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1.
R I Med J (2013) ; 105(6): 16-19, 2022 08 01.
Article in English | MEDLINE | ID: covidwho-1957812

ABSTRACT

COVID-19 has been highly linked to a hypercoagulable state among affected patients. This case highlights that COVID-19 associated thrombotic incidents are not exclusive to venous circulation and include atypical arterial thrombosis. Here, we report a case of celiac artery thrombus in self-limited outpatient COVID-19 illness as a rare thrombotic complication of COVID-19 infection.


Subject(s)
COVID-19 , Splenic Infarction , Thrombosis , COVID-19/complications , Celiac Artery/diagnostic imaging , Humans , Splenic Infarction/diagnostic imaging , Splenic Infarction/etiology , Thrombosis/diagnostic imaging , Thrombosis/etiology
2.
American Journal of Cardiovascular Disease ; 12(3):149-152, 2022.
Article in English | EMBASE | ID: covidwho-1955690

ABSTRACT

The COVID-19, actual pandemic due to SARS COV 2 is associated with numerous thromboembolic compli-cations. Although venous thrombosis including pulmonary embolisms have been widely described, arterial localiza-tion seems rarely reported. Acute limb ischemia and myocardial infarction are two major consequences of arterial thrombosis and their concomitant occurrence among COVID-19 patients is extremely rare. It is an evident aspect of hypercoagulability and a real challenge to physicians. We herein describe the management of a 77 years old COVID-19 patient presenting an acute lower limb ischemia with concomitant myocardial infarction. He underwent coronary angiography with subsequent stent placement then was transferred to the operating room where a throm-bectomy was performed. The outcome was poor as the cardiogenic shock persisted in addition to a reperfusion syndrome with multiorgan failure.

3.
European Stroke Journal ; 7(1 SUPPL):234, 2022.
Article in English | EMBASE | ID: covidwho-1928125

ABSTRACT

Background and aims: It is unknown whether the covid-19 pandemic and public health measures impact stroke subtypes. We aimed to evaluate if the distribution of stroke subtypes during the pandemic's first wave was different from pre-pandemic. Methods: For this retrospective cohort study, patients with ischemic or hemorrhagic stroke presenting at two comprehensive stroke-centers between March-May 2019 (pre-pandemic cohort) and March-May 2020 (pandemic cohort) were included. All patients had vascular and brain parenchymal imaging. We compared stroke subtypes and etiologies between cohorts. Results: The pre-pandemic cohort consisted of 234 patients and the pandemic cohort of 207 patients. There were no differences in age, sex, stroke severity, nor vascular risk factor profiles between cohorts. Proportions of patients presenting with ischemic versus hemorrhagic stroke were similar in both cohorts (77% vs 75% ischemic stroke, 12% vs 14% intraparenchymal hemorrhage, 11% vs 10% subarachnoid hemorrhage;p>0.6). There were no differences in ischemic or hemorrhagic stroke etiologies, except for a decreased proportion of ischemic stroke patients with large artery atherosclerosis in the pandemic cohort (15% vs 26%;OR: 0.5;95%CI: 0.3-0.9). Notably, during the pandemic, ischemic stroke etiology was more often unknown due to incomplete work-up (28% vs 13%;OR: 2.6;95%CI: 1.5-4.5). Conclusions: Stay-at-home orders and the pandemic's first wave seemed not to have largely influenced stroke triggers and subsequently stroke subtypes. However, a lower incidence of large artery atherosclerosis during the pandemic may suggest a higher incidence of ischemic strokes caused by an undetected cardio-embolic source or hypercoagulable state due to incomplete work-up.

