Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 290
Filter
1.
International Journal of Cardiology ; 369(Supplement):30-31, 2022.
Article in English | EMBASE | ID: covidwho-2210434

ABSTRACT

Background: Up to 30% of patients with pulmonary embolism (PE) were reported to have a normal 12-lead ECG. Right-sided ECG features in PE have been described in few reports and are generally a reflection of right ventricular (RV) ischemia or dilation. We believe that it would be an important tool to raise suspicion for PE in cases of normal left-sided ECG. Objective(s): Primary: To determine the utility of right-sided ECG in the diagnosis of PE. Secondary: To risk stratify patients whom have higher probability of PE, so that empirical treatment can be initiated while awaiting diagnostic imaging test especially in district hospitals and in times of pandemic such as COVID-19. Material(s) and Method(s): A cross-sectional study among patients in 3 hospitals were conducted from 1/6/2021 to 31/3/2022. A total of 105 patients with suspected PE were identified where simultaneous left and right-sided ECG were recorded and compared. CTPA confirmed the diagnosis of PE in 79 of them. Result(s): 75% of the cohort were diagnosed with PE. 52 of them had normal left-sided ECG, but right-sided ECG showed changes in 45 of them;namely 'R pattern' in one to three of the leads V4R, V5R and V6R (specificity 88.4%, sensitivity 50.6%) and 'Slurred S wave' in one to four of the leads V3R, V4R, V5R, V6R (specificity 84.6%, sensitivity 69.6%). 25 of patients with PE manifested RV strain pattern in both left and right-sided ECGs. There were 26 patients without PE, which served as a control group. Conclusion(s): Right-sided ECG has higher sensitivity and specificity than the standard ECG in the diagnosis of PE. Combining 'R' and 'Slurred S wave' pattern in right precordial leads increases its specificity to 100% and sensitivity to 69.6%, which highlights the importance of recording right-sided ECG along with standard ECG in patients with clinical suspicion of PE. Copyright © 2022

2.
Open Access Macedonian Journal of Medical Sciences ; Part F. 10:648-654, 2022.
Article in English | EMBASE | ID: covidwho-2201134

ABSTRACT

Since it was discovered in Wuhan in December 2019, most studies on COVID-19 have been centered on symptomatic adults. An expanded pro-inflammatory cytokine reaction, abnormal clot formation, overactive platelets, and hypercoagulable state are among the well-known clinical characteristics of endothelial dysfunction that may arise in patients with COVID-19. These conditions can lead to venous thromboembolism, arterial thrombosis, and pulmonary embolism. To date, the predominance of thromboembolic complications in children infected with severe acute respiratory syndrome coronavirus 2 has not been fully documented, and there is no explicit recommendation for the prevention of thrombosis in children. Copyright © 2022.

3.
Brain Sciences ; 12(12) (no pagination), 2022.
Article in English | EMBASE | ID: covidwho-2199778

ABSTRACT

Calcitonin gene-related peptide (CGRP) antagonists are a class of medications that act as antagonists of the CGRP receptor or ligand. They can be divided into monoclonal antibodies and non-peptide small molecules, also known as gepants. CGRP antagonists were the first oral agents specifically designed to prevent migraines. The second generation of gepants includes rimegepant (BHV-3000, BMS-927711), ubrogepant (MK-1602), and atogepant (AGN-241689, MK-8031). Zavegepant (BHV-3500, BMS-742413) belongs to the third generation of gepants characterized by different administration routes. The chemical and pharmacological properties of this new generation of gepants were calculated. The clinical trials showed that the new generation of CGRP antagonists is effective for the acute and/or preventive treatment of migraines. No increased mortality risks were observed to be associated with the second- and third-generation gepants. Moreover, the majority of the serious adverse events reported probably occurred unrelated to the medications. Interesting facts about gepants were highlighted, such as potency, hepatotoxicity, concomitant use with monoclonal antibodies targeting the CGRP, comparative analysis with triptans, and the "acute and preventive" treatment of migraine. Further studies should include an elderly population and compare the medications inside this class and with triptans. There are still concerns regarding the long-term side effects of these medications, such as chronic vascular hemodynamic impairment. Meanwhile, careful pharmacovigilance and safety monitoring should be performed in the clinical practice use of gepants. Copyright © 2022 by the authors.

