ABSTRACT
Coronavirus disease 2019 (COVID-19) is associated with a high incidence of venous and arterial thromboembolic events. The role of anticoagulation (AC) prior to hospital admission and how different types of oral AC influences the outcome of COVID-19 is currently unknown. This observational study compares the outcome in COVID-19 patients with prior use of direct oral anticoagulants (DOAC) or vitamin K antagonists (VKA), and without prior use of AC. We collected the baseline characteristics and outcomes of COVID-19 patients presented to the emergency department of Bernhoven Hospital, the Netherlands. The primary outcome was all-cause mortality within 30 days and analyzed in a multivariable Cox proportional hazards model including age, sex, symptom duration, home medication, and comorbidities. We included 497 patients, including 57 patients with DOAC (11%) and 53 patients with VKA (11%). Patients with AC had a lower body temperature and lower C-reactive protein levels. Comparing the primary outcome in patients with AC (DOAC or VKA) and no AC, the adjusted hazard ratio (aHR) was 0.64 (95% CI 0.42-0.96, P = 0.03). Comparing DOAC and no AC, the aHR was 0.53 (95% CI 0.32-0.89, P = 0.02) and comparing VKA and no AC, the aHR was 0.77 (95% CI 0.47-1.27, P = 0.30). In a subgroup analysis of DOAC, all nine patients with prior use of dabigatran survived within 30 days. In this observational study, the prior use of AC is associated with a better survival of COVID-19. DOAC, especially dabigatran, might have additional beneficial effects.
Subject(s)
Anticoagulants , COVID-19 , Dabigatran , Survival Rate , Administration, Oral , Anticoagulants/therapeutic use , COVID-19/mortality , Dabigatran/therapeutic use , Fibrinolytic Agents , Humans , Netherlands , Vitamin K/antagonists & inhibitorsABSTRACT
The hypercoagulable state observed in COVID-19 could be responsible for morbidity and mortality. In this retrospective study we investigated whether therapeutic anticoagulation prior to infection has a beneficial effect in hospitalized COVID-19 patients. This study included 1154 COVID-19 patients admitted to 6 hospitals in the Netherlands between March and May 2020. We applied 1:3 propensity score matching to evaluate the association between prior therapeutic anticoagulation use and clinical outcome, with in hospital mortality as primary endpoint. In total, 190 (16%) patients used therapeutic anticoagulation prior to admission. In the propensity score matched analyses, we observed no associations between prior use of therapeutic anticoagulation and overall mortality (risk ratio 1.02 [95% confidence interval; 0.80-1.30]) or length of hospital stay (7.0 [4-12] vs. 7.0 [4-12] days, P = .69), although we observed a lower risk of pulmonary embolism (0.19 [0.05-0.80]). This study shows that prior use of therapeutic anticoagulation is not associated with improved clinical outcome in hospitalized COVID-19 patients.
Subject(s)
COVID-19 , Anticoagulants , Cohort Studies , Humans , Propensity Score , Retrospective Studies , SARS-CoV-2ABSTRACT
We describe a case of Staphylococcus aureus sepsis after acupuncture for chronic fatigue syndrome (CFS). Sepsis is a rare, but potentially fatal complication of acupuncture. The most common cause of bacterial infection after acupuncture is S. aureus. The effectiveness of acupuncture for the treatment of CFS is not proven, therefore the potential benefits should be weighed against the risks.
Subject(s)
Acupuncture Therapy/adverse effects , Bacteremia/etiology , Staphylococcal Infections/etiology , Staphylococcus aureus/isolation & purification , Anti-Bacterial Agents/therapeutic use , Arthritis, Infectious/diagnosis , Arthritis, Infectious/drug therapy , Arthritis, Infectious/etiology , Bacteremia/diagnosis , Bacteremia/drug therapy , Fatigue Syndrome, Chronic/microbiology , Fatigue Syndrome, Chronic/therapy , Female , Floxacillin/therapeutic use , Humans , Middle Aged , Pneumonia, Staphylococcal/diagnosis , Pneumonia, Staphylococcal/drug therapy , Pneumonia, Staphylococcal/etiology , Shoulder Joint/microbiology , Shoulder Joint/physiopathology , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapyABSTRACT
OBJECTIVE: Formerly preeclamptic women with low plasma volume are at increased risk of recurrent gestational hypertensive disease. We hypothesized that a 4-week cycling training in formerly preeclamptic women improves (venous) hemodynamic function. METHODS: In 9 formerly preeclamptic women, we examined physical fitness and hemodynamic function, before and after the training. We assessed blood pressure, heart rate, cardiac output, plasma volume, and calf and forearm venous compliance. RESULTS: After the training, baseline blood pressure and cardiac output remained unchanged, but resting heart rate decreased (-7%, P = .02). Plasma volume was 8% higher after training (P = .01). Calf venous compliance increased (+18%, P = .02) but not forearm venous compliance (+14%, P = .09). CONCLUSION: Cycling training improves venous vascular function in formerly preeclamptic women. The decreased resting heart rate and improvement of venous compliance suggest reduced sympathetic activity. These rapid exercise-induced changes may improve maternal vascular adaptation in early pregnancy and with it the risk of (recurrent) gestational hypertensive disease.
