Thrombophilia, also called hypercoagulability or prothrombotic condition, usually reflects a certain imbalance that occurs either in the coagulation cascade or in the anticoagulation/fibrinolytic system. A similar imbalance may be induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Thrombotic complications are associated with multiorgan failure and increased mortality. In this context, activation of coagulation and thrombocytopenia appeared as prognostic markers in COVID-19. Our work provides a structured and updated analysis of inherited thrombophilia and its involvement in COVID-19, emphasizing the importance of diagnosing and initiating thromboprophylaxis. Since the state of hypercoagulation is directly correlated with COVID-19, we consider that studies on the genetic profiles of proteins involved in thrombophilia in patients who have had COVID-19 and thrombotic events are of great importance, both in treating and in preventing deaths due to COVID-19.
Haemophilia is an inherited disease that requires a different approach in order to evaluate, monitor and treat patients. Despite the great advances in therapeutic agents that have emerged, reports on the impact of monitoring outcomes on treatment decisions are rarely presented. Haemophilia A and haemophilia B are inherited bleeding disorders caused by deficiencies in blood clotting factor proteins. A systematic review was performed to identify literature reports on the current practices in haemophilic patients undergoing orthopedic surgery. The best therapy for haemophilic patients consists in performing primary prophylaxis to prevent joint bleeding and other complications. Besides the primary prophylaxis, thromboprophylaxis is used to prevent venous thrombosis in patients with hemophilia who undergo surgical orthopedic procedures. Further research is needed to better manage the pharmacologic approaches in haemophilic patients undergoing orthopedic surgery. Although patients with haemophilia present low risk for thromboembolic complications, such events have been reported in surgical procedures. The recommendations in patients with haemophilia are considerably variable in the current guidelines and clinical practice. The best therapy for haemophilic patients consists in performing primary prophylaxis to prevent joint bleeding and other complications.
What started with 41 hospitalized patients identified as having laboratory-confirmed coronavirus disease 2019 in Wuhan, China, by January 2, 2020, turned into an unprecedented pandemic with more than 113 million confirmed cases and a mortality exceeding 2.5 million deaths worldwide by the beginning of March 2021. Although the course of the disease is uneventful in most cases, there is a percentage of patients who become critically ill and need admission in the intensive care unit for severe respiratory failure. Numerous of these patients undergo invasive mechanical ventilation and have an extremely high mortality rate. For these patients, extracorporeal membrane oxygenation (ECMO) has emerged as a last standing resource. In the present study, the literature was reviewed to evaluate the worldwide data regarding the use of ECMO in the management of critically ill COVID-19 patients. ISI Thomson Web of Science was searched for articles with English language abstracts from inception to March 1, 2021, with 'ECMO in COVID-19' as key words. A total of 214 abstracts were screened (case reports, guidelines, reviews) and the most relevant articles were included in the present review. The use of ECMO in the management of critically ill patients with COVID-19-induced acute respiratory distress syndrome refractory to conventional mechanical invasive ventilation is increasing. By increasing the survival rate from less than 20% to more than 50%, ECMO proved to be a valuable resource in the management of the most challenging critically ill COVID-19 patients. Contents 1. Introduction 2. Worldwide data regarding the critically ill COVID-19 patients 3. Rational for extracorporeal membrane oxygenation (ECMO) use in the management of critically ill COVID-19 patients 4. ECMO use in the management of critically ill COVID-19 patients: Current guidelines 5. Worldwide data regarding ECMO-supported COVID-19 patients 6. Discussion 7. Conclusions
Modern antineoplastic therapy improves survival and quality of life in cancer patients, but its indisputable benefits are accompanied by multiple and major side effects, such as cardiovascular ones. Endothelial dysfunction, arterial spasm, intravascular thrombosis, and accelerated atherosclerosis affect the coronary arteries, leading to acute and chronic coronary syndromes that negatively interfere with the oncologic treatment. The cardiac toxicity of antineoplastic agents may be mitigated by using adequate prophylactic measures. In the absence of dedicated guidelines, our work provides the most comprehensive, systematized, structured, and up-to-date analyses of the available literature focusing on measures aiming to protect the coronary arteries from the toxicity of cancer therapy. Our work facilitates the implementation of these measures in daily practice. The ultimate goal is to offer clinicians the necessary data for a personalized therapeutic approach for cancer patients receiving evidence-based oncology treatments with potential cardiovascular toxicity.
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