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Ceylan MR, Kankılıç N, Öz Ö. Are H1 and H3 haplotypes of endothelial protein C receptor (PROCR) an important factor in contracting COVID-19? J Med Virol 2022; 94:4803-4808. [PMID: 35710974 DOI: 10.1002/jmv.27938] [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: 03/24/2022] [Revised: 06/03/2022] [Accepted: 06/11/2022] [Indexed: 11/08/2022]
Abstract
The development of cardiovascular disease shows increase after contracting coronavirus 2019 (COVID-19) disease and myocardial damage is observed in patients who have had the disease severely. The relationship between genetic cardiovascular risk factors with COVID-19 infection was investigated in our study. One hundred thirty-five patients, 27 of whom were COVID-19 (-) and 108 were COVID-19 (+) patients, were included in the study. Patients were divided into three groups ([COVID-19 [-], COVID-19 [+] asymptomatic, and COVID-19 [+] symptomatic + patients with pulmonary involvement]). Genetic cardiovascular risk factors were examined in blood samples taken from the patients with new generation sequencing analysis. In the clinical classification, there were no significant differences between the three groups in fibrinogen beta chain-455G>A, human platelet antigen 1 (HPA1b)/platelet receptor GPIIIa/(ITGB3) (HPA1a/b; GpIIIa; integrin beta 3 L33P), ACE I/D, AGT (M268T), AGTR1 (1166A>C), Apo E (E2/E3/E4) (rs7412, rs429358), eNOS (786T>C), eNOS (894G>T) genes (p > 0.05). However, significant differences were observed in PROCR H3 haplotype/G (endothelial protein C receptor gene [EPCR] 4600A>G [A3 haplotype]), PROCR H1 haplotype/C (EPCR 4678G>C [A1 haplotype]) genes (p < 0.05). When COVID-19 (+) and COVID-19 (-) groups were compared, it was observed that the infection was more common in people with PROCR H1 haplotype/C and PROCR H3 haplotype/G genotypes (p < 0.05). PROCR H1 and PROCR H3 haplotypes may be an important factor in contracting COVID-19 disease. In people with COVID-19 disease, revealing PROCR genetic differences and measuring sEPCR levels will be beneficial in the follow-up of the disease.
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Affiliation(s)
- Mehmet Reşat Ceylan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Campus of Osmanbey, University of Harran, Şanlıurfa, Turkey
| | - Nazım Kankılıç
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Harran, Şanlıurfa, Turkey
| | - Özlem Öz
- Department of Medical Genetics, Faculty of Medicine, University of Harran, Şanlıurfa, Turkey
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2
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Stroke Treatment in the Era of COVID-19: a Review. Curr Treat Options Neurol 2022; 24:155-171. [PMID: 35497091 PMCID: PMC9035774 DOI: 10.1007/s11940-022-00713-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 12/15/2022]
Abstract
Purpose of Review To describe a comprehensive review of the epidemiology, pathophysiology, and treatment of stroke in the era of COVID-19. Recent Findings COVID-19 is associated with myriad neurological disorders, including cerebrovascular disease. While ischemic stroke is the most common, COVID-19 is associated with an increased risk of intracranial hemorrhage, arterial dissection, posterior reversible encephalopathy syndrome, and cerebral venous sinus thrombosis. In this review, we discuss the epidemiology, pathophysiology, and treatment of stroke due to COVID-19. In addition, we describe how COVID-19 has changed the landscape of stroke systems of care and the effect this has had on patients with cerebrovascular disease. Summary While COVID-19 is associated with a heightened risk of stroke, the pandemic has led to advances in stroke systems of care that may reduce the long-term burden of stroke.