4.
European Stroke Journal ; 7(1 SUPPL):515-516, 2022.
Article in English | EMBASE | ID: covidwho-1928099

ABSTRACT

Background and aims: Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke, contributing to less than 1%. We report an unusual case of severe iron deficiency anaemia (IDA) causing CVST in a young woman with menorrhagia. Methods: Case report: A 40-year-old female with underlying anaemia presented with headache, right leg numbness and expressive dysphasia. She experienced massive menstrual bleeding prior to the symptoms onset on background of uterine fibroids. There was no history of contraceptive pills consumption, massive blood transfusion, COVID-19 infection or vaccination. Systemic review was unremarkable. Results: Blood investigations revealed haemoglobin of 4.5g/dl, MCV 52.3fL, platelet 657x1////////09/L and low ferritin level. Coagulation profile, connective tissue disease, thrombophilia screening, serum homocysteine and HIV test were normal. Computed tomography (CT) of the head showed left temporoparietal lobe infarct and left dural venous sinus thrombosis. CT venography revealed CVST within the distal left transverse sinus and the vein of Labbe. Pelvic ultrasound showed multiple uterine fibroids. She was warfarinised and had iron and red cell transfusion. She agreed to take progesterone-only pill and interval hysterectomy after gynaecological review. Discussion: CVST in association with IDA is rare in adults and is more prevalent in men. In IDA, hypercoagulability and venous stasis play a vital role in thrombus formation. One study found that IDA in women caused arachidonic acid-induced platelet dysfunction causing menorrhagia which is reversible with iron repletion. Conclusion: IDA is a rare cause of CVST but should be considered in the context of relevant history and blood tests.

5.
European Stroke Journal ; 7(1 SUPPL):349, 2022.
Article in English | EMBASE | ID: covidwho-1928082

ABSTRACT

Background and aims: Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare syndrome of unclear aetiology occurring after vaccinations against COVID-19. The aim of this study was to investigate the DNA vaccine-encoded Sars-cov-2 soluble spike protein (SP) as a potential trigger of platelet activation in VITT. Methods: We studied three VITT patients and seven healthy controls (HCs) within 3 weeks from the first dose of ChAdOx1 nCoV-19. Serum levels of SP, soluble angiotensin-converting enzyme 2 (sACE2), and platelet response to VITT serum stimulation were studied. A thrombus retrieved from middle cerebral artery during mechanical thrombectomy of one VITT patient, was analysed by immunohistochemistry for SP and ACE2. Neutrophil extracellular traps (NETs) markers and coagulation parameters were also measured. Results: We detected SP and sACE2 in all VITT patients, and in two and three out of 7 HCs, respectively. VITT sera markedly activated platelets and this activation was inhibited by both anti-SP and anti-FcγRIIA blocking antibodies. The retrieved thrombus showed positive immunohistochemical labelling of platelets using an anti-SP antibody with reduced ACE2 expression, compared to a thrombus from a pre-pandemic stroke patient. Markers of endothelial dysfunction, NETs and hypercoagulability state were present in VITT sera. Conclusions: The present data provide first evidence that DNA vaccineencoded Sars-cov-2 SP is detectable in VITT sera (up to several weeks post-vaccination) and in a platelet-rich thrombus, and suggest that SP may contribute to the initial platelet stimulation in VITT patients. Anti-PF4/ polyanion antibodies development could represent an epiphenomenon, which amplifies platelet aggregation, NETosis, and coagulation cascade.

6.
European Stroke Journal ; 7(1 SUPPL):349-350, 2022.
Article in English | EMBASE | ID: covidwho-1928076

ABSTRACT

Background and aims: There is a higher incidence of cerebrovascular disease (CVD) in patients with SARS-CoV-2 infection. We aim to describe a national series of CVD in patients with confirmed SARS-CoV-2 infection. Methods: Fourteen Brazilian Stroke Centers registered clinical, neuroimaging and laboratory findings from April to November 2020. Results: We included 344 patients in the final analysis. Age ranged from 20-95 (median 57[57, 75] years). Cerebral ischemia (CI) occurred in 83.7%(n=288), intraparenchymal hemorrhage (IPH) 6.7%(n=23), central venous thrombosis (CVT) 5.2%(n=18) and subarachnoid hemorrhage (SAH) 4.4% (n=15). CVD was the first symptom of SARS-CoV-2 in 37.8% of cases - among those with SAH, 60% had no systemic symptoms. CI cases had higher values of Dimer-D compared to others. Involvement of at least two arterial territories occurred in 13.8%. Among IPH patients, 25% were under anticoagulation with heparin. Patients with SAH had a spontaneous etiology in 35.7%. Dimer-D levels at admission were associated with worse outcomes (mRS3-6) (OR1.14, 95%CI1.008-1.29, p=0.03), in an adjusted analysis. The time of onset of neurological symptoms (TONS) since SARS-CoV-2 infection was indirectly related to neurological severity at admission (-0.17, p=0.04,). In-hospital treatment with corticosteroids was associated with in-hospital encephalopathy (OR2.5,95%CI 1.01-6.16,p=0.04). Poor outcome (mRS3-5) occurred in 54.1% of cases. Conclusions: Patients with CVD and SARS-CoV-2 are at higher risk of unfavorable outcomes. The TONS since infection is related to neurologic severity;and serum Dimer-D levels may be useful for prognostication. The higher prevalence of non-aneurysmal SAH cases suggests pathophysiological mechanisms other than a hypercoagulable state.

