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Nasir N, Tajuddin S, Akhtar A, Sheikh CF, Al Karim Manji A, Bhutto S, Khan N, Khan A, Khan MF, Mahmood SF, Jamil B, Khanum I, Habib K, Latif A, Samad Z, Haider AH. Risk factors for mortality in hospitalized COVID-19 patients across five waves in Pakistan. Sci Rep 2024; 14:20205. [PMID: 39215007 PMCID: PMC11364537 DOI: 10.1038/s41598-024-70662-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024] Open
Abstract
This retrospective cohort study aims to describe the clinical characteristics and outcomes and assess risk factors for mortality across the epidemic waves in hospitalized COVID-19 patients in a major tertiary-care center in Pakistan. A total of 5368 patients with COVID-19, hospitalized between March 2020 and April 2022 were included. The median age was 58 years (IQR: 44-69), 41% were females, and the overall mortality was 12%. Comparative analysis of COVID-19 waves showed that the proportion of patients aged ≥ 60 years was highest during the post-wave 4 period (61.4%) and Wave 4 (Delta) (50%) (p < 0.001). Male predominance decreased from 65.2% in Wave 2 to 44.2% in Wave 5 (Omicron) (p < 0.001). Mortality rate was lowest at 9.4% in wave 5 and highest at 21.6% in the post-wave 4 period (p = 0.041). In multivariable analysis for risk factors of mortality, acute respiratory distress syndrome (ARDS) was most strongly associated with mortality (aOR 22.98, 95% CI 15.28-34.55, p < 0.001), followed by need for mechanical ventilation (aOR 6.81, 95% CI 5.13-9.05, p < 0.001). Other significant risk factors included acute kidney injury (aOR 3.05, 95% CI 2.38-3.91, p < 0.001), stroke (aOR 2.40, 95% CI 1.26-4.60, p = 0.008), pulmonary embolism (OR 2.07, 95% CI 1.28-3.35, p = 0.003), and age ≥ 60 years (aOR 2.45, 95% CI 1.95-3.09, p < 0.001). Enoxaparin use was associated with lower mortality odds (aOR 0.45, 95% CI 0.35-0.60, p < 0.001. Patients hospitalized during Wave 4 (aOR 2.22, 95% CI 1.39-3.56, p < 0.001) and the post-wave 4 period (aOR 2.82, 95% CI 1.37-5.80, p = 0.005) had higher mortality odds compared to other waves. The study identifies higher mortality risk in patients admitted in Delta wave and post-wave, aged ≥ 60 years, and with respiratory and renal complications, and lower risk with anticoagulation during COVID-19 waves.
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Affiliation(s)
- Nosheen Nasir
- Section of Adult Infectious Diseases, Department of Medicine, Aga Khan University, Karachi, Pakistan.
| | - Salma Tajuddin
- Section of Adult Infectious Diseases, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Afshan Akhtar
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Chanza Fahim Sheikh
- Section of Adult Infectious Diseases, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | | | | | - Naveera Khan
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Adnan Khan
- Medical College, Aga Khan University, Karachi, Pakistan
| | | | - Syed Faisal Mahmood
- Section of Adult Infectious Diseases, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Bushra Jamil
- Section of Adult Infectious Diseases, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Iffat Khanum
- Section of Adult Infectious Diseases, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Kiren Habib
- Section of Adult Infectious Diseases, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Asad Latif
- Department of Anesthesiology, Aga Khan University, Karachi, Pakistan
| | - Zainab Samad
- Section of Adult Infectious Diseases, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Adil H Haider
- Medical College, Aga Khan University, Karachi, Pakistan
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Schulman S, Arnold DM, Bradbury CA, Broxmeyer L, Connors JM, Falanga A, Iba T, Kaatz S, Levy JH, Middeldorp S, Minichiello T, Nazy I, Ramacciotti E, Resnick HE, Samama CM, Sholzberg M, Thachil J, Zarychanski R, Spyropoulos AC. 2023 ISTH update of the 2022 ISTH guidelines for antithrombotic treatment in COVID-19. J Thromb Haemost 2024; 22:1779-1797. [PMID: 38503600 DOI: 10.1016/j.jtha.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/31/2024] [Accepted: 02/13/2024] [Indexed: 03/21/2024]
Abstract
Based on emerging evidence from the COVID-19 pandemic, the International Society on Thrombosis and Haemostasis (ISTH) guidelines for antithrombotic treatment in COVID-19 were published in 2022. Since then, at least 16 new randomized controlled trials have contributed additional evidence, which necessitated a modification of most of the previous recommendations. We used again the American College of Cardiology Foundation/American Heart Association methodology for assessment of level of evidence (LOE) and class of recommendation (COR). Five recommendations had the LOE upgraded to A and 2 new recommendations on antithrombotic treatment for patients with COVID-19 were added. Furthermore, a section was added to answer questions about COVID-19 vaccination and vaccine-induced immune thrombotic thrombocytopenia (VITT), for which studies have provided some evidence. We only included recommendations with LOE A or B. Panelists agreed on 19 recommendations, 4 for nonhospitalized, 5 for noncritically ill hospitalized, 3 for critically ill hospitalized, and 2 for postdischarge patients, as well as 5 for vaccination and VITT. A strong recommendation (COR 1) was given for (a) use of prophylactic dose of low-molecular-weight heparin or unfractionated heparin in noncritically ill patients hospitalized for COVID-19, (b) for select patients in this group, use of therapeutic-dose low-molecular-weight heparin/unfractionated heparin in preference to prophylactic dose, and (c) for use of antiplatelet factor 4 enzyme immunoassays for diagnosing VITT. A strong recommendation was given against (COR 3) the addition of an antiplatelet agent in hospitalized, noncritically ill patients. These international guidelines provide recommendations for countries with diverse healthcare resources and COVID-19 vaccine availability.
