Venous Thromboembolism in Hospitalized COVID-19 Patients

Sridharan, Gurusaravanan Kutti; Vegunta, Radhakrishna; Rokkam, Venkata Ram Pradeep; Aravamudan, Veeraraghavan Meyyur; Vegunta, Rathnamitreyee; Khan, Shahab R.; Ponnada, Suresh; Boregowda, Umesha; Prudhvi, Kalyan; Chamarthi, Gajapathiraju; Mohan, Babu P.

doi:10.1097/mjt.0000000000001295

Cited by 24 publications

(23 citation statements)

References 30 publications

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“…Patients who need to be admitted to hospital should have a prescription for thromboprophylaxis unless contraindicated, but the best effective dosage remains uncertain [ 29 ]. A recent meta-analysis suggested better primary prevention of VTE by using curative versus prophylactic anticoagulation [ 30 ]. However, the expected benefit on survival following curative versus prophylactic dosing regimen (standard vs. high) still remains controversial [ 17 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

D-Dimer Level and Neutrophils Count as Predictive and Prognostic Factors of Pulmonary Embolism in Severe Non-ICU COVID-19 Patients

Thoreau

Galland

Delrue

et al. 2021

Viruses

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The incidence of pulmonary embolism (PE) is high during severe Coronavirus Disease 2019 (COVID-19). We aimed to identify predictive and prognostic factors of PE in non-ICU hospitalized COVID-19 patients. In the retrospective multicenter observational CLOTVID cohort, we enrolled patients with confirmed RT-PCR COVID-19 who were hospitalized in a medicine ward and also underwent a CT pulmonary angiography for a PE suspicion. Baseline data, laboratory biomarkers, treatments, and outcomes were collected. Predictive and prognostics factors of PE were identified by using logistic multivariate and by Cox regression models, respectively. A total of 174 patients were enrolled, among whom 86 (median [IQR] age of 66 years [55–77]) had post-admission PE suspicion, with 30/86 (34.9%) PE being confirmed. PE occurrence was independently associated with the lack of long-term anticoagulation or thromboprophylaxis (OR [95%CI], 72.3 [3.6–4384.8]) D-dimers ≥ 2000 ng/mL (26.3 [4.1–537.8]) and neutrophils ≥ 7.0 G/L (5.8 [1.4–29.5]). The presence of these two biomarkers was associated with a higher risk of PE (p = 0.0002) and death or ICU transfer (HR [95%CI], 12.9 [2.5–67.8], p < 0.01). In hospitalized non-ICU severe COVID-19 patients with clinical PE suspicion, the lack of anticoagulation, D-dimers ≥ 2000 ng/mL, neutrophils ≥ 7.0 G/L, and these two biomarkers combined might be useful predictive markers of PE and prognosis, respectively.

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Section: Discussionmentioning

confidence: 99%

D-Dimer Level and Neutrophils Count as Predictive and Prognostic Factors of Pulmonary Embolism in Severe Non-ICU COVID-19 Patients

Thoreau

Galland

Delrue

et al. 2021

Viruses

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“…While every effort is being made by the medical experts to treat patients by taking suitable preventive measures employing anticoagulation therapeutics to deal with the coagulation issues. Despite superb benefits with the use of systemic anticoagulation therapies, the data seem to be retrospective in nature thus raising some questions on the possible interplay of other confounders, as well as, long-term benefits and safety of the systemic anticoagulation approach [26][27][28][29][30][31][32][33][34].…”

Section: Proteinase and Covid-19mentioning

confidence: 99%

Multi-organ damage by covid-19: congestive (cardio-pulmonary) heart failure, and blood-heart barrier leakage

Tyagi

Singh

2021

Mol Cell Biochem

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is caused by a coronavirus that is also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and is generally characterized by fever, respiratory inflammation, and multi-organ failure in susceptible hosts. One of the first things during inflammation is the response by acute phase proteins coupled with coagulation. The angiotensinogen (a substrate for hypertension) is one such acute phase protein and goes on to explain an association of covid-19 with that of angiotensin-converting enzyme-2 (ACE2, a metallopeptidase). Therefore, it is advisable to administer, and test the efficacy of specific blocker(s) of angiotensinogen such as siRNAs or antibodies to covid-19 subjects. Covid-19 activates neutrophils, macrophages, but decreases T-helper cells activity. The metalloproteinases promote the activation of these inflammatory immune cells, therefore; we surmise that doxycycline (a metalloproteinase inhibitor, and a safer antibiotic) would benefit the covid-19 subjects. Along these lines, an anti-acid has also been suggested for mitigation of the covid-19 complications. Interestingly, there are three primary vegetables (celery, carrot, and long-squash) which are alkaline in their pH-range as compared to many others. Hence, treatment with fresh juice (without any preservative) from these vegies or the antioxidants derived from purple carrot and cabbage together with appropriate anti-coagulants may also help prevent or lessen the detrimental effects of the covid-19 pathological outcomes. These suggested remedies might be included in the list of putative interventions that are currently being investigated towards mitigating the multi-organ damage by Covid-19 during the ongoing pandemic.

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“…However, only few of the included studies were of good quality and no information was provided regarding various age groups. A meta-analysis of hospitalised COVID-19 patients showed that anticoagulation in therapeutic dose was beneficial [ 80 ]. An analysis of 4389 hospitalised COVID-19 adults found that anticoagulation was associated with lower mortality and intubation, with a trend towards a higher benefit with therapeutic doses [ 81 ].…”

Section: Anticoagulantsmentioning

confidence: 99%

Protecting older patients with cardiovascular diseases from COVID-19 complications using current medications

et al. 2021

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Purpose In the pathogenesis of severe COVID-19 complications, derangements of renin–angiotensin–aldosterone system (RAAS), vascular endothelial dysfunction leading to inflammation and coagulopathy, and arrhythmias play an important role. Therefore, it is worth considering the use of currently available drugs to protect COVID-19 patients with cardiovascular diseases. Methods We review the current experience of conventional cardiovascular drugs [angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, anticoagulants, acetosalicylic acid, antiarrhythmic drugs, statins] as well as some other drug classes (antidiabetic drugs, vitamin D and NSAIDs) frequently used by older patients with cardiovascular diseases. Data were sought from clinical databases for COVID-19 and appropriate key words. Conclusions and recommendations are based on a consensus among all authors. Results Several cardiovascular drugs have a potential to protect patients with COVID-19, although evidence is largely based on retrospective, observational studies. Despite propensity score adjustments used in many analyses observational studies are not equivalent to randomised controlled trials (RCTs). Ongoing RCTs include treatment with antithrombotics, pulmonary vasodilators, RAAS-related drugs, and colchicine. RCTs in the acute phase of COVID-19 may not, however, recognise the benefits of long term anti-atherogenic therapies, such as statins. Conclusions Most current cardiovascular drugs can be safely continued during COVID-19. Some drug classes may even be protective. Age-specific data are scarce, though, and conditions which are common in older patients (frailty, comorbidities, polypharmacy) must be individually considered for each drug group.

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Venous Thromboembolism in Hospitalized COVID-19 Patients

Cited by 24 publications

References 30 publications

D-Dimer Level and Neutrophils Count as Predictive and Prognostic Factors of Pulmonary Embolism in Severe Non-ICU COVID-19 Patients

D-Dimer Level and Neutrophils Count as Predictive and Prognostic Factors of Pulmonary Embolism in Severe Non-ICU COVID-19 Patients

Multi-organ damage by covid-19: congestive (cardio-pulmonary) heart failure, and blood-heart barrier leakage

Protecting older patients with cardiovascular diseases from COVID-19 complications using current medications

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