Socio-emotional processes during the COVID 19 pandemic in graduate students

Introduction: the changes in the academic life of graduate students due to the pandemic generated complex socioemotional processes that need to be explored.Objective: to compare the socioemotional processes in graduate students during the closure of universities according to the area of knowledge and sex.Method: exploratory-descriptive -comparative quantitative study with a cross-sectional design. A total of 119 questionnaires were analyzed using the Mann -Whitney U non-parametric statistical test to determine significant differences in the independent variables. Results: significant differences were identified before and during the pandemic in prosocial emotions and mood affectations in both groups of students due to the overload of academic-work activities and the differentiated conditions by area. Women in area 2 were more affected.Discussion: the socio-structural and situational context and the educational level condition socioemotional processes in a statistically significant way. Scope and limitations of the study are discussed.

Trajectories of respiratory recovery after severe SARSCoV-2 infection (RE2COVERI): a pragmatic, longitudinal cohort study

Background: Severe COVID-19 survivors may exhibit functional impairment, radiological sequelae and persistent symptoms at short to mid-term follow-up. Aim(s): To determine the trajectories of respiratory recovery after severe COVID-19, and factors that could influence it. Method(s): Prospective, multicentre, longitudinal cohort study of adult patients hospitalized for severe COVID-19 (LOS >= 7d, oxygen flow >= 3L), evaluated at 3 months from hospital discharge with conditional follow-up at 6 and 12 months. Result(s): 486 participants from 13 French hospitals were included (median age 61y;female sex 27%): 173 needed oxygen only, 96 required non invasive ventilatory support and 217 were intubated. 454 (93%) patients were evaluated at 3 months, whereas 294 (60%) and 163 (34%) were followed up at 6 and 12 months, respectively. At 3- months assessment, a restrictive lung defect, an altered diffusion capacity and significant radiological abnormalities were observed in 33%, 71% and 57% of the cases, respectively. In case of extended follow-up, FVC (% pred.) increased by 4 points at M6 and by 7 points at M12, in mean;DLCO (% pred.) by 5 and 7 points, respectively. Age, sex, obesity, immunodepression, chronic cardiac or respiratory disease, initial extension of pneumonia and mechanical ventilation over 14 days were associated with lung function at 3 months but not with respiratory trajectories from this time point. Conclusion(s): A systematic follow-up seems justified after a severe COVID-19, especially in patients with extensive radiological lesions during acute illness. Pulmonary function and residual radiological abnormalities may improve up to 1-year after hospital discharge. Covid-19 A.

Socio-Emotional Experiences of University Students in the Face of Virtual Education Due to Covid-19

The article analyzes and compares the socio-emotional experience of university students from Mexico and Peru in the face of migration to remote emergency education due to Covid-19. This is an exploratory-descriptive-comparative quantitative study with two independent purposive samples. Based on the results, it is shown that socio-emotional affectations reflect and prolong the unequal social structures that condition the university community in Latin America. © 2022 Instituto de Estudios Sociales Contemporaneos IESCO. All rights reserved.

Ocular manifestations of COVID-19

The Sars-Cov- 2 virus, the etiological agent of Covid-19, causes systemic and ocular manifestations in humans. Due to the global repercussion that the pandemic has had, the multisystemic damage it causes and the presence of ocular manifestations, which could be the presentation of the disease, it is decided to carry out the present work to offer a theoretical reference about the ocular manifestations of Covid- 19 and some therapeutic guidelines to consider. A bibliographic search was carried out in the Pubmed, Infomed, SciELO and academic Google databases, of articles in Spanish and English, which included new information related to the disease and its impact on eye health. Inflammatory and infectious processes of the visual apparatus, such as conjunctivitis and uveitis, are found with remarkable frequency. In the recovery stage, ocular findings associated with systemic immunosuppression, vasculitic and thromboembolic processes are presented. The indicated therapy does not usually differ from the conventional ones. First-line doctors play an essential role in the timely diagnosis of cases, since ocular manifestations can be the first sign of systemic disease.

