scholarly journals Thrombosis in COVID-19 Patients

2021 ◽  
pp. 721-727
Author(s):  
S. Rakshana ◽  
Laya Mahadevan ◽  
A. S. Arunkumar
Keyword(s):  
Anticoagulant Therapy ◽  
Antithrombotic Therapy ◽  
Macrophage Activation ◽  
Diffuse Alveolar Damage ◽  
Special Care ◽  
Post Discharge ◽  
Pulmonary Vessels ◽  
Multiple Factors ◽  
Interstitial Inflammation ◽  
Severity Of The Disease

The magnitude of thrombosis in Coronavirus disease 2019 (COVID-19) patients is yet to be understood fully. Thrombosis in COVID-19 patients depends on multiple factors like the severity of the disease, presence or absence of prophylactic anticoagulants, and the number of anticoagulants prescribed. Histologically, lung tissues from COVID patients show florid capillary endothelitis with microthrombi formation in alveolar capillaries and small pulmonary vessels. Inflammation and diffuse alveolar damage, extensive pulmonary macrophage activation and diffuse interstitial inflammation play an important role in microthrombi formation in the pulmonary vessels. If antithrombotic therapy is already prescribed before the diagnosis of COVID-19, it should be continued. For all hospitalized pregnant patients, prophylactic anticoagulant therapy is prescribed unless contraindicated. Anticoagulant therapy during labor requires special care. Appropriate therapeutic and prophylactic anticoagulant regimens must be initiated as and when required including in the post discharge phase.

scholarly journals Risk factors and clinical features of deterioration in COVID-19 patients in Zhejiang, China: a single- centre, retrospective study

2020 ◽  
Author(s):  
Ping Yi ◽  
Xiang Yang ◽  
Cheng Ding ◽  
Yanfei Chen ◽  
Kaijin Xu ◽  
...  
Keyword(s):  
Risk Factors ◽  
T Lymphocyte ◽  
Lymphocyte Count ◽  
Clinical Characteristics ◽  
B Lymphocyte ◽  
Blood Cell Count ◽  
Single Centre ◽  
Multiple Factors ◽  
Independent Risk Factors ◽  
Severity Of The Disease

Abstract BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection swept through Wuhan and spread across China and overseas beginning in December 2019. To identify predictors associated with disease progression, we evaluated clinical risk factors for exacerbation of SARS-CoV-2 infection.MethodsA retrospective analysis was used for PCR-confirmed COVID-19 (coronavirus disease 2019)-diagnosed hospitalized cases between January 19, 2020, and February 19, 2020, in Zhejiang, China. We systematically analysed the clinical characteristics of the patients and predictors of clinical deterioration.ResultsOne hundred patients with COVID-19, with a median age of 54 years, were included. Among them, 49 patients (49%) had severe and critical disease. Age ([36-58] vs [51-70], P=0.0001); sex (49% vs 77.6%, P=0.0031); Body Mass Index (BMI ) ([21.53-25.51] vs [23.28-27.01], P=0.0339); hypertension (17.6% vs 57.1%, P<0.0001); IL-6 ([6.42-30.46] vs [16.2-81.71], P=0.0001); IL-10 ([2.16-5.82] vs [4.35-9.63], P<0.0001); T lymphocyte count ([305- 1178] vs [167.5-440], P=0.0001); B lymphocyte count ([91-213] vs [54.5-163.5], P=0.0001); white blood cell count ([3.9-7.6] vs [5.5-13.6], P=0.0002); D2 dimer ([172-836] vs [408-953], P=0.005), PCT ([0.03-0.07] vs [0.04-0.15], P=0.0039); CRP ([3.8-27.9] vs [17.3-58.9], P<0.0001); AST ([16, 29] vs [18, 42], P=0.0484); artificial liver therapy (2% vs 16.3%, P=0.0148); and glucocorticoid therapy (64.7% vs 98%, P<0.0001) were associated with the severity of the disease. Age and weight were independent risk factors for disease severity.ConclusionDeterioration among COVID-19-infected patients occurred rapidly after hospital admission. In our cohort, we found that multiple factors were associated with the severity of COVID19. Early detection and monitoring of these indicators may reduce the progression of the disease. Removing these factors may halt the progression of the disease. In addition, Oxygen support, early treatment with low doses of glucocorticoids and liver therapy, when necessary, may help reduce mortality in critically ill patients.

