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Objectives: The aim of this study was to assess Jordanian physicians' awareness about venous thromboembolism (VTE) risk among COVID-19 patients and its treatment protocol. Method(s): This was a cross-sectional-based survey that was conducted in Jordan in 2020. During the study period, a convenience sample of physicians working in various Jordanian hospitals were invited to participate in this study. Physicians' knowledge was evaluated and physicians gained one point for each correct answer. Then, a knowledge score out of 23 was calculated for each. Key Findings: In this study, 102 physicians were recruited. Results from this study showed that most of the physicians realize that all COVID-19 patients need VTE risk assessment (n = 69, 67.6%). Regarding VTE prophylaxis, the majority of physicians (n = 91, 89.2%) agreed that low molecular weight heparin (LMWH) is the best prophylactic option for mild-moderate COVID-19 patients with high VTE risk. Regarding severe/critically ill COVID-19 patients, 75.5% of physicians (n = 77) recognized that LMWH is the correct prophylactic option in this case, while 80.4% of them (n = 82) knew that mechanical prevention is the preferred prophylactic option for severe/critically ill COVID-19 patients with high bleeding risk. Moreover, 77.5% of physicians (n = 79) knew that LMWH is the treatment of choice for COVID-19 patients diagnosed with VTE. Finally, linear regression analysis showed that consultants had an overall higher knowledge score about VTE prevention and treatment in COVID-19 patients compared with residents (P = 0.009). Conclusion(s): All physicians knew about VTE risk factors for COVID-19 patients. However, consultants showed better awareness of VTE prophylaxis and treatment compared with residents. We recommend educational workshops be conducted to enhance physicians' knowledge and awareness about VTE thromboprophylaxis and management in COVID-19 patients.Copyright © 2022 The Author(s). Published by Oxford University Press on behalf of the Royal Pharmaceutical Society. All rights reserved.
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Background: Persistence of orthostatic tachycardia, palpitations, and fatigue beyond 4 weeks of an acute COVID-19 infection has been termed Post-Acute Sequelae of COVID-19 (PASC) POTS. We have previously reported 6-month outcomes of PASC POTS. Long-term management and outcomes of these patients is unknown. Objective(s): To examine the long-term management and outcomes of PASC POTS patients. Method(s): We conducted a retrospective study of all patients who were diagnosed with POTS at Cardiology, Neurology, and Rehabilitation Post-COVID clinic after a COVID-19 infection between March 1, 2020, and November 1, 2022, at the University of Texas Health San Antonio. We examined COVID history, POTS diagnosis, management, and one-year outcomes of post-COVID POTS patients. Result(s): In 42 patients that were diagnosed with PASC POTS, 33 had a one-year follow-up. 100% were female, 60.6% were Caucasian. Average age was 40.6 + 11 years while the average BMI was 31.9 + 10.4 kg/m2. The most common symptoms were fatigue (87.9%), palpitations (75.7%), brain fog (72.7%), orthostatic tachycardia, exercise intolerance, and dyspnea (70%). The mean heart rate change with 10-minute standing test was 42.68 + 26.73 beats per minute. At 12-months follow-up, the most common symptom was still fatigue (66.7%), palpitations (45.5%), orthostatic tachycardia, and orthostatic intolerance (42.4%). All patients were managed with increased salt and fluid intake, lower compression stockings and rehabilitation. Fifty five percent of patients were treated with Enhanced External Counter Pulsation (EECP), 42% were treated with beta blockers, 18% with fludrocortisone, 15% with midodrine, and 15% with Pyridostigmine. At 1 year follow-up, 33% of patients reported improvement in their symptoms, 33% reported worsening of symptoms, 24% reported stable symptoms, and 9% had resolution. Conclusion(s): PASC POTS patients continue to experience adverse symptoms even at one year. Physical therapy and rehabilitation and pharmacological therapy appear improve symptoms in a minority of patients.Copyright © 2023
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SESSION TITLE: Extraordinary Cardiovascular Reports SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 01:35 pm - 02:35 pm INTRODUCTION: Postural orthostatic tachycardia syndrome (POTS) is one of the most common autonomic disorders (1). POTS is diagnosed by increasing heart rate by 30 bpm on more, within the first 10 minutes of standing, without orthostatic hypotension (2). Associated debilitating symptoms are lightheadedness, fainting, tremor, orthostatic intolerance, and tachycardia (2). Viral infections such as HIV, hepatitis C, mumps, Epstein bar virus, and influenza have been commonly reported with POTS syndrome (3 ). We are presenting a rare case of COVID-19 induced POTS. CASE PRESENTATION: 38-year-old presented to the hospital with the chief complaint of shortness of breath chest tightness. Her past medical history was significant for COVID-19 infection two weeks before presentation. On arrival patient's vitals were within normal limits. Her physical examination was unremarkable. Laboratory investigations, including complete blood count, thyroid function test, and comprehensive metabolic profile, were unremarkable. Chest x-ray, CT angiogram, and echocardiogram were unremarkable for any consolidation, pulmonary embolism, and congestive heart failure. Orthostatic vitals were obtained, showing that the patient's heart rate increased from 90 beats/minute to 140 beats/minute, from supine to standing. This patient was diagnosed with COVID-19 induced POTS, given she was meeting the criteria of POTS and no other reason was found for postural orthostatic tachycardia. She was managed conservatively with hydration, and the patient was also instructed about yoga therapy. She was discharged home with a