scholarly journals Elevated TAT in COVID-19 Patients with Normal D-Dimer as a Predictor of Severe Respiratory Failure: A Retrospective Analysis of 797 Patients

2021 ◽  
Vol 11 (1) ◽  
pp. 134
Author(s):  
Yuichiro Takeshita ◽  
Jiro Terada ◽  
Yasutaka Hirasawa ◽  
Taku Kinoshita ◽  
Hiroshi Tajima ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Respiratory Failure ◽  
Logistic Regression Model ◽  
Early Stage ◽  
Severe Respiratory Failure ◽  
Single Center ◽  
Inhibitor Complex ◽  
Group A ◽  
Plasmin Inhibitor ◽  
D Dimer

Although previous studies have revealed that elevated D-dimer in the early stage of coronavirus 2019 (COVID-19) indicates pulmonary intravascular coagulation, the state of coagulation/fibrinolysis disorder with normal D-dimer is unknown. The study aimed to investigate how coagulation/fibrinolysis markers affect severe respiratory failure in the early stage of COVID-19. Among 1043 patients with COVID-19, 797 patients were included in our single-center retrospective study. These 797 patients were divided into two groups, the normal D-dimer and elevated D-dimer groups and analyzed for each group. A logistic regression model was fitted for age, sex, body mass index (BMI) ≥ 30 kg/m2, fibrinogen ≥ 617 mg/dL, thrombin-antithrombin complex (TAT) ≥ 4.0 ng/mL, and plasmin-alpha2-plasmin inhibitor-complex (PIC) > 0.8 µg/mL. A multivariate analysis of the normal D-dimer group demonstrated that being male and TAT ≥ 4.0 ng/mL significantly affected severe respiratory failure. In a multivariate analysis of the elevated D-dimer group, BMI ≥ 30 kg/m2 and fibrinogen ≥ 617 mg/dL significantly affected severe respiratory failure. The elevated PIC did not affect severe respiratory failure in any group. Our study demonstrated that hypercoagulation due to SARS-CoV-2 infection may occur even during a normal D-dimer level, causing severe respiratory failure in COVID-19.

scholarly journals Venous Doppler Ultrasound in Critically Ill Covid-19 Patients: Game Changer in Anticoagulation Therapy

2020 ◽  
Author(s):  
Marta Alfageme ◽  
Jorge González Plaza ◽  
María Luisa Collado ◽  
Santiago Méndez ◽  
Juan A. Gómez Patiño ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Respiratory Failure ◽  
Critically Ill ◽  
Doppler Ultrasound ◽  
Acute Pulmonary Embolism ◽  
Anticoagulation Therapy ◽  
Lower Limbs ◽  
Severe Respiratory Failure ◽  
Asymptomatic Patients ◽  
D Dimer

Abstract BackgroundCOVID-19 infection has been associated with a high rate of thrombotic events, such as deep vein thrombosis (DVT) and acute pulmonary embolism (APE).MethodsThe purpose of our retrospective study was to evaluate the prevalence of asymptomatic DVT in lower limbs in critically ill COVID-19 patients (n=23) with severe respiratory failure and high levels of D-dimer by bedside Doppler ultrasound (DU).ResultsDVT was diagnosed in 14 cases (60.87%), 5 in proximal venous territory and 9 in infrapopliteal veins. CTPA was performed in 6 patients and all of them showed acute pulmonary embolism (APE) at segmental or subsegmental branches of pulmonary arteries. These patients (APE or DVT confirmed) were treated with therapeutic doses of anticoagulant therapy.ConclusionIn critically COVID 19 ill ICU patients with severe respiratory failure y elevated D-dimer the incidence of asymptomatic DVT is high. We propose that DU allows detection of DVT in asymptomatic patients, adding a factor that may balance the decision to fully anticoagulated these patients.