A New Biomarker Tool for Risk Stratification in “De Novo” Acute Heart Failure (OROME)

2021 ◽  
Author(s):  
Rosa Agra Bermejo ◽  
Carla Cacho-Antonio ◽  
Eva Gonzalez-Babarro ◽  
Adriana Rozados-Luis ◽  
Marinela Couselo-Seijas ◽  
...  
Keyword(s):  
Heart Failure ◽  
Predictive Model ◽  
De Novo ◽  
Acute Phase Reactant ◽  
Rank Test ◽  
Post Discharge ◽  
Kaplan Meier ◽  
Acute Phase Reactant Protein ◽  
Severity Of The Disease

Abstract Background: Inflammation is one of the mechanisms involved on heart failure (HF) pathophysiology. Thus, the acute phase reactant protein, orosomucoid, was associated with a worse post-discharge prognosis in de novo acute HF (AHF). However, the presence of anti-inflammatory adipokine, omentin, might protect and reduce the severity of the disease. We wanted to evaluate the value of omentin and orosomucoid combination for stratifying risk of these patients.Methods and Results: Two independent cohorts of patients admitted for de novo AHF in two centers were included in the study (n=218). Orosomucoid and omentin circulating levels were determined by ELISA at discharge. Patients were follow-up for 317 (3-575) days. A predictive model was determined for primary endpoint, death and/or HF readmission. Differences in survival were evaluated using a Log-rank test. According cut-off values of orosomucoid and omentin, patients were classified on UpDown (high orosomucoid and low omentin levels), equal (both proteins high or low) and DownUp (low orosomucoid and high omentin levels). The Kaplan Meier determined worse prognosis for the UpDown group (Long-rank test p=0.02). The predictive model that includes the combination of orosomucoid and omentin groups (OROME) + NT-proBNP values achieved a higher C-index=0.84 than the predictive model with NT-proBNP (C-index=0.80) or OROME (C-index=0.79) or orosomucoid alone (C-index=0.80). Conclusions: The orosomucoid and omentin determination stratifies de novo AHF patients in high, mild and low risk of rehospitalization and/or death for HF. Its combination with NT-proBNP improves its predictive value in this group of patients.

Analysis of antithrombotic therapy in the elderly patients in clinical practice of family medicine centers of the Kyrgyz Republic

2021 ◽  
Author(s):  
К.К. Базира ◽  
Ф.О. Мусакеев ◽  
Н.К. Киндербаева ◽  
У.К. Кундашев ◽  
У.Ч. Мамажакып ◽  
...  
Keyword(s):  
Family Medicine ◽  
Antiplatelet Therapy ◽  
Anticoagulant Therapy ◽  
Antithrombotic Therapy ◽  
Primary Care Physicians ◽  
The Elderly ◽  
Kyrgyz Republic ◽  
Current State ◽  
The Republic ◽  
Real Picture

