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Nasiri S, Meshkati Yazd SM, Kamran H, Kahrizi MS, Azhdari M, Shahriarirad R. Autotransplantation of parathyroid tissue into subcutaneous subclavicular area following total parathyroidectomy in secondary hyperparathyroidism. J Endocrinol Invest 2022; 45:2291-2297. [PMID: 35849326 DOI: 10.1007/s40618-022-01864-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Total parathyroidectomy with autotransplantation is still an excellent treatment option for secondary hyperparathyroidism. Intramuscular or subcutaneous parathyroid autotransplantation has been previously reported; however, there have been no studies to date regarding the implantation of the parathyroid tissue in the subclavian area of the neck. METHODS This was a prospective cross-sectional study between 2018 and 2019. Patients who underwent total parathyroidectomy with autotransplantation of parathyroid tissue into subcutaneous subclavicular area due to secondary hyperparathyroidism were included. The patients' demographic information, including age and gender, was gathered, and the length of the dialysis period was asked from the patients. To evaluate the outcome of the study, parathyroid hormone (PTH) was measured and recorded before and after the operation. SPSS software, version 26, was used for data analysis. RESULTS Forty-two patients with a mean age of 41.05 ± 9.41 years were included. The mean length of the dialysis period was 8.07 ± 2.68 years. The mean primary PTH was 1770.61 ± 482.97 pg/ml (range: 656-2500 <). After 6 weeks of operation, 19 patients (45.2%) had functional autotransplanted tissue, and the median PTH was 28 pg/ml (IQR: 33.55, range: 0.1-221.8). However, the results showed that after 10 weeks, the patients with functional tissue were increased to 22 (52.4%), and the median PTH was 35 pg/ml (IQR: 48, range: 5.0-602.9). The functionality of autotransplanted tissue in the 6th and 10th weeks after surgery had no significant association with age, gender, and length of the dialysis period (p value > 0.05). CONCLUSION Subcutaneous implantation is recommended in the treatment of secondary hyperparathyroidism based on its high success rate and ease of use, suitable vascularization, easy accessibility to the surgery location in case of the need for autographtectomy.
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Affiliation(s)
- S Nasiri
- Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - S M Meshkati Yazd
- Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - H Kamran
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M S Kahrizi
- Department of Surgery, Alborz University of Medical Sciences, Karaj, Alborz, Iran
| | - M Azhdari
- Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - R Shahriarirad
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran.
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Abstract
Despite recent advances in the treatment of chronic heart failure, therapeutic options for acute heart failure (AHF) remain limited. AHF admissions are associated with significant multi-organ dysfunction, especially worsening renal failure, which results in significant morbidity and mortality. There are several aspects of AHF management: diagnosis, decongestion, vasoactive therapy, goal-directed medical therapy initiation and safe transition of care. Effective diagnosis and prognostication could be very helpful in an acute setting and rely upon biomarker evaluation with noninvasive assessment of fluid status. Decongestive strategies could be tailored to include pharmaceutical options along with consideration of utilizing ultrafiltration for refractory hypervolemia. Vasoactive agents to augment cardiac function have been evaluated in patients with AHF but have shown to only have limited efficacy. Post stabilization, initiation of quadruple goal-directed medical therapy—angiotensin receptor-neprilysin inhibitors, mineral receptor antagonists, sodium glucose type 2 (SGLT-2) inhibitors, and beta blockers—to prevent myocardial remodeling is being advocated as a standard of care. Safe transition of care is needed prior to discharge to prevent heart failure rehospitalization and mortality. Post-discharge close ambulatory monitoring (including remote hemodynamic monitoring), virtual visits, and rehabilitation are some of the strategies to consider. We hereby review the contemporary approach in AHF diagnosis and management.
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Affiliation(s)
- Hayaan Kamran
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
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Sahai A, Bhandari R, Godwin M, McIntyre T, Chung MK, Iskandar JP, Kamran H, Hariri E, Aggarwal A, Burton R, Kalra A, Bartholomew JR, McCrae KR, Elbadawi A, Bena J, Svensson LG, Kapadia S, Cameron SJ. Effect of aspirin on short-term outcomes in hospitalized patients with COVID-19. Vasc Med 2021; 26:626-632. [PMID: 34010070 PMCID: PMC8137864 DOI: 10.1177/1358863x211012754] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 is an ongoing viral pandemic marked by increased risk of thrombotic events. However, the role of platelets in the elevated observed thrombotic risk in COVID-19 and utility of antiplatelet agents in attenuating thrombosis is unknown. We aimed to determine if the antiplatelet effect of aspirin may mitigate risk of myocardial infarction, cerebrovascular accident, and venous thromboembolism in COVID-19. We evaluated 22,072 symptomatic patients tested for COVID-19. Propensity-matched analyses were performed to determine if treatment with aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) affected thrombotic outcomes in COVID-19. Neither aspirin nor NSAIDs affected mortality in COVID-19. Thus, aspirin does not appear to prevent thrombosis and death in COVID-19. The mechanisms of thrombosis in COVID-19, therefore, appear distinct and the role of platelets as direct mediators of SARS-CoV-2-mediated thrombosis warrants further investigation.