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3
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Battistoni I, Francioni M, Morici N, Rubboli A, Podda GM, Pappalardo A, Abdelrahim MEA, Elgendy MO, Elgendy SO, Khalaf AM, Hamied AAM, Garcés HH, Abdelhamid OES, Tawfik KAM, Zeduri A, Bassi G, Pongetti G, Angelini L, Giovinazzo S, Garcia PM, Serino FS, Polistina GE, Fiorentino G, Barbati G, Toniolo A, Fabbrizioli A, Belenguer-Muncharaz A, Porto I, Ocak S, Minuz P, Bernal F, Hermosilla I, Borovac JA. Pre- and in-hospital anticoagulation therapy in coronavirus disease 2019 patients: a propensity-matched analysis of in-hospital outcomes. J Cardiovasc Med (Hagerstown) 2022; 23:264-271. [PMID: 34878430 DOI: 10.2459/jcm.0000000000001284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To estimate if chronic anticoagulant (CAC) treatment is associated with morbidity and mortality outcomes of patients hospitalized for SARS-CoV-2 infection. METHODS In this European multicentric cohort study, we included 1186 patients of whom 144 were on CAC (12.1%) with positive coronavirus disease 2019 testing between 1 February and 30 July 2020. The average treatment effect (ATE) analysis with a propensity score-matching (PSM) algorithm was used to estimate the impact of CAC on the primary outcomes defined as in-hospital death, major and minor bleeding events, cardiovascular complications (CCI), and acute kidney injury (AKI). We also investigated if different dosages of in-hospital heparin were associated with in-hospital survival. RESULTS In unadjusted populations, primary outcomes were significantly higher among CAC patients compared with non-CAC patients: all-cause death (35% vs. 18% P < 0.001), major and minor bleeding (14% vs. 8% P = 0.026; 25% vs. 17% P = 0.014), CCI (27% vs. 14% P < 0.001), and AKI (42% vs. 19% P < 0.001). In ATE analysis with PSM, there was no significant association between CAC and primary outcomes except for an increased incidence of AKI (ATE +10.2%, 95% confidence interval 0.3-20.1%, P = 0.044). Conversely, in-hospital heparin, regardless of dose, was associated with a significantly higher survival compared with no anticoagulation. CONCLUSIONS The use of CAC was not associated with the primary outcomes except for the increase in AKI. However, in the adjusted survival analysis, any dose of in-hospital anticoagulation was associated with significantly higher survival compared with no anticoagulation.
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Affiliation(s)
- Ilaria Battistoni
- S.O.D. Cardiologia-Emodinamica-UTIC, Dipartimento di Scienze Cardiovascolari, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona
| | - Matteo Francioni
- S.O.D. Cardiologia-Emodinamica-UTIC, Dipartimento di Scienze Cardiovascolari, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona
| | - Nuccia Morici
- Unità di Cure Intensive Cardiologiche and De Gasperis Cardio-Center, ASST Grande Ospedale Metropolitano Niguarda
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan
| | - Andrea Rubboli
- Division of Cardiology, Laboratory of Interventional Cardiology, Ospedale Maggiore, Bologna
| | - Gian Marco Podda
- Unità di Medicina 2, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan
| | - Andrea Pappalardo
- Cardiology Unit, University Hospital Policlinico 'Paolo Giaccone', University of Palermo, Palermo, Italy
| | | | - Marwa O Elgendy
- Clinical Pharmacy Department, Teaching Hospital of Faculty of Medicine, Faculty of Medicine, Beni-Suef University
- Clinical Pharmacy Department, Faculty of Pharmacy, Nahda University (NUB)
| | - Sara O Elgendy
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Ahmed M Khalaf
- Internal Medicine Department, Faculty of Medicine, Beni-Suef University
| | | | | | | | - Karim A M Tawfik
- General Surgery Department, Ministry of Health, Beni-Suef, Egypt
| | | | - Gabriele Bassi
- Intensive Care Unit. SST Grande Ospedale Metropolitano Niguarda, Milan
| | - Giulia Pongetti
- S.O.D. Cardiologia-Emodinamica-UTIC, Dipartimento di Scienze Cardiovascolari, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona
| | - Luca Angelini
- S.O.D. Cardiologia-Emodinamica-UTIC, Dipartimento di Scienze Cardiovascolari, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona
| | - Stefano Giovinazzo
- Cardiothoracic and Vascular Department (DICATOV), IRCCS San Martino Hospital, Genoa, Italy
| | | | - Francesco Saverio Serino
- Internal Medicine Department, U.O. Infectious Disease-Jesolo Hospital- ASL 4 Veneto Orientale, San Donà di Piave
| | | | - Giuseppe Fiorentino
- Sub-Intensive Care Unit and Respiratory, Physiopathology Department, Cotugno - Monaldi Hospital, Naples
| | | | - Anna Toniolo
- UOC Anestesia e Rianimazione, Ospedale San Bortolo, Vicenza
| | - Azzurra Fabbrizioli
- Operative Unit of ICCU and Cardiology Hospital 'S.Maria della Misericordia', ASUR Marche, Urbino
| | | | - Italo Porto
- Cardiothoracic and Vascular Department (DICATOV), IRCCS San Martino Hospital, Genoa, Italy
- Department of Internal Medicine and Medical Specialties (Di.M.I), Cardiovascular Diseases Chair, University of Genoa, Genoa Italy
| | - Sibel Ocak
- Department of Internal Medicine University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Pietro Minuz
- Department of Medicine, Section of Internal Medicine C, University of Verona, Verona, Italy
| | | | | | - Josip A Borovac
