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Arnold JR, Yeo JL, Budgeon CA, Shergill S, England R, Shiwani H, Artico J, Moon JC, Gorecka M, Roditi G, Morrow A, Mangion K, Shanmuganathan M, Miller CA, Chiribiri A, Alzahir M, Ramirez S, Lin A, Swoboda PP, McDiarmid AK, Sykes R, Singh T, Bucciarelli-Ducci C, Dawson D, Fontana M, Manisty C, Treibel TA, Levelt E, Young R, McConnachie A, Neubauer S, Piechnik SK, Davies RH, Ferreira VM, Dweck MR, Berry C, McCann GP, Greenwood JP. Myocardial ischaemia following COVID-19: a cardiovascular magnetic resonance study. Int J Cardiovasc Imaging 2025; 41:247-256. [PMID: 39738791 PMCID: PMC11811239 DOI: 10.1007/s10554-024-03304-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Accepted: 11/27/2024] [Indexed: 01/02/2025]
Abstract
The pathophysiology of myocardial injury following COVID-19 remains uncertain. COVID-HEART was a prospective, multicentre study utilising cardiovascular magnetic resonance (CMR) to characterise COVID-related myocardial injury. In this pre-specified analysis, the objectives were to examine (1) the frequency of myocardial ischaemia following COVID-19, and (2) the association between ischaemia and myocardial injury. We studied 59 patients hospitalised with COVID-19 and elevated serum troponin (COVID + /troponin + , age 61 ± 11 years) and 37 control subjects without COVID-19 or elevated troponin and similar by age and cardiovascular comorbidities (COVID -/comorbidity + , 64 ± 10 years). Subjects underwent multi-parametric CMR (comprising assessment of ventricular volumes, stress perfusion, T1/T2 mapping and scar). The primary endpoint was the frequency of inducible myocardial ischaemia. Inducible ischaemia was evident in 11 (19%) COVID + /troponin + patients and in 8 (22%) control subjects (p = 0.72). In COVID + /troponin + patients with ischaemia, epicardial coronary disease pattern ischaemia was present in eight patients and microvascular disease pattern, in three patients. There was no significant difference in the frequency of inducible ischaemia in COVID + /troponin + patients with previous myocardial infarction and/or revascularisation compared to those without (2/12 [17%] vs. 9/47 [19%] respectively, p = 0.84), or in those with and without scar (7/27 [26%] vs. 4/32 [13%] respectively, p = 0.19). Myocardial ischaemia was present in ~ 20% of patients recently hospitalised with COVID-19 and with elevated cardiac troponin, but this was not different to matched comorbid controls. This finding coupled with the lack of an association between ischaemia and myocardial scar suggests that coronary artery abnormalities are unlikely to be the predominant mechanism underlying COVID-19 induced myocardial injury.
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Affiliation(s)
- J Ranjit Arnold
- University of Leicester and The NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK.
| | - Jian L Yeo
- University of Leicester and The NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Charley A Budgeon
- University of Leicester and The NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Simran Shergill
- University of Leicester and The NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Rachel England
- University of Leicester and The NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Hunain Shiwani
- Institute of Cardiovascular Science, University College London, London, UK
| | - Jessica Artico
- Institute of Cardiovascular Science, University College London, London, UK
| | - James C Moon
- Institute of Cardiovascular Science, University College London, London, UK
| | - Miroslawa Gorecka
- Institute of Cardiovascular and Metabolic Medicine, University of Leeds, and Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Giles Roditi
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Andrew Morrow
- Institute of Cardiovascular and Medical Sciences and British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Kenneth Mangion
- Institute of Cardiovascular and Medical Sciences and British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Mayooran Shanmuganathan
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK
- British Heart Foundation Centre of Research Excellence, Oxford, UK
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Christopher A Miller
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King's College London, BHF Centre of Excellence and The NIHR Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust, The Rayne Institute, St. Thomas' Hospital, London, UK
| | - Mohammed Alzahir
- Institute of Cardiovascular Science, University College London, London, UK
| | - Sara Ramirez
- Institute of Cardiovascular Science, University College London, London, UK
| | - Andrew Lin
- Institute of Cardiovascular Science, University College London, London, UK
| | - Peter P Swoboda
- Institute of Cardiovascular and Metabolic Medicine, University of Leeds, and Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Adam K McDiarmid
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Robert Sykes
- Institute of Cardiovascular and Medical Sciences and British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Trisha Singh
- University of Edinburgh and British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK
| | - Chiara Bucciarelli-Ducci
- School of Biomedical Engineering and Imaging Sciences, King's College London, BHF Centre of Excellence and The NIHR Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust, The Rayne Institute, St. Thomas' Hospital, London, UK
- Royal Brompton and Harefield Hospitals, London, UK
- Guys' and St Thomas NHS Trust, London, UK
- Bristol Heart Institute, University Hospitals Bristol and Weston NHS Trust, Bristol, UK
| | - Dana Dawson
- Department of Cardiology, Aberdeen Cardiovascular and Diabetes Centre, Aberdeen Royal Infirmary and University of Aberdeen, Aberdeen, UK
| | - Marianna Fontana
- Division of Medicine, Royal Free Hospital, University College London, London, UK
| | - Charlotte Manisty
- Institute of Cardiovascular Science, University College London, London, UK
| | - Thomas A Treibel
- Institute of Cardiovascular Science, University College London, London, UK
| | - Eylem Levelt
- Institute of Cardiovascular and Metabolic Medicine, University of Leeds, and Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Robin Young
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK
| | - Stefan K Piechnik
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK
| | - Rhodri H Davies
- Institute of Cardiovascular Science, University College London, London, UK
| | - Vanessa M Ferreira
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK
| | - Marc R Dweck
- University of Edinburgh and British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK
| | - Colin Berry
- Institute of Cardiovascular and Medical Sciences and British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Gerry P McCann
- University of Leicester and The NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - John P Greenwood
- Institute of Cardiovascular and Metabolic Medicine, University of Leeds, and Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Baker Heart and Diabetes Institute, Melbourne, Australia
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Akpoviroro O, Sauers NK, Uwandu Q, Castagne M, Akpoviroro OP, Humayun S, Mirza W, Woodard J. Severe COVID-19 infection: An institutional review and literature overview. PLoS One 2024; 19:e0304960. [PMID: 39163410 PMCID: PMC11335168 DOI: 10.1371/journal.pone.0304960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 05/21/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Our study aimed to describe the group of severe COVID-19 patients at an institutional level, and determine factors associated with different outcomes. METHODS A retrospective chart review of patients admitted with severe acute hypoxic respiratory failure due to COVID-19 infection. Based on outcomes, we categorized 3 groups of severe COVID-19: (1) Favorable outcome: progressive care unit admission and discharge (2) Intermediate outcome: ICU care (3) Poor outcome: in-hospital mortality. RESULTS Eighty-nine patients met our inclusion criteria; 42.7% were female. The average age was 59.7 (standard deviation (SD):13.7). Most of the population were Caucasian (95.5%) and non-Hispanic (91.0%). Age, sex, race, and ethnicity were similar between outcome groups. Medicare and Medicaid patients accounted for 62.9%. The average BMI was 33.5 (SD:8.2). Moderate comorbidity was observed, with an average Charlson Comorbidity index (CCI) of 3.8 (SD:2.6). There were no differences in the average CCI between groups(p = 0.291). Many patients (67.4%) had hypertension, diabetes (42.7%) and chronic lung disease (32.6%). A statistical difference was found when chronic lung disease was evaluated; p = 0.002. The prevalence of chronic lung disease was 19.6%, 27.8%, and 40% in the favorable, intermediate, and poor outcome groups, respectively. Smoking history was associated with poor outcomes (p = 0.04). Only 7.9% were fully vaccinated. Almost half (46.1%) were intubated and mechanically ventilated. Patients spent an average of 12.1 days ventilated (SD:8.5), with an average of 6.0 days from admission to ventilation (SD:5.1). The intermediate group had a shorter average interval from admission to ventilator (77.2 hours, SD:67.6), than the poor group (212.8 hours, SD:126.8); (p = 0.001). The presence of bacterial pneumonia was greatest in the intermediate group (72.2%), compared to the favorable group (17.4%), and the poor group (56%); this was significant (p<0.0001). In-hospital mortality was seen in 28.1%. CONCLUSION Most patients were male, obese, had moderate-level comorbidity, a history of tobacco abuse, and government-funded insurance. Nearly 50% required mechanical ventilation, and about 28% died during hospitalization. Bacterial pneumonia was most prevalent in intubated groups. Patients who were intubated with a good outcome were intubated earlier during their hospital course, with an average difference of 135.6 hours. A history of cigarette smoking and chronic lung disease were associated with poor outcomes.
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Affiliation(s)
- Ogheneyoma Akpoviroro
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, United States of America
| | - Nathan Kyle Sauers
- Department of Engineering, Pennsylvania State University, State College, Pennsylvania, United States of America
| | - Queeneth Uwandu
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, United States of America
| | - Myriam Castagne
- Clinical & Translational Science Institute, Boston University, Boston, Massachusetts, United States of America
| | | | - Sara Humayun
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, United States of America
| | - Wasique Mirza
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, United States of America
| | - Jameson Woodard
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, United States of America
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Wang W, Zhai WH, Zhang Y, Tao L, Li Y, Jiang TX, Zhang JP. Splenic abscess secondary to COVID-19 acute infection: A case report and literature review. Medicine (Baltimore) 2024; 103:e39194. [PMID: 39093790 PMCID: PMC11296440 DOI: 10.1097/md.0000000000039194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 07/16/2024] [Indexed: 08/04/2024] Open
Abstract
RATIONALE Splenic abscess is relatively rare in clinical practice as an invasive disease. However, during the continuous prevalence of coronavirus disease 2019 (COVID-19), the incidence rate of splenic abscess showed an upward trend. However, because the etiology of splenic abscess is not specific, it is easy to be covered by the respiratory symptoms of COVID-19, resulting in omission or delay in diagnosis. If splenic abscesses cannot be treated in a timely manner, the mortality rate can reach 100%. Therefore, it is important to fully understand the correlation between COVID-19 and the development of splenic abscesses. PATIENT CONCERNS A female patient, 71 years of age, was admitted to our hospital because of cough and sputum for 1 week and fever for 2 days. According to the positive results of novel coronavirus nucleic acid and chest computed tomography, novel coronavirus pneumonia was diagnosed. On the 4th day after treatment, abdominal distension and vomiting were observed. Abdominal ultrasound indicated splenomegaly and mixed echo masses in the spleen and abdominal computed tomography indicated 2 new round low-density lesions were found in the spleen. DIAGNOSES The patient was diagnosed with secondary splenic abscess after COVID-19 infection. INTERVENTIONS The patient and her family members refused to undergo ultrasound-guided splenic puncture drainage and splenectomy. In terms of treatment, she was given meropenem combined with vancomycin to continue anti-infection treatment. OUTCOMES The patient's body temperature and infection indicators gradually increased, and the scope of splenic abscess continued to expand. The infection worsened and progressed to septic shock. The patient abandoned rescue drugs and invasive treatment, and died on the 9th day after admission. LESSONS This case introduces the clinical characteristics of secondary splenic abscess caused by COVID-19 from the aspects of etiology, disease course, clinical manifestations, auxiliary examinations, and treatment methods. The focus is on improving the understanding of clinical doctors about secondary splenic abscesses caused by COVID-19, providing reference for early diagnosis and timely treatment.
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Affiliation(s)
- Wei Wang
- Emergency Department, 305 Hospital of People's Liberation Army, Beijing, People’s Republic of China
| | - Wen-Hui Zhai
- Emergency Department, 305 Hospital of People's Liberation Army, Beijing, People’s Republic of China
| | - Ying Zhang
- Emergency Department, 305 Hospital of People's Liberation Army, Beijing, People’s Republic of China
| | - Li Tao
- Emergency Department, 305 Hospital of People's Liberation Army, Beijing, People’s Republic of China
| | - Yun Li
- Emergency Department, 305 Hospital of People's Liberation Army, Beijing, People’s Republic of China
| | - Tong-xue Jiang
- Outpatient Department, 305 Hospital of People's Liberation Army, Beijing, People’s Republic of China
| | - Jin-ping Zhang
- Medical Department, 305 Hospital of People's Liberation Army, Beijing, People’s Republic of China
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Eftekhar Z, Haybar H, Mohebbi A, Saki N. Cardiac Complications and COVID-19: A Review of Life-threatening Co-morbidities. Curr Cardiol Rev 2024; 20:1-12. [PMID: 38415433 PMCID: PMC11284692 DOI: 10.2174/011573403x279782240206091322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/23/2023] [Accepted: 01/19/2024] [Indexed: 02/29/2024] Open
Abstract
The novel 2019 coronavirus disease (COVID-19) was first reported in the last days of December 2019 in Wuhan, China. The presence of certain co-morbidities, including cardiovascular diseases (CVDs), are the basis for worse outcomes in patients with COVID-19. Relevant English-language literature was searched and retrieved from the Google Scholar search engine and PubMed database up to 2023 using COVID-19, SARS-CoV-2, Heart failure, Myocardial infarction, and Arrhythmia and Cardiac complication as keywords. Increased hemodynamic load, ischemia-related dysfunction, ventricular remodeling, excessive neurohumoral stimulation, abnormal myocyte calcium cycling, and excessive or insufficient extracellular matrix proliferation are associated with heart failure (HF) in COVID-19 patients. Inflammatory reaction due to the excessive release of inflammatory cytokines, leads to myocardial infarction (MI) in these patients. The virus can induce heart arrhythmia through cardiac complications, hypoxia, decreased heart hemodynamics, and remarkable inflammatory markers. Moreover, studies have linked cardiac complications in COVID-19 with poor outcomes, extended hospitalization time, and increased mortality rate. Patients with COVID-19 and CVDs are at higher mortality risk and they should be given high priority when receiving the treatment and intensive care during hospitalization.
