563. Experience of a Private Hospital in the Treatment of COVID-19 Pneumonia in Veracruz, Mexico

Abstract Background Large mortality rates have been reported in the Mexican public health system, however in the experiences of private hospitals that have resources and infrastructure this is lower compared to the national average. Methods Descriptive and retrospective study. Adult patients treated for pneumonia due COVID-19 from April to December 2020 are entered into the study. Its general characteristics such as gender and age, comorbidities, influenza vaccination history, clinical characterization, laboratory and tomographic diagnosis of sars cov2 pneumonia are studied, as well as the drug and oxygen therapy treatments received and finally, its evolution and clinical outcome. Results 132 patients were studied, of which 51% were female. The main age groups affected were 65 and over (43.9%), 50-59 years (20.4%) and 25-44 years (16.6%). The main comorbidities found were: arterial hypertension (43.9%), Diabetes mellitus 2 (33.3%), heart disease (11.3%) and obesity (10.6%). 95.4% of the patients were not vaccinated against influenza. The main symptoms reported were: fever (92%), cough (87%), dyspnea (76%) and headache (52%). The diagnosis was confirmed with RT-PCR in 63%, reporting negative RT-PCR in 36%; the antigen test was positive in 1%. Regarding the findings of the chest computed tomography, CORADS 5 was reported in 30%, CORADS 6 in 3% and CORADS 4 in 20%. The main treatments used in patients with severe inflammatory pneumonia were: steroids (98%), enoxaparin (100%), tocilizumab (20%), baricitinib (60%), direct oral anticoagulants (10%), fibroquel (5%). 60% were treated with a combination of two or more drugs. The main oxygenation contributions were: 20% nasal tips - mask/reservoir, 60% high flow nasal cannula, 20% mechanical ventilation. In 95% the prone position was indicated. Regarding the clinical evolution, 65.1% were towards improvement, 17.4% died, 12.1% requested transfer to another unit and 5.3% requested voluntary discharge. Overall mortality was 17%. Medications in ICU Ventilation strategies Conclusion A hospital strategy that has the necessary resources and infrastructure as well as openness to the use of medication with emergency approvals for its use or off-label indications, can help limit morbidity and mortality in vulnerable populations and manifest risk factors such as Mexican population Disclosures All Authors: No reported disclosures

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Bleeding and Thrombotic Outcomes Following Perioperative Interruption of Direct Oral Anticoagulants in Patients with Prior Venous Thromboembolic Disease

Blood ◽

10.1182/blood.v128.22.2614.2614 ◽

2016 ◽

Vol 128 (22) ◽

pp. 2614-2614

Author(s):

Joseph Shaw ◽

Carine de Wit ◽

Gregoire Le Gal ◽

Marc Carrier

Keyword(s):

Major Bleeding ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Bleeding Risk ◽

Thromboembolic Complication ◽

Invasive Procedures ◽

Bleeding Rate ◽

Major Bleeding Rate ◽

Venous Thromboembolic ◽

Overall Mortality

Abstract Introduction: The use of Direct Oral Anticoagulants (DOACs) for the prevention and treatment of Venous Thromboembolic Disease (VTE) is increasingly common. Patients on longstanding anticoagulation for the prevention of VTE frequently undergo invasive procedures that necessitate interruption of anticoagulation in order to avoid excessive bleeding during the procedure. There is little evidence surrounding the safety of perioperative DOAC interruption in patients with VTE. Methods: This study represents a retrospective analysis of adult patients on DOAC therapy for prior VTE, who underwent temporary interruption of anticoagulation therapy for inpatient or outpatient invasive procedures. The timing to hold and resume DOAC anticoagulation was based on the estimated half-life of the DOAC, as well as the bleeding risk of the procedure (Standard vs High). Our primary outcomes included the 30-day thromboembolic complication rate, as well as the 30-day major bleeding rate (ISTH non-surgical and surgical major bleeding criteria). Secondary outcomes included clinically relevant non-major bleeding (CRNMB) and overall mortality. Results: To date, a total of 87 patients have been included in the analysis, 68% of which were male. The mean age of the cohort was 58.3 years. All patients were on DOAC anticoagulation for acute treatment or secondary prevention of recurrent VTE. A large majority of patients (94%) were anticoagulated with rivaroxaban. Procedures were performed on an inpatient or outpatient basis in 24 and 63 patients, respectively. Forty six patients underwent procedures with standard bleeding risk. Mean time to anticoagulation discontinuation for standard and high bleeding risk procedures was 41.3 (SD = 20.8) and 49.3 (SD = 17.7) hours, respectively. The 30-day thromboembolic complication rate was 1.2% (95% CI: 0.2 to 6.2%), whereas the 30-day major bleeding rate was 0% (95% CI: 0 to 4.2%). The rate of CRNMB was 3.5% (95% CI: 1.2 to 9.7%). Overall mortality was 0% (95% CI: 0 to 4.2%). Conclusion: The perioperative interruption of direct oral anticoagulation for invasive procedures in patients with prior VTE appears to be associated with a relatively low risk of major bleeding, as well as recurrent VTE. Prospective studies are needed to evaluate the benefits and risks of perioperative interruption of direct oral anticoagulation in patients with prior VTE. Disclosures Carrier: BMS: Research Funding; Leo Pharma: Research Funding.

