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Immuno-Thrombotic Complications of COVID-19: Implications for Timing of Surgery and Anticoagulation.
Bunch, Connor M; Moore, Ernest E; Moore, Hunter B; Neal, Matthew D; Thomas, Anthony V; Zackariya, Nuha; Zhao, Jonathan; Zackariya, Sufyan; Brenner, Toby J; Berquist, Margaret; Buckner, Hallie; Wiarda, Grant; Fulkerson, Daniel; Huff, Wei; Kwaan, Hau C; Lankowicz, Genevieve; Laubscher, Gert J; Lourens, Petrus J; Pretorius, Etheresia; Kotze, Maritha J; Moolla, Muhammad S; Sithole, Sithembiso; Maponga, Tongai G; Kell, Douglas B; Fox, Mark D; Gillespie, Laura; Khan, Rashid Z; Mamczak, Christiaan N; March, Robert; Macias, Rachel; Bull, Brian S; Walsh, Mark M.
  • Bunch CM; Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, United States.
  • Moore EE; Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, Denver, CO, United States.
  • Moore HB; Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, Denver, CO, United States.
  • Neal MD; Pittsburgh Trauma Research Center, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
  • Thomas AV; Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States.
  • Zackariya N; Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States.
  • Zhao J; Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States.
  • Zackariya S; Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States.
  • Brenner TJ; Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States.
  • Berquist M; Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States.
  • Buckner H; Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States.
  • Wiarda G; Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States.
  • Fulkerson D; Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States.
  • Huff W; Department of Neurosurgery, Saint Joseph Regional Medical Center, Mishawaka, IN, United States.
  • Kwaan HC; Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States.
  • Lankowicz G; Department of Neurosurgery, Saint Joseph Regional Medical Center, Mishawaka, IN, United States.
  • Laubscher GJ; Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
  • Lourens PJ; Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States.
  • Pretorius E; Mediclinic Stellenbosch, Stellenbosch, South Africa.
  • Kotze MJ; Mediclinic Stellenbosch, Stellenbosch, South Africa.
  • Moolla MS; Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa.
  • Sithole S; Department of Biochemistry and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom.
  • Maponga TG; Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa.
  • Kell DB; Division of General Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
  • Fox MD; Division of General Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
  • Gillespie L; Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
  • Khan RZ; Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa.
  • Mamczak CN; Department of Biochemistry and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom.
  • March R; The Novo Nordisk Foundation Centre for Biosustainability, Technical University of Denmark, Kgs. Lyngby, Denmark.
  • Macias R; Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States.
  • Bull BS; Department of Quality Assurance and Performance Improvement, Saint Joseph Regional Medical Center, Mishawaka, IN, United States.
  • Walsh MM; Department of Hematology, Michiana Hematology Oncology, Mishawaka, IN, United States.
Front Surg ; 9: 889999, 2022.
Article in English | MEDLINE | ID: covidwho-1862702
ABSTRACT
Early in the coronavirus disease 2019 (COVID-19) pandemic, global governing bodies prioritized transmissibility-based precautions and hospital capacity as the foundation for delay of elective procedures. As elective surgical volumes increased, convalescent COVID-19 patients faced increased postoperative morbidity and mortality and clinicians had limited evidence for stratifying individual risk in this population. Clear evidence now demonstrates that those recovering from COVID-19 have increased postoperative morbidity and mortality. These data-in conjunction with the recent American Society of Anesthesiologists guidelines-offer the evidence necessary to expand the early pandemic guidelines and guide the surgeon's preoperative risk assessment. Here, we argue elective surgeries should still be delayed on a personalized basis to maximize postoperative outcomes. We outline a framework for stratifying the individual COVID-19 patient's fitness for surgery based on the symptoms and severity of acute or convalescent COVID-19 illness, coagulopathy assessment, and acuity of the surgical procedure. Although the most common manifestation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is COVID-19 pneumonitis, every system in the body is potentially afflicted by an endotheliitis. This endothelial derangement most often manifests as a hypercoagulable state on admission with associated occult and symptomatic venous and arterial thromboembolisms. The delicate balance between hyper and hypocoagulable states is defined by the local immune-thrombotic crosstalk that results commonly in a hemostatic derangement known as fibrinolytic shutdown. In tandem, the hemostatic derangements that occur during acute COVID-19 infection affect not only the timing of surgical procedures, but also the incidence of postoperative hemostatic complications related to COVID-19-associated coagulopathy (CAC). Traditional methods of thromboprophylaxis and treatment of thromboses after surgery require a tailored approach guided by an understanding of the pathophysiologic underpinnings of the COVID-19 patient. Likewise, a prolonged period of risk for developing hemostatic complications following hospitalization due to COVID-19 has resulted in guidelines from differing societies that recommend varying periods of delay following SARS-CoV-2 infection. In conclusion, we propose the perioperative, personalized assessment of COVID-19 patients' CAC using viscoelastic hemostatic assays and fluorescent microclot analysis.
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Full text: Available Collection: International databases Database: MEDLINE Type of study: Observational study / Prognostic study Language: English Journal: Front Surg Year: 2022 Document Type: Article Affiliation country: Fsurg.2022.889999

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Observational study / Prognostic study Language: English Journal: Front Surg Year: 2022 Document Type: Article Affiliation country: Fsurg.2022.889999