Subject(s)
Communicable Diseases , Mpox (monkeypox) , Humans , Mpox (monkeypox)/diagnosis , HIV , Immunocompromised HostABSTRACT
BACKGROUND: Incidence of thrombotic events associated to Coronavirus disease-2019 (COVID-19) is difficult to assess and reported rates differ significantly. Optimal thromboprophylaxis is unclear. OBJECTIVES: We aimed to analyze the characteristics of patients with a confirmed thrombotic complication including inflammatory and hemostatic parameters, compare patients affected by arterial vs venous events and examine differences between survivors and non-survivors. We reviewed compliance with thromboprophylaxis and explored how the implementation of a severity-adjusted protocol could have influenced outcome. METHODS: Single-cohort retrospective study of COVID-19 patients admitted, from March 3 to May 3 2020, to the Infanta Leonor University Hospital in Madrid, epicenter of the Spanish outbreak. RESULTS: Among 1127 patients, 80 thrombotic events were diagnosed in 69 patients (6.1% of the entire cohort). Forty-three patients (62%) suffered venous thromboembolism, 18 (26%) arterial episodes and 6 (9%) concurrent venous and arterial thrombosis. Most patients (90%) with a confirmed thrombotic complication where under low-molecular-weight heparin treatment. Overt disseminated intravascular coagulation (DIC) was rare. Initial ISTH DIC score and pre-event CRP were significantly higher among non-survivors. In multivariate analysis, arterial localization was an independent predictor of mortality (OR = 18, 95% CI: 2.4-142, p < .05). CONCLUSIONS: Despite quasi-universal thromboprophylaxis, COVID-19 lead to a myriad of arterial and venous thrombotic events. Considering the subgroup of patients with thrombotic episodes, arterial events appeared earlier in the course of disease and conferred very poor prognosis, and an ISTH DIC score ≥ 3 at presentation was identified as a potential predictor of mortality. Severity-adjusted thromboprophylaxis seemed to decrease the number of events and could have influenced mortality. Randomized controlled trials are eagerly awaited.
Subject(s)
Anticoagulants/therapeutic use , COVID-19/complications , Heparin, Low-Molecular-Weight/therapeutic use , Thrombosis/drug therapy , Thrombosis/etiology , Aged , Aged, 80 and over , Disseminated Intravascular Coagulation/diagnosis , Disseminated Intravascular Coagulation/drug therapy , Disseminated Intravascular Coagulation/etiology , Female , Humans , Male , Middle Aged , Retrospective Studies , SARS-CoV-2/isolation & purification , Thrombophilia/diagnosis , Thrombophilia/drug therapy , Thrombophilia/etiology , Thrombosis/diagnosis , Venous Thromboembolism/diagnosis , Venous Thromboembolism/drug therapy , Venous Thromboembolism/etiologyABSTRACT
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Subject(s)
Humans , Male , Adult , Dermatitis, Atopic/complications , Kaposi Varicelliform Eruption/complications , Immunocompromised Host , Antiviral Agents/therapeutic useSubject(s)
Eczema/etiology , Herpes Simplex/diagnosis , Simplexvirus/physiology , Virus Activation , Acyclovir/therapeutic use , Adrenal Cortex Hormones/adverse effects , Adrenal Cortex Hormones/therapeutic use , Adult , Antiviral Agents/therapeutic use , Cyclosporine/adverse effects , Cyclosporine/therapeutic use , Dermatitis, Atopic/complications , Dermatitis, Atopic/drug therapy , Dermatitis, Atopic/immunology , Eczema/drug therapy , Eczema/immunology , Eczema/virology , Herpes Simplex/drug therapy , Herpes Simplex/immunology , Humans , Immunocompromised Host , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/therapeutic use , Male , PUVA Therapy/adverse effectsABSTRACT
Presentamos el caso de una mujer de 26 años con un nódulo eritematoso de consistencia firme, de 2 cm de diámetro, localizado en la cara externa de la pierna derecha, de tres meses de evolución. El estudio histológico e inmunohistoquímico fue compatible con el diagnóstico de fascitis nodular. Se realizó la extirpación quirúrgica de la lesión, estando la paciente asintomática en la actualidad (AU)