https://journal.chestnet.org/article/S0012-3692(12)60129-9/pdf

Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

https://www.healthcare.uiowa.edu/familymedicine/fpinfo/Docs/Chest%20Rx%20VTE%20Feb%202016.pdf

Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report

European Resuscitation Council Guidelines for Resuscitation.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pathogen responsible for the coronavirus disease 2019 (COVID-19) pandemic, which has resulted in global healthcare crises and strained health resources. As the population of patients recovering from COVID-19 grows, it is paramount to establish an understanding of the healthcare issues surrounding them. COVID-19 is now recognized as a multi-organ disease with a broad spectrum of manifestations. Similarly to post-acute viral syndromes described in survivors of other virulent coronavirus epidemics, there are increasing reports of persistent and prolonged effects after acute COVID-19. Patient advocacy groups, many members of which identify themselves as long haulers, have helped contribute to the recognition of post-acute COVID-19, a syndrome characterized by persistent symptoms and/or delayed or long-term complications beyond 4 weeks from the onset of symptoms. Here, we provide a comprehensive review of the current literature on post-acute COVID-19, its pathophysiology and its organ-specific sequelae. Finally, we discuss relevant considerations for the multidisciplinary care of COVID-19 survivors and propose a framework for the identification of those at high risk for post-acute COVID-19 and their coordinated management through dedicated COVID-19 clinics.

/pdf/post-acute-covid-19-syndrome-1bat2sg5js.pdf

Post-acute COVID-19 syndrome.

Pulmonary thromboembolism (PTE) is a fascinating and frustrating disease, but some studies suggest that short-term mortality after a PTE episode has decreased in the last decades. The RIETE registry evaluated short-term mortality trends in 23,858 patients with confirmed acute symptomatic PTE diagnosis between 2001 and 2013, (1) and found that 30-day all-cause mortality following the diagnosis had been reduced from 6.6 to 4.9% and that PTE specific mortality had decreased from 3.3% to 1.8% in that period. Several reasons could justify this survival improvement in patients with acute symptomatic PTE. The almost universal use of multidetector computed tomography angiography (MD-CTA) diagnoses small clots with scarce relevance in the vital prognosis of patients; nevertheless, there are also some interventions which have demonstrated to impact on the survival of patients with suspected or confirmed acute symptomatic PTE diagnosis. Roy et al. studied 1,529 consecutive ambulatory patients attending the Emergency Department with suspected acute symptomatic PTE. (2) According to clinical practice guidelines, the diagnostic evaluation was inappropriate in 662 patients (43%), and inadequate management was significantly associated with thrombotic events during follow-up [adjusted odds ratio (OR): 4.29; 95% confidence interval (CI): 1.45 to 12.70]. Similarly, Jiménez et al. showed that lack of adherence to clinical practice guideline recommendations for the treatment of the acute phase of PTE significantly worsened patient prognosis. (3) This study included 2,096 patients diagnosed with acute symptomatic PTE, 408 of which (20%) did not receive adequate treatment according to guideline recommendations. An ineffective treatment was significantly associated with higher all-cause mortality (adjusted OR: 2.39; 95% CI: 1.57 to 3.61) and specific PTE mortality (adjusted OR: 5.02; 95% CI: 2.42 to 10.42) during the first 30 days of follow-up. These results were validated in 34,380 patients with PTE from the RIETE registry. Consistent with these data and some studies confirming PTE management variability, (4) the registry

https://dialnet.unirioja.es/descarga/articulo/7072726.pdf

Aiming at Excellence in the Management of Pulmonary Thromboembolism

Background: Identification of patients with acute symptomatic pulmonary embolism (PE) who are at low-risk for short-term complications to warrant outpatient care lacks clarity. Method: In order to identify patients at low-risk for 30-day all-cause and PE-related mortality, we used a cohort of haemodynamically stable patients from the RIETE registry to compare the false-negative rate of four strategies: the simplified Pulmonary Embolism Severity Index (sPESI); a modified (i.e., heart rate cutoff of 100 beats/min) sPESI; and a combination of the original and the modified sPESI with computed tomography (CT)-assessed right ventricle (RV)/left ventricle (LV) ratio. Results: Overall, 137 of 3,117 patients with acute PE (4.4%) died during the first month. Of these, 41 (1.3%) died from PE, and 96 (3.1%) died from other causes. The proportion of patients categorized as having low-risk was highest with the sPESI and lowest with the combination of a modified sPESI and CT-assessed RV/LV ratio (32.5% versus 16.5%; P <0.001). However, among patients identified as low-risk, the 30-day mortality rate was lowest with the combination of a modified sPESI and CT-assessed RV/LV ratio and highest with the sPESI (0.4% versus 1.0%; P =0.03). The 30-day PE-related mortality rates for patients designated as low-risk by the sPESI, the modified sPESI, and the combination of the original and modified sPESI with CT-assessed RV/LV ratio were 0.7%, 0.4%, 0.7%, and 0.2%, respectively. Conclusions: The combination of a negative modified sPESI with CT-assessed RV/LV ratio <1 identifies patients with acute PE who are at very low-risk for short-term mortality. 

Identification of Low-risk Patients With Acute Symptomatic Pulmonary Embolism.

Purpose: To determine the diagnostic yield of the 6-minute walking test (6MWT) to predict chronic thromboembolic pulmonary hypertension (CTPH) in a cohort of patients with acute pulmonary embolism (PE). Methods: The study population included consecutive patients with confirmed diagnosis of acute symptomatic PE. All patients underwent transthoracic echocardiography and 6MWT 4 weeks after diagnosis. The correlation between the distance walked in the 6MWT and the echocardiographic findings was analized. Results: Of the 86 study patients, 19% had a diagnosis of pulmonary hypertension, defined by a systolic pulmonary pressure equal or greater than 30 mm Hg. With a predefined cut-off point of 300 hundred metres, the negative predictive value of the 6MWT for CPTH was 93% (95% CI, 85-100). The negative likelihood ratio was 0.3 (95% CI, 0.1-1). There was a significant correlation between the systolic pulmonary pressure measured by transthoracic echocardiography and the distance walked in the 6MWT (r = 0.79; P < 0.001). Conclusions: There is a significant correlation between the systolic pulmonary pressure measured by transthoracic echocardiography and the distance walked in the 6MWT.

David Jiménez

Papers

Aiming at Excellence in the Management of Pulmonary Thromboembolism

Identification of Low-risk Patients With Acute Symptomatic Pulmonary Embolism.

Correlation between 6-minute walking test and transthoracic echocardiography for diagnosing chronic thromboembolic pulmonary hypertension

Feasibility of a screening algorithm for chronic thromboembolic pulmonary hypertension: The OSIRIS study.

Cardiovascular mortality and morbidity in pulmonary embolism