quality of evidence was assessed based on the grading of recommendations assessment, development, and evaluation (GRADE) methodology. These were then compared to the most current living WHO COVID-19 pharmacological treatment guidelines v7.1. One of the authors of the NCOC guidelines reviewed and commented on the findings as well. Results We note that the data from our systematic review strongly supports corticosteroids use in treating severe and critically ill COVID-19 hospitalized patients correlating with WHO v7.1 guidelines 24 September 2021. However, evidence from our review and WHO v7.1 for the use of tocilizumab had some conflicting evidence, with data from our review until December 2020 supporting only a weak recommendation for its use, compared to the strong recommendation by the WHO for the use of tocilizumab in patients with severe or critical COVID-19 infection. Regarding the use of antibiotics and ivermectin use in treating COVID-19 hospitalized patients, data from our review and WHO v 7.1 recommend against their use. Conclusion Research data about the efficacy and safety of pharmacological interventions to treat hospitalized patients with COVID-19 are rapidly evolving, and based on it, the evidence for or against recommendations changes accordingly. Our study illustrates the challenges of keeping up with the evidence; the recommendations were based on studies up till December 2021, and we have compared our recommendations with the WHO v7.1, which showed some significant changes in the use of pharmacological treatment options.
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Engelen MM, Vandenbriele C, Spalart V, Martens CP, Vandenberk B, Sinonquel P, Lorent N, De Munter P, Willems R, Wauters J, Wilmer A, Dauwe D, Gunst J, Guler I, Janssens S, Martinod K, Pieters G, Peerlinck K, Verhamme P, Vanassche T. Thromboprophylaxis in COVID‐19: Weight and severity adjusted intensified dosing. Res Pract Thromb Haemost 2022; 6:e12683. [PMID: 35415384 PMCID: PMC8980774 DOI: 10.1002/rth2.12683] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 01/19/2022] [Accepted: 01/24/2022] [Indexed: 12/22/2022] Open
Abstract
Background Aims Methods Results Conclusion
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Affiliation(s)
- Matthias M. Engelen
- Department of Cardiovascular Diseases University Hospitals Leuven Leuven Belgium
- Center for Molecular and Vascular Biology Department of Cardiovascular Sciences KU Leuven Leuven Belgium
| | - Christophe Vandenbriele
- Department of Cardiovascular Diseases University Hospitals Leuven Leuven Belgium
- Center for Molecular and Vascular Biology Department of Cardiovascular Sciences KU Leuven Leuven Belgium
| | - Valérie Spalart
- Department of Cardiovascular Diseases University Hospitals Leuven Leuven Belgium
- Center for Molecular and Vascular Biology Department of Cardiovascular Sciences KU Leuven Leuven Belgium
| | - Caroline P. Martens
- Center for Molecular and Vascular Biology Department of Cardiovascular Sciences KU Leuven Leuven Belgium
| | - Bert Vandenberk
- Department of Cardiovascular Diseases University Hospitals Leuven Leuven Belgium
| | - Pieter Sinonquel
- Department of Gastro‐enterology and Hepatology University Hospitals Leuven Leuven Belgium
- Department of Translational Research in Gastrointestinal Diseases (TARGID) KU Leuven Leuven Belgium
| | - Natalie Lorent
- Department of Respiratory Diseases University Hospitals Leuven Leuven Belgium
| | - Paul De Munter
- Department of General Internal Medicine University Hospitals Leuven Leuven Belgium
- Department of Microbiology, Immunology and Transplantation KU Leuven Leuven Belgium
| | - Rik Willems
- Department of Cardiovascular Diseases University Hospitals Leuven Leuven Belgium
- Division of Clinical Cardiology, Department of Cardiovascular Sciences KU Leuven Leuven Belgium
| | - Joost Wauters
- Medical Intensive Care Unit Department of General Internal Medicine University Hospitals Leuven Leuven Belgium
| | - Alexander Wilmer
- Medical Intensive Care Unit Department of General Internal Medicine University Hospitals Leuven Leuven Belgium
| | - Dieter Dauwe
- Department of Intensive Care Medicine University Hospitals Leuven Leuven Belgium
| | - Jan Gunst
- Department of Intensive Care Medicine University Hospitals Leuven Leuven Belgium
- Laboratory of Intensive Care Medicine Department of Cellular and Molecular Medicine KU Leuven Leuven Belgium
| | - Ipek Guler
- Leuven Biostatistics and Statistical Bioinformatics Centre (L‐BioStat) KU Leuven Leuven Belgium
| | - Stefan Janssens
- Department of Cardiovascular Diseases University Hospitals Leuven Leuven Belgium
| | - Kimberly Martinod
- Center for Molecular and Vascular Biology Department of Cardiovascular Sciences KU Leuven Leuven Belgium
| | - Griet Pieters
- Department of Cardiovascular Diseases University Hospitals Leuven Leuven Belgium
