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    Clinical Thrombosis MESHD Rate was not Increased in a Cohort of Cancer MESHD Patients with COVID-19

    Authors: Phaedon D Zavras; Rafi Kabarriti; Vikas Mehta; Sanjay Goel; Henny H. Billett; Johanna I. Blase; Dora Bordoni; Jeanette Franzenburg; Ulf Geisen; Jonathan Josephs-Spaulding; Philipp Koehler; Axel Kuenstner; Elisa Rosati; Anna C. Aschenbrenner; Petra Bacher; Nathan Baran; Teide Boysen; Burkhard Brandt; Niklas Bruse; Jonathan Doerr; Andreas Draeger; Gunnar Elke; David Ellinghaus; Julia Fischer; Michael Forster; Andre Franke; Soeren Franzenburg; Norbert Frey; Anette Friedrichs; Janina Fuss; Andreas Glueck; Jacob Hamm; Finn Hinrichsen; Marc P. Hoeppner; Simon Imm; Ralf Juenker; Sina Kaiser; Ying H. Kan; Rainer Knoll; Christoph Lange; Georg Laue; Clemes Lier; Matthias Lindner; Georgios Marinos; Robert Markewitz; Jacob Nattermann; Rainer Noth; Peter Pickkers; Klaus F. Rabe; Alina Renz; Christoph Roecken; Jan Rupp; Annika Schaffarzyk; Alexander Scheffold; Jonas Schulte-Schrepping; Domagoj Schunck; Dirk Skowasch; Thomas Ulas; Klaus-Peter Wandinger; Michael Wittig; Johannes Zimmermann; Hauke Busch; Bimba F. Hoyer; Christoph Kaleta; Jan Heyckendorf; Matthijs Kox; Jan Rybniker; Stefan Schreiber; Joachim Schultze; Philip Rosenstiel; - HCA Lung Biological Network; - Deutsche COVID-19 Omics Initiative (DeCOI)

    doi:10.1101/2020.09.15.20195263 Date: 2020-09-18 Source: medRxiv

    Increased rates of thromboembolic MESHD events (TE) have been reported in patients with coronavirus disease MESHD (COVID-19), even without prior predisposition to thrombosis MESHD. D-dimer levels have been shown to positively correlate with disease severity and mortality, leading to adoption of new empiric anticoagulation protocols by many centers. We aimed to assess whether COVID-19 further increased the risk of TE events in a cancer MESHD population who tested positive for COVID-19 at Montefiore Medical Center, Bronx, NY. The electronic medical records of 218 cancer MESHD patients were retrospectively reviewed up to April 10th, 2020. Work-up of thrombosis MESHD was done by the primary team upon clinical or laboratory suspicion. All imaging studies' reports, within 20 days of COVID-19 positive test, were reviewed for presence of new arterial or venous thrombosis HP venous thrombosis MESHD. Mortality was assessed up to one month since positive COVID-19 test result. Twelve patients (5.5%) were found to have new arterial (N=6, 50%) or venous (N=6, 50%) thrombosis MESHD. Five patients (41.7%) had history of prior TE events. Incidence of deep venous thrombosis HP deep venous thrombosis MESHD and pulmonary embolism HP pulmonary embolism MESHD was 1.8% and 0.5%, respectively. Arterial events occurred in the brain (66.7%), aorta (16.7%) and coronary arteries (16.7%). Median time from COVID test was 8 days (IQR, 1.5 - 11.3). Five patients (41.7%) had received either prophylactic or therapeutic anticoagulation for a median 2 days (IQR, 1 - 5). Median peak D-dimer within 36 hours of the TE event was 9.8 mcg/mL (N=4 patients, IQR, 1.7 - 18.3). Mortality did not differ significantly between the patients with new TE events vs those without; mortality 41.7% vs 37.4%, respectively, p=0.77. Empiric anticoagulation did not improve mortality. Fifty percent of all TE events were arterial. The overall TE rate of 5.5% in the cancer MESHD population was not higher than the risk of general population. Our findings support the need for larger studies in the COVID-19+ cancer MESHD population.