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Affiliation(s)
- Aditya Sahai
- Section of Vascular Medicine, Department of Cardiovascular Medicine; Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rohan Bhandari
- Section of Vascular Medicine, Department of Cardiovascular Medicine; Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Matthew Godwin
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Thomas McIntyre
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mina K Chung
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Cardiovascular Medicine; Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Hayaan Kamran
- Section of Vascular Medicine, Department of Cardiovascular Medicine; Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Essa Hariri
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Anu Aggarwal
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Robert Burton
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Ankur Kalra
- Section of Vascular Medicine, Department of Cardiovascular Medicine; Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - John R Bartholomew
- Section of Vascular Medicine, Department of Cardiovascular Medicine; Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Keith R McCrae
- Department of Cardiovascular Medicine; Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ayman Elbadawi
- Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - James Bena
- Department of Quantitative Health Science, Cleveland Clinic, Cleveland, OH, USA
| | - Lars G Svensson
- Section of Vascular Medicine, Department of Cardiovascular Medicine; Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Samir Kapadia
- Section of Vascular Medicine, Department of Cardiovascular Medicine; Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Scott J Cameron
- Section of Vascular Medicine, Department of Cardiovascular Medicine; Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
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Iskandar JP, Hariri E, Kanaan C, Kassis N, Kamran H, Sese D, Wright C, Marinescu M, Cameron SJ. The safety and efficacy of systemic versus catheter-based therapies: application of a prognostic model by a pulmonary embolism response team. J Thromb Thrombolysis 2021; 53:616-625. [PMID: 34586572 DOI: 10.1007/s11239-021-02576-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 02/04/2023]
Abstract
The decision by pulmonary embolism response teams (PERTs) to utilize anticoagulation (AC) with or without systemic thrombolysis (ST) or catheter-directed therapies (CDT) for pulmonary embolism (PE) is a balance between the desire for a positive outcome and safety. Our primary aim was to develop a predictive model of in-hospital mortality for patients with high- or intermediate-risk PE managed by PERT while externally validating this model. Our secondary aim was to compare the relative safety and efficacy of ST and CDT in this cohort. Consecutive patients hospitalized between June 2014 and January 2020 at the Cleveland Clinic Foundation and The University of Rochester with acute high- or intermediate-risk PE managed by PERT were retrospectively evaluated. Groups were stratified by treatment strategy. The primary outcome was in-hospital mortality, and secondary outcome was major bleeding. A logistic regression model to predict the primary outcome was built using the derivation cohort, with 100-fold bootstrapping for internal validation. External validation was performed and the area under the receiver operating curve (AUC) was calculated. Of 549 included patients, 421 received AC alone, 71 received ST, and 64 received CDT. Predictors of major bleeding include ESC risk category, PESI score, hypoxia, hemodynamic instability, and serum lactate. CDT trended towards lower mortality but with an increased risk of bleeding relative to ST (OR = 0.42; 95% CI [0.15, 1.17] and OR = 2.14; 95% CI [0.9, 5.06] respectively). In the multivariable logistic regression model in the derivation institution cohort, predictors of in-hospital mortality were age, cancer, hemodynamic instability requiring vasopressors, and elevated NT-proBNP (AUC = 0.86). This model was validated using the validation institution cohort (AUC = 0.88). We report an externally-validated model for predicting in-hospital mortality in patients with PE managed by PERT. The decision by PERT to initiate CDT or ST for these patients had no impact on mortality or major bleeding, yet the long-term efficacy of these interventions needs to be elucidated.