- Department of Pathophysiology, University of Split School of Medicine, Split, Croatia
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4
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Jamil Z, Khan AA, Khalid S, Asghar M, Muhammad K, Waheed Y. Beneficial Effects of Anticoagulants on the Clinical Outcomes of COVID-19 Patients. Antibiotics (Basel) 2021; 10:antibiotics10111394. [PMID: 34827332 PMCID: PMC8615249 DOI: 10.3390/antibiotics10111394] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/03/2021] [Accepted: 11/10/2021] [Indexed: 02/07/2023] Open
Abstract
(1) Background: Severe coronavirus disease can be complicated by a hypercoagulable state in conjunction with sepsis, increasing the risk of venous thromboembolism. This study aimed to observe the effect of anticoagulants on 30-day high-dependency unit (HDU) outcomes of moderate to severe coronavirus disease 2019 (COVID-19) patients of a tertiary care hospital at Rawalpindi, Pakistan. (2) Methods: A retrospective propensity-based case-control study was carried out to examine COVID-19 patients admitted to the HDU. Patient groups who did and did not receive anticoagulants were labeled as "anticoagulant" and "non-anticoagulant", respectively. Case-control matching (1:1) was performed via propensity scores (calculated by a regression model). Kaplan-Meier and logrank analyses were used to study survival probability. Single predictors of outcomes were determined by Cox regression analysis. (3) Results: The anticoagulant group had elevated D-dimers, advanced age, more comorbidities and a higher frequency of severe disease compared to the non-anticoagulant group (p < 0.05). Therefore, 47 cases and 47 matched controls were selected based on their propensity scores. The primary endpoint was outcome (survived vs. died). The 30-day in-HDU mortality was 25.5% for cases and 61.7% for controls (p = 0.0004). The median time from admission to death was 16 days for the case group and 7 days for the control group (p < 0.0001). The 30-day mortality was 19.1% for the enoxaparin group and 16.4% for the heparin group (p > 0.05). Enoxaparin (therapeutic and prophylactic doses) and heparin (prophylactic dose) were found to be independent factors affecting the outcomes of these patients (p < 0.001). (4) Conclusions: Anticoagulants play a beneficial role in reducing mortality among COVID-19 patients. Both anticoagulant formulations, enoxaparin (therapeutic and prophylactic doses) and heparin (prophylactic dose), were associated with improving survival among these patients.
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Affiliation(s)
- Zubia Jamil
- Department of Medicine, Foundation University Medical College, Foundation University Islamabad, Islamabad 44000, Pakistan; (Z.J.); (S.K.)
| | - Azmat Ali Khan
- Pharmaceutical Biotechnology Laboratory, Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Samreen Khalid
- Department of Medicine, Foundation University Medical College, Foundation University Islamabad, Islamabad 44000, Pakistan; (Z.J.); (S.K.)
| | - Muhammad Asghar
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, 17177 Stockholm, Sweden;
- Department of Infectious Diseases, Karolinska University Hospital, 17164 Stockholm, Sweden
| | - Khalid Muhammad
- Department of Biology, College of Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates;
| | - Yasir Waheed
- Multidisciplinary Lab, Foundation University Medical College, Foundation University Islamabad, Islamabad 44000, Pakistan
- Correspondence:
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5
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Bobescu E, Marceanu LG, Covaciu A, Vladau LA. Thrombosis, an important piece in the COVID-19 puzzle: From pathophysiology to therapy. Anatol J Cardiol 2021; 25:601-608. [PMID: 34498590 DOI: 10.5152/anatoljcardiol.2021.475] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
A lot of data about coronavirus disease 2019 (COVID-19) have been already published; however, these still form only a part of the pandemic puzzle. Once we have all the pieces of the puzzle, we will be able to successfully treat this disease with its multiple challenges. COVID-19 has a high thrombogenic potential. In this study, we aimed to review published data about COVID-19 associated thrombosis from pathophysiology to treatment and the role in patient evolution. We searched for articles and studies published online through MEDLINE/PubMed database, Google Scholar, ScienceDirect, Wiley Online Library, and Nature Public Health Emergency Collection. We found numerous articles regarding COVID-19 infection but selected only those focused on thrombosis. D-dimers have a predictive value in identifying thrombosis and a high level correlates with the severity of the infection and death. Most patients who were on chronic anticoagulant therapy before contracting the virus had a better prognosis. Heparin has other favorable effects such as a direct antiviral and anti-inflammatory effect in addition to its anticoagulant effect. COVID-19 infections are frequently complicated by thrombotic pathology. High plasma level of D-dimers is a predictive factor for severe prognosis, and the recommended anticoagulant, associated with low mortality, is heparin followed by a direct oral anticoagulant. Randomized studies in large groups of patients and therapeutic guidelines are still needed on this subject.