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Affiliation(s)
- Sam Schulman
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Obstetrics and Gynecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
| | - Donald M Arnold
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | | | - Lisa Broxmeyer
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Jean Marie Connors
- Division of Hematology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Anna Falanga
- Department of Transfusion Medicine and Hematology, Hospital Papa Giovanni XXIII, Bergamo, Italy; University of Milan Bicocca, Monza, Italy
| | - Toshiaki Iba
- Department of Emergency and Disaster Medicine, Juntendo University, Tokyo, Japan
| | - Scott Kaatz
- Division of Hospital Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Jerrold H Levy
- Departments of Anesthesiology, Critical Care, and Surgery (Cardiothoracic), Duke University School of Medicine, Durham, North Carolina, USA
| | - Saskia Middeldorp
- Department of Internal Medicine and Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Tracy Minichiello
- Division of Hematology, San Francisco VA Medical Center, University of California, San Francisco, San Francisco, California, USA
| | - Ishac Nazy
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Eduardo Ramacciotti
- Science Valley Research Institute, São Paulo, Brazil; Hospital e Maternidade Christóvão da Gama, Grupo Leforte, Santo André, São Paulo, Brazil
| | | | - Charles Marc Samama
- Department of Anaesthesia, Intensive Care and Perioperative Medicine, Groupe Hospitalo-Universitaire, Assistance Publique-Hôpitaux de Paris Centre -Université Paris Cité, Cochin Hospital, Paris, France
| | - Michelle Sholzberg
- Departments of Medicine and Laboratory Medicine and Pathobiology, St Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada
| | - Jecko Thachil
- Department of Haematology, Manchester University Hospitals, Manchester, United Kingdom
| | - Ryan Zarychanski
- Sections of Hematology/Oncology and Critical Care, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alex C Spyropoulos
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA; Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, New York, USA
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3
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Poloni A, Casalini G, Pozza G, Giacomelli A, Colaneri M, Carrozzo G, Caloni B, Ciubotariu CL, Zacheo M, Rabbione A, Pieruzzi M, Barone F, Passerini M, Ridolfo AL, Rizzardini G, Gori A, Antinori S. Major Bleeding Events in Hospitalized COVID-19 Patients: A Retrospective Observational Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:814. [PMID: 38792997 PMCID: PMC11122796 DOI: 10.3390/medicina60050814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/08/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024]
Abstract
Thromboprophylaxis/anticoagulation treatment is often required in hospitalized COVID-19 patients. We aimed to estimate the prevalence of major bleeding events in hospitalized COVID-19 patients. This was a retrospective observational study including all COVID-19 hospitalized patients ≥18 years of age at one reference center in northern Italy. The crude prevalence (between February 2020-2022) of major bleeding events was estimated as the number of major bleeding episodes divided by patients at risk. Uni- and multivariable Cox models were built to assess factors potentially associated with major bleeding events. Twenty-nine (0.98%) out of 2,945 COVID-19 patients experienced a major bleeding event [prevalence of 0.55% (95%CI 0.37-0.79)], of which five were fatal. Patients who experienced a major bleeding event were older [78 years (72-84 IQR) vs. 67 years (55-78 IQR), p-value < 0.001] and more frequently exposed to anti-aggregating therapy (44.8% vs. 20.0%, p-value 0.002) when compared to those who did not. In the multivariable Cox model, age [per 1 year more AHR 1.05 (CI95% 1.02-1.09)] was independently associated with an increased risk of major bleeding events. A strict monitoring of older hospitalized COVID-19 patients is warranted due to the risk of major bleeding events.
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Affiliation(s)
- Andrea Poloni
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20122 Milan, Italy; (A.P.); (G.P.); (G.C.); (B.C.); (C.L.C.); (M.Z.); (A.R.); (M.P.); (F.B.); (A.G.); (S.A.)
- III Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (A.L.R.)
| | - Giacomo Casalini
- III Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (A.L.R.)
| | - Giacomo Pozza
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20122 Milan, Italy; (A.P.); (G.P.); (G.C.); (B.C.); (C.L.C.); (M.Z.); (A.R.); (M.P.); (F.B.); (A.G.); (S.A.)
- III Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (A.L.R.)
| | - Andrea Giacomelli
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20122 Milan, Italy; (A.P.); (G.P.); (G.C.); (B.C.); (C.L.C.); (M.Z.); (A.R.); (M.P.); (F.B.); (A.G.); (S.A.)
