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1.
Int J Mol Sci ; 23(6)2022 Mar 19.
Article in English | MEDLINE | ID: covidwho-1760654

ABSTRACT

Coronavirus Disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is frequently complicated by thrombosis. In some cases of severe COVID-19, fibrinolysis may be markedly enhanced within a few days, resulting in fatal bleeding. In the treatment of COVID-19, attention should be paid to both coagulation activation and fibrinolytic activation. Various thromboses are known to occur after vaccination with SARS-CoV-2 vaccines. Vaccine-induced immune thrombotic thrombocytopenia (VITT) can occur after adenovirus-vectored vaccination, and is characterized by the detection of anti-platelet factor 4 antibodies by enzyme-linked immunosorbent assay and thrombosis in unusual locations such as cerebral venous sinuses and visceral veins. Treatment comprises high-dose immunoglobulin, argatroban, and fondaparinux. Some VITT cases show marked decreases in fibrinogen and platelets and marked increases in D-dimer, suggesting the presence of enhanced-fibrinolytic-type disseminated intravascular coagulation with a high risk of bleeding. In the treatment of VITT, evaluation of both coagulation activation and fibrinolytic activation is important, adjusting treatments accordingly to improve outcomes.


Subject(s)
Blood Coagulation Disorders/etiology , COVID-19 Vaccines/adverse effects , COVID-19/complications , SARS-CoV-2 , Biomarkers , Blood Coagulation , Blood Coagulation Disorders/diagnosis , Blood Coagulation Disorders/prevention & control , Blood Coagulation Disorders/therapy , Blood Coagulation Tests , COVID-19/immunology , COVID-19/prevention & control , COVID-19 Vaccines/immunology , Combined Modality Therapy , Disease Management , Disease Susceptibility , Fibrinolysis , Humans , Prognosis , Treatment Outcome
2.
Am Surg ; 88(5): 1016-1017, 2022 May.
Article in English | MEDLINE | ID: covidwho-1741777

ABSTRACT

Coronavirus disease 2019 (COVID-19) is linked with a hypercoagulable state called COVID-19-associated coagulopathy (CAC). Due to elevated levels of factor VIII and fibrinogen as well as inflammation-linked hyperviscosity of blood, the risk for venous thromboembolism is increased in patients who have CAC. We report the case of a patient with recent COVID-19 infection and no other past medical history who presented after a motorcycle collision with left middle and distal femur fractures, who underwent retrograde intramedullary nailing, and then developed immediate massive bilateral pulmonary emboli. The patient was treated with tissue plasminogen activator administration via bilateral pulmonary artery thrombolysis catheters without improvement, and was then placed on venoarterial extracorporeal membrane oxygenation for subsequent cardiogenic shock. During a 58-day hospital stay, the patient recovered and was discharged with a good long-term prognosis. In this report, we discuss CAC, the role of surgical critical care in the management of the disease, and issues specific to this patient's disease process and treatment.


Subject(s)
Blood Coagulation Disorders , COVID-19 , Extracorporeal Membrane Oxygenation , Blood Coagulation Disorders/etiology , Blood Coagulation Disorders/therapy , COVID-19/complications , Extracorporeal Membrane Oxygenation/adverse effects , Humans , Shock, Cardiogenic/etiology , Tissue Plasminogen Activator
3.
Eur J Med Res ; 27(1): 25, 2022 Feb 15.
Article in English | MEDLINE | ID: covidwho-1690867

ABSTRACT

Coronavirus disease 2019 (COVID-19), with a high prevalence rate, has rapidly infected millions of people around the world. Since viral infections can disrupt the coagulation and homeostasis cascades, various inflammatory and coagulation problems occur due to COVID-19 infection, similar to coronavirus epidemics in 2003 and 2004. According to multiple previous studies, in the present research, we reviewed the most commonly reported problems of COVID-19 patients, such as venous thromboembolism, pulmonary embolism, disseminated intravascular coagulation, etc. and investigated the causes in these patients. Coagulation and inflammatory markers, such as platelets and fibrinogen, C-reactive protein, lactate dehydrogenase, d-dimer, prothrombin time, etc., were also discussed, and the treatment options were briefly reviewed. In addition to coagulation treatments, regular examination of coagulation parameters and thrombotic complications can be helpful in the timely treatment of patients. Therefore, it is helpful to review the coagulation problems in COVID-19 patients. Although all mentioned problems and markers are important in COVID-19, some of them are more valuable in terms of diagnosis and prognosis.


