ABSTRACT
The advent of computed tomodensitometry has led to an increase in the incidence rate of subsegmental pulmonary embolism. The clinical implications of this category of pulmonary embolism remain unclear up to now, to the point that some experts question the indication for therapeutic anticoagulation. The purpose of this article is to review the existing literature regarding the management of subsegmental pulmonary embolism and to propose a pragmatic approach regarding the indication for therapeutic anticoagulation.
L'apparition de la tomodensitométrie a mené à une augmentation du taux d'incidence des embolies pulmonaires sous-segmentaires. Les implications cliniques de cette catégorie d'embolie pulmonaire demeurent à ce jour encore incertaines, à tel point que certains experts se questionnent sur l'indication à une anticoagulation thérapeutique. Le but de cet article est de revoir la littérature existant pour la prise en charge des embolies pulmonaires sous-segmentaires et de proposer une approche pragmatique concernant l'indication à une anticoagulation thérapeutique.
Subject(s)
Anticoagulants , Pulmonary Embolism , Humans , Anticoagulants/therapeutic use , Pulmonary Embolism/diagnosis , Pulmonary Embolism/epidemiology , Pulmonary Embolism/therapyABSTRACT
Several topics among those that marked the year 2021 are discussed in this article. Factor XI represents an original target for new anticoagulants, and the first results of a phase 2 study of prophylaxis after knee replacement surgery are very promising. A real-life study confirms that the pulmonary embolism exclusion strategy using an age-adjusted D-dimer cut-off is safe and increases the diagnostic yield. Several studies of tranexamic acid provide further insight into the indications for its use and highlight some potential risks. Finally, the concerns regarding a potential risk of increased mortality related to paclitaxel-eluting technology used in lower limb revascularisation are questioned by the results of the latest trials.
Plusieurs sujets parmi ceux qui ont marqué l'année 2021 sont abordés dans cet article. Le facteur XI représente une cible originale pour de nouveaux anticoagulants et les premiers résultats d'une étude de phase 2 dans la prophylaxie après chirurgie du genou sont très prometteurs. Une étude de vie réelle confirme que la stratégie d'exclusion de l'embolie pulmonaire en utilisant un seuil de D-dimères adapté à l'âge est sûre et augmente le rendement diagnostique. Plusieurs études concernant l'acide tranexamique permettent de mieux cerner les indications de son utilisation et soulignent quelques risques potentiels. Finalement, les données récentes remettent en cause le risque de surmortalité liée à la technologie à élution au paclitaxel utilisée dans les interventions endovasculaires des membres inférieurs rapporté précédemment.
Subject(s)
Cardiology , Pulmonary Embolism , Anticoagulants/therapeutic use , Fibrin Fibrinogen Degradation Products , Hemostasis , HumansABSTRACT
BACKGROUND: Oncological patients have a higher risk of prolonged SARS-CoV-2 shedding, which, in turn, can lead to evolutionary mutations and emergence of novel viral variants. The aim of this study was to analyze biological samples of a cohort of oncological patients by deep sequencing to detect any significant viral mutations. METHODS: High-throughput sequencing was performed on selected samples from a SARS-CoV-2-positive oncological patient cohort. Analysis of variants and minority variants was performed using a validated bioinformatics pipeline. RESULTS: Among 54 oncological patients, we analyzed 12 samples of 6 patients, either serial nasopharyngeal swab samples or samples from the upper and lower respiratory tracts, by high-throughput sequencing. We identified amino acid changes D614G and P4715L as well as mutations at nucleotide positions 241 and 3037 in all samples. There were no other significant mutations, but we observed intra-host evolution in some minority variants, mainly in the ORF1ab gene. There was no significant mutation identified in the spike region and no minority variants common to several hosts. CONCLUSIONS: There was no major and rapid evolution of viral strains in this oncological patient cohort, but there was minority variant evolution, reflecting a dynamic pattern of quasi-species replication.
ABSTRACT
This study analyzed the cerebrospinal fluid features of 31 coronavirus disease 2019 (COVID-19) patients with neurological complications. We observed neither severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in the cerebrospinal fluid, nor intrathecal immunoglobulin G (IgG) synthesis but did observe signs of blood-brain barrier disruption. These results might serve as a basis for a better understanding of SARS-CoV-2 related neuropathogenesis.
Subject(s)
COVID-19 , SARS-CoV-2 , Humans , Immunoglobulin G , Reverse Transcriptase Polymerase Chain Reaction , Reverse TranscriptionABSTRACT
Arteriopathy of the lower limbs is a frequent pathology. In the face of persistent invalidating claudication or critical ischemia, surgical or endovascular revascularization treatment is necessary. The aim of this article is to review the evolution of the endovascular therapeutic arsenal of the femoropopliteal segment, to present the new endovascular devices available and to give current recommendations for post-interventional antithrombotic treatment.
L'artériopathie des membres inférieurs est une pathologie fréquente. Face à une claudication invalidante persistante ou à une ischémie critique, un traitement de revascularisation chirurgicale ou endovasculaire est nécessaire. Cet article a pour but de revenir sur l'évolution de l'arsenal thérapeutique endovasculaire du segment fémoro-poplité, de présenter les nouveaux dispositifs endovasculaires disponibles et de faire part des recommandations actuelles du traitement antithrombotique postinterventionnel.
Subject(s)
Endovascular Procedures , Lower Extremity/surgery , Vascular Diseases/surgery , Femoral Artery/surgery , Humans , Intermittent Claudication , Ischemia/complications , Vascular Diseases/complicationsABSTRACT
BACKGROUND: Venous thrombo-embolic events have been described in hospitalized patients with coronavirus disease 2019 (COVID-19), suggesting the presence of coagulopathy induced by the viral infection. To date, only rare cases of arterial thrombosis related to COVID-19 have been reported. CASE SUMMARY: A 54-year-old patient with an influenza-like illness 15 days earlier, which resolved, and no known cardiovascular risk factor presented with acute right lower limb ischaemia. A computed tomography angiogram of the abdominal aorta and lower extremities showed, in the absence of vascular disease, a subocclusive thrombosis of the right common iliac artery and an occlusion of the right internal iliac, profunda femoral, and popliteal arteries. On the left side, the computed tomography angiogram demonstrated a non-occlusive thrombosis of the common femoral artery. The patient underwent emergency surgical thrombectomy as well as endovascular revascularization on the right side followed by therapeutic anticoagulation, with normalization of the limb perfusion. A nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by real-time reverse transcription-PCR (rRT-PCR) was negative three times. Haemostasis analysis showed a mild hyperfibrinogenaemia and a shortening of the activated partial thromboplastin time. An extensive screening for cardio-embolism was negative. As the thrombotic event was unexplained, antibody testing for SARS-CoV-2 was performed and the result was positive. DISCUSSION: Venous thrombosis and pulmonary embolisms have been observed in COVID-19. As in our case, the first reports on COVID-19-associated arterial thrombotic events have emerged. A better understanding of the coagulopathy in COVID-19 is essential to guide prevention and treatment of venous as well as arterial thrombo-embolic events.
