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Favaloro EJ. 2024 Eberhard F. Mammen Award Announcements: Part I-Most Popular Articles. Semin Thromb Hemost 2024. [PMID: 38458226 DOI: 10.1055/s-0044-1782197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Affiliation(s)
- Emmanuel J Favaloro
- Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), Westmead Hospital, Westmead, NSW, Australia
- School of Dentistry and Medical Sciences, Faculty of Science and Health, Charles Sturt University, Wagga Wagga, New South Wales, Australia
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Westmead Hospital, Westmead, New South Wales, Australia
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Ortega-Paz L, Talasaz AH, Sadeghipour P, Potpara TS, Aronow HD, Jara-Palomares L, Sholzberg M, Angiolillo DJ, Lip GYH, Bikdeli B. COVID-19-Associated Pulmonary Embolism: Review of the Pathophysiology, Epidemiology, Prevention, Diagnosis, and Treatment. Semin Thromb Hemost 2023; 49:816-832. [PMID: 36223804 DOI: 10.1055/s-0042-1757634] [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: 12/15/2022]
Abstract
COVID-19 is associated with endothelial activation in the setting of a potent inflammatory reaction and a hypercoagulable state. The end result of this thromboinflammatory state is an excess in thrombotic events, in particular venous thromboembolism. Pulmonary embolism (PE) has been of special interest in patients with COVID-19 given its association with respiratory deterioration, increased risk of intensive care unit admission, and prolonged hospital stay. The pathophysiology and clinical characteristics of COVID-19-associated PE may differ from the conventional non-COVID-19-associated PE. In addition to embolic events from deep vein thrombi, in situ pulmonary thrombosis, particularly in smaller vascular beds, may be relevant in patients with COVID-19. Appropriate prevention of thrombotic events in COVID-19 has therefore become of critical interest. Several changes in viral biology, vaccination, and treatment management during the pandemic may have resulted in changes in incidence trends. This review provides an overview of the pathophysiology, epidemiology, clinical characteristics, and risk factors of COVID-19-associated PE. Furthermore, we briefly summarize the results from randomized controlled trials of preventive antithrombotic therapies in COVID-19, focusing on their findings related to PE. We discuss the acute treatment of COVID-19-associated PE, which is substantially similar to the management of conventional non-COVID-19 PE. Ultimately, we comment on the current knowledge gaps in the evidence and the future directions in the treatment and follow-up of COVID-19-associated PE, including long-term management, and its possible association with long-COVID.
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Affiliation(s)
- Luis Ortega-Paz
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida
| | - Azita H Talasaz
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Parham Sadeghipour
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Clinical Trial Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Tatjana S Potpara
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Intensive Arrhythmia Care, Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - Herbert D Aronow
- Department of Cardiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Cardiology, Henry Ford Health, Detroit, Michigan
| | - Luis Jara-Palomares
- Respiratory Unit, Hospital Universitario Virgen del Rocio, Sevilla, Spain
- Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias (CIBERES), Carlos III Health Institute, Madrid, Spain
| | - Michelle Sholzberg
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Behnood Bikdeli
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Yale/YNHH Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut
- Cardiovascular Research Foundation (CRF), New York, New York
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Luu IH, Buijs J, Krdzalic J, de Kruif MD, Mostard GJ, ten Cate H, Dormans TP, Mostard RL, Leers MP, van Twist DJ. Pulmonary embolism in hospitalized COVID-19 patients: Short- and long-term clinical outcomes. THROMBOSIS UPDATE 2023; 12:None. [PMID: 38562231 PMCID: PMC10286522 DOI: 10.1016/j.tru.2023.100142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/15/2023] [Accepted: 06/17/2023] [Indexed: 04/04/2024] Open
Abstract
Introduction Pulmonary embolism (PE) is a frequent complication in COVID-19. However, the influence of PE on the prognosis of COVID-19 remains unclear as previous studies were affected by misclassification bias. Therefore, we evaluated a cohort of COVID-19 patients whom all underwent systematic screening for PE (thereby avoiding misclassification) and compared clinical outcomes between patients with and without PE. Materials and methods We included all COVID-19 patients who were admitted through the ED between April 2020 and February 2021. All patients underwent systematic work-up for PE in the ED using the YEARS-algorithm. The primary outcome was a composite of in-hospital mortality and ICU admission. We also evaluated long-term outcomes including PE occurrence within 90 days after discharge and one-year all-cause mortality. Results 637 ED patients were included in the analysis. PE was diagnosed in 46 of them (7.2%). The occurrence of the primary outcome did not differ between patients with PE and those without (28.3% vs. 26.9%, p = 0.68). The overall rate of PE diagnosed in-hospital (after an initial negative PE screening in the ED) and in the first 90 days after discharge was 3.9% and 1.2% respectively. One-year all-cause mortality was similar between patients with and without PE (26.1% vs. 24.4%, p = 0.83). Conclusions In a cohort of COVID-19 patients who underwent systematic PE screening in the ED, we found no differences in mortality rate and ICU admissions between patients with and without PE. This may indicate that proactive PE screening, and thus timely diagnosis and treatment of PE, may limit further clinical deterioration and associated mortality in COVID-19 patients.
