Aspects épidémio-cliniques des manifestations thrombotiques au cours de la COVID- 19 au sein des hôpitaux militaires de Libreville et d'Akanda, Gabon / Epidemiology and clinical aspects of thrombotic manifestations during COVID-19 at the military hospitals of Libreville and Akanda, Gabon

Décrire les aspects épidémio-cliniques des manifestations thrombotiques au cours de la COVID-19 au sein des hôpitaux militaires de Libreville et Akanda, Gabon. Méthodes : Nous avons mené une étude rétrospective et descriptive multicentrique d'une durée de 7 mois, du 01er septembre 2021 au 31 mars 2022, portant sur les patients admis dans les unités de réanimation des hôpitaux d'instruction des armées de Libreville (HIAOBO) et d'Akanda (HIAA), pour COVID-19 documentée ou suspectée. Résultats : Durant la période d'étude, 167 patients ont été́ admis pour infection à SARS-CoV-2, parmi lesquels, 18 ont présentés des manifestations thromboemboliques (10,8%). La moyenne d'âge était de 54,7±6.4 ans. Il y avait une large prédominance masculine avec un sexe ratio à 2. Nous avons noté́ 9 cas d'embolie pulmonaire (50%), 5 cas d'accidents vasculaires cérébraux ischémiques (28%), 1 cas de thrombose veineuse profonde de membre inferieur (6%), 1 cas de thrombose veineuse cérébrale (6%), 1 cas de thrombose de la veine mésentérique (6%) et 1 cas de thrombose de la veine porte (6%). Les D-dimères étaient élevés chez tous les patients. Les globules blancs étaient élevés (>10000/mm3 ) chez 12 patients (67%). Les plaquettes étaient inférieures à 150000/mm3 pour 6 patients (33%). Tous les patients avaient une pneumonie à SARS-CoV-2 et la moyenne d'atteinte deslésions pulmonaires était estimée à 45%. Neuf patients étaient décédés (50%) au cours de l'hospitalisation. Conclusion : L'infection par le SARS-CoV-2 constitue vraisemblablement une prédisposition à la survenue d'un événement thrombotique. L'incidence des manifestations thrombotiques chez les patients atteints de COVID-19 reste élevée, renforçant ainsi la prescription systématique d'une anticoagulation prophylactique

To clot, or not to clot ­ Antithrombotic therapy is the question

Haemostasis and thrombosis rely on three components namely the vascular endothelial wall, blood platelets and the coagulation cascade. Non-physiologic excessive thrombosis occurs when haemostatic processes are dysfunctional, causing undue clot formation or reduced clot lysis. Antithrombotic agents including antiplatelet, anticoagulation and fibrinolytic agents are essential for the prophylaxis and pharmacological management of venous thromboembolism and arterial thrombosis. Anticoagulation treatment options have expanded steadily over the past few decades, providing a greater number of agents. Anticoagulants that directly target the enzymatic activity of thrombin and factor Xa have recently been developed to address the inadequacies of traditional vitamin K antagonists. Appropriate use of these agents requires knowledge of their individual characteristics, risks, and benefits

Using WhatsApp smartphone application to monitor INR in patients on Warfarin: first experience with 21 patients

Anticoagulation with warfarin is under-prescribed in eligible patients. The quality of anticoagulation as measured by Time in Therapeutic Range (TTR) is below the 60-70% standard in clinical practice (outside anticoagulation clinics) with lower rates in SubSaharan Africa when compared with Western Europe, Canada and the United States. WhatsApp is a free smartphone application that is increasingly used for telemedicine applications. In this retrospective study, we reviewed the use of WhatsApp for physician-patient communication of INR results and Warfarin dose adjustments. From March 5th, 2018 to May 15th, 2019, all patients (n=938) attending a private Cardiology clinic were offered WhatsApp as a means of direct communication with the Cardiologist on an as needed basis. 21 (2.2%) used it for INR reporting and Warfarin dose adjustment. The median age was 62 years, with a male to female ration of 10:11. The median TTR was 37% by Linear Interpolation, and 42.9% by percentage of therapeutic INRs. The median follow-up duration was 82 days. 23% of patients managed to achieve TTR of more than 72%. Most patients (61.9%) continued on warfarin during the study period, 9.5% switched to a Directly Acting Oral Anticoagulant, 9.5% stopped Warfarin due to bleeding while on therapeutic INR, 14.2% switched to another provider for INR monitoring, 9.5% were lost to follow-up. Smartphone technology may provide a solution for reduced Warfarin prescription for eligible patients, with some patients (23% in this study) achieving TTRs of more than 72%. However, overall TTR rates remained low in this study

High prevalence of atrial fibrillation in stroke patients admitted to university of Gondar hospital, northwest Ethiopia

Purpose : Even though atrial fibrillation is a common risk factor of stroke which contributes to poor outcome, data concerning this association is scarce in African countries. This study assessed the prevalence of confirmed atrial fibrillation and its effect on outcome in stroke patients admitted to University of Gondar Hospital.Methods: A Hospital based cross-sectional study by record analysis was done from December 2014 to February 2015. All adult stroke patients with documented head CT scan and ECG results admitted to university of Gondar hospital during June 2010 to May 2013 were included. Relevant data including sociodemographics, type of stroke, and presence of atrial fibrillation was collected from patient charts using a data extraction form.Results: A total of 94 patients with mean age of 67.4±12.4 years and Female to male ratio of 1.13:1 were analyzed. The prevalence of AF was 28.7%. It occurred in 34% and 14% of ischemic and hemorrhagic strokes respectively. The in hospital case fatality of stroke associated with and without atrial fibrillation was 22.2% and 8% respectively while the rate of improvement at discharge was 34% and 68% respectively. Atrial fibrillation was associated with a low rate of improvement at discharge (OR= 0.28 CI: 0.1-0.78).Conclusion: Atrial fibrillation is common in stroke patients in our hospital, especially in the elderly population. It is associated with low rate of improvement at discharge. Appropriate screening and treatment of atrial fibrillation is invaluable for the primary and secondary prevention of stroke