Subject(s)
Blood Coagulation Disorders/etiology , COVID-19/complications , SARS-CoV-2 , Blood Coagulation , Blood Coagulation Disorders/therapy , C-Reactive Protein/analysis , COVID-19/blood , Disseminated Intravascular Coagulation/etiology , Fibrin Fibrinogen Degradation Products/analysis , Humans , Partial Thromboplastin Time , Pulmonary Embolism/etiology , Venous Thromboembolism/etiology
5.
Dtsch Med Wochenschr ; 146(13-14): 899-903, 2021 Jul.
Article in German | MEDLINE | ID: covidwho-1493267

ABSTRACT

Infection with SARS-CoV-2 has a profound influence on the hematopoetic system that mediates clinical symptoms and mortality. Several studies have shown that treatment of the cytokine storm (CRS) with anti-inflammatory drugs like dexamethasone and tocilizumab can significantly improve survival. Systematic reviews confirm the safety of convalescent plasma administration and offer initial indications of its effectiveness in certain groups. COVID-associated coagulopathy (CAC) and vaccine-induced immune thrombotic thrombocytopenia (VITT) represent severe infection- or vaccination associated complications that require a specific diagnostic and therapeutic workup.


Subject(s)
COVID-19/blood , COVID-19/complications , Hematology , Hematopoiesis , Hemostasis , SARS-CoV-2/physiology , Blood Coagulation Disorders/etiology , Blood Coagulation Disorders/prevention & control , Blood Coagulation Disorders/therapy , COVID-19/mortality , COVID-19/therapy , Humans , Immunization, Passive
6.
Int J Biol Macromol ; 193(Pt A): 948-955, 2021 Dec 15.
Article in English | MEDLINE | ID: covidwho-1471998

ABSTRACT

The severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) keeps on destroying normal social integrity worldwide, bringing about extraordinary medical services, cultural and financial interruption. Individuals with diabetes have been demonstrated to be at higher risk of complications and even death when exposed to SARS-CoV-2. Regardless of pandemic scale infection, there is presently limited comprehension on the potential impact of SARS-CoV-2 on individuals with diabetes. Human serum albumin (HSA) is the most abundant circulating plasma protein in human serum and attracted more interest from researchers because most susceptible to non-enzymatic glycation reactions. Albumin down-regulates the expression of ACE2 that is the target receptor of COVID-19. Hypoalbuminemia, coagulopathy, and vascular disease have been connected in COVID-19 and appear to predict outcomes independent of age and morbidity. This review discusses the most recent evidence that the ACE/ACE2 ratio could influence by human serum albumin both the susceptibility of individuals to SARS-CoV-2 infection and the outcome of the COVID-19 disease.


Subject(s)
Angiotensin-Converting Enzyme 2/blood , COVID-19 , SARS-CoV-2/metabolism , Serum Albumin, Human/metabolism , Blood Coagulation Disorders/blood , Blood Coagulation Disorders/diagnosis , Blood Coagulation Disorders/therapy , COVID-19/blood , COVID-19/diagnosis , COVID-19/therapy , Disease Susceptibility , Humans , Vascular Diseases/blood , Vascular Diseases/diagnosis , Vascular Diseases/therapy
7.
Am J Health Syst Pharm ; 79(5): 329-337, 2022 02 18.
Article in English | MEDLINE | ID: covidwho-1450366

