Impact of proactive low-molecular weight heparin therapy on outcomes in COVID-1.

OBJECTIVES: Low molecular weight heparin (LMWH) may provide beneficial effects on outcomes of COVID-19. We aimed to examine the impact of LMWH treatment on clinical outcomes (duration of hospitalization, admission to intensive care unit, the requirement for mechanical ventilation, and death) of COVID-19 patients with normal D-dimer levels at admission. BACKGROUND: Coronavirus disease-2019 (COVID-19) predisposes patients to arterial and venous thrombosis. METHODS: In this retrospective, multicentre and observational study we analysed the data of 308 confirmed COVID-19 patients with normal D-dimer levels at initial admission. After propensity score matching (PSM) patients were grouped; Group 1; patients who received LMWH with D-dimer ≤0.5 mg/L, Group 2; patients who received LMWH after D-dimer levels exceeded 0.5 mg/L, and Group 3; patients who did not receive LMWH. RESULTS: After PSM, each group comprised 40 patients. The patients in Group1 had the best clinical outcomes compared to the other groups. Group 3 had the worst clinical outcomes (p<0.005). The benefit of LMWH increased with early prophylactic therapy especially when started while the D-dimer levels were ≤0.5 mg/L. CONCLUSION: Our results strongly suggest that proactive LMWH therapy improves clinical outcomes in hospitalized COVID-19 patients even with normal D-dimer levels (≤ 0.5 mg/L) (Tab. 3, Fig. 2, Ref. 34).

Carotid arteries and vertebrobasilary system intracranial stenosis correlates with multi vessel coronary artery disease.

BACKGROUND: The goal of this study was to show the importance of the identifying potential carotid and vertebrobasilar stenosis with Computed Tomography Angiography (CTA) in severe coronary artery disease. METHODS: In 109 patients, CTA of the carotid and the vertebrobasilar system were taken in the six months following the Coronary Angiography (CA). Coronary arteries and carotid vertebrobasilar system stenosis were considered significant at more than ≥ 50 %. RESULTS: A significant statistical relationship was found between a coronary artery group of three-vessel disease (3-VD) and stenosis of the cervical segments of the right (p = 0.022) and left internal carotid artery (ICA) (p = 0.001); intracranial segments of the right (p = 0.007) and left ICA (p = 0.020), and the right vertebral artery (VA) (p = 0.008). There was a significant statistical relationship between Gensini score and stenosis of both the right (p = 0.030) and the left ICA cervical segments (p = 0.003). CONCLUSION: In patients with severe coronary artery disease especially in 3-VD, CTA scan may be useful diagnostic tool for identifying stenosis of the carotid arteries, particularly in the intracranial segments of the ICA and in the preforaminal (V1) segment of the VA (Tab. 4, Fig. 3, Ref. 22).