Thrombotic Complication Of COVID-19 Research Articles

A platelet lipidomics signature in patients with COVID-19

Ischemic cardiovascular and venous thromboembolic events are a frequent cause of death in severe COVID-19 patients. Platelet activation plays a key role in these complications, however platelet lipidomics have not been studied yet. The aim of our pilot investigation was to perform a preliminary study of platelet lipidomics in COVID-19 patients compared to healthy subjects. Lipid extraction and identification of ultrapurified platelets from eight hospitalized COVID-19 patients and eight age- and sex-matched healthy controls showed a lipidomic pattern almost completely separating COVID-19 patients from healthy controls. In particular, a significant decrease of ether phospholipids and increased levels of ganglioside GM3 were observed in platelets from COVID-19 patients. In conclusion, our study shows for the first time that platelets from COVID-19 patients display a different lipidomics signature distinguishing them from healthy controls, and suggests that altered platelet lipid metabolism may play a role in viral spreading and in the thrombotic complications of COVID-19.

Concurrent Pansinusitis and Orbital Cellulitis Complicated by Extensive Head and Neck Venous Thrombosis in an Unvaccinated Adolescent Patient with COVID-19: A Case Report

BackgroundOrbital cellulitis is an infrequent but serious infectious complication of rhinosinusitis, most commonly seen in the pediatric population. Extension into the cavernous sinus, leading to further infection and thrombosis, is a rare but life-threatening complication. Although COVID-19 has been linked to an increased risk of venous thromboembolism, most cases involve extremity deep venous thrombosis or pulmonary embolism; reports of intracranial or jugular system thrombosis are rare. Case ReportWe describe a case of a 17-year-old female patient with no significant medical history or thrombotic risk factors found to have orbital cellulitis and severe pansinusitis, complicated by multiple venous thromboses in the head and neck requiring emergent surgical intervention and pediatric intensive care admission. Why Should an Emergency Physician Be Aware of This?Extensive head and neck venous thrombosis and intracranial abscesses are rare complications of pansinusitis and orbital cellulitis, and the thrombotic complications of COVID-19 are well documented. A delay in diagnosis and treatment can lead to potentially devastating consequences.

Thrombotic complications of COVID-19 and its relation with NADPH oxidase and tissue factor

Thrombotic complications of COVID-19 and its relation with NADPH oxidase and tissue factor

Arterial and Venous Thromboembolism in Critically Ill, COVID-19 Positive Patients Admitted to Intensive Care Unit

Arterial and Venous Thromboembolism in Critically Ill, COVID-19 Positive Patients Admitted to Intensive Care Unit

The Outcome of Catheter-Directed Thrombolysis in COVID-19-Associated Deep Vein Thrombosis.

IntroductionPublished evidence of venous thrombotic complications of COVID-19 is lacking from India. This case series consists of twenty-nine adult patients who were COVID -19 positive and treated for Deep Vein Thrombosis (DVT) during the second wave of the COVID-19 pandemic, in India. The study was aimed at analyzing patient demographics of patients with DVT and the outcome of Catheter-Directed Thrombolysis (CDT) in COVID positive patients. Material and Methods: Patients who developed DVT while or after being COVID positive were managed between February and April 2021 at the institution of the first two authors and were included in this retrospective study. Demographic, clinical data, laboratory data, and treatment given were analyzed. All patients were followed up for 3 months with a Villalta score. Results: There were a total of 29 patients (12 male and 17 female) included in the study with a mean age of 47 ± 17 years. The average time of presentation from being COVID positive was 17.8 ± 3.6 days and one patient developed DVT after becoming Covid negative. All but one patient had lower limb involvement, with 42.8% having proximal and 57.2% distal DVT. All patients with Iliofemoral and two with Femoropopliteal DVT were treated with catheter-di thrombolysis and the other 15 patients were managed with anticoagulation alone. No re-thrombosis was observed in the thrombolysis group. Overall average Villalta score at 3 months was 10.7 ± 2.1 with a score of 10.58 ± 2.1 in the anticoagulation-only group and 10.85 ± 2.3 in the CDT group. Conclusion: COVID-19 seems to be an additional risk factor in the development of DVT. The outcome of such patients, treated by thrombolysis appears to be similar to non-COVID patients. In this, observational experience of the authors suggests that CDT could be offered to COVID positive patients with symptomatic Iliofemoral DVT with good outcomes and an acceptable post-intervention Villalta score.