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Affiliation(s)
- Zeinab Eftekhar
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Habib Haybar
- Atherosclerosis Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Alireza Mohebbi
- Department of Hematology and Blood Banking, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Najmaldin Saki
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Walborn AT, Heath A, Neal MD, Zarychanski R, Kornblith LZ, Hunt BJ, Castellucci LA, Hochman JS, Lawler PR, Paul JD. Effects of inflammation on thrombosis and outcomes in COVID-19: secondary analysis of the ATTACC/ACTIV-4a trial. Res Pract Thromb Haemost 2023; 7:102203. [PMID: 37854455 PMCID: PMC10579532 DOI: 10.1016/j.rpth.2023.102203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 10/20/2023] Open
Abstract
Background Patients hospitalized for COVID-19 are at high risk of thrombotic complications and organ failure, and often exhibit severe inflammation, which may contribute to hypercoagulability. Objectives To determine whether patients hospitalized for COVID-19 experience differing frequencies of thrombotic and organ failure complications and derive variable benefits from therapeutic-dose heparin dependent on the extent of systemic inflammation and whether observed benefit from therapeutic-dose anticoagulation varies depending on the degree of systemic inflammation. Methods We analyzed data from 1346 patients hospitalized for COVID-19 enrolled in the ATTACC and ACTIV-4a platforms who were randomized to therapeutic-dose heparin or usual care for whom levels of C-reactive protein (CRP) were reported at baseline. Results Increased CRP was associated with worse patient outcomes, including a >98% posterior probability of increased organ support requirement, hospital length of stay, risk of 28-day mortality, and incidence of major thrombotic events or death (patients with CRP 40-100 mg/L or ≥100 mg/L compared to patients with CRP <40 mg/L). Patients with CRP 40 to 100 mg/L experienced the greatest degree of benefit from treatment with therapeutic doses of unfractionated or low molecular weight heparin compared with usual-care prophylactic doses. This was most significant for an increase in organ support-free days (odds ratio: 1.63; 95% confidence interval, 1.09-2.40; 97.9% posterior probability of beneficial effect), with trends toward benefit for other evaluated outcomes. Conclusion Moderately ill patients hospitalized for COVID-19 with CRP between 40 mg/L and 100 mg/L derived the greatest benefit from treatment with therapeutic-dose heparin.
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Affiliation(s)
- Amanda T. Walborn
- Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Anna Heath
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of the Biostatistics, The University of Toronto, Toronto, Ontario, Canada
- Department of Statistical Science, University College London, London, UK
| | - Matthew D. Neal
- Pittsburgh Trauma and Transfusion Medicine Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ryan Zarychanski
- Department of Internal Medicine, Sections of Hematology/Medical Oncology and Critical Care, Max Rad College of Medicine, University of Manitoba, Winnipeg, Manitoba
| | - Lucy Z. Kornblith
- University of California, San Francisco, San Francisco, California, USA
| | - Beverley J. Hunt
- Thrombosis & Haemophilia Centre, Kings Healthcare Partners, London, UK
| | - Lana A. Castellucci
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Judith S. Hochman
- Department of Medicine, Section of Cardiology, NYU Langone Health, New York, New York, USA
| | - Patrick R. Lawler
- Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
- Division of Cardiology and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan D. Paul
- Department of Medicine, Section of Cardiology, University of Chicago Medical Center, Chicago, Illinois, USA
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Tang SW, Helmeste DM, Leonard BE. COVID-19 as a polymorphic inflammatory spectrum of diseases: a review with focus on the brain. Acta Neuropsychiatr 2023; 35:248-269. [PMID: 36861428 DOI: 10.1017/neu.2023.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
There appear to be huge variations and aberrations in the reported data in COVID-19 2 years now into the pandemic. Conflicting data exist at almost every level and also in the reported epidemiological statistics across different regions. It is becoming clear that COVID-19 is a polymorphic inflammatory spectrum of diseases, and there is a wide range of inflammation-related pathology and symptoms in those infected with the virus. The host's inflammatory response to COVID-19 appears to be determined by genetics, age, immune status, health status and stage of disease. The interplay of these factors may decide the magnitude, duration, types of pathology, symptoms and prognosis in the spectrum of COVID-19 disorders, and whether neuropsychiatric disorders continue to be significant. Early and successful management of inflammation reduces morbidity and mortality in all stages of COVID-19.
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Affiliation(s)
- Siu Wa Tang
- Department of Psychiatry, University of California, Irvine, Irvine, CA, USA
- Institute of Brain Medicine, Hong Kong, China
| | - Daiga Maret Helmeste
- Department of Psychiatry, University of California, Irvine, Irvine, CA, USA
- Institute of Brain Medicine, Hong Kong, China
| | - Brian E Leonard
- Institute of Brain Medicine, Hong Kong, China
- Department of Pharmacology, National University of Ireland, Galway, Ireland
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Habib MB, Abdelghani MS, Elyas A, Ashour AA, Altermanini M, Imran S, Arabi AR. Acute thrombotic occlusion involving three coronary arteries. A unique association with COVID-19 pneumonia. Clin Case Rep 2023; 11:e7803. [PMID: 37593346 PMCID: PMC10427750 DOI: 10.1002/ccr3.7803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 05/12/2023] [Accepted: 07/09/2023] [Indexed: 08/19/2023] Open
Abstract
Key Clinical Message Respiratory viruses, particularly COVID-19, can be associated with severe cases of myocardial infarction (MI). Physicians should have a low threshold for MI in COVID-19 patients who present with persistent chest pain as MI in rapidly deteriorating cases can be missed. Prompt response includes both timely diagnosis and swift treatment. Abstract The coronavirus disease 2019 (COVID-19) is associated with coronary artery thrombosis. Many cases of single-vessel and few cases of two-vessel thrombosis were reported. Herein, we report a unique association in a middle-aged man diagnosed with COVID-19 and presented later with acute myocardial infarction causing cardiogenic shock. The patient was found to have three-vessel thrombosis.
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Affiliation(s)
- Mhd Baraa Habib
- Department of Internal MedicineHamad Medical CorporationDohaQatar
| | | | - Ahmed Elyas
- Cardiology Department, Heart HospitalHamad Medical CorporationDohaQatar
| | - Anas A. Ashour
- Department of Internal MedicineHamad Medical CorporationDohaQatar
| | | | - Shahid Imran
- Cardiology Department, Heart HospitalHamad Medical CorporationDohaQatar
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Mavropoulou X, Psoma E, Papachristodoulou A, Pyrrou N, Spanou E, Alexandratou M, Sidiropoulou M, Theocharidou A, Rafailidis V, Chrysanthidis T, Prassopoulos P. Gastrointestinal Imaging Findings in the Era of COVID-19: A Pictorial Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1332. [PMID: 37512143 PMCID: PMC10385728 DOI: 10.3390/medicina59071332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023]
Abstract
The potentially fatal COVID-19 pandemic has been associated with a largespectrum of clinical presentations. Beyond the classical pulmonary manifestations, gastrointestinal tract-related symptoms suchas nausea, diarrhea, abdominal distention and pain have been observed in patients, as a consequence of the binding of SARS-CoV-19 to Angiotensin-converting Enzyme 2 (ACE2) receptors in the gastrointestinal (GI) tract. The early recognition ofspecific imaging features, including hepatobiliary involvement, pancreatic involvement, development of solid organ infarcts, ischemic bowel changes and vascular occlusion, plays a key role through the course of the disease. Also, suspicious symptoms, especially in critically ill patients with clinical and biochemical markers of hypovolemia, necessitate timely imaging for bleeding complications. The aim of this pictorial review is to illustrate the spectrum of the GIimaging findings in patients with COVID-19. Awareness of diagnostic imaging hallmarks is crucial to optimize the management of these patients.
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Affiliation(s)
- Xanthippi Mavropoulou
- Department of Clinical Radiology, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece
| | - Elisavet Psoma
- Department of Clinical Radiology, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece
| | - Angeliki Papachristodoulou
- Department of Clinical Radiology, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece
| | - Nikoletta Pyrrou
- Department of Clinical Radiology, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece
| | - Ekaterini Spanou
- Department of Clinical Radiology, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece
| | - Maria Alexandratou
- Department of Clinical Radiology, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece
| | - Maria Sidiropoulou
- Department of Clinical Radiology, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece
| | - Anastasia Theocharidou
- Department of Clinical Radiology, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece
| | - Vasileios Rafailidis
- Department of Clinical Radiology, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece
| | - Theofilos Chrysanthidis
- Infectious Diseases Division, First Internal Medicine Department, School of Medicine, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece
| | - Panos Prassopoulos
- Department of Clinical Radiology, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece
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9
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Niculae CM, Gorea ME, Tirlescu LG, Constantin RA, Moroti R, Hristea A. Pulmonary Thrombosis despite Therapeutic Anticoagulation in COVID-19 Pneumonia: A Case Report and Literature Review. Viruses 2023; 15:1535. [PMID: 37515221 PMCID: PMC10386232 DOI: 10.3390/v15071535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
The rate of thrombotic complications in COVID-19 patients is high and could be associated with the risk of unfavourable outcomes. Moreover, pulmonary thrombotic events can occur even in patients already on anticoagulant treatment. We present the case of a patient with severe COVID-19 pneumonia, without traditional risk factors for thrombosis, who developed massive pulmonary thrombosis (PT) despite therapeutic anticoagulation. The diagnosis was challenging, and the case raised concerns about the protective role of conventional anticoagulant treatment in COVID-19 pneumonia. Thus, we searched for literature reports on COVID-19 patients who developed PT despite being under anticoagulation therapy. We identified 13 cohort studies including 4058 patients of which 346 (8.5%) developed PT and nine case reports/series enrolling 14 patients. Four cohorts were further analysed, which reported data on risk factors for thrombosis, outcomes and biological characteristics. We found that there were no differences between patients with and without PT regarding the classical risk factors for thrombosis. PT occurred regardless of the anticoagulation regimen, and the risk factor identified was severe COVID-19 pneumonia and a stay in an intensive care unit (ICU). Pulmonary thrombotic events in patients with COVID-19 are rather inflammation-related than correlated with traditional thromboembolic risk factors, and the therapeutic approach must take into consideration this aspect.
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Affiliation(s)
- Cristian-Mihail Niculae
- Infectious Diseases Department, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 050474 Bucharest, Romania
- National Institute for Infectious Diseases "Prof. Dr. Matei Bals", 1 Calistrat Grozovici Street, 021105 Bucharest, Romania
| | - Maria-Evelina Gorea
- National Institute for Infectious Diseases "Prof. Dr. Matei Bals", 1 Calistrat Grozovici Street, 021105 Bucharest, Romania
| | - Laura-Georgiana Tirlescu
- National Institute for Infectious Diseases "Prof. Dr. Matei Bals", 1 Calistrat Grozovici Street, 021105 Bucharest, Romania
| | - Rares-Alexandru Constantin
- National Institute for Infectious Diseases "Prof. Dr. Matei Bals", 1 Calistrat Grozovici Street, 021105 Bucharest, Romania
| | - Ruxandra Moroti
- Infectious Diseases Department, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 050474 Bucharest, Romania
- National Institute for Infectious Diseases "Prof. Dr. Matei Bals", 1 Calistrat Grozovici Street, 021105 Bucharest, Romania
| | - Adriana Hristea
- Infectious Diseases Department, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 050474 Bucharest, Romania
- National Institute for Infectious Diseases "Prof. Dr. Matei Bals", 1 Calistrat Grozovici Street, 021105 Bucharest, Romania
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10
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D'Amico R, Wolff T, Richarz S, Gurke L, Isaak A, Mujagic E. A Novel Percutaneous Technique for Aorto-Iliac Thrombectomy without the Risk of Embolization. Bioengineering (Basel) 2023; 10:778. [PMID: 37508805 PMCID: PMC10376630 DOI: 10.3390/bioengineering10070778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
Classic surgical thrombectomy of the aorta and iliac arteries through an incision in the groin vessels harbors the risk of embolization to the viscero-renal as well as hypogastric arteries, while percutaneous endovascular thrombectomy techniques can lead to peripheral embolization to the lower limbs. Therefore, we describe a novel, percutaneous technique that tackles the above issues. Furthermore, we also present our initial experience using the technique. The principle of the technique is to percutaneously place large-bore sheaths in the iliac arteries that deliberately occlude the latter to protect the lower limbs from embolization. Through one of these sheaths, over wire Fogarty® catheters can be placed and inflated in the ostia of the coeliac trunk, superior mesenteric artery, renal arteries, and hypogastric arteries as needed. A large thrombectomy balloon catheter is then used to bring any aorto-iliac thrombus into the sheaths, whereafter the thrombus is removed from the sheaths by simply deflating their valves. Additional endovascular procedures of the aorto-iliac branches can be performed as needed. We report nine procedures in 8 patients (4 males and 4 females) with a median age of 63 (53-68.5). Additional endovascular procedures were performed in 6 (66.7%) procedures. All but one procedure were technically successful, and all patients had palpable foot pulses on completion of the procedures, while no patient had clinical signs of peripheral embolization. This technique is a very valid addition to the vascular surgeon's armamentarium when treating aorto-iliac thrombotic events because it is minimally invasive while still protecting against embolization and offering the flexibility to perform a wide range of additional endovascular procedures where needed.
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Affiliation(s)
- Rosalinda D'Amico
- University Hospital of Basel, Spitalstrasse 21, 4031 Basel, Switzerland
- Kantonsspital Aarau, Tellstrasse 25, 5001 Aarau, Switzerland
- Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland
| | - Thomas Wolff
- University Hospital of Basel, Spitalstrasse 21, 4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland
| | - Sabine Richarz
- University Hospital of Basel, Spitalstrasse 21, 4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland
| | - Lorenz Gurke
- University Hospital of Basel, Spitalstrasse 21, 4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland
| | - Andrej Isaak
- Kantonsspital Aarau, Tellstrasse 25, 5001 Aarau, Switzerland
| | - Edin Mujagic
- University Hospital of Basel, Spitalstrasse 21, 4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland
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11
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Greistorfer T, Jud P. Clinical characteristics of COVID-19 associated vasculopathic diseases. Thromb J 2023; 21:61. [PMID: 37231476 DOI: 10.1186/s12959-023-00504-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/17/2023] [Indexed: 05/27/2023] Open
Abstract
Coronavirus disease 19 (COVID-19) has shown to be an infectious disease affecting not only of the respiratory system, but also cardiovascular system leading to different COVID-19-associated vasculopathies. Venous and arterial thromboembolic events have been frequently described among hospitalized patients with COVID-19 and inflammatory vasculopathic changes have also been observed. Several of the reported COVID-19 associated vasculopathies exhibit differences on epidemiology, clinical characteristics and outcome compared to non-COVID-19 types. This review focuses on the epidemiology, clinical, diagnostic and therapeutic characteristics as well as outcome data of COVID-19 associated thromboembolic events and inflammatory vasculopathies, elaborating similarities and differences with non-COVID-19 cohorts.
