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1.
Arch Cardiol Mex ; 91(Suplemento COVID): 055-063, 2021 Dec 20.
Article in Spanish | MEDLINE | ID: covidwho-1609074

ABSTRACT

There is a clear association between novel coronavirus 2 infection and the diagnosis of venous thromboembolic disease, as a cosequence of the development of a systemic inflammatory response syndrome due to the activation of the coagulation cascade. It occurs in 90% of patients with severe forms of the infection, evidencing the presence of pulmonary endovascular micro and macro thrombosis. This suggests a possible clinical benefit of thromboprophylaxis according to the patient's clinical risk. The suspicion of venous thromboembolic disease in the context of this pandemic represents a diagnostic challenge due to the co-existence of similarities between both conditions in several different aspects. It should be noted that the diagnosis of acute pulmonary embolism does not exclude the possibility of simultaneous viral infection. The evaluation of patients with suspected acute pulmonary embolism in the context of the pandemic should be optimized in order to implement a rapid diagnosis and treatment to reduce the associated morbidity and mortality. This will help reducing infectious risk for health-care professionals and other patients.


Existe una clara relación entre la infección por el nuevo coronavirus 2 y el diagnóstico de enfermedad tromboembólica venosa, como consecuencia del desarrollo de un síndrome de respuesta inflamatoria sistémica debido a la activación de la cascada de la coagulación. Se presenta en el 90% de los pacientes con formas graves de la infección, lo que revela la presencia de microtrombosis y macrotrombosis intravascular pulmonar. Esto sugiere un posible beneficio clínico de la aplicación de una tromboprofilaxis adecuada al riesgo clínico de cada paciente. Asimismo, la sospecha de enfermedad tromboembólica venosa en el contexto de esta pandemia representa un reto diagnóstico debido a la existencia de similitudes entre ambas alteraciones en varios aspectos. Debe tenerse en cuenta que el diagnóstico de tromboembolismo pulmonar agudo no excluye la posibilidad de infección viral. La valoración de pacientes con sospecha de tromboembolismo pulmonar agudo en el contexto de la pandemia debe ser eficaz para establecer un diagnóstico y tratamiento con rapidez, a fin de reducir la morbilidad y mortalidad adjuntas, sin que ello eleve el riesgo de infección para los profesionales de la salud y otros pacientes.


Subject(s)
COVID-19 , Pulmonary Embolism , Venous Thromboembolism , Anticoagulants/therapeutic use , COVID-19/complications , Humans , Pulmonary Embolism/diagnosis , Pulmonary Embolism/therapy , Venous Thromboembolism/diagnosis , Venous Thromboembolism/therapy
3.
Respir Res ; 22(1): 298, 2021 Nov 20.
Article in English | MEDLINE | ID: covidwho-1526637

ABSTRACT

BACKGROUND: This study assessed the impact of the COVID-19 epidemic on overall hospitalizations for pulmonary embolism (PE) in France in comparison with previous years, and by COVID-19 and non-COVID-19 status. METHODS: Hospitalization data (2017-2020) were extracted from the French National Discharge database (all public and private hospitals). We included all patients older than 18 years hospitalized during the 3 years and extracted PE status and COVID-19 status (from March 2020). Age, sex and risk factors for PE (such as obesity, cancer) were identified. We also extracted transfer to an intensive care unit (ICU) and hospital death. The number of PE and the frequency of death in patients in 2019 and 2020 were described by month and by COVID-19 status. Logistic regressions were performed to identify the role of COVID-19 among other risk factors for PE in hospitalized patients. RESULTS: The overall number of patients hospitalized with PE increased by about 16% in 2020 compared with 2019, and mortality also increased to 10.3% (+ 1.2%). These increases were mostly linked to COVID-19 waves, which were associated with PE hospitalization in COVID-19 patients (PE frequency was 3.7%; 2.8% in non-ICU and 8.8% in ICU). The final PE odds ratio for COVID-19 hospitalized patients was 4 compared with other hospitalized patients in 2020. The analyses of PE in non-COVID-19 patients showed a 2.7% increase in 2020 compared with the previous three years. CONCLUSION: In 2020, the overall number of patients hospitalized with PE in France increased compared to the previous three years despite a considerable decrease in scheduled hospitalizations. Nevertheless, proactive public policy focused on the prevention of PE in all patients should be encouraged.


