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1.
Indian J Pathol Microbiol ; 65(3): 653-656, 2022.
Article in English | MEDLINE | ID: covidwho-1964255

ABSTRACT

We describe three postmortem open lung-biopsy findings among patients with COVID-19 pneumonia who were on anticoagulant therapy. The spectrum of histopathological findings included lung inflammation in the form of diffuse alveolar damage (DAD) in exudative and organizing phases, with or without pulmonary artery thrombosis in different stages of evolution. This spectrum of inflammation and thrombosis may be indicative of a natural history of severe COVID-19 pneumonia or demonstrative of variation in therapeutics.


Subject(s)
COVID-19 , Pneumonia , Thrombosis , Humans , Inflammation/pathology , Lung/pathology , Pneumonia/diagnosis , Thrombosis/pathology
2.
R I Med J (2013) ; 105(6): 36-40, 2022 08 01.
Article in English | MEDLINE | ID: covidwho-1958239

ABSTRACT

Early in the pandemic, it was recognized that infection with COVID-19 was associated with an increased incidence in both venous and arterial thrombotic events leading to poor patient outcomes. Given the rapid rise of the pandemic, anticoagulation strategies were initially based upon retrospective and observational data with few high-quality randomized control trials to help direct strategies regarding the use of thromboprophylaxis during hospitalization, empiric therapeutic anticoagulation, and extended-duration thromboprophylaxis after discharge. Over the past year, several randomized control trials have now been published evaluating these strategies. In this article, we hope to review the current literature surrounding the use of intermediate-dose thromboprophylaxis, empiric therapeutic anticoagulation, and the use of extended-duration thromboprophylaxis for patients hospitalized with COVID-19.


Subject(s)
COVID-19 , Thrombosis , Venous Thromboembolism , Anticoagulants/therapeutic use , Humans , Inpatients , Retrospective Studies , SARS-CoV-2 , Thrombosis/drug therapy , Thrombosis/etiology , Thrombosis/prevention & control , Venous Thromboembolism/drug therapy , Venous Thromboembolism/etiology , Venous Thromboembolism/prevention & control
3.
Journal of Cardiology Cases ; 2022.
Article in English | ScienceDirect | ID: covidwho-1956192

ABSTRACT

Nonbacterial thrombotic endocarditis (NBTE) is characterized by the deposition of thrombi on the heart valves without bacteremia and predominantly affects patients with hypercoagulable state. Since the lesion of NBTE often exists in the left-sided valves, involvement of the tricuspid valve (TV) is rare. We herein report a 34-year-old woman with advanced ovarian cancer and pulmonary embolization showing NBTE on the TV. Plasma D-dimer level was markedly elevated and echocardiography showed highly mobile masses on the TV with moderate to severe regurgitation. After the initiation of heparin therapy, reduction of plasma D-dimer levels along with shrinkage of the TV vegetations was observed. However, she was forced to discontinue the heparin because its supply was interrupted in association with coronavirus disease 2019. Coupled with systemic metastasis of ovarian cancer, elevated plasma D-dimer level and exacerbation of NBTE were observed. Thereafter, she resumed subcutaneous injection of heparin, resulting in re-improvement. Learning objective Involvement of tricuspid valve (TV) by nonbacterial thrombotic endocarditis (NBTE) is rare, especially when they are associated with advanced cancer. Our case underlines the importance of listing the NBTE as a differential diagnosis in cancer patients showing valve vegetations even in the TV.

4.
IHJ Cardiovascular Case Reports (CVCR) ; 6(2):83-85, 2022.
Article in English | EMBASE | ID: covidwho-1956162
5.
Deutsche Apotheker Zeitung ; 162(24), 2022.
Article in German | EMBASE | ID: covidwho-1955750
6.
Pakistan Paediatric Journal ; 46(2):229-232, 2022.
Article in English | EMBASE | ID: covidwho-1955740