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Affiliation(s)
- Thiemo Greistorfer
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, 8036, Austria
| | - Philipp Jud
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, 8036, Austria.
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12
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Silva JTC, Fonseca Neto OCLDA. Acute mesenteric ischemia and COVID-19: an integrative review of the literature. Rev Col Bras Cir 2023; 50:e20233334. [PMID: 36921130 PMCID: PMC10519703 DOI: 10.1590/0100-6991e-20233334-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/24/2022] [Indexed: 03/18/2023] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) has spread rapidly around the world after the first cases were reported in December 2019 in China. Despite the prevention of the symptoms presented, extrapulmonary manifestations were identified. In particular, there was an increase in cases of Acute Mesenteric Ischemia (AMI), raising its incidence to 1.9%-3.8% in infected patients. The aim of this study was to investigate the existence of an association between IMA and COVID-19 through the literature. An Integrative Literature Review was carried out. The research question was "mesenteric ischemia in patients with COVID-19: coincidence or association?". After searching the database and applying the inclusion and exclusion criteria, 44 were selected for analysis. COVID-19 was confirmed by RT-PCR and imaging tests, gastrointestinal manifestations, alterations and primarily tomographic imaging findings were identified. Most patients were accelerated to laparotomy. As explanations include direct endothelial and injury by the binding of the ACE-2 virus, between hyperinflammation and hypercoagulability, dysregulation of the renin-angiotensin-aldosterone system and factors associated with the severity of the virus. IMA is an emergency with high associated morbidity and mortality, these cases may be a consequence mainly of the thromboinflammatory mechanism associated with SARS-CoV-2. An early diagnosis, diagnosis and diagnoses are crucial to clinical treatment; an assessment regime should be considered in accordance with current evidence and guidelines.
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13
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COVID-19 and the Response to Antiplatelet Therapy. J Clin Med 2023; 12:jcm12052038. [PMID: 36902825 PMCID: PMC10004309 DOI: 10.3390/jcm12052038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
The coronavirus SARS-CoV2 disease (COVID-19) is connected with significant morbidity and mortality (3.4%), disorders in hemostasis, including coagulopathy, activation of platelets, vascular injury, and changes in fibrinolysis, which may be responsible for an increased risk of thromboembolism. Many studies demonstrated relatively high rates of venous and arterial thrombosis related to COVID-19. The incidence of arterial thrombosis in severe/critically ill intensive care unit-admitted COVID-19 patients appears to be around 1%. There are several ways for the activation of platelets and coagulation that may lead to the formation of thrombi, so it is challenging to make a decision about optimal antithrombotic strategy in patients with COVID-19. This article reviews the current knowledge about the role of antiplatelet therapy in patients with COVID-19.
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14
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Alemayehu FM, Huluka DK, Beyene TK, Aboye AG, Mesfin HA. Acute limb ischemia in COVID-19 patients despite therapeutic anticoagulation: Experience from Africa. THROMBOSIS UPDATE 2023; 10:100128. [PMID: 38620973 PMCID: PMC9803376 DOI: 10.1016/j.tru.2022.100128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/15/2022] [Accepted: 12/18/2022] [Indexed: 01/01/2023] Open
Abstract
Background Hypercoagulability is a common complication seen in COVID-19 infection. However, arterial thrombosis such as acute limb ischemia (ALI) is far less common. Data on the incidence and nature of arterial thromboembolic complications in patients with COVID-19 is limited, originating from a few case reports and case series. Data in the African continent are very scarce. Method This is a case series of 10 patients with COVID-19 who developed ALI while on treatment at Eka Kotebe General Hospital, Addis Ababa, Ethiopia. All patients with ALI and COVID-19 admitted between February 1, 2021, and December 31, 2021, were retrospectively identified and reviewed. COVID-19 was confirmed by RT-PCR and ALI was confirmed by Doppler ultrasound and/or computed tomography angiography in the presence of clinical suspicion. Results A total of 3098 patients were hospitalized with confirmed COVID-19 during the study period. In a series of 10 patients, 8 (80%) males with a median age of 53.5 years were included. All except one (10%) had one or more risk factors for ALI and one had a 'possible' case of vaccine-induced thrombotic thrombocytopenia (VITT) associated with ALI. All were admitted with severe COVID-19 and most (80%) developed ALI during hospitalization (median of seven days from admission). The median duration between COVID-19 and ALI symptom onset was 14.5 days (IQR, 11-15). The majority (60%) were taking therapeutic anticoagulation at the time of ALI onset which is the standard of care for patients with severe disease. Five (50%) were successfully revascularized (median time of 3.5 days) and the rest underwent amputation. All survived and were discharged improved. Conclusion ALI can occur in the context of COVID-19 even while a patient is on therapeutic dose anticoagulation and in the absence of traditional risk factors. It is wise to be vigilant of this complication for timely intervention and better treatment outcomes.
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Affiliation(s)
- Fikremariam Melkeneh Alemayehu
- General Practitioner, Intensive Care Unit Trained, Ministry of Health (MOH) Eka Kotebe General Hospital, Addis Ababa, Ethiopia
| | - Dawit Kebede Huluka
- Internist, Pulmonologist, and Critical Care Subspecialist, Department of Internal Medicine, School of Medicine, Addis Ababa University, Ethiopia
| | - Tizazu Kebede Beyene
- Vascular Surgeon Fellow (F-2), Department of Vascular Surgery, School of Medicine, Addis Ababa University, Ethiopia
| | - Azmera Gissila Aboye
- Radiologist, Subspecialist in Cardiothoracic Imaging, Department of Radiology, School of Medicine, Addis Ababa University, Ethiopia
| | - Hiwotie Abebe Mesfin
- General Practitioner, Intensive Care Unit Trained, ICU Coordinator, MOH Eka Kotebe General Hospital, Addis Ababa, Ethiopia
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15
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Abstract
Although thrombosis frequently occurs in infectious diseases, the coagulopathy associated with COVID-19 has unique characteristics. Compared with bacterial sepsis, COVID-19-associated coagulopathy presents with minimal changes in platelet counts, normal prothrombin times, and increased D-dimer and fibrinogen levels. These differences can be explained by the distinct pathophysiology of the thromboinflammatory responses. In sepsis-induced coagulopathy, leukocytes are primarily responsible for the coagulopathy by expressing tissue factor, releasing neutrophil extracellular traps, multiple procoagulant substances, and systemic endothelial injury that is often associated with vasoplegia and shock. In COVID-19-associated coagulopathy, platelet activation is a major driver of inflammation/thrombogenesis and von Willebrand factor and platelet factor 4 are deeply involved in the pathogenesis. Although the initial responses are localized to the lung, they can spread systemically if the disease is severe. Since the platelets play major roles, arterial thrombosis is not uncommon in COVID-19. Despite platelet activation, platelet count is usually normal at presentation, but sensitive biomarkers including von Willebrand factor activity, soluble P-selectin, and soluble C-type lectin-like receptor-2 are elevated, and they increase as the disease progresses. Although the role of antiplatelet therapy is still unproven, current studies are ongoing to determine its potential effects.
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Affiliation(s)
- Toshiaki Iba
- Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hideo Wada
- Department of General Medicine, Mie Prefectural General Medical Center, Mie, Japan
| | - Jerrold H Levy
- Department of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, North Carolina
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16
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Aljabri B, Aldossary MY. Unexpected arterial thrombosis and acute limb ischemia in a young male patient with COVID-19: A case report. Front Surg 2023; 10:1092287. [PMID: 36798637 PMCID: PMC9927001 DOI: 10.3389/fsurg.2023.1092287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/09/2023] [Indexed: 01/31/2023] Open
Abstract
Introduction The spread of severe acute respiratory syndrome coronavirus 2 has resulted in coronavirus disease 2019 (COVID-19) pandemic, raising significant concerns. COVID-19 can lead to thrombotic complications such as acute limb ischemia (ALI). In patients with COVID-19, thrombotic complications may increase the risk of morbidity and mortality. Presentation of case We report the case of a 37-year-old man who presented with a 2 weeks history of right foot pain, toes blackish discoloration, and numbness. He tested positive for COVID-19 10 days prior to his presentation. Computed tomography angiography (CTA) of the lower limbs revealed near-complete occlusion of the right popliteal artery with single-vessel posterior tibial artery runoff. The patient was brought to a hybrid operating room, and diagnostic angiography confirmed the diagnosis. He underwent popliteal artery thromboembolectomy and intraoperative thrombolysis through a posterior approach. A completion angiography demonstrated a patent popliteal artery with a 2-vessels patency to the foot. His postoperative recovery was uneventful. After surgery, the popliteal, anterior tibial, and posterior tibial arteries were all palpable. The patient was discharged home on antiplatelet therapy with frequent postoperative follow-ups during the last 1 year in our outpatient clinic. Discussion The frequency of ALI has reduced worldwide, and the hypercoagulable condition remains an infrequent cause of limb ischemia. Patients with COVID-19 have a 35%-45% thromboembolic complication rate. In many studies, the virus launches a second attack between 7 and 14 days after symptom onset, possibly causing hypercoagulability. If conservative treatment fails, various surgical methods, including thromboembolectomy, thrombolysis, and thrombosuction, can be performed to treat ALI. Conclusion In mild ALI symptoms, unfractionated heparin can be used with vigilant follow-up. Open and endovascular procedures are currently used to treat patients with acute limb ischemia, and technological advancements continue to make interventions easier and safer.
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Affiliation(s)
- Badr Aljabri
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Yousef Aldossary
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Division of Vascular Surgery, Department of Surgery, Dammam Medical Complex, Dammam, Saudi Arabia
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17
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History of COVID-19 infection is not associated with increased D-dimer levels and risk of deep-vein thrombosis in total joint arthroplasty. Arch Orthop Trauma Surg 2023; 143:785-789. [PMID: 34546422 PMCID: PMC8453476 DOI: 10.1007/s00402-021-04181-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 09/09/2021] [Indexed: 11/09/2022]
Abstract
INTRODUCTION In the acute phase of COVID-19, elevated D-dimer levels indicate a hypercoagulable state putting the patients at increased risk for venous thromboembolic disease (VTE). It is unclear, if prior COVID-19 disease increases the risk for VTE after total joint arthroplasty (TJA) and if D-dimer levels can be used to identify patients at risk. MATERIALS AND METHODS D-Dimer levels of 313 consecutive SARS-CoV-2 IgG-positive and 2,053 -negative patients undergoing TJA between 05/20 and 12/20 were evaluated. D-Dimer levels were divided into three groups: < 200 ng/ml, 200-400 ng/ml, and > 400 ng/ml D-dimer units (DDU). 277 SARS-CoV-2 IgG-positive patients underwent a Doppler ultrasound to rule out deep-vein thrombosis (DVT) 4-6 weeks after TJA. RESULTS D-Dimer levels did not differ significantly between SARS-CoV-2 IgG-positive and -negative patients (p value 0.53). Among SARS-CoV-2 IgG-negative patients, 1687 (82.17%) had D-dimer levels < 200 ng/ml, 256 (12.47%) between 200 and 400 ng/ml, and 110 (5.36%) > 400 ng/ml. Of the SARS-CoV-2 IgG-positive patients, 257 (83.71%) had D-dimer levels < 200 ng/ml, 34 (11.07%) between 200 and 400 ng/ml, and 16 (5.21%) > 400 ng/ml. A postoperative DVT was detected in nine patients (2.9%) in the SARS-CoV-2 IgG-positive group and a PE in one patient (0.3%). 7/229 patients with < 200 ng/ml (3.1%), 1/28 patients (3.6%) with 200-400 ng/ml and 1/9 patients (11.1%) with D-dimer levels > 400 ng/ml had a DVT or PE (p = 0.43). CONCLUSIONS The findings of this investigation suggest there is no difference in D-dimer levels between SARS-CoV-2 IgG-positive and -negative patients undergoing TJA. Although there is a trend for increased VTE rates with increased D-dimer levels, routine D-dimer testing is not recommended based on the current data. SARS-CoV-2 IgG-positive patients have a low risk of VTE in the current study.
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18
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Dimitriou I, Christodoulou N, Chatzimargaritis K, Kaikis A, Kasti E, Triantos G. Splenic Artery Infarct Requiring Surgery: A Rare Complication of COVID-19 Infection. Case Rep Surg 2022; 2022:3391405. [PMID: 36505726 PMCID: PMC9729033 DOI: 10.1155/2022/3391405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/22/2022] [Accepted: 11/11/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction. Coronavirus disease (COVID-19) from SARS-CoV-2 infection is linked to a hypercoagulable state, leading to arterial and venous thrombotic events, of which pulmonary embolism is the most frequent. However, arterial thromboembolisms may also occur as visceral infracts in unusual sites, such as the renal, splenic, and intestinal arteries. Case Report. A 46-year-old unvaccinated male with a COVID-19 infection was admitted to the COVID-19 isolation ward with symptoms of respiratory infection. He complained of epigastric pain and fever for several days; radiological imaging of the abdomen revealed complete splenic arterial occlusion due to a large infarct. He was treated with low molecular weight heparin (enoxaparin) in therapeutic doses, resulting in minimal improvement. However, the pain worsened, and eventually, a laparotomy and splenectomy were performed. He was hospitalized for another 36 days before he was discharged in good condition. A second surgery was performed to remove a noninfected encapsulated hematoma from the subdiaphragmatic space. The patient remained healthy afterward, with no relapses. Discussion. Although rare, the number of cases of visceral infarcts in COVID-19 patients has increased. Splenic artery infarct is an exceptional case of acute abdominal pain that can be treated successfully with anticoagulant medication. Splenectomy may be required to manage refractory pain after failure of conservative management.
