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1.
PLoS One ; 18(1), 2023.
Article in English | ProQuest Central | ID: covidwho-2197050

ABSTRACT

Background Filter clotting is a major issue in continuous kidney replacement therapy (CKRT) that interrupts treatment, reduces delivered effluent dose, and increases cost of care. While a number of variables are involved in filter life, treatment modality is an understudied factor. We hypothesized that filters in pre-filter continuous venovenous hemofiltration (CVVH) would have shorter lifespans than in continuous venovenous hemodialysis (CVVHD). Methods This was a single center, pragmatic, unblinded, quasi-randomized cluster trial conducted in critically ill adult patients with severe acute kidney injury (AKI) at the University of Iowa Hospitals and Clinics (UIHC) between March 2020 and December 2020. Patients were quasi-randomized by time block to receive pre-filter CVVH (convection) or CVVHD (diffusion). The primary outcome was filter life, and secondary outcomes were number of filters used, number of filters reaching 72 hours, and in-hospital mortality. Results In the intention-to-treat analysis, filter life in pre-filter CVVH was 79% of that observed in CVVHD (mean ratio 0.79, 95% CI 0.65–0.97, p = 0.02). Median filter life (with interquartile range) in pre-filter CVVH was 21.8 (11.4–45.3) and was 26.6 (13.0–63.5) for CVVHD. In addition, 11.8% of filters in pre-filter CVVH were active for >72 hours, versus 21.2% in the CVVHD group. Finally, filter clotting accounted for the loss of 26.7% of filters in the CVVH group compared to 17.5% in the CVVHD group. There were no differences in overall numbers of filters used or mortality between groups. Conclusions Among critically patients with severe AKI requiring CKRT, use of pre-filter CVVH resulted in significantly shorter filter life compared to CVVHD. Trial registration ClinicalTrials.gov, NCT04762524. Registered 02/21/21—Retroactively registered, https://clinicaltrials.gov/ct2/show/NCT04762524?cond=The+Impact+of+CRRT+Modality+on+Filter+Life&draw=2&rank=1.

2.
European Heart Journal, Supplement ; 24(Supplement K):K139, 2022.
Article in English | EMBASE | ID: covidwho-2188670

ABSTRACT

A 71-year-old woman, known to have a non-ischemic dilated cardiomyopathy with reduced ejection fraction (EF), and a previous transcatheter edge-to-edge mitral valve repair (MitraClip), was admitted after a routine echocardiogram showing new onset multiple, highly mobile, left ventricle (LV) masses. The patient, fully vaccinated against Sars-Cov-2, experienced a paucisymptomatic COVID-19 infection 1 month before, followed by a full recovery. A transthoracic echocardiogram performed 3 months before showed no LV masses. On admission she was completely asymptomatic with no clinical signs of heart failure or systemic embolization. A multimodality imaging evaluation (contrast ecocardiography, cardiac computed tomography, cardiac magnetic resonance) confirmed a severe dilation of the LV with severe EF reduction, and 3 mobile LV masses;the largest mass was adhered to the middle portion of the anterolateral wall (maximum diameter 49x15 mm). mm). A diagnostic endomyocardial biopsy and cardiac surgery were excluded due to prohibitive embolic/procedural risk and an anticoagulant treatment with warfarin was started with a progressive reduction of the masses' dimension at transthoracic echocardiography. Thus, a diagnosis of exclusion of LV thrombosis was made. After 2-week a complete resolution of the masses was documented with no clinical or embolic events. Cardiovascular complications of the coronavirus disease have been documented both in the acute phase and in convalescence;one such complication is the formation of LV thrombus;the pro-thrombotic nature of COVID-19 infection is well known: the coagulation activation mechanism is currently uncler, but it might be correlated to excessive inflammation, COVID-induced hypoxia, direct cytopathic effects on the cardiac endothelial cells, immobilization. This case demonstrates how vulnerable patients, i.e. those with heart failure, may experience thrombotic complications following non-severe COVID-19 infection and despite having completed the vaccine course. Although currently unconfirmed by dedicated clinical trials, more assiduous echocardiographic monitoring could yield a benefit in selected patients;current guidelines do not support the use of anticoagulation prophylaxis for non-severe COVID.19, but further studies regarding anticoagulant prophylaxis for COVID-19 patients with chronic heart diseases, including DCM, are warranted. (Figure Presented).