4.
Vascular Medicine ; 27(6):NP20-NP21, 2022.
Article in English | EMBASE | ID: covidwho-2194547

ABSTRACT

Background: The Coronavirus Disease 2019 (COVID-19) has been shown to Increase incidence of venous thromboembolism (VTE). We describe a novel case of rivaroxaban treatment failure in a patient with COVID-19 infection who previously demonstrated efficacious treatment of prior pulmonary embolism (PE) with rivaroxaban Case presentation: A 75-year-old male patient originally presented for syncope and was found to have acute submissive PE on Computed tomography angiogram of his (CTA) chest. He was placed on heparin initially and he remained hemodynamically stable during his admission and was discharged home on rivaroxaban at standard induction dose. He presented again for shortness of breath 3 months later. CTA chest was repeated and demonstrated resolution of his prior PE. He was found to be positive for COVID-19 and admitted for further management, rivaroxaban was continued during his admission. Repeat CTA of his chest 2 weeks later demonstrated moderate right and small left PE without right heart strain. Vascular Medicine was consulted at that time. The patient reported taking his rivaroxaban as directed throughout the recommended course. He reported taking rivaroxaban with food. He said his son helped him with his medications and it was unlikely he missed any doses. He was able to get his medications from the Veterans Health Administration (VA) and had no issues with access to medications. Medication review revealed no drug interactions . that would decrease efficacy of rivaroxaban. The patient's weight of 116 kg was within the acceptable range for rivaroxaban use. Conclusion(s): This case is unique in that timing of CTA scans demonstrated complete resolution of patient's initial PE while taking rivaroxaban followed by new development of PE after COVID-19 infection despite continuation of rivaroxaban therapy.

5.
Critical Care Medicine ; 51(1 Supplement):295, 2023.
Article in English | EMBASE | ID: covidwho-2190581

ABSTRACT

INTRODUCTION: Previous studies have reported an increased risk of procoagulant events such as pulmonary embolism (PE) in adult patients with Coronavirus Disease-19 (COVID-19). However, scant information exists within pediatric samples. This study aimed to investigate the effect of COVID-19 acute infections on the incidence of PE among pediatric patients. METHOD(S): Using Virtual Pediatric Systems (VPS), retrospective data was collected of patients age < 18 years old who were admitted to participating pediatric critical care units from 2018-2021. Patients with an ICD diagnosis of COVID-19 infection or PE were extracted for further analysis. Additional information regarding patient age, gender, race, BMI, comorbidities were also obtained. RESULT(S): In total, there were 488,298 admissions to PICUS participating in VPS from 2018 - 2021. In 2018 and 2019, prior to the COVID-19 pandemic, the incidence of PE among the pediatric population was 2.29 per 1000 patients (n=614). During the COVID-19 pandemic in 2020-2021, the incidence of PE increased to 3.11 per 1000 patients (n=686). Of the PE cases between 2020 to 2021, 12.1% (n=83) patients had an acute COVID-19 infection (53.0% female;42.0% BMI> 35;91.6% >12 years of age;92.8% survival). Patients with acute COVID-19 infection had 3.4 (95% CI, 2.7 - 4.2) times the risk of pulmonary embolism than patients from 2020 to 2021 without acute COVID-19 infection. CONCLUSION(S): In this study, we report an increased incidence of PE among pediatric patients during the COVID-19 pandemic when compared with the years prior to the pandemic. Additionally, we report a significantly increased relative risk of pulmonary embolism in patients with acute COVID-19 infection compared to patients without acute COVID-19 infection. Further analysis is planned to adjust for hypercoagulable states. Additional research is needed to identify risk factors for PE in pediatric patients with COVID-19.