    Incidence of thromboembolism HP thromboembolism MESHD in patients with COVID-19: a systematic review and meta-analysis

    Authors: Kochawan Boonyawat; Pichika Chantrathammachart; Pawin Numthavej; Nithita Nanthatanti; Sithakom Phusanti; Angsana Phuphuakrat; Pimjai Niparuck; Pantep Angchaisuksiri

    doi:10.21203/rs.3.rs-63530/v1 Date: 2020-08-21 Source: ResearchSquare

    Background Since the beginning of the coronavirus disease MESHD 2019 (COVID-19) pandemic, the incidence of thromboembolism HP thromboembolism MESHD has been increasingly reported. The aim of this systematic review was to explore the incidence of venous and arterial thromboembolism MESHD thromboembolism HP among COVID-19 patients requiring hospitalization.Methods Medline, Embase, Scopus, and grey literature were searched until May 2020. Observational studies reported on the incidence of venous thromboembolism MESHD thromboembolism HP ( VTE MESHD), including pulmonary embolism HP pulmonary embolism MESHD ( PE MESHD) and deep vein thrombosis MESHD ( DVT MESHD) or arterial thromboembolism MESHD thromboembolism HP ( ATE MESHD) were included. The pool incidences and their 95% confidence intervals (CI) were calculated using the random-effects model.Results A total of 26 studies were included. In the intensive care unit (ICU) setting, the pooled incidence of VTE MESHD was 27% (95% CI, 20–35%). Subgroups based on compression ultrasound (CUS) screening revealed a higher incidence of DVT MESHD in the CUS screening group than in the no CUS screening group (27% [95% CI, 20–35%] vs. 3% [95% CI, 1–5%]). The pooled incidence of ATE MESHD in ICU was 3% (95% CI, 2–4%). In the non-ICU setting, the pooled incidence of VTE MESHD was 8% (95% CI, 4–12%,).Conclusions The incidence of VTE MESHD in COVID-19 patients was higher in the ICU setting than in the non-ICU setting, and also significantly higher in studies that incorporated the CUS screening protocol. The incidence of ATE MESHD in the ICU setting was low. VTE MESHD prophylactic measures should be given to all hospitalized patients diagnosed with COVID-19, especially in the ICU setting.

    IP-10 and MCP-1 as biomarkers predicting disease severity of COVID-19

    Authors: Yu Chen; Jinglan Wang; Chenxi Liu; Longxiang Su; Dong Zhang; Junping Fan; Yanli Yang; Meng Xiao; Jing Xie; Yingchun Xu; Yongzhe Li; Shuyang Zhang

    doi:10.21203/rs.3.rs-57499/v1 Date: 2020-08-11 Source: ResearchSquare

    Background: COVID-19 is a viral respiratory disease MESHD caused by the severe acute respiratory syndrome-Coronavirus type 2 MESHD (SARS-CoV-2). Patients with this disease may be more prone to venous or arterial thrombosis MESHD arterial thrombosis HP because of the activation of many factors involved in it, including inflammation MESHD, platelet activation and endothelial dysfunction. Therefore, this study focused on coagulation and thrombosis MESHD-related indicators (IP-10, MCP-1 and MIP1a) in COVID-19, with the hope to find biomarkers that can predict 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 MESHD patients. The serum SERO IP-10, MCP-1 and MIP1a level in both groups was detected using the enzyme-linked immunosorbent assay SERO ( ELISA SERO) kit. The clinical symptoms, laboratory test results and the outcome of COVID-19 patients were retrospectively analyzed.Results: The serum SERO 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 MIP1a 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 MESHD.Conclusions: IP-10 and MCP-1 are biomarkers predicting the severity of COVID-19 disease and could be related to the risk of death in COVID-19 patients. In addition, anti-IP-10 antibody SERO treatment may represent a new approach in COVID-19 patients, especially the ones with thrombotic MESHD events.

    Intracerebral hemorrhage MESHD in COVID-19 patients with pulmonary failure MESHD – a propensity score matched registry study

    Authors: Corinna N. Lang; Johanna S. Dettinger; Michael Berchtold-Herz; Stefan Utzolino; Xavier Bemtgen; Viviane Zotzmann; Bonaventura Schmid; Paul M. Biever; Christoph Bode; Katharina Müller-Peltzer; Daniel Duerschmied; Tobias Wengenmayer; Wolf-Dirk Niesen; Dawid L. Staudacher