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Affiliation(s)
- Jean-Pierre Iskandar
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Essa Hariri
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Christopher Kanaan
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Nicholas Kassis
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Hayaan Kamran
- Department of Cardiovascular Medicine, Section of Vascular Medicine, Heart Vascular and Thoracic Institute, Desk J-35, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Denise Sese
- Department of Pulmonary Critical Care, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Colin Wright
- University of Rochester Medical Center, Rochester, NY, USA
| | - Mark Marinescu
- University of Rochester Medical Center, Rochester, NY, USA
| | - Scott J Cameron
- Department of Cardiovascular Medicine, Section of Vascular Medicine, Heart Vascular and Thoracic Institute, Desk J-35, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA. .,Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland, USA. .,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
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Kamran H, Hariri EH, Iskandar JP, Sahai A, Haddadin I, Harb SC, Campbell J, Tefera L, Delehanty JM, Heresi GA, Bartholomew JR, Cameron SJ. Simultaneous Pulmonary Artery Pressure and Left Ventricle Stroke Volume Assessment Predicts Adverse Events in Patients With Pulmonary Embolism. J Am Heart Assoc 2021; 10:e019849. [PMID: 34482705 PMCID: PMC8649518 DOI: 10.1161/jaha.120.019849] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Certain echocardiographic parameters may serve as early predictors of adverse events in patients with hemodynamically compromising pulmonary embolism (PE). Methods and Results An observational analysis was conducted for patients with acute pulmonary embolism evaluated by a Pulmonary Embolism Response Team (PERT) between 2014 and 2020. The performance of clinical prediction algorithms including the Pulmonary Embolism Severity Index and Carl Bova score were compared using a ratio of right ventricle and left ventricle hemodynamics by dividing the pulmonary artery systolic pressure by the left ventricle stroke volume. The primary outcome of in‐hospital mortality, cardiac arrest, and the need for advanced therapies was evaluated by univariate and multivariable analyses. Of the 343 patients meeting the inclusion criteria, 215 had complete data. Pulmonary artery systolic pressure/left ventricle stroke volume was a clear predictor of the primary end point (odds ratio [OR], 2.31; P=0.005), performing as well or better than the Pulmonary Embolism Severity Index (OR, 1.43; P=0.06) or the Bova score (OR, 1.28; P=0.01). Conclusions This study is the first study to demonstrate the utility of early pulmonary artery systolic pressure/left ventricle stroke volume in predicting adverse clinical events in patients with acute pulmonary embolism. Pulmonary artery systolic pressure/left ventricle stroke volume may be a surrogate marker of ventricular asynchrony in high‐risk pulmonary embolism and should be prognostically evaluated.
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Affiliation(s)
- Hayaan Kamran
- Department of Cardiovascular Medicine Heart Vascular and Thoracic InstituteCleveland Clinic Foundation Cleveland OH
| | - Essa H Hariri
- Department of Medicine Cleveland Clinic Foundation Cleveland OH
| | | | - Aditya Sahai
- Department of Cardiovascular Medicine Heart Vascular and Thoracic InstituteCleveland Clinic Foundation Cleveland OH
| | - Ihab Haddadin
- Department of Radiology Cleveland Clinic Foundation Cleveland OH
| | - Serge C Harb
- Department of Cardiovascular Medicine Heart Vascular and Thoracic InstituteCleveland Clinic Foundation Cleveland OH
| | - Joseph Campbell
- Department of Cardiovascular Medicine Heart Vascular and Thoracic InstituteCleveland Clinic Foundation Cleveland OH
| | - Leben Tefera
- Department of Cardiovascular Medicine Heart Vascular and Thoracic InstituteCleveland Clinic Foundation Cleveland OH
| | - Joseph M Delehanty
- Division of Cardiology Department of Medicine University of Rochester Medical Center Rochester NY
| | - Gustavo A Heresi
- Department of Pulmonary and Critical Care Medicine Respiratory InstituteCleveland Clinic Foundation Cleveland OH
| | - John R Bartholomew
- Department of Cardiovascular Medicine Heart Vascular and Thoracic InstituteCleveland Clinic Foundation Cleveland OH
| | - Scott J Cameron
- Department of Cardiovascular Medicine Heart Vascular and Thoracic InstituteCleveland Clinic Foundation Cleveland OH.,Department of Cardiovascular and Metabolic Sciences Cleveland Clinic Lerner College of Medicine Cleveland OH
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Panagides V, Vase H, Shah SP, Basir MB, Mancini J, Kamran H, Batra S, Laine M, Eiskjær H, Christensen S, Karami M, Paganelli F, Henriques JPS, Bonello L. Impella CP Implantation during Cardiopulmonary Resuscitation for Cardiac Arrest: A Multicenter Experience. J Clin Med 2021; 10:jcm10020339. [PMID: 33477532 PMCID: PMC7831079 DOI: 10.3390/jcm10020339] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/08/2021] [Accepted: 01/15/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Impella CP is a left ventricular pump which may serve as a circulatory support during cardiopulmonary resuscitation (CPR) for cardiac arrest (CA). Nevertheless, the survival rate and factors associated with survival in patients undergoing Impella insertion during CPR for CA are unknown. METHODS We performed a retrospective multicenter international registry of patients undergoing Impella insertion during on-going CPR for in- or out-of-hospital CA. We recorded immediate and 30-day survival with and without neurologic impairment using the cerebral performance category score and evaluated the factors associated with survival. RESULTS Thirty-five patients had an Impella CP implanted during CPR for CA. Refractory ventricular arrhythmias were the most frequent initial rhythm (65.7%). In total, 65.7% of patients immediately survived. At 30 days, 45.7% of patients were still alive. The 30-day survival rate without neurological impairment was 37.1%. In univariate analysis, survival was associated with both an age < 75 years and a time from arrest to CPR ≤ 5 min (p = 0.035 and p = 0.008, respectively). CONCLUSIONS In our multicenter registry, Impella CP insertion during ongoing CPR for CA was associated with a 37.1% rate of 30-day survival without neurological impairment. The factors associated with survival were a young age and a time from arrest to CPR ≤ 5 min.
