Pulmonary thrombosis in Covid-19: before, during and after hospital admission

Vlachou, Maria; Drebes, Anja; Weeraman, Deshan; Mir, Naheed; Murch, Nick; Davies, Neil M; Coghlan, J. Gerry

doi:10.1007/s11239-020-02370-7

Cited by 42 publications

(39 citation statements)

References 24 publications

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“…While the former may be a result of reduced cardiovascular care during the early pandemic, 5,6 the latter could also be associated with preceding Covid-19 infections. 9 If the increased incidence of hospitalizations for acute myocardial infarction, aortic dissection and pulmonary embolism is a signal for a rising incidence of those conditions in the public, this could at least in part explain the observed excess mortality in Germany between late July and mid October 2020. 10 Those alarming signals require immediate attention and further studies.…”

Section: Discussionmentioning

confidence: 99%

Hospitalizations for emergency-sensitive conditions in Germany during the Covid-19 pandemic Insights from the German-wide Helios hospital network

Bollmann

Hohenstein

Pellissier

et al. 2021

Preprint

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Background: While there are numerous reports that describe emergency care during the early Covid-19 pandemic, there is scarcity of data for later stages. This study analyzes hospitalization rates for 37 emergency-sensitive conditions in the largest German-wide hospital network during different pandemic phases. Methods: Using claims data of 80 hospitals, consecutive cases between January 1 and November 17, 2020 were analyzed and compared to a corresponding period in 2019. Incidence-rate ratios (IRR) comparing the both periods were calculated using Poisson regression to model the number of hospitalizations per day. Results: There was a hospitalization deficit between March 12 and June 13, 2020 (coinciding with the 1st pandemic wave) with 32,807 hospitalizations as opposed to 39,379 in 2019 (IRR 0.83, 95% CI 0.82-0.85, P<0.01). During the following period (June 14 to November 17, 2020, including the start of 2nd wave), hospitalizations were reduced from 63,799 in 2019 to 59,910 in 2020, but this reduction was not that pronounced (IRR 0.94, 95% CI 0.93-0.95, P<0.01). There was an increase in hospitalizations for acute myocardial infarction, aortic aneurism/dissection and pulmonary embolism after the 1st wave during which hospitalizations had been reduced for those conditions. In contrast, hospitalizations for sepsis, pneumonia, obstructive pulmonary disease, and intracranial injuries were reduced during the entire pandemic. Conclusions: There was an overall reduction of hospitalizations for emergency-sensitive conditions in Germany during the Covid-19 pandemic with heterogeneous effects on different disease categories. The increase of hospitalizations for acute myocardial infarction, aortic aneurism/dissection and pulmonary embolism is an alarming signal that requires attention and further studies.

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Section: Discussionmentioning

confidence: 99%

Hospitalizations for emergency-sensitive conditions in Germany during the Covid-19 pandemic Insights from the German-wide Helios hospital network

Bollmann

Hohenstein

Pellissier

et al. 2021

Preprint

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“…This thromboembolic tendency was seen in another clinical study that showed 18 of 370 patients admitted with COVID had computed tomography (CT) evidence of thrombosis. 52 A review of most of the autopsy publications shows a confirmation bias of histological changes of diffuse alveolar damage but more attention should be given to images which show areas of positive antigen, but no significant other morphological changes, 46,53 suggesting that not all virus infection of the functional lung unit leads to massive damage and that the cytokine storm is only seen in a minor proportion of cases. 54 The problems with understanding human lung pathophysiology and COVID-19 are illustrated in two cases of fatal COVID-19 in which post-mortem was performed.…”

Section: Respiratorymentioning

confidence: 99%

Pathophysiology of infection with SARS‐CoV‐2—What is known and what remains a mystery