Changes in Fibrinogen After rt-PA Administration

1996 ◽  
Vol 2 (1) ◽  
pp. 43-50
Author(s):  
Justine Meehan Carr ◽  
Edwin G. Bovill ◽  
Russell P. Tracy ◽  
Martin Mankowski ◽  
Kenneth G. Mann ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Recombinant Tissue Plasminogen Activator ◽  
Low Molecular Weight ◽  
Tissue Plasminogen ◽  
Group A ◽  
Group B ◽  
Plasmin Inhibitor ◽  
D Dimer ◽  
Qualitative Changes ◽  
Time Point

Among patients participating in the TIMI-II protocol, there was a variability in the fibrinolytic re sponse to recombinant tissue plasminogen activator (rt- PA). A cohort of 20 TIMI-II patients was selected for detailed study because their responses to rt-PA varied widely in the degree of fibrin(ogen)olysis. Patient plasmas were analyzed by immunoblotting for changes in fibrino gen and plasminogen. Measurements of fibrinogen, fibrin ogen degradation product (FDP), D-dimer, Bβ 1-42, plas minogen, and t-PA were also correlated. Three patterns of response to rt-PA were identified: Group A ( n = 4) had fibrinogenolysis without fibrinolysis; Group B ( n = 11) had fibrinolysis and mild fibrinogenolysis; and Group C ( n = 5) had fibrinolysis with intense fibrinogenolysis. Group C patients also demonstrated qualitative changes in high- molecular-weight (HMW) and low-molecular-weight (LMW) fibrinogens, whereas Group A and B patients demonstrated only mild alterations in fibrinogen compo sition. Plasmin-inhibitor complexes were identified in all three groups. All patients had both plasmin-α2-anti plasmin and plasmin-α2-macroglobulin complexes at the 50-min time point. The concentration of pretreatment plasminogen correlated with the degree of fibrinogenoly sis.

scholarly journals Venous Doppler ultrasound in critically Ill COVID-19 patients: game changer in anticoagulation therapy

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Marta Alfageme ◽  
Jorge González Plaza ◽  
Santiago Méndez ◽  
Juan A. Gómez Patiño ◽  
María L. Collado ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Respiratory Failure ◽  
Critically Ill ◽  
Doppler Ultrasound ◽  
Acute Pulmonary Embolism ◽  
Anticoagulation Therapy ◽  
Lower Limbs ◽  
Severe Respiratory Failure ◽  
Asymptomatic Patients ◽  
D Dimer

Abstract Background COVID-19 infection has been associated with a high rate of thrombotic events, such as deep vein thrombosis (DVT) and acute pulmonary embolism (APE). Methods The purpose of our retrospective study was to evaluate the prevalence of asymptomatic DVT in lower limbs in critically ill COVID-19 patients (n = 23) with severe respiratory failure and high levels of D-dimer by bedside Doppler ultrasound (DU). Results DVT was diagnosed in 14 cases (60.87%), 5 in proximal venous territory and 9 in infrapopliteal veins. Computed Tomography Pulmonary Angiography (CTPA) was performed in six patients and all of them showed acute pulmonary embolism (APE) at segmental or subsegmental branches of pulmonary arteries. These patients (APE or DVT confirmed) were treated with therapeutic doses of anticoagulant therapy. Conclusion In critically COVID-19 ill ICU patients with severe respiratory failure and elevated D-dimer, the incidence of asymptomatic DVT is high. We propose that DU allows detection of DVT in asymptomatic patients, adding a factor that may balance the decision to fully anticoagulate these patients.

scholarly journals Pulmonary embolism in patients with severe COVID-19 treated with intermediate- to full-dose enoxaparin

2020 ◽  
Author(s):  
Cleante Scarduelli ◽  
Francesco Inglese ◽  
Massimiliano Beccaria ◽  
Fabio Spreafico ◽  
Martina Garuti ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Respiratory Failure ◽  
Case Series ◽  
Pulmonary Angiography ◽  
Arterial Oxygen ◽  
Positive Pressure ◽  
Severe Respiratory Failure ◽  
Retrospective Case ◽  
Full Dose ◽  
D Dimer