ABSTRACT

Staphylococcal aureus infection in children is a major public health problem globally. It causes a varied spectrum of clinical disease including bacteremia, endocarditis, skin and soft tissue infection, pleuro-pulmaonry and osteo-articular infection. Deep vein thrombosis (DVT) is a known complication of staphylococcal infection. We report a case series which included, 10-year old boy developed DVT, septic pulmonary emboli and Methicillin-resistant Staphylococcal aureus (MRSA) bacteremia following a furuculosis and 13 year old girl with thrombosis of internal and external jugular vein, cavernous sinus with pulmonary emboli and MRA bacteremia. Both patients are previously healthy showed complete recovery after aggressive appropriate antibiotics, anticoagulants and supportive care. The high index of suspicion of DVT in MRSA infection is needed, prompt diagnosis and aggressive appropriate therapies improve the outcomes and minimize the complications.

7.
SAGE Open Med Case Rep ; 10: 2050313X221113934, 2022.
Article in English | MEDLINE | ID: covidwho-1956966

ABSTRACT

Hypercoagulability in coronavirus disease 2019 infection is already a known fact. But in this article, we have discussed a unique case where the patient had suffered from relapsing thrombus formation. This report describes the case of a patient who presented with chronic coronavirus disease 2019-induced recurrent thrombi refractory to multiple antithrombotic regimens because of multiple recurrent inflammatory flares without any evidence of chronic persistent viral infection. The patient was treated with anticoagulation and anti-inflammatory medications. Still, he had repeated episodes of right ventricular thrombus. Coronavirus disease 2019 can provoke a severe relapsing hypercoagulable state without evidence of persisting viral infection. Rebound inflammatory flares rather than viral recurrence may play a trigger.

8.
Open Forum Infect Dis ; 9(7): ofac285, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1948428

ABSTRACT

Background: Randomized controlled trials (RCTs) have reported inconsistent effects from intensified anticoagulation on clinical outcomes in coronavirus disease 2019 (COVID-19). We performed an aggregate data meta-analysis from available trials to quantify effect on nonfatal and fatal outcomes and identify subgroups who may benefit. Methods: We searched multiple databases for RCTs comparing intensified (intermediate or therapeutic dose) vs prophylactic anticoagulation in adults with laboratory-confirmed COVID-19 through 19 January 2022. We used random-effects meta-analysis to estimate pooled risk ratios for mortality, thrombotic, and bleeding events (at end of follow-up or discharge) and performed subgroup analysis for clinical setting and dose of intensified anticoagulation. Results: Eleven RCTs were included (N = 5873). Intensified vs prophylactic anticoagulation was not associated with a mortality reduction up to 45 days (risk ratio [RR], 0.93 [95% confidence interval {CI}, .79-1.10]). There was a possible signal of mortality reduction for non-intensive care unit (ICU) patients, although with low precision and high heterogeneity (5 studies; RR, 0.84 [95% CI, .49-1.44]; I 2 = 75%). Risk of venous thromboembolism was reduced (RR, 0.53 [95% CI, .41-.69]; I 2 = 0%), with effect driven by therapeutic rather than intermediate dosing (interaction P = .04). Major bleeding was increased with intensified anticoagulation (RR, 1.73 [95% CI, 1.17-2.56]) with no interaction for dosing and clinical setting. Conclusions: Intensified anticoagulation has no effect on mortality among hospitalized adults with COVID-19 and is associated with increased bleeding risk. The observed reduction in venous thromboembolism risk and trend toward reduced mortality in non-ICU settings requires exploration in additional RCTs. Clinical Trials Registration. CRD42021273449 (PROSPERO).

9.
Int J Cardiol Heart Vasc ; 41: 101068, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1945153

ABSTRACT

Severe coronavirus (COVID-19) infection has been reportedly associated with a high risk of thromboembolism. Developing macrovascular thrombotic complications, including myocardial injury/infarction, venous thromboembolism, and stroke have been observed in one-third of severe COVID-19 hospitalized patients, leading to an increase in mortality and morbidity. The diagnosis of COVID-19 associated coagulopathy may be challenging because there are close similarities between pulmonary embolism and severe COVID-19 disease. Therefore, a critical step in improving the clinical outcome of patients with hospitalized COVID-19 is the recognition of coagulation abnormalities and the identification of patients with poor prognoses, prophylactic guidance, or antithrombotic therapy. Prescribing anticoagulants in all patients hospitalized with COVID-19 and 2-6 weeks post-hospital discharge in the absence of contraindications is recommended by most consensus documents published on behalf of professional societies. However, a decision on some variable factors such as intensity and duration of anticoagulation may be made based on an individual case and needs future randomized trial studies. Regarding little information on this subject, this study aims to review how inflammation and thrombosis are related to COVID-19 patients, discuss the types of thrombosis in these patients, and summarize the diagnosis and treatment of thrombosis in COVID19 patients.