ABSTRACT

PURPOSE: To provide an overview of current literature on the pathophysiology of sepsis, with a focus on mediators of endothelial injury and organ dysfunction. SUMMARY: Sepsis is a dysregulated response to infection that triggers cascades of interconnected systems. Sepsis has been a significant cause of mortality worldwide, and the recent viral pandemic that may produce severe sepsis and septic shock has been a major contributor to sepsis-related mortality. Understanding of the pathophysiology of sepsis has changed dramatically over the last several decades. Significant insight into the components of the inflammatory response that contribute to endothelial injury and trigger coagulation pathways has been achieved. Similarly, characterization of anti-inflammatory pathways that may lead to secondary infections and poor outcome has illustrated opportunities for improved therapies. Description of an increasing number of important mediators and pathways has occurred and may point the way to novel therapies to address immune dysregulation. Pharmacists will need a fundamental understanding of the overlapping pathways of the immune response to fully prepare for use of novel treatment options. While pharmacists typically understand coagulation cascade how to utilize anticoagulants, the issues in sepsis related coagulopathy and role of mediators such as cytokines and complement and role of activated platelets and neutrophils require a different perspective. CONCLUSION: Pharmacists can benefit from understanding both the cellular and organ system issues in sepsis to facilitate assessment of potential therapies for risk and benefit.


Subject(s)
Blood Coagulation Disorders , Sepsis , Shock, Septic , Anticoagulants , Blood Coagulation/physiology , Blood Coagulation Disorders/etiology , Blood Coagulation Disorders/therapy , Humans , Shock, Septic/complications
8.
Postgrad Med ; 133(8): 899-911, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1390265

ABSTRACT

INTRODUCTION: COVID-19-associated coagulopathy (CAC) is a well-recognized hematologic complication among patients with severe COVID-19 disease, where macro- and micro-thrombosis can lead to multiorgan injury and failure. Major societal guidelines that have published on the management of CAC are based on consensus of expert opinion, with the current evidence available. As a result of limited studies, there are many clinical scenarios that are yet to be addressed, with expert opinion varying on a number of important clinical issues regarding CAC management. METHODS: In this review, we utilize current societal guidelines to provide a framework for practitioners in managing their patients with CAC. We have also provided three clinical scenarios that implement important principles of anticoagulation in patients with COVID-19. CONCLUSION: Overall, decisions should be made on acase by cases basis and based on the providers understanding of each patient's medical history, clinical course and perceived risk.


Subject(s)
Anticoagulants/therapeutic use , Blood Coagulation Disorders/therapy , COVID-19/complications , Practice Guidelines as Topic , Thromboembolism/therapy , Thrombosis/therapy , Anticoagulants/adverse effects , Biomarkers/blood , Blood Coagulation Disorders/diagnosis , Blood Coagulation Disorders/virology , Drug Monitoring , Fibrinolytic Agents/therapeutic use , Hemorrhage/chemically induced , Hemorrhage/therapy , Heparin/therapeutic use , Humans , Prevalence , Thromboembolism/diagnosis , Thromboembolism/epidemiology , Thromboembolism/virology , Thrombosis/diagnosis , Thrombosis/epidemiology , Thrombosis/virology
9.
Dtsch Med Wochenschr ; 146(15): 944-949, 2021 Aug.
Article in German | MEDLINE | ID: covidwho-1338575

ABSTRACT

COVID-19, primarily a respiratory disease, is considered a multi-systemic disease as symptom severity increases. Blood coagulation abnormalities are key features of patients with severe symptoms and indicative of the high risk of both venous and arterial thromboembolism in COVID-19. This prothrombotic condition caused by an interplay of the infectious agent, inflammation, and the blood coagulation system is referred to as COVID-19-associated coagulopathy and characterized by greatly increased D-dimer, high fibrinogen, an extended prothrombin time, and a reduced number of platelets. Due to this high thrombotic potential, prophylactic anticoagulation is recommended in all hospitalized patients. However, the optimal dosage of anticoagulation is still debated. In this article, we provide an overview of the current state of knowledge about COVID-19-associated coagulopathy and discuss clinical therapeutic consequences.