3.
Acta Clinica Belgica ; 77(Supplement 2):69-70, 2022.
Article in English | EMBASE | ID: covidwho-2187673

ABSTRACT

Introduction: Pituitary apoplexy (PA) is a rare but life-threatening condition. Sometimes, atypical clinical presentations can be misleading and delay the diagnosis. Case report: An 86-year-old women presented at our emergency department (ED) with asthenia, nausea, vomiting, diarrhea. Ten days earlier, she presented at the ED of another hospital with complaints of right eye ptosis, headaches, myalgia and lower extremity edema. She was discharged with diagnosis of SARS-Cov-2 (positive PCR) and congestive heart failure and treated with diuretics. She had a medical history of arterial hypertension, type II diabetes, chronic kidney failure and a history of benign non-functional pituitary macroadenoma that was surgically removed in 1994. To note, atrial fibrillation was recently discovered, and she was taking oral anticoagulant therapy. The physical examination showed right eye ptosis, unstable gait, and lower extremity edema. Initial biology tests showed severe hypotonic hyponatremia (117 mmol/L, 238mOsm/kg) with decreased natriuresis (<10mmol, <9 mmol/24h, 183mOsml/kg). Brain CT scan was normal. The patient was admitted in the geriatric ward for further management of supposed syndrome of inappropriate antidiuretic hormone secretion (SIADH). Evolution during the first days was unsatisfactory with persistent hyponatremia despite well conducted fluid restriction. Six days after her admission, she developed acute right ophthalmoplegia, right visual loss, areactive mydriasis, complete right ptosis and worsening of headaches. An urgent brain MRI led to the diagnosis of macroadenoma with intra-adenomal hemorrhage. Recent introduction of anticoagulation therapy could have precipitate adenomal hemorrhage. Pituitary hormone function tests confirmed the diagnosis of PA. Urgent surgery was performed and the patient was discharged a few days later. Discussion(s): PA is a rare disease and most usually occurs due to sudden hemorrhage of non-functioning pituitary adenoma. This sudden hemorrhage causes an enlargement of the pituitary gland and subsequent pituitary stalk compression. This can lead to a large panel of symptoms (headaches, visual field impairment and decreased visual acuity) and biological findings (hypopituitarism and rarely acute cortisol deficiency). Our case presented early signs of compressive macroadenoma i.e., palpebral claudication and biological findings of SIADH. The latter has been described in cases of pituitary insufficiency and PA but is rather an uncommon initial finding. This atypical presentation could therefore have delayed the diagnosis in our patient. Moreover, hyponatremia is a frequent disorder which is commonly associated to more frequent diseases or medications and PA is a rather rare condition. The initial cerebral CT-scan performed in the ED was also misleading as it described enlargement of the pituitary gland without signs of compression. In conclusion, physicians should also think of PA in case of severe hyponatremia. MRI is the preferred technique for pituitary imaging.

