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Acute thrombotic manifestations of coronavirus disease 2019 infection: Experience at a large New York City health care system.
Ilonzo, Nicole; Rao, Ajit; Safir, Scott; Vouyouka, Ageliki; Phair, John; Baldwin, Melissa; Ting, Windsor; Soundararajan, Krishna; Han, Daniel; Tadros, Rami; Marin, Michael; Faries, Peter.
  • Ilonzo N; Division of Vascular Surgery, Department of Surgery, Mount Sinai Hospital, New York, NY. Electronic address: nicole.ilonzo@mountsinai.org.
  • Rao A; Division of Vascular Surgery, Department of Surgery, Mount Sinai Hospital, New York, NY.
  • Safir S; Division of Vascular Surgery, Department of Surgery, Mount Sinai Hospital, New York, NY.
  • Vouyouka A; Division of Vascular Surgery, Department of Surgery, Mount Sinai Hospital, New York, NY.
  • Phair J; Division of Vascular Surgery, Department of Surgery, Mount Sinai Hospital, New York, NY.
  • Baldwin M; Division of Vascular Surgery, Department of Surgery, Mount Sinai Hospital, New York, NY.
  • Ting W; Division of Vascular Surgery, Department of Surgery, Mount Sinai Hospital, New York, NY.
  • Soundararajan K; Division of Vascular Surgery, Department of Surgery, Mount Sinai Hospital, New York, NY.
  • Han D; Division of Vascular Surgery, Department of Surgery, Mount Sinai Hospital, New York, NY.
  • Tadros R; Division of Vascular Surgery, Department of Surgery, Mount Sinai Hospital, New York, NY.
  • Marin M; Division of Vascular Surgery, Department of Surgery, Mount Sinai Hospital, New York, NY.
  • Faries P; Division of Vascular Surgery, Department of Surgery, Mount Sinai Hospital, New York, NY.
J Vasc Surg ; 73(3): 789-796, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-863656
Semantic information from SemMedBD (by NLM)
1. Coronavirus Infections CAUSES upper respiratory symptom
Subject
Coronavirus Infections
Predicate
CAUSES
Object
upper respiratory symptom
2. Virus COEXISTS_WITH COVID-19
Subject
Virus
Predicate
COEXISTS_WITH
Object
COVID-19
3. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
4. Negative Regulation of Coagulation AFFECTS Patients
Subject
Negative Regulation of Coagulation
Predicate
AFFECTS
Object
Patients
5. Arteries LOCATION_OF Abnormal
Subject
Arteries
Predicate
LOCATION_OF
Object
Abnormal
6. Veins LOCATION_OF Abnormal
Subject
Veins
Predicate
LOCATION_OF
Object
Abnormal
7. Kidney Failur PROCESS_OF C0206194
Subject
Kidney Failur
Predicate
PROCESS_OF
Object
C0206194
8. Therapeutic procedure PREVENTS Blood Vessel complications
Subject
Therapeutic procedure
Predicate
PREVENTS
Object
Blood Vessel complications
9. Coronavirus Infections CAUSES upper respiratory symptom
Subject
Coronavirus Infections
Predicate
CAUSES
Object
upper respiratory symptom
10. Virus COEXISTS_WITH COVID-19
Subject
Virus
Predicate
COEXISTS_WITH
Object
COVID-19
11. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
12. Negative Regulation of Coagulation AFFECTS Patients
Subject
Negative Regulation of Coagulation
Predicate
AFFECTS
Object
Patients
13. Arteries LOCATION_OF Abnormal
Subject
Arteries
Predicate
LOCATION_OF
Object
Abnormal
14. Veins LOCATION_OF Abnormal
Subject
Veins
Predicate
LOCATION_OF
Object
Abnormal
15. Kidney Failure, Acute PROCESS_OF Survivors
Subject
Kidney Failure, Acute
Predicate
PROCESS_OF
Object
Survivors
16. Therapeutic procedure PREVENTS Blood Vessel complications
Subject
Therapeutic procedure
Predicate
PREVENTS
Object
Blood Vessel complications
ABSTRACT

BACKGROUND:

Coronavirus disease 2019 (COVID-19) is a novel coronavirus that has typically resulted in upper respiratory symptoms. However, we have encountered acute arterial and venous thrombotic events after COVID-19 infection. Managing acute thrombotic events from the novel virus has presented unprecedented challenges during the COVID-19 pandemic. In our study, we have highlighted the unique treatment required for these patients and discussed the role of anticoagulation for patients diagnosed with COVID-19.

METHODS:

The data from 21 patients with laboratory-confirmed COVID-19 disease and acute venous or arterial thrombosis were collected. The demographics, comorbidities, home medications, laboratory markers, and outcomes were analyzed. The primary postoperative outcome of interest was mortality, and the secondary outcomes were primary patency and morbidity. To assess for significance, a univariate analysis was performed using the Pearson χ2 and Fisher exact tests for categorical variables and the Student t test for continuous variables.

RESULTS:

A total of 21 patients with acute thrombotic events met our inclusion and exclusion criteria. Most cases were acute arterial events (76.2%), with the remainder venous cases (23.8%). The average age for all patients was 64.6 years, and 52.4% were male. The most prevalent comorbidity in the group was hypertension (81.0%). Several markers were markedly abnormal in both arterial and venous cases, including an elevated neutrophil/lymphocyte ratio (8.8) and D-dimer level (4.9 µg/mL). Operative intervention included percutaneous angiography in 25.00% of patients and open surgical embolectomy in 23.8%. Most of the patients who had undergone arterial intervention had developed a postoperative complication (53.9%) compared with a 0% complication rate after venous interventions. Acute kidney injury on admission was a factor in 75.0% of those who died vs 18.2% in the survivors (P = .04).

CONCLUSIONS:

We have described our experience in the epicenter of the pandemic of 21 patients who had experienced major thrombotic events from infection with COVID-19. The findings from our cohort have highlighted the need for increased awareness of the vascular manifestations of COVID-19 and the important role of anticoagulation for these patients. More data are urgently needed to optimize treatment and prevent further vascular complications of COVID-19 infections.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Blood Coagulation Disorders / COVID-19 Type of study: Cohort study / Observational study / Prognostic study Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: J Vasc Surg Journal subject: Vascular Diseases Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Blood Coagulation Disorders / COVID-19 Type of study: Cohort study / Observational study / Prognostic study Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: J Vasc Surg Journal subject: Vascular Diseases Year: 2021 Document Type: Article