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Castro-Varela A, Martinez-Magallanes DM, Reyes-Chavez MF, Gonzalez-Rayas JM, Paredes-Vazquez JG, Vazquez-Garza E, Castillo-Perez M, Flores-Sayavedra YZ, Martinez A, Ramos Cazares RE, Guajardo J, Lopez-de la Garza H, Salinas-Casanova JA, Betancourt H, Molina-Rodriguez AM, Panneflek J, Fabiani MA, Jerjes-Sanchez C. Risk Factors, Clinical Presentation, Therapeutic Trends, and Outcomes in Arterial Thrombosis Complicating Unvaccinated COVID-19 Patients: A Systematic Review. Angiology 2024; 75:625-634. [PMID: 37005343 PMCID: PMC10083125 DOI: 10.1177/00033197231167055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Data on characteristics and outcomes of coronavirus (COVID)-19 patients complicated with arterial thrombosis (AT) are scarce. Therefore, we carried out a systematic review (PRISMA, PROSPERO statements; PubMed, Scopus, and Web of Science) to identify risk factors, clinical presentation, treatment, and outcomes. We included publications from December 2019 to October 2020. Groups: (a) ischemic stroke, (b) thrombotic storm, (c) peripheral vascular thrombosis, (d) myocardial infarction, and (e) left cardiac thrombus or in-transit thrombus (venous system thrombus floating or attaching to the right heart). We considered 131 studies. The most frequent cardiovascular risk factors were: hypertension, diabetes, and dyslipidemia. A high proportion presented with asymptomatic, mild, or moderate COVID-19 (n = 91, 41.4%). We identified a high percentage of isolated ischemic stroke and thrombotic storm. Groups with higher mortality rate: intracardiac thrombus (1/2, 50.0%), thrombotic storm (18/49, 36.7%), and ischemic stroke (48/131, 36.6%). A small number received thromboprophylaxis. Most patients received antithrombotic treatment. The most frequent bleeding complication was intracranial hemorrhage, primarily with isolated stroke. Overall mortality was 33.6% (74/220). Despite a wide range of COVID-19 severity, a high proportion had AT as a complication of non-severe disease. AT can affect different vascular territories; mortality is associated with stroke, intensive care unit stay, and severe COVID-19.
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Affiliation(s)
- Alejandra Castro-Varela
- Tecnologico de
Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey,
Nuevo Leon, Mexico
| | | | - Maria Fernanda Reyes-Chavez
- Tecnologico de
Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey,
Nuevo Leon, Mexico
- Unidad Experimental de Terapias
Avanzadas del Hospital Zambrano Hellion, TecSalud, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | | | - Jose Gildardo Paredes-Vazquez
- Tecnologico de
Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey,
Nuevo Leon, Mexico
- Instituto de Cardiologia y Medicina
Vascular, TecSalud, Escuela de Medicina y Ciencias de la Salud,
Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Eduardo Vazquez-Garza
- Tecnologico de
Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey,
Nuevo Leon, Mexico
- Unidad Experimental de Terapias
Avanzadas del Hospital Zambrano Hellion, TecSalud, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Mauricio Castillo-Perez
- Tecnologico de
Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey,
Nuevo Leon, Mexico
| | | | - Arturo Martinez
- Tecnologico de
Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey,
Nuevo Leon, Mexico
| | - Ray Erick Ramos Cazares
- Tecnologico de
Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey,
Nuevo Leon, Mexico
| | - Jaime Guajardo
- Tecnologico de
Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey,
Nuevo Leon, Mexico
| | - Hector Lopez-de la Garza
- Tecnologico de
Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey,
Nuevo Leon, Mexico
| | | | - Hector Betancourt
- Tecnologico de
Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey,
Nuevo Leon, Mexico
| | | | - Jathniel Panneflek
- Unidad Experimental de Terapias
Avanzadas del Hospital Zambrano Hellion, TecSalud, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Mario Alejandro Fabiani
- Instituto de Cardiologia y Medicina
Vascular, TecSalud, Escuela de Medicina y Ciencias de la Salud,
Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Carlos Jerjes-Sanchez
- Tecnologico de
Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey,
Nuevo Leon, Mexico
- Unidad Experimental de Terapias
Avanzadas del Hospital Zambrano Hellion, TecSalud, San Pedro Garza Garcia, Nuevo Leon, Mexico
- Instituto de Cardiologia y Medicina
Vascular, TecSalud, Escuela de Medicina y Ciencias de la Salud,
Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
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2
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Mayer A, Mizdrak M, Mizdrak I. Multiple Kidney Infarctions Due to COVID-19 Infection in a Patient with Repeatedly Negative RT-PCR Tests-A Case Report. Indian J Nephrol 2023; 33:61-64. [PMID: 37197041 PMCID: PMC10185023 DOI: 10.4103/ijn.ijn_144_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 09/26/2021] [Accepted: 10/10/2021] [Indexed: 11/23/2022] Open
Abstract
Since the outbreak of novel coronavirus in 2019, SARS-CoV-2 has spread worldwide at an unexpected rate, becoming a major global health concern. Although respiratory tract infections represent typical clinical presentation, recently, numerous cases of acute arterial thrombosis and thromboembolic disease have been reported due to COVID-19 infection. Renal artery embolism is a condition that is easily missed due to its infrequent and nonspecific presentation. In this paper, we reported a case of a 63-year-old, previously healthy, male patient who has developed multiple right kidney infarctions due to COVID-19 infection without any respiratory or other typical clinical manifestations. Consecutive RT-PCR tests were negative and the diagnosis was set finally by serological screening. Our presentation has emphasized the necessity of clinical, laboratory, microbiological, and radiological integration in diagnostic approach to this novel and challenging disease with often unusual clinical presentations to avoid false negative discrimination.