6.
Human Gene Therapy Methods ; 33(23-24):A209-A210, 2022.
Article in English | EMBASE | ID: covidwho-2188082

ABSTRACT

In this study we investigated a link between adenovirus-based vaccines, deployed to fight the SARS-CoV-2 pandemic, and lifethreatening thromboembolisms after vaccination. Post-marketing surveillance showed that, following vaccination, Vaxzevria (ChAdOx1 based, AstraZeneca) and Jcovden (Adenovirus type 26 based, Johnson & Johnson) are associated with reduced platelet counts (thrombocytopenia) and blood clots (thrombosis) in some individuals. This extremely rare condition, with a rate between 1:50,000 - 1:350,000 cases per vaccinated individual, is above background rates of thrombosis in the population and can lead to fatal ischemic events including cerebral venous thrombosis, intracranial haemorrhage, and pulmonary embolism. It has been termed vaccine induced thrombotic thrombocytopenia (VITT) or thrombosis with thrombocytopenia syndrome (TTS). Heparin induced thrombocytopenia (HIT) is another condition with a similar clinical presentation to TTS. In HIT, immunoaggregates are formed due to the presence of strong anti-selfantibodies directed against Platelet Factor 4 (PF4). When similar anti-PF4 antibodies were detected in TTS patients, we investigated whether there could be a link between the adenovirus vectors used in the vaccines and PF4. This study demonstrates a direct interaction between adenovirus capsids and PF4 using surface plasmon resonance. We then utilized an integrative structural biology workflow including cryo-electron microscopy and molecular dynamics to characterize and demonstrate the mechanism of this interaction. These results demonstrate a previously unknown adenovirushost interaction and provide critical clues as to the underlying mechanism which causes TTS, including how these pathogenic anti-PF4 antibodies may be induced. We are therefore able to present a hypothesis as to the route of pathogenesis in TTS.

7.
Acta Clinica Belgica ; 77(Supplement 2):27, 2022.
Article in English | EMBASE | ID: covidwho-2187674

ABSTRACT

Background : Evidence-based guidelines are the best way to ensure the quality of patient care. The 2019 European Society of Cardiology (ESC) guidelines were established for the diagnosis and management of acute pulmonary embolism. Objective : To evaluate the adherence of clinicians to the ESC recommendations in the management of hemodynamically stable patients with pulmonary embolism. To evaluate the identification and orientation of patients at intermediate-high risk of mortality according to the guidelines (sPESI>1 and right ventricle dysfunction and positive troponin test). Material(s) and Method(s): We conducted a retrospective single-centre study on all the patients admitted into the emergency care unit (ECU) and diagnosed for pulmonary embolism from January 2021 to October 2021. Their data were collected from the patient health records of the ECU and the subsequent services where the patients were hospitalized. Hemodynamically unstable patients were excluded (Systolic blood pressure on arrival <90 mmHg, cardiac arrest or use of vasopressors). We evaluated the frequency of use of the recommended tools (PESI or sPESI) as well as the frequency of assessment of right ventricle dysfunction via imaging methods (heart ultrasound or via CT) and of laboratory biomarkers such as Troponin T (cutoff 10 pg/ml) and NT-proBNPs (cutoff 500 ng/L). For all of the selected patients, we retrospectively calculated the sPESI to assign them into three categories of early mortality risk (low, intermediate low and intermediate high) and examined whether the orientations of the patients to the intensive care unit (ICU) or other units were appropriate. Results :A total of 70 patients with a median age of 64 years were included. Sixteen (23%) patients were SARS-CoV2 positive. Out of the 70 patients,15 (21%) had a documented PESI or sPESI score on arrival, 51 (73%) had a troponin measured and 51 (73%) had a cardiac ultrasound performed of whom 9 (13%) had an ultrasound on arrival and 42 (60%) during their hospital stay. After calculating the sPESI on all patients based on the admission data in the ECU,16 (23%) patients were identified as being at intermediate-high risk. Amongst these 16 severely affected patients,10 had indeed benefitted from surveillance in the ICU whereas one did not benefit from surveillance and five were not transferred to the ICU based on the clinician's evaluation or the patient's desire to avoid therapeutic escalation. It appears that sPESI was more frequently calculated (33% vs 4%, p = 0,002) in patients who had certain radiological findings (bilateral embolism or embolism in a main pulmonary artery) compared to patients without radiological signs of severity. Conclusion : Adherence to the scores recommended by evidence-based guidelines was documented in only 23% of cases. This leaves room for improvement in the use of the PESI score and requires more systematic dosage of Troponins T and faster access to cardiac ultrasound. Our observation showed that even if radiological findings (besides signs of RV dysfunction) are not used in the ESC guidelines, some clinicians are prone to using radiological signs of severity to guide their use of the sPESI score. However, this can lead to a lack of identification and appropriate management of patients at intermediate-high risk of early mortality.