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Affiliation(s)
- Inge H.Y. Luu
- Department of Internal Medicine, Zuyderland Medical Centre, PO-box 5500, 6130, MB, Sittard, the Netherlands
| | - Jacqueline Buijs
- Department of Internal Medicine, Zuyderland Medical Centre, PO-box 5500, 6130, MB, Sittard, the Netherlands
| | - Jasenko Krdzalic
- Department of Radiology, Zuyderland Medical Centre, PO-box 5500, 6130, MB, Sittard, the Netherlands
| | - Martijn D. de Kruif
- Department of Pulmonology, Zuyderland Medical Centre, PO-box 5500, 6130, MB, Sittard, the Netherlands
| | - Guy J.M. Mostard
- Department of Internal Medicine, Zuyderland Medical Centre, PO-box 5500, 6130, MB, Sittard, the Netherlands
| | - Hugo ten Cate
- Department of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, PO-box 616, 6200, MD, Maastricht, the Netherlands
| | - Tom P.J. Dormans
- Department of Intensive Care, Zuyderland Medical Centre, PO-box 5500, 6130, MB, Sittard, the Netherlands
| | - Remy L.M. Mostard
- Department of Pulmonology, Zuyderland Medical Centre, PO-box 5500, 6130, MB, Sittard, the Netherlands
| | - Math P.G. Leers
- Department of Clinical Chemistry and Haematology, Zuyderland Medical Centre, PO-box 5500, 6130, MB, Sittard, the Netherlands
| | - Daan J.L. van Twist
- Department of Internal Medicine, Zuyderland Medical Centre, PO-box 5500, 6130, MB, Sittard, the Netherlands
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Gatto MC, Oliva A, Palazzolo C, Picariello C, Garascia A, Nicastri E, Girardi E, Antinori A. Efficacy and Safety of Anticoagulant Therapy in COVID-19-Related Pulmonary Embolism with Different Extension. Biomedicines 2023; 11:biomedicines11051282. [PMID: 37238955 DOI: 10.3390/biomedicines11051282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
Pulmonary embolism (PE) has been associated with SARS-CoV-2 infection, and its incidence is highly variable. The aim of our study was to describe the radiological and clinical presentations, as well as the therapeutic management, of PEs that occurred during SARS-CoV-2 infection in a cohort of hospitalized patients. In this observational study, we enrolled patients with moderate COVID-19 who developed PE during hospitalization. Clinical, laboratory, and radiological features were recorded. PE was diagnosed on clinical suspicion and/or CT angiography. According to CT angiography results, two groups of patients were further distinguished: those with proximal or central pulmonary embolism (cPE) and those with distal or micro-pulmonary embolism (mPE). A total of 56 patients with a mean age of 78 ± 15 years were included. Overall, PE occurred after a median of 2 days from hospitalization (range 0-47 days) and, interestingly, the majority of them (89%) within the first 10 days of hospitalization, without differences between the groups. Patients with cPE were younger (p = 0.02), with a lower creatinine clearance (p = 0.04), and tended to have a higher body weight (p = 0.059) and higher D-Dimer values (p = 0.059) than patients with mPE. In all patients, low-weight molecular heparin (LWMH) at anticoagulant dosage was promptly started as soon as PE was diagnosed. After a mean of 16 ± 9 days, 94% of patients with cPE were switched to oral anticoagulant (OAC) therapy, which was a direct oral anticoagulant (DOAC) in 86% of cases. In contrast, only in 68% of patients with mPE, the prosecution with OAC was indicated. The duration of treatment was at least 3 months from PE diagnosis in all patients who started OAC. At the 3-month follow-up, no persistence or recurrence of PE as well as no clinically relevant bleedings were found in both groups. In conclusion, pulmonary embolism in patients with SARS-CoV-2 may have different extensions. Used with clinical judgment, oral anticoagulant therapy with DOAC was effective and safe.