| | - Kathelijne Peerlinck
- Department of Cardiovascular Diseases University Hospitals Leuven Leuven Belgium
- Center for Molecular and Vascular Biology Department of Cardiovascular Sciences KU Leuven Leuven Belgium
| | - Peter Verhamme
- Department of Cardiovascular Diseases University Hospitals Leuven Leuven Belgium
- Center for Molecular and Vascular Biology Department of Cardiovascular Sciences KU Leuven Leuven Belgium
| | - Thomas Vanassche
- Department of Cardiovascular Diseases University Hospitals Leuven Leuven Belgium
- Center for Molecular and Vascular Biology Department of Cardiovascular Sciences KU Leuven Leuven Belgium
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Kankaria R, Sanina C, Gabr M, Wiley J, Bortnick AE. Extracardiac Prothrombotic Effects of COVID-19. Cardiol Clin 2022; 40:337-344. [PMID: 35851457 PMCID: PMC8960156 DOI: 10.1016/j.ccl.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kochneva ОL, Kislova M, Zhelnova EI, Petrenko AA, Baryakh EA, Yatskov KV, Dmitrieva EA, Misurina EN, Nikitin KE, Vasilieva EJ, Samsonova IV, Ptushkin VV, Baranova A, Nikitin EA. COVID-19 in patients with chronic lymphocytic leukemia: a Moscow observational study. Leuk Lymphoma 2022; 63:1607-1616. [DOI: 10.1080/10428194.2022.2034157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | | | | | - Andrei A. Petrenko
- Federal State Budgetary Educational Institution of Further Professional Education “Russian Medical Academy of Continuous Professional Education” of the Ministry of Healthcare of the Russian Federation
- Department of Radio Engineering and Cybernetics, Moscow Institute of Physics and Technology, Moscow, Russia
| | - Elena A. Baryakh
- City Clinical Hospital No. 52, Moscow, Russia
- Federal State Budgetary Educational Institution of Further Professional Education “Russian Medical Academy of Continuous Professional Education” of the Ministry of Healthcare of the Russian Federation
| | | | - Elena A. Dmitrieva
- Botkin Hospital, Moscow, Russia
- Federal State Budgetary Educational Institution of Further Professional Education “Russian Medical Academy of Continuous Professional Education” of the Ministry of Healthcare of the Russian Federation
| | | | - Konstantin E. Nikitin
- Department of Radio Engineering and Cybernetics, Moscow Institute of Physics and Technology, Moscow, Russia
| | | | | | - Vadim V. Ptushkin
- Botkin Hospital, Moscow, Russia
- Federal State Budgetary Educational Institution of Further Professional Education “Russian Medical Academy of Continuous Professional Education” of the Ministry of Healthcare of the Russian Federation
| | - Ancha Baranova
- School of Systems Biology, George Mason University, Fairfax, VA, USA
- Research Center for Medical Genetics, Moscow, Russia
| | - Eugene A. Nikitin
- Botkin Hospital, Moscow, Russia
- Federal State Budgetary Educational Institution of Further Professional Education “Russian Medical Academy of Continuous Professional Education” of the Ministry of Healthcare of the Russian Federation
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Izquierdo JL, Soriano JB, González Y, Lumbreras S, Ancochea J, Echeverry C, Rodríguez JM. Use of N-Acetylcysteine at high doses as an oral treatment for patients hospitalized with COVID-19. Sci Prog 2022; 105:368504221074574. [PMID: 35084258 PMCID: PMC8795755 DOI: 10.1177/00368504221074574] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Infection by SARS-CoV-2 causing coronavirus disease 2019 (COVID-19) can be
associated with serious and life-threatening conditions, including acute
respiratory distress syndrome (ARDS). Severity and mortality have been related
to a cytokine storm, an imbalance of oxidative stress, and a pro-thrombotic
state. We conducted an observational retrospective cohort study from a community-based
large population of hospitalized COVID-19 PCR + patients admitted from March 01,
2020, to January 24, 2021, with integrated primary to tertiary care information
in Castilla la Mancha, Spain. We explored the potential benefits of the
antioxidant, anti-inflammatory and anti-thrombotic drug N-acetylcysteine (NAC)
administered orally in high doses (600 mg every 8 h), added to standard of care
in COVID-19 patients by using the free text information contained in their
electronic health records (EHRs). Out of 19,208 patients with a diagnosis of COVID-19 hospitalized, we studied 2071
(10.8%) users of oral NAC at high doses. COVID-19 patients treated with NAC were
older, predominantly male, and with more comorbidities such as hypertension,
dyslipidemia, diabetes, and COPD when compared with those not on NAC (all
p < 0.05). Despite greater baseline risk, use of NAC in
COVID-19 patients was associated with significantly lower mortality (OR 0.56;
95%CI 0.47–0.67), a finding that remained significant in a multivariate analysis
adjusting by baseline characteristics and concomitant use of corticosteroids.