- III Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (A.L.R.)
| | - Marta Colaneri
- II Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (M.C.); (M.P.)
| | - Giorgia Carrozzo
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20122 Milan, Italy; (A.P.); (G.P.); (G.C.); (B.C.); (C.L.C.); (M.Z.); (A.R.); (M.P.); (F.B.); (A.G.); (S.A.)
- III Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (A.L.R.)
| | - Beatrice Caloni
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20122 Milan, Italy; (A.P.); (G.P.); (G.C.); (B.C.); (C.L.C.); (M.Z.); (A.R.); (M.P.); (F.B.); (A.G.); (S.A.)
- III Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (A.L.R.)
| | - Cosmin Lucian Ciubotariu
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20122 Milan, Italy; (A.P.); (G.P.); (G.C.); (B.C.); (C.L.C.); (M.Z.); (A.R.); (M.P.); (F.B.); (A.G.); (S.A.)
- III Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (A.L.R.)
| | - Martina Zacheo
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20122 Milan, Italy; (A.P.); (G.P.); (G.C.); (B.C.); (C.L.C.); (M.Z.); (A.R.); (M.P.); (F.B.); (A.G.); (S.A.)
- III Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (A.L.R.)
| | - Andrea Rabbione
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20122 Milan, Italy; (A.P.); (G.P.); (G.C.); (B.C.); (C.L.C.); (M.Z.); (A.R.); (M.P.); (F.B.); (A.G.); (S.A.)
- III Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (A.L.R.)
| | - Margherita Pieruzzi
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20122 Milan, Italy; (A.P.); (G.P.); (G.C.); (B.C.); (C.L.C.); (M.Z.); (A.R.); (M.P.); (F.B.); (A.G.); (S.A.)
- III Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (A.L.R.)
| | - Federico Barone
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20122 Milan, Italy; (A.P.); (G.P.); (G.C.); (B.C.); (C.L.C.); (M.Z.); (A.R.); (M.P.); (F.B.); (A.G.); (S.A.)
- III Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (A.L.R.)
| | - Matteo Passerini
- II Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (M.C.); (M.P.)
| | - Anna Lisa Ridolfo
- III Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (A.L.R.)
| | - Giuliano Rizzardini
- I Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy;
| | - Andrea Gori
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20122 Milan, Italy; (A.P.); (G.P.); (G.C.); (B.C.); (C.L.C.); (M.Z.); (A.R.); (M.P.); (F.B.); (A.G.); (S.A.)
- II Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (M.C.); (M.P.)
- Centre for Multidisciplinary Research in Health Science (MACH), Università degli Studi di Milano, 20122 Milan, Italy
| | - Spinello Antinori
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20122 Milan, Italy; (A.P.); (G.P.); (G.C.); (B.C.); (C.L.C.); (M.Z.); (A.R.); (M.P.); (F.B.); (A.G.); (S.A.)
- III Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (A.L.R.)
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4
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Vanassche T, Engelen MM, Orlando C, Vandenbosch K, Gadisseur A, Hermans C, Jochmans K, Minon JM, Motte S, Peperstraete H, Péters P, Sprynger M, Lancellotti P, Dehaene I, Emonts P, Vandenbriele C, Verhamme P, Oury C. The 2023 Belgian clinical guidance on anticoagulation management in hospitalized and ambulatory COVID-19 patients. Acta Clin Belg 2023; 78:497-508. [PMID: 37548503 DOI: 10.1080/17843286.2023.2241692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/24/2023] [Indexed: 08/08/2023]
Abstract
COVID-19 is associated with an increased risk for thrombotic complications. The trials investigating the optimal thromboprophylactic dose are performed in challenging times and seemingly produce conflicting evidence. The burdensome circumstances, divergent endpoints, and different analytical approaches hamper comparison and extrapolation of available evidence. Most importantly, clinicians should provide thromboprophylaxis in hospitalized COVID-19 patients while (re)assessing bleeding and thrombotic risk frequently. The COVID-19 Thromboprophylaxis Working Group of the BSTH updated its guidance document. It aims to summarize the available evidence critically and to guide clinicians in providing the best possible thromboprophylaxis.