Subject(s)
COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control/trends , Hospitalization/trends , Pulmonary Embolism/epidemiology , Pulmonary Embolism/therapy , Aged , Aged, 80 and over , Cohort Studies , Communicable Disease Control/methods , Female , France/epidemiology , Humans , Male , Middle Aged , Pulmonary Embolism/diagnosis , Retrospective Studies
4.
Vasc Endovascular Surg ; 56(2): 144-150, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1477210

ABSTRACT

BACKGROUND: The increasing prevalence of venous thromboembolism (VTE) among patients with coronavirus disease 2019 (COVID-19) is a matter of concern as it contributes significantly to patients' morbidity and mortality. Data regarding the optimal anticoagulation regimen for VTE prevention and treatment remain scarce. This study describes the characteristics, treatment, and outcomes of COVID-19 patients with VTE treated in a single academic center in Mexico. METHODS: We conducted a retrospective study of all patients with a positive PCR test for SARS-CoV-2 hospitalized in a single academic center in Monterrey, Mexico, between March 2020 and February 2021, with a radiologically confirmed VTE, including deep venous thrombosis (DVT) and pulmonary embolism (PE). Informed consent was obtained from each patient before reviewing their medical records. RESULTS: Of the 2000 COVID-19 hospitalized patients, 36 (1.8%) developed VTE and were included in the analysis. The median age was 60 years (range 32-88 years), and up to 78% (n = 28) were males. Most patients (n = 34, 94%) had an underlying comorbidity and 47% (n = 17) had a BMI ≥ 30 kg/m2. In most cases (n=28, 78%), VTE presented as a PE, whereas the remaining 22% (n = 8) had a DVT. The median time between hospital admission and VTE was 8 days (range 0-33 days). Regarding the thromboprophylaxis regimen, 35/36 patients received low molecular weight heparin enoxaparin on admission, most commonly at a dose of 60 mg daily (n = 19, 53%). Other complications presented were superinfection (n = 19, 53%), acute kidney injury (n = 11, 31%), and septic shock (n = 5, 14%). A total of 69% of patients (n = 25) required intensive care unit admission, and patients' overall mortality was 55.6%. CONCLUSION: VTE remains a significant cause of increased morbidity and mortality among patients with COVID-19. The strikingly high mortality among patients with VTE highlights the need for further investigation regarding the best preventive, diagnostic, and treatment approaches.


Subject(s)
COVID-19 , Pulmonary Embolism , Venous Thromboembolism , Adult , Aged , Aged, 80 and over , Anticoagulants/adverse effects , Humans , Male , Mexico/epidemiology , Middle Aged , Pulmonary Embolism/epidemiology , Pulmonary Embolism/therapy , Retrospective Studies , SARS-CoV-2 , Treatment Outcome , Venous Thromboembolism/diagnosis , Venous Thromboembolism/epidemiology
5.
Lancet ; 398(10307): 1257-1268, 2021 10 02.
Article in English | MEDLINE | ID: covidwho-1447236

ABSTRACT

Cardiopulmonary resuscitation prioritises treatment for cardiac arrests from a primary cardiac cause, which make up the majority of treated cardiac arrests. Early chest compressions and, when indicated, a defibrillation shock from a bystander give the best chance of survival with a good neurological status. Cardiac arrest can also be caused by special circumstances, such as asphyxia, trauma, pulmonary embolism, accidental hypothermia, anaphylaxis, or COVID-19, and during pregnancy or perioperatively. Cardiac arrests in these circumstances represent an increasing proportion of all treated cardiac arrests, often have a preventable cause, and require additional interventions to correct a reversible cause during resuscitation. The evidence for treating these conditions is mostly of low or very low certainty and further studies are needed. Irrespective of the cause, treatments for cardiac arrest are time sensitive and most effective when given early-every minute counts.