Subject(s)
Blood Coagulation Disorders/complications , COVID-19/complications , Thromboembolism/prevention & control , Blood Coagulation Disorders/blood , Blood Coagulation Disorders/prevention & control , Blood Coagulation Disorders/therapy , COVID-19/blood , Humans , Severity of Illness Index , Thromboembolism/etiology
10.
Arch Med Res ; 52(8): 788-797, 2021 11.
Article in English | MEDLINE | ID: covidwho-1329672

ABSTRACT

The diagnostic criteria of overt disseminated intravascular coagulation (DIC) were established by the International Society on Thrombosis and Haemostasis (ISTH) in 2001. Since then, DIC has long been associated with adverse outcomes. However, recent advances in sepsis shed light on the role of coagulation disorders in the progression of sepsis. Currently, inflammation and coagulation are recognized as the two drivers that promote organ dysfunction in sepsis and septic shock. The ISTH has published new diagnostic criteria for improved management, namely sepsis-induced coagulopathy (SIC), in 2017. SIC is a pragmatic scoring system composed of platelet count, prothrombin time, and organ dysfunction score to detect the early-stage of sepsis-associated DIC. Since overt DIC represents an uncompensated coagulation disorder, a two-step approach using SIC and overt DIC criteria is a novel strategy to evaluate the severity and manage this challenging complication. Although there is no globally agreed on anticoagulant therapy for DIC, the Japanese Surviving Sepsis Campaign Guidelines 2020 recommend using antithrombin and recombinant thrombomodulin for sepsis associated DIC. Since research in this area has been previously reported, an international collaborative study is necessary to develop future diagnostic tools and treatment strategies.


Subject(s)
Blood Coagulation Disorders , Disseminated Intravascular Coagulation , Sepsis , Shock, Septic , Thrombosis , Blood Coagulation Disorders/diagnosis , Blood Coagulation Disorders/etiology , Blood Coagulation Disorders/therapy , Disseminated Intravascular Coagulation/diagnosis , Disseminated Intravascular Coagulation/etiology , Disseminated Intravascular Coagulation/therapy , Humans , Sepsis/complications , Sepsis/diagnosis
12.
Gac Med Mex ; 157(2): 201-206, 2021.
Article in English | MEDLINE | ID: covidwho-1285654

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is the cause of the coronavirus disease 2019 (COVID-19) pandemic, which has a high case fatality rate. Most severely ill patients develop a special type of coagulopathy that had not been described before and that is now considered the main cause of death. For this reason, anticoagulant treatment has become one of the cornerstones of the treatment of this infection. However, the rate at which the evidence regarding the use of anticoagulants is generated is quite fast, and sometimes it is difficult to interpret and conflicting. After having performed an extensive review of the published literature, this proposal for the use of anticoagulant treatment is made, taking into account available resources in Mexico.


La infección por coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) es la causante de la pandemia de enfermedad por coronavirus 2019 (COVID-19), con un índice de letalidad alto. La mayoría de los pacientes graves desarrollan un tipo especial de coagulopatía no descrito hasta ahora y la cual se considera ahora la principal causa de muerte. Por esta razón, el tratamiento anticoagulante se ha convertido en una de las piedras angulares del tratamiento de esta infección. Sin embargo, la velocidad con la que se genera la evidencia respecto al uso de anticoagulantes es muy rápida y, en ocasiones difícil de interpretar y contradictoria. Luego de hacer una revisión extensa de la literatura publicada, se hace esta propuesta para el uso del tratamiento anticoagulante tomando en cuenta los recursos disponibles en México.