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Affiliation(s)
- Thomas Vanassche
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Matthias M Engelen
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Christelle Orlando
- Department of Haematology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Kristel Vandenbosch
- Department of Laboratory Haematology, CHU University Hospital of Liege, Liege, Belgium
| | - Alain Gadisseur
- Department of Haematology, Antwerp University Hospital, Antwerp, Belgium
| | | | - Kristin Jochmans
- Department of Haematology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jean-Marc Minon
- Department of Laboratory Medicine, Thrombosis-Haemostasis and Transfusion Unit, CHR Citadelle, Liege, Belgium
| | - Serge Motte
- Department of Vascular Diseases, Erasme University Hospital, Brussels, Belgium
| | | | - Pierre Péters
- Department of Laboratory Haematology, CHU University Hospital of Liege, Liege, Belgium
| | - Muriel Sprynger
- Department of Cardiology, CHU University Hospital of Liege, Liege, Belgium
| | | | - Isabelle Dehaene
- Vlaamse Vereniging Voor Obstetrie En Gynaecologie, Universitair Ziekenhuis Gent, Ghent, Belgium
| | - Patrick Emonts
- Groupement des Gynecologues Obstetriciens de Langue Francaise de Belgique, CHU University Hospital of Liege, Liège, Belgium
| | | | - Peter Verhamme
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Cecile Oury
- Laboratory of Cardiology, GIGA Institute, University of Liege, Liege, Belgium
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Feng K, Wang K, Zhou Y, Xue H, Wang F, Jin H, Zhao W. Non-Anticoagulant Activities of Low Molecular Weight Heparins-A Review. Pharmaceuticals (Basel) 2023; 16:1254. [PMID: 37765064 PMCID: PMC10537022 DOI: 10.3390/ph16091254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/23/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
Low molecular weight heparins (LMWHs) are derived from heparin through chemical or enzymatic cleavage with an average molecular weight (Mw) of 2000-8000 Da. They exhibit more selective activities and advantages over heparin, causing fewer side effects, such as bleeding and heparin-induced thrombocytopenia. Due to different preparation methods, LMWHs have diverse structures and extensive biological activities. In this review, we describe the basic preparation methods in this field and compare the main principles and advantages of these specific methods in detail. Importantly, we focus on the non-anticoagulant pharmacological effects of LMWHs and their conjugates, such as preventing glycocalyx shedding, anti-inflammatory, antiviral infection, anti-fibrosis, inhibiting angiogenesis, inhibiting cell adhesion and improving endothelial function. LMWHs are effective in various diseases at the animal level, including cancer, some viral diseases, fibrotic diseases, and obstetric diseases. Finally, we briefly summarize their usage and potential applications in the clinic to promote the development and utilization of LMWHs.
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Affiliation(s)
- Ke Feng
- State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy, Nankai University, 38 Tongyan Road, Jinnan District, Tianjin 300350, China; (K.F.); (K.W.); (Y.Z.); (H.X.); (W.Z.)
| | - Kaixuan Wang
- State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy, Nankai University, 38 Tongyan Road, Jinnan District, Tianjin 300350, China; (K.F.); (K.W.); (Y.Z.); (H.X.); (W.Z.)
| | - Yu Zhou
- State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy, Nankai University, 38 Tongyan Road, Jinnan District, Tianjin 300350, China; (K.F.); (K.W.); (Y.Z.); (H.X.); (W.Z.)
| | - Haoyu Xue
- State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy, Nankai University, 38 Tongyan Road, Jinnan District, Tianjin 300350, China; (K.F.); (K.W.); (Y.Z.); (H.X.); (W.Z.)
| | - Fang Wang
- Department of Stomatology, Tianjin Nankai Hospital, 6 Changjiang Road, Nankai District, Tianjin 300100, China
| | - Hongzhen Jin
- State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy, Nankai University, 38 Tongyan Road, Jinnan District, Tianjin 300350, China; (K.F.); (K.W.); (Y.Z.); (H.X.); (W.Z.)
| | - Wei Zhao
- State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy, Nankai University, 38 Tongyan Road, Jinnan District, Tianjin 300350, China; (K.F.); (K.W.); (Y.Z.); (H.X.); (W.Z.)
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Koulas I, Goldin M, Schulman S, Spyropoulos AC. Antithrombotic therapy in the management of hospitalised patients with COVID-19. Br J Hosp Med (Lond) 2023; 84:1-11. [PMID: 37235671 DOI: 10.12968/hmed.2022.0519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Hospitalised patients with coronavirus disease 2019 (COVID-19) are at a significantly higher risk of having thromboembolic events while in hospital and in the immediate post-hospital discharge period. Based on early data from observational studies, multiple high quality randomised controlled trials have been conducted worldwide to evaluate optimal thromboprophylaxis regimens to reduce thromboembolism and other COVID-19-related adverse outcomes in hospitalised patients. The International Society on Thrombosis and Haemostasis has published evidence-based guideline recommendations using established methodology for the management of antithrombotic therapy of COVID-19 patients, both in-hospital and in the immediate post-hospital discharge period. A good clinical practice statement supplemented these guidelines based on topics for which there was no or limited high-quality evidence. This review summarises the main recommendations of these documents to serve as a quick access tool for hospital doctors to use in their everyday practice when treating COVID-19 patients.
