Management of ST-Elevation Myocardial Infarction in the COVID-19 Era: The Role of Thrombosis and Anticoagulation Strategy

Al‐Sadawi, Mohammed; Mohiuddin, Amena; Hossain, Naseem; Shaikh, Shakil; Feit, Alan; Ramalanjaona, Benjamin; Salifu, Moro O.; McFarlane, Samy I.

doi:10.12691/ajmcr-8-9-2

Cited by 7 publications

(7 citation statements)

References 9 publications

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“…Conversely there are also multiple reports of patients without traditional risk factors, but with COVID-19, presenting with STEMI with a high thrombus burden. [50][51][52]56,[58][59][60] This observation underlies our suggestion that in patients without, or with few, risk factors presenting with high thrombus burden STEMI, there should be a high index of suspicion for COVID-19. 63 This suspicion should remain even if initial PCR testing is negative given the high false negative rates.…”

Section: Coronary Thrombus In Covid-19supporting

confidence: 54%

“…All patients with individual data reported above were loaded on dual antiplatelet therapy (DAP). Recommendations from individual case reports were made for the use of potent P2Y 12 inhibitors 51 or for the use of DAP (Aspirin and Clopidogrel) and low-dose Rivaroxaban 2.5 mg BD 56 based on extrapolation from the ATLAS ACS 2-TIMI trial. 57 Although there is currently no trial evidence to direct which antiplatelet/anticoagulant regime should be used in COVID-19 patients undergoing PCI, we suggest it is reasonable to use potent P2Y 12 inhibitors (prasugrel or ticagrelor) along with aspirin, in keeping with IA ESC recommendations for STEMI, 67 irrespective of the PCI indication.…”

Section: Procedural and Post-procedural Pharmacologymentioning

confidence: 99%

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Therapeutic Implications of COVID-19 for the Interventional Cardiologist

Kelham

Choudry

Hamshere

et al. 2020

J Cardiovasc Pharmacol Ther

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Although COVID-19 is viewed primarily as a respiratory disease, cardiovascular risk factors and disease are prevalent among infected patients and are associated with worse outcomes. In addition, among multiple extra-pulmonary manifestations, there has been an increasing recognition of specific cardiovascular complications of COVID-19. Despite this, in the initial stages of the pandemic there was evidence of a reduction in patients presenting to acute cardiovascular services. In this masterclass review, with the aid of 2 exemplar cases, we will focus on the important therapeutic implications of COVID-19 for interventional cardiologists. We summarize the existing evidence base regarding the varied cardiovascular presentations seen in COVID-19 positive patients and the prognostic importance and potential mechanisms of acute myocardial injury in this setting. Importantly, through the use of a systematic review of the literature, we focus our discussion on the observed higher rates of coronary thrombus burden in patients with COVID-19 and acute coronary syndromes.

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Section: Coronary Thrombus In Covid-19supporting

confidence: 54%

Section: Procedural and Post-procedural Pharmacologymentioning

confidence: 99%

Therapeutic Implications of COVID-19 for the Interventional Cardiologist

Kelham

Choudry

Hamshere

et al. 2020

J Cardiovasc Pharmacol Ther

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“…Table S3 summarizes the demographics, clinical features, inflammatory markers and coagulation parameters of the COVID‐19 patients with thrombotic complications that were described in the 48 case studies included in this report. 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 The case studies included a total of 163 patients whose ages ranged from 29 to 83.1 and 46.5% of which were males.…”

Section: Resultsmentioning

confidence: 99%

Systemic inflammation in COVID‐19 patients may induce various types of venous and arterial thrombosis: A systematic review

et al. 2021

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COVID-19 is a global pandemic with a daily increasing number of affected individuals. Thrombosis is a severe complication of COVID-19 that leads to a worse clinical course with higher rates of mortality. Multiple lines of evidence suggest that hyperinflammation plays a crucial role in disease progression. This review compiles clinical data of COVID-19 patients who developed thrombotic complications to investigate the possible role of hyperinflammation in inducing hypercoagulation. A systematic literature search was performed using PubMed, Embase, Medline and Scopus to identify relevant clinical studies that investigated thrombotic manifestations and reported inflammatory and coagulation biomarkers in COVID-19 patients. Only 54 studies met our inclusion criteria, the majority of which demonstrated significantly elevated inflammatory markers. In the cohort studies with control, D-dimer was significantly higher in COVID-19 patients with thrombosis as compared to the control. Pulmonary embolism, deep vein thrombosis and strokes were frequently reported which could be attributed to the hyperinflammatory response associated with COVID-19 and/or to the direct viral activation of platelets and endothelial cells, two mechanisms that are discussed in this review. It is recommended that all admitted COVID-19 patients should be assessed for hypercoagulation. Furthermore, several studies have suggested that anticoagulation may be beneficial, especially in hospitalized non-ICU patients. Although vaccines against SARS-CoV-2 have been approved and distributed in several countries, research should continue in the field of prevention and treatment of COVID-19 and its severe complications including thrombosis due to the emergence of new variants against which the efficacy of the vaccines is not yet clear.

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“…1 Estudos anteriores mostraram que pacientes com covid-19 estão predispostos a eventos trombembólicos, tanto venosos quanto arteriais, com trombembolismo periférico e pulmonar, acidente vascular encefálico (AVE), infarto agudo do miocárdio e isquemia aguda de membros inferiores. [2][3][4] O paciente descrito é um jovem sem fatores de risco para doença arterial coronariana, que apresentou episódio de IAM CSST inferior com alta carga trombótica, sem evidências de doença aterosclerótica em outras artérias coronárias e com Semelhante às ocorrências relatadas anteriormente, 5,7 o caso a seguir destaca um paciente com covid-19 e IAMCSST, e que apresenta alta carga trombótica na angiografia coronária e ausência de critérios de reperfusão após terapia fibrinolítica, o que revela a necessidade de terapia de intervenção percutânea de resgate precoce. A grande quantidade de trombo deve estimular o uso de terapia farmacológica mais agressiva, como fibrinolíticos, inibidor da glicoproteína IIb/IIIa e uso prolongado de anticoagulantes.…”

Section: Discussionunclassified