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Affiliation(s)
- Vassili Panagides
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France; (V.P.); (M.L.); (F.P.)
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France
- Centre for CardioVascular and Nutrition Research (C2VN), INSERM 1263, INRA 1260, 13015 Marseille, France
| | - Henrik Vase
- Department of Cardiology, Aarhus University Hospital, 8200 Aarhus, Denmark; (H.V.); (H.E.)
| | - Sachin P. Shah
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA 01805, USA; (S.P.S.); (H.K.); (S.B.)
| | - Mir B. Basir
- Department of Cardiology, Henry Ford Hospital, Detroit, MI 48202, USA;
| | - Julien Mancini
- Department of Public Health (BIOSTIC), Aix-Marseille University, INSERM, IRD, APHM, UMR1252, SESSTIM, Hôpital de la Timone, 13005 Marseille, France;
| | - Hayaan Kamran
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA 01805, USA; (S.P.S.); (H.K.); (S.B.)
| | - Supria Batra
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA 01805, USA; (S.P.S.); (H.K.); (S.B.)
| | - Marc Laine
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France; (V.P.); (M.L.); (F.P.)
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France
- Centre for CardioVascular and Nutrition Research (C2VN), INSERM 1263, INRA 1260, 13015 Marseille, France
| | - Hans Eiskjær
- Department of Cardiology, Aarhus University Hospital, 8200 Aarhus, Denmark; (H.V.); (H.E.)
| | - Steffen Christensen
- Department of Intensive Care Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark;
| | - Mina Karami
- Department of Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1081 HV Amsterdam, The Netherlands; (M.K.); (J.P.S.H.)
| | - Franck Paganelli
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France; (V.P.); (M.L.); (F.P.)
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France
- Centre for CardioVascular and Nutrition Research (C2VN), INSERM 1263, INRA 1260, 13015 Marseille, France
| | - Jose P. S. Henriques
- Department of Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1081 HV Amsterdam, The Netherlands; (M.K.); (J.P.S.H.)
| | - Laurent Bonello
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France; (V.P.); (M.L.); (F.P.)
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France
- Centre for CardioVascular and Nutrition Research (C2VN), INSERM 1263, INRA 1260, 13015 Marseille, France
- Correspondence: ; Tel.: +33-4-9196-7487
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Sahai A, Bhandari R, Koupenova M, Freedman JE, Godwin M, McIntyre T, Chung MK, Iskandar JP, Kamran H, Hariri E, Aggarwal A, Kalra A, Bartholomew JR, McCrae KR, Elbadawi A, Svensson LG, Kapadia S, Cameron SJ. SARS-CoV-2 Receptors are Expressed on Human Platelets and the Effect of Aspirin on Clinical Outcomes in COVID-19 Patients. Res Sq 2020:rs.3.rs-119031. [PMID: 33398263 PMCID: PMC7781327 DOI: 10.21203/rs.3.rs-119031/v1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Coronavirus disease-2019 (COVID-19) caused by SARS-CoV-2 is an ongoing viral pandemic marked by increased risk of thrombotic events. However, the role of platelets in the elevated observed thrombotic risk in COVID-19 and utility of anti-platelet agents in attenuating thrombosis is unknown. We aimed to determine if human platelets express the known SARS-CoV-2 receptor-protease axis on their cell surface and assess whether the anti-platelet effect of aspirin may mitigate risk of myocardial infarction (MI), cerebrovascular accident (CVA), and venous thromboembolism (VTE) in COVID-19. Expression of ACE2 and TMPRSS2 on human platelets were detected by immunoblotting and confirmed by confocal microscopy. We evaluated 22,072 symptomatic patients tested for COVID-19. Propensity-matched analyses were performed to determine if treatment with aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) affected thrombotic outcomes in COVID-19. Neither aspirin nor NSAIDs affected mortality in COVID-19. However, both aspirin and NSAID therapies were associated with increased risk of the combined thrombotic endpoint of (MI), (CVA), and (VTE). Thus, while platelets clearly express ACE2-TMPRSS2 receptor-protease axis for SARS-CoV-2 infection, aspirin does not prevent thrombosis and death in COVID-19. The mechanisms of thrombosis in COVID-19, therefore, appears distinct and the role of platelets as direct mediators of SARS-CoV-2-mediated thrombosis warrants further investigation.