10.
Clin Microbiol Infect ; 2022 May 29.
Article in English | MEDLINE | ID: covidwho-1944642
11.
Journal of Vascular Surgery ; 75(6):e178, 2022.
Article in English | EMBASE | ID: covidwho-1936909

ABSTRACT

Objectives: Hospital resource usage is under constant review, and the extent and intensity of postoperative care requirements for vascular surgical procedures has been especially relevant in the setting of the COVID-19 (coronavirus disease 2019) pandemic and its impact on staffed intensive care unit (ICU) beds. We evaluated the feasibility of regional anesthesia and low-intensity postoperative care for patients undergoing transcarotid artery revascularization (TCAR) at our institution. Methods: All patients at high risk for carotid endarterectomy undergoing TCAR at a single institution from 2018 to 2020 were reviewed. Perioperative management was standardized by the use of an institutional protocol that included hemodynamic parameters and requisite medications, anticoagulation and/or antiplatelet regimens, neurovascular examination guidelines, and nursing instructions. The anesthetic modality was at the surgeon’s preference. Patients were transferred to the postanesthesia care unit (PACU) for 2 hours (with a 1:1 or 1:2 nursing ratio) followed by the step-down unit (1:4 nursing ratio) for 4 hours, followed by transfer to the floor (1:6 ratio) or, alternatively, were transferred to the ICU (1:1 ratio). Intravenous (IV) blood pressure medications could be administered in all environments, except for the floor. The recovery location and length of stay were recorded. Results: A total of 83 patients had undergone TCAR during the study period. The mean age was 72 ± 9 years, 59% were men, and 36% were symptomatic. Regional anesthesia was used for 84%, with none converted to general anesthesia intraoperatively. Postoperatively, only seven patients (8%) had required monitoring in the ICU overnight (decided perioperatively). This was mostly for patients with prior neurologic symptoms but for one patient was because of a postoperative neurologic event and for another patient because of pulseless electrical activity arrest. Of the 83 patients, 76 (92%) had been monitored in the PACU, with 8 transferred to the floor after 4 hours and 13 discharged directly from the PACU (owing to limited bed availability). Of the patients in the PACU, 55 were transferred to the step-down unit after 2 hours and discharged from there. Six patients had required IV antihypertensive agents, and eight had required IV vasoactive support postoperatively. The mean length of stay in the ICU was 3.7 days (range, 1-15 days). The mean length of hospital stay was 1.8 ± 2.3 days (3.7 ± 5.4 days for those requiring the ICU and 1.4 ± 1.2 days for those not requiring the ICU). The incidence of stroke, death, and myocardial infarction was 2.4%. There was one postoperative stroke considered to be a recrudescence of a prior stroke, and one respiratory arrest fatality in a frail patient with a neck hematoma, both of whom had been treated under general anesthesia. Conclusions: Using perioperative care protocols, TCAR can safely be performed while avoiding both general anesthesia and an ICU stay for most patients.

12.
Journal of Vascular and Interventional Radiology ; 33(6):S231, 2022.
Article in English | EMBASE | ID: covidwho-1936899