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Affiliation(s)
- Ante Mayer
- Department of Nephrology and Hemodialysis, University Hospital Centre of Split, Split, Croatia
| | - Maja Mizdrak
- Department of Nephrology and Hemodialysis, University Hospital Centre of Split, Split, Croatia
- Department of Pathophysiology, University of Split School of Medicine, Split, Croatia
| | - Ivan Mizdrak
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Centre of Split, Split, Croatia
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3
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Brem FL, Tayef TAA, Rasras H, Mahi OE, Ouafi NE, Zakaria B. Concomitant renal and splenic infarctions in a COVID-19-patient with a catastrophic thrombotic syndrome. Radiol Case Rep 2022; 17:4030-4033. [PMID: 35999857 PMCID: PMC9389916 DOI: 10.1016/j.radcr.2022.06.076] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/12/2022] [Accepted: 06/21/2022] [Indexed: 11/29/2022] Open
Abstract
Since the outbreak of the COVID-19 pandemic, thrombotic events have been accurately described in patients infected by the SARS-CoV-2, especially venous thromboembolism. However, the mystery of arterial thrombosis is still unclear. Here, we report the case of a 59-year-old man with diabetes mellitus, admitted for COVID-19-pneumonia complicated by pulmonary embolism, a thrombus in the aortic isthmus, the descending thoracic aorta associated with splenic and left renal infarctions, and an acute right limb ischemia. The etiological assessment of this catastrophic thrombotic syndrome showed no evidence for preexisting inherited or acquired thrombophilia. Our case emphasizes the hypercoagulability state in COVID-19-patient leading to both arterial and venous thromboembolisms and the need to establish adequate strategies for the diagnosis and management of thrombo-embolisms to prevent these potentially fatal complications.
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Affiliation(s)
- Falmata Laouan Brem
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
- Corresponding author.
| | - Taha Abu Al Tayef
- Department of Vascular surgery, Mohamed VI University Hospital Center, Mohamed I University, Oujda, Morocco
| | - Hammam Rasras
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Omar El Mahi
- Department of Vascular surgery, Mohamed VI University Hospital Center, Mohamed I University, Oujda, Morocco
| | - Noha El Ouafi
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
- Epidemiological Laboratory of Clinical Research and Public Health, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Bazid Zakaria
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
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4
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Rey JR, Merino Llorens JL, Iniesta Manjavacas ÁM, Rosillo Rodríguez SO, Castrejón-Castrejón S, Arbas-Redondo E, Poveda-Pinedo ID, Tebar-Márquez D, Severo-Sánchez A, Rivero-Santana B, Juárez-Olmos V, Martínez-Cossiani M, Buño-Soto A, Gonzalez-Valle L, Herrero-Ambrosio A, López-de-Sá E, Caro-Codón J. Influence of statin treatment in a cohort of patients admitted for COVID-19. MEDICINA CLÍNICA (ENGLISH EDITION) 2022; 158:586-595. [PMID: 35693916 PMCID: PMC9166060 DOI: 10.1016/j.medcle.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/05/2021] [Indexed: 01/08/2023]
Abstract
Aims and objectives Statins have been proposed as potentially useful agents for modulating the host response in COVID-19. However, solid evidence-based recommendations are still lacking. Our aim was to study the association between statin use and clinical outcomes in a large cohort of hospitalized patients with SARS-CoV-2 infection, as well as the specific consequences of chronic treatment withdrawal during hospital admission. Material and methods Retrospective observational study including 2191 hospitalized patients with confirmed SARS-CoV-2 infection. Results Mean age was 68.0±17.8 years and 597 (27.3%) patients died during follow-up. A total of 827 patients (37.7% of the whole sample), received chronic treatment with statins. Even though they underwent more frequent admissions in critical care units, chronic treatment with statins was not independently associated with all-cause mortality [HR 0.95 (0.72-1.25)]. During the whole hospital admission, 371 patients (16.9%) received at least one dose of statin. Although these patients had a significantly worse clinical profile, both treatment with statins during admission [HR 1.03 (0.78-1.35)] and withdrawal of chronic statin treatment [HR 1.01 (0.78-1.30)] showed a neutral effect in mortality. However, patients treated with statins presented more frequently hepatic cytolysis, rhabdomyolysis and thrombotic/hemorrhagic events. Conclusions In this large cohort of hospitalized COVID-19 patients, statins were not independently associated with all-cause mortality during follow-up. Clinically relevant statin-associated adverse effects should be carefully monitored during hospital admission.
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Affiliation(s)
- Juan R Rey
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | - Antonio Buño-Soto
- Servicio de Análisis Clínicos, Hospital Universitario La Paz, Madrid, Spain
| | - Luis Gonzalez-Valle
- Servicio de Farmacia Hospitalaria, Hospital Universitario La Paz, Madrid, Spain
| | | | | | - Juan Caro-Codón
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
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5
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Alahyari S, Moradi M, Rajaeinejad M, Jalaeikhoo H. Post-COVID-19 hematologic complications: a systematic review. Expert Rev Hematol 2022; 15:539-546. [PMID: 35584541 DOI: 10.1080/17474086.2022.2080051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION COVID-19 crisis continues around the world. Some patients developed complications after the disease, which have been reported in limited studies. The aim of this study is to comprehensively assess the post-COVID hematologic complications in patients. AREAS COVERED We searched PubMed, Scopus and Google Scholar between January 2020 and August 2021 using related keywords. Evaluation of the articles was performed by two independent researchers. The extracted data included number of patients, age, type of hematological complication, duration of follow-up, response to treatment and prognosis. EXPERT OPINION Sixty five articles reported post-COVID hematologic complications. The most frequent hematologic complication in COVID-19 patients is thromboembolic events, which often occur in two forms: deep vein thrombosis (DVT) and pulmonary emboli (PE). In a group of patients after the diagnosis of COVID-19, a significant decrease in platelets was observed, which was attributed to the ITP induced by COVID-19. Hemolytic anemia and aplastic anemia have also been reported rarely in patients. Finally, post-COVID hematologic complications appear to go beyond thromboembolic events. Although these complications have been reported rarely, searching for methods to identify susceptible patients and prevent these complications could be the subject of future research.