7.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925583

ABSTRACT

Objective: To describe the clinicopathological correlations of 141 confirmed postmortem cases of coronavirus disease 2019 (COVID-19) due to severe acute respiratory syndrome-coronavirus -2 (SARS-CoV-2). Background: Analysis of 50 cases of COVID-19 with available neuropathology revealed three CNS findings. First, hypoxia-ischemia does not account for all relevant neuropathological features. Second, elevated levels of circulating cytokines suggest activation of post-infectious immunity indicative of a cytokine storm, with increased hypercoagulability leading to a risk for thrombotic and hemorrhagic parenchymal tissue infarction. Third, a minority of cases have acute demyelinating encephalomyelitis-(ADEM) like features or indolent brainstem encephalitis. Such cases may present with early altered sensorium and brainstem signs. Fourth, SARS-CoV-2 staining could not be confirmed due to paucity of available tissue specimens. Design/Methods: Ninety-four additional cases with available postmortem CNS neuropathology showed four additional findings. Results: First, positive SARS-CoV-2 genome by PCR testing is present in brain tissues especially in olfactory bulb neurons and glial cells lending support to a route of entry into the CNS and the importance of early anosmia. Second, SARS-CoV-2-positive neurons appear to be TUNEL positive and caspase-positive, displaying reversible pT231 Tau localization in some cell soma that may be highly neurotoxic and a driver of tauopathy. Third, expression of ACE2 in oligodendrocytes is associated with viral entry, while TMPRSS2 and TMPRSS4 staining is implicated in pruning of viral-decorating spikes. Fourth, meningeal and interstitial brainstem inflammation by cytotoxic T-cells coincides with the localization of SARS-CoV-2 viral proteins in cranial nerves and interstitial areas of lower brainstem encephalitis. The detection of brain microglial activation and sparse perivascular and leptomeningeal T-cell infiltrates correlates with critical illness encephalopathy. Conclusions: Genetic diversity, recombination, and viral mutation carries the foreseeable risk of continued fatality due to the direct and indirect effects of SARS-CoV-2 that include inflammatory vasculopathy, encephalitis, silent infarctions, and critical illness encephalopathy.

8.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925572

ABSTRACT

Objective: We aim to report clinical characteristics of an extremely rare case of myelitis with Guillain-Barré syndrome (GBS) and cerebellar ataxia (CA) after COVID-19 infection. Background: There have been many reports about neurological complications following the world pandemic of COVID-19. We found about 100 GBS, 50 myelitis, and 10 CA cases after COVID-19 infection. To best our knowledge, this is the first report of myelitis with GBS and CA accompanied by multiple autoantibodies. Design/Methods: NA Results: A 60-year-old man with fever and cough was diagnosed with mild COVID-19 infection. Fourteen days later from the onset, he developed gait disturbance and fell frequently. On hospitalization, he exhibited fever, hypoxemia, mild consciousness disturbance, flaccid paraplegia, mild numbness and severe deep sensory disturbance in the lower limbs, bladder and bowel disturbance, mild muscle weakness in the fingers, myoclonus in the extremities, and CA. The PCR of COVID-19 was negative. Blood investigations showed elevated inflammatory markers with dehydration, rhabdomyolysis, and hypercoagulation. Cerebrospinal fluid (CSF) analysis presented mild pleocytosis and elevated protein without anti-COVID-19 antibodies. Contrast-enhanced CT showed massive pulmonary embolisms and deep venous thromboses. Brain SPECT showed cerebellar hypoperfusion despite no abnormalities in brain MRI. Spine MRI revealed longitudinal hyperintense lesions mainly in the dorsal white matter, compatible with myelitis. Additional investigations of autoantibodies realized anti-GM3, TPI, GluR, and NMDAR IgG antibodies in serum, and anti-GluR and NMDAR IgG antibodies with increased granzyme B in CSF. Treatments of corticosteroid and intravenous immunoglobulin resulted in complete recovery to consciousness disturbance, muscle weakness of fingers, myoclonus, and CA, while paraparesis with deep sensory and bladder and bowel disturbance remained. Conclusions: We highlight the possibility of the coexistence of several post-infectious autoimmune neurological complications in patients of COVID-19. It is important to search autoantibodies carefully corresponding to clinical manifestations for appropriate treatments and understanding of pathophysiology.