ABSTRACT

Purpose: To examine the outcomes of patients with venous thromboembolism (VTE) who underwent placement of a bioabsorbable inferior vena cava filter (IVCF) for temporary pulmonary embolism (PE) protection Materials and Methods: From 10/1/2020 to 11/31/2021, 17 patients (mean age 71, range 45-92, 58% female) underwent placement of a bioabsorbable IVCF (Sentry, Boston Scientific) at a single academic center. Thirteen of the 17 filters (76.4%) were placed in the inpatient setting, and the remainder were placed outpatient. VTE risk factors included malignancy (70.6%), immobility (5.9%), COVID-19 (5.9%), and unprovoked (7.6%). Prior to IVCF, 11 patients presented with deep venous thrombosis (DVT) alone, two had PE alone, and four were diagnosed both DVT and PE. The contraindication to anticoagulation (AC) was active bleeding in 47.1% of the cohort, upcoming surgery in 41.2%, worsening of DVT on AC in 5.9%. and brain tumor in 5.9%. The pre-implantation infrarenal IVC diameter ranged from 1.6 to 2.6 cm. Technical success (TS), adverse events (AEs), and follow-up IVCF characteristics were recorded. Results: TS was 100%. No AEs occurred during placement. Mean follow-up period was 4.9 months (range 0-12.9). No new PEs were diagnosed after IVCF placement, and no patients required replacement of IVCF. Nine of the 17 patients had follow-up CTs after filter placement, two had follow up radiographs in which the filter state could be assessed, and the remaining six had no imaging evaluating the filter after placement. Asymptomatic IVCF associated non-occlusive thrombosis was seen in 3 patients. The longest amount of time after placement that a Sentry filter was observed to still be in the filter state was 3.9 months, and the shortest time in which imaging showed a filter bio-converted to the open state was 3.1 months. Three patients underwent serial imaging which incidentally demonstrated the timeframe in which the IVCF converted from a filter-state to an open-state. In one patient this conversion occurred between 2.1 and 3.1 months, in another between 1.7 and 3.3 months, and in the last patient between 3.9 and 4.4 months. Conclusion: In VTE patients with either a temporary contraindication to anticoagulation or a transitory high-PE-risk period, bioconvertible IVC filters are a safe and effective option for short-term protection against pulmonary embolism.

13.
American Journal of Blood Research ; 12(2):54-59, 2022.
Article in English | EMBASE | ID: covidwho-1935125

ABSTRACT

Objective: Severe acute respiratory syndrome (SARS) coronavirus 2 (SaRS-Cov-2) associated respiratory disease (COVID-19), announced as a pandemic, is a multisystem syndrome. SARS-CoV-2 directly infects and damages vascular endothelial cells, which leads to microvascular dysfunction and promotes a procoagulant state. Dipyridamole (DP) acts as a reversible phosphodiesterase inhibitor and is used mainly as an antiplatelet agent. It is hypothetised that it has possible activities in COVID-19. Design and Methodology: We report our retrospective, real-world results of DP added to low-molecular weight heparin (LMWH) in the treatment of 462 clinically diagnosed and hospitalized COVID-19 patients. We compared anticoagulation with and without DP addition with no administration of anticoagulation in the same time frame. The primary outcome was proven or highly suspected coagulopathy within 30 days of hospitalization. Results: Definitive coagulopathy has been diagnosed in 3 (3.5%) of 85 LMWH administered patients and 7 (2.13%) of 328 DP + LMWH received patients (P=0.456). Five cases with definitive coagulopathy were not initiated any anticoagulation at the time of the event. The multivariate analysis showed that DP addition to the anticoagulant approach did not have any impact on the risk of demonstrated coagulopathy and highly-suspected coagulopathy. Conclusion: We think that our clinical experience is valuable in showing the real-life results of DP + LMWH treatment in COVID-19. This approach did not affect the coagulopathy rate. Our data did also not document an additive effect of DP in the COVID-19 outcome. Prospective controlled trials would give more convincing results regarding the role of DP in COVID-19 endothelial dysfunction and clinical outcome.

