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Sonaglioni A, Lombardo M, Albini A, Harari S. High-risk pulmonary embolism in a post-COVID 19 female under hormonal contraception. Eur Heart J Case Rep 2023; 7:ytad547. [PMID: 38025128 PMCID: PMC10645401 DOI: 10.1093/ehjcr/ytad547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/18/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Andrea Sonaglioni
- Department of Cardiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Via San Vittore 12, 20123 Milan, Italy
| | - Michele Lombardo
- Department of Cardiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Via San Vittore 12, 20123 Milan, Italy
| | - Adriana Albini
- Scientific Directorate, European Institute of Oncology (IEO) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Sergio Harari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Buso G, Mazzolai L, Rueda-Camino JA, Fernández-Capitán C, Jiménez D, Bikdeli B, Lobo JL, Fernández-Reyes JL, Ciammaichella M, Monreal M. Pulmonary Embolism in Patients with COVID-19: Comparison between Different Care Settings. Semin Thromb Hemost 2023; 49:34-46. [PMID: 34902865 DOI: 10.1055/s-0041-1740152] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The clinical characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) who develop pulmonary embolism (PE) in the full spectrum of patient care settings need to be elucidated. The aim of this study was to compare the clinical characteristics, treatment, and 90-day outcomes in patients diagnosed with PE while recovering from COVID-19 in the outpatient setting versus those who were diagnosed with PE while being hospitalized with COVID-19. Data from the international Registro Informatizado de Enfermedad TromboEmbólica (RIETE) registry were used. The major study outcomes were all-cause death, major bleeding, and venous thromboembolism (VTE) recurrences during the first 90 days after PE. From March 2020 to March 2021, 737 patients with COVID-19 experienced acute PE. Of these, 340 (46%) were recovering from COVID-19 as outpatients (267 patients who had been treated at home for COVID-19 and 73 discharged after being hospitalized with COVID-19). Compared with inpatients with COVID-19, those recovering in the outpatient setting upon PE were less likely to be men (odds ratio [OR]: 0.54; 95% confidence interval [CI]: 0.40-0.72) and less likely to have hypertension (OR: 0.55; 95% CI: 0.41-0.74) or diabetes (OR: 0.51; 95% CI: 0.33-0.76). At 90-day follow-up, eight patients (none recovering from COVID-19 as outpatient vs. 2.4% of inpatients with COVID-19) developed recurrent VTE, 34 (1.9 vs. 7.9%) had major bleeding, and 128 (10 vs. 24%) died. On multivariable analysis, inpatients with COVID-19 were at a higher risk of major bleeding (adjusted hazard ratio [HR]: 6.80; 95% CI: 1.52-30.4) or death (adjusted HR: 2.24; 95% CI: 1.40-3.58). In conclusion, using a large multinational registry of patients with COVID-19 who experienced PE, thromboembolic episodes occurring in those recovering from COVID-19 as outpatients were associated with less ominous outcomes than inpatients with COVID-19.
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Affiliation(s)
- Giacomo Buso
- Angiology Division, Heart and Vessels Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Lucia Mazzolai
- Angiology Division, Heart and Vessels Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | | | | | - David Jiménez
- Respiratory Department, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain.,Medicine Department, Universidad de Alcala, Madrid, Spain
| | - Behnood Bikdeli
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Yale/YNHH Center for Outcomes Research & Evaluation (CORE), New Haven, Connecticut.,Cardiovascular Research Foundation (CRF), New York, New York
| | - José Luis Lobo
- Department of Pneumonology, Hospital Universitario Araba, Álava, Spain
| | | | | | - Manuel Monreal
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol. Badalona, Barcelona, Spain.,Chair for the Study of Thromboembolic Disease, Faculty of Health Sciences, UCAM - Universidad Católica San Antonio de Murcia, Spain
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ALGhasab NS, Altamimi LA, Alharbi MS, ALMesned SS, Khetan AK. Venous thromboembolism in COVID-19: A meta-summary of cases. Saudi Med J 2022; 43:979-990. [PMID: 36104055 PMCID: PMC9987652 DOI: 10.15537/smj.2022.43.9.20220316] [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: 04/15/2022] [Accepted: 06/13/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To summarize cases of venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT) among coronavirus disease (COVID-19) patients and discuss their symptoms, diagnostic method, clinical features, and prognosis. METHODS All major databases were searched for relevant studies published between December 1, 2019 and May 5, 2021. RESULTS A total of 233 articles were identified, 22 describing 48 patients were included. A total of 79.1% had PE and 20.9% had DVT. Most patients were men, with a mean age of 56 years. Comorbidities were present in 70.8%, and 85.4% had at least one risk factor of VTE. 56.3% had received anticoagulation therapy. Most patients were treated in the general ward. Complications occurred in 27.1% of the patients, and recovery was achieved in 80.4%. CONCLUSION Venous thromboembolism must be suspected even in patients who had received prior anticoagulant regimens or in stable cases, especially in males, the elderly, and patients with comorbidities and high D-dimer levels.