4.
Aktuelle Rheumatologie ; 47(6):490-501, 2022.
Article in German | EMBASE | ID: covidwho-2186307

ABSTRACT

In this review, we summarise the current knowledge on vaccine-induced immune thrombotic thrombocytopenia (VITT) and new insights into its underlying pathogenesis. VITT is characterised by severe thromboses occurring 5-20 days after vaccination with an adenoviral vector-based SARS-CoV-2 vaccine (AstraZeneca or Johnson & Johnson). Thromboses typically involve the cerebral sinus and venous system. Routine laboratory analyses show thrombocytopenia and high D-dimer levels. The pathogenesis is based on immunological processes similar to those in heparin-induced thrombocytopenia. Accordingly, VITT is associated with high-titre immunoglobulin G directed against platelet factor 4 (PF4). Interaction with adenoviral vector-based vaccines leads to modifications of PF4 allowing antibody-producing cells to identify PF4. Anti-PF4 antibodies activate platelets through FcgammaIIa receptors. The detection of platelet-activating anti-PF4 antibodies confirms the diagnosis of VITT. Treatment is based on anticoagulation, which inhibits thrombin itself or thrombin formation, and high-dose intravenous immunoglobulin G, which inhibits cell activation via FcgammaIIa receptors. In severe cases, plasma exchange could also be an option. In some patients, a pre-VITT syndrome precedes VITT. Pre-VITT patients typically present with severe headache before thromboses are manifest. The early identification of a pre-VITT syndrome allows for the prevention of thrombotic complications. The specific dynamics of the immune reaction in VITT correspond to a transient, secondary immune response. Current studies address how PF4 binds to different adenoviral proteins and investigate the functional role of other vaccine components. Some of these factors contribute to the induction of a pro-inflammatory danger signal that triggers the first stage of VITT pathogenesis. In the second stage, high-titre anti-PF4 antibodies activate platelets and granulocytes. In a process called NETosis (neutrophil extracellular traps), activated granulocytes release DNA. Anti-PF4 antibodies then bind to complexes of PF4 and DNA. This enhances further cell activation via Fcgamma receptors and consequently also the formation of thrombin. At the end of the article, we comment on how the current knowledge on VITT may influence global vaccination campaigns against SARS-CoV-2 and we address how anti-PF4 antibodies may be involved in recurrent arterial and venous thromboses not associated with VITT and HIT. Copyright © 2022 Georg Thieme Verlag. All rights reserved.

5.
Transfusion Clinique et Biologique ; 29(4):330, 2022.
Article in English | EMBASE | ID: covidwho-2183983

ABSTRACT

La pandemie de COVID-19 a ete a l'origine d'un nombre important d'hospitalisations et de deces a travers le monde et reste encore, a l'heure actuelle, un probleme de sante publique. Un risque thrombotique particulierement eleve a ete observe au cours de la COVID-19, avec pres de 10% d'evenements thromboemboliques veineux chez les patients hospitalises en service conventionnel et pres de 25% chez les patients de reanimation au cours de la premiere vague epidemique. Ce risque thrombotique particulier a conduit de nombreux groupes a proposer de majorer le traitement anticoagulant prophylactique par heparine a des doses intermediaires voir therapeutiques. Des etudes prospectives randomisees controlees ont ete realisees pour evaluer le benefice de cette strategie mais les resultats sont discordants. Chez les patients peu severes, l'etude ACTIV-4, ATTAC, REMAP-CAP plaide en faveur de l'utilisation d'une dose therapeutique d'heparine a la phase initiale de la maladie meme si d'autres etudes ne retrouvent pas ce benefice. En reanimation, le benefice d'une telle strategie est discute, notamment devant les resultats negatifs de grands essais randomises. Cependant, ces etudes souffrent de certains biais ne permettant pas d'ecarter un benefice pour certaines populations de patient bien selectionnes. C'est pour cela que certains groupes proposent toujours une dose renforcee d'heparine dans des situations ou la frequence des evenements thromboembolique est tres elevee. Le risque hemorragique, initialement considere comme faible, semble etre relativement marque dans la phase secondaire de la maladie, ce qui doit conduire a revenir a une prophylaxie a dose standard 7 a 10 jours apres l'admission a l'hopital. L'apparition de variant et l'utilisation plus large d'immunomodulateur pourrait modifier le risque thrombotique ce qui doit nous conduire a rester prudent et a rester attentif a l'evolution des connaissances sur le sujet, qui evoluent encore rapidement. Declaration de liens d'interets L'auteur declare ne pas avoir de conflit d'interet en lien avec ce resume. Copyright © 2022

