Therapeutic vs. prophylactic anticoagulation in COVID-19 patients: a systematic review and meta-analysis of real-world studies

Vio, Riccardo; Giordani, Andrea Silvio; Stefil, Maria; AlTurki, Ahmed; Russo, Vincenzo; China, Paolo; Gasperetti, Alessio; Schiavone, Marco; Čulić, Viktor; Biondi-Zoccai, Giuseppe; Themistoclakis, Sakis; Lip, Gregory Y.H.; Proietti, Riccardo

doi:10.23736/s2724-5683.22.06230-5

Cited by 1 publication

(2 citation statements)

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“…These responses suggested that in most cases, cardiac damage should be considered in the context of the overall respiratory infection rather than as an explanation of the prevailing display of the disease. Robust coagulation abnormalities established within the immune response to viral infection have proved that the venous and arterial circulation of COVID-19 patients were predisposed to thrombotic processes [43][44][45][46][47][48][49]. Choudhry and colleagues [48] evaluated patients who experienced COVID-19 and were hospitalized for ST-segment elevation myocardial infarction (STEMI) or patients with COVID-19 without STEMI.…”

Section: Clinical Evidence the Concern Of Diagnosis Related To Covid-...mentioning

confidence: 99%

“…The same etiopathogenetic profile has been described in a patient with COVID-19 in whom multiple spontaneous coronary thromboses causing ST-elevation myocardial infarction were observed. A meta-analysis, based on real-world studies and adjusted estimates of risk, reported a survival benefit of therapeutic anticoagulation over prophylactic anticoagulation in COVID-19 patients [49].…”

Section: Clinical Evidence the Concern Of Diagnosis Related To Covid-...mentioning

confidence: 99%

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SARS-CoV-2-Induced Myocarditis: A State-of-the-Art Review

Nappi

Singh

2023

Viruses

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In this review, we investigated whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can directly cause myocarditis with severe myocardial damage induced by viral particles. A review of the major data published from 2020 to 2022 was performed by consulting the major databases alongside first-hand experiences that emerged from the cardiac biopsies and autopsy examinations of patients who died of SARS-CoV-2 infections. From this study, a significantly large amount of data suggests that the Dallas criteria were met in a residual percentage of patients, demonstrating that SARS-CoV-2 myocarditis was a rare clinical and pathological entity that occurred in a small percentage of subjects. All cases described here were highly selected and subjected to autopsies or endomyocardial biopsies (EMBs). The most important discovery, through the detection of the SARS-CoV-2 genome using the polymerase chain reaction, consisted in the presence of the viral genome in the lung tissue of most of the patients who died from COVID-19. However, the discovery of the SARS-CoV-2 viral genome was a rare event in cardiac tissue from autopsy findings of patients who died of myocarditis It is important to emphasize that myocardial inflammation alone, as promoted by macrophages and T cell infiltrations, can be observed in noninfectious deaths and COVID-19 cases, but the extent of each cause is varied, and in neither case have such findings been reported to support clinically relevant myocarditis. Therefore, in the different infected vs. non-infected samples examined, none of our findings provide a definitive histochemical assessment for the diagnosis of myocarditis in the majority of cases evaluated. We report evidence suggesting an extremely low frequency of viral myocarditis that has also been associated with unclear therapeutic implications. These two key factors strongly point towards the use of an endomyocardial biopsy to irrefutably reach a diagnosis of viral myocarditis in the context of COVID-19.

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