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Affiliation(s)
- Sam Alahyari
- Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Milad Moradi
- Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Rajaeinejad
- AJA Cancer Epidemiology Research and Treatment Center (AJA- CERTC), AJA University of Medical Sciences, Tehran, Iran
| | - Hasan Jalaeikhoo
- AJA Cancer Epidemiology Research and Treatment Center (AJA- CERTC), AJA University of Medical Sciences, Tehran, Iran
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6
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Nuevo equipo editorial, nuevas perspectivas. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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7
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Gupta P, Agarwal R, Atreyapurapu V, Sharma P, Yerramsetty V, Saripalli C, Reddy KS, Atturu G. COVID-19 and clotting: A wave of acute limb ischemia. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2022. [DOI: 10.4103/ijves.ijves_47_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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8
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BONEVA BP, DIMOVA MP, NIKOLOV NK, STOYANOVA BI, ILCHEV BN. Arterial thrombosis: the obscure threat in COVID-19 pandemic victims. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2021. [DOI: 10.23736/s1824-4777.21.01509-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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9
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Caro-Codón J, Rey JR, Buño A, Iniesta AM, Rosillo SO, Castrejon-Castrejon S, Merino C, Marco I, Martinez LA, Garcia-Veas JM, Martin-Polo L, Rodriguez-Sotelo L, Martinez-Cossiani M, Gonzalez-Valle L, Herrero A, López-de-Sá E, Merino JL. Characterization of myocardial injury in a cohort of patients with SARS-CoV-2 infection. MEDICINA CLINICA (ENGLISH ED.) 2021; 157:274-280. [PMID: 34568576 PMCID: PMC8451250 DOI: 10.1016/j.medcle.2021.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/02/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Myocardial injury has been identified as a common complication in patients with COVID-19. However, recent research has serious limitations, such as non-guideline definition of myocardial injury, heterogenicity of troponin sampling or very short-term follow-up. Using data from a large European cohort, we aimed to overcome these pitfalls and adequately characterize myocardial damage in COVID-19. METHODS Consecutive patients with confirmed SARS-CoV-2 infection and available high-sensitive troponin I (hs-TnI), from March 1st to April 20th, 2020 who completed at least 1-month follow-up or died, were studied. RESULTS A total of 918 patients (mean age 63.2 ± 15.5 years, 60.1% male) with a median follow-up of 57 (49-63) days were included. Of these, 190 (20.7%) fulfilled strict criteria for myocardial injury (21.1% chronic, 76.8% acute non-ischemic, 2.1% acute ischemic). Time from onset of symptoms to maximum hs-TnI was 11 (7-18) days. Thrombotic and bleeding events, arrhythmias, heart failure, need for mechanical ventilation and death were significantly more prevalent in patients with higher hs-TnI concentrations, even without fulfilling criteria for myocardial injury. hs-TnI was identified as an independent predictor of mortality [HR 2.52 (1.57-4.04) per 5-logarithmic units increment] after adjusting for multiple relevant covariates. CONCLUSION Elevated hs-TnI is highly prevalent among patients with SARS-CoV-2 infection. Even mild elevations well below the 99th URL were significantly associated with higher rates of cardiac and non-cardiac complications, and higher mortality. Future research should address the role of serial hs-TnI assessment to improve COVID-19 prognostic stratification and clinical outcomes.
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Affiliation(s)
- Juan Caro-Codón
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Juan R Rey
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Antonio Buño
- Clinical Analytics Department, Hospital Universitario La Paz, Madrid, Spain
| | - Angel M Iniesta
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Sandra O Rosillo
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | | | - Carlos Merino
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Irene Marco
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Luis A Martinez
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | | | | | - Alicia Herrero
- Pharmacy Department, Hospital Universitario La Paz, Madrid, Spain
| | | | - Jose L Merino
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
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10
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Caro-Codón J, Rey JR, Buño A, Iniesta AM, Rosillo SO, Castrejon-Castrejon S, Merino C, Marco I, Martinez LA, Garcia-Veas JM, Martin-Polo L, Rodriguez-Sotelo L, Martinez-Cossiani M, Gonzalez-Valle L, Herrero A, López-de-Sá E, Merino JL. Characterization of myocardial injury in a cohort of patients with SARS-CoV-2 infection. Med Clin (Barc) 2021; 157:274-280. [PMID: 33846001 PMCID: PMC7988449 DOI: 10.1016/j.medcli.2021.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/29/2021] [Accepted: 02/02/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Myocardial injury has been identified as a common complication in patients with COVID-19. However, recent research has serious limitations, such as non-guideline definition of myocardial injury, heterogenicity of troponin sampling or very short-term follow-up. Using data from a large European cohort, we aimed to overcome these pitfalls and adequately characterize myocardial damage in COVID-19. METHODS Consecutive patients with confirmed SARS-CoV-2 infection and available high-sensitive troponin I (hs-TnI), from March 1st to April 20th, 2020 who completed at least 1-month follow-up or died, were studied. RESULTS A total of 918 patients (mean age 63.2±15.5 years, 60.1% male) with a median follow-up of 57 (49-63) days were included. Of these, 190 (20.7%) fulfilled strict criteria for myocardial injury (21.1% chronic, 76.8% acute non-ischemic, 2.1% acute ischemic). Time from onset of symptoms to maximum hs-TnI was 11 (7-18) days. Thrombotic and bleeding events, arrhythmias, heart failure, need for mechanical ventilation and death were significantly more prevalent in patients with higher hs-TnI concentrations, even without fulfilling criteria for myocardial injury. hs-TnI was identified as an independent predictor of mortality [HR 2.52 (1.57-4.04) per 5-logarithmic units increment] after adjusting for multiple relevant covariates. CONCLUSION Elevated hs-TnI is highly prevalent among patients with SARS-CoV-2 infection. Even mild elevations well below the 99th URL were significantly associated with higher rates of cardiac and non-cardiac complications, and higher mortality. Future research should address the role of serial hs-TnI assessment to improve COVID-19 prognostic stratification and clinical outcomes.