Введение. Риски тромбоза и кровотечения с возрастом увеличиваются одновременно, при этом пожилой контингент извлекает больше пользы от антитромботической терапии, чем лица молодого возраста. Цель исследования: изучить ситуацию с назначением антикоагулянтной терапии у пациентов пожилого и старческого возраста с фибрилляцией предсердий (ФП) при центрах семейной медицины южных регионов Кыргызской Республики. Материалы и методы. Из 2000 амбулаторных карт медицинского наблюдения отобрано 470 пациентов с неклапанной ФП, которые имели показания для назначения антитромботической терапии: 187 (39,8%) мужчин, 283 (60,2%) женщины, из них 212 (45,1%) городских жителей и 258 (54,9%) сельских жителей. Средний возраст обследованных составил 69,5 ± 10,2 лет. Результаты. Из 377 (80,2%) пациентов должная антикоагулянтная терапия была назначена 162 (42,9%), антиагрегантная терапия — 191 (50,6%), и терапия не была назначена 24 (6,4%) больным при наличии абсолютных показаний. В качестве антикоагулянтной терапии 148 больным был назначен варфарин, адекватная антикоагуляция к концу года составила всего 12,2%. Новый оральный антикоагулянт — ривароксабан был назначен 14 (8,6%) пациентам. Врачами-терапевтами сельской местности 50% больным при необходимости антикоагулянтов была назначена антиагрегантная терапия. Заключение. В южных регионах республики наблюдается неблагоприятная ситуация с назначением антикоагулянтной терапии и ведением пациентов пожилого и старческого возраста. Необходимо продолжить исследования по другим регионам страны для получения полноценной и реальной картины по проблеме и выработки единой и соответствующей рекомендации. Background. The risks of thrombosis and bleeding increase simultaneously with age. At the same time, the elderly population derives more benefit from antithrombotic therapy than young individuals. Objectives: to study the current state of the anticoagulant therapy prescription for elderly and senile patients with atrial fibrillation (AF) at the centers of family medicine in the southern regions of the Kyrgyz Republic. Patients/Methods. From 2000 outpatient medical records, 470 patients with nonvulvar AF were selected who had indications for prescribing antithrombotic therapy: 187 (39.8%) men, 283 (60.2%) women; 212 (45.1%) were urban residents and 258 (54.9%) were village residents. The average age was 69.5 ± 10.2 years. Results. From among 377 (80.2%) patients, needful anticoagulant therapy was prescribed to 162 (42.9%), 191 (50.6%) patients received antiplatelet therapy and therapy was not prescribed to 24 (6.4%) patients in the presence of absolute indications. Warfarin as anticoagulant therapy was prescribed to 148 patients; adequate anticoagulation by the end of the year was only 12.2%. A new oral anticoagulant — rivaroxaban was prescribed to 14 (8.6%) patients. In non-urban area primary care physicians prescribed antiplatelet therapy to 50% of patients who needed anticoagulants. Conclusions. An unfavorable situation is observed with the prescription of anticoagulant therapy and management of elderly and senile patients in the southern regions of the republic. It is necessary to continue study in other regions of the country in order to obtain a complete and real picture of the problem, and to develop a unified and relevant recommendation.

Risk factors concerning complications following permanent pacemaker implantation for patients on antithrombotic therapy: a cohort study

2020 ◽  
Vol 68 (4) ◽  
pp. 828-837
Author(s):  
Mª Reyes Carrión-Camacho ◽  
José Manuel Molina-Doñoro ◽  
José Rafael González-López
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Anticoagulant Therapy ◽  
Antithrombotic Therapy ◽  
Associated Factors ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Single Center ◽  
Factors Associated

The objective of this study was to identify the complications and associated factors presented by patients after pacemaker implantation, according to a regimen of antithrombotic therapy or without it. This is an analytical observational study on a prospective cohort of 310 consecutive patients with a permanent pacemaker implanted, included from January 1 to December 31, 2014 from 1 single center. The follow-up was conducted on 310 patients for 6 months. 239 patients (77%) received antithrombotic therapy at the time of the pacemaker implantation. 20.8% of complications are presented in patients without anticoagulant therapy, 80.8% of them being minor ones. In the case of patients with anticoagulant therapy, 30.3% of the complications are major ones. Factors associated with major complications were contusion (OR 2; 95% CI 1 to 3.8; p=0.049), and minor complications, arm immobilization >24 hours (p=<0.001) and contusion (p=0.002). This study found an increase in the overall risk and complications that can occur when implanting a permanent pacemaker in patients with antithrombotic therapy based on the time of immobilization and contusions after the implantation.

scholarly journals Recurrent thrombosis in patients with antiphospholipid antibodies and arterial thrombosis on antithrombotic therapy

2017 ◽  
Vol 1 (25) ◽  
pp. 2320-2324 ◽  
Author(s):  
William G. Jackson ◽  
Clara Oromendia ◽  
Ozan Unlu ◽  
Doruk Erkan ◽  
Maria T. DeSancho
Keyword(s):  
Anticoagulant Therapy ◽  
Antiphospholipid Antibodies ◽  
Arterial Thrombosis ◽  
Antithrombotic Therapy ◽  
Recurrent Thrombosis ◽  
Key Points

Key Points There is currently no clear consensus on the best approach to the management of patients with APS and arterial thrombosis. Combined antiplatelet and anticoagulant therapy may decrease risk of thrombosis recurrence in patients with APS and arterial thrombosis.

