Filter clotting with continuous renal replacement therapy in COVID-19
AbstractCoronavirus disease 2019 (COVID-19) appears to be associated with increased arterial and venous thromboembolic disease. These presumed abnormalities in hemostasis have been associated with filter clotting during continuous renal replacement therapy (CRRT). We aimed to characterize the burden of CRRT filter clotting in COVID-19 infection and to describe a CRRT anticoagulation protocol that used anti-factor Xa levels for systemic heparin dosing. Multi-center study of consecutive patients with COVID-19 receiving CRRT. Primary outcome was CRRT filter loss. Sixty-five patients were analyzed, including 17 using an anti-factor Xa protocol to guide systemic heparin dosing. Fifty-four out of 65 patients (83%) lost at least one filter. Median first filter survival time was 6.5 [2.5, 33.5] h. There was no difference in first or second filter loss between the anti-Xa protocol and standard of care anticoagulation groups, however fewer patients lost their third filter in the protocolized group (55% vs. 93%) resulting in a longer median third filter survival time (24 [15.1, 54.2] vs. 17.3 [9.5, 35.1] h, p = 0.04). The rate of CRRT filter loss is high in COVID-19 infection. An anticoagulation protocol using systemic unfractionated heparin, dosed by anti-factor Xa levels is reasonable approach to anticoagulation in this population.
Publication date: Available online 8 October 2020Source: Journal of Vascular Surgery: Venous and Lymphatic DisordersAuthor(s): Heepeel Chang, Caron B. Rockman, Glenn R. Jacobowitz, Giancarlo Speranza, William S. Johnson, James M. Horowitz, Karan Garg, Thomas S. Maldonado, Mikel Sadek, Michael E. Barfield
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WEDNESDAY, Oct. 7, 2020 -- The overall prevalence of venous thromboembolism (VTE) in patients with COVID-19 is estimated to be 14.1 percent, with a higher prevalence for patients in the intensive care unit (ICU), according to a review published...
Authors: Haque S, Jawed A, Akhter N, Dar SA, Khan F, Mandal RK, Areeshi MY, Lohani M, Wahid M PMID: 33015764 [PubMed - in process]
AbstractObjectivesEvidences from either small series or spontaneous reporting are accumulating that SARS-CoV-2 involves the Nervous Systems. The aim of this study is to provide an extensive overview on the major neurological complications in a large cohort of COVID-19 patients.MethodsRetrospective, observational analysis on all COVID-19 patients admitted from February 23rd to April 30th, 2020 to ASST Papa Giovanni XXIII, Bergamo, Italy for whom a neurological consultation/neurophysiological assessment/neuroradiologic investigation was requested. Each identified neurologic complication was then classified into main neurolog...
AbstractAlthough many clinical reports have been published, little is known about the pathological post-mortem findings from people who have died of the novel coronavirus disease. The need for postmortem information is urgent to improve patient management of mild and severe illness, and treatment strategies. The present systematic review was carried out according to the Preferred Reporting Items for Systematic Review (PRISMA) standards. A systematic literature search and a critical review of the collected studies were conducted. An electronic search of PubMed, Science Direct Scopus, Google Scholar, and Excerpta Medica Data...
The odds of a clot are highest for the most critically ill patients. Analysis of 66 studies found that 23% of COVID-19 patients in an intensive care unit (ICU) developed a blood clot in the leg, known as a deep vein thrombosis (DVT).