Coagulopathy and risk factors in patients with severe COVID-19

Background. The pandemic of novel coronavirus infection (NCI) COVID-19 is accompanied by a high risk of thrombosis and bleeding. The debate regarding the choice of dose of anticoagulant therapy in severe patients with NCI is ongoing at present. Objective: to assess coagulation parameters and identify risk factors in patients with severe COVID-19. Patients/Methods. Out of 370 patients with NCI COVID-19 treated in Ryazan covid hospitals in 2021, 173 (46.8%) patients with severe coronavirus infection were included in the retrospective study. Risk factors, the frequency of thrombotic complications and bleeding, laboratory parameters of hemostasis and inflammation (general blood analysis, blood biochemistry, coagulogram), dose variants of anticoagulant therapy (preventive, intermediate and therapeutic doses) were accessed. Results. Among 173 patients with severe COVID-19, 98 (56.7%) persons recovered, and 75 (43.3%) patients died. In non-survivors vs. survivors, hypertension was more often observed — in 64 (85.3%) cases (p = 0.043), as well as obesity — in 8 (50.7%) cases (p = 0.024) and type 2 diabetes mellitus — in 34 (45.3%) cases (p = 0.022), therapeutic dosage of anticoagulants was used more often (58.6% of cases). C-reactive protein (CRP) level on admission was significantly higher in non-survivors vs. survivors — 117.3 (185–356) mg/L vs. 90.4 (1.2–301.0) mg/L (p = 0.033) as well as fibrinogen content — 6.3 (1.3–10.0) g/L vs. 3.6 (1.1–12.0) g/L (p = 0.004). In patients with lethal outcome, pulmonary embolism (PE) without a source in the lower extremities was determined more often than in patients with favorable outcome — 10 (13.3%) vs. 0 (0%) cases (p = 0.002). Isolated deep vein thrombosis (DVT) occurred only in patients with favorable outcome. The analysis of hemorrhagic complications revealed that the frequency of major bleeding was higher among non-survivors vs. survivors — 7 (9.3%) vs. 2 (2.04%) cases (p = 0.032). Conclusions. The use of therapeutic doses of anticoagulants did not reduce the mortality rate in severe patients with NCI and was accompanied by PE development with and without a source in the lower extremities in 15 (20%) cases. High levels of CRP, fibrinogen, D-dimer, and low platelet count are predictive laboratory markers of unfavorable outcome in patients with severe NCI. © Kalinin R.E., Suchkov I.A., Agapov A.B., Mzhavanadze N.D., Maksaev D.A., Chobanyan A.A., 2022 © Gemostaz i Reologia LLC, 2022.

Increased Susceptibility for Thromboembolic Events versus High Bleeding Risk Associated with COVID-19.

The infection with the SARS-CoV-2 virus is associated with numerous systemic involvements. Besides the severe respiratory injuries and cardiovascular complications, it became obvious early on that this disease carries an increased risk of thromboembolic events, but a higher propensity for bleedings as well. We researched the medical literature over significant PubMed published articles debating on the prevalence, category of patients, the moment of occurrence, and evolution of venous thromboembolism (VTE), but also of venous and arterial "in situ" thrombosis (AT), and hemorrhagic events as well. Most researchers agree on an increased prevalence of thromboembolic events, ranging between 25 and 31% for VTE, depending on the analyzed population. For AT and hemorrhagic complications lower rates were reported, namely, about 2-3%, respectively, between 4.8 and 8%, occurring mostly in older patients, suffering from moderate/severe forms of COVID-19, with associated comorbidities. It is important to mention that patients suffering from hemorrhages frequently received thromboprophylaxis with anticoagulant drugs. As a consequence of thromboembolic and hemorrhagic complications which are both important negative prognostic factors, the evolution of patients infected with the SARS-CoV-2 virus is aggravated, determining an augmented morbidity and mortality of this population.

The pharmacology of anticoagulant drug treatment options in COVID-19 patients: reviewing real-world evidence in clinical practice.

INTRODUCTION: The optimal anticoagulation strategy for venous thromboembolism (VTE) prevention among COVID-19 patients, hospitalized or in the community setting, is still challenging and largely based on real-world evidence. AREAS COVERED: We analyzed real-world data regarding the safety and effectiveness of anticoagulant treatment, both parenteral and oral, for VTE prevention or atrial fibrillation (AF)/VTE treatment among COVID-19 patients. EXPERT OPINION: The efficacy of low-molecular-weight heparin (LMWH) doses for VTE prevention correlates with COVID-19 disease status. LMWH prophylactic dose may be useful in COVID-19 patients at the early stage of the disease. LMWH intermediate or therapeutic dose is recommended in COVID-19 patients with an advanced stage of the disease. COVID-19 patients on VKA therapy for atrial fibrillation (AF) and VTE should switch to NOACs in the community setting or LMWH in the hospital setting. No definitive data on de-novo starting of NOACs or VKA therapy for VTE prevention in COVID-19 outpatients are available. In patients at high risk discharged after hospitalization due to COVID-19, thromboprophylaxis with NOACs may be considered.