Trajectoires de recuperation respiratoire apres une infection COVID-19 severe (RE2COVERI) : resultats d'une etude pragmatique de suivi jusqu'a 1 an

Introduction: Les survivants de formes severes a critiques de COVID-19 peuvent presenter des sequelles fonctionnelles et radiologiques et des symptomes persistants a distance de l'episode aigu justifiant un suivi prolonge. L'objectif de l'etude est de determiner les trajectoires de recuperation respiratoire apres un COVID-19 severe, et les facteurs qui pourraient l'influencer. Methodes: Etude de cohorte prospective, multicentrique, longitudinale de patients adultes hospitalises pour COVID-19 severe (duree d'hospitalisation >= 7 j, debit d'oxygene >= 3 L) ou critique (intubation), evalues (clinique, TDM, EFR, test de marche, questionnaires de symptomes et de qualite de vie) 3 mois apres leur sortie de l'hopital, avec un suivi ulterieur conditionnel a 6 et 12 mois. Resultats: Au total, 486 participants ont ete inclus dans 13 hopitaux francais (age median : 61 ans;sexe feminin : 27 %) : 173 avaient necessite de l'oxygene seul, 96 un support ventilatoire non invasif (CPAP, OHD ou VNI) et 217 avaient ete intubes. Au total, 454 patients (93 %) ont ete evalues a 3 mois, 294 (60 %) et 163 (34 %) ont ete suivis respectivement jusqu'a 6 et 12 mois. Une dyspnee d'effort, un syndrome restrictif, un trouble de la diffusion et des anomalies radiologiques significatives ont ete observees respectivement dans 62 %, 33 %, 71 % et 57 % des cas a M3. En cas de suivi prolonge, la DLCO (% theo.) et la CVF (% theo.) augmentaient en moyenne de +4 points a M6 et respectivement de +6 points et +7 points a M12. Le sexe, l'indice de masse corporelle, les maladies cardiovasculaires ou respiratoires chroniques, l'immunodepression, l'etendue de la pneumonie pendant la phase aigue de la maladie et la duree prolongee (> 14 j) de ventilation mecanique invasive etaient associes a la DLCO a M3, mais pas a sa trajectoire ulterieure. Parmi 476 patients (97,9 %) ayant eu au moins une TDM thoracique au cours du suivi, 196 (41 %) avaient des sequelles significatives sur leur derniere imagerie. Le sexe, l'etendue de la pneumonie a la phase aigue, la duree de la ventilation mecanique invasive et la DLCO a M3 etaient independamment associes au resume des composantes physiques du SF-36, tandis que seul l'age etait associe au resume des composantes mentales du SF-36. Conclusion(s): Bien que la fonction respiratoire s'ameliore et que les anomalies radiologiques residuelles regressent jusqu'a 1 an apres l'episode aigu, une proportion importante des survivants de formes severes ou critiques de COVID-19 ont des sequelles radiologiques et fonctionnelles importantes et des symptomes residuels pouvant affecter leur qualite de vie et justifiant un tel suivi. Copyright © 2022

COVID-19 is a systemic vascular hemopathy: insight for mechanistic and clinical aspects