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Affiliation(s)
- Juan Caro-Codón
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain.
| | - Juan R Rey
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Antonio Buño
- Clinical Analytics Department, Hospital Universitario La Paz, Madrid, Spain
| | - Angel M Iniesta
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Sandra O Rosillo
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | | | - Carlos Merino
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Irene Marco
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Luis A Martinez
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | | | | | - Alicia Herrero
- Pharmacy Department, Hospital Universitario La Paz, Madrid, Spain
| | | | - Jose L Merino
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
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11
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Dayaramani C, De Leon J, Reiss AB. Cardiovascular Disease Complicating COVID-19 in the Elderly. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:833. [PMID: 34441038 PMCID: PMC8399122 DOI: 10.3390/medicina57080833] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 12/20/2022]
Abstract
SARS-CoV-2, a single-stranded RNA coronavirus, causes an illness known as coronavirus disease 2019 (COVID-19). The highly transmissible virus gains entry into human cells primarily by the binding of its spike protein to the angiotensin-converting enzyme 2 receptor, which is expressed not only in lung tissue but also in cardiac myocytes and the vascular endothelium. Cardiovascular complications are frequent in patients with COVID-19 and may be a result of viral-associated systemic and cardiac inflammation or may arise from a virus-induced hypercoagulable state. This prothrombotic state is marked by endothelial dysfunction and platelet activation in both macrovasculature and microvasculature. In patients with subclinical atherosclerosis, COVID-19 may incite atherosclerotic plaque disruption and coronary thrombosis. Hypertension and obesity are common comorbidities in COVID-19 patients that may significantly raise the risk of mortality. Sedentary behaviors, poor diet, and increased use of tobacco and alcohol, associated with prolonged stay-at-home restrictions, may promote thrombosis, while depressed mood due to social isolation can exacerbate poor self-care. Telehealth interventions via smartphone applications and other technologies that document nutrition and offer exercise programs and social connections can be used to mitigate some of the potential damage to heart health.
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Affiliation(s)
| | | | - Allison B. Reiss
- Department of Medicine and Biomedical Research Institute, NYU Long Island School of Medicine, Mineola, NY 11501, USA; (C.D.); (J.D.L.)
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12
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de Cortina Camarero C, Gómez Mariscal E, Espejo Bares V, Núñez Garcia A, Muñoz Aguilera R, Botas Rodriguez J. SARS-CoV-2 infection: A predisposing factor for acute coronary syndrome. MEDICINA CLÍNICA (ENGLISH EDITION) 2021; 157:114-117. [PMID: 34250244 PMCID: PMC8258610 DOI: 10.1016/j.medcle.2021.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 01/19/2021] [Indexed: 12/15/2022]
Abstract
Introduction Several case series of ACS have been reported in COVID 19 patients. We aim to study its incidence, characteristics, and three-month prognosis. To put this incidence in perspective we compared it with the incidence of in-hospital ACS during the same period of 2019. Methods Observational multicenter cohort study of 3.108 COVID-19 patients admitted to two hospitals in Madrid between March 1st and May 15th, 2020. Ten patients suffered an ACS while being hospitalized for COVID 19 and were followed for three months. The ACS incidence in hospitalized patients during the same period of 2019 was also studied. Results The incidence of ACS in COVID-19 patients was 3.31‰, significantly higher than in the 2019 period, 1.01‰ (p = 0.013). COVID-19 patients that suffered and ACS frequently had a severe infection, presented with STEMI (80%), and had multivessel disease (67%). Mortality rate (30%) and hospital readmissions at three months (20%) were very high. Conclusions Severe COVID-19 patients develop ACS more frequently than expected. Although the overall incidence was low, it carried a poor immediate and three-month prognosis.
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13
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Rey JR, Merino Llorens JL, Iniesta Manjavacas ÁM, Rodríguez SOR, Castrejón-Castrejón S, Arbas-Redondo E, Poveda-Pinedo ID, Tebar-Márquez D, Severo-Sánchez A, Rivero-Santana B, Juárez-Olmos V, Martínez-Cossiani M, Buño-Soto A, Gonzalez-Valle L, Herrero-Ambrosio A, López-de-Sá E, Caro-Codón J. Influence of statin treatment in a cohort of patients admitted for COVID-19. Med Clin (Barc) 2021; 158:586-595. [PMID: 34511251 PMCID: PMC8302844 DOI: 10.1016/j.medcli.2021.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/03/2021] [Accepted: 07/05/2021] [Indexed: 01/08/2023]
Abstract
Antecedentes y objetivos Se ha especulado que las estatinas pueden ser de utilidad en el tratamiento de pacientes con COVID-19, pero no existen evidencias clínicas sólidas. El objetivo de este trabajo es conocer su utilidad en una cohorte de gran tamaño de pacientes hospitalizados por COVID-19, así como si su retirada se asocia con un peor pronóstico. Material y métodos Estudio retrospectivo observacional. Se incluyeron 2.191 pacientes hospitalizados con infección confirmada con SARS-CoV-2. Resultados La edad media fue de 68,0 ± 17,8 años y fallecieron un total de 597 (27,3%) pacientes. Un total de 827 pacientes (37,7% de la muestra) estaban tratados previamente con estatinas. Aunque precisaron con mayor frecuencia de ingreso en camas de críticos, dicho grupo terapéutico no resultó un factor predictor independiente de muerte en el seguimiento [HR 0,95 (0,72-1,25)]. Un total de 371 pacientes (16,9%) recibió al menos una dosis de estatina durante el ingreso. A pesar de ser una población con un perfil clínico más desfavorable, tanto su uso [HR 1,03 (0,78-1,35)] como la suspensión durante el ingreso en pacientes que las recibían crónicamente [HR 1,01 (0,78-1,30)] presentaron un efecto neutro en la mortalidad. No obstante, el grupo con estatinas desarrolló con mayor frecuencia datos de citolisis hepática, rabdomiolisis y más eventos trombóticos y hemorrágicos. Conclusiones En nuestra muestra, las estatinas no se asociaron de forma independiente a una menor mortalidad en pacientes con COVID-19. En aquellos pacientes que tengan indicación de recibirlas por su patología previa es necesario monitorizar estrechamente sus potenciales efectos adversos durante el ingreso hospitalario.
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Affiliation(s)
- Juan R Rey
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, España.