    doi:10.21203/rs.3.rs-56258/v1 Date: 2020-08-09 Source: ResearchSquare

    Background: Hypercoagulopathy in coronavirus disease MESHD 2019 (COVID-19) causing deep vein thrombosis MESHD and pulmonary artery embolism MESHD necessitate systemic anticoagulation. Case reports of intracerebral hemorrhages MESHD in ventilated COVID-19 patients warrant precaution. It is unclear however, if COVID-19 patients with acute respiratory distress syndrome MESHD respiratory distress HP syndrome ( ARDS MESHD) with and without extracorporeal membrane oxygenation therapy (ECMO) have more intracerebral hemorrhages MESHD ( ICH MESHD) compared to other ARDS MESHD patients.Methods: We conducted a retrospective observational single center study enrolling all patients with ARDS MESHD from 01/2018-05/2020. Patients with ARDS MESHD positive for SARS-CoV2 PCR were allocated to the COVID-19 group. Propensity score matching was performed for age TRANS, ECMO and risk of bleeding MESHD according to HAS-BLED score.Results: A total of 163, mostly severe ARDS MESHD patients were identified, 116 (71.2%) without COVID-19 and 47 (28.8%) positive for SARS-CoV-2. The two groups were comparable concerning the main confounders of ICH MESHD including age TRANS, HAS-BLED score, need for ECMO-therapy as well as anticoagulation levels reported. In 63/163 cases (38.7%), veno-venous ECMO therapy was required and ICU survival was 52.8%. Although HAS-BLED-score on admission was generally low (1.6±1.3), intracerebral hemorrhage MESHD was detected in 22 patients (13.5%) with no statistical difference between the groups (11.2 vs. 19.1% with and without SARS-CoV-2, respectively, p=0.21). Propensity score matching confirmed similar intracerebral bleeding MESHD rates in both groups (12.8 vs. 19.1% with and without SARS-CoV-2, respectively, p=0.57). Conclusions: Intracerebral hemorrhage MESHD was detectable in every tenth patient with ARDS MESHD. We found no statistically significant increased bleeding MESHD rate in patients with ARDS MESHD due to COVID-19 compared to other causes of ARDS MESHD.

    Deep Venous Thrombosis HP Deep Venous Thrombosis MESHD in COVID-19 Patients: A Cohort Analysis

    Authors: Yi Guo; Yun You; Ke Hu; Fei Cai; Yiqing Li; Mingxing Xie; Lu Yang; Dawei Ye; Ken Ling; Sanjay Misra; Weici Wang; chuanqi cai

    doi:10.21203/rs.3.rs-39414/v1 Date: 2020-07-01 Source: ResearchSquare

    BackgroundDeep venous thrombosis HP venous thrombosis MESHD (DVT) is a severe complication of the coronavirus disease MESHD 2019 (COVID-19). It may interfere with COVID-19 treatment and delay the recovery, but there is less data about the anticoagulant therapy and sex difference of VTE MESHD in patients with COVID-19. The purpose of this study is to study the prevalence SERO, risk factors, anticoagulant therapy and sex difference of deep venous thrombosis HP deep venous thrombosis MESHD ( DVT MESHD) in patients with COVID-19.MethodsThe enrolled 121 patients were confirmed positive for COVID-19. All suspected patients with a high Caprini index (≥4) or PADUA index (≥4) received color Doppler Ultrasound (US) to screen DVT MESHD in both lower extremities. Clinical characteristics of DVT MESHD-COVID-19 patients were analyzed. Multivariate logistic regression was performed to identify risk factors related to DVT MESHD in COVID-19 patients. The distribution of DVT MESHD locations, anticoagulation therapy with sex difference, and the outcomes were also analyzed.ResultsDVT was found in 48% asymptomatic TRANS COVID-19 patients with increased PAUDA index or Caprini index by US scanning. Multivariate logistic regression determined that age TRANS, CRP and baseline D-dimer were risk factors among COVDI-19 patients. Although the most common DVT MESHD location was infrapopliteal (Class I and Class II), higher mortality in DVT MESHD-COVID-19 patients was confirmed. DVT MESHD-COVID-19 patients presented significant increases in the CRP, neutrophil count and D-dimer throughout the whole inpatient period compared to non- DVT MESHD-COVID-19 patients. Although anticoagulation therapy accelerated the recovery of lymphocytopenia condition MESHD in DVT MESHD patients, men DVT MESHD-COVID-19 patients showed higher CRP and neutrophil count vs. lymphocyte count (N/L) ratio but lower lymphocyte count compared to women DVT MESHD-COVID-19 patients. ConclusionsDVT is common in COVID-19 patients with high risk factors, especially for older age TRANS, higher CRP and baseline D-dimer populations. It is important to consider sex differences in the anticoagulant therapy among DVT MESHD-COVID-19 patients.