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is presenting as a systemic disease associated with vascular inflammation and endothelial injury. Severe forms of SARS-CoV-2 infection induce acute respiratory distress syndrome (ARDS) and there is still an ongoing debate on whether COVID-19 ARDS and its perfusion defect differs from ARDS induced by other causes. Beside pro-inflammatory cytokines (such as interleukin-1 beta [IL-1beta] or IL-6), several main pathological phenomena have been seen because of endothelial cell (EC) dysfunction: hypercoagulation reflected by fibrin degradation products called D-dimers, micro- and macrothrombosis and pathological angiogenesis. Direct endothelial infection by SARS-CoV-2 is not likely to occur and ACE-2 expression by EC is a matter of debate. Indeed, endothelial damage reported in severely ill patients with COVID-19 could be more likely secondary to infection of neighboring cells and/or a consequence of inflammation. Endotheliopathy could give rise to hypercoagulation by alteration in the levels of different factors such as von Willebrand factor. Other than thrombotic events, pathological angiogenesis is among the recent findings. Overexpression of different proangiogenic factors such as vascular endothelial growth factor (VEGF), basic fibroblast growth factor (FGF-2) or placental growth factors (PlGF) have been found in plasma or lung biopsies of COVID-19 patients. Finally, SARS-CoV-2 infection induces an emergency myelopoiesis associated to deregulated immunity and mobilization of endothelial progenitor cells, leading to features of acquired hematological malignancies or cardiovascular disease, which are discussed in this review. Altogether, this review will try to elucidate the pathophysiology of thrombotic complications, pathological angiogenesis and EC dysfunction, allowing better insight in new targets and antithrombotic protocols to better address vascular system dysfunction. Since treating SARS-CoV-2 infection and its potential long-term effects involves targeting the vascular compartment and/or mobilization of immature immune cells, we propose to define COVID-19 and its complications as a systemic vascular acquired hemopathy. Copyright © 2021, The Author(s), under exclusive licence to Springer Nature B.V.

Platelet activation and COVID-19 mortality: Insights from coagulopathy, antiplatelet therapy and inflammation

Background: Severe coronavirus disease 2019 (COVID-19) is associated with inflammatory cytokine burst and coagulopathy. Platelets may contribute to microthrombosis development and be a target in COVID-19 therapy. Aim(s): To determine the significance of platelet activation and antiplatelet agents (APAs) treatment in COVID-19 pathophysiology and mortality in two cohorts of patients with COVID-19. Method(s): We explored two cohorts of COVID-19 patients: Cohort A (NCT04624997) included 208 ambulatory and hospitalized patients of different clinical severity with evaluation of soluble CD40 ligand (sCD40L) and P-selectin (sP-sel) plasma levels of within the first 48 hours following admission. Cohort B included 2878 patients initially admitted in medical ward with collection of clinical characteristics and outcomes (NCT04344327). In both cohorts, the primary outcome was in-hospital mortality. Result(s): In cohort A, circulating median levels of sCD40L and sP-sel were significantly increased solely in critical patients with COVID-19 (sP-sel: 40059 pg/ml, IQR 26876-54678;sCD40L: 1914 pg/ml IQR 1410-2367;p < 0.001 for both), signaling platelet hyper-activation. However, pre-hospitalization APAs did not significantly modified sCD40L and sP-sel levels. Admission sP-sel levels were predictive in-hospital mortality (Kaplan-Meier log-rank p = 0.004), even after adjustment on CRP, while adjustment on D-dimer abolished this relationship, suggesting that platelet activation is highly interrelated with coagulopathy. We confirmed this finding in a Cox model adjusted for age, sex, CRP and D-dimer levels (Odds ratio 1.78, 95% CI 0.63-4.50). We confirmed in cohort B (2878 patients) that, among patients receiving APA before hospitalization, there was no significant difference in the proportion of death in a Cox model (Hazard ratio 1.0, IQR0.77-1.30) adjusted for demographic comorbidities. Conclusion(s): Our findings highlight the critical role of coagulopathy, in contrast to platelet activation, in discriminating COVID-19 severity and increased risk of in-hospital mortality. We also confirm that APAs before hospitalization do not influence neither mortality nor platelet activation. (Table Presented).

Bleeding risk of intramuscular injection of COVID-19 vaccines in adult patients with therapeutic anticoagulation