8.
British Journal of Oral and Maxillofacial Surgery ; 60(10):e56, 2022.
Article in English | EMBASE | ID: covidwho-2176815

ABSTRACT

Introduction/Aims: In the United Kingdom, maxillofacial and allied specialty units were required to perform tracheostomies for COVID-19 positive patients from the start of the pandemic in 2020. This necessitated changes to technique and workforce planning. We review our data relating to surgical and surgeon-assisted percutaneous tracheostomies performed in our unit since 2020. Material(s) and Method(s): A review of the electronic case notes for all surgical or surgeon-assisted percutaneous tracheostomies was performed. For COVID-19 positive patients who required a tracheostomy for weaning from mechanical ventilation, analysis of the timing of the procedure from admission to hospital and intubation was compared along with co-morbidities, body mass index and COVID-19 complications. The indications for surgical tracheostomy was appraised. Results/Statistics: Between January 2020 to mid January 2022, 126 surgical tracheostomy cases were performed with 67 (53%) on COVID-19 positive patients for weaning off mechanical ventilation. Two distinct activity peaks were appreciated, which corresponded to spikes in the UK hospital admission rates for COVID-19 and for the number of patients in mechanical ventilation beds (Source: UK Government). COVID-19 positive patients spent an average of 21.9 days in hospital and 19.7 days intubated prior to surgical tracheostomy. In addition to respiratory failure, 77.6% of patients had acute kidney injury and 22.3% a pulmonary embolism. High BMI and other anatomical constraints were the main indication for a surgical approach. Conclusions/Clinical Relevance: The anticipated increase in tracheostomy referrals with rising cases of the Omicron variant in the United Kingdom did not transpire in our hospital, as was seen with the first and second COVID-19 waves. Copyright © 2022

9.
European Geriatric Medicine ; 13(Supplement 1):S228, 2022.
Article in English | EMBASE | ID: covidwho-2175467

ABSTRACT

Introduction: Tensions during the COVID-19 crisis (particularly in the geriatric population) posed the problem of limiting care for older, frail and polypathological patients. The unpredictable evolution of the COVID-19 infection made decision making difficult, especially for physicians not familiar with geriatric practice, which often resulted in difficult communication with families. Method(s): Mrs L, 91 years, polypathological, suffering from hippocampal advanced neurocognitive disorders, loss of autonomy transferred from the emergency department for COVID-19 infection, desaturation at 88% on a pulmonary embolism. After 7 days, the patient still in poor general condition, congested, difficult to swallow per os, still on 2L oxygen, was transferred to palliative care. Despite the patient's condition, the unfavourable evolution and her transfer to palliative care, no discussion on the limitation of care and possible palliative management if decompensation is mentioned in the patient's file. Result(s): Mrs L, arrived on a Friday evening, had a precarious condition. Despite curative management with monitoring of the biological balance, the patient's condition remained stationary and she finally died on Sunday morning. During these few hours of hospitalisation in palliative care, her family was very demanding, not seeming to understand the seriousness of her condition, and the possibility of limiting care to avoid unreasonable obstinacy and relentless treatment. Conclusion(s): This case study of a polypathological COVID + patient demonstrates the importance of anticipating what to do in case of aggravation and decompensation. Communication with relatives seems to us to be essential for optimal management.

10.
Lymphologie in Forschung und Praxis ; 24(1):40, 2020.
Article in German | EMBASE | ID: covidwho-2167491
11.
Research and Practice in Thrombosis and Haemostasis Conference ; 6(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2128295

ABSTRACT

Background: There is an increased risk of thrombotic events in patients with COVID-19, while thrombosis in patients who recovered from COVID-19 is less investigated. Aim(s): To investigate thrombotic events in patients who recovered from COVID-19;to establish risk factors for thrombosis development. Method(s): We reviewed 32 patients who recovered from COVID-19 (M/F:13/19, median age: 57 [49-67] years). Group 1 included 16 patients who had had a thrombotic event, whereas 16 patients from group 2 had not. Statistical analysis was performed by non-parametric methods (median (Me), 95% confidence interval (95% CI), Mann-Whitney U test). We used odds ratio and relative risk to measure the association between risk factors and outcome. Result(s): 15 patients from group 1 had pulmonary embolism, 1 patient had ischemic stroke. The median term of thrombotic events was 45 (32-60) days. 2 patients had thrombophilia, 2 were hospitalized when the outcome occurred. 5 patients had BMI 30 or more, 7 did not have any risk factors. There was no statistically significant difference between two groups regarding age, weight, hospitalization duration, respiratory failure degree and its duration. Comorbidity, hospitalization requirement or oxigenotherapy during COVID-19 did not affect the outcome. The only one association found was increased risk of thrombosis in patients who had not received anticoagulation RR 2.829 (95% CI 1279;6255);OR 9.533 (95% CI 1.847;49.206). Risk was also significantly elevated in case of antiplatelet agent use RR -2.250 (95% CI 0.898;5.636);OR -4.333 (95% CI 0.742;25.295). Conclusion(s): Anticoagulant therapy was the only intervention decreased thrombosis probability in survivors after COVID-19. Absence of anticoagulation treatment increases the risk of thrombosis during post-covid period in 9 times.