9.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925537

ABSTRACT

Objective: This study aims to determine the rates of CVT and its impact on outcomes in patients with COVID-19. Background: Thromboembolism is one of the major complications of coronavirus disease 19 (COVID-19). Both arterial and venous thrombolytic involving various organs from COVID-19 related coagulopathy have been reported.Recently, cerebral venous sinus thrombosis (CVT) associated with COVID-19 has been increasingly recognized. The true incidence of CVT in COVID-19 patients remains unknown. Design/Methods: De-identified patient information was extracted on March 1st, 2021 using the TriNetX COVID-19 Research Network platform (www.trinetx.com). This study was exempt by our institutional IRB as it consisted of global de-identified patient data. Patients of ≥ 18 years of age suffering from CVT with or without COVID-19, irrespective of their need for hospitalization, were identified. The baseline characteristics and co-morbidities were compared between the two groups using the TriNetX analytics statistical function. Results: We identified 667,551 COVID-19 patients of which 42 had CVT, and 65,796,480 non COVID-19 patients of which 1022 had CVT (0.0001 vs 0.000002, OR = 40.99 [95% CI = 30.11 - 55.81], p < 0.00001). Among the 42 COVID-19 patients with CVT, 24 (57.1%) were females and 28 (66.6%) were Caucasians. A significantly higher prevalence of hypertension (p = 0.0278) and diabetes mellitus (p = 0.0107) was observed in patients suffering from CVT with COVID-19 compared to the non COVID-19 cohort. A significantly higher mortality rate was observed in patients suffering from CVT with COVID-19 compared to the non COVID-19 cohort (11.9% vs 2.8%, OR = 4.627 [95% CI = 1.320-13.032], p = 0.0011). Conclusions: The odds of developing CVT among COVID-19 patients in our study were 41 times higher than among non-COVID-19 patients. Our study also showed that the mortality from CVT is 4.6 times higher in COVID-19 patients than in the general population presumably due to underlying hypercoagulable state/systemic inflammation.

10.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925507

ABSTRACT

Objective: N/A Background: Severe Acute Respiratory Syndrome Corona Virus 2 (SARS CoV-2) an ongoing pandemic has affected over 200 million people worldwide and caused over 4.5 million deaths. COVID-19 related acute encephalopathy has been known to exist and is thought to be multifactorial, most often related to underlying systemic inflammation, ischemic strokes, hypoxic injury or direct viral invasion and is associated with increased mortality. Design/Methods: We report a case series of three young patients with acute necrotizing hemorrhagic encephalitis (ANHE) after COVID-19 infection and a review of literature. Two of the cases (without preexisting comorbidities) had self-limiting disease that improved with resolution of systemic illness, and one (with preexisting comorbidities) had pathological evidence of fungal invasion who improved only after antifungal therapy. Results: N/A Conclusions: Acute necrotizing hemorrhagic encephalitis is a potential complication of COVID19 and is multifactorial, mediated by cytokines, host inflammatory response, superimposed infections, hypoxemia, hypercoagulability and possibly direct viral invasion. Clinical course may range from mild self-limiting illness to severe encephalitis with co-infection with other pathogens. Low threshold for neuroimaging, even with mild neuropsychiatric symptoms like headaches, can help in early diagnosis and prompt management, potentially preventing further complications.

11.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925448

ABSTRACT

Objective: To describe a case report of Cerebral Venous Sinus Thrombosis (CSVT) and bilateral thalamic infarcts following Pfizer-BioNTech mRNA vaccine in a patient with ulcerative colitis. Background: CSVT has been reported as a rare but life-threatening side effect from SARS-CoV2 vaccines. Although the incidence of developing CSVT is higher following administration of viral vector vaccines (Oxford-AstraZeneca and Johnson&Johnson), six cases of CSVT have been reported following administration of mRNA vaccines (Moderna and Pfizer- BioNTech).1,2,3 In these six cases, only two patients had risk factors (oral contraceptives use and undiagnosed renal cell carcinoma).1,2,3 Our patient was diagnosed with ulcerative colitis (UC) after her presentation with CSVT. Current literature suggests the risk of thromboembolism is twice as common in patients with UC in comparison to the general population. Design/Methods: N/A Results: A 22-year female developed headache, vomiting, and altered mental status after 14 days following administration of the first dose of Pfizer-BioNTech mRNA vaccine. MRI/MRV confirmed bilateral symmetric thalamic infarctions with straight and inferior sagittal sinus thrombosis. She did not have other risk factors such as the use of oral contraceptive pills or pregnancy. ESR/CRP elevated, but platelet count, INR were normal. Hypercoagulable workup was unrevealing. Treatment with therapeutic anticoagulation led to an improvement in symptoms within a week. As the patient previously had rare intermittent bloody diarrhea, further workup (CT abdomen and colonoscopy with biopsy) led to a diagnosis of ulcerative colitis. Conclusions: The temporal association demonstrated between the development of CSVT and the administration of Pfizer-BioNTech mRNA vaccine in the patient is likely a result of the combined hypercoagulability effect of the vaccine and Ulcerative colitis. Active surveillance and continuous pharmacovigilance are necessary to clarify this association. This might help to identify at-risk populations where prophylactic short-term anticoagulation can be used to prevent CVST.

