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1.
Rev Med Liege ; 75(S1): 94-100, 2020.
Artigo em Francês | MEDLINE | ID: mdl-33211429

RESUMO

Rising from the province of Wuhan in China, the new coronavirus SARS-CoV-2 broke out in winter 2019, causing a global pandemic. In most cases reported, COVID-19 symptoms include cough, dyspnea, myalgia and asthenia. In some cases, the disease can also cause severe respiratory distress syndrome, requiring intensive care. Recent studies suggest that SARS-CoV-2 infection predisposes to thromboembolic event such as pulmonary embolism. Moreover, there is an overlap between signs and symptoms of pulmonary embolism and COVID-19, which brings a challenge for the diagnosis and could potentially be fatal. Nevertheless, the incidence rate of pulmonary embolism in cases of COVID-19 is currently not known. In this paper we describe six cases of pulmonary embolism associated with COVID-19.


Assuntos
Infecções por Coronavirus , Pandemias , Pneumonia Viral , Embolia Pulmonar , Betacoronavirus , China , Humanos , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiologia
2.
Kardiologiia ; 60(7): 20-27, 2020 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-33155937

RESUMO

Aim      To study the right ventricular (RV) myocardial longitudinal systolic strain in patient with RV myocardial infarction (MI), and pulmonary embolism (PE) with and without McConnell' phenomenon.Material and methods  This study included 53 patients with PE (mean age, 59.0±15.1 years; men, 58.5 %) and 30 patients with RVMI (mean age, 61.8±10.9 years; men, 90 %). Longitudinal strain of basal, medial and apical segments of the RV free wall (RVFW) and the interventricular septum (IVS) was determined in the mode of two-dimensional speckle tracking. Ratio of the IVS apical strain to the RVFW strain (apical ratio) was calculated. Systolic excursion of the RVFW apical segment (apical excursion) was measured in the anatomical M-mode from the apical four-chamber view.Results The McConnell's sign was observed in 23 (43.4 %) of 53 patients with PE and in 16 (53.3 %) of 30 patients with RVMI (p>0.05). Irrespective of the cause for the RV damage, patients with the McConnell's sign had higher values of the apical ratio (1.69±0.50 vs. 0.95±0.22; p<0.001; cutoff point, 1.18) and apical excursion (7.9±1.7 vs. 2.6±1.4 mm; p<0.001; cutoff point, 5.0 mm). Apical excursion closely correlated with the value of apical ratio (r=0.65; p<0.001) but not with the RVFW apical segment strain (r= -0.07; p>0.05).Conclusion      Incidence of the McConnell's sign was similar in patients with PE and RVMI. McConnell's sign is based on a passive systolic shift of the RVFW apical segment, which develops during contraction of the IVS apical segment. The greater the ratio of IVS apical segment to RBFW global strain the greater the amplitude of this shift. With the ratio value of 1.18 or more, the systolic shift of RVFW apical segment was >5 mm, which was visually perceived as the McConnell's sign.


Assuntos
Infarto do Miocárdio , Embolia Pulmonar , Disfunção Ventricular Direita , Adulto , Idoso , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico , Sístole , Disfunção Ventricular Direita/diagnóstico por imagem , Disfunção Ventricular Direita/etiologia , Função Ventricular Direita
3.
Mol Med ; 26(1): 97, 2020 10 29.
Artigo em Inglês | MEDLINE | ID: mdl-33121429

RESUMO

BACKGROUND: COVID-19 is a viral respiratory disease caused by the severe acute respiratory syndrome-Coronavirus type 2 (SARS-CoV-2). Patients with this disease may be more prone to venous or arterial thrombosis because of the activation of many factors involved in it, including inflammation, platelet activation and endothelial dysfunction. Interferon gamma inducible protein-10 (IP-10), monocyte chemoattractant protein-1 (MCP-1) and macrophage inflammatory protein 1-alpha (MIP1α) are cytokines related to thrombosis. Therefore, this study focused on these three indicators in COVID-19, with the hope to find biomarkers that are associated with patients' outcome. METHODS: This is a retrospective single-center study involving 74 severe and critically ill COVID-19 patients recruited from the ICU department of the Tongji Hospital in Wuhan, China. The patients were divided into two groups: severe patients and critically ill patients. The serum IP-10, MCP-1 and MIP1α level in both groups was detected using the enzyme-linked immunosorbent assay (ELISA) kit. The clinical symptoms, laboratory test results, and the outcome of COVID-19 patients were retrospectively analyzed. RESULTS: The serum IP-10 and MCP-1 level in critically ill patients was significantly higher than that in severe patients (P < 0.001). However, no statistical difference in MIP1α between the two groups was found. The analysis of dynamic changes showed that these indicators remarkably increased in patients with poor prognosis. Since the selected patients were severe or critically ill, no significant difference was observed between survival and death. CONCLUSIONS: IP-10 and MCP-1 are biomarkers associated with the severity of COVID-19 disease and can be related to the risk of death in COVID-19 patients.