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Affiliation(s)
- Elena Bobescu
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov; Brasov- Romania;Department of Cardiology, Clinical County Emergency Hospital Brasov; Brasov-Romania
| | - Luigi Geo Marceanu
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov; Brasov- Romania
| | - Alexandru Covaciu
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov; Brasov- Romania;Department of Cardiology, Clinical County Emergency Hospital Brasov; Brasov-Romania
| | - Larisa Alexandra Vladau
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov; Brasov- Romania;Department of Cardiology, Clinical County Emergency Hospital Brasov; Brasov-Romania
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6
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Makatsariya AD, Slukhanchuk EV, Bitsadze VO, Khizroeva JK, Tretyakova MV, Shkoda AS, Elalamy I, Di Renzo GC, Rizzo G, Pyatigorskaya NV, Solopova AG, Grigoreva KN, Nakaidze IA, Mitryuk DV. The Effect of Various Types of Anticoagulant Therapy on the Reduction of Mortality in COVID-19. ANNALS OF THE RUSSIAN ACADEMY OF MEDICAL SCIENCES 2021. [DOI: 10.15690/vramn1551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is a viral infection that, in severe course, leads to the development of a cytokine storm, systemic inflammatory response and coagulopathy. Unlike other sepsis-associated disseminated intravascular coagulopathy, COVID-19 induced coagulopathy is realized mainly in thrombosis. Researchers around the world are currently developing adequate diagnostic, monitoring and anticoagulant therapy approaches to safely and effectively manage patients with severe COVID-19. The need to develop laboratory monitoring is due to the fact that 20% of patients have changes in hemostasis indicators, while in patients with a severe form of the disease, they are present in 100% of cases. In case of deaths from COVID-19, there is an increase in the concentration of D-dimer and fibrinogen degradation products. Thus, the severity of hemostasis disorders has an important prognostic value. Anticoagulant therapy is included in the list of all recommendations as an effective means of reducing mortality from COVID-19. The questions of the recommended groups and doses of anticoagulant drugs are still open. The approach to the choice of an anticoagulant should be based not only on risk factors, characteristics of the course of the disease, anamnesis, but also on the wishes of the patient during long-term therapy at the post-hospital stage.
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7
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Ulanowska M, Olas B. Modulation of Hemostasis in COVID-19; Blood Platelets May Be Important Pieces in the COVID-19 Puzzle. Pathogens 2021; 10:370. [PMID: 33808640 PMCID: PMC8003436 DOI: 10.3390/pathogens10030370] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/11/2021] [Accepted: 03/17/2021] [Indexed: 02/07/2023] Open
Abstract
Although the precise pathogenesis of coronavirus disease 2019 (COVID-19) currently remains unknown, its complex nature is gradually being revealed. COVID-19 is a disease caused by the SARS-CoV-2 virus and leads to respiratory dysfunction. Studies on hemostatic parameters have showed that COVID-19 significantly affects the disruption of the coagulation system and may contribute to coagulation and thrombotic events. A relevant cause of hemostasis disorders is inflammation and cytokine storms, which cause, for example, endothelial dysfunction in blood vessels. In order to prevent and treat states of hypercoagulability and thrombosis, the administration of anticoagulants, e.g., heparin, is recommended. The present mini-review describes the relationship between hemostasis and COVID-19, and discusses whether this relationship may cast light on the nature of COVID-19. The present short manuscript also examines the relationship between blood platelets and COVID-19. In addition, the paper explores the potential use of antiplatelet drugs in COVID-19 cases. The studies were identified by searching electronic databases, including PubMed and SCOPUS.
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Affiliation(s)
| | - Beata Olas
- Department of General Biochemistry, University of Lodz, Pomorska 141/3, 90-236 Lodz, Poland;
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8
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Ethnic differences in thromboprophylaxis for COVID-19 patients: should they be considered? Int J Hematol 2021; 113:330-336. [PMID: 33471294 PMCID: PMC7816059 DOI: 10.1007/s12185-021-03078-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/07/2021] [Accepted: 01/07/2021] [Indexed: 12/13/2022]
Abstract
Thromboembolic events contribute to morbidity and mortality in coronavirus disease 2019 (COVID-19). As a result, thromboprophylaxis using low-molecular-weight heparin (LMWH) is universally recommended for hospitalized patients based on multiple guidelines. However, ethnic differences with respect to thrombogenicity have been reported and the incidence of thromboembolic events is considered to be lower in the Asian population. Despite the importance of thromboprophylaxis, bleeding is also a side effect that should be considered. We examine the data relating to potential ethnic differences in thrombosis and bleeding in COVID-19. Although sufficient data is not yet available, current evidence does not oppose routine anticoagulant use and thromboprophylaxis using a standard dose of LMWH for admitted patients regardless of ethnicity based on our review.