Apport de l'imagerie dans le diagnostic d'une thrombose veineuse cérébrale idiopathique: à propos d'un cas à Cotonou

Introduction : Une symptomatologie apparemment banale peut cacher une authentique pathologie grave. Nous rapportons un cas historique de thrombose veineuse cérébrale (TVC) révélé par la tomodensitométrie cérébrale chez un sujet jeune pris en charge pour des céphalées isolées et persistantes. Observation : patient de 25 ans, sans antécédents particuliers, admis pour des céphalées isolées,atroces, initialement temporales gauche, puis secondairement en casque sans aucun autre signe associé. L'examen neurologique était normal et le scanner révélait des signes directs et indirects de thrombose de plusieurs sinus cérébraux. Aucune étiologie n'a été retrouvée. L'évolution a été rapidement favorable et sans séquelles sous traitement anticoagulant.Conclusion : l'imagerie a un rôle capital dans le diagnostic de la TVC

Hypertension; Chronic Kidney Disease; Atrial Fibrillation and the Newer Anticoagulants

Atrial fibrillation (AF) is a common clinical condition that is associated with increased morbidity and mortality that mainly relates to an embolic stroke. Dominant risk factors for AF are advanced age and hypertension in the absence of mitral valve disease.1 In turn; hypertension and ageing are determinants of the congestive heart failure; hypertension; age; diabetes mellitus; prior stroke or transient ischaemic attack or thromboembolism (CHADS2) criteria for assessing the indication for anticoagulation. In addition; they are important risk factors for chronic kidney disease (CKD). In itself; CKD is an independent risk factor for AF and a higher risk of stroke.2 It is highly likely that a practitioner will encounter older patients with AF and concomitant hypertension and CKD that require anticoagulation therapy. Thus; it is essential for the practitioner to understand the risks and benefits of anticoagulation in older patients with AF; hypertension and CKD

Thrombose portale d'origine virale

Le virus d'Epstein-Barr est responsable de la mononucleose infectieuse. Il peut induire la formation d'anticoagulants circulants sans qu'apparaissent obligatoirement des manifestations thrombotiques. Nous rapportons le cas d'un jeune patient hospitalise pour une thrombose portale revelee par des manifestations douloureuses abdominales. La recherche d'anticoagulant circulant de type lupique dans le sang etait positive. Le bilan de thrombophilie s'averait negative. Nous n'avons pas retrouve de cas similaire dans la litterature. Le role des anticoagulants circulants semble etre primordial dans la constitution de cette obstruction de la veine porte. Une infection virale peut etre a l'origine de manifestations thrombotiques intra-abdominales par le biais de l'action thrombogene des anticoagulants circulants in vivo

Invasive and Anticoagulant Treatment for Coronary Ectasia : a Single Operator's Experience in a Tertiary Hospital in South Africa : Cardiovascular Topics

Introduction: Coronary artery ectasia (CAE) is a rare but well-recognised condition involving dilatation of a coronary artery to more than 1.5 times the diameter of the adjacent portion of the artery. As far as we are aware; the disease has not been described in any local literature and no other research has been conducted in Africa. We carried out this research in order to establish the incidence of the condition in South Africa; as well as the possible preferred method of treatment. Methods: Cases were identified from the database of the practice. The study involved only patients who were classified to have Markis type I; II and III disease. From a total of approximately 2 000 angiographies performed during the study period; CAE types I; II and III were diagnosed in 20 patients. Patients with type IV CAE were excluded from the group. Nineteen patients were male and were in their fourth or fifth decade of life; and one was female. Three of the patients were Indian; one was black; and the rest were white. Results: Four patients in the group had diabetes; 13 were smokers and eight had hypertension. Dyslipidaemia was observed in seven patients. The most commonly affected area of the coronary artery was the RCA-19 (isolated; or in combination). Patients were treated mainly with anticoagulation and; when necessary; with angioplasty and stent implantation. Morbidity was seen in 5of the patients and no mortality was observed. Conclusion: Most of the patients were male; and the occlusion involved mostly the right coronary artery. The cause of occlusion is still unknown; but it is thought to be due to slow blood flow; damaged endothelium; or a combination of the two. The best therapeutic approach is not known as yet

L'hemoperitoine spontane: une complication rare des anticoagulants

L'hemoperitoine spontane est defini par la presence de sang dans la cavite peritoneale en l'absence de tout traumatisme. Il s'agit d'un accident rare mais grave. Nous rapportons le cas d'une jeune femme de 28 ans; sous traitement anticoagulant oral; qui presentait une douleur abdominale aigue; une instabilite hemodynamique et une deglobulisation sans notion de traumatisme. Le traitement medical doit etre propose en premiere intention en cas d'hemoperitoine. La prevention reste la meilleure strategie dans la prise en charge des accidents des anticoagulants

Resolution of a Giant Atrial Thrombus Following Anticoagulation Therapy : Case Report

We report on a patient in whom a giant thrombus in the left atrium was detected by transthoracic echocardiography. Anticoagulant theraphy was started. After two months of therapy; repeat echocardiography showed complete resolution of the thrombus. This case indicates that large and presumably organised thrombi may be treated with anticoagulant the