AORTOILIAC THROMBOSIS AND LYMPHOCYTOSIS IN A PATIENT WITH COVID-19

TOPIC: Critical Care TYPE: Fellow Case Reports INTRODUCTION: Venous thromboembolism (VTE) and arterial thrombosis (AT) are known complications associated with critically ill COVID-19 patients. We report a case of a patient that developed an acute aortoiliac thrombosis and acute limb ischemia despite high-dose VTE prophylaxis and was subsequently found to have chronic lymphocytic leukemia (CLL). CASE PRESENTATION: A 62-year-old male with coronary artery disease and diabetes was admitted to the intensive care unit for acute hypoxemic respiratory failure from COVID-19 pneumonia. He was treated with Remdesivir, dexamethasone 6mg daily, and enoxaparin 30mg twice daily. On hospital day 5, he developed acute left lower extremity pain with sensory and motor loss and bilateral lower extremities became cold and pale. He had no palpable femoral or popliteal pulses and posterior tibial and dorsalis pedis pulses were not detected by doppler. A CTA demonstrated an acute, nearly occlusive thrombus at the level of the distal infrarenal aorta with extension to bilateral iliac and femoral arteries. The patient was taken emergently to the operating room and underwent percutaneous thrombectomy and left lower extremity fasciotomy. On further review, he was noted to have significant lymphocytosis (83% on admission), an unexpected finding for a patient with COVID-19. As a result, peripheral flow cytometry was performed and demonstrated CD5 positive B-cell leukemia. The patient eventually discharged to acute rehab after a 42-day hospitalization. DISCUSSION: Since the start of the pandemic, the thrombotic complications of COVID-19 have been a major research focus given the high incidence and associated increased risk of mortality. Most of the research has centered around VTE as the incidence among ICU patients with COVID-19 is estimated at 20-30%. The rate of AT is much less with an overall incidence between 2-4% and only 0.4% associated with acute limb ischemia. Our patient was at higher risk for thrombotic complications given his underlying but undiagnosed CLL. His lymphocytosis was striking, particularly because lymphopenia is the usual finding in patients with COVID-19, and further work up revealed the CLL diagnosis. CONCLUSIONS: Thrombotic complications are common and carry a higher risk of mortality in patients with COVID-19. While the rate of AT is much less compared with VTE, critical care practitioners must remain vigilant, particularly when patients are receiving mechanical ventilation and unable to report symptoms, and be mindful of other conditions, potentially undiagnosed, that may further predispose to thrombosis. REFERENCE #1: Jimenez D, Garcia-Sanchez A, Rali P, Muriel A, Bikdeli B, Ruiz-Artacho P, Le Mao R, Rodriguez C, Hunt BJ, Monreal M. Incidence of VTE and Bleeding Among Hospitalized Patients With Coronavirus Disease 2019: A Systematic Review and Meta-analysis. Chest. 2021 Mar;159(3):1182-1196. REFERENCE #2: Malas MB, Naazie IN, Elsayed N, Mathlouthi A, Marmor R, Clary B. Thromboembolism risk of COVID-19 is high and associated with a higher risk of mortality: A systematic review and meta-analysis. EClinicalMedicine. 2020 Dec;29:100639. REFERENCE #3: Tan BK, Mainbourg S, Friggeri A, Bertoletti L, Douplat M, Dargaud Y, Grange C, Lobbes H, Provencher S, Lega JC. Arterial and venous thromboembolism in COVID-19: a study-level meta-analysis. Thorax. 2021 Feb 23:thoraxjnl-2020-215383. DISCLOSURES: No relevant relationships by Amanda Jobe, source=Web Response No relevant relationships by Mohamed Ramez Mourad, source=Web Response

Abstract P100: Hemorrhagic Stroke in the Setting of COVID-19 is Associated With Anticoagulation Use

Introduction: While the thrombotic complications of COVID-19 have been described, there are limited data on its implications in hemorrhagic stroke. The clinical characteristics, underlying stroke mechanism, and outcomes in this group of patients are especially salient as empiric therapeutic anticoagulation becomes increasingly common in the treatment and prevention of thrombotic complications of COVID-19. Methods: We conducted a retrospective cohort study of patients with hemorrhagic stroke (both non-traumatic intracerebral hemorrhage and spontaneous non-aneurysmal subarachnoid hemorrhage) who were hospitalized between 3/1/20-5/15/20 at a NYC hospital system, during the coronavirus pandemic. We compared the demographic and clinical characteristics of patients with hemorrhagic stroke and COVID-19 to those without COVID-19 admitted to our hospital between 3/1/20-5/15/20 (contemporary controls) and 3/1/19-5/15/19 (historical controls), using Fischer’s exact test and non-parametric testing. We adjusted for multiple comparisons using the Bonferroni method. Results: During the study period, 19 out of 4071 (0.5%) patients who were hospitalized with COVID-19 had hemorrhagic stroke on imaging. Of all COVID-19 with hemorrhagic stroke, only 3 had non-aneurysmal SAH without intraparenchymal hemorrhage. Among hemorrhagic stroke and COVID-19 patients, coagulopathy was the most common etiology (73.7%); empiric anticoagulation was started in 89.5% vs 4.2% of contemporary and 10.0% of historical controls (both with p =<0.001). Compared to contemporary and historical controls, COVID-19 patients had higher initial NIHSS scores, INR, PTT and fibrinogen levels. These patients also had higher rates of in-hospital mortality [84.6% vs. 4.6%, p =<0.001]. Sensitivity analyses excluding patients with strictly subarachnoid hemorrhage yielded similar results. Conclusion: We observed an overall low rate of imaging-confirmed hemorrhagic stroke among patients hospitalized with COVID-19. Most hemorrhages in COVID-19 patients occurred in the setting of therapeutic anticoagulation and were associated with increased mortality. Further studies are needed to evaluate the safety and efficacy of therapeutic anticoagulation in COVID-19 patients.