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Affiliation(s)
- Ioannis Dimitriou
- 1st Surgery Department, General Hospital of Rhodes, Rhodes, Dodecanese, Greece
| | | | | | - Aristidis Kaikis
- Special Unit of Infectious Diseases, General Hospital of Rhodes, Rhodes, Dodecanese, Greece
| | - Eirini Kasti
- Radiological Department, General Hospital of Rhodes, Rhodes, Dodecanese, Greece
| | - Georgios Triantos
- 1st Surgery Department, General Hospital of Rhodes, Rhodes, Dodecanese, Greece
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19
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Ongen G, Nas OF, Aksoy F, Candan S, Dundar HZ, Ozpar R, Inecikli MF, Gursel BE, Tasar P, Savci G. Comparison of severity and complication rates of acute cholecystitis during pandemic and pre-pandemic periods? Acta Radiol 2022; 64:1363-1370. [PMID: 36412110 PMCID: PMC9692182 DOI: 10.1177/02841851221137048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Cancellations of surgeries for elective cases and late admissions of symptomatic cases during the pandemic period might have increased the number of cases of acute cholecystitis and its complications. Purpose To compare the severity of acute cholecystitis and complication rates during the pandemic and pre-pandemic periods. Material and Methods We evaluated the computed tomography (CT) findings observed for the diagnosis of complications for both acute simple and acute complicated cholecystitis during both the pandemic and pre-pandemic periods. Patients admitted to the hospital between March 2020 and December 2020 made up the study group and the corresponding appropriate patients from one year earlier were studied as the control group. In addition to the CT findings, clinical and laboratory findings, co-morbidities such as diabetes, as well as the admission time to hospital from the onset of the initial symptoms to hospital admission were also evaluated. Results A total of 88 patients were evaluated (54 in the study group, 34 in the control group; mean age = 64.3 ± 16.3 years). The male-to-female ratio was 51/37. The number of patients diagnosed with complicated cholecystitis were significantly higher in the study group ( P = 0.03). Murphy finding and diabetes status were similar between the two groups ( P = 0.086 and P = 0.308, respectively). Admission time to the hospital was significantly different for study and control groups in simple cholecystitis patients ( P = 0.045); with no significant difference in cases of complicated cholecystitis ( P = 0.499). Conclusion Our study reveals the course of acute cholecystitis during the pandemic period was much more serious with higher complications.
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Affiliation(s)
- Gokhan Ongen
- Department of Radiology, School of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Omer Fatih Nas
- Department of Radiology, School of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Fuat Aksoy
- Department of General Surgery, School of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Selman Candan
- Department of Radiology, Kelkit State Hospital, Kelkit, Gumushane, Turkey
| | - Halit Ziya Dundar
- Department of General Surgery, Bursa Medicana Hospital, Bursa, Turkey
| | - Rifat Ozpar
- Department of Radiology, School of Medicine, Bursa Uludag University, Bursa, Turkey
| | | | - Basak Erdemli Gursel
- Department of Radiology, School of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Pinar Tasar
- Department of General Surgery, School of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Gursel Savci
- Department of Radiology, School of Medicine, Bursa Uludag University, Bursa, Turkey
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20
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Bonfioli G, Tomasoni D, Metra M, Adamo M. Coronavirus disease 2019 and cardiovascular disease: what we have learnt during the last 2 years. J Cardiovasc Med (Hagerstown) 2022; 23:710-714. [DOI: 10.2459/jcm.0000000000001377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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21
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D’Alessandro E, Kawasaki A, Eandi CM. Pathogenesis of Vascular Retinal Manifestations in COVID-19 Patients: A Review. Biomedicines 2022; 10:2710. [PMID: 36359227 PMCID: PMC9687698 DOI: 10.3390/biomedicines10112710] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 07/29/2023] Open
Abstract
Pandemic infection secondary to coronavirus disease 2019 (COVID-19) had an important impact on the general population affecting not only respiratory tract but also many other organs. Ocular manifestations are quite common at the level of the anterior segment (conjunctivitis, dry eye), while posterior segment and, in particular, retinal findings are less frequent. In the retina, COVID-19 is associated with vascular events. Since retinal arteries and veins represent an accessible window to the microvasculature of the rest of the body, a better understanding of the profile of retinal vascular occlusive events may help elucidate mechanisms of thrombo-occlusive complications in other organs in patients affected by COVID-19. In this review, we conducted a systematic literature search focused on retinal arterial and/or retinal venous manifestations. Twenty-one studies were included, describing a wide range of manifestations from mild signs like cotton wool spots, focal and flame-shaped hemorrhages, and vein dilation to more severe retinal artery and vein occlusions. Two principal pathogenetic mechanisms are considered responsible for these complications: a hypercoagulative state and a massive inflammatory response leading to a disseminated intravascular coagulation-like syndrome.
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Affiliation(s)
- Elisa D’Alessandro
- Fondation Asile des Aveugles, Hôpital Ophtalmique Jules Gonin, University of Lausanne, 1004 Lausanne, Switzerland
| | - Aki Kawasaki
- Fondation Asile des Aveugles, Hôpital Ophtalmique Jules Gonin, University of Lausanne, 1004 Lausanne, Switzerland
| | - Chiara M. Eandi
- Fondation Asile des Aveugles, Hôpital Ophtalmique Jules Gonin, University of Lausanne, 1004 Lausanne, Switzerland
- Department of Surgical Sciences, University of Torino, 10126 Torino, Italy
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22
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Soroa G, Álvarez A, Monge I, Navarro D, Roca O. Osteonecrosis and Osteomyelitis of the Proximal Third of Tibia as a Late Sequela of COVID-19: A Case Report. PLASTIC AND AESTHETIC NURSING 2022; 42:190-196. [PMID: 36469389 DOI: 10.1097/psn.0000000000000458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Coronavirus disease was first described as an identified syndrome in December 2019 (COVID-19). Since then, a global pandemic has taken place and the disease has repeatedly been associated with thromboembolic complications, most of which are venous, but may also occur at the arterial level, even in patients receiving thromboprophylaxis. To date, only medium- and large-caliber vessels have been affected by arterial thrombosis secondary to COVID-19. This article describes the case of a 60-year-old woman with a prior severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection who developed multiple bone infarcts, complicated by secondary osteomyelitis. The patient underwent multiple surgical debridements and received a variety of antibiotics before the correct diagnosis was made and a multidisciplinary surgery was planned that provided coverage with a medial gastrocnemius flap. At 5-months follow-up, the patient had recovered well without any clinical evidence of infection or other complications. To the best of our knowledge, this is the first known case of a bone infarct complicated with a secondary osteomyelitis occurring in a patient having suffered a previous SARS-CoV-2 infection. We postulate as our main hypothesis that the prothrombogenic state secondary to SARS-CoV-2 infection may have contributed to thrombosis of small-caliber vessels, in our patient the arteria nutricia tibialis, triggering bone infarcts and a secondary infection with Staphylococcus aureus .
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Affiliation(s)
- Gonzalo Soroa
- Gonzalo Soroa, MD, is a plastic, reconstructive, and aesthetic surgery resident physician, Son Espases University Hospital, Palma de Mallorca, Spain
- Adela Álvarez, MD, is a plastic, reconstructive, and aesthetic surgery resident physician, Son Espases University Hospital, Palma de Mallorca, Spain
- Iván Monge, MD, is a plastic, reconstructive, and aesthetic surgery attending physician, Son Espases University Hospital, Palma de Mallorca, Spain
- Daniel Navarro, MD, is a plastic, reconstructive, and aesthetic surgery resident physician, Son Espases University Hospital, Palma de Mallorca, Spain
- Oriol Roca, MD, is a plastic, reconstructive, and aesthetic surgery attending physician, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Adela Álvarez
- Gonzalo Soroa, MD, is a plastic, reconstructive, and aesthetic surgery resident physician, Son Espases University Hospital, Palma de Mallorca, Spain
- Adela Álvarez, MD, is a plastic, reconstructive, and aesthetic surgery resident physician, Son Espases University Hospital, Palma de Mallorca, Spain
- Iván Monge, MD, is a plastic, reconstructive, and aesthetic surgery attending physician, Son Espases University Hospital, Palma de Mallorca, Spain
- Daniel Navarro, MD, is a plastic, reconstructive, and aesthetic surgery resident physician, Son Espases University Hospital, Palma de Mallorca, Spain
- Oriol Roca, MD, is a plastic, reconstructive, and aesthetic surgery attending physician, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Iván Monge
- Gonzalo Soroa, MD, is a plastic, reconstructive, and aesthetic surgery resident physician, Son Espases University Hospital, Palma de Mallorca, Spain
- Adela Álvarez, MD, is a plastic, reconstructive, and aesthetic surgery resident physician, Son Espases University Hospital, Palma de Mallorca, Spain
- Iván Monge, MD, is a plastic, reconstructive, and aesthetic surgery attending physician, Son Espases University Hospital, Palma de Mallorca, Spain
- Daniel Navarro, MD, is a plastic, reconstructive, and aesthetic surgery resident physician, Son Espases University Hospital, Palma de Mallorca, Spain
- Oriol Roca, MD, is a plastic, reconstructive, and aesthetic surgery attending physician, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Daniel Navarro
- Gonzalo Soroa, MD, is a plastic, reconstructive, and aesthetic surgery resident physician, Son Espases University Hospital, Palma de Mallorca, Spain
- Adela Álvarez, MD, is a plastic, reconstructive, and aesthetic surgery resident physician, Son Espases University Hospital, Palma de Mallorca, Spain
- Iván Monge, MD, is a plastic, reconstructive, and aesthetic surgery attending physician, Son Espases University Hospital, Palma de Mallorca, Spain
- Daniel Navarro, MD, is a plastic, reconstructive, and aesthetic surgery resident physician, Son Espases University Hospital, Palma de Mallorca, Spain
- Oriol Roca, MD, is a plastic, reconstructive, and aesthetic surgery attending physician, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Oriol Roca
- Gonzalo Soroa, MD, is a plastic, reconstructive, and aesthetic surgery resident physician, Son Espases University Hospital, Palma de Mallorca, Spain
- Adela Álvarez, MD, is a plastic, reconstructive, and aesthetic surgery resident physician, Son Espases University Hospital, Palma de Mallorca, Spain
- Iván Monge, MD, is a plastic, reconstructive, and aesthetic surgery attending physician, Son Espases University Hospital, Palma de Mallorca, Spain
- Daniel Navarro, MD, is a plastic, reconstructive, and aesthetic surgery resident physician, Son Espases University Hospital, Palma de Mallorca, Spain
- Oriol Roca, MD, is a plastic, reconstructive, and aesthetic surgery attending physician, Son Espases University Hospital, Palma de Mallorca, Spain
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Tohmasi S, Kabutey NK, Maithel S, Chen SL, Kuo IJ, Donayre CE, Fujitani RM, Chau AH. Management of acute aortoiliac arterial thrombosis in patients with the novel coronavirus disease 2019: A case series and systematic review of the literature. ANNALS OF VASCULAR SURGERY - BRIEF REPORTS AND INNOVATIONS 2022; 2:100105. [PMID: 35821740 PMCID: PMC9259024 DOI: 10.1016/j.avsurg.2022.100105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 12/11/2022]
Abstract
Objectives Venous thrombosis has been widely described in the setting of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection; however, arterial thrombosis has rarely been reported. This study aims to assess the incidence, risk factors, interventions, and outcomes of acute aortoiliac arterial thrombosis in patients with active SARS-CoV-2 infections. Methods We present seven SARS-CoV-2-positive patients from our institution who acutely developed thrombi in the aortoiliac arterial system (7/2020-1/2021). A systematic review of the literature on aortoiliac arterial thrombosis in patients with SARS-CoV-2 infections in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was also performed. The available data from all reported cases in the literature and at our institution were analyzed. Results Thirty published articles and journal correspondences, including 52 patients, were reviewed and analyzed in addition to our institution's 7 cases. In total, 59 SARS-CoV-2-positive patients were found to have acute aortoiliac thrombosis. The abdominal aorta was the most frequent location for the development of a thrombus. Baseline demographics and medical comorbidities were not significantly different between the symptomatic and asymptomatic cohorts. Seventy-one percent of patients were symptomatic (lower limb ischemia: 75.0%, renal infarction: 20.0%, stroke: 12.5%, mesenteric ischemia: 10.0%). All patients with thrombus involving the ascending aorta, aortic bifurcation, or iliac artery developed thromboembolic or ischemic complications. All patients received systemic anticoagulation. Fifty-three percent of all patients were managed medically. Ninety-four percent of the asymptomatic patients were managed medically. One asymptomatic patient underwent endovascular aspiration of a mobile thrombus. Three (23.1%) deaths occurred in the asymptomatic cohort from hypoxic respiratory failure. Fourteen (36.8%) deaths occurred in the symptomatic cohort. The in-hospital mortality rate was 33.3% overall and 43.8% for patients with thrombi involving more than one aortoiliac segment. Conclusions The presence of thrombi in the aortoiliac arterial system appears to be a poor prognostic indicator for patients with active SARS-CoV-2 infections. Medical management of patients with asymptomatic aortoiliac thrombi may be considered. The presence of thrombi involving the ascending aorta, aortic bifurcation, or iliac artery may warrant consideration for operative intervention due to the risk for thromboembolic or ischemic complications. Further study is needed to fully delineate the risk factors, optimal treatment, and outcomes of arterial thrombosis in the setting of SARS-CoV-2 infection.