6.
Transfusion Clinique et Biologique ; 29(4):330, 2022.
Article in English | EMBASE | ID: covidwho-2183982

ABSTRACT

L'emergence de SARS-CoV-2 debut 2020 a entraine un afflux massif de patients a l'hopital - et en reanimation - soulevant de nombreuses interrogations. L'une d'elle a ete la transfusion en contexte pandemique avec d'une part la gestion des dons et la securite transfusionnelle et d'autre part l'inconnue du COVID-19 en besoin transfusionnel. Rapidement, le COVID-19 est apparue comme une maladie << thrombotique >> avec presence d'anticoagulants circulants et une incidence elevee de thromboses vasculaires pulmonaires motivant l'introduction d'une anticoagulation << renforcee >>. Secondairement, sont apparus des manifestations hemorragiques, en particulier apres J10, alors que le risque thrombotique semblait reduit. Sur les 2291 patients hospitalises pour COVID-19 aux HUS, 225 (9,8%) ont ete transfuses dont 91 (40,4%) pour une hemorragie aigue;tous les patients etaient anticoagules. Le saignement etait digestif (35), postoperatoire (17), musculaire (12), ORL (12) ou lie a une ECMO (8). Tous ont recus des CGR (731, 4 [2-7]), 20 des PFC (148, 3 [2-6]) et 14 des CP (70, 2 [1-5]);un geste hemostatique a ete necessaire chez 45 patients. En l'absence d'hemorragie (144), la transfusion etait essentiellement erythrocytaire et liee a une anemie inflammatoire (116), carentielle (16), liee a une ECMO (10) ou en rapport avec une pathologie hematologique (12). Cela a represente 740 CGR soit une mediane a 4 [2-6]. La survenue d'une hemorragie n'est pas correlee avec dose d'anticoagulant ni avec le sejour en reanimation (62,4 vs. 80,7%, p=0,42) mais avec un IMC plus bas (26,3 vs. 27,7 kg/m2, p<0,05), le groupe sanguin B (p=0,18) alors que le diabete semble << protecteur >> (27,1 vs. 38,6%, p=0,08). La mortalite tendrait a etre plus elevee en cas d'anemie (25,9 vs. 38,1%, p=0,08). La survenue d'une hemorragie est rare au cours du COVID-19 (3,5%), souvent tardive (apres J10) et non liee a une hospitalisation en reanimation;l'anemie est frequente, multifactorielle et grave. Declaration de liens d'interets L'auteur declare ne pas avoir de conflit d'interet en lien avec ce resume. Copyright © 2022

7.
Neurological Sciences ; 43(Supplement 1):S25-S26, 2022.
Article in English | EMBASE | ID: covidwho-2174266

ABSTRACT

Cerebral venous thrombosis (CVT) is a rare adverse event reported in post-marketing surveillance of Covid-19 vaccine. Two main coagulation syndromes associated with vaccine-related CVT have been described: "vaccine-induced immune thrombotic thrombocytopenia" (VITT) and "vaccine associated-thrombosis" (VAT). VITT differs from VAT for evidence of thrombocytopenia (platelets count less than 150 x 103 muL), antibodies against platelet factor 4 (PF4) and high mortality. Larger cohort studies gathering CVT after Covid19-vaccines showed VITT only following adenovirus-based vaccine while more rarely VAT without thrombocytopenia or anti-PF4 antibodies may follow mRNA-based vaccine. We report a case of VAT following BNT162b2 (Pzifer-Biontech) where anti-PF4 antibodies have been detected despite normal platelets. A 24 years-oldmale in good health developed a "thunderclap" headache six days after the first dose of vaccine with initial response to analgesic treatment (CT brain was negative). A couple of weeks later he complained of chronic mild occipital and vertex headache. After 38 days he was admitted to neurological ward for headache and visual loss with papilledema.A cerebralMRangiography confirmed a CVT involving the right sigmoid sinus and internal jugular vein. Low molecular weight heparin was started, then shifted to fondaparinux the day after when a positive ELISA test of anti-PF4 was found. Specific platelet activation assay was not performed. Extensive coagulation work-up was unmarkable and platelet counts were normal all over the hospitalization stay. Patient improved and was discharged after 20 days with anticoagulant therapy. Anti-PF4 antibodies seem to have a major role in the pathogenesis of VITT, instead their relevance in VAT is still debated. It is already known that anti-PF4 antibodies may be founded in 5,6% of an healthy cohort after BNT162b2 vaccine with negative platelet activation assay. CVT following mRNA vaccine emphasizes the possibility of a spectrum of immune-mediated platelets disorder rarely triggered by covid-19 vaccine. Despite the supposed non-pathogenetic role of anti- PF4 antibodies in VAT, Lippi et al suggest that human cells transfected by mRNA-based vaccine can produce some forms of SARS-CoV-2 recombinant spike protein which may activate platelets via spike protein- ACE2 interaction in a very small proportion of vaccine recipients. Additional studies are necessary to understand if mRNA vaccines against Covid19 could rarely cause CVT without thrombocytopenia and the underlying mechanism.