Effect of Microwave Sterilisation on the Dimensional Property of Complete Denture: A Review

The Covid-19 pandemic over the past year has raised concern regarding the precautions needed to be taken to prevent cross-infection in the field of dentistry, as the virus is highly contagious and life-Threatening. At least half of the population above the age of 50 years are denture wearers. These dentures act as a base for the colonization of microorganisms, hence raise the chances of cross-contamination. When the patient wears contaminated dentures, the most common manifestation it may cause is oral candidiasis or denture-related stomatitis, this fungal infection leads to white or red sores, bleeding, swelling and burning sensations in the oral cavity. As the patient s oral cavity is a sterile tissue with mucous membranes, incompetent sterilisation of dentures bears the risk associated with the break of host barriers and carrying of environmental pathogens (e.g., Pseudomonas aeruginosa). The application of an improper sterilisation method in the maintenance of dental appliance mainly the complete denture concerns not only the patients but also the dental personnel and prosthesis laboratory. The first studies on microwave sterilisation of dentures were performed to confirm the potent of microwave sterilisation in preventing microorganisms attached to complete dentures prosthesis. Using different methods, definite results were obtained by studies, confirming that microwave irradiation can be an efficient technique in sterilizing the complete dentures prosthesis. Thus, executing microwave irradiation of a complete denture before it is brought to a lab, and immediately before it is placed in the patient s mouth, acts as a means of infection prevention system for all individuals. Microwave sterilisation of dentures has been recommended for denture sterilisation but its effect on the dimensional property of a complete denture still needs to be focused on. Hence, the current review presents the effect of microwave sterilisation on the physical properties, mainly the dimensional stability of the complete denture base. © (2022) Society for Biomaterials & Artificial Organs #20051922.

Hemorrhagic complications of а novel coronavirus infection: actual clinical problem

Hypercoagulable character of coagulopathy associated with the novel coronavirus infection COVID-19, and the high risk of associated thrombotic complications is a well-known fact. However, there are also case reports of hemorrhagic events in COVID patients in the literature. The review summarizes the publications describing bleedings in coronavirus infection;their overall frequency is on average 4–8%. Gastrointestinal bleeding are prevalent, intermuscular hematomas and hemorrhages in the skin and mucous membranes are frequent. The predictive role of anticoagulants use in therapeutic doses and hypofibrinogenemia is shown. The absence of clear understanding of the pathophysiological mechanisms is noted. © Simarova I. B., Perehodov S. N., Bulanov A.Yu., 2021 © Gemostaz i Reologia LLC, 2021.

Research on Intelligent Fingertip Blood Collection Robot

At present, fingertip blood sampling is mainly done manually by medical workers. Under the COVID-19 epidemic, medical workers are easily infected, in addition, the finger needs to be squeezed to increase the amount of bleeding during the blood collection process, which will cause the cell fluid to enter the blood and cause the test results to be inaccurate. This paper presents a kind of design about an intelligent fingertip blood sampling robot. We get the finger vein image through the near-infrared imaging module, and select the vein intersection area as the blood collection point after image segmentation, which will be helpful in improving the amount of bleeding. We use the laser to guide the end of the blood collection robot puncture needle and blood collection vessels to achieve rapid and accurate blood puncture and blood collection operation. The experimental results show that the maximum deviation between the blood sampling needle and the blood sampling point does not exceed 0.15mm and the longest time from fingertip blood sampling point selection to guide the blood sampling needle to the blood sampling point is less than 9.8 seconds. © 2021 ACM.

Heparin and SARS-CoV-2: Multiple Pathophysiological Links.