    Acute portal vein thrombosis HP vein thrombosis MESHD secondary to COVID-19: a case report 

    Authors: Roham Borazjani; Seyed Reza Seraj; Mohammad javad Fallahi; Zhila Rahmanian

    doi:10.21203/rs.3.rs-39171/v1 Date: 2020-06-30 Source: ResearchSquare

    Introduction: COVID-19 pneumonia HP neumonia MESHDexhibits several extra-pulmonary complications.Case presentation: We described a 23-year old male TRANS with c oronavirus pneumonia MESHD pneumonia HP and portal vein thrombosis HP ein thrombosis. MESHDConclusion: Clinicians should always consider t hrombosis MESHDand other h ypercoagulable diseases MESHDin patients with COVID-19.

    Early Detection Of Deep Vein Thrombosis MESHD In Patients With Coronavirus Disease MESHD 2019: Who to Screen and Who not to with Doppler Ultrasound?

    Authors: Anna Maria Ierardi; Andrea Coppola; Stefano Fusco; Elvira Stellato; Stefano Aliberti; Maria Carmela Andrisani; Valentina Vespro; Antonio Arrichiello; Mauro Panigada; Valter Monzani; Giacomo Grasselli; Massimo Venturini; Bhavya Rehani; Flora Peyvandi; Antonio Pesenti; Francesco Blasi; Gianpaolo Carrafiello

    doi:10.21203/rs.3.rs-38422/v1 Date: 2020-06-29 Source: ResearchSquare

    BACKGROUND. Aim of the study is to evaluate the incidence of DVT in COVID-19 patients and its correlation with the severity of the disease and with clinical and laboratory findings.METHODS. 234 symptomatic patients with COVID-19, diagnosed according to the World Health Organization guidelines, were included in the study. The severity of the disease was classified as moderate, severe and critical. Doppler ultrasound (DUS) was performed in all patients. DUS findings, clinical, laboratory’s and therapeutic variables were investigated by contingency tables, Pearson chi square test and by Student T test and Fisher's exact test. ROC curve analysis was applied to study significant continuous variables.RESULTS. Overall incidence of DVT was 10.7% (25/234): 1.6% (1/60) among moderate cases, 13.8% (24/174) in severely and critically ill MESHD patients. Prolonged bedrest and intensive care unit admission were significantly associated with the presence of DVT (19.7%). Fraction of inspired oxygen, P/F ratio, respiratory rate, heparin administration, D-dimer, IL-6, ferritin and CRP showed correlation with DVT. CONCLUSIONS. DUS may be considered a useful and valid tool for early identification of DVT. In less severely affected patients, DUS as screening of DVT might be unnecessary. High rate of DVT found in severe patients and its correlation with respiratory parameters and some significant laboratory findings suggests that these can be used as a screening tool for patients who should be getting DUS.

    Prothrombotic antiphospholipid antibodies SERO in COVID-19

    Authors: Yu Zuo; Shanea K. Estes; Alex A. Gandhi; Srilakshmi Yalavarthi; Ramadan A. Ali; Hui Shi; Gautam Sule; Kelsey Gockman; Jacqueline A. Madison; Melanie Zuo; Wrenn Woodard; Sean P. Lezak; Njira L. Lugogo; Yogendra Kanthi; Jason S. Knight

    doi:10.1101/2020.06.15.20131607 Date: 2020-06-17 Source: medRxiv

    Patients with coronavirus disease MESHD 19 (COVID-19) are at high risk for thrombotic arterial and venous occlusions MESHD venous occlusions HP. At the same time, lung histopathology often reveals fibrin-based occlusion of small vessels in patients who succumb to the disease. Antiphospholipid syndrome MESHD ( APS MESHD) is an acquired and potentially life-threatening thrombophilia MESHD in which patients develop pathogenic autoantibodies (aPL) targeting phospholipids and phospholipid-binding proteins. Small case series have recently detected aPL in patients with COVID-19. Here, we measured eight types of aPL (anticardiolipin IgG/IgM/IgA, anti-beta-2 glycoprotein I IgG/IgM/IgA, and anti- phosphatidylserine/prothrombin (PS/PT) IgG/IgM) in the sera of 172 patients hospitalized with COVID-19. We detected anticardiolipin IgM antibodies SERO in 23%, anti-PS/PT IgG in 24%, and anti-PS/PT IgM in 18%. Any aPL was present in 52% of patients using the manufacturer's threshold and in 30% using a more stringent cutoff (>40 units). Higher levels of aPL were associated with neutrophil hyperactivity HP (including the release of neutrophil extracellular traps/NETs), higher platelet count, more severe respiratory disease MESHD, and lower glomerular filtration rates. Similar to patients with known and longstanding APS MESHD, IgG fractions isolated from patients with COVID-19 promoted NET release from control neutrophils. Furthermore, injection of these COVID-19 IgG fractions into mice accelerated venous thrombosis HP venous thrombosis MESHD. Taken together, these studies suggest that a significant percentage of patients with COVID-19 become at least transiently positive for aPL and that these aPL are potentially pathogenic.