8.
Acute Medicine and Surgery ; 9(1) (no pagination), 2022.
Article in English | EMBASE | ID: covidwho-2172435

ABSTRACT

Aim: Coronavirus disease 2019 pneumonia differs from ordinary pneumonia in that it is associated with lesions that reduce pulmonary perfusion. Dual-energy computed tomography is well suited to elucidate the etiology of coronavirus disease 2019 pneumonia, because it highlights changes in organ blood flow. In this study, we investigated whether dual-energy computed tomography could be used to determine the severity of coronavirus disease 2019 pneumonia. Method(s): Patients who were diagnosed with coronavirus disease 2019 pneumonia, admitted to our hospital, and underwent dual-energy computed tomography were included in this study. Dual-energy computed tomography findings, plane computed tomography findings, disease severity, laboratory data, and clinical features were compared between two groups: a critical group (18 patients) and a non-critical group (30 patients). Result(s): The dual-energy computed tomography results indicated that the percentage of flow loss was significantly higher in the critical group compared with the non-critical group (P < 0.001). Additionally, our data demonstrated that thrombotic risk was associated with differences in clinical characteristics (P = 0.018). Receiver operating characteristic analysis revealed that the percentage of flow loss, evaluated using dual-energy computed tomography, could predict severity in the critical group with 100% sensitivity and 77% specificity. However, there were no significant differences in the receiver operating characteristic values for dual-energy computed tomography and plane computed tomography. Conclusion(s): Dual-energy computed tomography can be used to associate the severity of coronavirus disease 2019 pneumonia with high accuracy. Further studies are needed to draw definitive conclusions. Copyright © 2022 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf of Japanese Association for Acute Medicine.

9.
Germs ; 12(3):404-408, 2022.
Article in English | ProQuest Central | ID: covidwho-2170193

ABSTRACT

Introduction Cutibacterium acnes is a Gram-positive anaerobic rod that is part of the normal skin flora, as well as the oral cavity, genitourinary and gastrointestinal tracts. When detected, it is usually considered contaminant;but it is infrequently responsible for invasive infections, mainly neurosurgical and joint infections. It is rarely found as a pathogen responsible for lung infections or empyema. Case report We present a unique case of C. acnes empyema following severe COVID-19, making this the first documented case of empyema due to this bacterium following COVID -19. The microorganism was identified by 16S rRNA gene sequencing. The patient was treated with a combination of antibiotics and surgical intervention. Conclusions This case demonstrates the potential severity of C. acnes empyema. Further studies are needed to establish management guidance.

10.
Heart India ; 10(1):26-29, 2022.
Article in English | Scopus | ID: covidwho-2201706

ABSTRACT

Introduction: Left ventricular (LV) thrombus is a known complication of myocardial infarction (MI) and it usually occurs in areas of poorly contracting LV muscle as a result of endocardial injury with associated inflammation. There is a high risk of embolization within 3 months among patients with MI complicated by mural thrombus and this risk is maximum during the first 1-2 weeks. We report a case series of five patients who presented with acute coronary syndrome with LV apical thrombus and treated with triple anti-thrombotic therapy of rivaroxaban, aspirin, and clopidogrel. Case Series: Our series involves 5 cases who developed LV apical thrombus after acute coronary syndrome. Four patients had anterior wall ST-elevation MI (STEMI) whereas 1 patient had inferior wall STEMI. One of the patients with anterior STEMI also had COVID pneumonitis. All of these patients received triple anti-thrombotic therapy consisting of tab Aspirin 75 mg OD, tab clopidogrel 75 mg OD, and tab rivaroxaban 20 mg OD for 3 months duration. Repeat ECHO after 3 months showed complete resolution of LV thrombus in all of our cases. Discussion: LV thrombus reported in STEMI patients is from 1.6% up to 39% in various studies. The incidence of LV thrombus is on decreasing trend as a result of modern revascularization strategies. The role of novel oral anticoagulants (NOACs) in treating LV thrombus is scant as compared to oral Vitamin K antagonists (VKAs) like warfarin. The current recommendation for anticoagulation in the presence of a LV thrombus after acute coronary syndrome is with VKAs for up to 6 months. Conclusion: Although there is uncertainty in decision-making regarding antithrombotic therapy, our case series demonstrate that triple antithrombotic therapy with NOACs results in resolution of LV thrombus without any additional bleeding events in patients presenting with acute coronary syndrome. NOACs have an advantage of not requiring PT/INR monitoring and have less bleeding complications. Further large-scale research or randomized controlled trials are needed to find the optimal therapies in such cases. © 2022 by the Author(s).

