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    Deep Venous Thrombosis HP 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 MESHD venous thrombosis HP (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 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 venous thrombosis MESHD (DVT) 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 in both lower extremities. Clinical characteristics of DVT-COVID-19 patients were analyzed. Multivariate logistic regression was performed to identify risk factors related to DVT in COVID-19 patients. The distribution of DVT 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 location was infrapopliteal (Class I and Class II), higher mortality in DVT-COVID-19 patients was confirmed. DVT-COVID-19 patients presented significant increases in the CRP, neutrophil count and D-dimer throughout the whole inpatient period compared to non-DVT-COVID-19 patients. Although anticoagulation therapy accelerated the recovery of lymphocytopenia condition in DVT patients, men DVT-COVID-19 patients showed higher CRP and neutrophil count vs. lymphocyte count (N/L) ratio but lower lymphocyte count compared to women DVT-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-COVID-19 patients.

    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 HP. At the same time, lung histopathology often reveals fibrin-based occlusion of small vessels in patients who succumb to the disease MESHD. Antiphospholipid syndrome MESHD (APS) 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, 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 MESHD venous thrombosis HP. 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.

    High Incidence of Venous Thrombosis MESHD Venous Thrombosis HP in Patients with Moderate to Severe COVID-19

    Authors: Oleg B Kerbikov; Pavel Yu Orekhov; Ekaterina N Borskaya; Natalia S Nosenko

    doi:10.1101/2020.06.12.20129536 Date: 2020-06-14 Source: medRxiv

    COVID-19 predisposes to venous thromboembolism MESHD thromboembolism HP and there are multiple data regarding high incidence of venous thrombosis MESHD venous thrombosis HP in critical COVID-19 patients, however reports on this complication in less severe patients are not widely available. The aim of this study was to investigate the incidence of deep-vein thrombosis MESHD (DVT) in patients with moderate to severe COVID-19 and to assess the prevalence SERO of DVT with lung computerized tomography (lung CT) exams, clinical information and lab data. This study examined 75 consecutive patients with moderate to severe COVID-19, with specific exclusions. METHODS Almost all patients (pts) admitted to our hospital in the first half of May underwent comprehensive vein ultrasonography. 75 pts ( aged TRANS 27-92 y, median - 63 y, 36 males TRANS and 39 females TRANS) with moderate to severe COVID-19 were included in our study. RESULTS Spontaneous echo contrast (decreased blood SERO velocity and blood SERO stasis) was detected in common femoral veins in 53 pts (70.7%). DVT was found in 15 pts (20%). The vast majority of those with DVT (13 pts, 86.7%) had thrombi only in calf veins and ileofemoral thrombosis MESHD was detected in 2 pts with DVT (13.3%). There was no significant observed difference between DVT and non-DVT patients with respect to age TRANS, underlying diseases, lung MESHD CT scores and SpaO2 at admission. There was also no significant observed difference between DVT and non-DVT patients with respect to both "time from symptoms onset TRANS to admission" and with respect to the majority of lab data. However, a significant difference was observed in D-dimer level (1.87 +/- 1.62 vs 0.51 +/- 0,4 mcg/mL p<0.0001) and C-reactive protein (116.9 +/- 83,6 and 65.1 +/- 64.98 mg/L, p = 0.014) for patients with DVT and patients without DVT respectably (Receiver operating characteristics (ROC) curve analysis revealed that the level of D-dimer >/= 0.69 mcg/mL is the predictor of DVT with a sensitivity SERO of 76.9%, a specificity of 77.6%, p < 0.001 (AUC area under curve = 0.7944). Logistic regression confirmed that D-dimer is an independent predictor of DVT and patients with D-dimer >/= 0.69 mcg/mL have odds ratio (OR) of developing DVT = 5.1 (confidence interval [CI] 1.9 - 13.5)). CONCLUSION Patients with moderate to severe COVID-19 show high incidence of DVT, indicating that moderate to severe COVID-19 patients may require an early administration of anticoagulation therapy as part of their treatment. Such therapy may be continued after hospital discharge. Based on these findings, these patients may also require a follow-up with vein ultrasonography after recovery to rule out DVT.

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