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Affiliation(s)
- Maria Chiara Gatto
- National Institute for Infectious Diseases, Lazzaro Spallanzani, IRCCS, Via Portuense, 292, 00149 Rome, Italy
| | - Alessandra Oliva
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Piazzale Aldo Moro n.5, 00185 Rome, Italy
| | - Claudia Palazzolo
- National Institute for Infectious Diseases, Lazzaro Spallanzani, IRCCS, Via Portuense, 292, 00149 Rome, Italy
| | - Claudio Picariello
- UOC Cardiologia, Azienda Ospedaliera Santa Maria della Misericordia, ULSS5 Polesana, 45100 Rovigo, Italy
| | - Andrea Garascia
- Department of Cardiology, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Emanuele Nicastri
- National Institute for Infectious Diseases, Lazzaro Spallanzani, IRCCS, Via Portuense, 292, 00149 Rome, Italy
| | - Enrico Girardi
- National Institute for Infectious Diseases, Lazzaro Spallanzani, IRCCS, Via Portuense, 292, 00149 Rome, Italy
| | - Andrea Antinori
- National Institute for Infectious Diseases, Lazzaro Spallanzani, IRCCS, Via Portuense, 292, 00149 Rome, Italy
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Delrue M, Stépanian A, Voicu S, Nassarmadji K, Sène D, Bonnin P, Kevorkian JP, Sellier PO, Molina JM, Neuwirth M, Vodovar D, Mouly S, Mebazaa A, Mégarbane B, Siguret V. No VTE Recurrence After 1-Year Follow-Up of Hospitalized Patients With COVID-19 and a VTE Event: A Prospective Study. Chest 2022; 162:226-229. [PMID: 35398318 PMCID: PMC8986540 DOI: 10.1016/j.chest.2022.03.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/09/2022] [Accepted: 03/20/2022] [Indexed: 12/20/2022] Open
Affiliation(s)
- Maxime Delrue
- Hematology Laboratory & Thrombosis unit, Université Paris Cité, Hospital group Lariboisière-Fernand Widal, APHP, Paris, France; EA 3518, Université Paris Cité, Paris, France
| | - Alain Stépanian
- Hematology Laboratory & Thrombosis unit, Université Paris Cité, Hospital group Lariboisière-Fernand Widal, APHP, Paris, France; EA 3518, Université Paris Cité, Paris, France
| | - Sebastian Voicu
- Department of Medical and Toxicological Critical Care, Université Paris Cité, Hospital group Lariboisière-Fernand Widal, APHP, Paris, France; INSERM UMRS-1144, Université Paris Cité, Paris, France
| | - Kladoum Nassarmadji
- Department of Internal Medicine, Université Paris Cité, Hospital group Lariboisière-Fernand Widal, APHP, Paris, France
| | - Damien Sène
- Department of Internal Medicine, Université Paris Cité, Hospital group Lariboisière-Fernand Widal, APHP, Paris, France
| | - Philippe Bonnin
- Laboratory of Clinical Physiology, Université Paris Cité, Hospital group Lariboisière-Fernand Widal, APHP, Paris, France; INSERM UMRS-1148, Université Paris Cité, Paris, France
| | - Jean-Philippe Kevorkian
- Department of Diabetology-Endocrinology, Université Paris Cité, Hospital group Lariboisière-Fernand Widal, APHP, Paris, France
| | - Pierre-Olivier Sellier
- Department of infectious disease, Université Paris Cité, Hospital group Lariboisière-Fernand Widal, APHP, Paris, France
| | - Jean-Michel Molina
- Department of infectious disease, Université Paris Cité, Hospital group Lariboisière-Fernand Widal, APHP, Paris, France
| | - Marie Neuwirth
- Hematology Laboratory & Thrombosis unit, Université Paris Cité, Hospital group Lariboisière-Fernand Widal, APHP, Paris, France; INSERM UMRS-1140, Université Paris Cité, Paris, France
| | - Dominique Vodovar
- INSERM UMRS-1144, Université Paris Cité, Paris, France; Paris Poison Control Center, Université Paris Cité, Hospital group Lariboisière-Fernand Widal, APHP, Paris, France
| | - Stéphane Mouly
- INSERM UMRS-1144, Université Paris Cité, Paris, France; Department of Internal Medicine, Université Paris Cité, Hospital group Lariboisière-Fernand Widal, APHP, Paris, France
| | - Alexandre Mebazaa
- Department of Anesthesiology and Critical Care, Université Paris Cité, Hospital group Lariboisière-Fernand Widal, APHP, Paris, France; INSERM UMRS-942, Université Paris Cité, Paris, France
| | - Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, Université Paris Cité, Hospital group Lariboisière-Fernand Widal, APHP, Paris, France; INSERM UMRS-1144, Université Paris Cité, Paris, France
| | - Virginie Siguret
- Hematology Laboratory & Thrombosis unit, Université Paris Cité, Hospital group Lariboisière-Fernand Widal, APHP, Paris, France; INSERM UMRS-1140, Université Paris Cité, Paris, France.
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