12.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925357

ABSTRACT

Objective: To increase the awareness of neurological complications of arteriovenous malformation (AVM) due to obstruction of the venous drainage despite being on anticoagulants. Background: Cerebral AVMs are high-flow intracranial vascular malformation comprised of feeding arteries, a nidus of vessels with intervening brain parenchyma through which arteriovenous shunting occurs and dilated draining veins allowing significant hemodynamic gradient without an interposed resistance. Venous drainage stenosis or occlusion will increase the hemodynamic pressure gradient within the AVM compartments and potentially lead to redistribution of flow resulting in cerebral venous sinus thrombosis or hemorrhagic stroke from nidus rupture. This effect might be worsened in the presence of a generalized hypercoagulable state causing microvascular injury and thrombosis;despite adequate anticoagulation therapy. Design/Methods: N/A Results: 66-year-old obese woman with history of atrial fibrillation, coronary artery disease, diabetes, hypertension, hyperlipidemia, prior stroke, small left frontal AVM diagnosed on conventional angiogram and recent COVID-19 infection presented to our comprehensive stroke center with seizures and right hemiparesis. MRI brain showed T2/FLAIR hyperintense lesion in the left frontal/parasagittal region with an extensive vasogenic edema, heterogeneous diffusion restriction, and gyriform contrast enhancement. Conventional angiogram showed AVM without nidus opacification but with an associated mass effect correlating with parenchyma edema and early venous shunting. Patient was initially misdiagnosed as low-grade neoplasm although accurate diagnosis of left parasagittal frontal venous infarct in the setting of spontaneous venous thrombosis of left frontal AVM was made with conventional angiogram. Conclusions: Venous infarct due to CVST is a devastating complication of AVM. The hemodynamic pressure gradient within the AVM might play a larger role in contributing to hypercoagulable state within the venous system leading to cerebral venous sinus thrombosis despite patient being on therapeutic anticoagulation.

13.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925332

ABSTRACT

Objective: To investigate whether there is an association between cerebrovascular accidents (CVA's) and COVID-19 vaccination Background: CVA's have been reported in severe COVID-19 infections and are attributed to infection-related hypercoagulability and inflammation. Design/Methods: The reporting rate of CVA cases after COVID-19 vaccination was compared to the reporting rate of CVA after all other vaccinations in three periods: pre-COVID period (January 2019-August 2019), pre-COVID-19 vaccine period (April 2020-November 2020), and vaccine period (December 2020-July 2021). Results: 812 and 17 cases of CVA were reported after COVID-19 vaccination and all other vaccinations, respectively, during the COVID-19 vaccination period. The reporting rate of CVA after COVID-19 vaccination was significantly higher than the rate after all other vaccines (4.2 vs 0.07 per million p<0.00001). However, it was within the incidence range expected in the general population. Only 2 cases of CVA were reported after vaccination during the pandemic period and no cases outside the pandemic period. Based upon self-controlled and case-centered analyses, there is a significant difference in the reporting rate of CVA after COVID vaccination between the risk period (six weeks after vaccination was defined as the risk period of probable association) and control period (93.97% vs 1.97-2.96% p< 0.0001). The reporting rate of CVA after Pfizer was significantly higher compared to CVA after Moderna and Johnson and Johnson vaccinations (5.9 vs 2.8 vs 3.2 per million p<0.0001). However, all reporting rates were within the expected incidence range reported in the general population. Conclusions: There is no association between CVA and COVID-19 vaccination. Furthermore, this work is based on passive surveillance where several limitations exist, which include under-reporting, differential reporting and nonreported or undiagnosed concomitant COVID-19 infection. These factors preclude establishing a cause-effect relationship. Controlled studies are needed for further investigation.