Assuntos
Quimiocina CCL2/sangue , Quimiocina CXCL10/sangue , Infecções por Coronavirus/complicações , Síndrome da Liberação de Citocina/complicações , Coagulação Intravascular Disseminada/complicações , Pneumonia Viral/complicações , Embolia Pulmonar/complicações , Insuficiência Respiratória/complicações , Proteínas Adaptadoras de Transdução de Sinal/sangue , Idoso , Betacoronavirus/patogenicidade , Biomarcadores/sangue , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Estado Terminal , Síndrome da Liberação de Citocina/diagnóstico , Síndrome da Liberação de Citocina/mortalidade , Síndrome da Liberação de Citocina/virologia , Coagulação Intravascular Disseminada/diagnóstico , Coagulação Intravascular Disseminada/mortalidade , Coagulação Intravascular Disseminada/virologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Prognóstico , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/mortalidade , Embolia Pulmonar/virologia , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/mortalidade , Insuficiência Respiratória/virologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Análise de Sobrevida
4.
J Med Case Rep ; 14(1): 188, 2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-33054805

RESUMO

BACKGROUND: Currently, there is minimal data available highlighting the prevalence of venous thromboembolism in patients infected with coronavirus disease 2019 (COVID-19). This case report with a literature review emphasizes a unique presentation of COVID-19 that is highly important for health care providers to consider when treating their patients. CASE REPORT: A 65-year-old Caucasian male patient presented to the emergency department with a 2-day history of dyspnea on exertion after his wife's recent diagnosis of COVID-19. He additionally had experienced a couple of episodes of self-resolving diarrhea a few days before presentation. Based on the patient's clinical presentation and the laboratory workup identifying an elevated D-dimer, a computed tomography angiogram of the chest was obtained, which was significant for moderately large, bilateral pulmonary emboli with a saddle embolus, and an associated small, left lower lobe, pulmonary infarct. Ultrasound of the lower extremity showed non-occlusive deep vein thrombosis at the distal left femoral vein to the left popliteal vein. The patient was additionally diagnosed with COVID-19 when the results of the COVID-19 polymerase chain reaction test returned as positive. The patient was admitted to the COVID unit, and he was started on an intravenously administered, unfractionated heparin drip for management of his bilateral pulmonary emboli and deep vein thrombosis. The patient's clinical condition improved significantly with anticoagulation, and he was observed in the hospital for 3 days, after which he was discharged home on the enoxaparin bridge with warfarin. Post-discharge telephone calls at day 10 and week 4 revealed that the patient was appropriately responding to anticoagulation treatment and had no recurrence of his symptoms related to venous thromboembolism and COVID-19. CONCLUSION: As COVID-19 continues to lead to significant mortality, more data is emerging that is exposing its perplexing pathogenicity. Meanwhile, the presentation of venous thromboembolism in patients with COVID-19 remains an unusual finding. It is imperative for health care providers to be mindful of this unique association to make necessary diagnostic evaluations and provide appropriate treatment for the patients.


Assuntos
Infecções por Coronavirus , Enoxaparina/administração & dosagem , Veia Femoral/diagnóstico por imagem , Heparina/administração & dosagem , Pandemias , Pneumonia Viral , Embolia Pulmonar , Tromboembolia Venosa , Varfarina/administração & dosagem , Idoso , Anticoagulantes/administração & dosagem , Betacoronavirus/isolamento & purificação , Angiografia por Tomografia Computadorizada/métodos , Infecções por Coronavirus/sangue , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Hospitalização , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiologia , Embolia Pulmonar/terapia , Resultado do Tratamento , Ultrassonografia/métodos , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/terapia
5.
Eur Rev Med Pharmacol Sci ; 24(17): 9154-9160, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32965007

RESUMO

OBJECTIVE: Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that was first reported in Wuhan, China, and has subsequently spread worldwide. An association between increased venous thromboembolism in patients with pneumonia-related to COVID-19 has not yet been well described. PATIENTS AND METHODS: We aimed to illustrate cases of pulmonary thromboembolism in patients with acute respiratory distress syndrome related to COVID-19 treated in our intensive care unit. The medical records of patients affected by COVID-19 with acute respiratory distress syndrome in our institute from 1/3/2020 to 31/3/2020 were retrospectively reviewed. RESULTS: Our center registered a high prevalence of thromboembolic events among 62 patients affected by acute respiratory distress syndrome related to COVID-19 despite a regular antithrombotic prophylaxis. Out of these, 32 patients were transferred to other hospitals, and 30 were treated in our center. Venous thromboembolism was registered in 12 (19.3%) cases. In particular, 11 diagnoses of pulmonary embolism and 1 diagnosis of deep vein thrombosis were formulated. We described a case series of venous thromboembolism in nine patients treated in our Intensive Care Unit (ICU). Main pulmonary arteries were always involved in these patients. None of them died. CONCLUSIONS: In conclusion, critically ill patients with ARDS related to COVID-19 may have an increased risk of VTE that could be a leading cause of mortality. These patients require a high index of clinical suspicion and an accurate diagnostic approach, in order to immediately start an appropriate anticoagulant treatment.


Assuntos
Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Síndrome do Desconforto Respiratório do Adulto/complicações , Tromboembolia Venosa/diagnóstico , Idoso , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Estado Terminal , Feminino , Humanos , Unidades de Terapia Intensiva , Itália , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/virologia , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/diagnóstico por imagem , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Tromboembolia Venosa/complicações , Trombose Venosa/complicações , Trombose Venosa/diagnóstico
6.
Emerg Med Clin North Am ; 38(4): 931-944, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981627

RESUMO

Emergency physicians must be prepared to rapidly diagnose and resuscitate patients with pulmonary embolism (PE). Certain aspects of PE resuscitation run counter to typical approaches. A specific understanding of the pathophysiology of PE is required to avoid cardiovascular collapse potentially associated with excessive intravenous fluids and positive pressure ventilation. Once PE is diagnosed, rapid risk stratification should be performed and treatment guided by patient risk class. Although anticoagulation remains the mainstay of PE treatment, emergency physicians also must understand the indications and contraindications for thrombolysis and should be aware of new therapies and models of care that may improve outcomes.


Assuntos
Embolia Pulmonar/terapia , Anticoagulantes/uso terapêutico , Biomarcadores/sangue , Angiografia por Tomografia Computadorizada , Estado Terminal , Ecocardiografia , Eletrocardiografia , Serviço Hospitalar de Emergência , Oxigenação por Membrana Extracorpórea , Hidratação , Humanos , Intubação Intratraqueal , Ácido Láctico/sangue , Trombólise Mecânica , Peptídeo Natriurético Encefálico/sangue , Óxido Nítrico/uso terapêutico , Oxigenoterapia , Fragmentos de Peptídeos/sangue , Sistemas Automatizados de Assistência Junto ao Leito , Respiração com Pressão Positiva , Embolia Pulmonar/classificação , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/fisiopatologia , Ressuscitação/métodos , Medição de Risco , Índice de Gravidade de Doença , Terapia Trombolítica , Troponina/sangue , Vasoconstritores/uso terapêutico
7.
Respir Med ; 172: 106135, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32947171

RESUMO

PURPOSE: Patients hospitalized for infection with SARS-CoV-2 typically present with pneumonia. The respiratory failure is frequently complicated by pulmonary embolism in segmental pulmonary arteries. The distribution of pulmonary embolism in regard to lung parenchymal opacifications has not been investigated yet. METHODS: All patients with COVID-19 treated at a medical intensive care unit between March 8th and April 15th, 2020 undergoing computed tomography pulmonary angiography (CTPA) were included. All CTPA were assessed by two radiologists independently in respect to parenchymal changes and pulmonary embolism on a lung segment basis. RESULTS: Out of 22 patients with severe COVID-19 treated within the observed time period, 16 (age 60.4 ± 10.2 years, 6 female SAPS2 score 49.2 ± 13.9) underwent CT. A total of 288 lung segment were analyzed. Thrombi were detectable in 9/16 (56.3%) patients, with 4.4 ± 2.9 segments occluded per patient and 40/288 (13.9%) segments affected in the whole cohort. Patients with thrombi had significantly worse segmental opacifications in CT (p < 0.05) and all thrombi were located in opacitated segments. There was no correlation between d-dimer level and number of occluded segmental arteries. CONCLUSIONS: Thrombi in segmental pulmonary arteries are common in COVID-19 and are located in opacitated lung segments. This might suggest local clot formation.


Assuntos
Angiografia por Tomografia Computadorizada , Infecções por Coronavirus , Pulmão/diagnóstico por imagem , Pandemias , Pneumonia Viral , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar , Síndrome do Desconforto Respiratório do Adulto , Trombose , Betacoronavirus/isolamento & purificação , Coagulação Sanguínea , Angiografia por Tomografia Computadorizada/métodos , Angiografia por Tomografia Computadorizada/estatística & dados numéricos , Infecções por Coronavirus/sangue , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Correlação de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/sangue , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/etiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiologia , Radiografia Torácica/métodos , Radiografia Torácica/estatística & dados numéricos , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Síndrome do Desconforto Respiratório do Adulto/virologia , Estudos Retrospectivos , Trombose/diagnóstico por imagem , Trombose/etiologia
8.
Rev Inst Med Trop Sao Paulo ; 62: e63, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32901760

RESUMO

In late 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged as the cause of a cluster of pneumonia cases in China, and the corresponding disease was designated as Coronavirus Disease 2019 (COVID-19), spreading quickly around the world resulting in a pandemic. COVID-19 is associated with a set of coagulation abnormalities that increase the risk of thromboembolic events, especially in patients with severe/critical disease. We describe a series of five cases of mild COVID-19, treated in an outpatient clinic, which, after an apparent clinical improvement, developed acute pulmonary embolism (APE) between the third and the fourth week after the onset of symptoms, when they are mostly related to acute illness disappearance. Thromboembolic events are also a potential complication of mild COVID-19 and can manifest later in the disease course. This finding raises discussion about the prevention of thromboembolic events in selected group of patients with mild COVID-19.


Assuntos
Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Embolia Pulmonar/virologia , Doença Aguda , Adulto , Betacoronavirus , Brasil , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Embolia Pulmonar/diagnóstico
9.
BMJ ; 370: m2177, 2020 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-32759284

RESUMO

Pulmonary embolism is a common and potentially fatal cardiovascular disorder that must be promptly diagnosed and treated. The diagnosis, risk assessment, and management of pulmonary embolism have evolved with a better understanding of efficient use of diagnostic and therapeutic options. The use of either clinical probability adjusted or age adjusted D-dimer interpretation has led to a reduction in diagnostic imaging to exclude pulmonary embolism. Direct oral anticoagulation therapies are safe, effective, and convenient treatments for most patients with acute venous thromboembolism, with a lower risk of bleeding than vitamin K antagonists. These oral therapeutic options have opened up opportunities for safe outpatient management of pulmonary embolism in selected patients. Recent clinical trials exploring the use of systemic thrombolysis in intermediate to high risk pulmonary embolism suggest that this therapy should be reserved for patients with evidence of hemodynamic compromise. The role of low dose systemic or catheter directed thrombolysis in other patient subgroups is uncertain. After a diagnosis of pulmonary embolism, all patients should be assessed for risk of recurrent venous thromboembolism to guide duration of anticoagulation. Patients with a venous thromboembolism associated with a strong, transient, provoking risk factor can safely discontinue anticoagulation after three months of treatment. Patients with an ongoing strong risk factor, such as cancer, or unprovoked events are at increased risk of recurrent events and should be considered for extended treatment. The use of a risk prediction score can help to identify patients with unprovoked venous thromboembolism who can benefit from extended duration therapy. Despite major advances in the management of pulmonary embolism, up to half of patients report chronic functional limitations. Such patients should be screened for chronic thromboembolic pulmonary hypertension, but only a small proportion will have this as the explanation of their symptoms. In the remaining patients, future studies are needed to understand the pathophysiology and explore interventions to improve quality of life.


Assuntos
Anticoagulantes/uso terapêutico , Neoplasias/complicações , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Administração Oral , Anticoagulantes/efeitos adversos , Angiografia por Tomografia Computadorizada , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Fibrinolíticos/uso terapêutico , Humanos , Imagem de Perfusão , Gravidez , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/etiologia , Recidiva , Medição de Risco , Fatores de Risco , Filtros de Veia Cava , Tromboembolia Venosa/tratamento farmacológico
12.
BMJ Case Rep ; 13(8)2020 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-32747597

RESUMO

We describe a patient with COVID-19 who developed simultaneous pulmonary, intracardiac and peripheral arterial thrombosis. A 58-year-old man, without major comorbidity, was admitted with a 14-day history of breathlessness. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection was confirmed by laboratory testing. Initial imaging revealed COVID-19 pneumonia but no pulmonary thromboembolism (PTE) on CT pulmonary angiography (CTPA). The patient subsequently developed respiratory failure and left foot ischaemia associated with a rising D-dimer. Repeat CTPA and lower limb CT angiography revealed simultaneous bilateral PTE, biventricular cardiac thrombi and bilateral lower limb arterial occlusions. This case highlights a broad range of vascular sequalae associated with COVID-19 and the fact that these can occur despite a combination of prophylactic and treatment dose anticoagulation.


Assuntos
Infecções por Coronavirus , Enoxaparina/administração & dosagem , Cardiopatias , Pandemias , Doença Arterial Periférica , Pneumonia Viral , Embolia Pulmonar , Trombose , Varfarina/administração & dosagem , Anticoagulantes/administração & dosagem , Betacoronavirus/isolamento & purificação , Betacoronavirus/patogenicidade , Deterioração Clínica , Angiografia por Tomografia Computadorizada/métodos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Cardiopatias/diagnóstico , Cardiopatias/etiologia , Cardiopatias/terapia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/etiologia , Doença Arterial Periférica/terapia , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/etiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiologia , Embolia Pulmonar/terapia , Trombose/diagnóstico , Trombose/etiologia , Trombose/terapia , Resultado do Tratamento
14.
Adv Biol Regul ; 77: 100735, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32773098

RESUMO

The novel Corona virus infection (Covid-19) first identified in China in December 2019 has rapidly progressed in pandemic leading to significant mortality and unprecedented challenge for healthcare systems. Although the clinical spectrum of Covid-19 is variable, acute respiratory failure and systemic coagulopathy are common in severe Covid-19 patients. Lung is an important target of the SARS-CoV-2 virus causing eventually acute respiratory distress syndrome associated to a thromboinflammatory state. The cytokinic storm, thromboinflammation and pulmonary tropism are the bedrock of tissue lesions responsible for acute respiratory failure and for prolonged infection that may lead to multiple organ failure and death. The thrombogenicity of this infectious disease is illustrated by the high frequency of thromboembolic events observed even in Covid-19 patients treated with anticoagulation. Increased D-Dimers, a biomarker reflecting activation of hemostasis and fibrinolysis, and low platelet count (thrombocytopenia) are associated with higher mortality in Covid-19 patients. In this review, we will summarize our current knowledge on the thromboembolic manifestations, the disturbed hemostatic parameters, and the thromboinflammatory conditions associated to Covid-19 and we will discuss the modalities of anticoagulant treatment or other potential antithrombotic options.


Assuntos
Anticoagulantes/uso terapêutico , Betacoronavirus/patogenicidade , Infecções por Coronavirus/complicações , Síndrome da Liberação de Citocina/complicações , Coagulação Intravascular Disseminada/complicações , Pneumonia Viral/complicações , Embolia Pulmonar/complicações , Insuficiência Respiratória/complicações , Doença Aguda , Biomarcadores/sangue , Plaquetas/efeitos dos fármacos , Plaquetas/patologia , Plaquetas/virologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/virologia , Síndrome da Liberação de Citocina/diagnóstico , Síndrome da Liberação de Citocina/tratamento farmacológico , Síndrome da Liberação de Citocina/virologia , Coagulação Intravascular Disseminada/diagnóstico , Coagulação Intravascular Disseminada/tratamento farmacológico , Coagulação Intravascular Disseminada/virologia , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Heparina/uso terapêutico , Interações Hospedeiro-Patógeno , Humanos , Pulmão/irrigação sanguínea , Pulmão/efeitos dos fármacos , Pulmão/patologia , Pulmão/virologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/virologia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/virologia , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/tratamento farmacológico , Insuficiência Respiratória/virologia , Análise de Sobrevida
15.
Adv Biol Regul ; 77: 100744, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32773104
16.
PLoS One ; 15(8): e0238216, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32841275

RESUMO

INTRODUCTION: Coronavirus disease 2019 (COVID-19) pneumonia is associated to systemic hyper-inflammation and abnormal coagulation profile. D-dimer elevation is particularly frequent, and values higher than 1µg/mL have been associated with disease severity and in-hospital mortality. Previous retrospective studies found a high pulmonary embolism (PE) prevalence, however, it should be highlighted that diagnoses were only completed when PE was clinically suspected. MATERIAL AND METHODS: Single-center prospective cohort study. Between April 6th and April 17th 2020, consecutive confirmed cases of COVID-19 pneumonia with D-dimer >1 µg/mL underwent computed tomography pulmonary angiography (CTPA) to investigate the presence and magnitude of PE. Demographic and laboratory data, comorbidities, CTPA scores, administered treatments, and, clinical outcomes were analysed and compared between patients with and without PE. RESULTS: Thirty consecutive patients (11 women) were included. PE was diagnosed in 15 patients (50%). In patients with PE, emboli were located mainly in segmental arteries (86%) and bilaterally (60%). Patients with PE were significantly older (median age 67.0 (IQR 63.0-73.0) vs. 57.0 (IQR 48.0-69.0) years, p = .048) and did not differ in sex or risk factors for thromboembolic disease from the non-PE group. D-dimer, platelet count, and, C reactive protein values were significantly higher among PE patients. D-dimer values correlated with the radiologic magnitude of PE (p<0.001). CONCLUSIONS: Patients with COVID-19 pneumonia and D-dimer values higher than 1 µg/mL presented a high prevalence of PE, regardless of clinical suspicion. We consider that these findings could contribute to improve the prognosis of patients with COVID-19 pneumonia, by initiating anticoagulant therapy when a PE is found.


Assuntos
Infecções por Coronavirus/complicações , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Pneumonia Viral/complicações , Embolia Pulmonar/virologia , Idoso , Betacoronavirus , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Prevalência , Estudos Prospectivos , Embolia Pulmonar/diagnóstico , Espanha
19.
Vascul Pharmacol ; 133-134: 106783, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32835836

RESUMO

BACKGROUND: Low-molecular-weight heparins (LMWHs) influence the fibrin network structure in in vitro models. There have been no reports on LMWH-induced modifications of fibrin clot characteristics and their determinants in acute pulmonary embolism (PE). AIM: We investigated how enoxaparin alters fibrin clot properties in acute PE patients. METHODS: Clots were generated from plasma of 46 acute PE patients, aged 47-77 years treated with enoxaparin 1 mg/kg bid. Fibrin clot permeability (Ks) and clot lysis time (CLT), along with coagulation and fibrinolysis proteins were determined. Plasma fibrin clot nanostructure was assessed using scanning electron microscopy (SEM). RESULTS: Both Ks and CLT were associated with anti-factor (F)Xa activity (r = 0.75, p < 0.0001 and r = -0.37, p = 0.011). Anti-FXa was positively associated with fibrin fiber diameter and the pore area, and inversely with fibrin fiber density on SEM images. Multiple regression analysis adjusted for age, body-mass index, and fibrinogen levels showed that anti-FXa activity, antithrombin activity, and FVIII activity determined Ks, while anti-FXa activity, plasminogen activator inhibitor-1 level, and presence of right ventricular dysfunction determined CLT. CONCLUSIONS: We identified new laboratory and clinical factors contributing to prothrombotic plasma fibrin clot characteristics during enoxaparin treatment, which might help elucidate mechanisms underlying therapy failure in patients with acute PE.


Assuntos
Coagulação Sanguínea/efeitos dos fármacos , Enoxaparina/uso terapêutico , Fibrina/metabolismo , Fibrinolíticos/uso terapêutico , Embolia Pulmonar/tratamento farmacológico , Adulto , Idoso , Feminino , Fibrina/ultraestrutura , Tempo de Lise do Coágulo de Fibrina , Humanos , Masculino , Pessoa de Meia-Idade , Permeabilidade , Porosidade , Embolia Pulmonar/sangue , Embolia Pulmonar/diagnóstico , Falha de Tratamento
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