Acute limb ischemia in patients with COVID-19 pneumonia.
TL;DR: Successful revascularization was lower than expected which the authors hypothesize is due to a virus-related hypercoagulable state and the use of prolonged systemic heparin may improve surgical treatment efficacy as well as improve limb salvage and overall mortality.
About: This article is published in Journal of Vascular Surgery.The article was published on 2020-12-01 and is currently open access. It has received 351 citations till now. The article focuses on the topics: Revascularization.
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TL;DR: The interaction between the viral spike protein and angiotensin-converting enzyme 2, which triggers entry of the virus into host cells, is likely to be involved in the cardiovascular manifestations of COVID-19.
Abstract: Coronavirus disease 2019 (COVID-19), caused by a strain of coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic that has affected the lives of billions of individuals. Extensive studies have revealed that SARS-CoV-2 shares many biological features with SARS-CoV, the zoonotic virus that caused the 2002 outbreak of severe acute respiratory syndrome, including the system of cell entry, which is triggered by binding of the viral spike protein to angiotensin-converting enzyme 2. Clinical studies have also reported an association between COVID-19 and cardiovascular disease. Pre-existing cardiovascular disease seems to be linked with worse outcomes and increased risk of death in patients with COVID-19, whereas COVID-19 itself can also induce myocardial injury, arrhythmia, acute coronary syndrome and venous thromboembolism. Potential drug-disease interactions affecting patients with COVID-19 and comorbid cardiovascular diseases are also becoming a serious concern. In this Review, we summarize the current understanding of COVID-19 from basic mechanisms to clinical perspectives, focusing on the interaction between COVID-19 and the cardiovascular system. By combining our knowledge of the biological features of the virus with clinical findings, we can improve our understanding of the potential mechanisms underlying COVID-19, paving the way towards the development of preventative and therapeutic solutions.
927 citations
TL;DR: The latest evidence indicating that platelet and endothelial dysfunction are essential components of CO VID-19 pathology is summarized, the potential mechanisms underlying the contribution of cardiovascular risk factors to the most severe outcomes in COVID-19 are described and the roles of coagulopathy, thrombocytopathy and endotheliopathy are highlighted.
Abstract: The core pathology of coronavirus disease 2019 (COVID-19) is infection of airway cells by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that results in excessive inflammation and respiratory disease, with cytokine storm and acute respiratory distress syndrome implicated in the most severe cases. Thrombotic complications are a major cause of morbidity and mortality in patients with COVID-19. Patients with pre-existing cardiovascular disease and/or traditional cardiovascular risk factors, including obesity, diabetes mellitus, hypertension and advanced age, are at the highest risk of death from COVID-19. In this Review, we summarize new lines of evidence that point to both platelet and endothelial dysfunction as essential components of COVID-19 pathology and describe the mechanisms that might account for the contribution of cardiovascular risk factors to the most severe outcomes in COVID-19. We highlight the distinct contributions of coagulopathy, thrombocytopathy and endotheliopathy to the pathogenesis of COVID-19 and discuss potential therapeutic strategies in the management of patients with COVD-19. Harnessing the expertise of the biomedical and clinical communities is imperative to expand the available therapeutics beyond anticoagulants and to target both thrombocytopathy and endotheliopathy. Only with such collaborative efforts can we better prepare for further waves and for future coronavirus-related pandemics.
267 citations
NewYork–Presbyterian Hospital1, Yale University2, University of Alcalá3, Harvard University4, Beth Israel Deaconess Medical Center5, University of Insubria6, University of Texas Health Science Center at Houston7, Chinese PLA General Hospital8, University of Liverpool9, Huazhong University of Science and Technology10, Jean Monnet University11, Hospital of the University of Pennsylvania12, Leonard Davis Institute of Health Economics13, Veterans Health Administration14, University of Vermont15, University of Montpellier16, Westmead Hospital17, Loyola University Medical Center18, University of Chicago19, NorthShore University HealthSystem20, University of Milan21, Auckland City Hospital22, St Thomas' Hospital23, Hofstra University24, University of Michigan25, Population Health Research Institute26, McMaster University27, I.M. Sechenov First Moscow State Medical University28, Ottawa Hospital Research Institute29, Brigham and Women's Hospital30, Vanderbilt University31, Icahn School of Medicine at Mount Sinai32, University of Cologne33, Universidad Católica San Antonio de Murcia34, University of Mainz35, Aalborg University36
TL;DR: Novel dosing approaches are described for commonly used antithrombotic agents (especially heparin-based regimens) and the potential use of less widely used antithsombotic drugs in the absence of confirmed thrombosis.