| | | | | | | | | | | | | | | | | | | | | | | | - Antonio Buño-Soto
- Servicio de Análisis Clínicos, Hospital Universitario La Paz, Madrid, España
| | - Luis Gonzalez-Valle
- Servicio de Farmacia Hospitalaria, Hospital Universitario La Paz, Madrid, España
| | | | | | - Juan Caro-Codón
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, España
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14
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Topcu AC, Ozturk-Altunyurt G, Akman D, Batirel A, Demirhan R. Acute Limb Ischemia in Hospitalized COVID-19 Patients. Ann Vasc Surg 2021; 74:88-94. [PMID: 33819591 PMCID: PMC8017914 DOI: 10.1016/j.avsg.2021.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/09/2021] [Accepted: 03/16/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND COVID-19 is a multisystemic disorder. Hematologic and cardiovascular involvement of COVID-19 causes thromboembolic events across multiple organs which mainly manifest as venous thromboembolism, and rarely, peripheral arterial thromboembolic events. In-situ thrombosis of a healthy, non-atherosclerotic native artery is rare, and COVID-19 has been reported to be a cause of this phenomenon. We aimed to report our institutional experience with COVID-19 patients who developed acute limb ischemia (ALI) during hospitalization or after discharge. METHODS This was a single-center cross-sectional study. Records of all patients ≥18 years of age admitted to a tertiary center with a confirmed diagnosis of COVID-19 infection between September 1 and December 31, 2020 were retrospectively examined. Data regarding patient demographics, co-morbidities and outcomes were collected. Patients were followed-up during index hospitalization and for 30 days postdischarge. Acute limb ischemia was diagnosed by means of duplex ultrasound and computed tomography angiography in the presence of a clinical suspicion. RESULTS A total of 681 consecutive patients (38.5% women) were hospitalized with a confirmed diagnosis of COVID-19 during the study period. Median age was 63 years (IQR, 52-74). In-hospital mortality occurred in 94 (13.8%) patients. Ninety (13.2%) patients required intensive care unit admission at some point of their hospital stay. Six (0.9%) patients (one woman) with a median age of 62 years experienced ALI (IQR, 59-64.3). All patients were receiving low molecular weight heparin when they developed ALI. The median of duration between COVID-19 diagnosis and ALI symptom onset was 13 days (IQR, 11.3-14). Three patients underwent emergent surgical thrombectomy combined with systemic anticoagulation, and 3 received systemic anticoagulation alone. Two patients with ALI did not survive to hospital discharge. Among survivors, 1 patient underwent bilateral major amputations, and another underwent a minor amputation within 1 month of hospital discharge. Symptoms of ALI completely resolved in 2 patients without sequelae. CONCLUSIONS COVID-19 is a multisystemic disorder with involvement of hematologic and cardiovascular systems. Despite widespread use of thromboprophylaxis, hospitalized patients with COVID-19 are at increased risk of ALI, and subsequent limb loss or even death.
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Affiliation(s)
- Ahmet Can Topcu
- Department of Cardiovascular Surgery, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey.
| | - Gozde Ozturk-Altunyurt
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Dilara Akman
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Ayse Batirel
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Recep Demirhan
- Department of Thoracic Surgery, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
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15
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Ulloa JH, Figueroa V, Cifuentes JS, Pinto P, Lurie F. The Impact of COVID-19 on Vascular Surgery Practice: A Systematic Review. Vasc Endovascular Surg 2021; 55:601-611. [PMID: 33657926 DOI: 10.1177/1538574421998212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND COVID-19 is characterized by a pulmonary interstitial compromise which can require intensive care unit (ICU) and mechanical ventilation. Covid patients develop a wide range of pathologies. This study aims to identify the impact of COVID-19 in diseases commonly treated by vascular surgeons. METHODS Four conditions were selected: venous thromboembolism (VTE), pulmonary embolism (PE), peripheral arterial disease (PAD), and microangiopathy. A systematic review of the literature using PRISMA guidelines was. RESULTS Out of 1195 papers reviewed for conditions in COVID-19 patients relevant to routine vascular surgery practice, 43 papers were included and analyzed. Venous thrombosis was found to be the most common COVID-19 associated pathology with a cumulative incidence of 25% at 7 days and 48% at 14 days. Additionally, D-dimer levels proved to be a good predictor, even in the early stages of the disease with a sensitivity of 85%, specificity of 88.5% and a negative predictive value of 94.7%. Patients in the ICU demonstrated a significantly higher risk of developing VTE, even when receiving pharmacologic thromboprophylaxis. Although evidence of arterial thrombosis was less common (1% to 16.3%), its consequences were typically more serious, including limb loss and death even in young individuals (OR = 25, 95% CI). Finally, microangiopathy has a wide spectrum of clinical presentations from retinal microangiopathy to other more severe manifestations such as myocardial injury, pulmonary compromise and potential multiple organ dysfunction syndrome. CONCLUSIONS Although the pathophysiological pathway by which COVID-19 produces thrombosis is not completely clear, the incidence of both arterial and venous thrombosis is increased. D-dimer screening should be done in all COVID-19 patients, as a predictor of thrombotic complications.
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Affiliation(s)
| | - Valentin Figueroa
- 173061Hospital Universitario de la Fundacion Santa Fe de Bogota, Bogotá, Colombia
| | | | - Paula Pinto
- 27991Universidad de los Andes, Bogota, Colombia
| | - Fedor Lurie
- 92661Jobst Vascular Institute, Toledo, OH, USA.,University of Michigan, Ann Arbor, MI, USA
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16
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Caro-Codón J, Rey JR, Buño A, Iniesta AM, Rosillo SO, Castrejon-Castrejon S, Rodriguez-Sotelo L, Martinez LA, Marco I, Merino C, Martin-Polo L, Garcia-Veas JM, Martinez-Cossiani M, Gonzalez-Valle L, Herrero A, López-de-Sa E, Merino JL. Characterization of NT-proBNP in a large cohort of COVID-19 patients. Eur J Heart Fail 2021; 23:456-464. [PMID: 33421281 PMCID: PMC8013330 DOI: 10.1002/ejhf.2095] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/02/2021] [Accepted: 01/05/2021] [Indexed: 12/14/2022] Open
Abstract
Aims Extensive research regarding the association of troponin and prognosis in coronavirus disease 2019 (COVID‐19) has been performed. However, data regarding natriuretic peptides are scarce. N‐terminal pro B‐type natriuretic peptide (NT‐proBNP) reflects haemodynamic stress and has proven useful for risk stratification in heart failure (HF) and other conditions such as pulmonary embolism and pneumonia. We aimed to adequately characterize NT‐proBNP concentrations using a large cohort of patients with COVID‐19, and to investigate its association with prognosis. Methods and results Consecutive patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection and available NT‐proBNP determinations, from March 1st to April 20th, 2020 who completed at least 1‐month follow‐up or died, were studied. Of 3080 screened patients, a total of 396 (mean age 71.8 ± 14.6 years, 61.1% male) fulfilled all the selection criteria and were finally included, with a median follow‐up of 53 (18–62) days. Of those, 192 (48.5%) presented NT‐proBNP levels above the recommended cut‐off for the identification of HF. However, only 47 fulfilled the clinical criteria for the diagnosis of HF. Patients with higher NT‐proBNP during admission experienced more frequent bleeding, arrhythmias and HF decompensations. NT‐proBNP was associated with mortality both in the whole study population and after excluding patients with HF. A multivariable Cox model confirmed that NT‐proBNP was independently associated with mortality after adjusting for all relevant confounders (hazard ratio 1.28, 95% confidence interval 1.13–1.44, per logarithmic unit). Conclusion NT‐proBNP is frequently elevated in COVID‐19. It is strongly and independently associated with mortality after adjusting for relevant confounders, including chronic HF and acute HF. Therefore, its use may improve early prognostic stratification in this condition.