Abstract Background: Coronavirus disease 2019 (COVID-19) may predispose patients to venous thromboembolism (VTE) due to inflammation, hypoxia, immobilization, and diffuse intravascular coagulation, despite standard thrombopropylaxis. Our retrospective study reports the incidence of pulmonary embolism (PE) in patients with COVID-19 and severe respiratory failure(SRF) treated with intermediate to full-dose enoxaparin. .Methods: This retrospective case series analysed data from patients with COVID-19 pneumonia and severe respiratory failure (SRF) admitted to our Respiratory Intensive Care Unit (RICU) between February 27 and April 20, 2020 for non-invasive positive-pressure ventilation. All patients received at least intermediate-dose enoxaparin (40 mg twice daily). If PE was suspected or diagnosed, patients were treated with full-dose enoxaparin (1 mg/kg twice daily). Computed tomography pulmonary angiography (CTPA) was used to detect PE in patients with elevated D-dimer levels (> 3000 ng/mL) and/or other clinical indicators, including sudden worsening of cardiopulmonary status.Results: Ninety-two patients (71 males, 21 females; mean age 58 ± 11 years) with COVID-19 pneumonia and SRF (mean arterial oxygen partial pressure/fractional inspired oxygen [PaO2/FiO2] of 143 ± 45 mm Hg) were admitted to our RICU. Twenty-two patients underwent CTPA (24%), with PEs detected in 11 (12%). Mean PaO2/FiO2 and mean D-dimer levels did not significantly differ between patients with or without PE. Eleven patients (12%) died in the hospital, with a mean age of 70 ± 11 years for deceased patients and 56 ± 11 years for surviving patients (p < 0.0001).Conclusions: PE was diagnosed in 12% of patients despite intermediate to full-dose enoxaparin treatment. However the incidence of PE in our patients was lower than that previously reported. We hypothesize that this reduced PE incidence may have been secondary to the higher than prophylactic enoxaparin dose that was used.

Outcome of Disseminated Intravascular Coagulation in Relation to the Score when Treatment was Begun

1995 ◽  
Vol 74 (03) ◽  
pp. 848-852 ◽  
Author(s):  
Hideo Wada ◽  
Yoshihiro Wakita ◽  
Tutomu Nakase ◽  
Minori Shimura ◽  
Katsuyo Hiyoyama ◽  
...  
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Plasma Levels ◽  
Early Stage ◽  
Coagulation Factors ◽  
Underlying Disease ◽  
Blood Coagulation Factors ◽  
Intravascular Coagulation ◽  
The Relationship ◽  
Plasmin Inhibitor ◽  
D Dimer

SummaryWe examined 395 patients with disseminated intravascular coagulation (DIC) divided into two groups: non-leukemic and leukemic. In 58% of the patients as a whole, treatment of DIC resulted in complete or partial remission, while exacerbation and death occurred in 31%. The efficacy of DIC treatment in the non-leukemic group was less than that in the leukemic group, indicating that the outcome of DIC depended, in part, on the underlying disease. We examined hemostatic indicators in relation to DIC score: prothrombin time (PT) ratio, FDP, platelet count, and fibrinogen levels were found to be important indicators for the diagnosis of DIC, but not for Pre-DIC. Plasma levels of fibrin-D-dimer, thrombin-antithrombin complex (TAT), and plasmin- plasmin inhibitor complex (PPIC) were significantly increased in pre-DIC. The efficacy of treatment in relation to the DIC score when the treatment was begun showed that greater efficacy was achieved in pre-DIC than in DIC patients. The outcome was poorer with increasing DIC score, suggesting that early diagnosis and early treatment are important. On examining the relationship between outcome and hemostatic indicators, we found that the PT ratio and the levels of antithrombin, plasminogen, PPIC, the PPIC/TAT ratio, and thrombomodulin were related to outcome, suggesting that very high consumption of blood coagulation factors, liver dysfunction, hypofibrinolysis, or organ failure caused a poor outcome. Although the outcome in DIC patients may not depend substantially on plasma levels of TAT and fibrin-D- dimer, we can use these indicators to treat DIC patients at an early stage.

scholarly journals CLINICAL FEATURES OF SEVERE COVID-19 WITH LETHAL OUTCOME IN VOLYN REGION RESIDENTS