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Affiliation(s)
- Ioannis Koulas
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Mark Goldin
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Sam Schulman
- Department of Medicine, Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, ON, Canada
| | - Alex C Spyropoulos
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Medicine, Anticoagulation and Clinical Thrombosis Services, Northwell Health at Lenox Hill Hospital, New York, NY, USA
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7
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Schulman S, Sholzberg M, Spyropoulos AC, Zarychanski R, Resnick HE, Bradbury CA, Broxmeyer L, Connors JM, Falanga A, Iba T, Kaatz S, Levy JH, Middeldorp S, Minichiello T, Ramacciotti E, Samama CM, Thachil J. ISTH guidelines for antithrombotic treatment in COVID-19. J Thromb Haemost 2022; 20:2214-2225. [PMID: 35906716 PMCID: PMC9349907 DOI: 10.1111/jth.15808] [Citation(s) in RCA: 93] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/17/2022] [Accepted: 07/03/2022] [Indexed: 11/29/2022]
Abstract
Antithrombotic agents reduce risk of thromboembolism in severely ill patients. Patients with coronavirus disease 2019 (COVID-19) may realize additional benefits from heparins. Optimal dosing and timing of these treatments and benefits of other antithrombotic agents remain unclear. In October 2021, ISTH assembled an international panel of content experts, patient representatives, and a methodologist to develop recommendations on anticoagulants and antiplatelet agents for patients with COVID-19 in different clinical settings. We used the American College of Cardiology Foundation/American Heart Association methodology to assess level of evidence (LOE) and class of recommendation (COR). Only recommendations with LOE A or B were included. Panelists agreed on 12 recommendations: three for non-hospitalized, five for non-critically ill hospitalized, three for critically ill hospitalized, and one for post-discharge patients. Two recommendations were based on high-quality evidence, the remainder on moderate-quality evidence. Among non-critically ill patients hospitalized for COVID-19, the panel gave a strong recommendation (a) for use of prophylactic dose of low molecular weight heparin or unfractionated heparin (LMWH/UFH) (COR 1); (b) for select patients in this group, use of therapeutic dose LMWH/UFH in preference to prophylactic dose (COR 1); but (c) against the addition of an antiplatelet agent (COR 3). Weak recommendations favored (a) sulodexide in non-hospitalized patients, (b) adding an antiplatelet agent to prophylactic LMWH/UFH in select critically ill, and (c) prophylactic rivaroxaban for select patients after discharge (all COR 2b). Recommendations in this guideline are based on high-/moderate-quality evidence available through March 2022. Focused updates will incorporate future evidence supporting changes to these recommendations.
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Affiliation(s)
- Sam Schulman
- Department of Medicine, Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Michelle Sholzberg
- Departments of Medicine, and Laboratory Medicine and Pathobiology, St Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada
| | - Alex C Spyropoulos
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Ryan Zarychanski
- Sections of Hematology/Oncology and Critical Care, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | | | - Jean Marie Connors
- Division of Hematology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Anna Falanga
- Department of Transfusion Medicine and Hematology, Hospital Papa Giovanni XXIII, Bergamo, Italy
- University of Milan Bicocca, Monza, Italy
| | - Toshiaki Iba
- Department of Emergency and Disaster Medicine, Juntendo University, Tokyo, Japan
| | - Scott Kaatz
- Division of Hospital Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Jerrold H Levy
- Departments of Anesthesiology, Critical Care, and Surgery (Cardiothoracic), Duke University School of Medicine, Durham, North Carolina, USA
| | - Saskia Middeldorp
- Department of Internal Medicine and Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Tracy Minichiello
- Division of Hematology, San Francisco VA Medical Center, University of California, San Francisco, San Francisco, California, USA
| | - Eduardo Ramacciotti
- Science Valley Research Institute, São Paulo, Brazil
- Hospital e Maternidade Christóvão da Gama, Grupo Leforte, Santo André, São Paulo, Brazil
| | - Charles Marc Samama
- Department of Anaesthesia, Centre-Université de Paris-Cochin Hospital, Intensive Care and Perioperative Medicine GHU AP-HP, Paris, France
| | - Jecko Thachil
- Department of Haematology, Manchester University Hospitals, Manchester, UK
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8
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da Silveira WC, Ramos LEF, Silva RT, de Paiva BBM, Pereira PD, Schwarzbold AV, Garbini AF, Barreira BSM, de Castro BM, Ramos CM, Gomes CD, Cimini CCR, Pereira EC, Roesch EW, Kroger EMS, Aranha FFMG, Anschau F, Botoni FA, Aranha FG, Crestani GP, Vietta GG, Bastos GAN, Costa JHSM, da Fonseca JRCS, Ruschel KB, de Oliveira LS, Pinheiro LS, Pacheco LS, Segala LB, Couto LSF, Kopittke L, Floriani MA, Silva MM, Carneiro M, Ferreira MAP, Martins MAP, de Faria MNZ, Nogueira MCA, Guimarães Júnior MH, Sampaio NDCS, de Oliveira NR, Pertile NDM, Andrade PGS, Assaf PL, Valacio RA, Menezes RM, Francisco SC, Guimarães SMM, Araújo SF, Rezende SM, Pereira SA, Kurtz T, Fereguetti TO, Polanczyk CA, Pires MC, Gonçalves MA, Marcolino MS. Predictors of venous thromboembolism in COVID-19 patients: results of the COVID-19 Brazilian Registry. Intern Emerg Med 2022; 17:1863-1878. [PMID: 35648280 PMCID: PMC9156830 DOI: 10.1007/s11739-022-03002-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/06/2022] [Indexed: 12/15/2022]
Abstract
Previous studies that assessed risk factors for venous thromboembolism (VTE) in COVID-19 patients have shown inconsistent results. Our aim was to investigate VTE predictors by both logistic regression (LR) and machine learning (ML) approaches, due to their potential complementarity. This cohort study of a large Brazilian COVID-19 Registry included 4120 COVID-19 adult patients from 16 hospitals. Symptomatic VTE was confirmed by objective imaging. LR analysis, tree-based boosting, and bagging were used to investigate the association of variables upon hospital presentation with VTE. Among 4,120 patients (55.5% men, 39.3% critical patients), VTE was confirmed in 6.7%. In multivariate LR analysis, obesity (OR 1.50, 95% CI 1.11-2.02); being an ex-smoker (OR 1.44, 95% CI 1.03-2.01); surgery ≤ 90 days (OR 2.20, 95% CI 1.14-4.23); axillary temperature (OR 1.41, 95% CI 1.22-1.63); D-dimer ≥ 4 times above the upper limit of reference value (OR 2.16, 95% CI 1.26-3.67), lactate (OR 1.10, 95% CI 1.02-1.19), C-reactive protein levels (CRP, OR 1.09, 95% CI 1.01-1.18); and neutrophil count (OR 1.04, 95% CI 1.005-1.075) were independent predictors of VTE. Atrial fibrillation, peripheral oxygen saturation/inspired oxygen fraction (SF) ratio and prophylactic use of anticoagulants were protective. Temperature at admission, SF ratio, neutrophil count, D-dimer, CRP and lactate levels were also identified as predictors by ML methods. By using ML and LR analyses, we showed that D-dimer, axillary temperature, neutrophil count, CRP and lactate levels are risk factors for VTE in COVID-19 patients.