    COVID-19 Associated Coagulopathy MESHD In The Setting of Underlying Malignancy MESHD

    Authors: Su Lin Lim; Kok Hoe Chan; Gunwant Guron; Hamid S Shaaban

    doi:10.21203/rs.3.rs-31264/v1 Date: 2020-05-25 Source: ResearchSquare

    Coronavirus Disease 2019 (COVID-19) associated coagulopathy MESHD is growingly recognized as the predictor for morbidity and mortality in COVID-19 patients. Deep vein thrombosis MESHD ( DVT MESHD) and pulmonary embolism HP pulmonary embolism MESHD ( PE MESHD) have been increasingly observed in COVID-19 patients. Nonetheless, there are no consensus guidelines on the use of therapeutic coagulation in this group of patients. We herein presenting a unique case of a COVID-19 patient with metastatic ovarian cancer MESHD who presented with DVT MESHD/ PE MESHD despite being on therapeutic anticoagulation, highlighting the unpredictability of COVID-19 associated coagulopathy MESHD. This is to raise the awareness that thrombophilic state in metastatic malignancies is potentially augmented by COVID-19. We also discussed the complexity of making anticoagulation treatment decision in COVID-19 patients in the absence of evidence-based guidelines.

    Pulmonary embolism HP Pulmonary embolism MESHD and screening for concomitant proximal deep vein thrombosis MESHD in noncritically ill hospitalized patients with coronavirus disease MESHD 2019.

    Authors: Álvaro Dubois-Silva; Cristina Barbagelata-López; Álvaro Mena; Patricia Piñeiro-Parga; Diego Llinares-García; Santiago Freire-Castro

    doi:10.21203/rs.3.rs-30389/v1 Date: 2020-05-19 Source: ResearchSquare

    Background The clinical characteristics of noncritically ill patients with coronavirus disease MESHD 2019 (COVID-19) who develop pulmonary embolism HP pulmonary embolism MESHD ( PE MESHD) and the prevalence SERO of concomitant proximal deep-vein thrombosis MESHD ( DVT MESHD) of the lower limbs have not been evaluated consistently.Methods We identified nonintensive care unit (non-ICU) patients admitted with COVID-19 who were diagnosed with PE MESHD at a single center in northwest Spain. Point-of-care compression ultrasonography (CUS) of the lower limbs was performed to screen for concomitant proximal DVT MESHD. Clinical data were analyzed retrospectively.Results From April 2 to April 17, 2020, 8 patients with COVID-19 and PE MESHD were identified. PE MESHD was diagnosed a median of 19 (interquartile range [IQR], 17–23) days after onset of COVID-19 symptoms and a median of 13 (IQR, 8–15) days after admission. All patients received thromboprophylaxis with enoxaparin or biosimilar at a median dose of 40 mg. All tested patients had high levels of D-dimer (≥2000 ng/mL), serum SERO ferritin (≥300 mg/dL) and IL-6 (≥5 pg/mL) at PE MESHD diagnosis. Six (75%) and 7 (87.5%) patients had high C-reactive-protein (≥1 mg/dL) and lactate dehydrogenase (≥250 U/L) levels, respectively. All PE MESHD events were segmental or subsegmental, with lobar involvement in only one. None of these patients had concomitant proximal DVT MESHD of the lower limbs on CUS.Conclusions Non-ICU hospitalized patients with COVID-19 diagnosed with PE MESHD had mainly segmental or subsegmental events without concomitant proximal DVT MESHD of the lower limbs. Our findings suggest a predominance of small-vessel thrombosis MESHD secondary to inflammatory and immune responses in these patients.

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