Subject(s)
Anaphylaxis/therapy , Asphyxia/therapy , Cardiopulmonary Resuscitation/methods , Heart Arrest/therapy , Hypothermia/therapy , Pregnancy Complications, Cardiovascular/therapy , Pulmonary Embolism/therapy , Wounds and Injuries/therapy , Anaphylaxis/complications , Asphyxia/complications , COVID-19/complications , COVID-19/therapy , Electric Countershock , Female , Heart Arrest/etiology , Humans , Hypothermia/complications , Intraoperative Complications/therapy , Out-of-Hospital Cardiac Arrest/etiology , Out-of-Hospital Cardiac Arrest/therapy , Personal Protective Equipment , Postoperative Complications/therapy , Practice Guidelines as Topic , Pregnancy , Pulmonary Embolism/complications , Return of Spontaneous Circulation , SARS-CoV-2 , Wounds and Injuries/complications
6.
Rev. méd. Urug ; 37(3): e37312, set. 2021. tab, graf
Article in Spanish | WHO COVID, LILACS (Americas) | ID: covidwho-1436538

ABSTRACT

Resumen: Introducción: la vacunación contra SARS-CoV-2 es una herramienta imprescindible en el combate contra la pandemia de COVID-19. La vacuna desarrollada en colaboración entre la Universidad de Oxford y el laboratorio de productos farmacéuticos AstraZeneca (AZN) ha demostrado buena eficacia, pero ha habido reporte de trombosis venosas. Caso clínico: se presenta el caso de un paciente de 70 años, de sexo masculino, que 7 días después de la administración de la primera dosis de la vacuna AZN desarrolla trombosis venosa profunda de ambos miembros inferiores y tromboembolismo pulmonar. Coincide con trombocitopenia de 15.000/mm3, descenso del fibrinógeno y elevación de los D-dímeros. La situación clínica evoca el planteo de trombocitopenia trombótica inducida por vacuna (VITT). Se realizó tratamiento con inmunoglobulinas intravenosas, metilprednisolona y crioprecipitados. Requirió colocación de un filtro de la vena cava inferior. Una vez mejorado el recuento plaquetario se instaló tratamiento anticoagulante con apixaban. Evolucionó favorablemente. Discusión: se trata del primer reporte nacional de VITT. Las trombosis subsiguientes a la vacuna de AZN pueden verse con las vacunas que comparten la misma plataforma vacunal (adenovirus inactivado). Se han reportado casos fundamentalmente en menores de 60 años y en topografías inhabituales. Este caso tiene la particularidad de que se trata de un paciente mayor de 60 años, que ya había tenido COVID-19 cinco meses antes y que se presenta con una trombosis en sitios habituales. El manejo terapéutico se adecuó a las pautas internacionales. El caso deja un aprendizaje relevante tanto en lo que refiere al diagnóstico precoz como al manejo terapéutico.


Abstract: Introduction: vaccines against SARS-CoV-2 are an essential tool against the COVID-19 pandemic. The vaccine developed in collaboration with the University of Oxford and the AstraZeneca (AZN) laboratory has proved to be effective, although venous thrombosis have been reported. Clinical case: the study presents the case of a 70 year old male patient who, 7 days after receiving the first dose of the AZN vaccination develops deep vein thrombosis (DVT) in the lower extremities and pulmonary embolism. Simultaneously, thrombocytopenia is 15.000/mm3, fibrinogen levels drop D-dimer levels are elevated. The clinical situation leads to the suspicion of vaccine-associated immune thrombosis and thrombocytopenia (VITT). The patient was treated with intravenous immune globulin, methylprednisolone and cryoprecipitates, requiring a filter to be placed in the inferior vena cava. Once platelets count improved, anti-coagulation therapy including apixaban was commenced, evolution being good. Discussion: this is the first national report on VITT. Thrombosis after the AZN vaccination may be seen in other vaccines that use the same vaccine platform (inactive adenovirus). Cases have been reported mainly in patients younger than 60 years old and in unusual topographies. In particular, this case presents a male patient that is older than 60 years old, who had already been infected with COVID-19 five months before and who currently consults with thrombosis in regular sites. Therapeutic handling observed international guidelines. The case contributes relevant data both in terms of early diagnosis and therapeutic handling.