12.
Research and Practice in Thrombosis and Haemostasis Conference ; 6(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2128273

ABSTRACT

Background: Diagnostic strategies for pulmonary embolism (PE) in patients already facing respiratory failure due to COVID-19 is challenging. The use of the conventional diagnostic algorithm and clinical prediction rules (CPR) for PE is controversial. Aim(s): To evaluate the accuracy of currently available diagnostic algorithms for the diagnosis of PE and CPRs to assess the risk for venous thromboembolism (VTE) in medically ill patients affected by COVID-19. Method(s): Consecutive patients >18 years hospitalized for COVID-19 (confirmed by molecular testing) at Perugia Hospital (Italy) from March 2020 to September 2021 were included if underwent chest- CT angiography for suspicion of PE. The study outcome was the accuracy of currently available CPRs, for PE diagnosis (Wells and Geneva) and for VTE-risk stratification in medically ill patients (IMPROVE, IMPROVEDD and Padua score), to predict PE. Result(s): 74 patients were included (mean age 68 years, male 64.9%), 13 (17.6%) had PE confirmed. No significant differences were observed for comorbidities, antithrombotic treatment and mortality between the two groups. D-dimer resulted significantly higher in patients with compared to patients without PE. Poor discrimination was observed for Wells and Geneva scores (AUC 0.596, 95% CI 0.413-0.779, and AUC 0.603, 95% CI 0.439-0.767, respectively), without substantial differences adding D-dimer at conventional cut-off (Table). The IMPROVEDD score had the highest discriminative power among CPRs for VTE (AUC 0.699, 95% CI 0.539-0.860). Scores' performance improved by increasing the D-dimer cut-off at level of 2000 ng/ml. Conclusion(s): The accuracy of the currently used diagnostic and predictive scores for PE or VTE in COVID-19 patients is poor. D-dimer improves the diagnostic accuracy of these scores;most of all, it seems to allow a diagnostic strategy with a high negative predictive value, so we can rule out a consistent part of the patients with a low risk of PE. (Table Presented).

13.
Research and Practice in Thrombosis and Haemostasis Conference ; 6(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2128266

ABSTRACT

Background: During the first quarter of 2021, several European countries suspended the use of the Oxford-AstraZeneca vaccine amid reports of blood clot events and the death of a vaccinated person. This was followed by several reports of fatalities related to pulmonary embolism and other thrombotic events including thrombocytopenia which has been referred to as vaccine-induced immune thrombotic thrombocytopenia (VITT). Aim(s): This study investigated the occurrence of thrombotic adverse events and their clinical outcomes of the three approved and most used COVID-19 vaccines namely Moderna, Pfizer and Oxford-AstraZeneca, using one of the largest spontaneous adverse events databases, namely EudraVigilance. Method(s): A retrospective descriptive analysis was conducted of spontaneous reports for Moderna, Pfizer and Oxford-AstraZeneca COVID-19 vaccines submitted to the EudraVigilance database in the period from 17 February to 14 June 2021. Result(s): There were 729,496 adverse events for the three vaccines, of which 3420 were thrombotic, mainly Oxford-AstraZeneca (n = 1988, 58 1%) followed by Pfizer (n = 1096, 32 0%) and Moderna (n = 336, 9 8%). As serious adverse events, there were 705 reports of pulmonary embolism for the three vaccines, of which 130 reports (18 4%) were for Moderna, 226 reports (32 1%) for Pfizer and 349 (49 5%) for Oxford-AstraZeneca vaccines. The occurrence of pulmonary embolism is significantly associated with a fatal outcome (p = < 0 001). Sixty-three fatalities were recorded (63/3420, 1.8%), of which Moderna (n = 6), Pfizer (n = 25) and Oxford-AstraZeneca (n = 32). Conclusion(s): Thrombotic adverse events reported for the three vaccines remains extremely rare with multiple causative factors reported elsewhere as precipitating these events. Practicing vigilance and proper clinical management for the affected vaccines, as well as continuing to report adverse events, are essential. More than 4 89 billion doses of different COVID-19 vaccines have been administered across the globe. On the basis of scientific evidence showing that benefit outweighs risk, people continue to be urged to accept the vaccination when offered.