Abstract: Coronavirus disease 2019 (COVID-19), currently a worldwide pandemic, is a viral illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The suspected contribution of thrombotic events to morbidity and mortality in COVID-19 patients has prompted a search for novel potential options for preventing COVID-19-associated thrombotic disease. In this article by the Global COVID-19 Thrombosis Collaborative Group, we describe novel dosing approaches for commonly used antithrombotic agents (especially heparin-based regimens) and the potential use of less widely used antithrombotic drugs in the absence of confirmed thrombosis. Although these therapies may have direct antithrombotic effects, other mechanisms of action, including anti-inflammatory or antiviral effects, have been postulated. Based on survey results from this group of authors, we suggest research priorities for specific agents and subgroups of patients with COVID-19. Further, we review other agents, including immunomodulators, that may have antithrombotic properties. It is our hope that the present document will encourage and stimulate future prospective studies and randomized trials to study the safety, efficacy, and optimal use of these agents for prevention or management of thrombosis in COVID-19.
191 citations
TL;DR: In this article, the authors examined prescription drug and health-care use after SARS-CoV-2 infection not requiring hospital admission and found that SARS co-v2-positive individuals were not at an increased risk of initiating new drugs.
Abstract: Summary Background Individuals admitted to hospital for COVID-19 might have persisting symptoms (so-called long COVID) and delayed complications after discharge. However, little is known regarding the risk for those not admitted to hospital. We therefore examined prescription drug and health-care use after SARS-CoV-2 infection not requiring hospital admission. Methods This was a population-based cohort study using the Danish prescription, patient, and health insurance registries. All individuals with a positive or negative RT-PCR test for SARS-CoV-2 in Denmark between Feb 27 and May 31, 2020, were eligible for inclusion. Outcomes of interest were delayed acute complications, chronic disease, hospital visits due to persisting symptoms, and prescription drug use. We used data from non-hospitalised SARS-CoV-2-positive and matched SARS-CoV-2-negative individuals from 2 weeks to 6 months after a SARS-CoV-2 test to obtain propensity score-weighted risk differences (RDs) and risk ratios (RRs) for initiation of 14 drug groups and 27 hospital diagnoses indicative of potential post-acute effects. We also calculated prior event rate ratio-adjusted rate ratios of overall health-care use. This study is registered in the EU Electronic Register of Post-Authorisation Studies (EUPAS37658). Findings 10 498 eligible individuals tested positive for SARS-CoV-2 in Denmark from Feb 27 to May 31, 2020, of whom 8983 (85·6%) were alive and not admitted to hospital 2 weeks after their positive test. The matched SARS-CoV-2-negative reference population not admitted to hospital consisted of 80 894 individuals. Compared with SARS-CoV-2-negative individuals, SARS-CoV-2-positive individuals were not at an increased risk of initiating new drugs (RD Interpretation The absolute risk of severe post-acute complications after SARS-CoV-2 infection not requiring hospital admission is low. However, increases in visits to general practitioners and outpatient hospital visits could indicate COVID-19 sequelae. Funding None.
175 citations
TL;DR: The mechanisms underlying cardiovascular injury, including that of thromboembolic disease and arrhythmia, are described, and their clinical sequelae are discussed.
149 citations
References
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TL;DR: The clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia who were admitted to the intensive care unit (ICU) of Wuhan Jin Yin-tan hospital between late December, 2019 and Jan 26, 2020 are described.