Resumo: Introdução: a vacinação contra a SARS-CoV-2 é uma ferramenta essencial na luta contra a pandemia de COVID-19. A vacina desenvolvida pela colaboração entre a Universidade de Oxford e o laboratório farmacêutico AstraZeneca (AZN) tem demonstrado boa eficácia, mas foram relatados casos de trombose venosa. Caso clínico: apresenta-se o caso de um paciente do sexo masculino, 70 anos, que 7 dias após a administração da primeira dose da vacina AZN desenvolveu trombose venosa profunda de ambos os membros inferiores e tromboembolismo pulmonar. Coincide com trombocitopenia de 15.000 / mm3, diminuição do fibrinogênio e aumento dos D-dímeros. A situação clínica lembra a trombocitopenia trombótica induzida por vacina (VITT). O tratamento foi realizado com imunoglobulinas intravenosas, metilprednisolona e crioprecipitados. Foi necessário colocar um filtro de veia cava inferior. Uma vez que a contagem de plaquetas melhorou, o tratamento anticoagulante com apixaban foi instalado. O paciente favoravelmente. Discussão: este é o primeiro relatório nacional de VITT. As tromboses subseqüentes à vacina AZN podem ser vistas com vacinas que compartilham a mesma plataforma (adenovírus inativado). Os casos foram relatados principalmente em pessoas com menos de 60 anos de idade e em topografias incomuns. Este caso tem a particularidade de se tratar de um paciente com mais de 60 anos, já com COVID-19 há cinco meses e que apresenta trombose em sítios comuns. O manejo terapêutico foi adaptado às diretrizes internacionais. O caso deixa um aprendizado relevante tanto no que diz respeito ao diagnóstico precoce quanto ao manejo terapêutico.


Subject(s)
Humans , Male , Aged , Pulmonary Embolism/therapy , Thrombocytopenia/therapy , Venous Thrombosis/therapy , COVID-19 Vaccines/adverse effects
7.
Vasc Endovascular Surg ; 55(8): 903-906, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1346177

ABSTRACT

Venous thromboembolism from a "thrombotic storm"-like syndrome is a major cause of morbidity and mortality in patients with active or "recovered" COVID-19. Patients should be risk-stratified, optimally by a pulmonary embolism (PE) response team (PERT), and considered for escalation of care if found with intermediate or high-risk PE. We present a series of patients with COVID-19-associated PE and thrombotic storm with D-dimer >10 000 ng/mL who underwent successful mechanical thrombectomy for intermediate to high-risk PE. All patients had immediate improvement in hemodynamics and large amounts of thrombi were retrieved.


Subject(s)
Blood Coagulation , COVID-19/complications , Pulmonary Embolism/therapy , Thrombectomy , Aged , Biomarkers/blood , COVID-19/diagnosis , COVID-19/virology , Female , Fibrin Fibrinogen Degradation Products/metabolism , Humans , Male , Middle Aged , Pulmonary Embolism/blood , Pulmonary Embolism/diagnosis , Pulmonary Embolism/virology , Treatment Outcome , Young Adult
8.
Sci Rep ; 11(1): 16025, 2021 08 06.
Article in English | MEDLINE | ID: covidwho-1345583

ABSTRACT

To determine, in patients with coronavirus disease 2019 (COVID-19) infection, the associations of pulmonary embolism (PE) with mortality and risk factors for PE as well as the therapeutic benefit of anticoagulant prophylaxis. Embase, PubMed, Cochrane controlled trials register, and Web of Science databases were searched from inception to October 10, 2020. We included all published trials on PE in patients diagnosed with COVID-19 with eligibility of the trials assessed following the PRISMA guidelines. Sixteen clinical trials with 5826 patients were eligible. There were significant associations of PE with the male gender [odd ratio (OR) = 1.59, 95% CI 1.28-1.97], mechanical ventilation (OR = 3.71, 95% CI 2.57-5.36), intensive care unit admission (OR = 2.99, 95% CI 2.11-4.23), circulating D-dimer [mean difference (MD) = 5.04 µg/mL, 95% CI 3.67-6.42) and CRP (MD = 1.97 mg/dL, 95% CI 0.58- 3.35) concentrations without significant correlation between PE and mortality (OR = 1.31, 95% CI 0.82-2.08) as well as other parameters or comorbidities. After omitting one trial with strict patient selection criteria for anticoagulant prophylaxis, significant prophylactic benefit was noted (OR = 0.31, 95% CI 0.1-0.91). Our findings identified the risk factors associated with PE in COVID-19 patients and supported the therapeutic benefit of anticoagulant prophylaxis against PE in this patient population.