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Affiliation(s)
- Steven Tohmasi
- University of California, Irvine Medical Center, Division of Vascular and Endovascular Surgery, Department of Surgery, Orange, CA, United States
| | - Nii-Kabu Kabutey
- University of California, Irvine Medical Center, Division of Vascular and Endovascular Surgery, Department of Surgery, Orange, CA, United States
| | - Shelley Maithel
- University of California, Irvine Medical Center, Division of Vascular and Endovascular Surgery, Department of Surgery, Orange, CA, United States
| | - Samuel L Chen
- University of California, Irvine Medical Center, Division of Vascular and Endovascular Surgery, Department of Surgery, Orange, CA, United States
| | - Isabella J Kuo
- University of California, Irvine Medical Center, Division of Vascular and Endovascular Surgery, Department of Surgery, Orange, CA, United States
| | - Carlos E Donayre
- University of California, Irvine Medical Center, Division of Vascular and Endovascular Surgery, Department of Surgery, Orange, CA, United States
| | - Roy M Fujitani
- University of California, Irvine Medical Center, Division of Vascular and Endovascular Surgery, Department of Surgery, Orange, CA, United States
| | - Anthony H Chau
- University of California, Irvine Medical Center, Division of Vascular and Endovascular Surgery, Department of Surgery, Orange, CA, United States
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Childers J, Do TVC, Smith F, Vangara A, Ganti SS, Akella R. Incidental and Asymptomatic Splenic Infarction and Infrarenal Thrombus in a COVID-19 Patient. Cureus 2022; 14:e26555. [PMID: 35936145 PMCID: PMC9348832 DOI: 10.7759/cureus.26555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2022] [Indexed: 12/03/2022] Open
Abstract
The cytokine storm associated with coronavirus disease 2019 (COVID-19) triggers a hypercoagulable state leading to venous and arterial thromboembolism. Lab findings associated with this phenomenon are elevated D-dimer, fibrinogen, C-reactive protein (CRP), ferritin, and procalcitonin. We present the case of a 66-year-old male with dyslipidemia who was diagnosed with COVID-19 with worsening shortness of breath, myalgia, and loss of taste. Physical examination was remarkable for crackles with diminished lung sounds and use of his accessory muscles. Labs showed normal white blood cell count, D-dimer of 1.42 mg/L, ferritin of 961 ng/mL, lactate dehydrogenase (LDH) of 621 U/L, and CRP of 2.1 mg/dL. Chest X-ray showed atypical pneumonitis with patchy abnormalities. He required oxygen supplementation with fraction of inspired oxygen of 100% proning as tolerated. He received remdesivir, ceftriaxone, azithromycin, dexamethasone, prophylactic enoxaparin, and a unit of plasma therapy. His D-dimer had increased from 1.65 to 3.51 mg/L with worsening dyspnea. At this time, computed tomography angiogram (CTA) of the chest showed extensive ground-glass opacities and a 2.4 × 1.9 × 1.3 cm distal thoracic aortic intraluminal thrombus. He was started on a heparin drip. A follow-up CTA of the aorta showed thrombus or hypoattenuation within the splenic artery and wedge-shaped areas extending from the hilum with possible infarction and a 6 mm thrombus in the infrarenal abdominal aorta. He was transitioned to enoxaparin 1 mg/kg twice daily. He remained asymptomatic from his splenic infarction. This case adds more insight to splenic infarction associated with COVID-19 in addition to the 32 reported cases documented thus far. Management of thromboembolism includes a therapeutic dose of anticoagulation. To prevent thromboembolism, prophylactic anticoagulation is recommended for those hospitalized with COVID-19.
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25
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Bauer KL. Differentiation of Lower Extremity Skin Changes in the Intensive Care Setting. AACN Adv Crit Care 2022; 33:196-207. [PMID: 35657763 DOI: 10.4037/aacnacc2022737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Digital and lower extremity skin changes often signify critical underlying disorders. Patients in the intensive care unit also frequently have hemodynamic instability requiring the use of vasoactive medications, which may lead to various presentations of limb ischemia; preexisting conditions increase these patients' risk for arterial embolization. Most arterial emboli are clots that originate in the heart and travel to distant vascular beds, where they cause arterial occlusion, ischemia, and, potentially, infarction; the 2 most common sequelae are stroke and lower limb ischemia. Emboli also arise from atherosclerotic plaques. Other conditions can also cause skin color changes in this vulnerable population. Prompt recognition and differentiation of lower extremity skin changes can result in improved patient outcomes. A thorough literature search was conducted to differentiate the primary causes of lower extremity and digital skin changes in the critically ill patient and outline diagnostic and management techniques.
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Affiliation(s)
- Karen L Bauer
- Karen L. Bauer is Director of Wound and Vascular Services, Division of Vascular, Endovascular, and Wound Surgery, University of Toledo, 3000 Arlington Avenue, Mail Stop 1095, Toledo, OH 43614
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Gastrointestinal Ischemia—Stumbling Stone in COVID-19 Patients. GASTROENTEROLOGY INSIGHTS 2022. [DOI: 10.3390/gastroent13020021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The emergence of the novel SARS-CoV2 virus, proclaimed by the World Health Organization (WHO) as a culpable agent for the pandemic situation, caught the scientific and medical communities off guard. One of the most common complications following pulmonary disease is represented by gastrointestinal (GI) disorders, especially ischemic damage. Inflammation, vasculopathy, immobility, endothelial dysfunction, and a hypercoagulable condition have all been proposed as pathophysiological factors for GI ischemia in these patients. Owing to the COVID-19 effect on a variety of GI conditions, especially ischemic changes, and the high mortality rate, physicians should always keep in mind this complication. They should take a deeper look at clinical and imaging modalities in this cohort of patients so that a proper and time-saving treatment strategy can be applied. Our study aimed to elucidate the thrombogenic mechanism in different GI disorders. Moreover, we analyzed the factors related to necrotic GI changes, by summarizing the already reported data of GI ischemia in COVID-19. To the best of our knowledge, this review is the first to incorporate all GI ischemia cases reported in the literature so far.
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Gaisinskaya P, VanHelmond TA, Reano K. Acute Limb Ischemia Following a Mild Case of COVID-19. Cureus 2022; 14:e25234. [PMID: 35755547 PMCID: PMC9217669 DOI: 10.7759/cureus.25234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/23/2022] [Indexed: 11/05/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) was a novel virus that originated in China in November 2019 and is most known for its respiratory compromise; however, many patients have experienced vascular thrombosis as sequelae of COVID-19. It is thought that the virus causes endothelial cell damage and increased platelet and leukocyte adhesion, causing a hypercoagulable state. While the most common presentation of hypercoagulability associated with COVID-19 is venous thrombosis, there are reports of patients who present with acute limb ischemia. We present a case of acute leg ischemia in an otherwise asymptomatic patient with no atherosclerotic risk factors.
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Ippolito D, Vernuccio F, Maino C, Cannella R, Giandola T, Ragusi M, Bigiogera V, Capodaglio C, Sironi S. Multiorgan Involvement in SARS-CoV-2 Infection: The Role of the Radiologist from Head to Toe. Diagnostics (Basel) 2022; 12:1188. [PMID: 35626344 PMCID: PMC9140872 DOI: 10.3390/diagnostics12051188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/29/2022] [Accepted: 05/05/2022] [Indexed: 01/08/2023] Open
Abstract
Radiology plays a crucial role for the diagnosis and management of COVID-19 patients during the different stages of the disease, allowing for early detection of manifestations and complications of COVID-19 in the different organs. Lungs are the most common organs involved by SARS-CoV-2 and chest computed tomography (CT) represents a reliable imaging-based tool in acute, subacute, and chronic settings for diagnosis, prognosis, and management of lung disease and the evaluation of acute and chronic complications. Cardiac involvement can be evaluated by using cardiac computed tomography angiography (CCTA), considered as the best choice to solve the differential diagnosis between the most common cardiac conditions: acute coronary syndrome, myocarditis, and cardiac dysrhythmia. By using compressive ultrasound it's possible to study the peripheral arteries and veins and to exclude the deep vein thrombosis, directly linked to the onset of pulmonary embolism. Moreover, CT and especially MRI can help to evaluate the gastrointestinal involvement and assess hepatic function, pancreas involvement, and exclude causes of lymphocytopenia, thrombocytopenia, and leukopenia, typical of COVID-19 patients. Finally, radiology plays a crucial role in the early identification of renal damage in COVID-19 patients, by using both CT and US. This narrative review aims to provide a comprehensive radiological analysis of commonly involved organs in patients with COVID-19 disease.
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Affiliation(s)
- Davide Ippolito
- Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (D.I.); (C.M.); (T.G.); (M.R.); (V.B.); (C.C.)
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
| | - Federica Vernuccio
- Department of Radiology, University Hospital of Padova, Via Nicolò Giustiniani, 2, 35128 Padova, PD, Italy
| | - Cesare Maino
- Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (D.I.); (C.M.); (T.G.); (M.R.); (V.B.); (C.C.)
| | - Roberto Cannella
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Via del Vespro, 129, 90127 Palermo, PA, Italy;
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Via del Vespro, 129, 90127 Palermo, PA, Italy
| | - Teresa Giandola
- Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (D.I.); (C.M.); (T.G.); (M.R.); (V.B.); (C.C.)
| | - Maria Ragusi
- Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (D.I.); (C.M.); (T.G.); (M.R.); (V.B.); (C.C.)
| | - Vittorio Bigiogera
- Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (D.I.); (C.M.); (T.G.); (M.R.); (V.B.); (C.C.)
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
| | - Carlo Capodaglio
- Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (D.I.); (C.M.); (T.G.); (M.R.); (V.B.); (C.C.)
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
- Department of Diagnostic Radiology, H Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, BG, Italy
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Zareef R, Diab M, Al Saleh T, Makarem A, Younis NK, Bitar F, Arabi M. Aspirin in COVID-19: Pros and Cons. Front Pharmacol 2022; 13:849628. [PMID: 35370686 PMCID: PMC8965577 DOI: 10.3389/fphar.2022.849628] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/21/2022] [Indexed: 01/08/2023] Open
Abstract
Since its emergence, the COVID-19 pandemic has been ravaging the medical and economic sectors even with the significant vaccination advances. In severe presentations, the disease of SARS-CoV-2 can manifest with life-threatening thromboembolic and multi-organ repercussions provoking notable morbidity and mortality. The pathogenesis of such burdensome forms has been under extensive investigation and is attributed to a state of immune dysfunction and hyperinflammation. In light of these extraordinary circumstances, research efforts have focused on investigating and repurposing previously available agents that target the inflammatory and hematological cascades. Aspirin, due to its well-known properties and multiple molecular targets, and ought to its extensive clinical use, has been perceived as a potential therapeutic agent for COVID-19. Aspirin acts at multiple cellular targets to achieve its anti-inflammatory and anti-platelet effects. Although initial promising clinical data describing aspirin role in COVID-19 has appeared, evidence supporting its use remains fragile and premature. This review explores the notion of repurposing aspirin in COVID-19 infection. It delves into aspirin as a molecule, along with its pharmacology and clinical applications. It also reviews the current high-quality clinical evidence highlighting the role of aspirin in SARS-CoV-2 infection.
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Affiliation(s)
- Rana Zareef
- Pediatric and Adolescent Medicine Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwa Diab
- Pediatric and Adolescent Medicine Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Tala Al Saleh
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Adham Makarem
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nour K. Younis
- Brigham and Women’s Hospital-Harvard Medical School, Boston, MA, United States
| | - Fadi Bitar
- Pediatric and Adolescent Medicine Department, American University of Beirut Medical Center, Beirut, Lebanon
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Pediatric Department, Division of Pediatric Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Arabi
- Pediatric and Adolescent Medicine Department, American University of Beirut Medical Center, Beirut, Lebanon
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Pediatric Department, Division of Pediatric Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
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Atıcı SD, Akpınar G. Splenic infarct in a COVID-19 patient under anticoagulant therapy with normal D-dimer levels. Int J Surg Case Rep 2022; 92:106847. [PMID: 35194547 PMCID: PMC8855613 DOI: 10.1016/j.ijscr.2022.106847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 01/23/2022] [Accepted: 02/15/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Many studies have shown that COVID-19 can progress with coagulopathy and multisystemic thrombotic events. We report a patient who presented with abdominal pain after COVID-19 and was found to have splenic infarction (SI) concomitant with acute myocardial infarctus (MI) under anticoagulant treatment. CASE PRESENTATION A 45-year-old man was admitted to the emergency department with left-sided abdominal pain radiating through to his back persisting for one day. He had COVID-19 PCR positivity nine days ago. After seven days of hospitalization due to COVID-19 pneumonia, he had been discharged with low-molecular-weight heparin (LMWH). Abdominal computerized tomography (CT) showed SI. His ECG and laboratory parameters were normal except for 17.2 × 10∧3/μL leukocytosis. The anticoagulant drug dose that he was taking was increased to 2 × 0.6 mL during hospitalization. He described new-onset chest pain during follow-up. Acute anterior MI was detected on ECG. Successful percutaneous coronary angiography was performed by cardiologists. No problems were observed in the follow-up. The patient was discharged on the fifth day of conservative treatment due to splenic infarction. CONCLUSION Thrombosis prophylaxis with prophylactic doses of LMWH in hospitalized COVID-19 patients may not be sufficient to prevent the development of coagulopathy in patients. Abdominal-visceral thromboembolism should be suspected in a COVID-19-positive patient presenting with abdominal pain despite receiving anticoagulant therapy and normal d-dimer levels.
