Risks of venous thromboembolic complications in related to combined oral contraceptives

Hormonal contraception is the most popular and effective reversible method for preventing unwanted pregnancy exerting multiple prophylactic and therapeutic effect along with contraceptive activity. The main adverse coupled to combined oral contraceptives (COCs) is its impact on the hemostasis and increased risk of venous thromboembolic complications. A great evolutionary path has been travelled after beginning application of hormonal contraception to reduce dose of its estrogen component and improving quality of gestagen component. Nevertheless, thrombotic complications related to COCs use still remain a pressing issue not only due to disease severity and high mortality rate from pulmonary embolism (PE), but also due to the difficulties in its timely diagnostics. Here we describe a clinical case of a 19-year-old patient suffering from vena cava inferior thrombosis complicated by PE after using COCs.

Anticoagulants after Discharge in Patients with COVID-19: What we Know at the End of 2021

This review discusses reasons for prolonged use of anticoagulants after discharge of patients with COVID-19 without additional indication for anticoagulation. Data regarding rate of thrombotic and thromboembolic complications in patients with COVID-19 after discharge from the hospital are presented. Large randomized controlled trials EXCLAIM, ADOPT, MAGELLAN, APEX and MARINER with prolonged use of anticoagulants in patients hospitalized with acute nonsurgical diseases before pandemia of COVID-19 are discussed. The first prospective randomized controlled trial MICHELLE with direct oral anticoagulant rivaroxaban in a dose 10 mg once daily after discharge of patients with COVID-19 with high risk at least venous thromboembolism are analyzed. It seems that the most relevant approach for the determination of indications for prolonged use of anticoagulants in doses dedicated for primary prevention of venous thromboembolism after discharge of patients with COVID-19 without apparent indication for anticoagulation is a modified IMPROVE VTE risk score with the addition of elevated in-hospital D-dimer level. And the most well-studied approach for anticoagulation in these patients is a direct peroral anticoagulant rivaroxaban 10 mg once daily for 35 (and possibly up to 45) days after discharge.

Knowledge and attitude of dental students in treating patients on antiplatelet and/ or anticoagulant medications

Background: Antiplatelet and anticoagulant medications are widely prescribed for the prevention of thromboembolic events. Dental management of patients taking such medications can be troublesome because of the possibility of excessive bleeding during surgical procedures. On the other hand, stopping these medications will increase the risk of thromboembolic complications. This study aimed to evaluate the level of knowledge and attitude of dental students and internship trainees at King Saud university in treating patients on antiplatelet and/or anticoagulant medications.Methods: A 17-question survey was distributed among dental students in third, fourth, and fifth (seniors) academic year levels, as well as internship trainees. The survey included questions aiming to evaluate participants’ knowledge in treating patients on antiplatelet and/or anticoagulant medications. A total of 281 surveys were returned complete.Results: In our study, most participants were aware of aspirin (86.1%) and warfarin (92.2%) but only a few were aware of newer medications like rivaroxaban (10.7%) or apixaban (8.2%). The majority of participants would consult with the patient’s physician (76.9%) before stopping any medications and/or would rely on local hemostatic techniques to control bleeding (70.8%).Conclusions: In this study, we concluded that only a small percentage of participants were aware of and following the latest guidelines. The findings of the present study suggest a need for educational programs and workshops regarding this topic.

Scoping Review: Ultrasonographic evidence of intraabdominal manifestations of COVID-19 infection

COVID-19 is an infectious disease caused by the novel SARS-CoV-2 coronavirus that in the majority of patients will only cause mild symptoms. The most common serious complication is COVID-19 pneumonia, however, gastrointestinal (GI) COV-ID-19 is also a frequent presentation and likely due to the high expression of the ACE2 receptor in the GI tract. As diagnostic ultrasound has been frequently used in the management of this patient cohort, we conducted a literature search with the aim to present and review the currently published evidence of using ultrasound examinations in the management of intraabdominal manifestations of COVID-19. Our analysis showed that sonographic abnormalities of the hepatobiliary system are the most commonly reported findings in adults, while gastrointestinal abnormalities are the most common findings in children. The most severe complications are related to thromboembolic complications in the intensive care unit.

