Medical bridging therapy before pulmonary endarterectomy?

Introduction: Pulmonary endarterectomy (PEA) is the recommended treatment for patients with operable chronic thromboembolic pulmonary hypertension (CTEPH). Reducing PVR pre-surgery may lower the surgical risk, but efficacy of drug treatment in operable CTEPH has not yet been proven and surgeons are concerned that dissection may be more difficult in pre-treated patients. Methodology: A randomised, double-blind, placebo controlled, multinational prospective study was performed in patients with operable CTEPH and PVR >800 dynes.sec.cm-5 at baseline (NCT03273257). Patients were randomised to Riociguat or placebo for 3 months prior to PEA. Primary endpoint was the change in PVR from baseline to before PEA. Secondary endpoints included perioperative findings and evaluation of the PEA specimen. Planned recruitment was 88 patients over 2 years. Result(s): The study was terminated early because of slow recruitment and the COVID-19 pandemic. At the time of study cessation, 14 patients were randomised (7 in each group) and 11 patients completed PEA surgery. At diagnosis, PVR was 944.0 dynes.sec.cm-5 in the Riociguat group and 1007.5 dynes.sec.cm-5 in the control group. -5 -5 The mean change in PVR prior to PEA was -28.4% for Riociguat and -6.9% for placebo (p=0.14). Completeness of surgical clearance was as expected in all patients. In the Riociguat group ease of dissection plane was rated as easier in 1, normal in 3 and more difficult in 2. In the control group, it was rated as easier in 1 and normal in 4. There were no surgical complications or post-operative deaths and no new safety signals. Conclusion(s): Due to the premature study discontinuation and the limited sample size, we are unable to determine the impact of bridging therapy on PEA outcomes.

Breastfeeding in the case of suspected or confirmed SARS-CoV-2 infection

Breastfeeding or lactation by donated milk in the event of mother-infant separation are not contraindicated in women with suspected or confirmed Covid-19 infection. The benefits of this method of feeding are well established. Perinatal care providers should encourage mothers to breastfeed. Their support is even more important in a context of viral circulation. © 2020 Elsevier Masson SAS La mise au sein ou l'allaitement maternel par don de lait en cas de séparation mère-nouveau-né ne sont pas contre-indiqués chez la femme chez qui une infection à la Covid-19 est suspectée ou confirmée. Les bienfaits de ce mode d'alimentation ne sont plus à démontrer. Les acteurs de la périnatalité doivent encourager les mères à allaiter. Leur accompagnement est encore plus important dans un contexte de circulation virale. © 2020 Elsevier Masson SAS

Anticoagulant therapy in COVID-19 critically ill: Should we go for more?

Critically ill COVID-19 patients often develop a severe pro-thrombotic milieu, as reflected by the markedly increased d-dimer levels. Several cohort studies have reported high rates of thrombotic complications, including deep venous thrombosis (DVT) and pulmonary embolism (PE), myocardial infarction, stroke and microvascular thrombosis. Accordingly, COVID-19 patients who are hospitalized either at a normal, non-intensive care unit (ICU) or at the ICU need to receive appropriate dosages of anticoagulant therapy to prevent or treat these thrombotic complications. This manuscript summarizes the institutional guidance for the antithrombotic prophylaxis and treatment of VTE as outlined by a multidisciplinary team of experts during the first weeks of the COVID-19 pandemic in Europe. Controlled studies are needed to verify the optimal anticoagulation for both prophylaxis and treatment.