ABSTRACT
Objective: Our objective in this study is to determine the predictive factors of thromboembolic complications in patients with previous heart disease and severe covid-19 infection and the impact of previous use of antithrombotic drugs on protection against these complications. Method(s): We conducted a single-center retrospective study of 158 patients with heart disease admitted to an intensive care unit for severe SARS-COV-2 infection. To determine the predictive factors, we used a logistic regression analysis. Result(s): Out of 158 patients, 22 were complicated by a thromboembolic event, i.e. 13.9%, mean age of our population was 64.03 (SD = 15.27), with a male predominance of 98 (62%), For the predictive factors of thromboembolic complications, and after multivariate analysis, we find the duration of hospitalization with (OR=0.92 ;95%CI (0.863 - 0.983), p=0.014, previous use of anti-thrombotic drugs as a protective factor with ( OR=0.288, 95%CI (0.091 - 0.911), p=0.034 for anti-platelet agents ) and ( OR=0, 322, 95%CI (0.131 - 0.851), p=0.021) for anti-coagulants (Figure1), and finally thrombocytopenia at admission as a risk factor ( OR=4.58 95%CI (1.2 - 10.627), p=0.021). D-dimer was not detected as a risk factor, and this can be explained by the characteristics of our population. Although the previous use of anti-thrombotic drugs protects against thrombo-embolic complications during severe infection, there was no benefit in terms of mortality (Figure2). Conclusion(s): Prior use of antithrombotic drugs is a protective factor against thromboembolic complications in patients with a history of heart disease but has no effect on mortality.
ABSTRACT
Background : Since the spread of the novel Coronavirus 2(Sarscov2) lately in December 2019, proinflammatory and hypercoagulable states with marked elevation seen in D-Dimer levels have been widely described in COVID-19-patients even in the absence of pulmonary embolism (PE). Aims : We sought to compare D-dimer levels in COVID-19-patients with and without pulmonary embolism and to establish an optimal D-dimer threshold for predicting the incidence of pulmonary embolism which guides the pulmonary computed tomography angiography (CTPA) indications. Methods : We carried out a retrospective analysis of all COVID-19-patients admitted between October 1st and November 22th, 2020, at the University Hospital Center of Mohammed VI, Oujda (Morocco) who were suspected to have PE and underwent a CTPA. Demographic, clinical, characteristics as well as blood test results at the time of PE suspicion, were compared between patients with and without PE. D-dimer levels were compared using the non-parametric test of U-man Whitney. The optimal D-Dimer ' threshold to predict the occurrence of PE was established based on the receiver operating characteristics curve constructed. Results : 84 confirmed-RT-PCR COVID-19-patients with a mean age of 64.93 years (SD14,19) were included in the final analysis. PE was diagnosed on CTPA in 31 (36.9%) patients. Clinical symptoms and inhospital outcomes were similar in both groups except that more men had PE ( P = 0.025). The median value of D-dimer was significantly higher in the PE-positive group compared to the PE-negative group (14680 [IQR 33620-3450] ng/mL vs 2980 [IQR 6870-1600] ng/mL respectively, ( P < 0.001)). (Table1) A D-dimer at 2600 ng/mL was the optimal threshold for predicting PE with a sensitivity of 90.3% and AUC was 0.773 [CI 95%,0.667-0.876). Conclusions : A D-dimer cut-off value of 2600 ng/mL is a significant predictor of PE in COVID-19-patients with a sensitivity of 90.3% and a higher threshold at 3285 ng/mL a with a sensitivity of 83.9%.
ABSTRACT
INTRODUCTION AND IMPORTANCE: Since COVID 19 was described for the first time in December 2019, we have not stopped discovering its different clinical manifestations. Despite the respiratory complication which is the most common symptomatology, multi-organ dysfunction and multiple cardiovascular complications were described such as acute myocarditis, heart failure and even arrhythmias. CASES PRESENTATION: Two patients aged 26 and 56 year-old, developed acute myocarditis related to Covid-19 infection but with different symptomatology. CASE 1: Presented to the emergency room with digestive symptomatology, Covid-19 infection was confirmed by a positive chest CT scan and positive COVID-19 serology testing. Clinical, biological, radiological findings allowed making the diagnosis of a Covid-19 infection with a bacterial superinfection complicated by a fulminant myocarditis. CASE 2: Presented to the emergency department with a chest pain, dyspnoea, paroxistic cough, myalgia and fever. A Covid-19 infection was confirmed. The electrocardiogram showed a diffuse ST elevation, echocardiography showed normal systolic function and the high-sensitivity cardiac troponin I level was high. Invasive coronary angiography was performed, revealing angiographically normal coronary arteries. CLINICAL DISCUSSION: Our 2 cases were treated differently, case 1 received antibiotherapy because of the bacterial superinfection and inotropic support for the septic and cardiogenic choc. Contrarily to case 2 who received inotropic support, immunoglobulin and corticosteroid. With a total recovery for both patients. CONCLUSION: This article can help in considering cardiac affection due to SARS-CoV2, even with poor respiratory symptomatology, and to insist on the importance of the cardiac evaluation for young patients with a sever Covid-19 infection.