Rivaroxaban to prevent major clinical outcomes in non-hospitalised patients with COVID-19: the CARE – COALITION VIII randomised clinical trial DOI Creative Commons
Álvaro Avezum, Haliton Alves de Oliveira, Precil Diego Miranda de Menezes Neves

et al.

EClinicalMedicine, Journal Year: 2023, Volume and Issue: 60, P. 102004 - 102004

Published: May 18, 2023

COVID-19 progression is associated with an increased risk of arterial and venous thrombosis. Randomised trials have demonstrated that anticoagulants reduce the thromboembolism in hospitalised patients COVID-19, but a benefit routine anticoagulation has not been outpatient setting.We conducted randomised, open-label, controlled, multicentre study, evaluating use rivaroxaban mild or moderate patients. Adults ≥18 years old, probable confirmed SARS-CoV-2 infection, presenting within ≤7 days from symptom onset no clear indication for hospitalization, plus at least 2 factors complication, were randomised 1:1 either to 10 mg OD 14 care. The primary efficacy endpoint was composite thromboembolic events, need mechanical ventilation, acute myocardial infarction, stroke, limb ischemia, death due during first 30 days. ClinicalTrials.gov: NCT04757857.Enrollment prematurely stopped sustained reduction new cases. From September 29th, 2020, through May 23rd, 2022, 660 (median age 61 [Q1-Q3 47-69], 55.7% women). There significant difference between control (4.3% [14/327] vs 5.8% [19/330], RR 0.74; 95% CI: 0.38-1.46). major bleeding group 1 group.On light these findings decision can be made about utility improve outcomes outpatients COVID-19. Metanalyses data provide evidence anticoagulant prophylaxis These result underpowered therefore should interpreted caution.COALITION Brazil Bayer S.A.

Language: Английский

The pathophysiology, diagnosis, and management of sepsis-associated disseminated intravascular coagulation DOI Creative Commons
Toshiaki Iba, Julie Helms, Jean M. Connors

et al.

Journal of Intensive Care, Journal Year: 2023, Volume and Issue: 11(1)

Published: May 23, 2023

Abstract Background The International Society on Thrombosis and Haemostasis (ISTH) released overt disseminated intravascular coagulation (DIC) diagnostic criteria in 2001. Since then, DIC has been understood as the end-stage consumptive coagulopathy not therapeutic target. However, is merely a decompensated disorder, but also includes early stages with systemic activation coagulation. Thus, ISTH recently sepsis-induced (SIC) that can diagnose compensated-phase of readily available biomarkers. Main body laboratory-based diagnosis due to various critical conditions, although sepsis most common underlying disease. pathophysiology sepsis-associated multifactorial, addition suppressed fibrinolysis, multiple inflammatory responses are initiated by activated leukocytes, platelets, vascular endothelial cells part thromboinflammation. Although were established advanced stage DIC, additional detect an earlier needed for potential considerations. Accordingly, introduced SIC 2019 easy use require only platelet count, prothrombin time-international normalized ratio, Sequential Organ Failure Assessment Score. score be used evaluate disease severity determine timing interventions. One major disadvantages treating lack availability specific approaches beyond infection. Clinical trials date have failed because included patients who coagulopathic. Nevertheless, infection control, anticoagulant therapy will choice DIC. Therefore, efficacy heparin, antithrombin, recombinant thrombomodulin proven future clinical studies. Conclusion It necessary develop novel strategy against improve outcomes. Consequently, we recommend screening monitoring using scoring system.

Language: Английский

Citations

59
2023 ISTH update of the 2022 ISTH guidelines for antithrombotic treatment in COVID-19 DOI Creative Commons
Sam Schulman, Donald M. Arnold, Charlotte Bradbury

et al.

Journal of Thrombosis and Haemostasis, Journal Year: 2024, Volume and Issue: 22(6), P. 1779 - 1797

Published: March 18, 2024

Based on emerging evidence from the COVID-19 pandemic, International Society Thrombosis and Haemostasis (ISTH) guidelines for antithrombotic treatment in were published 2022. Since then, at least 16 new randomized controlled trials have contributed additional evidence, which necessitated a modification of most previous recommendations. We used again American College Cardiology Foundation/American Heart Association methodology assessment level (LOE) class recommendation (COR). Five recommendations had LOE upgraded to A 2 patients with added. Furthermore, section was added answer questions about vaccination vaccine-induced immune thrombotic thrombocytopenia (VITT), studies provided some evidence. only included or B. Panelists agreed 19 recommendations, 4 nonhospitalized, 5 noncritically ill hospitalized, 3 critically postdischarge patients, as well VITT. strong (COR 1) given (a) use prophylactic dose low-molecular-weight heparin unfractionated hospitalized COVID-19, (b) select this group, therapeutic-dose heparin/unfractionated preference dose, (c) antiplatelet factor enzyme immunoassays diagnosing against 3) addition an agent patients. These international provide countries diverse healthcare resources vaccine availability.

