Assuntos
Doenças Transmissíveis , Mpox , Humanos , Mpox/diagnóstico , HIV , Hospedeiro ImunocomprometidoRESUMO
BACKGROUND: Incidence of thrombotic events associated to Coronavirus disease-2019 (COVID-19) is difficult to assess and reported rates differ significantly. Optimal thromboprophylaxis is unclear. OBJECTIVES: We aimed to analyze the characteristics of patients with a confirmed thrombotic complication including inflammatory and hemostatic parameters, compare patients affected by arterial vs venous events and examine differences between survivors and non-survivors. We reviewed compliance with thromboprophylaxis and explored how the implementation of a severity-adjusted protocol could have influenced outcome. METHODS: Single-cohort retrospective study of COVID-19 patients admitted, from March 3 to May 3 2020, to the Infanta Leonor University Hospital in Madrid, epicenter of the Spanish outbreak. RESULTS: Among 1127 patients, 80 thrombotic events were diagnosed in 69 patients (6.1% of the entire cohort). Forty-three patients (62%) suffered venous thromboembolism, 18 (26%) arterial episodes and 6 (9%) concurrent venous and arterial thrombosis. Most patients (90%) with a confirmed thrombotic complication where under low-molecular-weight heparin treatment. Overt disseminated intravascular coagulation (DIC) was rare. Initial ISTH DIC score and pre-event CRP were significantly higher among non-survivors. In multivariate analysis, arterial localization was an independent predictor of mortality (OR = 18, 95% CI: 2.4-142, p < .05). CONCLUSIONS: Despite quasi-universal thromboprophylaxis, COVID-19 lead to a myriad of arterial and venous thrombotic events. Considering the subgroup of patients with thrombotic episodes, arterial events appeared earlier in the course of disease and conferred very poor prognosis, and an ISTH DIC score ≥ 3 at presentation was identified as a potential predictor of mortality. Severity-adjusted thromboprophylaxis seemed to decrease the number of events and could have influenced mortality. Randomized controlled trials are eagerly awaited.
Assuntos
Anticoagulantes/uso terapêutico , COVID-19/complicações , Heparina de Baixo Peso Molecular/uso terapêutico , Trombose/tratamento farmacológico , Trombose/etiologia , Idoso , Idoso de 80 Anos ou mais , Coagulação Intravascular Disseminada/diagnóstico , Coagulação Intravascular Disseminada/tratamento farmacológico , Coagulação Intravascular Disseminada/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , SARS-CoV-2/isolamento & purificação , Trombofilia/diagnóstico , Trombofilia/tratamento farmacológico , Trombofilia/etiologia , Trombose/diagnóstico , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/etiologiaRESUMO
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Assuntos
Humanos , Masculino , Adulto , Dermatite Atópica/complicações , Erupção Variceliforme de Kaposi/complicações , Hospedeiro Imunocomprometido , Antivirais/uso terapêuticoAssuntos
Eczema/etiologia , Herpes Simples/diagnóstico , Simplexvirus/fisiologia , Ativação Viral , Aciclovir/uso terapêutico , Corticosteroides/efeitos adversos , Corticosteroides/uso terapêutico , Adulto , Antivirais/uso terapêutico , Ciclosporina/efeitos adversos , Ciclosporina/uso terapêutico , Dermatite Atópica/complicações , Dermatite Atópica/tratamento farmacológico , Dermatite Atópica/imunologia , Eczema/tratamento farmacológico , Eczema/imunologia , Eczema/virologia , Herpes Simples/tratamento farmacológico , Herpes Simples/imunologia , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Masculino , Terapia PUVA/efeitos adversosRESUMO
Presentamos el caso de una mujer de 26 años con un nódulo eritematoso de consistencia firme, de 2 cm de diámetro, localizado en la cara externa de la pierna derecha, de tres meses de evolución. El estudio histológico e inmunohistoquímico fue compatible con el diagnóstico de fascitis nodular. Se realizó la extirpación quirúrgica de la lesión, estando la paciente asintomática en la actualidad (AU)