There were no significant differences with the use of NAC on the mean duration
of hospitalization, admission to the intensive care unit or use of invasive
mechanical ventilation. The observed association signaling to better relevant
outcomes in COVID-19 patients treated with NAC at high doses should be further
explored in other settings and populations and in randomized controlled
trials.
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Affiliation(s)
- José Luis Izquierdo
- Department of Medicine and Medical Specialties, Universidad de Alcalá, Madrid, Spain.,Respiratory Medicine, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Joan B Soriano
- Respiratory Medicine, 16517Hospital Universitario de La Princesa, Madrid, Spain.,Universidad Autónoma de Madrid, Madrid, Spain.,Respiratory Diseases Networking Biomedical Research Centre (CIBERES), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | | | - Sara Lumbreras
- SAVANA.,16768Universidad Pontificia Comillas-IIT, Madrid, Spain
| | - Julio Ancochea
- Respiratory Medicine, 16517Hospital Universitario de La Princesa, Madrid, Spain.,Universidad Autónoma de Madrid, Madrid, Spain.,Respiratory Diseases Networking Biomedical Research Centre (CIBERES), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | | | - José Miguel Rodríguez
- Department of Medicine and Medical Specialties, Universidad de Alcalá, Madrid, Spain.,Respiratory Medicine, 16269Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
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A phase 2 single center open label randomised control trial for convalescent plasma therapy in patients with severe COVID-19. Nat Commun 2022; 13:383. [PMID: 35046397 PMCID: PMC8770561 DOI: 10.1038/s41467-022-28064-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 01/07/2022] [Indexed: 11/08/2022] Open
Abstract
A single center open label phase 2 randomised control trial (Clinical Trial Registry of India No. CTRI/2020/05/025209) was done to assess clinical and immunological benefits of passive immunization using convalescent plasma therapy. At the Infectious Diseases and Beleghata General Hospital in Kolkata, India, 80 patients hospitalized with severe COVID-19 disease and fulfilling the inclusion criteria (aged more than 18 years, with either mild ARDS having PaO2/FiO2 200–300 or moderate ARDS having PaO2/FiO2 100–200, not on mechanical ventilation) were recruited and randomized into either standard of care (SOC) arm (N = 40) or the convalescent plasma therapy (CPT) arm (N = 40). Primary outcomes were all-cause mortality by day 30 of enrolment and immunological correlates of response to therapy if any, for which plasma abundance of a large panel of cytokines was quantitated before and after intervention to assess the effect of CPT on the systemic hyper-inflammation encountered in these patients. The secondary outcomes were recovery from ARDS and time taken to negative viral RNA PCR as well as to report any adverse reaction to plasma therapy. Transfused convalescent plasma was characterized in terms of its neutralizing antibody content as well as proteome. The trial was completed and it was found that primary outcome of all-cause mortality was not significantly different among severe COVID-19 patients with ARDS randomized to two treatment arms (Mantel-Haenszel Hazard Ratio 0.6731, 95% confidence interval 0.3010-1.505, with a P value of 0.3424 on Mantel-Cox Log-rank test). No adverse effect was reported with CPT. In severe COVID-19 patients with mild or moderate ARDS no significant clinical benefit was registered in this clinical trial with convalescent plasma therapy in terms of prespecified outcomes. Convalescent plasma therapy (CPT) is used to treat patients with Covid-19, but evidence for clinical benefit from clinical trials is divergent. Here the authors report in that CPT treatment does not affect mortality in patients with severe Covid-19 in phase 2 single center open label randomised controlled trial.
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