Subject(s)
Anticoagulants/therapeutic use , Blood Coagulation Disorders/etiology , Blood Coagulation Disorders/therapy , COVID-19/complications , Adult , Algorithms , Blood Coagulation Disorders/prevention & control , Guidelines as Topic , Humans , Mexico
13.
J Heart Lung Transplant ; 40(7): 631-641, 2021 07.
Article in English | MEDLINE | ID: covidwho-1157308

ABSTRACT

BACKGROUND: The shortage of blood products has become a worldwide problem, especially during the COVID-19 Pandemic. Here, we investigated whether a point of care (POC) approach to perioperative bleeding and coagulopathy based on rotational thromboelastometry (ROTEM) results could decrease perioperative blood loss and the perioperative consumption of blood products during lung transplantation. METHODS: Patients undergoing bilateral lung transplantation were randomized into two groups: In the first group, designated the "non POC" group, the management of perioperative bleeding and coagulopathy was based on the clinical experience of the anesthesiologist; in the second group, designated the "POC" group, the management of perioperative bleeding, and coagulopathy was based on the ROTEM results. RESULTS: After performing an interim statistical analysis, the project was prematurely terminated as the results were significantly in favor of the POC approach. Data were analyzed for the period January 2018 until June 2020 when 67 patients were recruited into the study. There was significantly decreased perioperative blood loss in the POC group (n = 31 patients) with p = 0.013, decreased perioperative consumption of RBC with p = 0.009, and decreased perioperative consumption of fresh frozen plasma with p < 0.0001 (practically no fresh frozen plasma was used in the POC group) without deteriorating clot formation in secondary and primary hemostasis as compared to the non POC group (n = 36). CONCLUSION: POC management of perioperative bleeding and coagulopathy based on ROTEM results is a promising strategy to decrease perioperative blood loss and the consumption of blood products in lung transplantation.


Subject(s)
Blood Coagulation Disorders/diagnosis , COVID-19/epidemiology , Hemostasis/physiology , Lung Transplantation/adverse effects , Pandemics , Thrombelastography/methods , Blood Coagulation Disorders/etiology , Blood Coagulation Disorders/therapy , Blood Transfusion/methods , Female , Humans , Male , Middle Aged , SARS-CoV-2
14.
J Am Coll Surg ; 232(6): 995-1003, 2021 06.
Article in English | MEDLINE | ID: covidwho-1144761

ABSTRACT

The COVID-19 pandemic has introduced a global public health threat unparalleled in our history. The most severe cases are marked by ARDS attributed to microvascular thrombosis. Hypercoagulability, resulting in a profoundly prothrombotic state, is a distinct feature of COVID-19 and is accentuated by a high incidence of fibrinolysis shutdown. The aims of this review were to describe the manifestations of fibrinolysis shutdown in COVID-19 and its associated outcomes, review the molecular mechanisms of dysregulated fibrinolysis associated with COVID-19, and discuss potential implications and therapeutic targets for patients with severe COVID-19.


Subject(s)
COVID-19/complications , Fibrinolysis , Thrombophilia/etiology , Blood Coagulation Disorders/etiology , Blood Coagulation Disorders/therapy , Blood Coagulation Disorders/virology , COVID-19/blood , Humans , Thrombophilia/therapy , Thrombophilia/virology
15.
An Sist Sanit Navar ; 43(2): 245-249, 2020 Aug 31.
Article in Spanish | MEDLINE | ID: covidwho-1083299

ABSTRACT

One of the most significant negative prognostic factors in patients suffering from the disease caused by SARS-CoV-2 (COVID-19) is the development of coagulopathy, associated with abnormal laboratory findings, such as increased D-dimer, and venous thromboembolic complications, requiring thromboprophylactic strategies. The main clinical characteristics of COVID-19 patients are revised here as compared to other coronavirus infections, such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS), emphasizing clinical, diagnostic and therapeutic aspects.