11.
Indian Journal of Forensic Medicine and Toxicology ; 17(1):97-101, 2023.
Article in English | EMBASE | ID: covidwho-2206443

ABSTRACT

Introduction: Coronavirus Disease-19 (COVID-19) caused by the severe acute respiratory syndrome coronavirus-2 (SARSCoV-2) was declared a worldwide pandemic on March 11, 2020 and globally, on April 29, 2022, there were 510,270,667 confirmed COVID-19 cases, including 6,233,526 deaths, reported to WHO. As of April 2022, the Government of the Republic of Indonesia has reported 4,249,323 confirmed cases of COVID-19. There have been 143,592 COVID-19-related deaths reported and 4,096,194 patients have recovered from the disease. COVID-19 is associated with a high risk of venous thromboembolism (VTE), however, to date, optimal prophylactic anticoagulant therapy remains uncertain and may depend on the severity of COVID-19. Objective(s): The aim of this study was to determine the difference in efficacy and safety in administering prophylactic doses with intermediate/therapeutic doses in confirmed COVID-19 patients. Result(s): This study used 6 studies that met the inclusion of differences in efficacy and safety in administering prophylactic doses with intermediate/therapeutic doses in confirmed COVID-19 patients. Conclusion(s): From 6 studies, there were 2 studies comparing anticoagulant prophylactic doses with intermediate doses and 4 studies comparing anticoagualnt prophylactic doses with therapeutic doses. In all studies, there were no significant differences in thromboembolic events or all-cause mortality in COVID-19 patients. The incidence of bleeding at the intermediate and therapeutic doses increased compared to the prophylactic dose, but the difference was not significant. Copyright © 2023, Institute of Medico-legal Publication. All rights reserved.

12.
Biointerface Research in Applied Chemistry ; 13(5), 2023.
Article in English | Scopus | ID: covidwho-2206048

ABSTRACT

Since December 2019, the COVID-19 pandemic has continued to spread across the world. Elevated D-dimer has known to have occurred in COVID-19 patients, which was associated with hypercoagulable conditions and could lead to various complications. This literature study aims to identify the effect of increasing D-dimer on the severity, mortality, and other outcomes and the benefits of anticoagulants used in COVID-19 patients. The research was conducted from February 17, 2021, to July 28, 2021, through PubMed, Scopus, and Clinical Trials.gov databases. It was then updated on November 1, 2022, and 116 articles were obtained for this study. The results showed that increased D-dimer was associated as a risk factor for severity, disease progression, and mortality and could predict several outcomes, such as the need for intensive care, cardiac injury, respiratory failure, and thromboembolic events. Several studies suggested the benefit of using prophylactic anticoagulants in COVID-19 patients, but there was insufficient evidence showing that higher doses of anticoagulants were beneficial. © 2023 by the authors.