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Affiliation(s)
- Naif Saad ALGhasab
- From the Department of Internal Medicine (ALGhasab), Medical Collage, Ha’il University; from the Department of Medicine (Alharbi), College of Medicine, University of Ha’il, Ha’il; from the College of Medicine (Altamimi), King Saud University, Riyadh; from the Department of Surgery (ALMesned), Medical College, Qassim University, Buraydah, Kingdom of Saudi Arabia; and from the Department of Medicine (ALGhasab, Khetan), McMaster University, Canada.
| | - Leen A. Altamimi
- From the Department of Internal Medicine (ALGhasab), Medical Collage, Ha’il University; from the Department of Medicine (Alharbi), College of Medicine, University of Ha’il, Ha’il; from the College of Medicine (Altamimi), King Saud University, Riyadh; from the Department of Surgery (ALMesned), Medical College, Qassim University, Buraydah, Kingdom of Saudi Arabia; and from the Department of Medicine (ALGhasab, Khetan), McMaster University, Canada.
- Address correspondence and reprint request to: Dr. Leen A. Altamimi, from the College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail: ORCID ID: https://orcid.org/0000-0003-3718-5291
| | - Mohammed Salem Alharbi
- From the Department of Internal Medicine (ALGhasab), Medical Collage, Ha’il University; from the Department of Medicine (Alharbi), College of Medicine, University of Ha’il, Ha’il; from the College of Medicine (Altamimi), King Saud University, Riyadh; from the Department of Surgery (ALMesned), Medical College, Qassim University, Buraydah, Kingdom of Saudi Arabia; and from the Department of Medicine (ALGhasab, Khetan), McMaster University, Canada.
| | - Sulaman S. ALMesned
- From the Department of Internal Medicine (ALGhasab), Medical Collage, Ha’il University; from the Department of Medicine (Alharbi), College of Medicine, University of Ha’il, Ha’il; from the College of Medicine (Altamimi), King Saud University, Riyadh; from the Department of Surgery (ALMesned), Medical College, Qassim University, Buraydah, Kingdom of Saudi Arabia; and from the Department of Medicine (ALGhasab, Khetan), McMaster University, Canada.
| | - Aditya K. Khetan
- From the Department of Internal Medicine (ALGhasab), Medical Collage, Ha’il University; from the Department of Medicine (Alharbi), College of Medicine, University of Ha’il, Ha’il; from the College of Medicine (Altamimi), King Saud University, Riyadh; from the Department of Surgery (ALMesned), Medical College, Qassim University, Buraydah, Kingdom of Saudi Arabia; and from the Department of Medicine (ALGhasab, Khetan), McMaster University, Canada.
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Valenzuela-Vallejo L, Corredor-Orlandelli D, Alzate-Ricaurte S, Hernández-Santamaría V, Aguirre-Ruiz JF, Peña-Peña A. Hormonal Contraception and Massive Pulmonary Embolism in a COVID-19 Ambulatory Patient: A Case Report. Clin Pract 2021; 11:914-918. [PMID: 34940004 PMCID: PMC8700756 DOI: 10.3390/clinpract11040105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 10/22/2021] [Accepted: 11/05/2021] [Indexed: 11/16/2022] Open
Abstract
Coronavirus 19 disease (COVID-19) presents a highly variable clinical presentation and course, ranging from asymptomatic patients to rapidly progressive, fatal pneumonia. The known heterogeneous outcomes can affect both previously healthy patients and those with significant comorbidities, who develop clinical courses with possibly more multisystemic compromise. Likewise, the development of thrombotic phenomena during the acute course of the disease is associated with complications that worsen patient prognosis. We present a case report of a 45-year-old multiparous patient with a history of overweight and chronic use of oral hormonal contraception with low doses of levonorgestrel and estradiol as the only risk factors favoring the development of thrombotic events. During her outpatient COVID-19 clinical course, she developed massive pulmonary thromboembolism resulting in secondary obstructive shock, which required pharmacological thrombolysis. At discharge, hormonal contraception was considered contraindicated, and the patient was released from our institution with continued oral anticoagulant therapy. COVID-19 infection, contraceptive hormone therapy, and overweight are known risk factors for the development of thromboembolic events. The impact of their concomitance has not been studied to date. From our experience, we discuss the impact these risk factors have when present together and invite others to report similar cases.
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Affiliation(s)
- Laura Valenzuela-Vallejo
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 110111, Colombia; (D.C.-O.); (S.A.-R.); (V.H.-S.)
- Correspondence: ; Tel.: +57-(857)-4378300
| | - David Corredor-Orlandelli
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 110111, Colombia; (D.C.-O.); (S.A.-R.); (V.H.-S.)
| | - Sergio Alzate-Ricaurte
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 110111, Colombia; (D.C.-O.); (S.A.-R.); (V.H.-S.)
| | - Valentina Hernández-Santamaría
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 110111, Colombia; (D.C.-O.); (S.A.-R.); (V.H.-S.)
| | - Juan Felipe Aguirre-Ruiz
- Internal Medicine Department Fundación Cardioinfantil—LaCardio, Bogotá 110111, Colombia; (J.F.A.-R.); (A.P.-P.)
| | - Adwar Peña-Peña
- Internal Medicine Department Fundación Cardioinfantil—LaCardio, Bogotá 110111, Colombia; (J.F.A.-R.); (A.P.-P.)