Low molecular weight heparin, enoxaparin, has been one of most used drugs to fight the SARS-CoV-2 pandemic. Pharmacological properties of heparin recognize its specific ability, as with other oligosaccharides and glycosaminoglycan, to bind several types of viruses during their pass through the extracellular matrix of the respiratory tract, as well as its anticoagulant activity to prevent venous thromboembolism. Antithrombotic actions of enoxaparin have been testified both for inpatients with COVID-19 in regular ward and for inpatients in Intensive Care Units (ICUs). Prophylactic doses seem to be able to prevent venous thromboembolism (VTE) in inpatients in the regular ward, while intermediate or therapeutic doses have been frequently adopted for inpatients with COVID-19 in ICU. On the other hand, although we reported several useful actions of heparin for inpatients with COVID-19, an increased rate of bleeding has been recorded, and it may be related to several conditions such as underlying diseases with increased risks of bleeding, increased doses or prolonged administration of heparin, personal trend to bleed, and so on.

Association between ChAdOx1 nCoV-19 vaccination and bleeding episodes: Large population-based cohort study.

OBJECTIVE: To compare prevalence of skin, nose and gingival bleedings after receipt of adeno-vectored or mRNA-vaccines against COVID-19. The hypothesis is that milder symptoms indicating altered thrombocyte function may affect a larger proportion of vaccinated individuals than the recently reported severe cases with thrombosis and thrombocytopenia. METHODS: Using an ongoing large, population-based cohort study, more than 80000 cohort participants were asked through electronic questionnaires about COVID-19 vaccination and potential side effects during weeks 11-13, 2021. The response rate was 58% (81267/138924). Among the vaccinated, 83% were female, 85% health care workers and 80% were aged 40-55 years. The prevalence of self-reported episodes of skin, nose and gingival bleedings were compared after mRNA and adenovirus-vectored vaccination. Estimates were adjusted for age, sex, occupation, previous COVID-19 infection and chronic disease. RESULTS: Four of the 3416 subjects (0.2%) who were vaccinated with a single dose of mRNA vaccine reported skin bleeding as a side effect, as opposed to 163 of 5132 subjects (3.2%) vaccinated with a single dose of the adenovirus-vectored vaccine, OR (odds ratio) = 16.0 (95% confidence interval (CI) 7.5-34.1). Corresponding ORs for nose and gingival bleeding were 8.0 (4.0-15.8) and 9.3 (4.3-20.0), respectively. CONCLUSIONS: These findings could potentially indicate that the adenovirus-vectored vaccine may lead to mild bleeding episodes in a larger proportion of vaccinated individuals, and not only in rare cases with documented thrombosis and thrombocytopenia. Studies are needed to understand the possible mechanisms behind these observations, and to establish or refute whether they share similarities with the severe thromboembolic bleeding complications.

Thromboprofilaxys With Fondaparinux vs. Enoxaparin in Hospitalized COVID-19 Patients: A Multicenter Italian Observational Study.

Importance: The use of anticoagulant therapy with heparins decreased mortality in hospitalized patients with severe coronavirus disease 2019 (COVID-19). Even if enoxaparin and fondaparinux have the same clinical indication for venous thromboembolism (VTE) prevention; to date, there are no data about the use of fondaparinux in terms of safety, effectiveness, and impact on clinical prognosis among COVID-19 patients. Objective: To evaluate the safety, effectiveness, and clinical impact of VTE prophylaxis with fondaparinux and enoxaparin among COVID-19 patients hospitalized in internal medicine units. Design, Setting, and Participants: This was a retrospective multicenter observation study, including consecutive symptomatic patients with laboratory-proven COVID-19 admitted to internal medicine units of five Italian hospitals from 15th February to 15th March 2020. Main Outcomes and Measures: The primary safety outcome was the composite of major bleeding and clinically relevant non-major bleeding; the primary effectiveness outcome was the composite of all events classified as pulmonary embolism and deep venous thrombosis. The secondary effectiveness outcome included acute respiratory distress syndrome and all-cause death. Results: Among 120 COVID-19 patients enrolled in the study, 74 were taking enoxaparin (4,000 or 6,000 units/day) and 46 fondaparinux (2.5 units/day). No statistically significant difference in demographic and laboratory and clinical characteristics between the two groups has been shown. During a median follow-up of 32 (interquartile range: 14-51) days, the cumulative incidence rates of VTE and bleeding events on pharmacological thromboprophylaxis with heparins were 19% and 8%, respectively. The incidence of both VTE (6.5 vs. 13.5%; P = 0.36) and bleeding events (6.5 vs. 4.1%; P = 0.68) did not show a significant difference between COVID-19 patients on fondaparinux compared with those on enoxaparin therapy. The regression model for the risk of outcome events according to different VTE prophylaxis drugs did not show significant differences. Conclusions and Relevance: Although these results need confirmation by prospective studies including a larger population, our study provides preliminary evidence of a safe and efficacy use of fondaparinux for VTE prophylaxis in hospitalized COVID-19 patients.