14.
Clinical and Experimental Surgery ; 10(2):7-12, 2022.
Article in Russian | EMBASE | ID: covidwho-1939716

ABSTRACT

Background. Coronavirus infection (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients with cardiovascular disease especially patients with advanced heart failure are at particularly high risk of morbidity and mortality. Patients with left ventricular assist device (LVAD) represent a unique population at risk because of comorbidities and functionally compromised immunity. Аim of this article was to analyze clinical cases of COVID-19 among LVAD patients of the Republic of Kazakhstan. Material and methods. Characteristics of LVAD patients of the Republic of Kazakhstan who developed COVID-19 between March 2020 and August 2021, initial manifestations of the disease, comorbidities, complications and clinical outcomes were collected and analyzed. Results. A total of 177 patients with LVAD who were supported and registered by the NAO “National Scientific Cardiac Surgery Center” were interviewed. 41 (23.2%) patients had classic COVID-19 symptoms. The mean age of the patients was 55 years (interquartile range, 17-75), and 9 (21.9%) patients were female. The majority of patients (n=36, 87.8%) were implanted with LVAD HeartMate 3. The largest number, 19 (46%) patients, were patients with dilated cardiomyopathy (DCM). The time of LVAD support ranged from 1 month to 83 months before the onset of symptoms and diagnosis of COVID-19. 13 (31.7%) patients required hospitalization due to decreased oxygen saturation (less than 94%) and oxygen deprivation. 3 patients (1.7% among 177 supported patients and 7.3% among patients with COVID-19) required care and treatment in an intensive care unit. Conclusion. We presented an analysis of clinical cases in LVAD patients with COVID-19 in Kazakhstan. To note, there are no guidelines for management and treatment, no data related to the clinical course of COVID-19 in patients on LVAD support to date. Close monitoring of clinical status, anticoagulation and frequent collection of device parameters and DL exit site images, precautionary measures consideration, early diagnosis, timely initiated treatment, supportive psychological care, multidisciplinary approach and rigorous follow-up are crucial in the management of LVAD patients with COVID-19.

15.
REVIEWS IN CARDIOVASCULAR MEDICINE ; 23(6), 2022.
Article in English | Web of Science | ID: covidwho-1939696

ABSTRACT

Venous thromboembolic (VTE) events have been increasingly reported in patients with coronavirus disease 2019 (COVID-19) after hospital discharge. Acute pulmonary embolism (PE) is the most frequent type of post-discharge VTE complication. Levels of procoagulants (fibrinogen, factor VIII, von Willebrand factor), and D-dimer are higher during the SARS-CoV-2 infection. Patients with more severe inflammatory and procoagulant response experience higher VTE rates during hospitalization, while the risk after hospital discharge have not been well characterized. The incidence of VTE events following hospitalization is heterogeneous, ranging from low (3.1 per 1000 discharges), to 1.8%, which appears higher than for other medical condition. This discrepancy was partially explained by the differences in VTE screening and follow-up strategies, and by the period when the information about the VTE was collected. These data were based mainly on observational and retrospective studies;however, evolving data are to come after the completion of the prospective trials. The current guidelines do not recommend routine post-hospital VTE prophylaxis for COVID-19 patients but recommend it for all hospitalized adults. A careful risk-benefit assessment of VTE probability should be performed, to determine whether an individual patient may merit post-discharge thromboprophylaxis. A score such IMPROVE DD can help identify the patient who will potentially benefit but is also important to consider the bleeding risk and the feasibility. The optimal duration and the type of extended thromboprophylaxis is still under debate (from a minimum of 14 days to a maximum of 42 days), and future studies will help to validate these protocols in different populations. Direct oral anticoagulants (DOACs), warfarin and low molecular weight heparin (LMWH) are recommended, but low doses of DOACs rather than LMVII or warfarin were predominantly used in most patients. Finally, the COVID-19 patients should be educated to recognize and advised to seek urgent medical care should VTE events occur after hospital discharge.

16.
Open Access Macedonian Journal of Medical Sciences ; 10:1383-1391, 2022.
Article in English | EMBASE | ID: covidwho-1939099