Subject(s)
Betacoronavirus , Blood Coagulation Disorders/virology , Coronavirus Infections/diagnosis , Middle East Respiratory Syndrome Coronavirus , SARS Virus , Thrombosis/virology , Blood Coagulation Disorders/diagnosis , Blood Coagulation Disorders/therapy , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Fibrinolytic Agents/therapeutic use , Humans , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Prognosis , SARS-CoV-2 , Severe Acute Respiratory Syndrome/complications , Severe Acute Respiratory Syndrome/diagnosis , Severe Acute Respiratory Syndrome/physiopathology , Severe Acute Respiratory Syndrome/therapy , Thrombosis/diagnosis , Thrombosis/therapy
16.
BMJ Case Rep ; 14(1)2021 Jan 18.
Article in English | MEDLINE | ID: covidwho-1066836

ABSTRACT

This case represents a rare fulminant course of fried-rice associated food poisoning in an immunocompetent person due to pre-formed exotoxin produced by Bacillus cereus, with severe manifestations of sepsis, including multi-organ (hepatic, renal, cardiac, respiratory and neurological) failure, shock, metabolic acidosis, rhabdomyolysis and coagulopathy. Despite maximal supportive measures (continuous renal replacement therapy, plasmapheresis, N-acetylcysteine infusion and blood products, and broad-spectrum antimicrobials) and input from a multidisciplinary team (consisting of infectious diseases, intensive care, gastroenterology, surgery, toxicology, immunology and haematology), mortality resulted. This case is the first to use whole genome sequencing techniques to confirm the toxigenic potential of B. cereus It has important implications for food preparation and storage, particularly given its occurrence in home isolation during the COVID-19 pandemic.


Subject(s)
Bacillus cereus/genetics , Exotoxins/genetics , Foodborne Diseases/diagnosis , Acetylcysteine/therapeutic use , Acidosis/physiopathology , Acidosis/therapy , Adult , Anti-Arrhythmia Agents/therapeutic use , Anti-Bacterial Agents/therapeutic use , Arrhythmias, Cardiac/physiopathology , Arrhythmias, Cardiac/therapy , Bacillus cereus/isolation & purification , Blood Coagulation Disorders/physiopathology , Blood Coagulation Disorders/therapy , Blood Transfusion , Brain Diseases , Continuous Renal Replacement Therapy , Fatal Outcome , Female , Foodborne Diseases/microbiology , Foodborne Diseases/physiopathology , Foodborne Diseases/therapy , Free Radical Scavengers/therapeutic use , Humans , Immunocompetence , Liver Failure/physiopathology , Liver Failure/therapy , Multiple Organ Failure/physiopathology , Multiple Organ Failure/therapy , Plasmapheresis , Renal Insufficiency/physiopathology , Renal Insufficiency/therapy , Rhabdomyolysis/physiopathology , Rhabdomyolysis/therapy , Sepsis/physiopathology , Sepsis/therapy , Shock/physiopathology , Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization , Whole Genome Sequencing
18.
Shock ; 55(6): 700-716, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-998566

ABSTRACT

ABSTRACT: There is increasing evidence that novel coronavirus disease 2019 (COVID-19) leads to a significant coagulopathy, a phenomenon termed "COVID-19 associated coagulopathy." COVID-19 has been associated with increased rates of both venous and arterial thromboembolic events, a source of significant morbidity and mortality in this disease. Further evidence suggests a link between the inflammatory response and coagulopathy associated with COVID-19. This presents a unique set of challenges for diagnosis, prevention, and treatment of thrombotic complications. In this review, we summarize and discuss the current literature on laboratory coagulation disruptions associated with COVID-19 and the clinical effects of thromboembolic events including pulmonary embolism, deep vein thrombosis, peripheral arterial thrombosis, and acute ischemic stroke in COVID-19. Endothelial injury and augmented innate immune response are implicated in the development of diffuse macro- and microvascular thrombosis in COVID-19. The pathophysiology of COVID-19 associated coagulopathy is an important determinant of appropriate treatment and monitoring of these complications. We highlight the importance of diagnosis and management of dysregulated coagulation in COVID-19 to improve outcomes in COVID-19 patients with thromboembolic complications.