Subject(s)
COVID-19/complications , Pulmonary Embolism/etiology , COVID-19/blood , COVID-19/mortality , COVID-19/therapy , Female , Fibrin Fibrinogen Degradation Products/analysis , Humans , Male , Pulmonary Embolism/blood , Pulmonary Embolism/mortality , Pulmonary Embolism/therapy , Respiration, Artificial , Risk Factors , SARS-CoV-2/isolation & purification , Sex Factors
10.
Methodist Debakey Cardiovasc J ; 17(2): e33-e36, 2021.
Article in English | MEDLINE | ID: covidwho-1335453

ABSTRACT

We present a case describing the use of the AngioVac system (AngioDynamics, Inc.) and SENTINEL™ cerebral protection system (SCPS; Boston Scientific) in a patient with COVID-19 who initially presented with a large deep-vein thrombosis of the left lower extremity, complicated by a pulmonary embolism. Although he initially improved with systemic alteplase, he later developed a second large clot diagnosed in transit in the right atrium. Within 12 hours from initial thrombolysis, this large clot wedged across an incidental patent foramen ovale (PFO), the atrial septum, and the cavotricuspid annulus. We emergently performed a percutaneous clot extraction with preemptive placement of the SCPS in anticipation of cardioembolic phenomenon. A large (> 10 cm) clot was extracted without complication, and the patient was discharged home. The combined use of SCPS and AngioVac in this case suggests a potential role for percutaneous treatment of severe and consequential thromboembolic disease, especially in patients with a PFO, and may be considered as an alternative and less-invasive option in patients with COVID-19. While cerebral embolic protection devices are approved for and widely used in transcatheter aortic valve replacement procedures, there is a theoretical benefit for use in percutaneous thrombolectomies as well.


Subject(s)
COVID-19/complications , Endovascular Procedures , Pulmonary Embolism/therapy , Thrombectomy , Adult , COVID-19/diagnosis , Embolic Protection Devices , Endovascular Procedures/instrumentation , Humans , Male , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/etiology , Thrombectomy/instrumentation , Treatment Outcome
11.
J Investig Med ; 69(6): 1153-1155, 2021 08.
Article in English | MEDLINE | ID: covidwho-1247390

ABSTRACT

Venous thromboembolism associated with COVID-19, particularly acute pulmonary embolism, may represent a challenging and complex clinical scenario. The benefits of having a multidisciplinary pulmonary embolism response team (PERT) can be important during such a pandemic. The aim of PERT in the care of such patients is to provide fast, appropriate, multidisciplinary, team-based approach, with the common goal to tailor the best therapeutic decision making, prioritizing always optimal patient care, especially given lack of evidence-based clinical practice guidelines in the setting of COVID-19, which potentially confers a significant prothrombotic state. Herein, we would like to briefly emphasize the importance and potential critical role of PERT in the care of patients in which these two devastating illnesses are present together.


Subject(s)
COVID-19/therapy , Pulmonary Embolism/therapy , Thromboembolism/therapy , Venous Thromboembolism/therapy , Acute Disease , Anticoagulants/therapeutic use , COVID-19/complications , Cardiology/organization & administration , Decision Making , Evidence-Based Medicine , Humans , Interdisciplinary Communication , Practice Guidelines as Topic , Pulmonary Embolism/complications , Pulmonary Medicine/organization & administration , Quality of Life , SARS-CoV-2 , Thromboembolism/complications , Thrombolytic Therapy , Treatment Outcome , Venous Thromboembolism/complications
13.
Semin Respir Crit Care Med ; 42(2): 169-170, 2021 04.
Article in English | MEDLINE | ID: covidwho-1189326
14.
Emerg Med Clin North Am ; 39(2): 323-338, 2021 May.
Article in English | MEDLINE | ID: covidwho-1179441

ABSTRACT

Older adults are susceptible to serious illnesses, including atrial fibrillation, congestive heart failure, pneumonia, and pulmonary embolism. Atrial fibrillation is the most common arrhythmia in this age group and can cause complications such as thromboembolic events and stroke. Congestive heart failure is the most common cause of hospital admission and readmission in the older adult population. Older adults are at higher risk for pulmonary embolism because of age-related changes and comorbidities. Pneumonia is also prevalent and is one of the leading causes of death.