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Affiliation(s)
- Juan Caro-Codón
- Cardiology, Hospital Universitario La Paz, IdiPaz, CiberCV, Madrid, Spain
| | - Juan R Rey
- Cardiology, Hospital Universitario La Paz, IdiPaz, CiberCV, Madrid, Spain
| | - Antonio Buño
- Clinical Analytics, Hospital Universitario La Paz, IdiPaz, CiberCV, Madrid, Spain
| | - Angel M Iniesta
- Cardiology, Hospital Universitario La Paz, IdiPaz, CiberCV, Madrid, Spain
| | - Sandra O Rosillo
- Cardiology, Hospital Universitario La Paz, IdiPaz, CiberCV, Madrid, Spain
| | | | | | - Luis A Martinez
- Cardiology, Hospital Universitario La Paz, IdiPaz, CiberCV, Madrid, Spain
| | - Irene Marco
- Cardiology, Hospital Universitario La Paz, IdiPaz, CiberCV, Madrid, Spain
| | - Carlos Merino
- Cardiology, Hospital Universitario La Paz, IdiPaz, CiberCV, Madrid, Spain
| | - Lorena Martin-Polo
- Cardiology, Hospital Universitario La Paz, IdiPaz, CiberCV, Madrid, Spain
| | - Jose M Garcia-Veas
- Cardiology, Hospital Universitario La Paz, IdiPaz, CiberCV, Madrid, Spain
| | | | - Luis Gonzalez-Valle
- Pharmacy Department, Hospital Universitario La Paz, IdiPaz, CiberCV, Madrid, Spain
| | - Alicia Herrero
- Pharmacy Department, Hospital Universitario La Paz, IdiPaz, CiberCV, Madrid, Spain
| | | | - Jose L Merino
- Cardiology, Hospital Universitario La Paz, IdiPaz, CiberCV, Madrid, Spain
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17
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de Cortina Camarero C, Gómez Mariscal E, Espejo Bares V, Núñez Garcia A, Muñoz Aguilera R, Botas Rodriguez J. [SARS-CoV-2 infection: A predisposing factor for acute coronary syndrome]. Med Clin (Barc) 2021; 157:114-117. [PMID: 33632511 PMCID: PMC7843069 DOI: 10.1016/j.medcli.2021.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 12/15/2022]
Abstract
Introducción Se han reportado series de casos de SCA en pacientes COVID 19. Nuestro objetivo fue describir su incidencia, características, y pronóstico a 3 meses. Para contextualizar esta incidencia se comparó con la incidencia de SCA intrahospitalarios durante el mismo periodo del 2019. Métodos Estudio observacional de cohortes multicéntrico, de 3.108 pacientes COVID-19 ingresados en dos hospitales madrileños, entre el 1 de marzo y 15 de mayo de 2020. Diez pacientes sufrieron un SCA durante la fase hospitalaria realizándose un seguimiento clínico de 3 meses. Se estudiaron asimismo los pacientes con SCA intrahospitalarios durante el mismo periodo del 2019. Resultados La incidencia de SCA en COVID-19 fue 3,31‰, significativamente superior a la del periodo 2019, de 1,01‰ (p=0,013). Los pacientes COVID-19 con SCA, tenían una infección grave, mayoritariamente SCACEST (80%) y enfermedad multivaso (67%). La tasa de mortalidad (30%) y reingresos hospitalarios a 3 meses (20%) fueron muy elevadas. Conclusiones El SCA es una complicación más frecuente de lo habitual en COVID-19 grave pero poco común y con mal pronóstico inmediato y a 3 meses.
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Affiliation(s)
| | - Eloy Gómez Mariscal
- Servicio de Cardiología, Hospital Universitario Infanta Leonor, Madrid, España
| | | | - Alberto Núñez Garcia
- Servicio de Cardiología, Hospital Universitario Fundación Alcorcón, Madrid, España
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18
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Valga F, Vega-Díaz N, Macía M, Rodríguez-Pérez JC. A new inflammatory-microthrombotic syndrome as an explanation for thrombotic complications in patients with COVID-19. REVISTA ESPAÑOLA DE CARDIOLOGÍA (ENGLISH EDITION) 2021; 74:115-116. [PMID: 33069615 PMCID: PMC7531278 DOI: 10.1016/j.rec.2020.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/18/2020] [Indexed: 11/01/2022]
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19
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Kow CS, Hasan SS. The use of antiplatelet agents for arterial thromboprophylaxis in COVID-19. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2021; 74:114-115. [PMID: 32933883 PMCID: PMC7455174 DOI: 10.1016/j.rec.2020.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/14/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Chia Siang Kow
- School of Postgraduate Studies, International Medical University, Kuala Lumpur, Malaysia.