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Affiliation(s)
- Aditya Sahai
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Rohan Bhandari
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
- Department of Cardiovascular and Metabolic Sciences, Cleveland Clinic, Cleveland, OH
| | - Milka Koupenova
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Jane E. Freedman
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Matthew Godwin
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Thomas McIntyre
- Department of Cardiovascular and Metabolic Sciences, Cleveland Clinic, Cleveland, OH
- Case Western Reserve University Cleveland Clinic Lerner College of Medicine, Cleveland, OH
| | - Mina K. Chung
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
- Department of Cardiovascular and Metabolic Sciences, Cleveland Clinic, Cleveland, OH
- Case Western Reserve University Cleveland Clinic Lerner College of Medicine, Cleveland, OH
| | | | - Hayaan Kamran
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Essa Hariri
- Department of Medicine, Cleveland Clinic, Cleveland, OH
| | - Anu Aggarwal
- Department of Cardiovascular and Metabolic Sciences, Cleveland Clinic, Cleveland, OH
| | - Ankur Kalra
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - John R. Bartholomew
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
- Case Western Reserve University Cleveland Clinic Lerner College of Medicine, Cleveland, OH
| | - Keith R. McCrae
- Case Western Reserve University Cleveland Clinic Lerner College of Medicine, Cleveland, OH
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Ayman Elbadawi
- Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX
| | - Lars G. Svensson
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
- Case Western Reserve University Cleveland Clinic Lerner College of Medicine, Cleveland, OH
| | - Samir Kapadia
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
- Case Western Reserve University Cleveland Clinic Lerner College of Medicine, Cleveland, OH
| | - Scott J. Cameron
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
- Department of Cardiovascular and Metabolic Sciences, Cleveland Clinic, Cleveland, OH
- Case Western Reserve University Cleveland Clinic Lerner College of Medicine, Cleveland, OH
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Kamran H, Brar S, Ganatra S, Formica P, Shah SP, Venesy DM, Patten RD. Acute Heart Failure and Atrial Fibrillation with Rapid Ventricular Response - Role of Gender and Alcohol in Suspected Tachycardia-induced Cardiomyopathy. J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.09.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Affiliation(s)
- Hayaan Kamran
- Department of Cardiovascular Medicine, Section of Vascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Deborah Hornacek
- Department of Cardiovascular Medicine, Section of Vascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Doran Mix
- Department of Surgery, Division of Vascular Surgery, University of Rochester School of Medicine, Rochester, NY, USA
| | - Colin Wright
- Department of Medicine, Division of Cardiology, University of Rochester School of Medicine, Rochester, NY, USA
| | - Scott J Cameron
- Department of Cardiovascular Medicine, Section of Vascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
- Department of Medicine, Division of Cardiology, University of Rochester School of Medicine, Rochester, NY, USA
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Patten GE, Kamran H, Flynn K, Todd N, Ackroyd C, Mavroides M, Rybicki M, Venesy D, Shah S, Patten RD. Quantifying Burden among Caregivers of Elderly Patients with Heart Failure. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kamran H, Ganatra S, Formica P, Shah SP, Venesy DM, Patten RD. Incidence of Primary, Dilated Rather Than Tachycardia-Induced Cardiomyopathy among Patients Presenting with New Onset Atrial Arrhythmia and Heart Failure with Reduced Ejection Fraction. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Naggar I, Orman R, Lazar J, Nakase K, Kamran H, Stewart M. How do epileptic seizures cause death? Auton Neurosci 2013. [DOI: 10.1016/j.autneu.2013.05.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Terry P, Siu S, Salak K, Lee D, Kamran H, Blanton E, Tak V, Ko W. Efficacy of a novel nurse driven multidisciplinary protocol for transition from intravenous to subcutaneous insulin after cardiac surgery. Can J Diabetes 2009. [DOI: 10.1016/s1499-2671(09)33263-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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