92 research outputs found
Thrombotic complications in patients with COVID-19 : pathophysiological mechanisms, diagnosis, and treatment
Introduction
Emerging evidence points to an association between severe clinical presentation of COVID-19 and increased risk of thromboembolism. One-third of patients hospitalized due to severe COVID-19 develops macrovascular thrombotic complications, including venous thromboembolism, myocardial injury/infarction and stroke. Concurrently, the autopsy series indicate multiorgan damage pattern consistent with microvascular injury.
Prophylaxis, diagnosis and treatment
COVID-19 associated coagulopathy has distinct features, including markedly elevated D-dimers concentration with nearly normal activated partial thromboplastin time, prothrombin time and platelet count. The diagnosis may be challenging due to overlapping features between pulmonary embolism and severe COVID-19 disease, such as dyspnoea, high concentration of D-dimers, right ventricle with dysfunction or enlargement, and acute respiratory distress syndrome. Both macro- and microvascular complications are associated with an increased risk of in-hospital mortality. Therefore, early recognition of coagulation abnormalities among hospitalized COVID-19 patients are critical measures to identify patients with poor prognosis, guide antithrombotic prophylaxis or treatment, and improve patientsâ clinical outcomes.
Recommendations for clinicians
Most of the guidelines and consensus documents published on behalf of professional societies focused on thrombosis and hemostasis advocate the use of anticoagulants in all patients hospitalized with COVID-19, as well as 2-6 weeks post hospital discharge in the absence of contraindications. However, since there is no guidance for deciding the intensity and duration of anticoagulation, the decision-making process should be made in individual-case basis.
Conclusions
Here, we review the mechanistic relationships between inflammation and thrombosis, discuss the macrovascular and microvascular complications and summarize the prophylaxis, diagnosis and treatment of thromboembolism in patients affected by COVID-19
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Impact of specific functional groups in flavonoids on the modulation of platelet activation
Flavonoids exert innumerable beneficial effects on cardiovascular health including the
reduction of platelet activation, and thereby, thrombosis. Hence, flavonoids are deemed to be a
molecular template for the design of novel therapeutic agents for various diseases including
thrombotic conditions. However, the structure-activity relationships of flavonoids with platelets is
not fully understood. Therefore, this study aims to advance the current knowledge on structure-activity
relationships of flavonoids through a systematic analysis of structurally-related flavones.
Here, we investigated a panel of 16 synthetic flavones containing hydroxy or methoxy groups at
C-7,8 positions on the A-ring, with a phenyl group or its bioisosteres as the B-ring, along with
their thio analogues possessing a sulfur molecule at the 4th carbon position of the C-ring. The
antiplatelet efficacies of these compounds were analysed using human isolated platelets upon
activation with cross-linked collagen-related peptide by optical aggregometry. The results
demonstrate that the hydroxyl groups in flavonoids are important for optimum platelet inhibitory
activities. In addition, the 4-C=O and B ring phenyl groups are less critical for the antiplatelet
activity of these flavonoids. This structure-activity relationships of flavonoids upon the
modulation of platelet function may guide the design, optimisation and development of flavonoid
scaffolds as antiplatelet agents
The effects of the mediterranean diet on biomarkers of vascular wall inflammation and plaque vulnerability in subjects with high risk for cardiovascular disease. A randomized trial
Background: Adherence to the Mediterranean diet (MD) is associated with reduced morbidity and mortality due to
cardiovascular disease. However, how the MD exerts its effects is not fully known.
Aim: To assess the 12-month effects of two enhanced MDs compared to a low-fat diet on inflammatory biomarkers related
to atherosclerosis and plaque vulnerability in a subcohort of the PREDIMED (PrevencioÂŽn con Dieta MediterraÂŽnea) study.
Methods: A total of 164 participants at high risk for cardiovascular disease were randomized into three diet groups: MD
supplemented with 50 mL/d of extra virgin olive oil (MD+EVOO) or 30 g/d of nuts (MD+Nuts) and a low-fat diet. Changes in
classical cardiovascular risk factors, inflammatory biomarkers of atherosclerosis and plaque vulnerability were measured
after 12 months of intervention.
Results: Compared to participants in the low-fat diet group, those receiving MD+EVOO and MD+Nuts showed a higher
decrease in systolic (6 mmHg) and diastolic (3 mmHg) blood pressure (P = 0.02; both), as well as a reduction of 10% and 8%
in LDL-cholesterol (P = 0.04), respectively. Patients in the MD+Nuts group showed a significant reduction of 34% in CD40
expression on monocyte surface compared to low-fat diet patients (P = 0.03). In addition, inflammatory biomarkers related
to plaque instability such as C-reactive protein and interleukin-6 were reduced by 45% and 35% and 95% and 90% in the
MD+EVOO and MD+Nuts groups, respectively (P,0.05; all) compared to the low-fat diet group. Likewise, sICAM and Pselectin
were also reduced by 50% and 27%, respectively in the MD+EVOO group (P = 0.04) and P-selectin by 19% in MD+
Nuts group (P = 0.04) compared to the low-fat diet group.
Conclusions: Adherence to the MD is associated with an increase in serum markers of atheroma plaque stability which may
explain, at least in part, the protective role of MD against ischemic heart disease
Proteome from patients with metabolic syndrome is regulated by quantity and quality of dietary lipids
Background: Metabolic syndrome is a multi-component disorder associated to a high risk of cardiovascular disease.
Its etiology is the result of a complex interaction between genetic and environmental factors, including dietary
habits. We aimed to identify the target proteins modulated by the long-term consumption of four diets differing in
the quality and quantity of lipids in the whole proteome of peripheral blood mononuclear cells (PBMC).
Results: A randomized, controlled trial conducted within the LIPGENE study assigned 24 MetS patients for 12 weeks
each to 1 of 4 diets: a) high-saturated fatty acid (HSFA), b) high-monounsaturated fatty acid (HMUFA), c) low-fat,
high-complex carbohydrate diets supplemented with placebo (LFHCC) and d) low-fat, high-complex carbohydrate
diets supplemented with long chain (LC) n-3 polyunsaturated fatty acids (PUFA) (LFHCC n-3). We analyzed the
changes induced in the proteome of both nuclear and cytoplasmic fractions of PBMC using 2-D proteomic analysis.
Sixty-seven proteins were differentially expressed after the long-term consumption of the four diets. The HSFA diet
induced the expression of proteins responding to oxidative stress, degradation of ubiquitinated proteins and DNA
repair. However, HMUFA, LFHCC and LFHCC n-3 diets down-regulated pro-inflammatory and oxidative stress-related
proteins and DNA repairing proteins.
Conclusion: The long-term consumption of HSFA, compared to HMUFA, LFHCC and LFHCC n-3, seems to increase the
cardiovascular disease (CVD) risk factors associated with metabolic syndrome, such as inflammation and oxidative stress,
and seem lead to DNA damage as a consequence of high oxidative stress
The effects of a psychological intervention directed at optimizing immune function: study protocol for a randomized controlled trial
Smoking- and alcohol habits in relation to the clinical picture of women with microscopic colitis compared to controls
The relationship between mild alcohol consumption and mortality in Koreans: a systematic review and meta-analysis
Impact of Polyphenols and Polyphenol-Rich Dietary Sources on Gut Microbiota Composition
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