2021 ◽  
Vol 29 (2) ◽  
pp. 16-24
Author(s):  
O. K. Yakovenko ◽  
O. G. Khanin ◽  
V. V. Lotysh ◽  
S. L. Gryf
Keyword(s):  
Renal Failure ◽  
Respiratory Failure ◽  
Clinical Features ◽  
Demographic Data ◽  
Demographic Factors ◽  
Lung Pathology ◽  
Severe Respiratory Failure ◽  
Lethal Outcome ◽  
Laboratory Markers ◽  
D Dimer

On March, 11 2020 WHO declared novel SARS-CoV-2 outbreak as pandemic (Coronavirus disease, COVID-19), which took away almost 4 million lives of our planet population. Management of severe COVID-19 represents the most challenging problem being associated with high level of mortality. Aim of the study: to assess the clinical features of severe COVID-19, demographic factors, laboratory markers and lung pathology findings associated with severe course and lethal outcome. Material and methods. In retrospective cohort survey we recruited 171 adult patients (age > 18 years) with severe COVID-19, admitted to 2nd infection disease department of municipal hospital �Volyn regional clinical hospital� (CE �Voklen�). 101 patients were discharged after completion of treatment. 70 patients died. In two groups (discharged or deceased) we analyzed demographic data, clinical diagnosis, comorbidity and complications, duration of disease and hospital stay, body temperature at admission, blood oxygen saturation at admission and during the course of treatment, major laboratory parameters (WBC, neutrophils, lymphocytes, thrombocytes, RBC, neutrophil/lymphocyte ration (NLR), C-RP, AST, ALT, creatinine, total protein, blood glucose and procalcitonin). Almost all patients were tested for D-dimer, lupus anticoagulant (LA) and blood gases. In part of deceased patients (n=10) an autopsy was performed with subsequent lung tissue histological examination. Results and discussion. Acute respiratory distress syndrome (ARDS) and severe respiratory failure were the major cause of death from COVID19. Concomitant conditions, which worsened the clinical course and prognosis: renal failure, thrombotic events, in part associated with elevation of D-dimer and LA, neoplasm, cardiovascular conditions and diabetes mellitus. Female sex and younger age were the demographic factors of favorable outcome. Leukocytosis, high NLR, increased creatinine (as an indicator of renal failure), hypoproteinemia and high serum glucose level were the laboratory markers of unfavorable prognosis. LA, associated with severe respiratory failure, stroke and vascular thrombosis, were found positive in 40 % of patients with severe COVID-19. Key words: COVID-19, severe course, mortality, prognosis factors.

Selflessness in Anorexia Nervosa as Reflected in the Rorschach Comprehensive System

2012 ◽  
Vol 33 (1) ◽  
pp. 78-93 ◽  
Author(s):  
Gili Curiel-Levy ◽  
Laura Canetti ◽  
Esti Galili-Weisstub ◽  
Myrna Milun ◽  
Eitan Gur ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Anorexia Nervosa ◽  
Analysis Of Variance ◽  
Clinical Observation ◽  
Comparison Group ◽  
Comprehensive System ◽  
Multivariate Analysis Of Variance ◽  
Rorschach Comprehensive System ◽  
Group A

This study examines the expression of selflessness – the tendency to ignore one’s own needs and serve others’ needs – in Rorschach protocols of women suffering from anorexia nervosa. The protocols of 35 women suffering from anorexia nervosa were compared to 30 protocols of a psychiatric comparison group. A multivariate analysis of variance over five variables (AG, PER, PHR, COP, and GHR) was significant: Anorexic patients showed higher characteristics of selflessness compared to the psychiatric comparison group. These findings contribute to the validation of the Rorschach technique and to the clinical observation of selflessness in anorexic patients, and they emphasize specific characteristics in the treatment of anorexia nervosa patients.

Mastectomy trends for early-stage breast cancer: a single-center experience

2020 ◽  
Vol 1 (50) ◽  
pp. 9
Author(s):  
Cristian Lungulescu ◽  
Mihaela Dănciulescu ◽  
Denisa Bărbulescu ◽  
Ana Dorobanţu ◽  
Georgiana Camen
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Single Center ◽  
Single Center Experience
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