13.
Messenger of Anesthesiology and Resuscitation ; 19(4):15-21, 2022.
Article in Russian | Scopus | ID: covidwho-2204890

ABSTRACT

Extracorporeal membrane oxygenation (ECMO) is a method that makes it possible to compensate for critical changes caused by acute respiratory failure, with the ineffectiveness of treatment with rigid modes of artificial lung ventilation (ventilator) in patients with acute respiratory distress syndrome in intensive care units. The search for the optimal state of the hemostasis system is one of the main tasks in the treatment of critical patients in ECMO conditions. The objective: to study changes in hemostatic parameters in patients with COVID-19 undergoing ECMO and determine the need for their correction. Subjects and Methods. According to the inclusion and exclusion criteria, 100 patients were included in the study: 72 men and 28 women aged 26 to 75 years old, the median age made 55 years [47;60]. VV-ECMO was performed in all observations. In 100% of cases, the cause of respiratory failure which required VV-ECMO was COVID-19-associated pneumonia. Results. 49 episodes of hemorrhagic complications and 76 episodes of thrombotic complications were recorded from the 1st to the 7th day from the moment of ECMO initiation. We found that the chance of developing thrombosis decreased by an average of 0.3% with an increase in the activity of antithrombin-3 by 1%. A statistically significant association of thrombosis risk was also found for prothrombin and prothrombin time. Conclusion. During the first 7 days of ECMO, patients with COVID-19 demonstrate the increase in APTT, prothrombin time and a decrease in the number of platelets, prothrombin activity, and fibrinogen concentration. The risk of thrombosis in this group of patients significantly decreases with the increasing activity of antithrombin-3 and prothrombin and increases with rising need of the higher dose of unfractionated heparin. The tactics of restrictive anticoagulant therapy when using unfractionated heparin can be taken into account as a way to reduce the risk of thrombosis and requires further research. © 2022 The authors.

14.
International Journal of Laboratory Hematology ; : 1, 2022.
Article in English | Academic Search Complete | ID: covidwho-2161646

ABSTRACT

Objective Methods Results Conclusions Lupus anticoagulant (LA) are commonly detected during SARS‐CoV‐2 infection. However, the relationship between LA and clinical significance is still unclear.A retrospective chart analysis was performed on COVID‐19 patients who were tested for LA at our hospital from March 2020 to November 2021. We analyzed the patient's characteristics based on the result of the LA test. In addition, subgroup analysis performed the LA‐positive group who had undergone serial LA tests.A total of 219 COVID‐19 patients were enrolled in the study, 148 patients (67.6%) were positive for LA test. The LA‐positive group received more treatment of high flow nasal cannula (LA‐positive 73.0%, LA‐negative 57.7%, p = 0.024). The LA‐positive group showed prolonged aPTT, higher levels of CRP and fibrinogen (all p's < 0.05). Among 148 LA‐positive patients, 127 patients (86.5%) were found to be LA‐positive within 10 days of SARS‐CoV‐2 positive, and LA‐positive group confirmed a median time to LA loss of 10 days. However, there was a group that was negative for LA in the early stages of infection and became positive about 13 days later. A subgroup analysis showed that these patients had different characteristics due to their longer hospital stays and higher D‐dimer levels.In COVID‐19 patients, LA is expected to be associated to disease severity. Since the clinical significance of LA is different depending on the onset time of LA positivity, the LA test is suggested to be done at diagnosis of SARS‐CoV‐2 infection, even if LA is negative, follow‐up test should be considered within 10 days. [ FROM AUTHOR]

15.
International Journal of Biological Macromolecules ; 226:974-981, 2023.
Article in English | ScienceDirect | ID: covidwho-2158944

ABSTRACT

The ongoing pandemic of COVID-19, caused by the infection of SARS-CoV-2, has generated significant harm to the world economy and taken numerous lives. This syndrome is characterized by an acute inflammatory response, mainly in the lungs and kidneys. Accumulated evidence suggests that exogenous heparin might contribute to the alleviation of COVID-19 severity through anticoagulant and various non-anticoagulant mechanisms, including heparanase inhibition, chemokine and cytokine neutralization, leukocyte trafficking interference, viral cellular-entry obstruction, and extracellular cytotoxic histone neutralization. However, the side effects of heparin and potential drawbacks of administering heparin therapy need to be considered. Here, the current heparin therapy drawbacks were covered in great detail: structure-activity relationship (SAR) mystery, potential contamination, and anticoagulant activity. Considering these unfavorable effects, specific non-anticoagulant heparin derivatives with antiviral activity could be promising candidates to treat COVID-19. Furthermore, a structurally diverse library of non-anticoagulant heparin derivatives, constructed by chemical modification and enzymatic depolymerization, would contribute to a deeper understanding of SAR mystery. In short, targeting non-anticoagulant mechanisms may produce better therapeutic effects, overcoming the side effects in patients suffering from COVID-19 and other inflammatory disorders.