Subject(s)
Atrial Fibrillation , COVID-19/diagnosis , Emergency Service, Hospital , Heart Failure , Pneumonia , Pulmonary Embolism , Aged , Anticoagulants/therapeutic use , Atrial Fibrillation/diagnosis , Atrial Fibrillation/drug therapy , Heart Failure/diagnosis , Heart Failure/therapy , Humans , Lung/diagnostic imaging , Pneumonia/diagnosis , Pneumonia/therapy , Pulmonary Embolism/diagnosis , Pulmonary Embolism/therapy , Radiography, Thoracic , Thrombotic Stroke/prevention & control , Ultrasonography
16.
Clin Appl Thromb Hemost ; 27: 10760296211008988, 2021.
Article in English | MEDLINE | ID: covidwho-1169937

ABSTRACT

Coagulation abnormalities have been reported in COVID-19 patients, which may lead to an increased risk of Pulmonary Embolism (PE). We aimed to describe the clinical characteristics and outcomes of COVID-19 patients diagnosed with PE during their hospital stay. We analyzed patients with PE and COVID-19 in a tertiary center in Mexico City from April to October of 2020. A total of 26 (100%) patients were diagnosed with Pulmonary Embolism and COVID-19. We observed that 14 (54%) patients were receiving either prophylactic or full anticoagulation therapy, before PE diagnosis. We found a significant difference in mortality between the group with less than 7 days (83%) and the group with more than 7 days (15%) in Intensive Care Unit (P = .004); as well as a mean of 8 days for the mortality group compared with 20 days of hospitalization in the survivor group (P = .003). In conclusion, there is an urgent need to review antithrombotic therapy in these patients in order to improve clinical outcomes and decrease hospital overload.


Subject(s)
COVID-19/mortality , Hospitalization , Intensive Care Units , Pulmonary Embolism/mortality , SARS-CoV-2 , Adult , Aged , COVID-19/therapy , Female , Humans , Male , Mexico/epidemiology , Middle Aged , Pulmonary Embolism/therapy , Retrospective Studies , Tertiary Care Centers , Time Factors
17.
Vasc Med ; 26(4): 426-433, 2021 08.
Article in English | MEDLINE | ID: covidwho-1166685

ABSTRACT

Coronavirus disease 2019 (COVID-19) may predispose patients to venous thromboembolism (VTE). Limited data are available on the utilization of the Pulmonary Embolism Response Team (PERT) in the setting of the COVID-19 global pandemic. We performed a single-center study to evaluate treatment, mortality, and bleeding outcomes in patients who received PERT consultations in March and April 2020, compared to historical controls from the same period in 2019. Clinical data were abstracted from the electronic medical record. The primary study endpoints were inpatient mortality and GUSTO moderate-to-severe bleeding. The frequency of PERT utilization was nearly threefold higher during March and April 2020 (n = 74) compared to the same period in 2019 (n = 26). During the COVID-19 pandemic, there was significantly less PERT-guided invasive treatment (5.5% vs 23.1%, p = 0.02) with a numerical but not statistically significant trend toward an increase in the use of systemic fibrinolytic therapy (13.5% vs 3.9%, p = 0.3). There were nonsignificant trends toward higher in-hospital mortality or moderate-to-severe bleeding in patients receiving PERT consultations during the COVID-19 period compared to historical controls (mortality 14.9% vs 3.9%, p = 0.18 and moderate-to-severe bleeding 35.1% vs 19.2%, p = 0.13). In conclusion, PERT utilization was nearly threefold higher during the COVID-19 pandemic than during the historical control period. Among patients evaluated by PERT, in-hospital mortality or moderate-to-severe bleeding were not significantly different, despite being numerically higher, while invasive therapy was utilized less frequently during the COVID-19 pandemic.