ABSTRACT

BACKGROUND: No gold standard therapy was approved globally for COVID-19 pneumonia to the date of this study. The pathophysiology of SARS-CoV-2 infection displayed the predominance of hyperinflammation and immune dysregulation in inducing multiorgan damage. Therefore, the potential benefits of both immune modulation and suppression in COVID-19 have been extensively discussed as a modality to control cytokine release syndrome (CRS). Abnormally high levels of interleukin-6 (IL-6) are a common finding in COVID-19 patients with pneumonia and acute respiratory distress syndrome, so the use of IL-6 antagonist was tested as a therapeutic option in controlling the disease. Tocilizumab is a recombinant humanized anti-human IL-6 receptor monoclonal antibody that can specifically bind the membrane-bound IL-6 receptor and soluble IL-6 receptor, thereby inhibiting signal transduction. Tocilizumab is currently FDA approved for the management of rheumatoid arthritis, giant cell arthritis, polyarticular juvenile idiopathic arthritis, and systemic juvenile idiopathic arthritis. This study is a retrospective analysis of data polled during Phase I of COVID pandemic, adopted by the isolation hospital of Kasr Al-Ainy Medical School, Cairo University, during the period from May to September 2020. AIM: The aim of this study is to evaluate tocilizumab influence in the outcome;in terms of reducing the hospital stay, risk and duration of mechanical ventilation (invasive and noninvasive), mortality, and the incidence of complications related to drugs use (secondary bacterial infection and GIT bleeding) in patients with moderate-to-severe COVID-19. METHODS: This retrospective, observational cohort study included adults (between 18 and 80 years) with moderate-to-severe COVID-19 pneumonia, who were admitted to isolation hospital of Kasr Al-Ainy Medical School, Cairo University, between May and September 2020. We segregated the patients into two groups: Group A: In addition to the standard care protocol according to the local guidelines of the Egyptian Ministry of Health and Population in that period (supplemental oxygen, steroids in a dose of 1–2 mg/kg methylprednisolone for 5–10 days, broad-spectrum antibiotics, vitamins, and prophylactic dose of anticoagulation with low-molecular-weight heparin, proton-pump inhibitor, and poly-vitamins), they received tocilizumab intravenously in a dose of 8 mg/kg bodyweight (up to a maximum of 800 mg per dose), divided in two shots 12–24 h apart. Group B: Those received the standard care protocol alone, noting that guidelines were adjusted later on according to the updated scientific publications and WHO recommendations. The primary endpoint was to evaluate the effect of different regimens in controlling the disease, the need for mechanical ventilation and its duration (either invasive or non-invasive), length of ICU stay, hospital stay, and in-hospital mortality. Comparisons between quantitative variables were done using the non-parametric Mann–Whitney U-test. For comparison of serial measurements within each patient, the non-parametric Wilcoxon signed-rank test was used. For comparing categorical data, Chi-square (2) test was performed. Exact test was used instead when the expected frequency was <5. Correlations between quantitative variables were done using Spearman correlation coefficient. RESULTS: During this period, 166 patients were admitted to ICU, suffering from severe hypoxemia with moderate to severe COVID-19 pneumonia, 10 of them were excluded (three were over 80 years old, other three had advanced stages of malignancy, two were on steroids therapy and non-invasive home ventilation due to chronic chest condition, and two were presented with MODs and deceased in <48 h from admission), thus, 156 were included in the study. Group A: Seventy-six patients (49%) received tocilizumab in addition to standard therapy, Group B: Eighty patients (51%) received standard therapy only. In Group A, the mean length of ICU stay was 8.96 days with mean length of hospital stay 13.76, compared to mean length f ICU stay 9 days in Group B (p = 0.57) and mean length of hospital stay 12.46 days (p = 0.117). In Group A, 35 patients (46%) needed non-invasive mechanical ventilation (MV),12 patients of the 35 needed invasive MV in later stage, compared to 26 patients (32%) in Group B, 14 patients of the 26 needed invasive MV in later stage (p = 0.16). In Group A, 14 patients (18.4%) needed invasive mechanical ventilation, compared to 19 patients (23.7%) in Group B (p = 0.213). In Group A, 6 (7.9%) of 76 patients died, compared to 13 (16.3%) of 80 in Group B p = 0.11. The incidence of secondary bacterial infection in Group A was 16 patients (21%) compared to 21 (26%) in Group B (p = 0.44). CONCLUSION: In this study, we did not detect statistical difference in both groups of patients coming during CRS-associated COVID-19 pneumonia, regarding (ICU stay, need for and length of MV, the incidence of secondary bacterial infection, and in-hospital mortality) for COVID-19 moderate-to-severe pneumonia.

