Complications thromboemboliques veineuses chez les patients hospitalisés pour COVID-19

Médecine vasculaireIntroduction : l’infection au SARS-CoV-2 a été associée à un risque thrombotique élevé partiellement expliqué par la réaction inflammatoire systémique, des durées d’hospitalisation longues, la présence de cathéters centraux et d’ECMO. Un potentiel thrombotique intrinsèque du virus est questionné devant la mise en évidence d’un anticoagulant circulant (ACC) chez certains patients infectés. Objectifs : cette étude s’est proposé d’évaluer l’incidence des évènements thromboemboliques veineux (ETEV) chez des adultes hospitalisés pour COVID-19. Méthodes : il s’agit d’une analyse rétrospective des patients consécutivement hospitalisés pour infection au SARSCoV-2 (RT-PCR positive) admis au CHU de Strasbourg du 25/02/2020 au 01/04/2020. Les patients hospitalisés pour moins de 24h ont été exclus. La période d’observation s'étendait jusqu'à la fin de l'hospitalisation. Résultats : au cours de la période d’étude, 943 patients COVID-19 ont été hospitalisés dans notre institution. Parmi eux, 772 ont été inclus dans l’analyse actuelle. L’âge médian était de 68 (56-79) ans et 58 patients avaient un antécédent de maladie thromboembolique veineuse (MTEV). Au total, un ETEV est survenu chez 61 patients (7.9%): 46 embolies pulmonaires (EP), 13 thromboses veineuses profondes isolées et 2 thromboses veineuses superficielles. Sur l’effectif global, 81% des patients avaient bénéficié d’un traitement anticoagulant dès leur admission. L’incidence de la MVTE était supérieure chez les patients avec des formes plus sévère de pneumopathie définie par un des critères suivants: conduisant au décès/nécessitant une intubation ou une oxygénothérapie nasale à haut débit ou une ventilation non-invasive (22% versus 2%, p-0.001). La mortalité totale était de 22.4% et elle était plus élevée chez des patients ayant présenté un ETEV (34% versus 21%, p=0.024). Une recherche d’ACC a été réalisée chez 70% des patients ayant présenté un ETEV et elle s’est avérée positive dans 88% des cas. Au total, 37 complications hémorragiques majeures ont été notées (4.8%) dont 38% cérébrales. En analyse multivariée, la survenue d’un ETEV était corrélée à un âge inférieur à 75 ans, une élévation des D-dimères à plus de 1500ug/l et une atteinte parenchymateuse supérieure à 25%. Conclusion : notre étude a montré que la survenue d’un ETEV était corrélée à la sévérité de pneumopathie COVID-19 et était associée à un risqué plus élevé de décès.ntroduction: SARS-CoV-2 infection was associated with a high thrombotic risk partially explained by systemic inflammatory reaction, long hospital stays, presence of central catheters and ECMO. An intrinsic thrombotic potential of the virus is questioned when a circulating anticoagulant (ACC) is identified in some infected patients. Objectives: This study proposed to assess the incidence of venous thromboembolic events (ETEVs) in adults hospitalized for COVID-19. Methods: This is a retrospective analysis of patients subsequently hospitalized for SARSCoV-2 infection (RT-PCR positive) admitted to the Strasbourg University Hospital from 25/02/2020 to 01/04/2020. Patients hospitalized for less than 24 hours were excluded. The observation period extended until the end of the hospitalization. Results: During the study period, 943 COVID-19 patients were hospitalized in our institution. Of these, 772 were included in the current analysis. The median age was 68 (56-79 years) and 58 patients had a history of venous thromboembolic disease (VTS). A total of 61 patients (7.9%), an ETE occurred: 46 pulmonary embolisms (EPs), 13 isolated deep vein thrombosis and 2 superficial venous thrombosis. Of the total workforce, 81% of patients had received anticoagulant treatment upon admission. The incidence of MVTE was higher in patients with more severe forms of lung disease defined by one of the following criteria: leading to death/requiring high-flow nasal intubation or oxygen therapy or non-invasive ventilation (22% versus 2%, p-001). Total mortality was 22.4% and was higher in patients with ETEV (34% vs. 21%, p-0.024). VAC research was conducted in 70% of patients with ETEV and was positive in 88% of cases. A total of 37 major haemorrhagic complications were noted (4.8%) 38% of whom are cerebral. In multivariate analysis, the occurrence of an ETEV was correlated at an age of less than 75 years, an elevation of D-dimers to more than 1500ug/l and parenchymatous impairment greater than 25%. Conclusion: Our study showed that the occurrence of an ETEV was correlated with the severity of COVID-19 lung disease and was associated with a higher risk of deat

Aminotransferases disorders associated with venous thromboembolic events in patients infected with COVID-19

Introduction and objectives: Since the outbreak of the COVID-19 pandemic, increasing evidence suggests that infected patients present a high incidence of venous thromboembolic (VTE) events and elevated aminotransferases (AT).The objective of this work was to evaluate the incidence of aminotransferases disorders in patients infected with COVID-19 and to manage the VTE events associated with elevated AT. Patients or Materials and methods: We report a retrospective study of 46 patients admitted for COVID-19 infection. Venous duplex ultrasound of lower limbs was performed in all patients at Day 0 and Day 5. All patients had antithrombotic-prophylaxis upon admission using low molecular weight heparin with Enoxaparin. Demographics, comorbidities and laboratory parameters were collected and analyzed. Results: Elevated AT were reported in 28 patients (61%). 10 had acute VTE events of which eight (17.4%) had aminotransferases disorders. They had been treated with curative Enoxaparin. After a follow-up of 15 and/or 30 days, six of them were controlled, and treated with direct oral anticoagulant (DOACs) after normalization of aminotransferases. Conclusions: The incidence of aminotransferases disorders associated with acute VTE events in patients infected with COVID-19 is significant. The use of DOACs appear pertinent in these patients. Monitoring of the liver balance should therefore be considered at a distance from the acute episode in the perspective of DOACs relay