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Real-world effectiveness and the safety of anticoagulant treatment in elderly non-valvular atrial fibrillation in the ANAFIE registry, the largest real-world elderly AF registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.0527 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

T Yamashita ◽

H Inoue

Keyword(s):

Elderly Patients ◽

Major Bleeding ◽

Real World ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Age Groups ◽

Funding Source ◽

Anticoagulant Treatment ◽

Very Elderly ◽

Private Company

Abstract Background The optimal anticoagulant regimen for elderly AF has not been well elucidated, because this population, especially the very elderly (≥85 years), have not been sufficiently represented in most randomized controlled clinical trials for stroke prevention in non-valvular AF (NVAF). Purpose The ANAFIE registry was designed to evaluate the real-world anticoagulant treatment status of elderly (≥75 years) NVAF patients including >8,000 very elderly patients. In this main analysis of the ANAFIE, the incidence of stroke or systemic embolic events (stroke/SEE), and major bleeding were compared between warfarin (WF) and direct oral anticoagulants (DOACs). Methods A total of 33,018 NVAF patients aged ≥75 years was enrolled in the ANAFIE, and followed for 2 years. The incidence of stroke/SEE and major bleeding by type of anticoagulants (WF and all DOACs) was estimated using Kaplan-Meier method. Hazard ratio (HR) and 95% confidence interval (95% CI) were calculated by Cox proportional hazard model. Results In the analysis set of 32,099 patients, the mean age was 81.5 years. 23,738 (74%) were <85 years and 8,361 (26.0%) were ≥85 years. 92.5% of the whole population used anticoagulants including WF (27.6%) or DOACs (72.3%). The ratio of each DOAC was dabigatran 7.8%, rivaroxaban 21.5%, apixaban 26.9% and edoxaban 16.1%. Stroke/SEE and major bleeding was observed in 396 patients (1.24/100 patient-years [py]) and 279 patients (0.87/100py). The time in therapeutic range for patients <85 years and ≥85 years in the WF group was 76.7% and 72.2%, respectively. The incidence of stroke/SEE was numerically lower in patients taking any DOAC vs. WF regardless of age group (<85 years [HR 0.83] and ≥85 years [HR 0.71]). Major bleeding was also lower vs. WF in both age groups (<85 years [HR 0.60] and ≥85 years [HR 0.65]). Conclusion In elderly NVAF patients enrolled in the ANAFIE registry, the incidence of stroke/SEE and major bleeding was lower in patients taking a DOAC compared with WF for all patients ≥75 years, even for very elderly patients. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Daiichi Sankyo Co., Ltd.

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Direct Oral Anticoagulants and Mortality in Atrial Fibrillation

Blood ◽

10.1182/blood-2018-99-111182 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 5061-5061

Author(s):

Martin Ellis ◽

Sergienko Ruslan ◽

Hammerman Ariel ◽

Sari Greenberg-Dotan ◽

Erez Battat ◽

...