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Affiliation(s)
- Warley Cezar da Silveira
- Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
- University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 110, Santa Efigênia, Belo Horizonte, MG CEP 30130-100 Brazil
| | | | - Rafael Tavares Silva
- Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
| | | | - Polianna Delfino Pereira
- Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
- Institute for Health Technology Assessment (IATS/ CNPq), Rua Ramiro Barcelos, 2359, Prédio 21 | Sala 507, Porto Alegre, Brazil
| | | | - Andresa Fontoura Garbini
- Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Av. Francisco Trein, 326, Porto Alegre, Brazil
| | | | | | | | | | - Christiane Corrêa Rodrigues Cimini
- Mucuri Medical School – FAMMUC, Universidade Federal dos Vales do Jequitinhonha e Mucuri – UFVJM, Rua Cruzeiro, 01, Teófilo Otoni, Brazil
- Hospital Santa Rosalia, Rua do Cruzeiro, 01, Teófilo Otoni, Brazil
| | | | - Eliane Würdig Roesch
- Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, Brazil
| | | | | | - Fernando Anschau
- Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Av. Francisco Trein, 326, Porto Alegre, Brazil
| | | | | | | | | | | | | | | | - Karen Brasil Ruschel
- Institute for Health Technology Assessment (IATS/ CNPq), Rua Ramiro Barcelos, 2359, Prédio 21 | Sala 507, Porto Alegre, Brazil
- Hospital Mãe de Deus, Rua José de Alencar, 286, Porto Alegre, Brazil
| | | | | | - Liliane Souto Pacheco
- Hospital Universitário de Santa Maria, Av. Roraima, 1000, prédio 22, Santa Maria, Brazil
| | - Luciana Borges Segala
- Hospital Universitário de Santa Maria, Av. Roraima, 1000, prédio 22, Santa Maria, Brazil
| | | | - Luciane Kopittke
- Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Av. Francisco Trein, 326, Porto Alegre, Brazil
| | | | | | - Marcelo Carneiro
- Hospital Santa Cruz, Rua Fernando Abott, 174, Santa Cruz do Sul, Brazil
| | | | | | | | - Matheus Carvalho Alves Nogueira
- Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
- Hospitais da Rede Mater Dei, Av. do Contorno, 9000, Belo Horizonte, Brazil
| | | | | | | | | | | | - Pedro Ledic Assaf
- Hospital Metropolitano Doutor Célio de Castro, Rua Dona Luiza, 311, Belo Horizonte, Brazil
| | | | | | | | | | | | - Suely Meireles Rezende
- Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
| | - Susany Anastácia Pereira
- Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
| | - Tatiana Kurtz
- Hospital Santa Cruz, Rua Fernando Abott, 174, Santa Cruz do Sul, Brazil
| | | | - Carísi Anne Polanczyk
- Institute for Health Technology Assessment (IATS/ CNPq), Rua Ramiro Barcelos, 2359, Prédio 21 | Sala 507, Porto Alegre, Brazil
| | - Magda Carvalho Pires
- Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
| | - Marcos André Gonçalves
- Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
- Institute for Health Technology Assessment (IATS/ CNPq), Rua Ramiro Barcelos, 2359, Prédio 21 | Sala 507, Porto Alegre, Brazil
| | - Milena Soriano Marcolino
- Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
- Institute for Health Technology Assessment (IATS/ CNPq), Rua Ramiro Barcelos, 2359, Prédio 21 | Sala 507, Porto Alegre, Brazil
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 110, Belo Horizonte, Brazil
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9
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Arayici ME, Kipcak N, Kayacik U, Kelbat C, Keskin D, Kilicarslan ME, Kilinc AV, Kirgoz S, Kirilmaz A, Kizilkaya MA, Kizmaz IG, Kocak EB, Kochan E, Kocpinar B, Kordon F, Kurt B, Ellidokuz H. Effects of SARS-CoV-2 infections in patients with cancer on mortality, ICU admission and incidence: a systematic review with meta-analysis involving 709,908 participants and 31,732 cancer patients. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04191-y. [PMID: 35831763 PMCID: PMC9281353 DOI: 10.1007/s00432-022-04191-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/06/2022] [Indexed: 12/24/2022]
Abstract
Background Cancer patients constitute one of the highest-risk patient groups during the COVID-19 pandemic. In this study, it was aimed to perform a systematic review and meta-analysis to determine both the incidence and ICU (Intensive Care Unit) admission rates and mortality in SARS-CoV-2 infected cancer patients. Methods The PRISMA guidelines were closely followed during the design, analysis, and reporting of this systematic review and meta-analysis. A comprehensive literature search was performed for the published papers in PubMed/Medline, Scopus, medRxiv, Embase, and Web of Science (WoS) databases. SARS-CoV-2 infection pooled incidence in the cancer populations and the risk ratio (RR) of ICU admission rates/mortality in cancer and non-cancer groups, with 95% confidence intervals (CIs), were calculated using the random-effects model. Results A total of 58 studies, involving 709,908 participants