7,787 citations
"Acute limb ischemia in patients wit..." refers background in this paper
...Recently reported studies have described the clinical characteristics and overall outcomes of patients with COVID-19 and the effects of treating these patient on the healthcare system.(4) Two studies have reported associated coagulopathy disorders....
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TL;DR: In the recent outbreak of novel coronavirus infection in Wuhan, China, significantly abnormal coagulation parameters in severe novel coronvirus pneumonia (NCP) cases were a concern.
4,510 citations
"Acute limb ischemia in patients wit..." refers background in this paper
...associated with higher mortality.(5,6) A sudden and significant increase of COVID-19einfected patients who were presenting with ALI has been noted at our institutions with the viral spread....
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McMaster University1, American University of Beirut2, University of Alcalá3, University of Geneva4, Leiden University Medical Center5, Virginia Commonwealth University6, University of California, San Diego7, Ohio State University8, University of Utah9, UCLA Medical Center10, Ottawa Hospital Research Institute11, Uniformed Services University of the Health Sciences12
TL;DR: Recommendations on 12 topics that were in the 9th edition of these guidelines are updated, and 3 new topics are addressed.
3,934 citations
"Acute limb ischemia in patients wit..." refers methods in this paper
...First, plenty of data have shown that heparin is the most effective method for the prevention of thromboembolism.(14) Second, it is well-known that heparin has suppressive activity against the development of a cytokines storm, which is a typical pathogenetic process of COVID-19 infection that eventually results in acute lung injury and death....
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TL;DR: The coagulation function in patients with SARS-CoV-2 is significantly deranged compared with healthy people, but monitoring D-dimer and FDP values may be helpful for the early identification of severe cases.
Abstract: Background As the number of patients increases, there is a growing understanding of the form of pneumonia sustained by the 2019 novel coronavirus (SARS-CoV-2), which has caused an outbreak in China. Up to now, clinical features and treatment of patients infected with SARS-CoV-2 have been reported in detail. However, the relationship between SARS-CoV-2 and coagulation has been scarcely addressed. Our aim is to investigate the blood coagulation function of patients with SARS-CoV-2 infection. Methods In our study, 94 patients with confirmed SARS-CoV-2 infection were admitted in Renmin Hospital of Wuhan University. We prospectively collect blood coagulation data in these patients and in 40 healthy controls during the same period. Results Antithrombin values in patients were lower than that in the control group (p < 0.001). The values of D-dimer, fibrin/fibrinogen degradation products (FDP), and fibrinogen (FIB) in all SARS-CoV-2 cases were substantially higher than those in healthy controls. Moreover, D-dimer and FDP values in patients with severe SARS-CoV-2 infection were higher than those in patients with milder forms. Compared with healthy controls, prothrombin time activity (PT-act) was lower in SARS-CoV-2 patients. Thrombin time in critical SARS-CoV-2 patients was also shorter than that in controls. Conclusions The coagulation function in patients with SARS-CoV-2 is significantly deranged compared with healthy people, but monitoring D-dimer and FDP values may be helpful for the early identification of severe cases.
945 citations
"Acute limb ischemia in patients wit..." refers background or methods in this paper
...Although thrombolysis has been reported to not be the best choice for most patients with severe ischemia, it was included as adjunctive intraoperative procedure to improve the distal microcirculation, which might have had a potential role in stealing outflow vessels of an otherwise successful femoropopliteal-tibial vessel declotting.(2,3,6,7) In contrast, heparin prevents propagation of the thrombus both proximally and distally and maintains patency of the collateral vessels....
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...The clinical status was defined using the Rutherford classification system.(6)...
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...associated with higher mortality.(5,6) A sudden and significant increase of COVID-19einfected patients who were presenting with ALI has been noted at our institutions with the viral spread....
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TL;DR: A comprehensive review of the published evidence for management of a given condition according to ESC Committee for Practice Guidelines (CPG) policy and approved by the ESVS and ESO was undertaken, including assessment of the risk–benefit ratio.
664 citations