14.
Research and Practice in Thrombosis and Haemostasis Conference ; 6(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2128255

ABSTRACT

Background: Pulmonary embolism (PE) is the third most common cause of cardiovascular death with a case fatality rate of 10% at 30 days. COVID-19 is associated with systemic inflammation and abnormal coagulation profile leading to an increased thromboembolic risk. Reported incidence of PE among COVID-19 patients is highly variable and mainly short-term studies are present in literature. Aim(s): Evaluatethe impact of COVID-19 on incidence and clinical, laboratoristic and radiological characteristics of PE over a 24-month period Methods: We conducted an observational cross-sectional study on all patients diagnosed with PE in one of the seven hospitals of the Azienda Socio Sanitaria Territoriale Sette Laghi, during a 24 month period, going from 12 months before (pre-COVID period) up to 12 months after (COVID period) February 21st 2020, day of first diagnosed italian case of COVID-19. Data were collected on clinical, laboratoristic and radiological characteristics and Non-COVID- 19 patients were compared to COVID-19 patients. Result(s): 489 patients with acute PE were identified: 217 in the pre-COVID period and 272 in the COVID period of whom 50 patients had COVID-19. The prevalence of PE in hospitalized patients with COVID-19 was 1.1% (50/4568). In patients with PE and COVID-19, male sex was more common (72% vs 42%;p-value < 0.01), D-Dimer values were significantly higher (> 9000 mcg/L in 50% of them vs 28% among non-COVID patients;p-value: 0.002), median Troponin T level was lower (32 ng/ml vs 14.5 ng/ml,;p-value: 0.02), distal obstruction was more common (68.4% vs 48% p-value: 0.03). Conclusion(s): Incidence of PE has significantly increased after the onset of pandemic (55 more cases;20%). Male sex appears to be a risk factor for PE in COVID-19 patients. Despite the high procoagulant profile of COVID-19 patients, our study found a predominantly distal distribution of PE and events appear to have lower severity indicators as compared to non-COVID- 19 patients. (Figure Presented).

15.
Research and Practice in Thrombosis and Haemostasis Conference ; 6(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2128239

ABSTRACT

Background: University Hospitals Plymouth, NHS trust, is a teaching hospital which has been a venous thromboembolism (VTE) exemplar centre since 2010. Data on VTE events, whether hospital acquired (HAT) and radiology scans performed, has been collected since 2010. Aim(s): To review whether COVID had an impact on number of VTE events diagnosed, number of HAT events and radiological investigations performed. Method(s): Collect VTE outcome data from computed tomography pulmonary angiography (CTPA), ventilation perfusion scans (V/Q) and Doppler ultrasounds of upper and lower limbs. Review positive VTE events as to whether they meet criteria for HAT and compare outcome data for 2021 with an average from 2010 -2020. Result(s): In 2021 number of VTE events was 944, an increase of 153 (19%) over previous 11 years. HAT events were 206, increased by 17 (9%) though as a percentage of total VTE fell from 24% to 22%. Total pulmonary embolism (PE) was 590, increase of 136 (30%), although deep vein thrombosis (DVT) events were 354, representing an increase of 18 (5%). CTPA scans rose by 891 (41%) to 7021 though DUS remained similar with 2714 scans against an average of 2704 and VQ scans reduced to 339 compared with 545. Of the positive VTE events, 72 (8%) were associated with a COVID diagnosis and a significant number 67 (93%) being PE compared to 5 (7%) DVT. Conclusion(s): There is likely to be an association between VTE increase and shielding as well as positive COVID events causing a decrease in usual physical activity. It is not entirely clear why PE increased significantly but as COVID is a respiratory virus and causes significant inflammation within the lungs, this may have impacted on these figures. Initial review of data confirms no significant changes to VTE risk factors. We will continue to collect and monitor this data in 2022. (Table Presented).