Background: Concerns emerged for the management of intramuscular (IM) injections for COVID-19 vaccines in patients with therapeutic anticoagulation. Aim(s): The aim of the study was to evaluate the risk of bleeding events following IM vaccination in patients under therapeutic anticoagulation Methods: We first performed a French multicentre prospective study including patient treated by anticoagulant therapy for venous thromboembolism between May 2021 and September 2021. Consecutive patients were asked to report bleeding events at the site of COVID-19 vaccine injection during follow-up. We next performed a request in the French national pharmacovigilance database to identify cases of bleeding events at the site of injections following COVID-19 vaccine in patients under therapeutic anticoagulation between December, 27th, 2020 and June, 30th, 2021. Result(s): Between May and September 2021, a total of 348 patients with anticoagulant therapy received 561 IM injections of COVD-19 vaccines. Median age of patients was 68.4 years and 65.2% were males. Almost all patients were treated with direct oral anticoagulant (DOAC 96.6%), 11 (3.2%) patients with vitamin K antagonist and one (0.2%) with tinzaparin. Among them, 17.9% had pressure at the injection site after the injection and 4.2% had anticoagulant dose skipping before vaccination. After IM injections, a total of 3 (0.6%) bleeding events were observed, 2 (0.4%) minor and one (0.2%) clinically relevant non-major bleeding. We next observed in the French national pharmacovigilance database a total of 13 bleeding events (all minor bleeding) at the site of injection in patients on therapeutic anticoagulation between December, 27th, 2020 and June, 30th, 2021. In France, 69,089,410 doses of COVID-19 vaccine were administered during this period. These bleeding events correspond to a spontaneous notification rate of 0.19 cases (95% CI 0.09-0.29) reported per million of doses administered. Conclusion(s): IM vaccination appears safe in patients under therapeutic anticoagulation in particular with DOAC, and may not require skipping doses.

Prognostic value of troponin elevation at admission and during monitoring in COVID-19 patients

Background: Troponin seems to be a biological marker of interest in the risk-stratification of COVID 19 at admission, but few studies focus on exploring its prognostic abilities during hospitalization. Aim(s): To assess the ability of troponin levels at admission and during follow-up to predict in-hospital mortality in COVID-19 patients. Method(s): Troponin was measured at admission and throughout hospitalization amongst COVID-19 patients. We explored the prognostic ability of baseline troponin and kinetics on COVID-19 patients outcomes using logistic regression and Cox model. Result(s): Amongst 399 patients enrolled with confirmed COVID-19, 247 had at least 2 troponin measurements during hospitalization and 319 (80%) survived, while 80 (20%) died during hospitalization. Elevated troponin upon arrival was significantly associated with mortality (Odds Ratio (OR) 5.65 (95% CI 3.24 -9.88);p < 0.01). Patients with an elevated troponin level and underlying cardiovascular diseases were more likely to experience death than those without elevated troponin nor cardiovascular history (Hazard Ratio 4.62 (1.96-10.91);p < 0.001). There seems to be a level-dependent association between troponin level and in-hospital mortality (p < 0.01). To assess the ability of troponin monitoring during the first 10 days of hospitalization to predict in-hospital mortality we analyzed the ratio of troponin (ROT) between the highest level of troponin and the baseline troponin measurement. An increase over 75% of the ROT was not significantly associated with in hospital mortality (OR 1.02 (95% CI 1.01-1.04);p = 0.12). During follow-up, there was no significant differences of in-mortality between patients with constant elevated troponin throughout hospitalization and those who went from a normal to an elevated troponin (p = 0.15). Conclusion(s): For COVID-19 patients, troponin seems to be a relevant factor for in-hospital mortality and risk-stratification at admission but its monitoring during follow-up does not appear to be valuable in predicting disease progression.

Development of a prioritisation protocol for the use of immunoglobulins in view of the global supply problem