16.
Best Pract Res Clin Haematol ; 35(3):101402, 2022.
Article in English | PubMed | ID: covidwho-2158488

ABSTRACT

Antiphospholipid syndrome and the coagulopathy of COVID-19 share many pathophysiologic features, including endotheliopathy, hypercoagulability, and activation of platelets, complement pathways, and neutrophil extracellular traps, all acting in concert via a model of immunothrombosis. Antiphospholipid antibody production in COVID-19 is common, with 50% of COVID-19 patients being positive for lupus anticoagulant in some studies, and with non-Sapporo criteria antiphospholipid antibodies being prevalent as well. The biological significance of antiphospholipid antibodies in COVID-19 is uncertain, as such antibodies are usually transient, and studies examining clinical outcomes in COVID-19 patients with and without antiphospholipid antibodies have yielded conflicting results. In this review, we explore the biology of antiphospholipid antibodies in COVID-19 and other infections and discuss mechanisms of thrombogenesis in antiphospholipid syndrome and parallels with COVID-19 coagulopathy. In addition, we review the existing literature on safety of COVID-19 vaccination in patients with antiphospholipid antibodies and antiphospholipid syndrome.

17.
Croatian Medical Journal ; 63(5):490-494, 2022.
Article in English | EMBASE | ID: covidwho-2154644

ABSTRACT

Acquired antibodies against factor II (prothrombin) are rare and most commonly associated with severe liver disease or vitamin K antagonist treatment. In very rare cases, these antibodies and associated hypoprothrombinemia are found in patients with lupus anticoagulant (LAC), an antiphospholipid antibody that inhibits phospholipid-dependent coagulation tests. This uncommon entity, called lupus anticoagulant-hypoprothrombinemia syndrome (LAHPS), may cause both severe, life-threatening bleeding and a predisposition to thrombosis. Coronavirus disease 2019 (COVID-19) is associated with a variety of coagulation abnormalities and an increased risk of thrombosis. Bleeding may occur, but it is less common than thromboembolism and has mostly been described in association with the severity of the disease and anticoagulation treatment in hospitalized patients, rarely in the post-acute phase of the disease. We report on a case of an 80-year-old man who developed LAHPS with prothrombin antibodies and severe bleeding after COVID-19. Copyright © 2022 Medicinska Naklada Zagreb. All rights reserved.

19.
Heart Failure Clinics ; 19(1):xv-xvi, 2023.
Article in English | EMBASE | ID: covidwho-2149787
20.
Phytother Res ; 2022.
Article in English | PubMed | ID: covidwho-2148460

ABSTRACT

The SARS-CoV-2 outbreak has been one of the largest public health crises globally, while thrombotic complications have emerged as an important factor contributing to mortality. Therefore, compounds that regulate the processes involved in thrombosis could represent a dietary strategy to prevent thrombotic complications involved in COVID-19. In August 2022, various databases were consulted using the keywords "flavonoids", "antiplatelet", "anticoagulant", "fibrinolytic", and "nitric oxide". Studies conducted between 2019 and 2022 were chosen. Flavonoids, at concentrations mainly between 2 and 300 μM, are capable of regulating platelet aggregation, blood coagulation, fibrinolysis, and nitric oxide production due to their action on multiple receptors and enzymes. Most of the studies have been carried out through in vitro and in silico models, and limited studies have reported the in vivo and clinical effect of flavonoids. Currently, quercetin has been the only flavonoid evaluated clinically in patients with COVID-19 for its effect on D-dimer levels. Therefore, clinical studies in COVID-19 patients analyzing the effect on platelet, coagulant, fibrinolytic, and nitric oxide parameters are required. In addition, further high-quality studies that consider cytotoxic safety and bioavailability are required to firmly propose flavonoids as a treatment for the thrombotic complications implicated in COVID-19.

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