cardiology follow-up. DISCUSSION: COVID-19 induced POTS is a relatively new entity that most commonly affect female, and the estimated prevalence is around is 17 per 100,000 patients (3). It has been reported that 10% of the patient who tests positive for COVID-19 infection remains unwell beyond three weeks after recovery from the infection (2). For some of those patients, POTS may be the cause of their symptoms. The exact pathophysiology for COVID-19 induced POTS is poorly understood and may includes peripheral neuropathy, baroreceptor dysfunction, hypovolemia, and increased serum norepinephrine (2). Nonpharmacological treatment includes increasing fluid consumption of 2 to 3 L of water per day, lower limb compression stockings, and regular exercise (2). The commonly off-label pharmacological treatment include ivabradine, fludrocortisone, midodrine, and beta-blockers (2). CONCLUSIONS: POTS is a new and under-recognized entity. The clinician should have a high suspicion of POTS syndrome in a patient with a history of recent or remote COVID-19 infection presenting with orthostatic symptoms. Timely diagnosis is essential to prevent the morbidity associated with debilitating symptoms. Reference #1: Blitshteyn S & Whitelaw S. Postural Orthostatic Tachycardia Syndrome (POTS) and Other Autonomic Disorders After COVID-19 Infection: A Case Series of 20 Patients. Immunol Res. 2021;69(2):205-11. Reference #2: Jenna Stephanie O'Sullivan, Andrew Lyne, Carl J Vaughan. COVID-19-Induced Postural Orthostatic Tachycardia Syndrome Treated with Ivabradine. BMJ Case Reports CP. 2021;14(6):e243585. Reference #3: Sujana Reddy, Satvik Reddy, Manish Arora. A Case of Postural Orthostatic Tachycardia Syndrome Secondary to the Messenger RNA COVID-19 Vaccine. Cureus. 2021;13(5). DISCLOSURES: No relevant relationships by Arshan Khan
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Aim and background: COVID-19 is caused by the severe acute respiratory syndrome coronavirus (SARS-CoV-2). COVID-19 is associated with a prothrombotic state leading to adverse clinical outcomes. We aimed to compare DVT compression stockings with anticoagulants versus anticoagulants alone for the prevention of thromboembolism in severely ill ICU COVID patients. Materials and methods: A retrospective chart review of patients admitted to ICU of a tertiary care hospital in Bangalore to assess the incidence of thrombosis (DVT and/or pulmonary embolism) and requirement of thrombolysis in severely ill COVID-19 patients treated with DVT stockings with anticoagulation versus patients treated with anticoagulants alone. Results: A total of 154 patients were admitted to our ICU with severe COVID-19 symptoms, 54 (35.1%) were females, and 100 (64.9%) were males. 121 patients were treated with DVT stockings with anticoagulation and 33 patients were given anticoagulation alone. 8 patients developed thrombotic events, 6 patients developed DVT alone, and 2 patients developed DVT and pulmonary embolism requiring thrombolysis. Out of 8 patients, 6 patients developing thrombotic events were treated with anticoagulation alone for the prevention of thrombosis. Out of 121 patients who were treated with DVT stocking with anticoagulation, only 2 patients developed DVT and none of them developed pulmonary embolism. Conclusion: In patients, hospitalized in ICU with severe COVID-19, use of DVT compression stockings along with anticoagulants significantly reduced the incidence of thrombotic events (DVT and/or pulmonary embolism) and thus reducing the need for e proving eventually decreasing the financial burden.
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Methods: We reviewed reports of post COVID dysautonomia and management strategies pursued to understand best practices and provide a primer for clinicians to guide patient management. We reviewed the literature for case reports of post COVID dysautonomia and compiled the cases into a table. Treatment approaches and outcomes were aggregated into an algorithm for management guidance. Results: Ten studies regarding post COVID dysautonomia were reviewed. Strategies included conservative approaches such as fluids, salt consumption, compression stockings, abdominal binders and head of bed elevation as well as strength building such as yoga, resistance exercise, and recumbent physical activity. Moreover, psychosocial support including cognitive behavioral therapy, biofeedback, and support groups were emphasized along with pharmacologic remedies such as midodrine, ivabradine, fludrocortisone, intravenous immunoglobulin, gabapentin, and topical lidocaine in additoin to interventions such as enhanced external counterpulsation. Primary and secondary outcomes included self-report surveys, autonomic laboratory testing, hand grip strength and heart rate variability. Background: Growing numbers of cases of dysautonomia after acute COVID-19 infection are being reported involving previously healthy patients. This post-COVID dysautonomia is predominantly characterized by lingering neurologic and cardiovascular dysfunction including tachycardia, orthostatic intolerance, migraine, exercise intolerance, fatigue, and cognitive impairment. Anxiety, insomnia, and uncertainty surrounding the COVID-19 pandemic present additional risk factors for sympathetic overdrive and deconditioning. Best management strategies and practice guidelines for this patient population remains unknown. Conclusion: Our review suggests consideration of an integrative, multimodal treatment approach involving physical activity, mental well-being, nutrition, stress management, and medication. These primarily facilitate management of dysautonomia, but rarely lead to complete symptom resolution. Despite the uncertainty associated with post-COVID dysautonomia, patient validation, education, and lifestyle approaches provide the cornerstone of management. Since post-COVID dysautonomia will comprise an increasing number of care consultations, clinician awareness, prompt diagnosis, and personalized management are essential.