14.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925196

ABSTRACT

Objective: NA Background: COVID-19 infection has been associated with a state of hypercoagulability. The hypercoagulability typically presents as a Deep Venous thrombus or Pulmonary Embolism but rarely can manifest as CVST even after recovery from the original COVID-19 infection. Case Report: 27-year-old Caucasian female who had a COVID-19 infection 2 weeks prior, presented with 4 days of persistent headaches associated with nausea and vomiting. Patient also had episodes of rightward gaze without loss of awareness. No prior history of seizures. NIHStrokeScale was 0. CT head showed a hyper density within the sylvian fissure and the sulci of the right temporal and right lateral frontal lobes suggestive of subarachnoid hemorrhage(SAH);CTA head showed cerebral venous sinus thrombosis(CVST) involving straight sinus, most of vein of Gale, right transverse and right sigmoid sinuses that was also seen on MR venogram. MRI brain showed illdefined edema in a distribution concerning for venous infarct due to CVST. CTA chest also showed multiple bilateral pulmonary emboli. EEG showed focal slowing in the right hemisphere and no epileptiform discharges. Patient was started on heparin and transitioned to Dabigatran on discharge. Past medical history was remarkable for Wolf-Parkinson-White syndrome (s/p ablation), obesity and depression. Patient has no personal or family history of hypercoagulability or malignancy. Patient reported birth control use which she stopped 3 weeks prior to this presentation. Patient stopped cigarette smoking 5 years ago. Patient has a healthy 2.5-year-old son and has no history of miscarriages. Patient was not vaccinated for COVID. Results: NA Conclusions: This is a case of CVST without major classical predisposing factors for CVST however patient had recent COVID-19 infection which should be considered as a potential risk factor for CVST. Considering MR venogram of the head in patients presenting with persistent post-COVID headaches can help identify this potential life threating condition in a timely manner.

15.
Ann Vasc Surg Brief Rep Innov ; 1(1): 100004, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1920692

ABSTRACT

Objectives: we describe Coronavirus Disease (COVID-19) patients also manifesting gastro-intestinal symptoms. Methods: five women, between the ages of 32 and 82 years old, were admitted for acute abdomen, and received a nasopharyngeal swab for COVID-19 screening, lab test analysis, and contrast thoraco-abdominal CT-scan. All presented leukocytosis, different localizations of visceral vessels thrombosis and ischemia, and COVID-19. Results: emergency laparotomy was accepted by all but 1, who died after 5 days. Postoperatively, 1 died of multi-organ failure, 3 were discharged home after 14, 8 and 10 days respectively, under anti-platelet and anticoagulation treatment. Conclusions: in COVID-19 patients with acute abdomen, abdominal contrast CT-scans should be systematically extended to the thorax to detect visceral COVID-19 initial pulmonary signs. Emergency laparotomy and visceral arteries thrombectomy could be necessary.

16.
Pakistan Journal of Medical and Health Sciences ; 16(5):331-332, 2022.
Article in English | EMBASE | ID: covidwho-1918397

ABSTRACT

Background: There is significant evidence to support that patients with the Coronavirus disease 2019 (COVID-19) have a higher propensity to develop thrombotic events. COVID-19 patients in intensive care units (ICU) have an increased rate of venous thromboembolism (VTE), ranging from 17% to 25%. Apart from acute respiratory failure, coagulopathy remains a common abnormality in these patients, within creased levels of both fibrinogen and D-dimers. Anticoagulation using subcutaneous heparin is known to reduce the incidence of thromboembolic events;although concern regarding over-anticoagulation resulting in excessive bleeding remains an impediment. Objective: Study Design: Retrospective study Place and Duration of Study: Bahria International Hospital Lahore from 1st May 2020 to 31st October 2020. Methodology: One hundred and eight patients admitted in the ICU were enrolled. The incidence of thrombotic and bleeding events in patients treated with subcutaneous heparin during their admission with moderate to severe COVID19 in the ICU. All patients were given therapeutic dosed anticoagulation universally unless contraindicated. Results: Thromboembolic events were seen in 10 patients while 98 patients did not have any such event. 3 patients had a bleeding event during their stay. Conclusions: Using prophylactic therapeutic dose anti-coagulation therapy is an effective and safe strategy in COVID-19 patients and it is associated with improved outcomes in terms of reducing morbidity and mortality.