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9
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Bolzetta F, Maselli M, Formilan M, Busonera F, Albanese P, Chiaromanni F, Romano A, Veronese N. Prophylactic or therapeutic doses of heparins for COVID-19 infection? A retrospective study. Aging Clin Exp Res 2021; 33:213-217. [PMID: 33196991 PMCID: PMC7667217 DOI: 10.1007/s40520-020-01750-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/30/2020] [Indexed: 02/07/2023]
Abstract
Background Coronavirus disease 19 (COVID-19) is a global outbreak. COVID-19 patients seem to have relevant coagulative abnormalities, even if they are not typical of disseminated intravascular coagulopathy (DIC) of the kind seen in septicaemia. Therefore, anticoagulant therapy with heparins is increasing in interest for a clinical approach to these patients, particularly if older. Studies comparing if prophylactic doses are more effective than therapeutic ones are still missing. Methods Data were collected in the Geriatric Section of the Dolo Hospital, ULSS 3 “Serenissima”, Venice from 31st March to 01st May 2020. Heparins (calciparin, fondaparinux, enoxaparine) were divided into prophylactic or therapeutic doses. People previously treated with oral anticoagulants were removed. Vital status was assessed using administrative data. Cox’s regression analysis, adjusted for potential confounders, was used for assessing the strength of the association between heparins and mortality. The data were reported as hazard ratio (HR) with 95% confidence intervals (CIs). Results 81 older people (mean age 84.1 years; females = 61.9%) were included. No significant differences in terms of demographic and clinical characteristics emerged between people treated with prophylactic or therapeutic doses, including age, gender, X-rays findings or severity of disease. Therapeutic doses were not associated to a better survival rate (HR 1.06; 95% CI 0.47–2.60; p = 0.89), even after adjusting for 15 confounders related to mortality (HR 0.89; 95% CI 0.30–2.71; p = 0.84). Conclusions Our paper indicates that in older people affected by COVID-19 there is no justification for using therapeutic doses instead of prophylactic ones, having a similar impact on mortality risk.
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Affiliation(s)
- Francesco Bolzetta
- Medical Department, Geriatric Unit, Azienda ULSS [Unità Locale Socio Sanitaria] 3 "Serenissima", Dolo-Mirano District, Venice, Italy
| | - Monica Maselli
- Medical Department, Geriatric Unit, Azienda ULSS [Unità Locale Socio Sanitaria] 3 "Serenissima", Dolo-Mirano District, Venice, Italy
| | - Marino Formilan
- Medical Department, Geriatric Unit, Azienda ULSS [Unità Locale Socio Sanitaria] 3 "Serenissima", Dolo-Mirano District, Venice, Italy
| | - Flavio Busonera
- Medical Department, Geriatric Unit, Azienda ULSS [Unità Locale Socio Sanitaria] 3 "Serenissima", Dolo-Mirano District, Venice, Italy
| | - Paolo Albanese
- Medical Department, Geriatric Unit, Azienda ULSS [Unità Locale Socio Sanitaria] 3 "Serenissima", Dolo-Mirano District, Venice, Italy
| | - Federica Chiaromanni
- Medical Department, Geriatric Unit, Azienda ULSS [Unità Locale Socio Sanitaria] 3 "Serenissima", Dolo-Mirano District, Venice, Italy
| | - Antonietta Romano
- Medical Department, Geriatric Unit, Azienda ULSS [Unità Locale Socio Sanitaria] 3 "Serenissima", Dolo-Mirano District, Venice, Italy
| | - Nicola Veronese
- Primary Care Department, Azienda ULSS 3 [Unità Locale Socio Sanitaria] "Serenissima", Dolo-Mirano District, Via Murano, 17 Spinea, Venice, Italy.
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10
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Tan L, Lin ZC, Ray J, Wesselingh R, Oxley TJ, McFadyen J, Kapoor M, Hutton E. Neurological implications of COVID-19: a review of the science and clinical guidance. BMJ Neurol Open 2020; 2:e000101. [PMID: 33681805 PMCID: PMC7871721 DOI: 10.1136/bmjno-2020-000101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/13/2020] [Accepted: 11/18/2020] [Indexed: 12/15/2022] Open
Abstract
COVID-19 is a significant global health burden. The pulmonary morbidity and mortality of COVID-19 is well described, however, there is mounting evidence of neurological manifestations of SARS-CoV-2, which may be of prognostic significance. This paper summarises the available evidence in order to provide clinicians with a concise summary of the peripheral and central neurological manifestations of COVID-19, discusses specific issues regarding the management of chronic neurological disease in the context of the pandemic, and provides a summary of the thrombotic implications of the disease for the neurologist.