scholarly journals Analysis of antithrombotic therapy in elderly patients with nonvalvular atrial fibrillation in the Kyrgyz Republic and ways to increase treatment adherencе

2021 ◽  
Vol 102 (4) ◽  
pp. 439-445
Author(s):  
N K Kinderbaeva ◽  
K Bazira ◽  
N M Karabekova ◽  
R M Mamatova ◽  
Zh Asel ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Elderly Patients ◽  
Anticoagulant Therapy ◽  
Antithrombotic Therapy ◽  
Oral Anticoagulants ◽  
International Normalized Ratio ◽  
Average Score ◽  
The Third ◽  
Number Of Patients ◽  
Specialized Team

Aim. To analyze anticoagulant therapy in elderly patients with non-valvular atrial fibrillation and ways to increase adherence in the work of a specialized team. Methods. The study followed 250 patients with non-valvular atrial fibrillation aged 65 to 74 years (mean age 70.74.39 years). The patients were divided into three groups: the first group included 105 people, who were prescribed warfarin in a retrospective study; the second group 57 people treated with rivaroxaban, and the third group 88 people treated with warfarin. The second and third groups were prospective study groups which were supervised by a specialized team of physicians. The groups were matched on sex and age, comorbidities. Statistical data analysis and mathematical processing were performed by using the methods of descriptive and variational statistics. Most parameters reported as absolute values and percentages, while quantitative data the 25th and 75th percentiles. Results. All patients included in the study had a high risk of developing thromboembolic complications by their CHA2DS2-VASc score (2) and a low risk of developing hemorrhagic complications on the HAS-BLED scale (average score 1.490.04). They were prescribed anticoagulant therapy. By the end of the year follow-up from the start of anticoagulant therapy, only 9.5% of patients were treatment adherent, in the second group 43.8%, in the third group 70.5% of patients. The reason for refusing to take warfarin in the vast majority of cases was the inability to control the international normalized ratio, medical contraindications, and the high cost of the drug in prescribing rivaroxaban. The results showed that the majority of patients with atrial fibrillation (90.5%) receive inadequate antithrombotic therapy in routine outpatient clinical practice. At the same time, in a very small number of patients (9.5%) receiving warfarin, this type of therapy can be considered adequate (60% or more of the stay time in the therapeutic range of international normalized ratio of 2.0 to 3.0). Conclusion. Anticoagulant therapy prescription under the supervision of a specialized team contributes to a significant improvement in treatment adherence (from 43.8 to 70.5%); promising in the future is the use of drugs from the group of new oral anticoagulants that do not require routine monitoring of coagulogram.

scholarly journals Antithrombotic Therapy in Elderly Patients with Atrial Fibrillation: The State of the Problem in the Real Clinical Practice of a Family Medicine Doctor

2021 ◽  
Vol 6 (2) ◽  
pp. 63-69
Author(s):  
Bazira Kanat кyzy ◽  
N. K. Kinderbaeva ◽  
S. O. Turdaliyev ◽  
Zh. A. Mahmudova ◽  
U. K. Kundashev ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Family Medicine ◽  
Anticoagulant Therapy ◽  
Antithrombotic Therapy ◽  
Age Groups ◽  
Target Range ◽  
Specialized Team ◽  
Real Clinical Practice