Background and importanceHighly purified immunoglobulins (95%) are obtained from the purification of human plasma extracted from healthy donors. The mechanism of action consists of an antigen-specific activity, exerting immunomodulatory functions in addition to those of the natural immunoglobulins. The increase in demand, the dependence exclusively on plasma donations, and the pandemic situation have reduced the supply of immunoglobulins worldwide.Aim and objectivesTo elaborate a protocol at regional level (seven hospitals) to prioritise, rationalise and reduce the use of immunoglobulins in view of the worldwide supply problem.Material and methodsA multidisciplinary work team was created comprising professionals involved in the use of these therapies (immunologists, haematologists, internists, neurologists, paediatricians and pharmacists). The main pathologies involved were specified.Subsequently, the indications depicted in the technical data sheet and the available scientific evidence were reviewed, to define three priority groups:Priority 1: Necessary treatment, there is no other therapeutic alternative.Priority 2: Pathologies or clinical situations where the use of immunoglobulins is recommended.Priority 3: Clinical situations without sufficient scientific evidence.Finally, the indications and dose regimen of all patients under active treatment were reviewed.ResultsThe work team defined Priority 1 as follows:Chronic treatments: primary and secondary immunodeficiencies, CAR–T hypogammaglobulinaemia in paediatrics, pure motor chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy.Acute treatments: Kawasaki disease, primary immune thrombocytopenia (PIT) before undergoing urgent surgery or PIT with severe thrombopenia/large bleeding diathesis.Priority 2 included: Guillain-Barré syndrome, myasthenia gravis, PIT with high risk of bleeding, CIDP (excluding pure motor), severe neonatal sepsis, alloimmune haemolytic disease in neonates, alloimmune neonatal thrombocytopenia, haemophagocytic syndrome and paediatric multisystem inflammatory syndrome due to SARS-CoV-2.Pathologies not mentioned above were considered Priority 3, being evaluated by a multidisciplinary Experts Committee.After reviewing the active treatments, 21% of them were temporarily suspended. Since the protocol approval, eight new cases have been assessed as Priority 3, with only one of them being denied.Conclusion and relevanceThe creation of the protocol has made it possible to rationalise the use of immunoglobulins, reducing their consumption and promoting the use of therapeutic alternatives. Thus, completely necessary treatments are guaranteed through equitable and equal access throughout the region.References and/or acknowledgementsConflict of interestNo conflict of interest

Characteristics of patients with acute ischemic stroke and covid-19 who required intensive care unit admission versus ward-only: The mississippi academic center experience

Background: Coronavirus disease 2019 (COVID-19) is a viral disease that has primarily been known to cause respiratory symptoms;however, there has also been an association of COVID-19 with neurological symptoms, including acute ischemic stroke (AIS). There is a lack of data on the characteristics of AIS patients with COVID-19 from the stroke belt. We aim to describe the characteristics of patients with COVID-19 and AIS and compare the characteristics of those who required intensive care unit (ICU) admission versus ward-only. Methods: Single center, retrospective cohort study of adult patients admitted in a tertiary academic center from March 1-December 31, 2020. The institutional COVID database was utilized for data collection. Demographic, clinical and laboratory data were collected. Primary outcome measure was mortality. Secondary outcomes included hospital length of stay (LOS) and discharge disposition. Results: Both COVID-19 and AIS were found in 2.4% (n=75) of patients out of 3,031 patients with COVID-19, during the study period. These patients were male (45, 60%), African American (43, 57%), 65±12 years old, with hypertension (69, 92%) and Diabetes Mellitus type 2 (50, 67%). We noted a 20% (n=15) overall in-patient mortality rate among patients with both COVID-19 and AIS. Among these patients, 23% (n=17) required ICU admission. Demographic, clinical and laboratory characteristics were comparable among ICU versus ward-only patients except for higher LDH (476.12±189.70 vs 276.17±88.35 U/L, p==0.0003);and lower relative lymphocytic count (3.57±3.56 vs 8.93±7.83 10 cells/μL, p=0.0160) among those admitted into the ICU. Mortality (13, 68% vs 6, 32%, p<0.001) was significantly higher among the ICU cohort while majority of the ward-only cohort were discharged home (21, 95%). Conclusion: We present the first description of characteristics and outcomes of patients with AIS and COVID-19 from Mississippi. Novel to this cohort is the comparison of those who were admitted into the ICU versus ward-only. Prospective studies analyzing larger datasets of COVID-19 and stroke in the stroke-belt are warranted to further study disparities of care and outcomes.