17.
Circulation: Cardiovascular Quality and Outcomes ; 15, 2022.
Article in English | EMBASE | ID: covidwho-1938116

ABSTRACT

Background: Asymptomatic patients with atrial fibrillation (AF) pose challenges to diagnosis. Early diagnosis can reduce morbidity and mortality. Systematic screening in primary care may result in early intervention. Objectives: We sought to examine the implementation outcomes of a systematic, team-based quality improvement education (QIE) intervention for AF screening in primary care during the COVID-19 pandemic. Methods: QIE intervention was implemented in academic-based (n=4) and community-based (n=2) practices to address COVID-19 challenges. Surveys administered by site identified existing approaches and provider teams developed screening protocol based on targeted education, deploying a mobile ECG device (Kardiamobile™). Patient charts were reviewed (Dec 2020-May 2021) to determine eligibility, i.e., patients aged 65-74 (with prior stroke/TIA or two other risk factors) or aged ≥75 (with one other risk factor) without prior AF. Patient EHR data were examined for demographic/clinical data and screening outcome. Provider interviews (n=12) and validation from representative patients (n=2) accounted for sustainability of outcomes. Results: A total of 1,221 patients were evaluated for AF risk, with 408 eligible for screening. Of these, 277 (68%) were female and CHA2DS2-VASc varied-score=3 (45%);score=4 (24%);score=5+ (31%). Patients (n=7;2%) who screened positive for AF were referred or started on anticoagulation, like other primary care studies. Figure 1 shows how systematic screening was re-imagined and implemented Satisfaction and engagement increased among providers and patients-attributed, in part, to benefits of team-based planning and targeted education. Conclusion: An AF screening program was adapted to improve patient care despite COVID-19 related challenges. A QIE toolkit was launched to assist primary care practices with implementing streamlined, sustainable, and patient-engaging strategies to reduce stroke.

18.
Journal of Hypertension ; 40:e171-e172, 2022.
Article in English | EMBASE | ID: covidwho-1937716

ABSTRACT

Objective: During the last two years Covid 19 has turned into a deadly pandemia, but it also has a devastating effect on noninfectious chronic diseases, particularly on cardiovascular diseases. This situations was described by Prof. Hector Bueno as “sindemia”. SARS Covid-2 - related respiratory syndrome has a direct and strong biological, patophysiological and social interactions with cardiovascular system. Another serious problem is the admission to hospital because, many of cardiologial units and ICU s were transformed into Covid 19 wards. That is why the outpatient treatment of cardiovascular diseases and risk factors became even more important. Design and method: According to the regulations of the National Healthcare Fund in Bulgaria, all patients with cardiovascular diseases must have an annual examination by cardiologist. We studied the real -life data from one outpatient cardiological practice in Sofia, Bulgaria. 634 patients had to be checked in 2021 15 of these patients had died with Covid 19 infection, one with myocardial infarction and one with stroke. Results: Only 243 patients attended the annual cardiological examination.172 of them were with worsened control of blood pressure, 48 with new symptoms of heart failure, 16 with newly found atrial fibrillation and 13 with newly diagnosed diabetes mellitus. In just one day the cardiologist met a patient with new decompensated diabetes, patient with new ECG data for myocardial cicatrix, patient with atrial fibrillation and patient with several collapses and ventricular tachycardia on ECG Holter! Many patients had antiaplatelet and anticoagulant treatment prescribed after Covid 19 infection, but also had uncontrolled hypertension and that increases the risk of hemorrhagic stroke Conclusions: Covid 19 infection, as an endothelial disease, has a devastating impact on patients with cardiovascular, cerebrovascular, pulmonary and metabolic disorders. The absence of team approach to the therapy leads to very high rate of mortality and long term consequences. The outpatient care of cardiovascular diseases is strongly damaged in Bulgaria. That results in bad control of arterial hypertension, delayed hospitalizations for acute coronary syndromes and heart failure, uncertain control of anticoagulation. It is time to recover healthcare system!.