Sridhar

Nicholls

2021

Respirology

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Coronavirus disease 2019 (COVID-19), caused by coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused extensive disruption and mortality since its recent emergence. Concomitantly, there has been a race to understand the virus and its pathophysiology. The clinical manifestations of COVID-19 are manifold and not restricted to the respiratory tract. Extrapulmonary manifestations involving the gastrointestinal tract, hepatobiliary system, cardiovascular and renal systems have been widely reported. However, the pathophysiology of many of these manifestations is controversial with questionable support for direct viral invasion and an abundance of alternative explanations such as pre-existing medical conditions and critical illness. Prior research on SARS-Co-V and NL63 was rapidly leveraged to identify angiotensin-converting enzyme 2 (ACE2) receptor as the key cell surface receptor for SARS-CoV-2. The distribution of ACE2 has been used as a starting point for estimating vulnerability of various tissue types to SARS-CoV-2 infection. Sophisticated organoid and animal models have been used to demonstrate such infectivity of extrapulmonary tissues in vitro, but the clinical relevance of these findings remains uncertain. Clinical autopsy studies are typically small and inevitably biased towards patients with severe COVID-19 and prolonged hospitalization. Technical issues such as delay between time of death and autopsy, use of inappropriate antibodies for paraffin-embedded tissue sections and misinterpretation of cellular structures as virus particles on electron micrograph images are additional problems encountered in the extant literature. Given that SARS-CoV-2 is likely to circulate permanently in human populations, there is no doubt that further work is required to clarify the pathobiology of COVID-19.

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“…Nonetheless, in hospitalized patients with COVID-19, asymptomatic DVT was also observed, suggesting that emboli from lower extremities may also contribute to the burden of PE [ 81 ]. In the paper of Vlachou et al, PE episodes were observed up to 4 weeks after COVID-19 recovery, frequently not associated with significant lung involvement [ 82 ]. This highlights that thrombotic risk in the pulmonary vasculature may persist after hospital discharge.…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular Involvement in COVID-19: What Sequelae Should We Expect?

Polito¹,

Silverio

Bellino

et al. 2021

Cardiol Ther

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Several forms of cardiovascular involvement have been described in patients with Coronavirus disease 19 (COVID-19): myocardial injury, acute coronary syndrome, acute heart failure, myocarditis, pericardial diseases, arrhythmias, takotsubo syndrome, and arterial and venous atherothrombotic and thromboembolic events. Data on long-term outcome of these patients are still sparse, and the type and real incidence of cardiovascular sequelae are poorly known. It is plausible that myocardial injury may be the initiator of an inflammatory cascade, edema, and subsequent fibrosis, but also a consequence of systemic inflammation. The extent and distribution of ongoing inflammation may be the basis for ventricular dysfunction and malignant arrhythmias. Indeed, preliminary observational findings seem to emphasize the importance of close monitoring of COVID-19 patients with myocardial injury after discharge. Residual subclinical disease may be effectively investigated by using second-level imaging modalities such as cardiac magnetic resonance, which allows better characterization of the type and extension of myocardial damage, as well as of the ongoing inflammation after the acute phase. In patients with venous thromboembolism, a very common complication of COVID-19, the type and the duration of anticoagulation therapy after the acute phase should be tailored to the patient and based on the estimation of the individual thromboembolic and hemorrhagic risk. Large randomized clinical trials are ongoing to address this clinical question. Whether the severity of cardiovascular involvement, the type of treatments adopted during the acute phase, and the hemodynamic response, may influence the long-term outcome of patients recovered from COVID-19 is unknown. An etiological diagnosis of myocardial injury during the hospitalization is the first step for an appropriate follow-up in these patients. After discharge, the screening for residual left and right ventricular dysfunction, arrhythmias, residual thrombosis, and myocardial scar should be considered on a case-by-case basis, whereas an active clinical surveillance is mandatory in any patient.

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Pulmonary thrombosis in Covid-19: before, during and after hospital admission

Cited by 42 publications

References 24 publications

Hospitalizations for emergency-sensitive conditions in Germany during the Covid-19 pandemic Insights from the German-wide Helios hospital network

Hospitalizations for emergency-sensitive conditions in Germany during the Covid-19 pandemic Insights from the German-wide Helios hospital network

Pathophysiology of infection with SARS‐CoV‐2—What is known and what remains a mystery

Cardiovascular Involvement in COVID-19: What Sequelae Should We Expect?

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