Collective intelligence and web tools in the educational process

The knowledge society has managed to address one of the biggest changes, in the last two years, which has had a total and partial confinement, of this issue that afflicts humanity, the health emergency caused by the COVID-19. The world could not be paralyzed in all scenarios, for this reason, it was necessary to act and get to incorporate information and communication technologies (ICT) into daily activities. The educational context was one which incorporates and uses of ICT is most reflected, which had to make a stop along the way, to think of how it would be implemented communication strategies to interact with students and be able to continue with education at home. In this way, ICTs began to be more relevant through Web tools and, to be incorporated, used, and adapted to keep the educational process active. In this way, individual work was also privileged, and even more collaborative one allowing Collective Intelligences to be empowered in education, by developing favorable spaces to home learning. This research project addressed the research question "How to promote the development of Collective Intelligence supported by web tools?"where the intervention and relevance of the web tools were understood in depth, as well as their incorporation, use, adaptation, and contribution to the development of the educational processes;whereas teachers, students and now family, they have played an active role facing this health emergency caused by COVID-19. The interactions and reflections made around these tools, allow to strengthen the competences, the collaborative and cooperative learning, which increases the group work team. One of the purposes was to interact with Web tools to strengthen the development of Collective Intelligences, the educational process conceived in a decentralized context allows to generate a technological transformation in education. This has allowed teachers, students, and parents to act in collective environments, in this sense, the expanded open classroom education that works collectively has taken a considerable enough of strength, where everyone acts, reflects and participates in active roles. The research was worked with the methodological approach of qualitative type, which allowed to know about the reality that surrounds the educational process, by observing to describe and explain the attitudes and academic developments of students in situations identified in a theoretical-practical context. One of the results was the interaction and the way who works emotional intelligence was addressed, when students and teachers are working as a team, in developing Collective Intelligences. The project has been advanced, thanks to the observation as an instrument that has made it possible to demonstrate the applicability of web tools to strengthen the development of Collective Intelligences in the educational process. © 2021 ACM.

Does hydroxychloroquine prevent symptomatic venous thromboembolism in patients with mild to moderate COVID-19?

Background : SARS-CoV-2 infection can trigger an important immune reaction, induce antiphospholipid antibodies, and is associated with a high-risk of venous thromboembolism (VTE), especially in patients with severe or critical disease. Hydroxychloroquine is an immunomodulator that had proven some efficacy in preventing thrombosis in antiphospholipid syndrome. Aims : To investigate if hydroxychloroquine prevents symptomatic VTE in patients with mild to moderate COVID-19. Methods : Ancillary study of HYCOVID trial, a prospective, multicenter, randomized, double-blind trial aiming to assess the efficacy of hydroxychloroquine with regard to the 14-day rate of death or invasive ventilation ( https://clini caltr ials.gov/ct2/show/NCT04 325893 ). COVID-19 patients were included, with their informed consent, if they had at least one of the following risk factors for worsening: need for supplemental oxygen, age ≥75 years, age between 60 -74 years and presence of at least one comorbidity. Eligible patients were randomized to receive either 800 mg hydroxychloroquine on Day 0 followed by 400 mg per day for 8 days, or a placebo. In the present study, we assessed the 28-day cumulative rate of symptomatic VTE. All suspected events were adjudicated by an independent committee, blinded to treatment allocation. Results : Two hundred and fifty patients were enrolled;124 and 123 patients received hydroxychloroquine or placebo and were included in the modified intention-to-treat analysis, respectively. Eightyseven percent of the patients received an anticoagulant treatment during hospitalization (104 [83.9%] and 111 [91.2%] in the hydroxychloroquine and the placebo group, respectively) (Table). Two patients in each group experienced VTE within the 28 days following inclusion. All events were pulmonary embolism (PE), including one fatal PE in the placebo group. The VTE rate was 1.61% (95%CI: 0.20 to 5.70) in the hydroxychloroquine group and 1.63% (95% confidence interval: 0.20 to 5.75) in the placebo group ( P = 1.00). Conclusions : In patients hospitalized for mild to moderate COVID-19, the rate of symptomatic VTE was low with no evidence of benefit of hydroxychloroquine.