| | - Syed Shahzad Hasan
- Department of Pharmacy, University of Huddersfield, Huddersfield, United Kingdom
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20
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Putko RM, Bedrin MD, Clark DM, Piscoya AS, Dunn JC, Nesti LJ. SARS-CoV-2 and limb ischemia: A systematic review. J Clin Orthop Trauma 2021; 12:194-199. [PMID: 33281415 PMCID: PMC7700725 DOI: 10.1016/j.jcot.2020.11.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Recent spread of severe acute respiratory coronavirus syndrome-2 (SARS-CoV-2) has led to the coronavirus disease (COVID-19) pandemic, resulting in new challenges across all medical specialties. Limb and digit ischemia have been associated with COVID-19 infection. This systematic review includes primary studies of COVID-19 limb ischemia to identify risk factors, comorbidities, case characteristics, and treatment strategies to better understand the nature of this disease and its effects on the extremities. METHODS A literature search for studies detailing COVID-19 infected patients with limb or digit ischemia was performed, identifying 157 articles, 12 of which met inclusion criteria, accounting for 47 patients. Inclusion criteria were (1) primary studies, (2) positive disease diagnosis (3) limb ischemia, (4) reported treatment. Demographic data, case characteristics, treatments, outcomes and mortality were collected and pooled. RESULTS The average patient age was 67.6 years, predominantly male (79.6%). Of the 44 cases discussing treatment, 13 (30%) patients underwent medical treatment alone, while 23 (52.3%) patients underwent medical plus surgical treatment. Four patients (9.1%) were treated with observation. In 10 of the 12 studies, lab findings, thrombosis, or conclusions supporting a hypercoagulable state as a cause of limb/digit ischemia were cited. Five patients (10.6%) were on vasopressors and 8 patients (17.0%) were on a ventilator. Of those treated with observation alone, there was 100% resolution of symptoms. Of those treated medically without surgical intervention (17 patients), 6 patients (35.3%) were reported to have revascularization, 6 patients (35.3%) died, and the remaining outcomes were not reported. Medical and surgical treatment resulted in one limb amputation (4.4%) and altogether 74% of patients achieved revascularization of the affected limb/digit. Mortality rate was 45%. CONCLUSIONS COVID-19 infection may be associated with increased risk of limb or digital ischemia, although the quality of evidence supporting this theory is limited. Evidence of inflammatory-mediated thrombosis and endothelial injury are possible explanations which would support the use of immunotherapy in addition to anticoagulation for treatment or prevention of thromboembolic events. Current outcomes and treatment strategies are variable. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Robert M. Putko
- Department of Orthopaedic Surgery, Uniformed Services University - Walter Reed National Military Medical Center Surgery, Bethesda, MD, 20889, USA
- Corresponding author. Department of Orthopaedic Surgery, Uniformed Services University - Walter Reed National Military Medical Center Surgery, 8901 Wisconsin Ave, America Building (19), 2nd Floor, Bethesda, MD, 20889, USA.
| | - Michael D. Bedrin
- Department of Orthopaedic Surgery, Uniformed Services University - Walter Reed National Military Medical Center Surgery, Bethesda, MD, 20889, USA
| | - DesRaj M. Clark
- Department of Orthopaedic Surgery, Uniformed Services University - Walter Reed National Military Medical Center Surgery, Bethesda, MD, 20889, USA
| | - Andres S. Piscoya
- Department of Orthopaedic Surgery, Uniformed Services University - Walter Reed National Military Medical Center Surgery, Bethesda, MD, 20889, USA
| | - John C. Dunn
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, TX, 79920, USA
| | - Leon J. Nesti
- Department of Orthopaedic Surgery, Uniformed Services University - Walter Reed National Military Medical Center Surgery, Bethesda, MD, 20889, USA
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21
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Arterial thrombotic complications in hospitalized patients with COVID-19. Response to related letters. REVISTA ESPAÑOLA DE CARDIOLOGÍA (ENGLISH EDITION) 2021; 74:116. [PMID: 33121911 PMCID: PMC7550077 DOI: 10.1016/j.rec.2020.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 09/09/2020] [Indexed: 11/23/2022]
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22
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Malas MB, Naazie IN, Elsayed N, Mathlouthi A, Marmor R, Clary B. Thromboembolism risk of COVID-19 is high and associated with a higher risk of mortality: A systematic review and meta-analysis. EClinicalMedicine 2020; 29:100639. [PMID: 33251499 PMCID: PMC7679115 DOI: 10.1016/j.eclinm.2020.100639] [Citation(s) in RCA: 387] [Impact Index Per Article: 96.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/31/2020] [Accepted: 11/02/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Studies have suggested that there is increased risk of thromboembolism (TE) associated with coronavirus disease 2019 (COVID-19). However, overall arterial and venous TE rates of COVID-19 and effect of TE on COVID-19 mortality is unknown. METHODS We did a systematic review and meta-analysis of studies evaluating TE in COVID-19. We searched PubMed, Cochrane, and Embase for studies published up to June 12, 2020. Random effects models were used to produce summary TE rates and odds ratios (OR) of mortality in COVID-19 patients with TE compared to those without TE. Heterogeneity was quantified with I 2 . FINDINGS Of 425 studies identified, 42 studies enrolling 8271 patients were included in the meta-analysis. Overall venous TE rate was 21% (95% CI:17-26%): ICU, 31% (95% CI: 23-39%). Overall deep vein thrombosis rate was 20% (95% CI: 13-28%): ICU, 28% (95% CI: 16-41%); postmortem, 35% (95% CI:15-57%). Overall pulmonary embolism rate was 13% (95% CI: 11-16%): ICU, 19% (95% CI:14-25%); postmortem, 22% (95% CI:16-28%). Overall arterial TE rate was 2% (95% CI: 1-4%): ICU, 5% (95%CI: 3-7%). Pooled mortality rate among patients with TE was 23% (95%CI:14-32%) and 13% (95% CI:6-22%) among patients without TE. The pooled odds of mortality were 74% higher among patients who developed TE compared to those who did not (OR, 1.74; 95%CI, 1.01-2.98; P = 0.04). INTERPRETATION TE rates of COVID-19 are high and associated with higher risk of death. Robust evidence from ongoing clinical trials is needed to determine the impact of thromboprophylaxis on TE and mortality risk of COVID-19. FUNDING None.