Atrial Cardiomyopathy: a Role in the Pathogenesis of Atrial Fibrillation and Influence on the Results of Its Treatment

The work is dedicated to the issue of atrial cardiomyopathies (ACs). They have a significant effect on the heart function, provoke rhythm disturbances and increase the risk of thromboembolic complications. The aim. To analyze the latest publications on the topic. The material for the analysis were the papers published by the leading arrhythmological clinics. Discussion. This paper describes the origin of the term “atrial cardiomyopathy”, highlights the conditional classification of changes in the atrial myocardium according to the EHRAS classification. The causes of this nosological form may be some types of gene mutations, as well as hypertension, congestive circulatory failure, diabetes mellitus, myocarditis, etc. ACs play an important role in the occurrence of atrial fibrillation (AF) and also affect its natural course and treatment outcomes. Electroanatomical mapping and magnetic resonance data show significant fibrotic changes in the atria in individuals with this form of arrhythmia. The DECAAF study (Delayed enhancement MRI and atrial fibrillation catheter ablation) showed that fibrotic changes in the atrial myocardium are directly related to the frequency of recurrent arrhythmias after catheter ablation. The DECAAFII study confirmed the effectiveness of the influence on the fibrous substrate in the catheter treatment of AF at stages 1 and 2 of fibrosis. The results of catheter treatment depend on the severity of fibrosis, which shows the importance of taking this factor into account when determining the indications for ablation. Conclusions. Thus, AC is an important component of the pathogenesis of AF. Improvement of techniques for influencing the fibrous substrate will improve the results of catheter treatment of AF.

Jadassohn anetoderma: clinical observation

The article presents a clinical observation of a rare dermatosis - Jadassohn anetoderma. The described case demonstrates the important role of differential diagnostic in patients with atrophic skin changes, paying attention to the possibility of rare dermatoses. Difficulties in diagnosing such diseases are largely due not only to the low frequency of occurrence in the practice of a dermatologist, but also to the sometimes-untimely treatment of patients due to the lack of subjective sensations, especially when the rashes are located in places inaccessible for self-examination. At the same time, despite the fact that the exact pathophysiological mechanisms of the development of anetoderma remain unknown, a number of studies indicate the possibility of autoimmune diseases of the connective tissue, antiphospholipid syndrome and an increased risk of thromboembolic complications in such patients. This fact convincingly proves that the timely diagnosis of anetoderma not only makes it possible to form the correct approach to the management of such patients, but also to provide vigilance regarding the development of autoimmune pathology of the connective tissue.

Adverse Outcome in COVID-19 Is Associated With an Aggravating Hypo-Responsive Platelet Phenotype

Thromboembolic complications are frequently observed in Coronavirus disease 2019 (COVID-19). While COVID-19 is linked to platelet dysregulation, the association between disease outcome and platelet function is less clear. We prospectively monitored platelet activation and reactivity in 97 patients during the first week of hospitalization and determined plasma markers of platelet degranulation and inflammation. Adverse outcome in COVID-19 was associated with increased basal platelet activation and diminished platelet responses, which aggravated over time. Especially GPIIb/IIIa responses were abrogated, pointing toward impeded platelet aggregation. Moreover, platelet-leukocyte aggregate formation was diminished, pointing toward abrogated platelet-mediated immune responses in COVID-19. No general increase in plasma levels of platelet-derived granule components could be detected, arguing against platelet exhaustion. However, studies on platelets from healthy donors showed that plasma components in COVID-19 patients with unfavorable outcome were at least partly responsible for diminished platelet responses.Taken together this study shows that unfavorable outcome in COVID-19 is associated with a hypo-responsive platelet phenotype that aggravates with disease progression and may impact platelet-mediated immunoregulation.