Keyword(s):

Atrial Fibrillation ◽

Propensity Score ◽

Propensity Score Matching ◽

Stroke Prevention ◽

Lower Risk ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Routine Practice ◽

Newly Diagnosed ◽

Overall Mortality

Abstract Background Direct oral anticoagulants (DOACs) are at least as effective as vitamin K antagonists (VKAs) for stroke prevention in patients with non-valvular atrial fibrillation (NVAF). DOACs are associated with less intracranial hemorrhage and are easier to administer and therfore have become standard of care for stroke prevention in NVAF patients. Nevertheless, many eligible patients still receive no anticoagulation. The effect on overall mortality in routine practice of DOAC therapy compared to no anticoagulation in NVAF patients is unknown. Methods We identified all newly diagnosed, anticoagulant naive NVAF patients eligible for DOAC therapy from 2011 to 2016 in Clalit Health Services, the largest HMO in Israel. We created a matched cohort, using 1:1 propensity score matching of DOAC -treated versus non-anticoagulant treated NVAF patients. The primary outcome was overall mortality rate in the two cohorts. Secondary outcomes were rates of stroke, major cardiac and bleeding events. Results 28,195 newly diagnosed CHADS2 ≥2 NVAF patients were identified. Of these 8 298 received a DOAC and 10 603 received no anticaogulation. The remainder received a VKA and were not included in this study. Patients recieving DOAC therapy were younger (77.4 vs 78.0 years), had a higher socioeconomic status (5.6 vs. 5.3), had a female predominance (53.7% vs 52.0%), had a higher BMI (29.6 vs 28.3) and had a greater prevalance of accompanying cardiovascular morbidities namely congestive heart failure (CHF) (29% vs 27%) and stroke (33% vs 30%) (P<0.001 for all variables) . 5,657 patients who received DOAC therapy were matched with 5,657 patients not receiving an anticoagulant using propensity score matching. DOAC therapy was associated with significantly lower risk for death (hazard ratio 0.66, 95% CI 0.60-0.71, P<0.001). Rates of stroke and major cardiac were significantly lower in the DOAC-treated than in the non-anticoagulated patients. DOAC therapy was associated with a significant survival benefit across all patient subgroups. Conclusions In this cohort of newly diagnosed NVAF patients treated in routine clinical practice, DOAC therapy was associated with a lower risk for death compared to no oral anticoagulation. Our findings provide further evidence for the importance of DOAC therapy in NVAF patients. Disclosures No relevant conflicts of interest to declare.

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Hemostasis and Thrombosis in the Oldest Old

Seminars in Thrombosis and Hemostasis ◽

10.1055/s-0038-1657779 ◽

2018 ◽

Vol 44 (07) ◽

pp. 624-631 ◽

Cited By ~ 5

Author(s):

Ron Hoffman ◽

Manuel Monreal ◽

Inna Tzoran

Keyword(s):

Oldest Old ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Age Groups ◽

Real Life ◽

The Elderly ◽

Western World ◽

Chronic Obstructive ◽

Bleeding Disorders ◽

Acquired Von Willebrand Syndrome

AbstractThere is a growing proportion of the elderly population in the Western world, and these individuals require special considerations regarding a broad variety of aspects, including treatment approaches to illnesses that affect all age groups. The hemostatic system in individuals changes considerably with aging. Specifically, changes in levels of procoagulant and natural anticoagulant factors along with thrombopathy simultaneously create a hypercoagulable state and hemostatic difficulties. Underlying morbidities, such as congestive heart failure, chronic obstructive pulmonary disease, diabetes mellitus, and cancer, increase the risk for venous and arterial thrombosis. This population is also increasingly affected by acquired bleeding disorders, including acquired hemophilia and acquired von Willebrand syndrome, as well as mild congenital bleeding disorders. Real-life data demonstrate that recurrent and fatal venous thromboembolism is the major hemostatic concern in the elderly. The fact that treatment of thrombotic complications increases the bleeding risk also has to be taken into consideration, particularly in the older age group. This remains true in the era of direct oral anticoagulants. In conclusion, maintaining a delicate balance between thrombosis and bleeding risks is the key issue in providing qualified treatment to elderly patients.

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SARS-COV-2: RT-PCR CYCLE THRESHOLD (CT) VALUE AT DIAGNOSIS AND ITS RELATION TO AGE AND SEX IN ASSAM, INDIA

10.36106/ijsr/8903824 ◽

2021 ◽

pp. 28-30

Author(s):

Runumi Chowdhury ◽

Malavika Barman ◽

Devyashree Medhi ◽

Sumi Deka ◽

Bandeepa Duarah ◽

...