17.
Journal of Clinical and Diagnostic Research ; 16(6):BC12-BC16, 2022.
Article in English | EMBASE | ID: covidwho-1918104

ABSTRACT

group and non diabetic control group. Data was presented as Introduction: Since the end of 2019, a novel Coronavirus percentages for categorical variables and median (interquartile Disease 2019 (COVID-19), declared a pandemic by World Health range) for continuous variables. Chi-square test was used to see Organization (WHO) has ravaged the world. Diabetic patients the association of different qualitative information and Mann-have been reported to be more susceptible to intensive care Whitney U test was used to see the association of quantitative admissions, and deaths due to COVID-19. Diabetes Mellitus data and all p-values were given for justification. A p-value <0.05 (DM) and COVID-19, both associated with chronic and acute was considered statistically significant. inflammation respectively can impact each other in terms of Results: The sample included 300 diabetic and 200 non diabetic clinical progression and outcome. Given the novelty of Severe COVID-19 patients. The mean age non diabetic patients (47.5 Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) years) was significantly less as compared to the diabetic group pathogen, there is need to update and increase the limited (54.5 years), p-value <0.001. The serum level of inflammatory evidence on the probability of DM acting as a risk factor and biomarkers, C-Reactive Protein (CRP), ferritin, and markers of influencing disease severity and progression. hypercoagulable state, D-dimer, was found to be significantly high Aim: To compare the markers of inflammation and coagulation (p-value <0.001) in diabetic patients as compared to non diabetic dysfunction between COVID-19 patients with and without DM patients. Diabetics had a poor prognosis with 231 (77%) receiving as co-morbidity and thereby to study the effect DM has on the oxygen as compared to 51 (25.5%) of non diabetic patients. Total prognosis of COVID-19. 173 (57.7%) of diabetic COVID-19 patients had to be shifted to Materials and Methods: This was a retrospective, observational, ICU, 201 (67%) suffered from post COVID-19 complications and single-centre study, conducted Department of Biochemistry at the mortality rate was higher at 18% in diabetics as compared to Gauhati Medical College and Hospital, Guwahati, Assam, India, 1.5% in non diabetic subjects. from January 2021 to June 2021. Clinical and laboratory data Conclusion: Diabetic patients are at higher risk of uncontrolled of 500 laboratory confirmed COVID-19 patients were reviewed inflammation and hypercoagulable state which eventually leads in this study. The patients were grouped as diabetic case to deterioration of COVID-19 infection status.

18.
Exp Physiol ; 107(7): 749-758, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1916373

ABSTRACT

NEW FINDINGS: What is the topic of this review? Overview of the coagulation abnormalities, including elevated D-dimers widely reported with COVID-19, often labelled as COVID coagulopathy. What advances does it highlight? The review highlights the changes in bronchoalveolar haemostasis due to apoptosis of alveolar cells, which contributes to acute lung injury and acute respiratory distress syndrome; the pathophysiological mechanisms, including endothelial dysfunction and damage responsible for thrombosis of pulmonary microcirculation and potential contribution to the hypoxaemia of COVID-19 acute lung injury; and changes in coagulation proteins responsible for the hypercoagulability and increased risk of thrombosis in other venous and arterial beds. The rationale for anticoagulation and fibrinolytic therapies is detailed, and potential confounders that might have led to less than expected improvement in the various randomised controlled trials are considered. ABSTRACT: Coronavirus disease 19 (COVID-19) causes acute lung injury with diffuse alveolar damage, alveolar-capillary barrier disruption, thrombin generation and alveolar fibrin deposition. Clinically, hypoxaemia is associated with preserved lung compliance early in the disease, suggesting the lack of excessive fluid accumulation typical of other lung injuries. Notably, autopsy studies demonstrate infection of the endothelium with extensive capillary thrombosis distinct from the embolic thrombi in pulmonary arteries. The inflammatory thrombosis in pulmonary vasculature secondary to endothelial infection and dysfunction appears to contribute to hypoxaemia. This is associated with elevated D-dimers and acquired hypercoagulability with an increased risk of deep vein thrombosis. Hypercoagulability is secondary to elevated plasma tissue factor levels, von Willebrand factor, fibrinogen, reduced ADAMTS-13 with platelet activation and inhibition of fibrinolysis. Multi-platform randomised controlled studies of systemic therapeutic anticoagulation with unfractionated and low molecular mass heparins demonstrated a survival benefit over standard care with full-dose anticoagulation in patients with non-severe disease who require supplemental oxygen, but not in severe disease requiring ventilatory support. Late intervention and the heterogeneous nature of enrolled patients can potentially explain the apparent lack of benefit in severe disease. Improvement in oxygenation has been demonstrated with intravenous fibrinolytics in small studies. Inhaled anticoagulants, thrombolytic agents and non-specific proteolytic drugs in clinical trials for decreasing alveolar fibrin deposition might benefit early disease. Essentially, COVID-19 is a multi-system disorder with pulmonary vascular inflammatory thrombosis that requires an interdisciplinary approach to combination therapies addressing both inflammation and intravascular thrombosis or alveolar fibrin deposits to improve outcomes.