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Yadav P, Kumar D, Meena DS, Midha NK, Bohra GK, Garg MK, Purohit AH. Post-Discharge Prophylactic Anticoagulation in COVID-19 Patients: A Clinical Dilemma. Cardiovasc Hematol Disord Drug Targets 2021; 21:206-209. [PMID: 34521335 DOI: 10.2174/1871529x21666210914113752] [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] [Received: 01/15/2021] [Revised: 06/28/2021] [Accepted: 07/03/2021] [Indexed: 11/22/2022]
Abstract
COVID-19 pandemic has taken a great toll on the health care system worldwide. Along with the pandemic, there is also a concern regarding post COVID-19 complications in recovered patients. Thromboembolism (TE) has been reported as a fatal complication in recovered patients with COVID-19. There is still a great dilemma in post-discharge TE prophylaxis and its long-term benefits. We reported three cases of post COVID-19 with complications related to both diseases as well as post discharge anticoagulant therapy. The first case is about a 60-yr-old male who developed Covid-19 pneumonia (moderate disease) and was discharged on rivaroxaban after initial improvement. 3 weeks later, the patient was readmitted with lower gastro-intestinal bleeding. The other two cases developed pulmonary thromboembolism within a span of 2-3 months (after recovered from Covid-19 pneumonia). Both these patients were not prescribed anticoagulants for TE prophylaxis. There is an imperative need for effective guidelines for post discharge TE prophylaxis in COVID-19.
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Affiliation(s)
- Prakrati Yadav
- Department of Internal Medicine, All India Institute of Medical Sciences Jodhpur. India
| | - Deepak Kumar
- Department of Internal Medicine, All India Institute of Medical Sciences Jodhpur. India
| | - Durga Shankar Meena
- Department of Internal Medicine, All India Institute of Medical Sciences Jodhpur. India
| | - Naresh Kumar Midha
- Department of Internal Medicine, All India Institute of Medical Sciences Jodhpur. India
| | - Gopal Krishana Bohra
- Department of Internal Medicine, All India Institute of Medical Sciences Jodhpur. India
| | - Mahendra Kumar Garg
- Department of Internal Medicine, All India Institute of Medical Sciences Jodhpur. India
| | - Abhishek Hl Purohit
- Department of Internal Medicine, All India Institute of Medical Sciences Jodhpur. India
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Polito MV, Silverio A, Bellino M, Iuliano G, Di Maio M, Alfano C, Iannece P, Esposito N, Galasso G. Cardiovascular Involvement in COVID-19: What Sequelae Should We Expect? Cardiol Ther 2021; 10:377-396. [PMID: 34191268 PMCID: PMC8243311 DOI: 10.1007/s40119-021-00232-8] [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: 05/10/2021] [Indexed: 01/08/2023] Open
Abstract
Several forms of cardiovascular involvement have been described in patients with Coronavirus disease 19 (COVID-19): myocardial injury, acute coronary syndrome, acute heart failure, myocarditis, pericardial diseases, arrhythmias, takotsubo syndrome, and arterial and venous atherothrombotic and thromboembolic events. Data on long-term outcome of these patients are still sparse, and the type and real incidence of cardiovascular sequelae are poorly known. It is plausible that myocardial injury may be the initiator of an inflammatory cascade, edema, and subsequent fibrosis, but also a consequence of systemic inflammation. The extent and distribution of ongoing inflammation may be the basis for ventricular dysfunction and malignant arrhythmias. Indeed, preliminary observational findings seem to emphasize the importance of close monitoring of COVID-19 patients with myocardial injury after discharge. Residual subclinical disease may be effectively investigated by using second-level imaging modalities such as cardiac magnetic resonance, which allows better characterization of the type and extension of myocardial damage, as well as of the ongoing inflammation after the acute phase. In patients with venous thromboembolism, a very common complication of COVID-19, the type and the duration of anticoagulation therapy after the acute phase should be tailored to the patient and based on the estimation of the individual thromboembolic and hemorrhagic risk. Large randomized clinical trials are ongoing to address this clinical question. Whether the severity of cardiovascular involvement, the type of treatments adopted during the acute phase, and the hemodynamic response, may influence the long-term outcome of patients recovered from COVID-19 is unknown. An etiological diagnosis of myocardial injury during the hospitalization is the first step for an appropriate follow-up in these patients. After discharge, the screening for residual left and right ventricular dysfunction, arrhythmias, residual thrombosis, and myocardial scar should be considered on a case-by-case basis, whereas an active clinical surveillance is mandatory in any patient.
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Affiliation(s)
| | - Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy.
| | - Michele Bellino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
| | - Giuseppe Iuliano
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
| | - Marco Di Maio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
| | - Carmine Alfano
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
| | - Patrizia Iannece
- Department of Chemistry and Biology, University of Salerno, Fisciano, Italy
| | - Nicolino Esposito
- Department of Cardiology, Ospedale Evangelico Betania, Naples, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
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