Language: Английский

Citations

21
Thromboinflammation in acute injury: infections, heatstroke, and trauma DOI Creative Commons
Toshiaki Iba, Julie Helms, Marcel Levi

et al.

Journal of Thrombosis and Haemostasis, Journal Year: 2023, Volume and Issue: 22(1), P. 7 - 22

Published: Aug. 3, 2023

Language: Английский

Citations

40
Risk of Thrombosis during and after a SARS-CoV-2 Infection: Pathogenesis, Diagnostic Approach, and Management DOI Creative Commons
Henry Sutanto, Gatot Soegiarto

Hematology Reports, Journal Year: 2023, Volume and Issue: 15(2), P. 225 - 243

Published: April 3, 2023

Coronavirus disease 2019 (COVID-19) increases the risk of thromboembolic events, especially in patients with severe infections requiring intensive care and cardiorespiratory support. COVID-19 complications have a higher death, if they survive, these are expected to negatively affect patients’ quality life. Moreover, recent data reported that thromboembolism remains high months after infection. Therefore, understanding pathogenesis thrombosis setting may facilitate early prevention treatment COVID-19-associated reduce concomitant morbidity, mortality, disability. This review will first discuss clinical characteristics infections, particularly regard underlying pathophysiology. Then, at molecular cellular levels be comprehensively reviewed. Next, manifestations venous arterial as well potential benefits several laboratory markers further discussed. Lastly, preventive therapeutic management during also explained.

Language: Английский

Citations

38
Effect of Thromboprophylaxis on Clinical Outcomes After COVID-19 Hospitalization DOI

Tracy Y. Wang,

Abdus S. Wahed, Alison Morris

et al.

Annals of Internal Medicine, Journal Year: 2023, Volume and Issue: 176(4), P. 515 - 523

Published: March 20, 2023

Background: Patients hospitalized with COVID-19 have an increased incidence of thromboembolism. The role extended thromboprophylaxis after hospital discharge is unclear. Objective: To determine whether anticoagulation superior to placebo in reducing death and thromboembolic complications among patients discharged hospitalization. Design: Prospective, randomized, double-blind, placebo-controlled clinical trial. (ClinicalTrials.gov: NCT04650087) Setting: Done during 2021 2022 127 U.S. hospitals. Participants: Adults aged 18 years or older for 48 hours more ready discharge, excluding those a requirement for, contraindication to, anticoagulation. Intervention: 2.5 mg apixaban versus twice daily 30 days. Measurements: primary efficacy end point was 30-day composite death, arterial thromboembolism, venous safety points were major bleeding clinically relevant nonmajor bleeding. Results: Enrollment terminated early, 1217 participants randomly assigned, because lower than anticipated event rate declining hospitalizations. Median age 54 years, 50.4% women, 26.5% Black, 16.7% Hispanic; 30.7% had World Health Organization severity score 5 greater, 11.0% International Medical Prevention Registry on Venous Thromboembolism risk prediction greater 4. Incidence the 2.13% (95% CI, 1.14 3.62) group 2.31% (CI, 1.27 3.84) group. Major occurred 2 (0.4%) 1 (0.2%) 3 (0.6%) 6 (1.1%) apixaban-treated placebo-treated participants, respectively. By day 30, thirty-six (3.0%) lost follow-up, 8.5% 11.9% permanently discontinued study drug treatment. Limitations: introduction SARS-CoV-2 vaccines decreased hospitalization death. Study enrollment spanned peaks Delta Omicron variants United States, which influenced illness severity. Conclusion: thromboembolism low this cohort COVID-19. Because early termination, results imprecise inconclusive. Primary Funding Source: National Institutes Health.

Language: Английский

Citations

29
Heparin, Low Molecular Weight Heparin, and Non-Anticoagulant Derivatives for the Treatment of Inflammatory Lung Disease DOI Creative Commons
Janis K. Shute

Pharmaceuticals, Journal Year: 2023, Volume and Issue: 16(4), P. 584 - 584

Published: April 13, 2023

Unfractionated heparin has multiple pharmacological activities beyond anticoagulation. These anti-inflammatory, anti-microbial, and mucoactive are shared in part by low molecular weight non-anticoagulant derivatives. Anti-inflammatory include inhibition of chemokine activity cytokine synthesis, inhibitory effects on the mechanisms adhesion diapedesis involved neutrophil recruitment, heparanase activity, proteases coagulation complement cascades, elastase neutralisation toxic basic histones, HMGB1 activity. This review considers potential for its derivatives to treat inflammatory lung disease, including COVID-19, ALI, ARDS, cystic fibrosis, asthma, COPD via inhaled route.