Could Low Doses Acetylsalicylic Acid Prevent Thrombotic Complications in COVID-19 Patients?

Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) can induce inflammatory and thrombotic complications of pulmonary district (interstitial pneumonia), sometimes evolving toward acute respiratory failure. In adults, Acetylsalicylic Acid (ASA) is widely employed at low doses for primary and secondary prevention of cardiovascular diseases (CVD). Apart their anti-thrombotic effect, low ASA doses also exert an anti-inflammatory action. So, when these are assumed for CVD prevention, could prevent both inflammatory reaction and pro-coagulant tendency of Coronavirus-2019 (COVID-19) infection. In addition, some patients receiving ASA are simultaneously treated with Statins, to correct dyslipidemia. But, for their pleiotropic effects, Statins can also be useful to antagonize pulmonary thrombo-inflammation induced by COVID-19. Thus ASA, with or without Statins, employed for CVD prevention, could be useful to avoid or minimize inflammatory reaction and thrombotic complications of COVID-19. But, further studies performed in a wide range are requested to validate this hypothesis.

Vitamin K epoxide reductase complex subunit 1 (VKORC1) gene polymorphism as determinant of differences in Covid-19-related disease severity

Covid-19, caused by SARS-CoV-2, has major world-wide health-related and socio-economic consequences. There are large disparities in the burden of Covid-19 with an apparent lower risk of poor outcomes in East Asians compared to populations in the West. A recent study suggested that Covid-19 leads to a severe extrahepatic vitamin K insufficiency, which could lead to impaired activation of extrahepatic proteins like endothelial anticoagulant protein S in the presence of normal hepatic procoagulant activity. This would be compatible with the enhanced thrombogenicity in severe Covid-19. The same study showed that vitamin K antagonists (VKA) that inhibit vitamin K recycling, had a greater impact on procoagulant activity than on the activation of extrahepatic vitamin K-dependent proteins during SARS-CoV-2 infections. A genetic polymorphism in the vitamin K epoxide reductase complex 1, VKORC1 −1639A, is particularly prevalent in East Asia and associates with low vitamin K recycling rates. Carriage of the allele may be regarded as bioequivalent to low-dose VKA use. We speculate that VKORC1 −1639A confers protection against thrombotic complications of Covid-19 and that differences in its allele frequency are partially responsible for the differences in Covid-19 severity between East and West.

How Does the Novel Coronavirus Kill? A Machine Learning Approach

Background: Identifying patient characteristics associated with poor outcomes is vital to minimizing death due to COVID-19. Identification of features that predict mortality may improve triage and management of COVID-19 patients. Methods: A machine learning algorithm was applied to retrospective patient data to identify features correlated with mortality. Four populations were analyzed: 221 COVID-19 patients admitted to general isolated wards or ICU in Wuhan, China between January and February 2020; 230 COVID-19 inpatients admitted across four U.S. hospitals between January and April 2020; 99,224 inpatients admitted to a U.S. hospital; and 8,492 inpatients admitted to a U.S. hospital with viral infections other than SARS-CoV-2. Findings: Features associated with predicted mortality varied across populations. Among Chinese COVID-19 patients, creatinine was the top predictor of mortality, but was not among the most important features for the U.S. COVID-19 patients. Blood pressure was a more important predictor for U.S COVID-19 patients than for the U.S. viral or general hospitalized populations. Interpretation: The SARS-CoV-2 virus may affect different patient populations in different ways. This may be due to differences in treatment practice across populations, or to evolution of SARS-Cov-2 itself over time. The finding that creatinine was an important predictor only in the Chinese COVID-19 population may indicate that kidney-related complications due to SARS-CoV-2 are becoming less severe. Blood pressure was found to be an important feature in the U.S. COVID-19 population, suggesting an increased importance of cardiac and thrombotic complications of COVID-19. Funding Statement: None. Declaration of Interests: All authors who have affiliations listed with Dascena (Oakland, California, USA) are employees or contractors of Dascena. Ethics Approval Statement: All patient data was maintained in compliance with the Health Insurance Portability and Accountability Act (HIPAA). This study has been determined by the Pearl Institutional Review Board to be Exempt according to FDA 21 CFR 56.104 and 45CFR46.104(b)(4): (4) Secondary Research Uses of Data or Specimens under study number 20-DASC-119.

A thrombotic complication of COVID-19: cerebral ischaemia in the intensive care unit.

COVID-19 may predispose to thromboembolic disease due to severe inflammation, hypoxia, and immobilisation [1]. The severe hypercoagulable state of COVID-19 patients includes systemic micro- and macrovascular thrombosis. Anticoagulant therapy, mainly with low-molecular-weight heparin, appears to be associated with better prognosis in severe COVID-19 patients [2].