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Affiliation(s)
- Semra Demirli Atıcı
- University of Health Sciences Tepecik Training and Research Hospital, Department of General Surgery, Turkey.
| | - Göksever Akpınar
- University of Health Sciences Tepecik Training and Research Hospital, Department of General Surgery, Turkey
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31
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Petrov A, De Glee Romera JP, Wilbring M, Alexiou K, Kappert U, Matschke KE, Tugtekin SM. Aortic Thrombosis following COVID-19: A Systematic Review. Thorac Cardiovasc Surg 2022; 70:323-332. [PMID: 35108736 DOI: 10.1055/s-0041-1740554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Arterial and venous thromboses associated with the coronavirus disease 2019 (COVID-19) have been well described. These events are caused by a hypercoagulable state due to endotheliopathy and infection-driven coagulopathy. There has been an ever-increasing number of documented cases of aortic thrombosis (AoT) in COVID-19 patients. We conducted a systematic review of current scientific literature to identify and consolidate evidence of AoT in COVID-19 patients. METHODS A systematic review of literature was conducted between March 15, 2020, and May 1, 2021, on PubMed and Cochrane databases. Additionally, a case from our facility was included. RESULTS A total of 38 studies (12 case series and 26 case reports) and a case from our facility describing AoT in 56 COVID-19 patients were included. Patients were aged 64.8 ± 10.5 years, were predominantly male (75%), and had several comorbidities. AoT was symptomatic in 82,14% of patients; however, when D dimers were reported, they were significantly elevated even in otherwise asymptomatic patients. Most patients had no previous history of aortic disease. Thrombosis was described in all parts of the aorta, with several cases reporting multiple locations. The median reported time until development of AoT was 10 days. Peripheral thrombosis occurred in 73.21% of cases, most commonly causing lower limb ischemia. Mortality rate was 30.4%. CONCLUSIONS AoT can occur with no clinical symptoms or as a primary symptom in otherwise asymptomatic COVID-19 patients. D dimers are a highly sensitive diagnostic tool. Diagnosis of this condition prior to development of complications could be instrumental in saving many lives.
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Affiliation(s)
- Asen Petrov
- Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | | | - Manuel Wilbring
- Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | - Konstantin Alexiou
- Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | - Utz Kappert
- Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | | | - Sems-Malte Tugtekin
- Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
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32
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Jongkind V, Earnshaw JJ, Bastos Gonçalves F, Cochennec F, Debus ES, Hinchliffe R, Menyhei G, Svetlikov AV, Tshomba Y, Van Den Berg JC, Björck M. Editor's Choice - Update of the European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia in Light of the COVID-19 Pandemic, Based on a Scoping Review of the Literature. Eur J Vasc Endovasc Surg 2022; 63:80-89. [PMID: 34686452 PMCID: PMC8418912 DOI: 10.1016/j.ejvs.2021.08.028] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 08/18/2021] [Accepted: 08/26/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To perform a scoping review of how patients with COVID-19 are affected by acute limb ischaemia (ALI) and evaluate the recommendations of the 2020 ESVS ALI Guidelines for these patients. METHODS Research questions were defined, and a systematic literature search was performed following the PRISMA guidelines. Abstracts and unpublished literature were not included. The definition of ALI in this review is in accordance with the ESVS guidelines. RESULTS Most identified papers were case reports or case series, although population based data and data from randomised controlled trials were also identified. In total, 114 unique and relevant papers were retrieved. Data were conflicting concerning whether the incidence of ALI increased, or remained unchanged, during the pandemic. Case reports and series reported ALI in patients who were younger and healthier than usual, with a greater proportion affecting the upper limb. Whether or not this is coincidental remains uncertain. The proportion of men/women affected seems unchanged. Most reported cases were in hospitalised patients with severe COVID-19. Patients with ALI as their first manifestation of COVID-19 were reported. Patients with ALI have a worse outcome if they have a simultaneous COVID-19 infection. High levels of D-dimer may predict the occurrence of arterial thromboembolic events in patients with COVID-19. Heparin resistance was observed. Anticoagulation should be given to hospitalised COVID-19 patients in prophylactic dosage. Most of the treatment recommendations from the ESVS Guidelines remained relevant, but the following were modified regarding patients with COVID-19 and ALI: 1) CTA imaging before revascularisation should include the entire aorta and iliac arteries; 2) there should be a high index of suspicion, early testing for COVID-19 infection and protective measures are advised; and 3) there should be preferential use of local or locoregional anaesthesia during revascularisation. CONCLUSION Although the epidemiology of ALI has changed during the pandemic, the recommendations of the ESVS ALI Guidelines remain valid. The above mentioned minor modifications should be considered in patients with COVID-19 and ALI.
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Affiliation(s)
- Vincent Jongkind
- Department of Vascular Surgery, Amsterdam University Medical Centres, Amsterdam, the Netherlands.
| | | | - Frederico Bastos Gonçalves
- NOVA Medical School, Universidade NOVA de Lisboa & Centro Hospitalar Universitário de Lisboa Central, Portugal
| | | | - E Sebastian Debus
- Department for Vascular Medicine (Vascular Surgery, Angiology, Endovascular Therapy), University Heart & Vascular Centre, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Robert Hinchliffe
- Bristol Centre for Surgical Research, Bristol NIHR Biomedical Research Centre, Bristol, UK
| | - Gabor Menyhei
- Department of Vascular Surgery, University of Pecs, Pecs, Hungary
| | - Alexei V Svetlikov
- Division of Cardio-Vascular of the North-Western Medical University named after II Mechnikov, St Petersburg, Russia
| | - Yamume Tshomba
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jos C Van Den Berg
- Service of Interventional Radiology Centro Vascolare Ticino Ospedale Regionale di Lugano and Universitätsinstitut für Diagnostische, Interventionelle und Pädiatrische Radiologie Inselspital, Bern, Switzerland
| | - Martin Björck
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Acute ischemic stroke due to floating thrombus of ascending aorta: An acute and subacute complication of SARS-CoV-2 infection. NEUROIMMUNOLOGY REPORTS 2022. [PMCID: PMC9394099 DOI: 10.1016/j.nerep.2022.100127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective To describe ischemic stroke due to floating thrombus of ascending aorta occurring as acute and subacute complication of SARS-CoV-2 infection. Material and Methods consecutive identification in clinical practice of ischemic strokes secondary to aortic arch thrombosis and history of acute or recent Covid-19 infection. Results two patients had ischemic stroke with evidence of aortic arch thrombosis. The first case had concomitant acute Covid-19 infection, the second had recent Covid-19 infection. Both patients underwent intravenous thrombolysis, and subsequent anticoagulation. One patient died due to cerebral hemorrhage. Discussion and Conclusions aortic arch thrombosis can be an incidental finding in acute ischemic stroke in patients with concomitant and recent COVID-19 disease. However, the infection may lead to thrombosis in non-atherosclerotic vessels and to cerebral embolism. Our findings support active radiological search for aortic thrombosis during acute stroke in patients with acute or recent COVID-19 disease.
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Increased Pulmonary Embolism Incidence and Mortality in Patients Subsequently Diagnosed with COVID-19: An Analysis of Health Insurance Claims Data. Eur J Vasc Endovasc Surg 2022; 63:159-160. [PMID: 34627680 PMCID: PMC8418913 DOI: 10.1016/j.ejvs.2021.08.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/16/2021] [Accepted: 08/26/2021] [Indexed: 01/04/2023]
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Galyfos G, Sianou A, Frountzas M, Vasilios K, Vouros D, Theodoropoulos C, Michalopoulou V, Sigala F, Filis K. Acute limb ischemia among patients with COVID-19 infection. J Vasc Surg 2022; 75:326-342. [PMID: 34390791 PMCID: PMC8358086 DOI: 10.1016/j.jvs.2021.07.222] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/27/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE/BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with thrombotic complications such as deep vein thrombosis or stroke. Recently, numerous cases of acute limb ischemia (ALI) have been reported although pooled data are lacking. METHODS We systematically searched PubMed, Embase, Scopus, and the Cochrane Library for studies published online up to January 2021 that reported cases with SARS-CoV-2 infection and ALI. Eligible studies should have reported early outcomes including mortality. Primary endpoints included also pooled amputation, clinical improvement, and reoperation rates. RESULTS In total, 34 studies (19 case reports and 15 case series/cohort studies) including a total of 540 patients (199 patients were eligible for analysis) were evaluated. All studies were published in 2020. Mean age of patients was 61.6 years (range, 39-84 years; data from 32 studies) and 78.4% of patients were of male gender (data from 32 studies). There was a low incidence of comorbidities: arterial hypertension, 49% (29 studies); diabetes mellitus, 29.6% (29 studies); dyslipidemia, 20.5% (27 studies); chronic obstructive pulmonary disease, 8.5% (26 studies); coronary disease, 8.3% (26 studies); and chronic renal disease, 7.6% (28 studies). Medical treatment was selected as first-line treatment for 41.8% of cases. Pooled mortality rate among 34 studies reached 31.4% (95% confidence interval [CI], 25.4%%-37.7%). Pooled amputation rate among 34 studies reached 23.2% (95% CI, 17.3%-29.7%). Pooled clinical improvement rate among 28 studies reached 66.6% (95% CI, 55.4%%-76.9%). Pooled reoperation rate among 29 studies reached 10.5% (95% CI, 5.7%%-16.7%). Medical treatment was associated with a higher death risk compared with any intervention (odds ratio, 4.04; 95% CI, 1.075-15.197; P = .045) although amputation risk was not different between the two strategies (odds ratio, 0.977; 95% CI, 0.070-13.600; P = .986) (data from 31 studies). CONCLUSIONS SARS-CoV-2 infection is associated with a high risk for thrombotic complications, including ALI. COVID-associated ALI presents in patients with a low incidence of comorbidities, and it is associated with a high mortality and amputation risk. Conservative treatment seems to have a higher mortality risk compared with any intervention, although amputation risk is similar.
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Affiliation(s)
- George Galyfos
- Vascular Surgery Unit, First Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece.
| | - Argiri Sianou
- Department of Microbiology, National and Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
| | - Maximos Frountzas
- Vascular Surgery Unit, First Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - Kotsarinis Vasilios
- Vascular Surgery Unit, First Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - Dimitrios Vouros
- Vascular Surgery Unit, First Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - Charis Theodoropoulos
- Vascular Surgery Unit, First Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - Victoria Michalopoulou
- Vascular Surgery Unit, First Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - Frangiska Sigala
- Vascular Surgery Unit, First Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - Konstantinos Filis
- Vascular Surgery Unit, First Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
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Cenko E, Badimon L, Bugiardini R, Claeys MJ, De Luca G, de Wit C, Derumeaux G, Dorobantu M, Duncker DJ, Eringa EC, Gorog DA, Hassager C, Heinzel FR, Huber K, Manfrini O, Milicic D, Oikonomou E, Padro T, Trifunovic-Zamaklar D, Vasiljevic-Pokrajcic Z, Vavlukis M, Vilahur G, Tousoulis D. Cardiovascular disease and COVID-19: a consensus paper from the ESC Working Group on Coronary Pathophysiology & Microcirculation, ESC Working Group on Thrombosis and the Association for Acute CardioVascular Care (ACVC), in collaboration with the European Heart Rhythm Association (EHRA). Cardiovasc Res 2021; 117:2705-2729. [PMID: 34528075 PMCID: PMC8500019 DOI: 10.1093/cvr/cvab298] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/10/2021] [Indexed: 01/08/2023] Open
Abstract
The cardiovascular system is significantly affected in coronavirus disease-19 (COVID-19). Microvascular injury, endothelial dysfunction, and thrombosis resulting from viral infection or indirectly related to the intense systemic inflammatory and immune responses are characteristic features of severe COVID-19. Pre-existing cardiovascular disease and viral load are linked to myocardial injury and worse outcomes. The vascular response to cytokine production and the interaction between severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and angiotensin-converting enzyme 2 receptor may lead to a significant reduction in cardiac contractility and subsequent myocardial dysfunction. In addition, a considerable proportion of patients who have been infected with SARS-CoV-2 do not fully recover and continue to experience a large number of symptoms and post-acute complications in the absence of a detectable viral infection. This conditions often referred to as 'post-acute COVID-19' may have multiple causes. Viral reservoirs or lingering fragments of viral RNA or proteins contribute to the condition. Systemic inflammatory response to COVID-19 has the potential to increase myocardial fibrosis which in turn may impair cardiac remodelling. Here, we summarize the current knowledge of cardiovascular injury and post-acute sequelae of COVID-19. As the pandemic continues and new variants emerge, we can advance our knowledge of the underlying mechanisms only by integrating our understanding of the pathophysiology with the corresponding clinical findings. Identification of new biomarkers of cardiovascular complications, and development of effective treatments for COVID-19 infection are of crucial importance.
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Affiliation(s)
- Edina Cenko
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Giuseppe Massarenti 9, 40134 Bologna, Italy
| | - Lina Badimon
- Cardiovascular Program ICCC-Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CiberCV, Barcelona, Spain
| | - Raffaele Bugiardini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Giuseppe Massarenti 9, 40134 Bologna, Italy
| | - Marc J Claeys
- Department of Cardiology, University Hospital Antwerp, Edegem, Belgium
| | - Giuseppe De Luca
- Cardiovascular Department of Cardiology, Ospedale “Maggiore della Carità”, Eastern Piedmont University, Novara, Italy
| | - Cor de Wit
- Institut für Physiologie, Universität zu Lübeck, Lübeck, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Geneviève Derumeaux
- IMRB U955, UPEC, Créteil, France
- Department of Physiology, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France
- Fédération Hospitalo-Universitaire « SENEC », Créteil, France
| | - Maria Dorobantu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Dirk J Duncker
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Etto C Eringa
- Department of Physiology, Amsterdam Cardiovascular Science Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Department of Physiology, Maastricht University, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Diana A Gorog
- Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, UK
- Department of Postgraduate Medicine, University of Hertfordshire, Hatfield, UK
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Frank R Heinzel
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria
- Medical School, Sigmund Freud University, Vienna, Austria
| | - Olivia Manfrini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Giuseppe Massarenti 9, 40134 Bologna, Italy
| | - Davor Milicic
- Department of Cardiovascular Diseases, University Hospital Centre Zagreb, University of Zagreb, Zagreb, Croatia
| | - Evangelos Oikonomou
- Department of Cardiology, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Teresa Padro
- Cardiovascular Program ICCC-Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CiberCV, Barcelona, Spain
| | - Danijela Trifunovic-Zamaklar
- Cardiology Department, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Marija Vavlukis
- University Clinic of Cardiology, Medical Faculty, Ss' Cyril and Methodius University in Skopje, Skopje, Republic of Macedonia
| | - Gemma Vilahur
- Cardiovascular Program ICCC-Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CiberCV, Barcelona, Spain
| | - Dimitris Tousoulis
- Department of Cardiology, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Imam M, Hammond GW. Splenic infarction secondary to COVID-19 complicated by Clostridium Paraputrificum infection. IDCases 2021; 27:e01357. [PMID: 34900587 PMCID: PMC8647475 DOI: 10.1016/j.idcr.2021.e01357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/01/2021] [Accepted: 12/05/2021] [Indexed: 11/24/2022] Open
Abstract
A 58-year-old woman with COVID-19 presented with an acute abdomen. Her spleen was found to be infarcted with a large fluid and gas collection. Treatment included broad-spectrum antibiotics and CT-guided drainage. Definitive treatment was splenectomy. We postulate that COVID-19 related splenic infarction created ideal conditions for Clostridium paraputrificum to cause a splenic abscess.