Language: Английский

Citations

28
Managing sepsis and septic shock in an endothelial glycocalyx-friendly way: from the viewpoint of surviving sepsis campaign guidelines DOI Creative Commons
Toshiaki Iba, Cheryl L. Maier, Julie Helms

et al.

Annals of Intensive Care, Journal Year: 2024, Volume and Issue: 14(1)

Published: April 24, 2024

Maintaining tissue perfusion in sepsis depends on vascular integrity provided by the endothelial glycocalyx, critical layer covering luminal surface of blood vessels. The glycocalyx is composed proteoglycans, glycosaminoglycans, and functional plasma proteins that are for antithrombogenicity, regulating tone, controlling permeability, reducing interactions with leukocytes platelets. Degradation substantial due to thromboinflammation, treatments septic shock may exacerbate endotheliopathy via additional injury. As a result, therapeutic strategies aimed at preserving should be considered, including modifications fluid volume resuscitation, minimizing catecholamine use, hyperglycemia, potential use corticosteroids anticoagulants. In this review, we explore treatment aligned recommendations outlined Surviving Sepsis Campaign Guidelines 2021 special emphasis evidence regarding protection.

Language: Английский

Citations

13
Appropriate thromboprophylaxis strategy for COVID-19 patients on dosage, antiplatelet therapy, outpatient and post-discharge prophylaxis: a meta-analysis of randomized controlled trials DOI Creative Commons
Jiahao Meng,

Hang Tang,

Yifan Xiao

et al.

International Journal of Surgery, Journal Year: 2024, Volume and Issue: unknown

Published: March 28, 2024

There was controversy surrounding the optimal thromboprophylaxis strategy for coronavirus disease 2019 (COVID-19) patients. This included debates on dosage of anticoagulants thromboembolism prophylaxis, requirement additional antiplatelet therapy, and necessity prophylaxis outpatients postdischarge. To explore this, authors performed a meta-analysis randomized controlled trials.

Language: Английский

Citations

10
COVID-19-Associated Pulmonary Embolism: Review of the Pathophysiology, Epidemiology, Prevention, Diagnosis, and Treatment DOI Open Access
Luis Ortega‐Paz, Azita H. Talasaz, Parham Sadeghipour

et al.

Seminars in Thrombosis and Hemostasis, Journal Year: 2022, Volume and Issue: 49(08), P. 816 - 832

Published: Oct. 12, 2022

Abstract COVID-19 is associated with endothelial activation in the setting of a potent inflammatory reaction and hypercoagulable state. The end result this thromboinflammatory state an excess thrombotic events, particular venous thromboembolism. Pulmonary embolism (PE) has been special interest patients given its association respiratory deterioration, increased risk intensive care unit admission, prolonged hospital stay. pathophysiology clinical characteristics COVID-19-associated PE may differ from conventional non–COVID-19-associated PE. In addition to embolic events deep vein thrombi, situ pulmonary thrombosis, particularly smaller vascular beds, be relevant COVID-19. Appropriate prevention therefore become critical interest. Several changes viral biology, vaccination, treatment management during pandemic have resulted incidence trends. This review provides overview pathophysiology, epidemiology, characteristics, factors Furthermore, we briefly summarize results randomized controlled trials preventive antithrombotic therapies COVID-19, focusing on their findings related We discuss acute PE, which substantially similar non-COVID-19 Ultimately, comment current knowledge gaps evidence future directions follow-up including long-term management, possible long-COVID.

Language: Английский

Citations

34
Rivaroxaban for Prevention of Thrombotic Events, Hospitalization, and Death in Outpatients With COVID-19: A Randomized Clinical Trial DOI Creative Commons
Gregory Piazza, Alex C. Spyropoulos, Judith Hsia

et al.

Circulation, Journal Year: 2023, Volume and Issue: 147(25), P. 1891 - 1901

Published: May 8, 2023

COVID-19 (coronavirus disease 2019) is associated with heightened risks of venous and arterial thrombosis hospitalization due to respiratory failure. To assess whether prophylactic anticoagulation can safely reduce the frequency thrombosis, hospitalization, death in nonhospitalized patients symptomatic at least one risk factor, we conducted PREVENT-HD double-blind, placebo-controlled randomized trial (A Study Rivaroxaban Reduce Risk Major Venous Arterial Thrombotic Events, Hospitalization Death Medically Ill Outpatients With Acute, Symptomatic COVID-19] Infection).

Language: Английский

Citations

20