and 31,732 cancer patients, were included in this study. The incidence in cancer patients was calculated as 8% (95% CI: 8–9%). Analysis results showed that mortality and ICU admission rate was significantly higher in patients with cancer (RR = 2.26, 95% CI: 1.94–2.62, P < 0.001; RR = 1.45, 95% CI: 1.28–1.64, p < 0.001, respectively). Conclusion As a result, cancer was an important comorbidity and risk factor for all SARS-CoV-2 infected patients. This infection could result in severe and even fatal events in cancer patients. Cancer is associated with a poor prognosis in the COVID-19 pandemic. Cancer patients should be assessed more sensitively in the COVID-19 outbreak. Supplementary Information The online version contains supplementary material available at 10.1007/s00432-022-04191-y.
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Affiliation(s)
- Mehmet Emin Arayici
- Department of Preventive Oncology, Institute of Health Sciences, Dokuz Eylul University, 15 July Medicine and Art Campus, Inciralti-Balcova 35340, Izmir, Turkey
| | - Nazlican Kipcak
- Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Ufuktan Kayacik
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Cansu Kelbat
- Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Deniz Keskin
- Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | | | - Ahmet Veli Kilinc
- Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Sumeyye Kirgoz
- Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Anil Kirilmaz
- Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Melih Alihan Kizilkaya
- Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Irem Gaye Kizmaz
- Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Enes Berkin Kocak
- Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Enver Kochan
- Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Begum Kocpinar
- Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Fatmanur Kordon
- Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Batuhan Kurt
- Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Hulya Ellidokuz
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
- Department of Preventive Oncology, Institute of Oncology, Dokuz Eylul University, Izmir, Turkey
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10
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Poli D, Antonucci E, Ageno W, Prandoni P, Barillari G, Bitti G, Imbalzano E, Bucherini E, Chistolini A, Fregoni V, Galliazzo S, Gandolfo A, Grifoni E, Mastroianni F, Panarello S, Pesavento R, Pedrini S, Sala G, Pignatelli P, Preti P, Simonetti F, Sivera P, Visonà A, Villalta S, Marcucci R, Palareti G. Thromboembolic Complications in COVID-19 Patients Hospitalized in Italian Ordinary Wards: Data from the Multicenter Observational START-COVID Register. TH OPEN 2022; 6:e251-e256. [PMID: 36299804 PMCID: PMC9467691 DOI: 10.1055/a-1878-6806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/21/2022] [Indexed: 11/11/2022] Open
Abstract
Background
Coronavirus disease 2019 (COVID-19) infection causes acute respiratory insufficiency with severe interstitial pneumonia and extrapulmonary complications; in particular, it may predispose to thromboembolic disease. The reported incidence of thromboembolic complications varies from 5 to 30% of cases.
Aim
We conducted a multicenter, Italian, retrospective, observational study on COVID-19 patients admitted to ordinary wards, to describe the clinical characteristics of patients at admission and bleeding and thrombotic events occurring during the hospital stay.
Results
The number of hospitalized patients included in the START-COVID-19 Register was 1,135, and the number of hospitalized patients in ordinary wards included in the study was 1,091, with 653 (59.9%) being males and 71 years (interquartile range 59–82 years) being the median age. During the observation, two (0.2%) patients had acute coronary syndrome episodes and one patient (0.1%) had an ischemic stroke; no other arterial thrombotic events were recorded. Fifty-nine patients had symptomatic venous thromboembolism (VTE) (5.4%) events, 18 (30.5%) deep vein thrombosis (DVT), 39 (66.1%) pulmonary embolism (PE), and 2 (3.4%) DVT+PE. Among patients with DVT, eight (44.4%) were isolated distal DVT and two cases were jugular thrombosis. Among patients with PE, seven (17.9%) events were limited to subsegmental arteries. No fatal PE was recorded. Major bleeding events occurred in nine (1.2%) patients and clinically relevant nonmajor bleeding events in nine (1.2%) patients. All bleeding events occurred among patients receiving thromboprophylaxis, more frequently when treated with subtherapeutic or therapeutic dosages.
Conclusion
Our findings confirm that patients admitted to ordinary wards for COVID-19 infection are at high risk for thromboembolic events. VTE recorded among these patients is mainly isolated PE, suggesting a peculiar characteristic of VTE in these patients.