The Conundrum of Occult Cancer Screening in Venous Thromboembolism: Lessons from the REMOTEV Registry

(1) Background and Objectives: Venous thromboembolism (VTE) is strongly associated with cancer, and may be the first event revealing occult neoplasia. Nonetheless, the reasonable extent of the etiological assessment after an unprovoked VTE event remains debated. The main objective of this study was to evaluate the incidence of occult neoplasia one year after an episode of VTE, in consecutively hospitalized patients for VTE from the REMOTEV registry. The secondary objectives were to assess the performance of the various tests used for occult cancer screening in a real-life setting and analyze the risk factors associated with the discovery of cancer and the 1-year prognosis. (2) Methods: REMOTEV is a prospective, non-interventional cohort study of patients with acute VTE. Patients included in the registry from 23 October 2013 to 28 July 2018 were analyzed after a follow-up of 12 months. Cancer detection was performed according to local practices and consisted of a limited strategy to which an abdominal ultrasound was added. In the presence of suggestive clinical manifestations, further examinations were performed on an individual basis. (3) Results: A total of 993 patients were included in the study. At 1 year, the incidence of newly diagnosed cancer was low (5.3%). Half of the detected cancers were metastatic at discovery (51%) and had a poor global prognosis (32% of mortality at 1 year). Admission pulmonary CT scans as well as (thoracic)-abdomino-pelvic CT scans (when performed) were responsible for the majority of detected cancers. Age over 65 years and the concomitant presence of an unusual site and lower-limb deep vein thrombosis were the only factors associated with occult neoplasia in this cohort. After 1-year FU, mortality was higher in cancer patients (HR 6.0 (CI 95% 3.5–10.3, p < 0.0001)), and cancer evolution was the leading cause of death in the cancer group. (4) Conclusions: In REMOTEV, VTE-revealed occult cancer prevalence was low, but similar to recent reports and associated with higher age, multiple thrombotic sites and worse prognosis

Prognostic Value of Troponin Elevation in COVID-19 Hospitalized Patients

(1) Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) penetrates the respiratory epithelium through angiotensin-converting enzyme-2 (ACE2) binding. Myocardial and endothelial expression of ACE2 could account for the growing body of reported evidence of myocardial injury in severe forms of Human Coronavirus Disease 2019 (COVID-19). We aimed to provide insight into the impact of troponin (hsTnI) elevation on SARS-CoV-2 outcomes in patients hospitalized for COVID-19. (2) Methods: This was a retrospective analysis of hospitalized adult patients with the SARS-CoV-2 infection admitted to a university hospital in France. The observation period ended at hospital discharge. (3) Results: During the study period, 772 adult, symptomatic COVID-19 patients were hospitalized for more than 24 h in our institution, of whom 375 had a hsTnI measurement and were included in this analysis. The median age was 66 (55-74) years, and there were 67% of men. Overall, 205 (55%) patients were placed under mechanical ventilation and 90 (24%) died. A rise in hsTnI was noted in 34% of the cohort, whereas only three patients had acute coronary syndrome (ACS) and one case of myocarditis. Death occurred more frequently in patients with hsTnI elevation (HR 3.95, 95% CI 2.69-5.71). In the multivariate regression model, a rise in hsTnI was independently associated with mortality (OR 3.12, 95% CI 1.49-6.65) as well as age >= 65 years old (OR 3.17, 95% CI 1.45-7.18) and CRP >= 100 mg/L (OR 3.62, 95% CI 1.12-13.98). After performing a sensitivity analysis for the missing values of hsTnI, troponin elevation remained independently and significantly associated with death (OR 3.84, 95% CI 1.78-8.28). (4) Conclusion: Our study showed a four-fold increased risk of death in the case of a rise in hsTnI, underlining the prognostic value of troponin assessment in the COVID-19 context

Outcomes of COVID-19 Hospitalized Patients Previously Treated with Renin-Angiotensin System Inhibitors

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) penetrates respiratory epithelium through angiotensin-converting enzyme-2 binding, raising concerns about the potentially harmful effects of renin-angiotensin system inhibitors (RASi) on Human Coronavirus Disease 2019 (COVID-19) evolution. This study aimed to provide insight into the impact of RASi on SARS-CoV-2 outcomes in patients hospitalized for COVID-19. Methods: This was a retrospective analysis of hospitalized adult patients with SARS-CoV-2 infection admitted to a university hospital in France. The observation period ended at hospital discharge. Results: During the study period, 943 COVID-19 patients were admitted to our institution, of whom 772 were included in this analysis. Among them, 431 (55.8%) had previously known hypertension. The median age was 68 (56-79) years. Overall, 220 (28.5%) patients were placed under mechanical ventilation and 173 (22.4%) died. According to previous exposure to RASi, we defined two groups, namely, "RASi" (n = 282) and "RASi-free" (n = 490). Severe pneumonia (defined as leading to death and/or requiring intubation, high-flow nasal oxygen, noninvasive ventilation, and/or oxygen flow at a rate of >= 5 L/min) and death occurred more frequently in RASi-treated patients (64% versus 53% and 29% versus 19%, respectively). However, in a propensity score-matched cohort derived from the overall population, neither death (hazard ratio (HR) 0.93 (95% confidence interval (CI) 0.57-1.50), p = 0.76) nor severe pneumonia (HR 1.03 (95%CI 0.73-1.44), p = 0.85) were associated with RASi therapy. Conclusion: Our study showed no correlation between previous RASi treatment and death or severe COVID-19 pneumonia after adjustment for confounders