Impairment of platelet function in both mild and severe COVID-19 patients

Abnormalities of platelet function were reported in patients with severe COVID-19 (severe-C), but few data are available in patients with mild COVID-19 (mild-C) and after COVID-19 recovery. The aim of this study was to investigate platelet parameters in mild-C patients (n = 51), with no evidence of pneumonia, and severe-C patients (n = 49), during the acute phase and after recovery, compared to 43 healthy controls. Both mild-C and severe-C patients displayed increased circulating activated platelets, low d-granule content (ADP, serotonin), impaired platelet activation by collagen (light transmission aggregometry) and impaired platelet thrombus formation on collagen-coated surfaces under controlled flow conditions (300/s shear rate). The observed abnormalities were more marked in severe-C patients than in mild-C patients. Overall, 61% (30/49) of mild-C and 73% (33/45) of severe-C patients displayed at least one abnormal platelet parameter. In a subgroup of just 13 patients who showed no persisting signs/symptoms of COVID-19 and were re-evaluated at least 1 month after recovery, 11 of the 13 subjects exhibited normalization of platelet parameters. In conclusion, mild abnormalities of platelet parameters were present not only in severe-C but also, albeit to a lesser extent, in mild-C patients during the acute phase of COVID-19 and normalized in most tested patients after clinical recovery

Thrombopoietin receptor agonists for the treatment of primary immune thrombocytopenia : a meta-analysis and systematic review

Previous meta-analyses reported discordant results on the efficacy and safety of thrombopoietin receptor agonists (TPO-RA) as second-line treatment in patients with immune thrombocytopenia (ITP). We conducted a meta-analysis of primary ITP treatment with the TPO-RA Romiplostim, Eltrombopag and Avatrombopag, including additional studies and relevant endpoints. We searched MEDLINE, EMBASE and CENTRAL for randomized clinical trials (RCTs) and cohort studies on TPO-RA in ITP published until December 31, 2018. The primary endpoints were: risk ratio (RR) of treatment failure and bleeding of WHO grade 652; rate of remission after discontinuation of treatment. The principal safety outcome was RR and incidence of thrombotic events and liver damage. From 1044 identified records we selected 16 RCTs and 19 cohort studies. RCTs included 909 patients assigned to TPO-RA and 427 to the control arm. Treatment failure was observed in 21% TPO-RA-treated patients and 47% control arm patients (RR = 0.42, 95% CI 0.33\u20130.53) in RCTs during a median follow-up of 13 weeks, and in 29% TPO-RA-treated patients in cohort studies, during a median follow-up of 69 weeks. The incidence of remission after TPO discontinuation was 18% (5\u201336%). RR of WHO grade 652 bleeding was 0.58 (0.38\u20130.86) in TPO-RA-treated patients, compared to control arm patients. Adverse events were rare and not significantly different in the two groups of patients. All-cause mortality was significantly lower with TPO-RA (RR 0.21, 95% CI, 0.06\u20130.68). In conclusion, TPO-RA are effective and safe in patients with ITP, even in the long term

Capillary leak syndrome : una rara causa di shock ipovolemico

Descrivere un caso di Capillary Laek Syndrome (CLS) per diffondere la conoscenza di una malattia, rara, potenzialmente fatale

Guided anti-P2Y12 therapy in patients undergoing PCI: 3 systematic reviews with meta-analyses of randomized controlled trials with homogeneous design

Background: The value of guided therapy (GT) with anti-P2Y12 drugs in percutaneous coronary intervention (PCI) is unclear. Meta-analyses lumped together randomized controlled trials (RCTs) with heterogeneous designs, comparing either genotype-GT or platelet function test (PFT)-GT with unguided therapy. Some meta-analysis also included RCTs that did not explore GT, but the effects of switching patients with high on-treatment platelet reactivity (HTPR) to alternative therapies (HTPR-Therapy). We performed 3 distinct systematic reviews/meta-analyses, each exploring only RCTs with homogeneous design. Methods. MEDLINE, Embase and Central databases were searched for RCTs testing genotype-GT, PFT-GT or HTPR-Therapy in PCI-treated patients, through October 1st 2022. Two reviewers extracted the data. Risk ratios (RR) (95% confidence intervals) were calculated. Primary outcomes were major bleedings (MB) and major adverse cardiovascular events (MACE). Results: In 7 genotype-GT RCTs, RR were: MB, 1.06 (0.73-1.54; p=0.76); MACE, 0.65 (0.47-0.91); p=0.01), but significant risk reduction was observed in RCTs performed in China (0.30, 0.16-0.54; p<0.0001) and not elsewhere (0.75, 0.48-1.18; p=0.21). In 6 PFT-GT RCTs, RR were: MB, 0.91 (0.64-1.28, p=0.58); MACE, 0.82 (0.56 -1.19; p=0.30): 0.62 (0.42-0.93; p=0.02) in China, 1.08 (0.82-1.41; p=0.53) elsewhere. In 8 HTPR-Therapy RCTs, RR were: MB, 0.71 (0.41-1.23; p=0.22); MACE, 0.57 (0.44-0.75; p<0.0001): 0.56 (0.43-0.74, p<0.0001) in China, 0.58 (0.27-1.23, p=0.16) elsewhere. Conclusion: No GT strategy affected MB. Overall, genotype-GT but not PFT-GT reduced MACE. However, genotype-GT and PFT-GT reduced MACE in China, but not elsewhere. PFT-GT performed poorly compared to HTPR-Therapy, likely due to inaccurate identification of HTPR patients by PFT