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Affiliation(s)
- Malaz Imam
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada.,Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gregory William Hammond
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada.,Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Stretti L, Zippo D, Coats AJ, Anker MS, von Haehling S, Metra M, Tomasoni D. A year in heart failure: an update of recent findings. ESC Heart Fail 2021; 8:4370-4393. [PMID: 34918477 PMCID: PMC9073717 DOI: 10.1002/ehf2.13760] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 11/28/2021] [Accepted: 12/01/2021] [Indexed: 12/22/2022] Open
Abstract
Major changes have occurred in these last years in heart failure (HF) management. Landmark trials and the 2021 European Society of Cardiology guidelines for the diagnosis and treatment of HF have established four classes of drugs for treatment of HF with reduced ejection fraction: angiotensin-converting enzyme inhibitors or an angiotensin receptor-neprilysin inhibitor, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose co-transporter 2 inhibitors, namely, dapagliflozin or empagliflozin. These drugs consistently showed benefits on mortality, HF hospitalizations, and quality of life. Correction of iron deficiency is indicated to improve symptoms and reduce HF hospitalizations. AFFIRM-AHF showed 26% reduction in total HF hospitalizations with ferric carboxymaltose vs. placebo in patients hospitalized for acute HF (P = 0.013). The guanylate cyclase activator vericiguat and the myosin activator omecamtiv mecarbil improved outcomes in randomized placebo-controlled trials, and vericiguat is now approved for clinical practice. Treatment of HF with preserved ejection fraction (HFpEF) was a major unmet clinical need until this year when the results of EMPEROR-Preserved (EMPagliflozin outcomE tRial in Patients With chrOnic HFpEF) were issued. Compared with placebo, empagliflozin reduced by 21% (hazard ratio, 0.79; 95% confidence interval, 0.69 to 0.90; P < 0.001), the primary outcome of cardiovascular death or HF hospitalization. Advances in the treatment of specific phenotypes of HF, including atrial fibrillation, valvular heart disease, cardiomyopathies, cardiac amyloidosis, and cancer-related HF, also occurred. Coronavirus disease 2019 (COVID-19) pandemic still plays a major role in HF epidemiology and management. All these aspects are highlighted in this review.
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Affiliation(s)
- Lorenzo Stretti
- Cardiology, Cardio‐Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Dauphine Zippo
- Cardiology, Cardio‐Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | | | - Markus S. Anker
- Department of Cardiology (CBF)Charité ‐ Universitätsmedizin BerlinBerlinGermany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT)BerlinGermany
- German Centre for Cardiovascular Research (DZHK), partner site BerlinBerlinGermany
| | - Stephan von Haehling
- Department of Cardiology and PneumologyUniversity of Göttingen Medical CenterGöttingenGermany
- German Center for Cardiovascular Research (DZHK), partner site GöttingenGöttingenGermany
| | - Marco Metra
- Cardiology, Cardio‐Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Daniela Tomasoni
- Cardiology, Cardio‐Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
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Ali Nasir S, Arif A, Shahid M, Ahmed Y, Riaz B, Sherwani NZF. Acute Limb Ischemia in a Patient With COVID-19 Pneumonia. Cureus 2021; 13:e18574. [PMID: 34760417 PMCID: PMC8571996 DOI: 10.7759/cureus.18574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 11/06/2022] Open
Abstract
COVID-19, which is caused by the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2), is known to cause a myriad of complications along with the typical lower respiratory tract involvement. One of the emerging complications is a hypercoagulable state leading to venous or arterial thromboembolism. These complications are more common in those presenting with a severe disease with significantly elevated inflammatory markers. Although co-morbid illnesses play a role in worsening such complications, yet they are not the main determinants as these complications also occur in those without any co-morbid illness. Here, we report a case of a 64-year-old male with severe COVID-19 pneumonia presenting with acute limb ischemia with a non-salvageable limb who required subsequent amputation of the affected limb.
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Affiliation(s)
| | - Anum Arif
- Vascular Surgery, Combined Military Hospital (CMH) Lahore Medical College, Lahore, PAK
| | - Mubasshar Shahid
- Internal Medicine, Combined Military Hospital (CMH) Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Yashfeen Ahmed
- Internal Medicine, Combined Military Hospital, Lahore, PAK
| | - Bismah Riaz
- Internal Medicine, Combined Military Hospital (CMH) Lahore Medical and Dental College, Lahore, PAK
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Jandial A, Gupta A, Malviya A, Agastam S, Kumar D. Coagulation abnormalities & thromboprophylaxis in COVID-19. Indian J Med Res 2021; 153:606-618. [PMID: 34643567 PMCID: PMC8555598 DOI: 10.4103/ijmr.ijmr_3841_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The ongoing pandemic of novel coronavirus 2019 is rapidly evolving, and newer organ- and system-specific manifestations are being observed. Thrombotic complications and coagulopathy are frequent manifestations of the disease, especially in sick patients, which appear to be unique and distinct from sepsis-induced coagulopathy, disseminated intravascular coagulation and other viral infection-induced coagulation abnormalities. Elevated D-dimers and fibrinogen in the early stage of the disease with minimally deranged prothrombin time and platelet counts are prominent and distinguishing features. Venous and arterial thromboses, as opposed to bleeding events, are the major clinical correlates. There is much to be known about the pathogenesis of COVID-associated coagulopathy; however, the mechanisms overlap with thrombotic microangiopathy, haemophagocytic syndrome and antiphospholipid syndrome compounded by the diffuse endothelial damage. The recommendations regarding the treatment are still evolving, but antithrombotic therapy has a definite role in positive outcomes of sick patients.
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Affiliation(s)
- Aditya Jandial
- Department of Hematology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Anunay Gupta
- Department of Cardiology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Amit Malviya
- Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences, Shillong, Meghalaya, India
| | - Sourabh Agastam
- Department of Cardiology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Dilip Kumar
- Department of Cardiology, Cardiac Catheterization Laboratory, Medical Institute of Cardiovascular Sciences, Kolkata, West Bengal, India
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Pérez-Campos Mayoral L, Hernández-Huerta MT, Papy-García D, Barritault D, Zenteno E, Sánchez Navarro LM, Pérez-Campos Mayoral E, Matias Cervantes CA, Martínez Cruz M, Mayoral Andrade G, López Cervantes M, Vázquez Martínez G, López Sánchez C, Pina Canseco S, Martínez Cruz R, Pérez-Campos E. Immunothrombotic dysregulation in chagas disease and COVID-19: a comparative study of anticoagulation. Mol Cell Biochem 2021; 476:3815-3825. [PMID: 34110554 PMCID: PMC8190527 DOI: 10.1007/s11010-021-04204-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 06/03/2021] [Indexed: 12/27/2022]
Abstract
Chagas and COVID-19 are diseases caused by Trypanosoma cruzi and SARS-CoV-2, respectively. These diseases present very different etiological agents despite showing similarities such as susceptibility/risk factors, pathogen-associated molecular patterns (PAMPs), recognition of glycosaminoglycans, inflammation, vascular leakage hypercoagulability, microthrombosis, and endotheliopathy; all of which suggest, in part, treatments with similar principles. Here, both diseases are compared, focusing mainly on the characteristics related to dysregulated immunothrombosis. Given the in-depth investigation of molecules and mechanisms related to microthrombosis in COVID-19, it is necessary to reconsider a prompt treatment of Chagas disease with oral anticoagulants.
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Affiliation(s)
- Laura Pérez-Campos Mayoral
- Centro de Investigación Facultad de Medicina UNAM-UABJO, Facultad de Medicina y Cirugía, Universidad Autónoma Benito Juárez de Oaxaca, Oaxaca, 68020, México
| | | | | | | | - Edgar Zenteno
- Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, 04360, México
| | | | - Eduardo Pérez-Campos Mayoral
- Centro de Investigación Facultad de Medicina UNAM-UABJO, Facultad de Medicina y Cirugía, Universidad Autónoma Benito Juárez de Oaxaca, Oaxaca, 68020, México
| | | | | | - Gabriel Mayoral Andrade
- Centro de Investigación Facultad de Medicina UNAM-UABJO, Facultad de Medicina y Cirugía, Universidad Autónoma Benito Juárez de Oaxaca, Oaxaca, 68020, México
| | | | | | - Claudia López Sánchez
- Tecnológico Nacional de México / Instituto Tecnológico de Oaxaca, Oaxaca, 68030, México
| | - Socorro Pina Canseco
- Centro de Investigación Facultad de Medicina UNAM-UABJO, Facultad de Medicina y Cirugía, Universidad Autónoma Benito Juárez de Oaxaca, Oaxaca, 68020, México
| | - Ruth Martínez Cruz
- Centro de Investigación Facultad de Medicina UNAM-UABJO, Facultad de Medicina y Cirugía, Universidad Autónoma Benito Juárez de Oaxaca, Oaxaca, 68020, México
| | - Eduardo Pérez-Campos
- Tecnológico Nacional de México / Instituto Tecnológico de Oaxaca, Oaxaca, 68030, México.
- Laboratorio de Patología Clínica "Eduardo Pérez Ortega", Oaxaca, 68000, México.
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Matli K, Chamoun N, Fares A, Zibara V, Al-Osta S, Nasrallah R, Salameh P, Mokhbat J, Ghanem G. Combined anticoagulant and antiplatelet therapy is associated with an improved outcome in hospitalised patients with COVID-19: a propensity matched cohort study. Open Heart 2021; 8:e001785. [PMID: 34611018 PMCID: PMC8493601 DOI: 10.1136/openhrt-2021-001785] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/05/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND COVID-19 is a respiratory disease that results in a prothrombotic state manifesting as thrombotic, microthrombotic and thromboembolic events. As a result, several antithrombotic modalities have been implicated in the treatment of this disease. This study aimed to identify if therapeutic anticoagulation (TAC) or concurrent use of antiplatelet and anticoagulants was associated with an improved outcome in this patient population. METHODS A retrospective observational cohort study of adult patients admitted to a single university hospital for COVID-19 infection was performed. The primary outcome was a composite of in-hospital mortality, intensive care unit (ICU) admission or the need for mechanical ventilation. The secondary outcomes were each of the components of the primary outcome, in-hospital mortality, ICU admission, or the need for mechanical ventilation. RESULTS 242 patients were included in the study and divided into four subgroups: Therapeutic anticoagulation (TAC), prophylactic anticoagulation+antiplatelet (PACAP), TAC+antiplatelet (TACAP) and prophylactic anticoagulation (PAC) which was the reference for comparison. Multivariable Cox regression analysis and propensity matching were done and showed when compared with PAC, TACAP and TAC were associated with less in-hospital all-cause mortality with an adjusted HR (aHR) of 0.113 (95% CI 0.028 to 0.449) and 0.126 (95% CI 0.028 to 0.528), respectively. The number needed to treat in both subgroups was 11. Furthermore, PACAP was associated with a reduced risk of invasive mechanical ventilation with an aHR of 0.07 (95% CI 0.014 to 0.351). However, the was no statistically significant difference in the occurrence of major or minor bleeds, ICU admission or the composite outcome of in-hospital mortality, ICU admission or the need for mechanical ventilation. CONCLUSION The use of combined anticoagulant and antiplatelet agents or TAC alone in hospitalised patients with COVID-19 was associated with a better outcome in comparison to PAC alone without an increase in the risk of major and minor bleeds. Sufficiently powered randomised controlled trials are needed to further evaluate the safety and efficacy of combining antiplatelet and anticoagulants agents or using TAC in the management of patients with COVID-19 infection.
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Affiliation(s)
- Kamal Matli
- Cardiology, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
- Internal Medicine, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
| | - Nibal Chamoun
- Department of Pharmacy Practice, Lebanese American University School of Pharmacy, Byblos, Lebanon
| | - Aya Fares
- Internal Medicine, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
| | - Victor Zibara
- Lebanese American University School of Medicine, Byblos, Lebanon
| | - Soad Al-Osta
- Lebanese American University School of Medicine, Byblos, Lebanon
| | - Rabih Nasrallah
- Internal Medicine, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
| | - Pascale Salameh
- Lebanese University Faculty of Pharmacy, Hadath, Lebanon
- University of Nicosia Medical School, Nicosia, Cyprus
| | - Jacques Mokhbat
- Internal Medicine, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
- Lebanese American University School of Medicine, Byblos, Lebanon
| | - Georges Ghanem
- Cardiology, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
- Lebanese American University School of Medicine, Byblos, Lebanon
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Barrios-López JM, Rego-García I, Fernández Pérez MD. Reply. Neurologia 2021; 36:563-564. [PMID: 34332953 PMCID: PMC8316972 DOI: 10.1016/j.nrleng.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 04/06/2021] [Indexed: 01/10/2023] Open
Affiliation(s)
- J M Barrios-López
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, Spain.
| | - I Rego-García
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - M D Fernández Pérez
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, Spain
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Italia L, Tomasoni D, Bisegna S, Pancaldi E, Stretti L, Adamo M, Metra M. COVID-19 and Heart Failure: From Epidemiology During the Pandemic to Myocardial Injury, Myocarditis, and Heart Failure Sequelae. Front Cardiovasc Med 2021; 8:713560. [PMID: 34447795 PMCID: PMC8382715 DOI: 10.3389/fcvm.2021.713560] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 07/12/2021] [Indexed: 02/06/2023] Open
Abstract
A close and intriguing relationship has been suggested between heart failure (HF) and coronavirus disease 2019 (COVID-19). First, COVID-19 pandemic represented a global public health emergency in the last year and had a catastrophic impact on health systems worldwide. Several studies showed a reduction in HF hospitalizations, ranging from 30 to 66% in different countries and leading to a subsequent increase in HF mortality. Second, pre-existing HF is a risk factor for a more severe clinical course of COVID-19 and an independent predictor of in-hospital mortality. Third, patients hospitalized for COVID-19 may develop both an acute decompensation of chronic HF and de-novo HF as a consequence of myocardial injury and cardiovascular (CV) complications. Myocardial injury occurred in at least 10% of unselected COVID-19 cases and up to 41% in critically ill patients or in those with concomitant CV comorbidities. Few cases of COVID-19-related acute myocarditis, presenting with severe reduction in the left ventricular (LV) ejection fraction and peculiar histopathological findings, were described. However, recent data suggested that COVID-19 may be associated with both systolic and diastolic LV dysfunction, with LV diastolic impairment, pulmonary hypertension, and right ventricular dysfunction representing the most frequent findings in echocardiographic studies. An overview of available data and the potential mechanisms behind myocardial injury, possibly leading to HF, will be presented in this review. Beyond the acute phase, HF as a possible long-term consequence of cardiac involvement in COVID-19 patients has been supposed and need to be investigated yet.