Adjusting D-dimer to lung disease extent to exclude pulmonary embolism in COVID-19 patients (Co-LEAD)

Background : D-dimer is a safe tool to exclude pulmonary embolism (PE) but its specificity is decreased in COVID-19. Aims : Our aim was to derive a new algorithm with D-dimer threshold adjusted to CT extent of lung damage. Methods : We conducted a multicenter, retrospective cohort study among 774 COVID-19 patients with suspected PE. D-dimer threshold adjusted to CT extent of lung damage was derived in a patient set ( n = 337), and its safety assessed in an independent validation set ( n = 337). Results : According to ROC curves, D-dimer safely excluded PE, with one false negative when using a 900 ng/mL threshold when lung damage extent was <50% and 1700 ng/mL when lung damage extent was ≥50%. In the derivation set, the algorithm's sensitivity was 98.2% (95% CI: 94.7-100.0), and its specificity 28.4% (95% CI: 24.1-32.3). The negative likelihood ratio (NLR) was 0.06 (95% CI: 0.01-0.44) and the AUC was 0.63 (95% CI: 0.60-0.67). In the validation set, sensitivity and specificity were 96.7% (95% CI: 88.7-99.6) and 39.2% (95% CI: 32.2-46.1), respectively. The NLR was 0.08 (95% CI: 0.02-0.33), and the AUC did not differ from that of the derivation set (0.68 (95% CI: 0.64-0.72), P = 0.097). Using the Co-LEAD algorithm, 76/250 (30.4%) COVID-19 patients with suspected PE could have been managed without CT pulmonary angiography (CTPA). Conclusions : The Co-LEAD algorithm safely excludes PE, and allows reducing the use of CTPA in COVID-19 patients. Prospective management studies are necessary to validate this strategy.

Suspicion of heparin-induced thrombocytopenia in COVID-19: Results from a multi-centric retrospective study

Background : High rates of venous thromboembolic events associated to LMWH/heparin therapy lead to numerous heparin-induced thrombocytopenia (HIT) suspicion during COVID-19 outbreak. Aims : We aim to describe HIT-suspected patient's characteristics and prevalence between March 15 and April 15 of 2020. Methods : This is a multi-centric retrospective cohort study of HITsuspected patients referred to our center. 4T score has been realized by experienced hematologist and/or pharmacologist and allowed us to trigger specific HIT assays if score was >3 (IgG anti-PF4/H and 14C-serotonine release assay, SRA). We included all consecutive HIT-suspected patients during COVID-19 outbreak compared to the same period in 2019. Results : During 2019 and 2020-study periods we identified, respectively, 17 and 41 consecutive HIT-suspected patients. Among the 2020-group, 23 were COVID-19 and 18 were non-COVID-19 patients. Clinical and biological characteristics were not significantly different between the 2019, 2020 non-COVID-19 and COVID-19 HIT-suspected patients. During 2019-period study, 11 (64.7%) patients had a 4T score >3, 4 (36.3%) of them had positive anti-PF4/H antibodies and only one had a positive SRA assay. During 2020-period study, 8 (44.4%) non-COVID-19 and 10 (43.5%) COVID-19 patients had a 4T score >3. Among them, respectively, 3 (37.5%) and 3 (30.%) had positive anti-PF4/H antibodies. SRA assay was positive in 3 non-COVID-19 patients tested and in the only one COVID-19 tested patient. The 4T score was able to exclude HIT in 67% of COVID-19 patients suspected. In 2020-study period, when comparing COVID-19 and non-COVID-19 patients, the only significantly difference in term of HIT suspicion criteria was the mean duration of heparin exposition before suspicion: 9.9 days ±6.3 for non-COVID-19 patients versus 15.2 days ±8.8 for COVID-19 patients, P = 0.043). Conclusions : HIT suspicion in COVID-19 occurs after longer anticoagulation time than non-COVID-19. We did not observe more confirmed HIT in COVID-19 in contrast our two non-COVID-19 control groups.