16.
Research and Practice in Thrombosis and Haemostasis Conference ; 6(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2128223

ABSTRACT

Background: We found that the number of patients diagnosed with PE following COVID began to increase so we wanted to study the trend and triggers In a recent review of our COVID-19 admissions, the incidence of VTE in patients with SARSCoV-2 was 34.5% in imaged patients (119 patients had CT pulmonary angiograms, and 41patients had identified pulmonary thromboembolism (Barnet Hospital, unpublished data, 2020 Kumar el at 2020). Aim(s): To review the number of patients referred to the clinic before and present, make a comparison of number of VTEs before and during COVID pandemic Methods: Retrospective cohort study was conducted from Jan until June 2020. All patients who have confirmed as COVID with VTE were included, suspected COVID were excluded from the study The anticoagulation team all uploaded information to excel and this was analysed and report produced Results: A total of 657 patients were referred to the anticoagulation clinic between Jan to June 2020 Out of them 184 had VTE out of that number 32 were identified as COVID 19. DOAC drug prescribed Total number 32 Apixaban 5 mg BD 20 Rivaroxaban 20 mg 8 Dabigatran 150 mg 0 Edoxaban 60 mg OD 0 LMWH 3 Conclusion(s): Conclusion(s): Most patients did not have any issues related to the VTE but they were still recovering as a result of COVID. They reported feeling tired, short of breath and weak. These are not the usual symptoms reported by VTE patients apart from PE patients We treated them for duration of three months but if these patients were not fully mobile or had on going symptoms we plan to continue the therapy for a total of six months.

17.
Research and Practice in Thrombosis and Haemostasis Conference ; 6(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2128213

ABSTRACT

Background: Thrombotic events are frequent in COVID-19 patients. The use of DOACs to treatment or extended prophylaxis is not clear in these population. Aim(s): To know the prevalence of PE associated with COVID-19 pneumonia in our population. To describe the use of DOACs for ambulatory prophylaxis after COVID-19 pneumonia patients. To describe the use of DOACs for ambulatory treatment in PE COVID-19 patients. Method(s): Retrospective registry of patients admitted for COVID-19 pneumonia from May 2020 to December 2021. Internists evaluated thrombosis risk after discharge according to IMPROVE score and body mass index (BMI) >=30 following a local guideline. Exclusion criteria: Treatment with other anticoagulants, no follow-up, death. Statistics: Quantitative data through parametric analysis of variance and categorical data according to contingency tables Results: 345 patients were admitted;279 were evaluable (Table 1). 37.5% patients received extended prophylaxis (87/232: 54 Apixaban, 33 Rivaroxaban). Mean prophylaxis time 14.27 days (7-28). There was no consensus among internists regarding prescribing ambulatory prophylaxis. 16.8% of COVID-19 pneumonias had PE (47/279). 70% were incidental (imaging studies due to underlying disease) and 30% were symptomatic. 38 were on Apixaban, 9 on Rivaroxaban. The mean days on anticoagulation treatment was 92 days (20-80). We had 4 thrombosis after discharge (Table 2). We have not recurrent thrombosis in the PE group. Bleeding events occurred in 3 cases on therapeutic doses. Only one was a major bleeding (hematuria). Conclusion(s): Our prevalence of PE in COVID-19 pneumonia was 16.8%. With respect to DOACs treatment we have not bleeding at prophylaxis doses and one mayor bleeding at therapeutic doses. We have four thrombosis after discharge. No recurrent thrombosis was seen in PE patients. The use of DOACs in extended prophylaxis or treatment after COVID-19 pneumonia seems to be safe, with no differences with the non-COVID- 19 population. (Table Presented).

18.
Research and Practice in Thrombosis and Haemostasis Conference ; 6(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2128167