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Affiliation(s)
- Daniela Poli
- SOD Malattie Aterotrombotiche, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | | | - Walter Ageno
- Dipartimento di Medicina e Chirurgia, Università dell'Insubria, Varese, Italy
| | | | | | | | | | | | - Antonio Chistolini
- Dipartimento di Medicina Traslazionale e di Precisione, Sapienza Università di Roma, Roma, Italy
| | - Vittorio Fregoni
- U.O.C. Medicina Generale, ASST Valtellina e Alto Lario Ospedale di Sondalo, Italy
| | - Silvia Galliazzo
- UOC Medicina Generale, Ospedale San Valentino, Montebelluna (TV), Italy
| | - Alberto Gandolfo
- SC (UCO) Clinica Medica, ASUGI, Ospedale di Cattinara, Trieste, Italy
| | - Elisa Grifoni
- Medicina Interna 2, Ospedale San Giuseppe, Empoli (Fi), Italy
| | - Franco Mastroianni
- UOC Medicina Interna, Covid Unit, EE Ospedale F. Miulli, Acquaviva delle Fonti (Ba), Italy
| | | | | | - Simona Pedrini
- UO, laboratorio Analisi, Fondazione Poliambulanza Brescia, Italy
| | - Girolamo Sala
- UOC Medicina II, Ospedale di Circolo Busto Arsizio (Va), Italy
| | - Pasquale Pignatelli
- I Clinica Medica, Medicina Interna Covid e Centro Trombosi Sapienza, Università di Roma, Roma, Italy
| | - Paola Preti
- Unità di Medicina Interna, Malattie Vascolari e Metaboliche Policlinico San Matteo, Pavia, Italy
| | - Federico Simonetti
- UOC Ematologia Aziendale – Ospedale Versilia –Lido di Camaiore (Lucca), Italy
| | - Piera Sivera
- SCDU Ematologia e terapie cellulari, AO Ordine Mauriziano Umberto 1° Torino, Italy
| | - Adriana Visonà
- UOC Angiologia, Ospedale San Giacomo Apostolo, Castelfranco Veneto (Treviso), Italy
| | - Sabina Villalta
- UOC Medicina Generale, Ospedale San Giacomo Apostolo, Castelfranco Veneto (Treviso), Italy
| | - Rossella Marcucci
- SOD Malattie Aterotrombotiche, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
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11
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Drost CC, Rovas A, Osiaevi I, Rauen M, van der Vlag J, Buijsers B, Salmenov R, Lukasz A, Pavenstädt H, Linke WA, Kümpers P. Heparanase Is a Putative Mediator of Endothelial Glycocalyx Damage in COVID-19 - A Proof-of-Concept Study. Front Immunol 2022; 13:916512. [PMID: 35757776 PMCID: PMC9226442 DOI: 10.3389/fimmu.2022.916512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/17/2022] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a systemic disease associated with injury (thinning) of the endothelial glycocalyx (eGC), a protective layer on the vascular endothelium. The aim of this translational study was to investigate the role of the eGC-degrading enzyme heparanase (HPSE), which is known to play a central role in the destruction of the eGC in bacterial sepsis. Excess activity of HPSE in plasma from COVID-19 patients correlated with several markers of eGC damage and perfused boundary region (PBR, an inverse estimate of glycocalyx dimensions of vessels with a diameter 4-25 µm). In a series of translational experiments, we demonstrate that the changes in eGC thickness of cultured cells exposed to COVID-19 serum correlated closely with HPSE activity in concordant plasma samples (R = 0.82, P = 0.003). Inhibition of HPSE by a nonanticoagulant heparin fragment prevented eGC injury in response to COVID-19 serum, as shown by atomic force microscopy and immunofluorescence imaging. Our results suggest that the protective effect of heparin in COVID-19 may be due to an eGC-protective off-target effect.
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Affiliation(s)
- Carolin Christina Drost
- Department of Medicine D, Division of General Internal and Emergency Medicine, Nephrology, and Rheumatology, University Hospital Münster, Münster, Germany
| | - Alexandros Rovas
- Department of Medicine D, Division of General Internal and Emergency Medicine, Nephrology, and Rheumatology, University Hospital Münster, Münster, Germany
| | - Irina Osiaevi
- Department of Medicine A, Division of Hematology, Oncology, Hemostaseology and Pneumology, University Hospital Münster, Münster, Germany
| | - Matthias Rauen
- Department of Medicine D, Division of General Internal and Emergency Medicine, Nephrology, and Rheumatology, University Hospital Münster, Münster, Germany
| | - Johan van der Vlag
- Department of Nephrology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Baranca Buijsers
- Department of Nephrology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Rustem Salmenov
- Department of Nephrology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Alexander Lukasz
- Department of Medicine D, Division of General Internal and Emergency Medicine, Nephrology, and Rheumatology, University Hospital Münster, Münster, Germany
| | - Hermann Pavenstädt
- Department of Medicine D, Division of General Internal and Emergency Medicine, Nephrology, and Rheumatology, University Hospital Münster, Münster, Germany
| | - Wolfgang A Linke
- Institute of Physiology II, University of Münster, Münster, Germany
| | - Philipp Kümpers
- Department of Medicine D, Division of General Internal and Emergency Medicine, Nephrology, and Rheumatology, University Hospital Münster, Münster, Germany
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