Keyword(s):

Old Age ◽

Virus Disease ◽

Age Groups ◽

P Value ◽

Age Group ◽

Global Public Health ◽

Rt Pcr ◽

Corona Virus ◽

Gender And Age ◽

The Difference

COVID-19 (corona virus disease 2019) is a global public health emergency caused by a new corona virus with severe acute respiratory syndromelike characteristics (SARS-CoV-2). We aimed to evaluate whether gender and age are major risk factors for SARS-CoV-2 infection. For the study, 300 positive cases diagnosed during the period of July 2020 to September 2020 were included. Results showed that 69% of study samples were male of which 84% were in the >51 years old age group. And 31% of study samples were female of which 63% were in the 4-19 years old age group. ANOVAresults indicated that the means of Ct values varied signicantly between age groups (F=2.703; p-value= 0.045). The lower Ct values were recorded in males (29.01±4.35) in comparison to females (29.84±3.98) while, the difference between the means of the two groups was not signicant. Our study concluded that males have higher viral load than females and for both sexes, age was found to be a signicant risk factor for severity of COVID-19.

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Outcome of Morbidly Obese Patients with Acute Venous Thromboembolism Managed with Direct Oral Anticoagulants

Blood ◽

10.1182/blood-2019-132202 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 4973-4973

Author(s):

Nwabundo Anusim ◽

Filip Ionescu ◽

Vishal Jindal ◽

Ruby Gupta ◽

Ishmael Jaiyesimi ◽

...

Keyword(s):

Venous Thromboembolism ◽

Conflicts Of Interest ◽

Vitamin K Antagonists ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Beaumont Hospital ◽

Age Groups ◽

Morbidly Obese ◽

Obese Patients ◽

Obese Population

Background. Obesity is a major epidemic affecting all age groups in the USA. It has been associated with venous thromboembolism (VTE), which requires prolonged anticoagulation. Classic options (vitamin K antagonists, heparins) are increasingly replaced by direct oral anticoagulants (DOACs), which have not been well studied in patients with body mass index (BMI) > 40kg/m2 or weight above 120 kg. Despite limited safety and efficacy data, patients and their caregivers often opted for this medication owing to its ease of administration, lack of requirement for frequent laboratory testing and for dietary restrictions. Methods. This is a retrospective study of all morbidly obese patients (BMI > 40kg/m2) diagnosed with acute VTE managed with DOACs at Beaumont hospital between January of 2018 and December of 2018. Data regarding demographics, specific DOAC, major bleeding (hemoglobin decrease by 2 g/dL) and new or progressive thrombosis were recorded during a sixty-day follow up. Data was analyzed using JMP statistical software. Results A total of 42 patients diagnosed with acute VTE received DOACs during the study period. Most were female (76%); the median BMI was 44 (IQR 42-60) and mean age was 57. Most patients had a BMI of 40-50 kg/m2 (n=34, 81%) compared to BMI 50-60 kg/m2 (n=6, 14%) and BMI >60kg/m2 (n=6, 14%). Apixaban was the most frequently used DOAC (n=27, 65%). No clinically significant bleeding occurred during the study period. There were 2 thrombotic episodes (5% of patients) within 60 days of starting a DOAC; both occurred in patients receiving rivaroxaban. One event was present in the BMI 40-50kg/m2 group and one in the >60kg/m2 group. Conclusions DOACs appear to be safe and efficacious for the management of VTE in the morbidly obese population. Future studies may focus on the comparative efficacy of apixaban and rivaroxaban in the morbidly obese population. Disclosures No relevant conflicts of interest to declare.

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Measurement Invariance of Divergent Thinking Across Gender, Age, and School Forms

European Journal of Psychological Assessment ◽

10.1027/1015-5759.25.1.1 ◽

2009 ◽

Vol 25 (1) ◽

pp. 1-7 ◽

Cited By ~ 12

Author(s):

Jörg-Tobias Kuhn ◽

Heinz Holling

Keyword(s):

Measurement Invariance ◽

Divergent Thinking ◽

Factor Model ◽

Age Groups ◽

Thinking Skills ◽

Specific Model ◽

Confirmatory Factor Analyses ◽

Domain Specific ◽

Gender And Age ◽

Confirmatory Factor

The present study explores the factorial structure and the degree of measurement invariance of 12 divergent thinking tests. In a large sample of German students (N = 1328), a three-factor model representing verbal, figural, and numerical divergent thinking was supported. Multigroup confirmatory factor analyses revealed that partial strong measurement invariance was tenable across gender and age groups as well as school forms. Latent mean comparisons resulted in significantly higher divergent thinking skills for females and students in schools with higher mean IQ. Older students exhibited higher latent means on the verbal and figural factor, but not on the numerical factor. These results suggest that a domain-specific model of divergent thinking may be assumed, although further research is needed to elucidate the sources that negatively affect measurement invariance.

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