Cardiac surgery with cardiopulmonary bypass markedly lowers SARS-COV-2 antibody titer.

Background: This study aims to investigate the effect of cardiopulmonary bypass on antibody titers in patients vaccinated against the severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) undergoing cardiac surgery with cardiopulmonary bypass. Methods: Between October 2021 and October 2022, a total of 70 patients (44 males, 26 females; mean age 59.9±10.3; range, 26 to 79 years) who completed their recommended COVID-19 vaccinations and underwent elective cardiac surgery with cardiopulmonary bypass were prospectively included. Serum samples for antibody titer measurements were taken at anesthesia induction and the end of cardiopulmonary bypass after decannulation. The SARS-CoV-2 total immunoglobulin antibodies against N-protein were measured. The antibody titer measurements at anesthesia induction and at the end of cardiopulmonary bypass were compared in all patients. Results: The median levels after cardiopulmonary bypass were lower than the preoperative levels (1,739.0 vs. 857.0, respectively; p<0.001). There was a drop of 40.0% (21.2%-62.6%) in the antibody titers among all patients. The decrease in antibody titers was consistent regardless of the number of vaccine doses or whether the last dose was received within the last three months. Among the studied factors, no parameter was significantly associated with a lesser or higher decrease in antibody titers. Conclusion: Cardiac surgery with cardiopulmonary bypass causes a decrease in SARS-CoV-2 antibody titers at the end of cardiopulmonary bypass. Revaccination after cardiac operations may be considered in this patient group that is highly vulnerable due to their comorbidities and lowered antibody levels.

Factors associated with positive thrombus findings at ultrasonography in COVID-19 ward patients who underwent imaging for suspected deep vein thrombosis under prophylactic anticoagulation.

OBJECTIVE: The incidence of deep vein thrombosis (DVT) is increased in patients with coronavirus disease 2019 (COVID-19) and its presence is associated with worse outcomes. Ultrasound examination of patients with COVID-19 with a suspected DVT is challenging owing to concerns with disease transmission; the timely initiation of therapeutic anticoagulation is essential. This study aimed to identify patient factors associated with positive thrombus findings at ultrasound examination in patients with COVID-19 who underwent imaging for suspected DVT. METHODS: Patients who did not require intensive care unit treatment and who underwent ultrasound imaging for suspected DVT between March and December 2020 were included retrospectively. Patient demographics, comorbidities, modified Well's score, and d-dimer results on the day of ultrasound examination were recorded. Parameters for a higher likelihood of a positive DVT result were determined by comparing patients with confirmed DVT on ultrasound examination and patients with negative ultrasound findings. To determine a cut-off for d-dimer levels, a receiver operating characteristic curve was constructed. The sensitivity and specificity of the determined high-risk factors in the prediction of positive ultrasound results were calculated. RESULTS: A positive history for DVT (25% vs 4%; P < .001), thrombophilia (9% vs 2%; P = .048), immobilization (53% vs 23%; P = .001), and a Well's score ≥ 2 (50% vs 21%; P = .001) were more frequent in patients with DVT. The mean d-dimer levels were higher in patients with DVT (3871 ± 1805 vs 2075 ± 1543; P < .001). The presence of either thrombophilia or a d-dimer level of >2020 had a sensitivity of 93% and a specificity of 64%. The presence of either thrombophilia, a d-dimer level of >2020, or a Well's score of ≥2 had a sensitivity of 100% and a specificity of 51%. CONCLUSIONS: Patients with COVID-19 with a d-dimer of >2020, a positive history for thrombophilia, and a Well's score of ≥2 should undergo a timely ultrasound examination. The high risk of DVT should be remembered for all hospitalized patients with COVID-19.

Extensive Arterial Thrombus Following Discharge after a Covid-19 Infection.

The novel coronavirus pandemic is associated with coagulopathy and an increased risk of thromboembolic events. A case of an extensive arterial thrombus in the left leg of a patient that occurred after discharge from Covid-19 pneumonia is described. Some patients may be under continued risk of thromboembolism after discharge and the value of extended thromboprophylaxis should be investigated.