Subject(s)
Blood Coagulation Disorders , Blood Coagulation/immunology , COVID-19 , Immunity, Innate , SARS-CoV-2/immunology , Blood Coagulation Disorders/etiology , Blood Coagulation Disorders/immunology , Blood Coagulation Disorders/pathology , Blood Coagulation Disorders/therapy , COVID-19/complications , COVID-19/pathology , COVID-19/therapy , Humans , Ischemic Stroke/complications , Ischemic Stroke/metabolism , Ischemic Stroke/pathology , Pulmonary Embolism/etiology , Pulmonary Embolism/immunology , Pulmonary Embolism/pathology , Pulmonary Embolism/therapy , Thrombosis/etiology , Thrombosis/immunology , Thrombosis/pathology , Thrombosis/therapy
19.
Phytomedicine ; 81: 153433, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-957350

ABSTRACT

OBJECTIVE: Previous studies mainly reported the clinical characteristics of novel coronavirus 2019 (COVID-19) infections, but the research on clinical characteristics and treatment outcomes of COVID-19 patients with stroke is still rare. METHODS: A multi-center retrospective study was conducted at 11 hospitals in 4 provinces of China, and COVID-19 patients with stroke were enrolled from February 24 to May 4, 2020. We analyzed epidemiological, demographic, and clinical characteristics of cases as well as the laboratory test results, treatment regimens and outcomes, and the clinical characteristics and therapeutic outcomes were compared between severe and nonsevere patients, and by age group, respectively. RESULTS: A total of 27 patients [mean age: 66.41 (SD 12.1) years] were enrolled. Among them, 9 (33.3%) were severe patients and 18 (66.7%) were nonsevere patients; 17 (63.0%) were female; 19 (70.4%) were aged 60 years and above. The most common symptoms were fever [19 (70.4%)], fatigue [12 (44.4%)] and cough [11 (40.7%)], respectively. Abnormal laboratory findings of COVID-19 patients with stroke included high levels of C-reactive protein [19 (73.1%)], D-dimer [14 (58.3%)], blood glucose [14 (53.8%)], fibrinogen [13 (50.0%)], and decreased lymphocytes [12 (44.4%)]. Comparing to nonsevere cases with stroke, severe patients with stroke were likely to be older, susceptible to receiving oxygen inhalation, and had more complications (p < 0.05). In addition, there were significant differences in lymphocytes, neutrophils, lactate dehydrogenase, C-reactive protein, creatine kinase between the severe cases and nonsevere cases (p < 0.05). The older patients had a decreased platelet count and elevated fibrinogen, compared with the younger (p < 0.05). All patients (100%) received antiviral treatment, 12 (44.4%) received antibiotics treatment, 26 (96.3%) received Traditional Chinese Medicine (Lung cleansing & detoxifying decoction), and oxygen inhalation was in 18 (66.7%). The median duration of hospitalization was 16 days. By May 4, 2020, a total of 26 (96.3%) patients were cured and discharged, and 1 (3.7%) patients died. CONCLUSION: COVID-19 patients with stroke had poor indicators of coagulation system, and severe and older patients might have a higher risk of complications and unfavorable coagulation system. However, the overall treatment outcome is favorable.


Subject(s)
COVID-19/complications , COVID-19/therapy , Stroke/complications , Stroke/therapy , Adult , Age Factors , Aged , Aged, 80 and over , Antiviral Agents/therapeutic use , Blood Coagulation Disorders/complications , Blood Coagulation Disorders/therapy , COVID-19/epidemiology , China/epidemiology , Female , Humans , Male , Middle Aged , Oxygen Inhalation Therapy , Retrospective Studies , Stroke/epidemiology , Treatment Outcome
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