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Affiliation(s)
- Lynn Tan
- Neurology Department, Alfred Hospital, Melbourne, Victoria, Australia
| | - Zhiliang Caleb Lin
- Monash Emergency, Monash University School of Clinical Sciences at Monash Health, Clayton, Victoria, Australia
| | - Jason Ray
- Neurology Department, Alfred Hospital, Melbourne, Victoria, Australia.,Neuroscience Department, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Robb Wesselingh
- Neurology Department, Alfred Hospital, Melbourne, Victoria, Australia.,Neuroscience Department, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Thomas J Oxley
- Cerebrovascular Centre, Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA.,Vascular Bionics Laboratory, Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - James McFadyen
- Haematology Department, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Clayton, Victoria, Australia.,Atherothrombosis and Vascular Biology Program, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Mahima Kapoor
- Neurology Department, Alfred Hospital, Melbourne, Victoria, Australia.,Neuroscience Department, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Elspeth Hutton
- Neurology Department, Alfred Hospital, Melbourne, Victoria, Australia.,Neuroscience Department, Monash University Central Clinical School, Melbourne, Victoria, Australia
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11
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Wenzler E, Engineer MH, Yaqoob M, Benken ST. Safety and Efficacy of Apixaban For Therapeutic Anticoagulation in Critically Ill ICU Patients with Severe COVID-19 Respiratory Disease. TH OPEN 2020; 4:e376-e382. [PMID: 33244512 PMCID: PMC7685067 DOI: 10.1055/s-0040-1720962] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/05/2020] [Indexed: 12/19/2022] Open
Abstract
Introduction
Despite the use of unfractionated heparin (UFH) or low molecular weight heparin (LMWH), rates of thromboembolic disease, and subsequent morbidity and mortality remain unacceptably high in patients with severe novel coronavirus disease 2019 (COVID-19) disease. Direct oral anticoagulants (DOACs), such as apixaban, have numerous purported benefits although the safety and efficacy of their use in intensive care unit (ICU) patients with severe COVID-19 has yet to be evaluated.
Materials and Methods
Single-center, retrospective cohort study of 21 ICU patients with severe COVID-19 respiratory disease treated with apixaban for atrial fibrillation (AFib), venous thromboembolism (VTE), catheter-induced thrombosis, and/or COVID-19-induced coagulopathy. The primary objective was to evaluate the incidence of bleeding events and secondary objectives included thromboembolic events, coagulation parameters, and mortality.
Results
Ninety percent of patients were non-White, 43% were obese, 90% had acute respiratory distress syndrome, and 76% required mechanical ventilation. Nearly half of (47.6%) also experienced renal dysfunction and required renal replacement therapy. Eighty-six percent of patients received prophylaxis or treatment with UFH or LMWH within the 24-hour period prior to apixaban initiation. Patients were initiated on apixaban for the treatment of suspected or confirmed VTE (67%) or AFib (33%). All coagulation parameters remained abnormal but stable throughout the 10-day monitoring period. No patients experienced any major bleeding events or thrombosis throughout the study period. There were four deaths during the follow-up period, all deemed unrelated to coagulopathy or bleeding.
Conclusion
Apixaban appeared safe and efficacious in ICU patients with severe COVID-19 disease. These data encourage future trials seeking to optimize anticoagulation strategies in patients with severe COVID-19.