ABSTRACT

Background: Venous thromboembolism (VTE) is common in patients with coronavirus disease-2019 (COVID-19). The optimal heparin regimen remains unknown and should balance thromboembolic and bleeding risks. Aim(s): The aim of this study is to evaluate the efficacy and safety of standard or higher heparin regimens for the prevention of VTE in patients hospitalized due to COVID-19. Method(s): We performed a systematic literature search;studies reporting on hospitalized patients with COVID-19 who received standard heparin prophylaxis vs. high (intermediate or therapeutic) heparin regimens were included if outcome events were reported by treatment group and more than 10 patients were included. Primary study outcome was in-hospital VTE. Secondary study outcomes were major bleeding (MB), all-cause death, fatal bleeding and fatal pulmonary embolism. Result(s): Overall, 30 studies (10,637 patients) were included. Venous thromboembolic events occurred in 5.5% and in 8.8% of patients who received heparin prophylaxis with at high-dose or standard-dose, respectively (RR 0.70, 95% CI 0.54-0.90, I2 58.9%). MB was significantly higher in patients who received high-compared to the standard-dose (3.8% vs. 2.1%, RR 1.89, 95% CI 1.41-2.53, I2 18.1%). Sub-analyses showed a slight benefit associated with high-dose heparin in patients admitted to non-intensive care unit (ICU) but not in those to ICU. No significant differences were observed for mortality outcomes. Conclusion(s): Heparin prophylaxis at high-dose reduces the risk of VTE, but increased the risk of MB compared to the standard-dose. No clinical benefit for heparin high-dose was observed for ICU setting, but its role in the non-ICU deserves further evaluation.

19.
Research and Practice in Thrombosis and Haemostasis Conference ; 6(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2128145

ABSTRACT

Background: Critically ill patients with COVID 19 are at high risk for pulmonary embolism (PE). Specific PE prediction rules have not been validated in this population yet. Aim(s): The present sub study of national project (20.80009.8007.28) aimed to assessed the Wells and revised Geneva scoring systems as predictors of PE in critically ill patients with coronavirus SARSCOV2. Method(s): Study included patients with PE. A sub analyses was performed on patients with COVID positive test. Pulmonary CT angiograms (CTAs) performed for suspected PE in critically ill adult patients were retrospectively identified. Wells and revised Geneva scores were calculated based on information from medical records. Patients were dichotomized into low and intermediate/high probability groups. The reliability of both scores as predictors of PE was determined using receiver operating characteristic (ROC) curve analysis. Result(s): Of 108 patients, 42 (38.8%) were positive for PE based on pulmonary CTA. The mean group value of the Wells score was 3.8 points, with 46.2% of patients having a score of >=3, which qualifies the patient with probable PE. The average value of the Geneva score represents 7.78 points, and 60.99% of patients qualify in the group with probable PE. According to the Wells and revised Geneva scores, (52.2%) patients and (39.1%) patients, respectively, were considered as low probability for PE. Of those considered as low risk by the Wells score, 25.8% had filling defects on CTA, including 2 patients with main pulmonary artery embolism. The area under the ROC curve was 0.64 for the Wells score and 0.56 for the revised Geneva score. Wells score >4 had a sensitivity of 38%, specificity of 77%, positive predictive value of 49%, and negative predictive value of 73% to predict risk of PE. Conclusion(s): In this population of critically ill patients with covid 19, Wells and revised Geneva scores were not reliable predictors of PE.

20.
PM and R ; 14(Supplement 1):S164, 2022.
Article in English | EMBASE | ID: covidwho-2127987

ABSTRACT

Case Diagnosis: Aortitis from COVID-19 infection. Case Description or Program Description: 74-yearold male with prior MI s/p 2 vessel CAB, and known COVID-19 infection prior to arrival who presented to the local acute care hospital with complaints of worsening shortness of breath and ataxia. He was medically stabilized but found to have continued deficits in selfcare, mobility, and cognition for which he was transferred to an acute inpatient rehabilitation. On his 3rd rehab day he was found to have ongoing fatigue and sustained tachycardia concerning for pulmonary embolism (PE). CT angiogram of the chest revealed no signs of PE, but found evidence suggesting aortitis. Setting(s): Acute Inpatient Rehab Hospital Assessment/Results: Rheumatology was consulted and confirmed aortitis with elevated inflammatory and immunologic markers. He was started the patient on oral prednisone, and had rapid improvement in symptoms in 6 days. He was discharged home with a long-term course of oral steroids and follow up with Rheumatology. Discussion (relevance): We present a rare complication from COVID-19 infection presenting with sustained tachycardia concerning for pulmonary embolism, but found to have aortitis. At the time of diagnosis this was only the third documented case of COVID-19 induced aortitis in the world. Conclusion(s): This case reports a rare and atypical sequela of COVID-19 infection, as it helps illustrate another unique cell-mediated immune response to COVID-19 infection. It highlights the role of a multidisciplinary approach to COVID patients even after the acute infection has resolved.

SELECTION OF CITATIONS
SEARCH DETAIL