Loss of engagement in controlling chronic anticoagulation therapy during Covid-19 stringency measures. A single center experience of disproportioned increase of stuck mechanical valves

Vriz, Olga; Zadra, Andrea Rossi; Eltayeb, Abdalla; Asiri, Fatima; Pragliola, Claudio; Fawzy, Nader Ashraf; Galzerano, Domenico; Feras, Khalid; Al‐Halees, Zohair; Kinsara, Abdulhalim Jamal; Elmula, Fadl Elmula M. Fadl

doi:10.4081/monaldi.2021.2065

Cited by 5 publications

(2 citation statements)

References 15 publications

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“…The most frequent risk factors contributing to PVT include inadequate anticoagulation, AF, recent infection, and plasma fibrinogen level, as reported by Bezanjani et al Furthermore, with regards to inadequate anticoagulation, it has been recently recognized that public policy-related COVID-19 restriction measures have posed a challenge for patients and physicians to regularly assess patients’ INR levels and ensure effective anticoagulation; Vriz et al found that the incidence of stuck prosthetic valves has significantly increased amid these restrictions [ 24 ]. While we acknowledge that COVID-19 restriction measures themselves may have had an influence on PVT incidence during the COVID-19 pandemic, it is important to note that none of the cases included in this review noted significant non-adherence to anticoagulation medication nor INR check-ups.…”

Section: Discussionmentioning

confidence: 99%

Comprehensive collection of COVID-19 related prosthetic valve failure: a systematic review

Trieu

Birkeland

Kimchi

et al. 2022

J Thromb Thrombolysis

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Since the beginning of the SARS-CoV-2 (COVID-19) pandemic, correlation of venous thromboembolism (VTE) and COVID-19 infection has been well established. Increased inflammatory response in the setting of COVID-19 infection is associated with VTE and hypercoagulability. Venous and arterial thrombotic events in COVID-19 infection have been well documented; however, few cases have been reported involving cardiac valve prostheses. In this review, we present a total of eight cases involving COVID-19-related prosthetic valve thrombosis (PVT), as identified in a systematic review. These eight cases describe valve position (mitral versus aortic) and prosthesis type (bioprosthetic versus mechanical), and all cases demonstrate incidents of PVT associated with simultaneous or recent COVID-19 infection. None of these eight cases display obvious non-adherence to anticoagulation; five of the cases occurred greater than three years after the most recent valve replacement. Our review offers insights into PVT in COVID-19 infected patients including an indication for increased monitoring in the peri-infectious period. We explore valve thrombosis as a mechanism for prosthetic valve failure. We describe potential differences in antithrombotic strategies that may offer added antithrombotic protection during COVID-19 infection. With the growing population of valve replacement patients and recurring COVID-19 infection surges, it is imperative to explore relationships between COVID-19 and PVT.

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Section: Discussionmentioning

confidence: 99%

Comprehensive collection of COVID-19 related prosthetic valve failure: a systematic review

Trieu

Birkeland

Kimchi

et al. 2022

J Thromb Thrombolysis

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“…Unfortunately, the COVID-19 pandemic has made it difficult for patients to visit anticoagulation clinics to obtain AMSs (Gong et al, 2020;Zhang, 2020). Previous studies have shown a significant increase in adverse events of warfarin treatment during COVID-19 stringency measures (Vriz et al, 2021). Therefore, measures should be taken to improve the anticoagulation quality of patients during the COVID-19 pandemic.…”

Section: Introductionmentioning

confidence: 99%

Warfarin anticoagulation management during the COVID-19 pandemic: The role of internet clinic and machine learning

Dai

Zhang

et al. 2022

Front. Pharmacol.

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Background: Patients who received warfarin require constant monitoring by hospital staff. However, social distancing and stay-at-home orders, which were universally adopted strategies to avoid the spread of COVID-19, led to unprecedented challenges. This study aimed to optimize warfarin treatment during the COVID-19 pandemic by determining the role of the Internet clinic and developing a machine learning (ML) model to predict anticoagulation quality.Methods: This retrospective study enrolled patients who received warfarin treatment in the hospital anticoagulation clinic (HAC) and “Internet + Anticoagulation clinic” (IAC) of the Nanjing Drum Tower Hospital between January 2020 and September 2021. The primary outcome was the anticoagulation quality of patients, which was evaluated by both the time in therapeutic range (TTR) and international normalized ratio (INR) variability. Anticoagulation quality and incidence of adverse events were compared between HAC and IAC. Furthermore, five ML algorithms were used to develop the anticoagulation quality prediction model, and the SHAP method was introduced to rank the feature importance.Results: Totally, 241 patients were included, comprising 145 patients in the HAC group and 96 patients in the IAC group. In the HAC group and IAC group, 73.1 and 69.8% (p = 0.576) of patients achieved good anticoagulation quality, with the average TTR being 79.9 ± 20.0% and 80.6 ± 21.1%, respectively. There was no significant difference in the incidence of adverse events between the two groups. Evaluating the five ML models using the test set, the accuracy of the XGBoost model was 0.767, and the area under the receiver operating characteristic curve was 0.808, which showed the best performance. The results of the SHAP method revealed that age, education, hypertension, aspirin, and amiodarone were the top five important features associated with poor anticoagulation quality.Conclusion: The IAC contributed to a novel management method for patients who received warfarin during the COVID-19 pandemic, as effective as HAC and with a low risk of virus transmission. The XGBoost model could accurately select patients at a high risk of poor anticoagulation quality, who could benefit from active intervention.

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Warfarin

2022

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Loss of engagement in controlling chronic anticoagulation therapy during Covid-19 stringency measures. A single center experience of disproportioned increase of stuck mechanical valves

Cited by 5 publications

References 15 publications

Comprehensive collection of COVID-19 related prosthetic valve failure: a systematic review

Comprehensive collection of COVID-19 related prosthetic valve failure: a systematic review

Warfarin anticoagulation management during the COVID-19 pandemic: The role of internet clinic and machine learning

Warfarin

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