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Affiliation(s)
- Eric Wenzler
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, United States
| | - Monaz H Engineer
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, United States
| | - Maidah Yaqoob
- Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States
| | - Scott T Benken
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, United States
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Mareev VY, Orlova YA, Pavlikova EP, Akopyan ZA, Matskeplishvili ST, Plisyk AG, Seredenina EM, Potapenko AV, Malakhov PS, Samokhodskaya LM, Mershina ЕА, Sinitsyn VE, Asratyan DA, Zhdanova EA, Mareev YV, Begrambekova YL, Shatochina EA, Kamalov АА. [Proactive anti-inflammatory and anticoagulant therapy in the treatment of advanced stages of novel coronavirus infection (COVID-19). Case Series and Study Design: COLchicine versus ruxolitinib and secukinumab in open prospective randomIzed trial (COLORIT)]. ACTA ACUST UNITED AC 2020; 60:4-21. [PMID: 33131470 DOI: 10.18087/cardio.2020.9.n1338] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/26/2020] [Indexed: 01/08/2023]
Abstract
The article is devoted to the treatment of the new coronavirus infection (COVID-19) in the advanced stages of the disease. The types of response of the immune system to the viral load of SARS-CoV-2 with the start of the inflammation process are considered. The situation is analyzed in detail in which the growing autoimmune inflammation (up to the development of a "cytokine storm") affects not only the pulmonary parenchyma, but also the endothelium of the small vessels of the lungs. Simultaneous damage to the alveoli and microthrombosis of the pulmonary vessels are accompanied by a progressive impairment of gas exchange, the development of acute respiratory distress syndrome, the treatment of which, even with the use of invasive ventilation, is ineffective and does not really change the prognosis of patients with COVID-19. In order to interrupt the pathological process at the earliest stages of the disease, the necessity of proactive anti-inflammatory therapy in combination with active anticoagulation treatment is substantiated. The results of the first randomized studies on the use of inhibitors of pro-inflammatory cytokines and chemokines (interleukin-6 (tocilizumab), interleukin-17 (secukinumab), Janus kinase blockers, through which the signal is transmitted to cells (ruxolitinib)), which have potential in the early treatment of COVID- 19. The use of a well-known anti-inflammatory drug colchicine (which is used for gout treatment) in patients with COVID-19 is considered. The design of the original COLORIT comparative study on the use of colchicine, ruxolitinib and secukinumab in the treatment of COVID-19 is presented. Clinical series presented, illustrated early anti-inflammatory therapy together with anticoagulants in patients with COVID-19 and the dangers associated with refusing to initiate such therapy on time.
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Affiliation(s)
- V Yu Mareev
- Medical Research and Educational Center of the M. V. Lomonosov Moscow State University, Moscow, Russia Faculty of Fundamental Medicine, Lomonosov Moscow State University, Russia
| | - Ya A Orlova
- Medical Research and Educational Center of the M. V. Lomonosov Moscow State University, Moscow, Russia Faculty of Fundamental Medicine, Lomonosov Moscow State University, Russia
| | - E P Pavlikova
- Medical Research and Educational Center of the M. V. Lomonosov Moscow State University, Moscow, Russia Faculty of Fundamental Medicine, Lomonosov Moscow State University, Russia
| | - Z A Akopyan
- Medical Research and Educational Center of the M. V. Lomonosov Moscow State University, Moscow, Russia Faculty of Fundamental Medicine, Lomonosov Moscow State University, Russia
| | - S T Matskeplishvili
- Medical Research and Educational Center of the M. V. Lomonosov Moscow State University, Moscow, Russia
| | - A G Plisyk
- Medical Research and Educational Center of the M. V. Lomonosov Moscow State University, Moscow, Russia Faculty of Fundamental Medicine, Lomonosov Moscow State University, Russia
| | - E M Seredenina
- Medical Research and Educational Center of the M. V. Lomonosov Moscow State University, Moscow, Russia Faculty of Fundamental Medicine, Lomonosov Moscow State University, Russia
| | - A V Potapenko
- Medical Research and Educational Center of the M. V. Lomonosov Moscow State University, Moscow, Russia Faculty of Fundamental Medicine, Lomonosov Moscow State University, Russia
| | - P S Malakhov
- Medical Research and Educational Center of the M. V. Lomonosov Moscow State University, Moscow, Russia
| | - L M Samokhodskaya
- Medical Research and Educational Center of the M. V. Lomonosov Moscow State University, Moscow, Russia Faculty of Fundamental Medicine, Lomonosov Moscow State University, Russia
| | - Е А Mershina
- Medical Research and Educational Center of the M. V. Lomonosov Moscow State University, Moscow, Russia Faculty of Fundamental Medicine, Lomonosov Moscow State University, Russia
| | - V E Sinitsyn
- Medical Research and Educational Center of the M. V. Lomonosov Moscow State University, Moscow, Russia Faculty of Fundamental Medicine, Lomonosov Moscow State University, Russia
| | - D A Asratyan
- Medical Research and Educational Center of the M. V. Lomonosov Moscow State University, Moscow, Russia
| | - E A Zhdanova
