The tug-of-war between coagulopathy and anticoagulant agents in patients with COVID-19

Siciliano, Roberta; Scudiero, Fernando; Sanna, Giuseppe D; Canonico, Mario Enrico

doi:10.1093/ehjcvp/pvaa048

Cited by 19 publications

(20 citation statements)

References 4 publications

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“…[2] In addition, prolonged immobilization in critically ill patients promotes venous stasis and increases the risk of thromboembolic events. [5] Of note, anticoagulant treatment has been associated with lower risk of mortality in patients with severe COVID- 19. [6] The prevalence of pulmonary embolism (PE) in COVID-19 is still poorly investigated.…”

Section: Introductionmentioning

confidence: 99%

“…Elevated D-dimer levels were strongly associated with in-hospital mortality [ 4 ], and non survivors among infected patients met clinical criteria for disseminated intravascular coagulation (DIC) [ 2 ]. In addition, prolonged immobilization in critically ill patients promotes venous stasis and increases the risk of thromboembolic events [ 5 ]. Of note, anticoagulant treatment has been associated with lower risk of mortality in patients with severe COVID-19 [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Pulmonary embolism in COVID-19 patients: prevalence, predictors and clinical outcome

Scudiero

Silverio

Maio

et al. 2021

Thrombosis Research

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Introduction The incidence, characteristics, and prognosis of pulmonary embolism (PE) in Coronavirus disease 2019 (COVID-19) have been poorly investigated. We aimed to investigate the prevalence and the correlates with the occurrence of PE as well as the association between PE and the risk of mortality in COVID-19. Methods Retrospective multicenter study on consecutive COVID-19 patients hospitalized at 7 Italian Hospitals. At admission, all patients underwent medical history, laboratory and echocardiographic evaluation. Results The study population consisted of 224 patients (mean age 69 ± 14, male sex 62%); PE was diagnosed in 32 cases (14%). Patients with PE were hospitalized after a longer time since symptoms onset (7 IQR 3–11 days, 3 IQR 1–6 days; p = 0.001) and showed higher D-dimers level (1819 IQR 568–5017 ng/ml vs 555 IQR 13–1530 ng/ml; p < 0.001) and higher prevalence of myocardial injury(47% vs 28%, p = 0.033). At multivariable analysis, tricuspid annular plane systolic excursion (TAPSE; HR = 0.84; 95% CI 0.66–0.98; p = 0.046) and systolic pulmonary arterial pressure (sPAP; HR = 1.12; 95% CI 1.03–1.23; p = 0.008) resulted the only parameters independently associated with PE occurrence. Mortality rates (50% vs 27%; p = 0.010) and cardiogenic shock (37% vs 14%; p = 0.001) were significantly higher in PE as compared with non-PE patients. At multivariate analysis PE was significant associated with mortality. Conclusion PE is relatively common complication in COVID-19 and is associated with increased mortality risk. TAPSE and sPAP resulted the only parameters independently associated with PE occurrence in COVID-19 patients.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pulmonary embolism in COVID-19 patients: prevalence, predictors and clinical outcome

Scudiero

Silverio

Maio

et al. 2021

Thrombosis Research

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“… 5 Moreover, virus-induced local inflammatory reactions may affect endothelial cell function leading to vessel wall damage; finally, adverse drug–drug interactions between anticoagulant agents and experimental COVID-19 therapies could induce clinicians to substitute the oral anticoagulant with heparin causing on out of range therapeutic periods. 6 On the other hand, systemic anticoagulation could attenuate COVID-19 pro-coagulant profile 7 and it is associated with better clinical outcomes among hospitalized patients. 8 , 9 Accordingly, the recommendation of pharmacological thrombotic prophylaxis in hospitalized COVID-19 patients should include high-dose anticoagulant prophylaxis.…”

Section: Discussionmentioning

confidence: 99%

Acute pulmonary embolism in COVID-19 patient: a case report of free-floating right heart thrombus successfully treated with fibrinolysis

Scudiero

Pitì

Keim

et al. 2020

European Heart Journal - Case Reports

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Background Despite the fast-growing understanding of the coronavirus disease 2019 (COVID-19), patient management remains largely empirical or based on retrospective studies. In this complex scenario, an important clinical issue appears to be represented by the high prevalence of thromboembolic events, but the data regarding high-risk pulmonary embolism (PE) is still not available. Case summary A patient with COVID-19 developed sudden shortness of breath and hypoxia. Early echocardiographic diagnosis of high-risk PE related to right heart thrombus was performed. Systemic thrombolysis was administered with excellent clinical and haemodynamic response. Discussion Pulmonary thromboembolism is a common occurrence in severe COVID-19 infection. In our experience, systemic thrombolysis proved to be effective and for this reason may be considered for life-threatening PE in COVID-19 patients.

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“…However, the dose of the prophylaxis and even the choice between a prophylactic and a treatment regimen remains controversial 8 The International Society for Thrombosis and Hemostasis (ISTH ) suggests the use of low molecular weight at the already recognized doses for DVT prophylaxis in adults 9 In contrast, other centers propose to administer a higher prophylactic dose (double dose) in patients critically ill, after the report of an incidence of thrombotic event in ICU patients as high as 31%, despite regular prophylactic anticoagulation 10 . Finally, others clinician recommend therapeutic anticoagulation in patients with severe SARS-CoV-2 infection.…”

Section: A C C E P T E D a R T I C L Ementioning

confidence: 99%

MicroCLOTS pathophysiology in coronavirus disease 2019

Renzi¹,

Landoni²,

Zangrillo³

et al. 2023

Korean J Intern Med

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The tug-of-war between coagulopathy and anticoagulant agents in patients with COVID-19

Cited by 19 publications

References 4 publications

Pulmonary embolism in COVID-19 patients: prevalence, predictors and clinical outcome

Pulmonary embolism in COVID-19 patients: prevalence, predictors and clinical outcome

Acute pulmonary embolism in COVID-19 patient: a case report of free-floating right heart thrombus successfully treated with fibrinolysis

MicroCLOTS pathophysiology in coronavirus disease 2019

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