Subject(s)
Acute Lung Injury , COVID-19 , Thrombophilia , Thrombosis , Acute Lung Injury/drug therapy , Anticoagulants/therapeutic use , Fibrin/metabolism , Humans , Hypoxia/drug therapy , SARS-CoV-2 , Thrombophilia/drug therapy , Thrombophilia/etiology , Thrombosis/drug therapy
19.
Italian Journal of Medicine ; 16(SUPPL 1):20, 2022.
Article in English | EMBASE | ID: covidwho-1913257

ABSTRACT

Introduction: Thromboembolism is a known phenomenon of coronavirus disease. Patients hospitalized with severe covid-19 demonstrate clinical and laboratory markers compatible with hypercoagulability. Case Report: A 85-old-man with a previous history of hypertension and diabetes. He presented to emergency room afebrile, oriented, cooperative (CGS 15), with cough, dyspnea and hypoxemia (oxygen saturation 88% on room air) requiring non-invasive-ventilation (C-PAP Fi O2 50% PEEP 5). Vital signs were: BP 100/70 mmHg, HR 88 bpm, RR 26/min;ECG: no arrhythmia;PCR for Sars- CoV2 was positive;the ChestX-Ray revealed bilateral consolidations. Laboratory findings at admission: WBC 10.4 K/microL, Neutrophils 9.7 K/microL, Lymphocytes 0,5 K/microL, Platelet Count 306 mm3, D-Dimer 703 ng/ml, CRP 158 mg/L. The patient started therapy with Piperacillin/Tazobactam, LMWH, steroids in addition to standard supportive care and admitted in covid department. On the second day he didn't respond to painful stimulations, neurological examination revealed bilateral babinski, left sides hemiplegia followed by absent corneal and vestibule-ocular reflexes (CGS 4);brain CT-Scan revealed acute large ischemic infarct. Laboratory findings after onset of stroke: WBC 17.6 K/microL, Neutrophils 16.4 K/microL, Lymphocytes 0,3 K/microL, Platelet Count 457 mm3, D-Dimers 7464 ng/ml, CRP 166 mg/L. Conclusions: Systemic inflammation and the potential direct action of the coronavirus may cause endothelial disfunction, resulting in a hypercoagulable state that could be considered a potential cause of ischemic stroke.

20.
Healthcare (Basel) ; 10(7)2022 Jun 22.
Article in English | MEDLINE | ID: covidwho-1911292

ABSTRACT

Background. To evaluate relationships between lung aeration assessed by lung ultrasound (LUS) with viscoelastic profiles obtained by thromboelastography (TEG) in COVID-19 respiratory failure. Methods. Retrospective analysis in a tertiary ICU in Rome, Italy. Forty invasively ventilated adults with COVID-19 underwent LUS and TEG assessment. A simplified LUS protocol consisting in scanning six areas, three per side, was adopted. A score from 0 to 3 was assigned to each area. TEG®6s was used to obtain viscoelastic hemostatic assay parameters which were compared to LUS score. Results. There was a significant inverse correlation between LUS score and static compliance of the respiratory system (Crs, rs -0.75; p < 0.001). We found a significant association between LUS and functional fibrinogen maximum amplitude (FF-MA): among 18 patients with LUS score ≤ 12, median FF-MA was 31 mm [IQR 28-39] whilst, among 22 patients with LUS score > 12, it was 46.3 mm [IQR 40-53], p = 0.0004. Median of the citrated recalcified kaolin-activated maximum amplitude (CK-MA) was 66.1 mm [64.4-68] in the LUS score ≤ 12 group, and 69.6 [68.5-70.7] when LUS score > 12, p < 0.002. Conclusions. The hypercoagulable profile as defined by elevated FF-MA and CK-MA may be associated with a low degree of lung aeration as assessed by LUS.

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