- Medical Research and Educational Center of the M. V. Lomonosov Moscow State University, Moscow, Russia Faculty of Fundamental Medicine, Lomonosov Moscow State University, Russia
| | - Yu V Mareev
- National Medical Research Centre for Therapy and Preventive Medicine, Moscow, Russia Robertson Centre for Biostatistics, Glasgow, Great Britain
| | - Yu L Begrambekova
- Medical Research and Educational Center of the M. V. Lomonosov Moscow State University, Moscow, Russia Faculty of Fundamental Medicine, Lomonosov Moscow State University, Russia
| | - E A Shatochina
- Medical Research and Educational Center of the M. V. Lomonosov Moscow State University, Moscow, Russia
| | - А А Kamalov
- Medical Research and Educational Center of the M. V. Lomonosov Moscow State University, Moscow, Russia Faculty of Fundamental Medicine, Lomonosov Moscow State University, Russia
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Puri S, Coulson-Thomas YM, Gesteira TF, Coulson-Thomas VJ. Distribution and Function of Glycosaminoglycans and Proteoglycans in the Development, Homeostasis and Pathology of the Ocular Surface. Front Cell Dev Biol 2020; 8:731. [PMID: 32903857 PMCID: PMC7438910 DOI: 10.3389/fcell.2020.00731] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/15/2020] [Indexed: 12/20/2022] Open
Abstract
The ocular surface, which forms the interface between the eye and the external environment, includes the cornea, corneoscleral limbus, the conjunctiva and the accessory glands that produce the tear film. Glycosaminoglycans (GAGs) and proteoglycans (PGs) have been shown to play important roles in the development, hemostasis and pathology of the ocular surface. Herein we review the current literature related to the distribution and function of GAGs and PGs within the ocular surface, with focus on the cornea. The unique organization of ECM components within the cornea is essential for the maintenance of corneal transparency and function. Many studies have described the importance of GAGs within the epithelial and stromal compartment, while very few studies have analyzed the ECM of the endothelial layer. Importantly, GAGs have been shown to be essential for maintaining corneal homeostasis, epithelial cell differentiation and wound healing, and, more recently, a role has been suggested for the ECM in regulating limbal stem cells, corneal innervation, corneal inflammation, corneal angiogenesis and lymphangiogenesis. Reports have also associated genetic defects of the ECM to corneal pathologies. Thus, we also highlight the role of different GAGs and PGs in ocular surface homeostasis, as well as in pathology.
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Affiliation(s)
- Sudan Puri
- College of Optometry, University of Houston, Houston, TX, United States
| | - Yvette M Coulson-Thomas
- Molecular Biology Section, Department of Biochemistry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Tarsis F Gesteira
- College of Optometry, University of Houston, Houston, TX, United States.,Optimvia, LLC, Batavia, OH, United States
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Thrombosis in Coronavirus disease 2019 (COVID-19) through the prism of Virchow's triad. Clin Rheumatol 2020; 39:2529-2543. [PMID: 32654082 PMCID: PMC7353835 DOI: 10.1007/s10067-020-05275-1] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 06/26/2020] [Accepted: 06/30/2020] [Indexed: 02/07/2023]
Abstract
The pathogenesis of Coronavirus disease 2019 (COVID-19) is gradually being comprehended. A high number of thrombotic episodes are reported, along with the mortality benefits of heparin. COVID-19 can be viewed as a prothrombotic disease. We overviewed the available evidence to explore this possibility. We identified various histopathology reports and clinical case series reporting thromboses in COVID-19. Also, multiple coagulation markers support this. COVID-19 can be regarded as a risk factor for thrombosis. Applying the principles of Virchow's triad, we described abnormalities in the vascular endothelium, altered blood flow, and platelet function abnormalities that lead to venous and arterial thromboses in COVID-19. Endothelial dysfunction, activation of the renin-angiotensin-aldosterone system (RAAS) with the release of procoagulant plasminogen activator inhibitor (PAI-1), and hyperimmune response with activated platelets seem to be significant contributors to thrombogenesis in COVID-19. Stratifying risk of COVID-19 thromboses should be based on age, presence of comorbidities, D-dimer, CT scoring, and various blood cell ratios. Isolated heparin therapy may not be sufficient to combat thrombosis in this disease. There is an urgent need to explore newer avenues like activated protein C, PAI-1 antagonists, and tissue plasminogen activators (tPA). These should be augmented with therapies targeting RAAS, antiplatelet drugs, repurposed antiinflammatory, and antirheumatic drugs. Key Points • Venous and arterial thromboses in COVID-19 can be viewed through the prism of Virchow's triad. • Endothelial dysfunction, platelet activation, hyperviscosity, and blood flow abnormalities due to hypoxia, immune reactions, and hypercoagulability lead to thrombogenesis in COVID-19. • There is an urgent need to stratify COVID-19 patients at risk for thrombosis using age, comorbidities, D-dimer, and CT scoring. • Patients with COVID-19 at high risk for thrombosis should be put on high dose heparin therapy.
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