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Affiliation(s)
| | | | - Nadin Elsayed
- Department of Surgery, University of California San Diego Health System, San Diego, CA 92093, United States
| | - Asma Mathlouthi
- Department of Surgery, University of California San Diego Health System, San Diego, CA 92093, United States
| | - Rebecca Marmor
- Department of Surgery, University of California San Diego Health System, San Diego, CA 92093, United States
| | - Bryan Clary
- Department of Surgery, University of California San Diego Health System, San Diego, CA 92093, United States
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23
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Incidence of thrombotic outcomes for patients hospitalized and discharged after COVID-19 infection. Thromb Res 2020; 196:491-493. [PMID: 33091702 PMCID: PMC7557256 DOI: 10.1016/j.thromres.2020.10.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/17/2020] [Accepted: 10/08/2020] [Indexed: 12/24/2022]
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24
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Rey JR, Caro-Codón J, Rosillo SO, Iniesta ÁM, Castrejón-Castrejón S, Marco-Clement I, Martín-Polo L, Merino-Argos C, Rodríguez-Sotelo L, García-Veas JM, Martínez-Marín LA, Martínez-Cossiani M, Buño A, Gonzalez-Valle L, Herrero A, López-Sendón JL, Merino JL. Heart failure in COVID-19 patients: prevalence, incidence and prognostic implications. Eur J Heart Fail 2020; 22:2205-2215. [PMID: 32833283 PMCID: PMC7461427 DOI: 10.1002/ejhf.1990] [Citation(s) in RCA: 164] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/04/2020] [Accepted: 08/18/2020] [Indexed: 02/06/2023] Open
Abstract
AIMS Data on the impact of COVID-19 in chronic heart failure (CHF) patients and its potential to trigger acute heart failure (AHF) are lacking. The aim of this work was to study characteristics, cardiovascular outcomes and mortality in patients with confirmed COVID-19 infection and a prior diagnosis of heart failure (HF). Further aims included the identification of predictors and prognostic implications for AHF decompensation during hospital admission and the determination of a potential correlation between the withdrawal of HF guideline-directed medical therapy (GDMT) and worse outcomes during hospitalization. METHODS AND RESULTS Data for a total of 3080 consecutive patients with confirmed COVID-19 infection and follow-up of at least 30 days were analysed. Patients with a previous history of CHF (n = 152, 4.9%) were more prone to the development of AHF (11.2% vs. 2.1%; P < 0.001) and had higher levels of N-terminal pro brain natriuretic peptide. In addition, patients with previous CHF had higher mortality rates (48.7% vs. 19.0%; P < 0.001). In contrast, 77 patients (2.5%) were diagnosed with AHF, which in the vast majority of cases (77.9%) developed in patients without a history of HF. Arrhythmias during hospital admission and CHF were the main predictors of AHF. Patients developing AHF had significantly higher mortality (46.8% vs. 19.7%; P < 0.001). Finally, the withdrawal of beta-blockers, mineralocorticoid receptor antagonists and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was associated with a significant increase in in-hospital mortality. CONCLUSIONS Patients with COVID-19 have a significant incidence of AHF, which is associated with very high mortality rates. Moreover, patients with a history of CHF are prone to developing acute decompensation after a COVID-19 diagnosis. The withdrawal of GDMT was associated with higher mortality.
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Affiliation(s)
- Juan R Rey
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Juan Caro-Codón
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Sandra O Rosillo
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Ángel M Iniesta
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | | | | | | | | | | | - Antonio Buño
- Clinical Analytics, Hospital Universitario La Paz, Madrid, Spain
| | | | - Alicia Herrero
- Pharmacy Department, Hospital Universitario La Paz, Madrid, Spain
| | | | - José L Merino
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
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25
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Kow CS, Hasan SS. [The use of antiplatelet agents for arterial thromboprophylaxis in COVID-19]. Rev Esp Cardiol 2020; 74:114-115. [PMID: 32989336 PMCID: PMC7510769 DOI: 10.1016/j.recesp.2020.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Chia Siang Kow
- School of Postgraduate Studies, International Medical University, Kuala Lumpur, Malasia
| | - Syed Shahzad Hasan
- Department of Pharmacy, University of Huddersfield, Huddersfield, Reino Unido
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26
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Rey JR, Merino JL, Iniesta ÁM, Caro-Codón J. [Arterial thrombotic complications in hospitalized patients with COVID-19. Response to related letters]. Rev Esp Cardiol 2020; 74:116. [PMID: 32958974 PMCID: PMC7494312 DOI: 10.1016/j.recesp.2020.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Juan R Rey
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, España
| | - José Luis Merino
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, España
| | - Ángel M Iniesta
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, España
| | - Juan Caro-Codón
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, España
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27
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Valga F, Vega-Díaz N, Macía M, Rodríguez-Pérez JC. [A new inflammatory-microthrombotic syndrome as an explanation for thrombotic complications in patients with COVID-19]. Rev Esp Cardiol 2020; 74:115-116. [PMID: 32901168 PMCID: PMC7470697 DOI: 10.1016/j.recesp.2020.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Francisco Valga
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, España
| | - Nicanor Vega-Díaz
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, España
| | - Manuel Macía
- Servicio de Nefrología, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, España
| | - José Carlos Rodríguez-Pérez
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, España
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28
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Abstract
A striking feature of COVID-19 is the high frequency of thrombosis, particularly in patients who require admission to intensive care unit because of respiratory complications (pneumonia/adult respiratory distress syndrome). The spectrum of thrombotic events is wide, including in situ pulmonary thrombosis, deep-vein thrombosis and associated pulmonary embolism, as well as arterial thrombotic events (stroke, myocardial infarction, limb artery thrombosis). Unusual thrombotic events have also been reported, e.g., cerebral venous sinus thrombosis, mesenteric artery and vein thrombosis. Several hematology abnormalities have been observed in COVID-19 patients, including lymphopenia, neutrophilia, thrombocytopenia (usually mild), thrombocytosis, elevated prothrombin time and partial thromboplastin times (the latter abnormality often indicating lupus anticoagulant phenomenon), hyperfibrinogenemia, elevated von Willebrand factor levels, and elevated fibrin d-dimer. Many of these abnormal hematologic parameters—even as early as the time of initial hospital admission—indicate adverse prognosis, including greater frequency of progression to severe respiratory illness and death. Progression to overt disseminated intravascular coagulation in fatal COVID-19 has been reported in some studies, but not observed in others. We compare and contrast COVID-19 hypercoagulability, and associated increased risk of venous and arterial thrombosis, from the perspective of heparin-induced thrombocytopenia (HIT), including the dilemma of providing thromboprophylaxis and treatment recommendations when available data are limited to observational studies. The frequent use of heparin—both low-molecular-weight and unfractionated—in preventing and treating COVID-19 thrombosis, means that vigilance for HIT occurrence is required in this patient population. HIT and COVID-19 are associated with a high risk of thrombosis (venous > arterial). HIT and COVID-19 both feature coagulation and “pancellular” activation. Therapeutic anticoagulation is indicated for HIT, but dosing unknown for COVID-19.
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