Subject(s)
COVID-19/therapy , Health Resources/trends , Health Services Needs and Demand/trends , Patient Care Team/trends , Practice Patterns, Physicians'/trends , Pulmonary Embolism/therapy , Thrombolytic Therapy/trends , Venous Thromboembolism/therapy , Adult , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/diagnosis , COVID-19/mortality , Female , Hemorrhage/etiology , Hemorrhage/mortality , Hospital Mortality , Humans , Male , Middle Aged , Pulmonary Embolism/diagnosis , Pulmonary Embolism/etiology , Pulmonary Embolism/mortality , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome , Venous Thromboembolism/diagnosis , Venous Thromboembolism/etiology , Venous Thromboembolism/mortality
19.
Braz J Anesthesiol ; 71(3): 292-294, 2021.
Article in English | MEDLINE | ID: covidwho-1144515

ABSTRACT

Catatonic patients may develop deep vein thrombosis (DVT) and pulmonary embolism (PE) due to prolonged periods of immobility. These life-threatening conditions demand prompt recognition and management. We describe the case of a patient with catatonia who presented to anesthesia for electroconvulsive therapy (ECT) at the outset of the current coronavirus disease 2019 pandemic. She complained of breathing difficulty and was suspected to have COVID-19 infection. On further evaluation, she was found to have DVT and PE and required oxygen therapy and intensive care management. The diagnostic delay in our patient would have probably not occurred, had it not been for the existing pandemic situation.


Subject(s)
COVID-19/diagnosis , Catatonia/complications , Delayed Diagnosis , Electroconvulsive Therapy , Pulmonary Embolism/diagnosis , Venous Thrombosis/diagnosis , Anesthesia , Catatonia/therapy , Diagnosis, Differential , Female , Humans , Middle Aged , Oxygen/therapeutic use , Pulmonary Embolism/therapy , Tomography, X-Ray Computed , Venous Thrombosis/therapy
20.
J Thromb Thrombolysis ; 52(3): 759-765, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1130879

ABSTRACT

Severe acute respiratory syndrome-associated coronavirus-2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), which has been considered a pandemic by the World Health Organization (WHO). Clinical manifestations of COVID-19 disease may differ, most cases are mild, but a significant minority of patients may develop moderate to severe respiratory symptoms, with the most severe cases requiring intensive care and/or mechanical ventilatory support. In this study, we aimed to identify validity of our modified scoring system for foreseeing the approach to the COVID-19 patient and the disease, the treatment plan, the severity of morbidity and even the risk of mortality from the clinician's point of view. In this single center study, we examined the patients hospitalized with the diagnosis of COVID-19 between 01/04/2020 and 01/06/2020, of the 228 patients who were between 20 and 90 years of age, and whose polymerase chain reaction (PCR) tests of nasal and pharyngeal swab samples were positive. We evaulated 228 (92 male and 136 female) PCR (+) patients. Univariate analysis showed that advanced age (p < 0.001), hemoglobin (p < 0.001), troponin-I (p < 0.001), C-reactive protein (CRP) (p < 0.001), fibrinogen (p < 0.001), HT (p = 0.01), CAD (p = 0.001), DM (p < 0.001), history of malignancy (p = 0.008), along with m-sPESI scores (p < 0.001) were significantly higher in patients that needed intensive care due to COVID-19 infection. In the multivariable logistic regression analysis, only the m-sPESI score higher than ≥ 2 was found to be highly significant in terms of indicating the need for ICU admission (AUC 0.948; 84.6% sensitivity and 94.6% specificity) (p < 0.001). With an increasing number of hospitalized patients, healthcare providers are confronting a deluge of lab results in the process of caring for COVID-19 patients. It is imperative to identify risk factors for mortality and morbidity development. The modified sPESI scoring system, which we put forward, is successful in predicting the course of the disease at the presentation of the patient with COVID-19 disease and predicting the need for intensive care with high specificity and sensitivity, can detect the need for intensive care with high specificity and sensitivity.


Subject(s)
COVID-19/diagnosis , Critical Care , Decision Support Techniques , Hospitalization , Pulmonary Embolism/diagnosis , Adult , Age Factors , Aged , Aged, 80 and over , Biomarkers/blood , COVID-19/complications , COVID-19/therapy , Comorbidity , Female , Humans , Intensive Care Units , Male , Middle Aged , Predictive Value of Tests , Prognosis , Pulmonary Embolism/etiology , Pulmonary Embolism/therapy , Retrospective Studies , Risk Assessment , Risk Factors , Severity of Illness Index , Young Adult
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