19.
Journal of Pediatric Intensive Care ; 2022.
Article in English | EMBASE | ID: covidwho-1937481

ABSTRACT

The Multisystem Inflammatory Syndrome in Children (MIS-C) is a postinfectious syndrome associated with coronavirus disease 2019 (COVID-19) disease in children. The aim of this study is to conduct a thorough review to assist health care professionals in diagnosis and management of this complication of COVID-19 disease in children. A thorough systematic review was conducted through an on-line search based on MIS-C with the primary focus on epidemiology, clinical characteristics, diagnosis, pathophysiology, management, and long-term follow-up. This syndrome is characterized by an exaggerated and uncontrolled release of proinflammatory cytokines involving dysfunction of both innate and adaptive immunity. In this review, a summary of observational studies and case reports was conducted, in which we found that MIS-C generates multiple-organ failure frequently presenting with hemodynamic instability further characterized by Kawasaki-like symptoms (such as persistent high fever, polymorphic rash, and bilateral conjunctivitis) and predominance of gastrointestinal and cardiovascular signs and symptoms. Keys to effective management involve early diagnosis, timely treatment and re-evaluation following hospital discharge. Diagnosis is marked by significant elevation of inflammatory biomarkers, laboratory evidence of COVID-19 infection or history of recent exposure, and absence of any other plausible explanation for the associated signs, symptoms, and presentation. Management includes hemodynamic stabilization, empiric antibiotic therapy (de-escalation if cultures and polymerase chain reaction studies indicate no bacterial co-infection), immunomodulatory therapy (methylprednisolone, intravenous immunoglobulin, anakinra, tocilizumab, siltuximab, Janus kinase inhibitors, tumor necrosis factor-α inhibitors), antivirals (remdesivir), and anticoagulation (acetylsalicylic acid, unfractionated or low-molecular-weight heparin or new oral anticoagulants). In addition, we identified poor prognostic risk factors to include concurrent comorbidities, blood-component consumption and marrow suppression (lymphopenia, thrombocytopenia), depletion of homeostatic components (hypoalbuminemia), and marked evidence of a hyperinflammatory response to include elevated values of ferritin, C-reactive protein, and D-dimer. MIS-C constitutes a postinfectious syndrome characterized by a marked cytokine storm, characterized by fever, bilateral conjunctivitis, and multiple organ dysfunction. Promoting future research and long-term follow-up will be essential for the development of guidelines and recommendations leading to effective identification and management of MIS-C.

20.
Thromb Res ; 217: 52-56, 2022 Jul 16.
Article in English | MEDLINE | ID: covidwho-1937244

ABSTRACT

INTRODUCTION: Patients taking warfarin require frequent international normalized ratio (INR) monitoring in healthcare settings, putting them at increased risk of Coronavirus disease 2019 (COVID-19) exposure during the pandemic. Thus, strategies to limit in-person visits to healthcare facilities were recommended by the Anticoagulation Forum. The objective of this study was to describe the number and types of changes made to anticoagulation therapy as a result of pharmacist intervention during the COVID-19 pandemic. MATERIALS AND METHODS: A retrospective chart review of patients included in a primary care COVID-19 anticoagulation intervention was conducted. During this intervention, pharmacists provided individualized recommendations for anticoagulation changes in patients taking warfarin to limit their healthcare facility exposure while also maintaining safe anticoagulation management practices. RESULTS: As a result of pharmacist intervention, 83 (55.7 %) of the 149 patients included in the intervention had changes in anticoagulation including: switching to a direct oral anticoagulant (n = 12), extending the INR monitoring interval (n = 48), switching to home INR monitoring (n = 21), or stopping anticoagulation (n = 2). For those patients who were taking warfarin for the entire 6 months pre- and post-intervention, the total number of healthcare facility and laboratory visits with an INR completed decreased from 8.8 to 6.4 (p < 0.001) per patient without a statistically significant decrease in time in therapeutic range (p = 0.76). CONCLUSIONS: This study depicts rapid implementation of a population health-based approach to assess all patients taking warfarin for options to minimize healthcare visits and decrease risk for COVID-19 exposure. Methods to reduce healthcare visit burden while maintaining patient safety should be considered as a regular component of anticoagulation management post-pandemic.

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