ABSTRACT
On December 13, 2021, an expert council was held to determine the position of experts of different specialties regarding the reasons for the low level of diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) in real clinical practice in a pandemic of a new coronavirus infection and possible ways to improve detection in patients with pulmonary embolism (PE) ) in history. The reasons for the low level of diagnosis of CTEPH are the insufficient level of knowledge of specialists, especially primary care physicians; lack of clear regulatory documents and expert centers for the management of this category of patients. Primary diagnosis of CTEPH in a pandemic can be strengthened through the widespread use of telemedicine for consultations of primary care physicians with specialists from expert centers; to maximize the role of echocardiography and computed tomography (CT) as differential diagnostic tools for dyspnea, in particular in patients with COVID-19. To increase the detection rate of CTEPH, diagnostic vigilance is required in patients with risk factors and episodes of venous thromboembolism. To improve the screening of CTEPH, it is necessary to create an algorithm for monitoring patients who have had PE; provide educational activities, including through the media; create materials for patients with accessible information. The regulatory documents should designate the circle of responsible specialists who will be engaged in long-term monitoring of patients with PE. Educational programs are needed for primary care physicians, cardiologists, and other physicians who come into the field of view of patients with CTEPH; introduction of a program to create expert centers for monitoring and managing patients with the possibility of performing ventilation-perfusion lung scintigraphy, cardiopulmonary stress test, CT, right heart catheterization. It seems important to build cooperation with the Ministry of Health of Russia in order to create special protocols, procedures for managing patients with PE and CTEPH.
Subject(s)
COVID-19 , Hypertension, Pulmonary , Pulmonary Embolism , Humans , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/etiology , Chronic Disease , COVID-19/complications , Pulmonary Embolism/diagnosis , Pulmonary Embolism/complications , EchocardiographyABSTRACT
By the middle of 2021, the official global number of coronavirus disease 2019 (COVID-19) patients was close to 230 million, but the number accounting for asymptomatic patients was much higher. Consequences and rehabilitation after COVID-19 are of particular interest and raise many controversial and unresolved issues. On May 18, 2021, the Eurasian Association of Therapists organized an international panel of experts to analyze challenges associated with the post-COVID-19 period. This panel aimed to develop approaches to identify gaps in the discussed issues. This interdisciplinary team of leading experts reviewed the current literature and presented their data to formulate practical guidance on management of patients after COVID-19. The panel of experts also presented recommendations on how to implement the gained knowledge into health care practices. Copyright © 2021, Silicea-Poligraf. All rights reserved.
ABSTRACT
The means of drug intervention for the prevention and treatment of new coronavirus infection (COVID-19) are discussed. Changes in approaches aimed at the main links of pathogenesis and capable of positively influencing the course and outcome of the disease that have been implemented after the appearance of the results of numerous randomized trials are presented. Some aspects of the ongoing study of the problem are characterized.
ABSTRACT
During the ongoing COVID-19 pandemic, with a significant variety of available vaccines, it is crucial to consider their effects on the hemostasis system. Objective. To study thrombodynamics features of individuals vaccinated against SARS-CoV-2 with Gam-COVID-Vac and Covi-Vac vaccines in a prospective observational study. Materials and methods. Data from 99 vaccinated individuals who completed the first three visits were analyzed. Of these, 18 were vaccinated with Gam-COVID-Vac, and 81 with CoviVac. Venous blood was collected before injection of the components I and II of the vaccine and 42 days after administration of the component I to analyze thrombodynamics parameters using the Thrombo-dynamics Analyzer System T2 (Hemacore, Russia). Results. In the analysis of thrombodynamics test data, no significant differences were found between the Gam-COVID-Vac group and the CoviVac group at any of the three stages of the study. Moreover, no significant increase in any of the parameters from the visit 1 to visit 3 was observed in both groups. Conclusion. The obtained study data suggest that such plasma hemostasis parameters as stationary rate of clot growth and ini-tial rate of clot growth, lag-time, clot density and clot size, spontaneous clots formation time show no significant changes during 42 days after the component I of Gam-COVID-Vac and CoviVac vaccines injection. © 2021, Media Sphera Publishing Group. All rights reserved.
ABSTRACT
This review discusses reasons for prolonged use of anticoagulants after discharge of patients with COVID-19 without additional indication for anticoagulation. Data regarding rate of thrombotic and thromboembolic complications in patients with COVID-19 after discharge from the hospital are presented. Large randomized controlled trials EXCLAIM, ADOPT, MAGELLAN, APEX and MARINER with prolonged use of anticoagulants in patients hospitalized with acute nonsurgical diseases before pandemia of COVID-19 are discussed. The first prospective randomized controlled trial MICHELLE with direct oral anticoagulant rivaroxaban in a dose 10 mg once daily after discharge of patients with COVID-19 with high risk at least venous thromboembolism are analyzed. It seems that the most relevant approach for the determination of indications for prolonged use of anticoagulants in doses dedicated for primary prevention of venous thromboembolism after discharge of patients with COVID-19 without apparent indication for anticoagulation is a modified IMPROVE VTE risk score with the addition of elevated in-hospital D-dimer level. And the most well-studied approach for anticoagulation in these patients is a direct peroral anticoagulant rivaroxaban 10 mg once daily for 35 (and possibly up to 45) days after discharge. © 2021 Stolichnaya Izdatelskaya Kompaniya. All rights reserved.
ABSTRACT
This article discusses relevant aspects in the treatment of patients with COVID-19. Up-to-date information about principles for administration of statins, antithrombotics, and antiarrhythmics is presented. The authors addressed in detail specific features of reversing heart rhythm disorders in patients with coronavirus infection and the interaction of antiarrhythmic and antiviral drugs. Recommendations are provided for outpatient and inpatient antithrombotic therapy for patients with COVID-19. Issues of antithrombotic and antiviral drug interaction are discussed.
Subject(s)
Anticoagulants , Cardiology , Coronavirus Infections , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Pandemics , Pneumonia, Viral , Anti-Arrhythmia Agents/therapeutic use , Anticoagulants/therapeutic use , Betacoronavirus , COVID-19 , Coronavirus Infections/drug therapy , Coronavirus Infections/epidemiology , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Pneumonia, Viral/drug therapy , Pneumonia, Viral/epidemiology , Russia , SARS-CoV-2 , Societies, Medical , COVID-19 Drug TreatmentABSTRACT
In this review changes of hemostatic parameters in patients with COVID-19 and their practical value are discussed. Current approaches to prevention and treatment of thrombotic/thromboembolic complications in patients with COVID-19 are considered. © 2020 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved.