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1.
Eur Rev Med Pharmacol Sci ; 24(24): 13044-13048, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33378056

RESUMO

As a severe and highly contagious infection, coronavirus disease (COVID-19) affects all aspects of society and has become a global public health problem. Because of the complexity of the pathology of COVID-19, it is difficult to treat. An increasing number of reports have indicated that COVID-19 may have neurological complications, including stroke. The nervous system complications of COVID-19 have gradually attracted research attention. In this review, we summarize the latest findings related to COVID 19, elaborate on the possible mechanism of COVID 19 related onset of stroke, and summarize current treatment options because an improved understanding and appropriate treatments may improve the prognosis of patients with COVID-19-related stroke.


Assuntos
/fisiopatologia , Cefaleia/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Distúrbios do Paladar/fisiopatologia , /metabolismo , Anticoagulantes/uso terapêutico , Transtornos da Coagulação Sanguínea/complicações , Transtornos da Coagulação Sanguínea/fisiopatologia , /imunologia , Transtornos da Consciência/fisiopatologia , Citocinas/imunologia , Endotélio Vascular/metabolismo , Endotélio Vascular/fisiopatologia , Humanos , Sistema Renina-Angiotensina , Meias de Compressão , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/imunologia , Acidente Vascular Cerebral/terapia , Terapia Trombolítica
2.
Rev Cardiovasc Med ; 21(3): 315-319, 2020 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-33070537

RESUMO

Great attention has been paid to endothelial dysfunction (ED) in coronavirus disease 2019 (COVID-19). There is growing evidence to suggest that the angiotensin converting enzyme 2 receptor (ACE2 receptor) is expressed on endothelial cells (ECs) in the lung, heart, kidney, and intestine, particularly in systemic vessels (small and large arteries, veins, venules, and capillaries). Upon viral infection of ECs by severe acute respiratory syndrome coronarvirus 2 (SARS-CoV-2), ECs become activated and dysfunctional. As a result of endothelial activation and ED, the levels of pro-inflammatory cytokines (interleukin -1, interleukin-6 (IL-6), and tumor necrosis factor-α), chemokines (monocyte chemoattractant protein-1), von Willebrand factor (vWF) antigen, vWF activity, and factor VIII are elevated. Higher levels of acute phase reactants (IL-6, C-reactive protein, and D-dimer) are also associated with SARS-CoV-2 infection. Therefore, it is reasonable to assume that ED contributes to COVID-19-associated vascular inflammation, particularly endotheliitis, in the lung, heart, and kidney, as well as COVID-19-associated coagulopathy, particularly pulmonary fibrinous microthrombi in the alveolar capillaries. Here we present an update on ED-relevant vasculopathy in COVID-19. Further research for ED in COVID-19 patients is warranted to understand therapeutic opportunities.


Assuntos
Betacoronavirus , Transtornos da Coagulação Sanguínea/etiologia , Infecções por Coronavirus/complicações , Endotélio Vascular/fisiopatologia , Pneumonia Viral/complicações , Doenças Vasculares/etiologia , Vasodilatação/fisiologia , Transtornos da Coagulação Sanguínea/fisiopatologia , Infecções por Coronavirus/epidemiologia , Humanos , Inflamação/etiologia , Inflamação/fisiopatologia , Pandemias , Pneumonia Viral/epidemiologia , Doenças Vasculares/fisiopatologia
3.
Medicine (Baltimore) ; 99(43): e22635, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120752

RESUMO

Coronavirus Disease 2019 (COVID-19) has became a major problem affecting global health security.To assess the differences and dynamic changes of blood coagulation function in COVID-19 patients with different severity.A total of 261 COVID-19 patients from January 24 to March 25, 2020 in Huangshi, Hubei Province were enrolled.We designed a retrospective observational study. Clinical information, including age, blood routine and blood coagulation function, were collected. According to the Diagnosis and Treatment Guidelines for COVID-19 (seventh version) that issued by the National Health Committee of the People's Republic of China, patients were divided into 3 subgroups: 186 ordinary, 45 severe and 30 critical ones. We compared the differences in blood coagulation factors among groups.Average age in critical group (71.47 ±â€Š11.48 years) was the oldest of 3 subgroups. At admission, statistically differences could be observed among ordinary, severe and critical patients in D-dimer (0.18 ±â€Š0.33, 0.63 ±â€Š1.13 and 1.16 ±â€Š1.58 mg/L), fibrinogen/fibrin degradation products (FDP) (3.11 ±â€Š5.30, 9.82 ±â€Š23.91 and 21.94 ±â€Š40.98 µg/ml), platelet [(169 ±â€Š62.85), (188 ±â€Š71.56) and (117 ±â€Š38.31) × 10/L)] and lymphocyte count [(1.18 ±â€Š0.46), (0.82 ±â€Š0.35) and (0.75 ±â€Š0.39) × 10/L)], respectively (P < .05). During hospitalization, the peak values of coagulation and valley values of blood routine were monitored. There were significant differences among ordinary, severe and critical patients in D-dimer (0.26 ±â€Š0.46, 1.39 ±â€Š1.51 and 2.89 ±â€Š1.68 mg/L), FDP (3.29 ±â€Š5.52, 23.68 ±â€Š39.07 and 56.11 ±â€Š49.94 µg/ml), platelet [(164 ±â€Š55.53), (171 ±â€Š69.96) and (84 ±â€Š57.80) × 10/L)] and lymphocyte count [(1.10 ±â€Š0.46), (0.65 ±â€Š0.35) and (0.55 ±â€Š0.31) × 10/L)], respectively (P < .001). D-dimer and FDP in the course of disease in severe/critical groups showed a first upward and then downward trend.We concluded that coagulation function indexes such as D-dimer and FDP could be served as markers to estimate COVID-19 patients condition. Close monitoring of coagulation function may be helpful for early diagnosis of severe patients and guidance of treatments.


Assuntos
Betacoronavirus , Transtornos da Coagulação Sanguínea/virologia , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos da Coagulação Sanguínea/diagnóstico , Transtornos da Coagulação Sanguínea/fisiopatologia , Testes de Coagulação Sanguínea , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Estudos Retrospectivos , Índice de Gravidade de Doença
4.
Clin Appl Thromb Hemost ; 26: 1076029620964868, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33030047

RESUMO

To discuss the coagulation dysfunction in COVID-19 patients and to find new biomarkers to separate severe COVID-19 patients from mild ones. We use a retrospective analysis of 88 COVID-19 patients, and compare the coagulation function between severe and mild groups. We found the prothrombin time (PT), thrombin time (TT), D-dimer were significantly higher in the severe group (P < 0.05), and the highest area under the curve (AUC) is 0.91 for D-dimer, while the AUC of PT and TT were 0.80 and 0.61 respectively. We identified that D-dimer has a better value in predicting patients who are likely to develop into severe cases, with the sensitivity and specificity were 84.4% and 88.8%, respectively. D-dimer may be a good biomarker to separate the severe COVID-19 patients from the mild ones.


Assuntos
Transtornos da Coagulação Sanguínea/etiologia , Testes de Coagulação Sanguínea/métodos , Infecções por Coronavirus/complicações , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Pneumonia Viral/complicações , Adulto , Idoso , Área Sob a Curva , Biomarcadores/sangue , Transtornos da Coagulação Sanguínea/sangue , Transtornos da Coagulação Sanguínea/fisiopatologia , China , Estudos de Coortes , Infecções por Coronavirus/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Valor Preditivo dos Testes , Tempo de Protrombina , Curva ROC , Estudos Retrospectivos , Índice de Gravidade de Doença , Tempo de Trombina
5.
Ups J Med Sci ; 125(4): 293-296, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32990149

RESUMO

BACKGROUND: The novel coronavirus disease 2019 (COVID-19) is currently breaking out worldwide. COVID-19 patients may have different degrees of coagulopathy, but the mechanism is not yet clear. We aimed to analyse the relationship between coagulation dysfunction and liver damage in patients with COVID-19. METHODS: A retrospective analysis of 74 patients with COVID-19 admitted to the First People's Hospital of Yueyang from 1 January to 30 March 2020 was carried out. According to the coagulation function, 27 cases entered the coagulopathy group and 47 cases entered the control group. A case control study was conducted to analyse the correlation between the occurrence of coagulation dysfunction and liver damage in COVID-19 patients. RESULTS: Alanine aminotransferase (ALT) and aspartate aminotransferase (AST), markers of liver damage, were positively correlated with coagulopathy (p = 0.039, OR 2.960, 95% CI 1.055-8.304; and p = 0.028, OR 3.352, 95% CI 1.137-9.187). Alkaline phosphatase (ALP), γ-glutamyl transpeptidase (γ-GT), and total bilirubin (TBIL) were not statistically correlated with coagulopathy. According to the diagnosis and treatment plan, the included cases were classified into mild, moderate, severe, and critical. The results showed that the occurrence of coagulation dysfunction had no statistical correlation with the severity of COVID-19. CONCLUSION: Coagulation dysfunction in patients with COVID-19 is closely related to liver damage. A longer course of the disease may cause a vicious circle of coagulopathy and liver damage. Clinicians need to closely monitor coagulation and liver function tests and to give prophylactic or supportive therapy when needed.


Assuntos
Betacoronavirus , Transtornos da Coagulação Sanguínea/etiologia , Infecções por Coronavirus/complicações , Hepatopatias/etiologia , Pneumonia Viral/complicações , Adulto , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Biomarcadores/sangue , Transtornos da Coagulação Sanguínea/fisiopatologia , Estudos de Casos e Controles , China , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Feminino , Humanos , Hepatopatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Estudos Retrospectivos , Fatores de Risco
6.
Rev. esp. cardiol. (Ed. impr.) ; 73(9): 749-757, sept. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-187648

RESUMO

La pandemia producida por la infección del nuevo coronavirus SARS-CoV-2, que da lugar a una enfermedad altamente contagiosa (COVID-19), ha producido un colapso de los sistemas sanitarios de todo el mundo. Se ha descrito que estos pacientes sufren un estado inflamatorio que condiciona un alto riesgo trombótico. Sin embargo, apenas hay información sobre cómo abordar el riesgo trombótico, la coagulopatía y el tratamiento anticoagulante de estos pacientes. Por otra parte, incluso los pacientes no infectados por COVID-19 sufren una tremenda influencia en su abordaje habitual por la situación sanitaria actual. El objetivo del presente documento, elaborado por el Grupo de Trabajo de Trombosis Cardiovascular de la Sociedad Española de Cardiología, es presentar la información disponible y dar unas pautas sencillas de tratamiento con fármacos antitrombóticos


The new coronavirus SARS-CoV-2, which gives rise to the highly contagious COVID-19 disease, has caused a pandemic that is overwhelming health care systems worldwide. Affected patients have been reported to have a heightened inflammatory state that increases their thrombotic risk. However, there is very scarce information on the management of thrombotic risk, coagulation disorders, and anticoagulant therapy. In addition, the situation has also greatly influenced usual care in patients not infected with COVID-19. This article by the Working Group on Cardiovascular Thrombosis of the Spanish Society of Cardiology aims to summarize the available information and to provide a practical approach to the management of antithrombotic therapy


Assuntos
Humanos , Fibrinolíticos/administração & dosagem , Infecções por Coronavirus/tratamento farmacológico , Vírus da SARS/patogenicidade , Trombose/tratamento farmacológico , Síndrome Respiratória Aguda Grave/tratamento farmacológico , Tromboembolia Venosa/tratamento farmacológico , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Inibidores da Agregação de Plaquetas/administração & dosagem , Trombose/prevenção & controle , Anticoagulantes/administração & dosagem , Heparina de Baixo Peso Molecular/administração & dosagem , Vitamina K/antagonistas & inibidores , Pandemias , Pneumonia Viral/tratamento farmacológico , Transtornos da Coagulação Sanguínea/fisiopatologia , Interações Medicamentosas
7.
Phys Ther ; 100(12): 2127-2133, 2020 12 07.
Artigo em Inglês | MEDLINE | ID: mdl-32914188

RESUMO

Physical therapists have a unique role in both prevention of venous thromboembolism (VTE) through the promotion of early mobility and physical activity and diagnosis through discovery of signs and symptoms of VTE. This Perspective updates clinicians on the latest information regarding pathophysiology of coagulopathy associated with COVID-19 and applies VTE clinical practice guidelines to COVID-19 in order to provide guidance on physical therapist management.


Assuntos
Transtornos da Coagulação Sanguínea/virologia , Fisioterapia , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/prevenção & controle , Algoritmos , Transtornos da Coagulação Sanguínea/fisiopatologia , /reabilitação , Humanos , Guias de Prática Clínica como Assunto , Medição de Risco , Fatores de Risco , Fatores de Tempo , Tromboembolia Venosa/reabilitação , Tromboembolia Venosa/virologia
8.
Semin Perinatol ; 44(7): 151284, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32792262

RESUMO

The 2019 novel coronavirus disease (COVID-19) pandemic poses unique challenges to the medical community as the optimal treatment has not been determined and is often at the discretion of institutional guidelines. Pregnancy has previously been described as a high-risk state in the context of infectious diseases, given a particular susceptibility to pathogens and adverse outcomes. Although ongoing studies have provided insight on the course of this disease in the adult population, the implications of COVID-19 on pregnancy remains an understudied area. The objective of this study is to review the literature and describe clinical presentations among pregnant women afflicted with COVID-19.


Assuntos
/fisiopatologia , Complicações Infecciosas na Gravidez/fisiopatologia , Lesão Renal Aguda/fisiopatologia , Infecções Assintomáticas , Transtornos da Coagulação Sanguínea/fisiopatologia , /metabolismo , Cardiomiopatias/fisiopatologia , Doenças do Sistema Nervoso Central/fisiopatologia , Progressão da Doença , Feminino , Síndrome HELLP/metabolismo , Humanos , Hipercapnia , Hipóxia/diagnóstico , Hipóxia/fisiopatologia , Hipóxia/terapia , Hepatopatias/metabolismo , Hepatopatias/fisiopatologia , Programas de Rastreamento , Mialgia/fisiopatologia , Miocardite/fisiopatologia , Oxigenoterapia , Pré-Eclâmpsia/metabolismo , Gravidez , Complicações Infecciosas na Gravidez/imunologia , Complicações Infecciosas na Gravidez/metabolismo , Complicações Infecciosas na Gravidez/terapia , Índice de Gravidade de Doença , Distúrbios do Paladar/fisiopatologia
9.
Am J Cardiovasc Drugs ; 20(5): 393-403, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32748336

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has brought many unique pathologies, such as coagulopathy, prompting a desperate need for effective management. COVID-19-associated coagulopathy (CAC) can cause various thromboembolic complications, especially in critically ill patients. The pathogenesis is likely due to endothelial injury, immobilization, and an increase in circulating prothrombotic factors. Data on treatment are limited, although prophylactic anticoagulation is advised in all hospitalized patients. Herein, we have comprehensively reviewed the current literature available on CAC and highlight the pathogenesis, clinical features, and management of CAC.


Assuntos
Transtornos da Coagulação Sanguínea , Quimioprevenção/métodos , Infecções por Coronavirus , Fármacos Hematológicos/farmacologia , Pandemias , Pneumonia Viral , Trombofilia , Betacoronavirus/fisiologia , Transtornos da Coagulação Sanguínea/etiologia , Transtornos da Coagulação Sanguínea/fisiopatologia , Transtornos da Coagulação Sanguínea/prevenção & controle , Infecções por Coronavirus/sangue , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Humanos , Pneumonia Viral/sangue , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Trombofilia/tratamento farmacológico , Trombofilia/virologia
10.
Clin Appl Thromb Hemost ; 26: 1076029620948137, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32795186

RESUMO

The SARS-CoV-2 virus caused a global pandemic within weeks, causing hundreds of thousands of people infected. Many patients with severe COVID-19 present with coagulation abnormalities, including increase D-dimers and fibrinogen. This coagulopathy is associated with an increased risk of death. Furthermore, a substantial proportion of patients with severe COVID-19 develop sometimes unrecognized, venous, and arterial thromboembolic complications. A better understanding of COVID-19 pathophysiology, in particular hemostatic disorders, will help to choose appropriate treatment strategies. A rigorous thrombotic risk assessment and the implementation of a suitable anticoagulation strategy are required. We review here the characteristics of COVID-19 coagulation laboratory findings in affected patients, the incidence of thromboembolic events and their specificities, and potential therapeutic interventions.


Assuntos
Anticoagulantes/administração & dosagem , Transtornos da Coagulação Sanguínea/epidemiologia , Infecções por Coronavirus/epidemiologia , Mortalidade Hospitalar , Pneumonia Viral/epidemiologia , Embolia Pulmonar/epidemiologia , Trombose Venosa/epidemiologia , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Transtornos da Coagulação Sanguínea/fisiopatologia , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Incidência , Masculino , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/fisiopatologia , Medição de Risco , Índice de Gravidade de Doença , Análise de Sobrevida , Trombose Venosa/tratamento farmacológico , Trombose Venosa/fisiopatologia
11.
Paediatr Respir Rev ; 35: 20-24, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32653469

RESUMO

Since the initial description in 2019, the novel coronavirus SARS-Cov-2 infection (COVID-19) pandemic has swept the globe. The most severe form of the disease presents with fever and shortness of breath, which rapidly deteriorates to respiratory failure and acute lung injury (ALI). COVID-19 also presents with a severe coagulopathy with a high rate of venous thromboembiolism. In addition, autopsy studies have revealed co-localized thrombosis and inflammation, which is the signature of thromboinflammation, within the pulmonary capillary vasculature. While the majority of published data is on adult patients, there are parallels to pediatric patients. In our experience as a COVID-19 epicenter, children and young adults do develop both the coagulopathy and the ALI of COVID-19. This review will discuss COVID-19 ALI from a hematological perspective with discussion of the distinct aspects of coagulation that are apparent in COVID-19. Current and potential interventions targeting the multiple thromboinflammatory mechanisms will be discussed.


Assuntos
Lesão Pulmonar Aguda/sangue , Infecções por Coronavirus/sangue , Inflamação/sangue , Pneumonia Viral/sangue , Trombose/sangue , Lesão Pulmonar Aguda/tratamento farmacológico , Lesão Pulmonar Aguda/imunologia , Lesão Pulmonar Aguda/fisiopatologia , Anticoagulantes/uso terapêutico , Antitrombinas/uso terapêutico , Betacoronavirus , Transtornos da Coagulação Sanguínea/sangue , Transtornos da Coagulação Sanguínea/imunologia , Transtornos da Coagulação Sanguínea/fisiopatologia , Capilares/imunologia , Capilares/fisiopatologia , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/fisiopatologia , Endotélio Vascular/imunologia , Endotélio Vascular/fisiopatologia , Inibidores do Fator Xa/uso terapêutico , Humanos , Inflamação/tratamento farmacológico , Inflamação/imunologia , Inflamação/fisiopatologia , Pandemias , Ativação Plaquetária , Inibidores da Agregação de Plaquetas/uso terapêutico , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/imunologia , Pneumonia Viral/fisiopatologia , Embolia Pulmonar/sangue , Embolia Pulmonar/imunologia , Embolia Pulmonar/fisiopatologia , Trombina/imunologia , Trombina/metabolismo , Trombose/tratamento farmacológico , Trombose/imunologia , Trombose/fisiopatologia
12.
Rheumatol Int ; 40(10): 1539-1554, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32666137

RESUMO

The coronavirus disease-2019 (COVID-19) pandemic is likely to pose new challenges to the rheumatology community in the near and distant future. Some of the challenges, like the severity of COVID-19 among patients on immunosuppressive agents, are predictable and are being evaluated with great care and effort across the globe. A few others, such as atypical manifestations of COVID-19 mimicking rheumatic musculoskeletal diseases (RMDs) are being reported. Like in many other viral infections, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection can potentially lead to an array of rheumatological and autoimmune manifestations by molecular mimicry (cross-reacting epitope between the virus and the host), bystander killing (virus-specific CD8 + T cells migrating to the target tissues and exerting cytotoxicity), epitope spreading, viral persistence (polyclonal activation due to the constant presence of viral antigens driving immune-mediated injury) and formation of neutrophil extracellular traps. In addition, the myriad of antiviral drugs presently being tried in the treatment of COVID-19 can result in several rheumatic musculoskeletal adverse effects. In this review, we have addressed the possible spectrum and mechanisms of various autoimmune and rheumatic musculoskeletal manifestations that can be precipitated by COVID-19 infection, its therapy, and the preventive strategies to contain the infection.


Assuntos
Doenças Autoimunes/fisiopatologia , Infecções por Coronavirus/fisiopatologia , Doenças Musculoesqueléticas/fisiopatologia , Pneumonia Viral/fisiopatologia , Doenças Reumáticas/fisiopatologia , Anticorpos Antinucleares/imunologia , Anticorpos Antifosfolipídeos/imunologia , Antivirais/efeitos adversos , Artralgia/etiologia , Artralgia/imunologia , Artralgia/fisiopatologia , Doenças Autoimunes/etiologia , Doenças Autoimunes/imunologia , Betacoronavirus , Transtornos da Coagulação Sanguínea/etiologia , Transtornos da Coagulação Sanguínea/imunologia , Transtornos da Coagulação Sanguínea/fisiopatologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/imunologia , Reações Cruzadas/imunologia , Armadilhas Extracelulares/imunologia , Produtos de Degradação da Fibrina e do Fibrinogênio , Síndrome de Guillain-Barré/etiologia , Síndrome de Guillain-Barré/imunologia , Síndrome de Guillain-Barré/fisiopatologia , Humanos , Inibidor de Coagulação do Lúpus/imunologia , Mimetismo Molecular , Síndrome de Linfonodos Mucocutâneos/etiologia , Síndrome de Linfonodos Mucocutâneos/imunologia , Síndrome de Linfonodos Mucocutâneos/fisiopatologia , Debilidade Muscular/etiologia , Debilidade Muscular/imunologia , Debilidade Muscular/fisiopatologia , Doenças Musculoesqueléticas/etiologia , Doenças Musculoesqueléticas/imunologia , Mialgia/etiologia , Mialgia/imunologia , Mialgia/fisiopatologia , Miocardite/etiologia , Miocardite/imunologia , Miocardite/fisiopatologia , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/imunologia , Doenças Reumáticas/etiologia , Doenças Reumáticas/imunologia
14.
G Ital Cardiol (Rome) ; 21(7): 483-488, 2020 Jul.
Artigo em Italiano | MEDLINE | ID: mdl-32555563

RESUMO

On March 11, 2020, just after 2 months from the first cases of coronavirus disease 2019 (COVID-19) in China, the Director-General of the World Health Organization stated that COVID-19 has to be considered as a pandemic. Italian doctors were the first protagonists, after the Chinese ones, in the management of this disease. Clinical observations showed that, in addition to the respiratory infection, a systemic inflammatory response occurs, which leads to coagulation disorders and consequent venous thromboembolism as well as other thrombotic complications. We here review the available literature on this issue to better understand the pathophysiological mechanisms of coagulopathy useful to draw future clinical and therapeutic conclusions.


Assuntos
Transtornos da Coagulação Sanguínea/epidemiologia , Infecções por Coronavirus/epidemiologia , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Tromboembolia Venosa/epidemiologia , Viremia/epidemiologia , Anticoagulantes/uso terapêutico , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Transtornos da Coagulação Sanguínea/fisiopatologia , Causas de Morte , Comorbidade , Infecções por Coronavirus/diagnóstico , Feminino , Humanos , Incidência , Itália , Masculino , Pneumonia Viral/diagnóstico , Medição de Risco , Análise de Sobrevida , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/tratamento farmacológico , Viremia/diagnóstico , Organização Mundial da Saúde
16.
Gen Thorac Cardiovasc Surg ; 68(8): 754-761, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32507998

RESUMO

OBJECTIVES: Hypothermic circulatory arrest (HCA) has been considered to cause coagulopathy during cardiac surgery. However, coagulopathy associated with HCA has not been understood clearly in details. The objective of this study is to analyze the details of coagulopathy related to HCA in cardiac surgery by using rotational thromboelastometry (ROTEM). METHODS: We retrospectively analyzed 38 patients who underwent elective cardiac surgery (HCA group = 12, non-HCA group = 26) in our hospital. Blood samples were collected before and after cardiopulmonary bypass (CPB). Standard laboratory tests (SLTs) and ROTEM were performed. We performed four ROTEM assays (EXTEM, INTEM, HEPTEM and FIBTEM) and analyzed the following ROTEM parameters: clotting time (CT), clot formation time (CFT), maximum clot firmness (MCF) and maximum clot elasticity (MCE). The amount of perioperative bleeding, intraoperative transfusion and perioperative data were compared between the HCA and non-HCA group. RESULTS: Operation time and hemostatic time were significantly longer in the HCA group, whereas CPB time had no difference between the groups. The amount of perioperative bleeding and intraoperative transfusion were much higher in the HCA group. SLTs showed no difference between the groups both after anesthesia induction and after protamine reversal. In ROTEM analysis, MCE contributed by platelet was reduced in the HCA group, whereas MCE contributed by fibrinogen had no difference. CONCLUSION: Our study confirmed that the amount of perioperative bleeding and intraoperative transfusion were significantly higher in the HCA group. ROTEM analysis would indicate that clot firmness contributed by platelet component is reduced by HCA in cardiac surgery.


Assuntos
Transtornos da Coagulação Sanguínea/fisiopatologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Ponte Cardiopulmonar/efeitos adversos , Idoso , Transtornos da Coagulação Sanguínea/sangue , Transtornos da Coagulação Sanguínea/etiologia , Feminino , Humanos , Hipotermia Induzida , Complicações Intraoperatórias/sangue , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/fisiopatologia , Masculino , Estudos Retrospectivos , Tromboelastografia
17.
J Hand Surg Am ; 45(6): 518-522, 2020 06.
Artigo em Inglês | MEDLINE | ID: covidwho-228547

RESUMO

As coronavirus 2019 (COVID-19) continues to cause an immense burden on the global health care systems, it is crucial to understand the breadth of this disease process. Recent reports identified hypercoagulability in a subset of critically ill patients and extremity ischemia in an even smaller cohort. Because abnormal coagulation parameters and extremity ischemia have been shown to correlate with poor disease prognosis, understanding how to treat these patients is crucial. To better describe the identification and management of this phenomenon, we present 2 cases of critically ill patients with COVID-19 who developed fingertip ischemia while in the intensive care unit.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Dedos/irrigação sanguínea , Isquemia/tratamento farmacológico , Isquemia/etiologia , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Adulto , Idoso , Betacoronavirus , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Transtornos da Coagulação Sanguínea/etiologia , Transtornos da Coagulação Sanguínea/fisiopatologia , Terapia Combinada , Infecções por Coronavirus/terapia , Cuidados Críticos/métodos , Estado Terminal/terapia , Progressão da Doença , Evolução Fatal , Feminino , Seguimentos , Humanos , Unidades de Terapia Intensiva , Isquemia/fisiopatologia , Masculino , Pandemias , Alta do Paciente , Doenças Vasculares Periféricas/diagnóstico , Doenças Vasculares Periféricas/tratamento farmacológico , Doenças Vasculares Periféricas/etiologia , Pneumonia Viral/terapia , Medição de Risco , Amostragem
18.
Arterioscler Thromb Vasc Biol ; 40(6): 1441-1453, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32375545

RESUMO

Megakaryocyte-derived platelets and endothelial cells store their hemostatic cargo in α- and δ-granules and Weibel-Palade bodies, respectively. These storage granules belong to the lysosome-related organelles (LROs), a heterogeneous group of organelles that are rapidly released following agonist-induced triggering of intracellular signaling pathways. Following vascular injury, endothelial Weibel-Palade bodies release their content into the vascular lumen and promote the formation of long VWF (von Willebrand factor) strings that form an adhesive platform for platelets. Binding to VWF strings as well as exposed subendothelial collagen activates platelets resulting in the release of α- and δ-granules, which are crucial events in formation of a primary hemostatic plug. Biogenesis and secretion of these LROs are pivotal for the maintenance of proper hemostasis. Several bleeding disorders have been linked to abnormal generation of LROs in megakaryocytes and endothelial cells. Recent reviews have emphasized common pathways in the biogenesis and biological properties of LROs, focusing mainly on melanosomes. Despite many similarities, LROs in platelet and endothelial cells clearly possess distinct properties that allow them to provide a highly coordinated and synergistic contribution to primary hemostasis by sequentially releasing hemostatic cargo. In this brief review, we discuss in depth the known regulators of α- and δ-granules in megakaryocytes/platelets and Weibel-Palade bodies in endothelial cells, starting from transcription factors that have been associated with granule formation to protein complexes that promote granule maturation. In addition, we provide a detailed view on the interplay between platelet and endothelial LROs in controlling hemostasis as well as their dysfunction in LRO related bleeding disorders.


Assuntos
Plaquetas/ultraestrutura , Grânulos Citoplasmáticos/fisiologia , Células Endoteliais/ultraestrutura , Hemostasia/fisiologia , Lisossomos/fisiologia , Transtornos da Coagulação Sanguínea/genética , Transtornos da Coagulação Sanguínea/fisiopatologia , Colágeno/fisiologia , Grânulos Citoplasmáticos/ultraestrutura , Humanos , Lisossomos/ultraestrutura , Corpos de Weibel-Palade/fisiologia , Corpos de Weibel-Palade/ultraestrutura , Fator de von Willebrand/metabolismo
19.
J Hand Surg Am ; 45(6): 518-522, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32387155

RESUMO

As coronavirus 2019 (COVID-19) continues to cause an immense burden on the global health care systems, it is crucial to understand the breadth of this disease process. Recent reports identified hypercoagulability in a subset of critically ill patients and extremity ischemia in an even smaller cohort. Because abnormal coagulation parameters and extremity ischemia have been shown to correlate with poor disease prognosis, understanding how to treat these patients is crucial. To better describe the identification and management of this phenomenon, we present 2 cases of critically ill patients with COVID-19 who developed fingertip ischemia while in the intensive care unit.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Dedos/irrigação sanguínea , Isquemia/tratamento farmacológico , Isquemia/etiologia , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Adulto , Idoso , Betacoronavirus , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Transtornos da Coagulação Sanguínea/etiologia , Transtornos da Coagulação Sanguínea/fisiopatologia , Terapia Combinada , Infecções por Coronavirus/terapia , Cuidados Críticos/métodos , Estado Terminal/terapia , Progressão da Doença , Evolução Fatal , Feminino , Seguimentos , Humanos , Unidades de Terapia Intensiva , Isquemia/fisiopatologia , Masculino , Pandemias , Alta do Paciente , Doenças Vasculares Periféricas/diagnóstico , Doenças Vasculares Periféricas/tratamento farmacológico , Doenças Vasculares Periféricas/etiologia , Pneumonia Viral/terapia , Medição de Risco , Amostragem
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