Introduction. The research aimed at studying the efficacy and safety of anticoagulant therapy in patients with atrial fibrillation (AF), especially in older age groups, is now increasingly relevant.The aim of the study is to analyze the situation with prescribing anticoagulant therapy in elderly and senile persons with atrial fibrillation in real clinical practice and to demonstrate the possibility of improving the quality of observation and management of a group of patients as part of the work of a specialized team.Materials and methods. A total of 2,770 medical records of outpatient patients with atrial fibrillation were studied for the period from 2017 to 2019. Of this number, 320 patients with AF of nonvalvular etiology were selected, the average age of which was 70.3 ± 8.15 years. There were 270 women and 50 men. An observational prospective study in 45 elderly and senile patients with AF of non-valvular etiology was carried out by a team of specialized doctors for 12 months.Results. Of the 301 patients, anticoagulant therapy was prescribed to 166 (55.1 %), of which only 17 (10.2 %) people received proper anticoagulant therapy. The excessive activity was observed in 114 (37.9 %) patients, who underwent antiplatelet therapy with aspirin, and 21 (7.0 %) patients remained without any treatment with anticoagulants nor antiplatelet agents. Although, in the case of both, prescribing aspirin and not prescribing, anticoagulants have been indicated. In the prospective part of the study (for 12 months), all 45 patients continued to take anticoagulants and were systematically monitored. The INR in the target range over 60 % of the time was achieved in 37 % of patients receiving warfarin therapy.Conclusion. In the actual clinical practice of Kyrgyzstan family medicine centers, older patients with atrial fibrillation receive inadequate antithrombotic therapy. The main drug of choice for specialists remains warfarin, a therapy that can be recognized as adequate only in a small number (16 %) of patients. The ability to improve the quality of surveillance and management of a group of patients with AF and high adherence to treatment was demonstrated by the work of a specialized team of doctors. 

scholarly journals 2020 Russian and European clinical practice guidelines for the management of NSTEMI patients: have approaches to antithrombotic therapy been simplified?

2021 ◽  
Vol 10 (2) ◽  
pp. 92-101
Author(s):  
O. L. Barbarash ◽  
V. V. Kashtalap
Keyword(s):  
Clinical Practice ◽  
Anticoagulant Therapy ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Antithrombotic Therapy ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Coronary Syndromes ◽  
Esc Guidelines

Highlights. Prescribtion patterns of antithrombotic therapy in patients with non-ST-segment elevation acute coronary syndromes have been comapred in 2020 Russian and European clinical practice guidelines for the management of NSTEMI patients.A comparative assessment of novel approaches of antiplatelet and anticoagulant therapy recommended in 2020 European and Russian clinical practice guidelines for the management of patients with non-ST-segment elevation acute coronary syndrome is reported. In prescribing antiplatelet therapy, ESC guidelines suggest focusing attention on a more complex set of regimens to balance ischemic and hemorrhagic risks. Approaches to prescribing anticoagulant therapy do not differ in the recommendations of two medical societies. Fondaparinux has compelling advantages over other drugs regarding the combination of efficacy and safety in patients.

scholarly journals COVID-19 pathology: experience of 2000 autopsies

2020 ◽  
Vol 6 (4) ◽  
pp. 10-23
Author(s):  
Oleg V. Zayratyants ◽  
Maria V. Samsonova ◽  
Andrey L. Cherniaev ◽  
Oleko D. Mishnev ◽  
Liudmila M. Mikhaleva ◽  
...  
Keyword(s):  
Vascular System ◽  
Morphological Changes ◽  
Diffuse Alveolar Damage ◽  
Severe Form ◽  
Pathological Process ◽  
Pathological Anatomy ◽  
Legal Documents ◽  
Multiple Factors ◽  
Pulmonary Changes ◽  
Made In

Background: Pathological anatomy, patogenesis and the morphogenesis of manifestations and complications of COVID-19 remain insufficiently studied. The fullest information on structural bases of organs and tissues alterations by new coronavirus disease can be obtained as a result of autopsies. Aims: The aim of the study was to study the morphological changes of lungs and other organs of the autopsies of COVID-19 deceased persons. Results of 2000 autopsies of people who died of a severe form of COVID-19 in Moscow, consisting of 1212 men and 788 women, from March 20 to May 22, 2020 (a ratio 1.54:1) aged from 20 to 99 years (on average 68.515.63 years) were presented. This experience was previously generalized in the Atlas COVID-19 pathology. Autopsies were made in the converted interstationary pathoanatomical offices at strict observance of rules of biosafety according to standard and legal documents of WHO, Russian Ministry of Health and Rospotrebnadzor. Results: Morphological changes of lungs with varying severity and extent were detected in all examined cases; however, damage to other organs was also common, which in some cases prevailed over pulmonary changes and was the cause of death. The main morphological changes in lungs were diffuse alveolar damage and microangiopathy, alveolar hemorrhage syndrome, thrombosis, and thromboembolism. Conclusion: The involvement of the lungs, other organs, and vascular system in the pathological process is a result of multiple factors. It is advisable to implement clinical and morphological masks of COVID-19.

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