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Affiliation(s)
- Leonardo Italia
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Daniela Tomasoni
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Stefano Bisegna
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Edoardo Pancaldi
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Lorenzo Stretti
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marianna Adamo
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marco Metra
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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Pirola L, Palermo A, Mulinacci G, Ratti L, Fichera M, Invernizzi P, Viganò C, Massironi S. Acute mesenteric ischemia and small bowel imaging findings in COVID-19: A comprehensive review of the literature. World J Gastrointest Surg 2021; 13:702-716. [PMID: 34354803 PMCID: PMC8316849 DOI: 10.4240/wjgs.v13.i7.702] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/12/2021] [Accepted: 07/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19), an infectious condition caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread worldwide since its first description in Wuhan in December 2019. Even though respiratory manifestations are the most prevalent and responsible for disease morbidity and mortality, extrapulmonary involvement has progressively gained relevance. In particular, gastrointestinal (GI) signs and symptoms, reported in up to two-thirds of patients with COVID-19, might represent the first and, in some cases, the only disease presentation. Their presence has been associated in some studies with an increased risk of a severe disease course. Proposed pathogenic mechanisms explaining GI tract involvement are either direct viral access to intestinal cells via angiotensin-converting enzyme 2 or indirect damage of the intestinal wall through mesenteric ischemia induced by the hypercoagulable state associated with COVID-19 infection. Although not typical of SARS-CoV-2 infection, several small bowel manifestations have been described in infected patients who underwent any form of abdominal imaging. The radiological findings were mainly reported in patients with abdominal symptoms, among which abdominal pain was the most common.
AIM To discuss small bowel radiological manifestations of SARS-CoV-2 infection in abdominal imaging studies.
METHODS Bibliographical searches were performed in PubMed, using the following keywords: “COVID-19” AND “imaging” AND “gastrointestinal” OR “abdominal” OR “small bowel”.
RESULTS Of 62 patients with described radiologic small bowel alterations, mesenteric ischemia was diagnosed in 31 cases (50%), small bowel wall thickening in 10 cases (16%), pneumatosis in nine cases (15%), intussusception in eight cases (13%), pneumoperitoneum in two cases (3%) and paralytic ileus in two cases (3%). We also reported mesenteric adipose tissue hypertrophy and lymph nodes enlargement in a young woman.
CONCLUSION So far it is difficult to establish whether these manifestations are the direct consequence of SARS-CoV-2 infection or collateral findings in infected patients, but their recognition would be pivotal to set a closer follow-up and to reduce missed diagnoses.
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Affiliation(s)
- Lorena Pirola
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Andrea Palermo
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Giacomo Mulinacci
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Laura Ratti
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Maria Fichera
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Pietro Invernizzi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Chiara Viganò
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Sara Massironi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
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Topcu AC, Ozturk-Altunyurt G, Akman D, Batirel A, Demirhan R. Acute Limb Ischemia in Hospitalized COVID-19 Patients. Ann Vasc Surg 2021; 74:88-94. [PMID: 33819591 PMCID: PMC8017914 DOI: 10.1016/j.avsg.2021.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/09/2021] [Accepted: 03/16/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND COVID-19 is a multisystemic disorder. Hematologic and cardiovascular involvement of COVID-19 causes thromboembolic events across multiple organs which mainly manifest as venous thromboembolism, and rarely, peripheral arterial thromboembolic events. In-situ thrombosis of a healthy, non-atherosclerotic native artery is rare, and COVID-19 has been reported to be a cause of this phenomenon. We aimed to report our institutional experience with COVID-19 patients who developed acute limb ischemia (ALI) during hospitalization or after discharge. METHODS This was a single-center cross-sectional study. Records of all patients ≥18 years of age admitted to a tertiary center with a confirmed diagnosis of COVID-19 infection between September 1 and December 31, 2020 were retrospectively examined. Data regarding patient demographics, co-morbidities and outcomes were collected. Patients were followed-up during index hospitalization and for 30 days postdischarge. Acute limb ischemia was diagnosed by means of duplex ultrasound and computed tomography angiography in the presence of a clinical suspicion. RESULTS A total of 681 consecutive patients (38.5% women) were hospitalized with a confirmed diagnosis of COVID-19 during the study period. Median age was 63 years (IQR, 52-74). In-hospital mortality occurred in 94 (13.8%) patients. Ninety (13.2%) patients required intensive care unit admission at some point of their hospital stay. Six (0.9%) patients (one woman) with a median age of 62 years experienced ALI (IQR, 59-64.3). All patients were receiving low molecular weight heparin when they developed ALI. The median of duration between COVID-19 diagnosis and ALI symptom onset was 13 days (IQR, 11.3-14). Three patients underwent emergent surgical thrombectomy combined with systemic anticoagulation, and 3 received systemic anticoagulation alone. Two patients with ALI did not survive to hospital discharge. Among survivors, 1 patient underwent bilateral major amputations, and another underwent a minor amputation within 1 month of hospital discharge. Symptoms of ALI completely resolved in 2 patients without sequelae. CONCLUSIONS COVID-19 is a multisystemic disorder with involvement of hematologic and cardiovascular systems. Despite widespread use of thromboprophylaxis, hospitalized patients with COVID-19 are at increased risk of ALI, and subsequent limb loss or even death.
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Affiliation(s)
- Ahmet Can Topcu
- Department of Cardiovascular Surgery, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey.
| | - Gozde Ozturk-Altunyurt
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Dilara Akman
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Ayse Batirel
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Recep Demirhan
- Department of Thoracic Surgery, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
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de Roquetaillade C, Bredin S, Lascarrou JB, Soumagne T, Cojocaru M, Chousterman BG, Leclerc M, Gouhier A, Piton G, Pène F, Stoclin A, Llitjos JF. Timing and causes of death in severe COVID-19 patients. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:224. [PMID: 34193220 PMCID: PMC8243043 DOI: 10.1186/s13054-021-03639-w] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/12/2021] [Indexed: 01/08/2023]
Abstract
Background Previous studies reporting the causes of death in patients with severe COVID-19 have provided conflicting results. The objective of this study was to describe the causes and timing of death in patients with severe COVID-19 admitted to the intensive care unit (ICU). Methods We performed a retrospective study in eight ICUs across seven French hospitals. All consecutive adult patients (aged ≥ 18 years) admitted to the ICU with PCR-confirmed SARS-CoV-2 infection and acute respiratory failure were included in the analysis. The causes and timing of ICU deaths were reported based on medical records. Results From March 1, 2020, to April 28, 287 patients were admitted to the ICU for SARS-CoV-2 related acute respiratory failure. Among them, 93 patients died in the ICU (32%). COVID-19-related multiple organ dysfunction syndrome (MODS) was the leading cause of death (37%). Secondary infection-related MODS accounted for 26% of ICU deaths, with a majority of ventilator-associated pneumonia. Refractory hypoxemia/pulmonary fibrosis was responsible for death in 19% of the cases. Fatal ischemic events (venous or arterial) occurred in 13% of the cases. The median time from ICU admission to death was 15 days (25th–75th IQR, 7–27 days). COVID-19-related MODS had a median time from ICU admission to death of 14 days (25th–75th IQR: 7–19 days), while only one death had occurred during the first 3 days since ICU admission. Conclusions In our multicenter observational study, COVID-19-related MODS and secondary infections were the two leading causes of death, among severe COVID-19 patients admitted to the ICU.
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Affiliation(s)
- Charles de Roquetaillade
- Department of Anesthesiology and Critical Care, Hôpital Lariboisière, FHU PROMICE, DMU Parabol, APHP. Nord, Paris, France.,Inserm U942 MASCOT, Paris, France
| | - Swann Bredin
- Intensive Care Unit, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris Centre, Paris, France
| | | | - Thibaud Soumagne
- Intensive Care Unit, Hôpital Jean Minjoz Hospital, Besançon, France
| | - Mariana Cojocaru
- Surgical Intensive Care Unit, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris Centre, Paris, France
| | - Benjamin Glenn Chousterman
- Department of Anesthesiology and Critical Care, Hôpital Lariboisière, FHU PROMICE, DMU Parabol, APHP. Nord, Paris, France.,Inserm U942 MASCOT, Paris, France
| | - Maxime Leclerc
- Intensive Care Unit, Centre Hospitalier Mémorial France Etats-Unis, Saint-Lô, France
| | - Albin Gouhier
- Intensive Care Unit, Centre Hospitalier Intercommunal Alençon Mamers, Alençon, France
| | - Gaël Piton
- Intensive Care Unit, Hôpital Jean Minjoz Hospital, Besançon, France
| | - Frédéric Pène
- Intensive Care Unit, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris Centre, Paris, France
| | - Annabelle Stoclin
- Intensive Care Unit, Gustave Roussy, Université Paris-Saclay, Villejuif, France
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Vaidya T, Nanivadekar A, Patel R. Imaging spectrum of abdominal manifestations of COVID-19. World J Radiol 2021; 13:157-170. [PMID: 34249237 PMCID: PMC8245751 DOI: 10.4329/wjr.v13.i6.157] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/11/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has posed a serious threat to global public health with its rapid spread, high fatality, and severe burden on health care providers all over the world. Although COVID-19 has been established as a respiratory tract infection, it can manifest with gastrointestinal symptoms as a consequence of direct infection by the virus or due to inflammation-mediated cytotoxicity. It has been observed that COVID-19 patients presenting with gastrointestinal symptoms tend to progress to a severe form of disease with increased morbidity and mortality, thus indicating the need for timely management. COVID-19 manifests with a wide spectrum of radiologic findings on gastrointestinal tract imaging, encompassing bowel abnormalities, hepato-biliary and pancreatic involvement, vascular occlusion, and solid organ infarction. Early recognition of these imaging features can facilitate timely treatment of COVID-19 associated gastrointestinal tract complications and may prompt the diagnosis of COVID-19 in patients with atypical disease manifestations. The aim of this article is to provide an overview of the various gastrointestinal imaging manifestations that can be encountered in patients with COVID-19, with an emphasis on early diagnosis of the disease as well as treatment related complications.
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Affiliation(s)
- Tanvi Vaidya
- Department of Radiology, Ruby Hall Clinic, Pune 411001, Maharashtra, India
| | | | - Rajan Patel
- Department of Radiology, Ruby Hall Clinic, Pune 411001, Maharashtra, India
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Kerawala AA, Das B, Solangi A. Mesenteric ischemia in COVID-19 patients: A review of current literature. World J Clin Cases 2021; 9:4700-4708. [PMID: 34222436 PMCID: PMC8223851 DOI: 10.12998/wjcc.v9.i18.4700] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/13/2021] [Accepted: 04/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) virus has affected all the systems of the body, defying all impressions of it being a respiratory virus only.
AIM To see the association of mesenteric ischemia with COVID-19.
METHODS After initial screening and filtering of the titles on PubMed and Google Scholar, 124 articles were selected. Articles were read in full, and the references were skimmed for relevance. Twenty-six articles (case reports and case series) were found to eligible for inclusion. References of these 26 articles were checked for any additional cases. Two more publications were found, and a total of 28 articles (22 case reports and 6 case series) have been included for review in this manuscript.
RESULTS A total of 41 cases of acute mesenteric ischemia in COVID-19 patients have been reported in the literature since the outbreak of this pandemic. Most of them include patients with comorbidities.
CONCLUSION In conclusion, based on this literature review and precise published knowledge regarding acute mesenteric ischemia in patients with COVID-19, it is essential to understand its relevance in all patients with gastrointestinal symptoms. The threshold for the diagnostic investigations should also be kept low for the timely diagnosis and management of this disorder.
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Affiliation(s)
- Asad Ali Kerawala
- Department of Surgery, Cancer Foundation Hospital, Karachi 75300, Pakistan
| | - Bhagwan Das
- Department of Medicine, Cancer Foundation Hospital, Karachi 75300, Pakistan
| | - Ahda Solangi
- New York Medical College, Valhalla, NY 10595, United States
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50
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Splenic infarction with aortic thrombosis in COVID-19. Am J Med Sci 2021; 362:418-423. [PMID: 34161825 PMCID: PMC8214812 DOI: 10.1016/j.amjms.2021.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 05/23/2021] [Accepted: 06/18/2021] [Indexed: 12/30/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has been associated with an increased risk of venous and arterial thrombotic disease. Although pulmonary embolism has been the most common thrombotic complication, there have been recent reports of COVID-19-associated large-vessel ischemic stroke, acute upper- and lower-limb ischemia, as well as infarctions of the abdominal viscera, including renal, splenic, and small bowel infarctions. Here, we describe a case of splenic infarction (SI) associated with aortic thrombosis, which evolved despite the prophylactic use of low-molecular-weight heparin (LMWH), in a 60-year-old female patient with COVID-19. The patient was treated clinically with a therapeutic dose of LMWH, followed by warfarin, and eventually presented a favorable outcome. We also present a review of the literature regarding SI in patients with COVID-19.
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