vitamin-k-semiquinone-radical and Pneumonia--Viral

Topics: Anticoagulants; Betacoronavirus; Coronavirus Infections; COVID-19; Humans; International Normalized Ratio; Monitoring, Physiologic; Pandemics; Pneumonia, Viral; SARS-CoV-2; Vitamin K

Topics: Aged; Aged, 80 and over; Anticoagulants; Betacoronavirus; Blood Coagulation; Blood Coagulation Disorders; Coronavirus Infections; COVID-19; Drug Interactions; Drug Monitoring; Female; Host-Pathogen Interactions; Humans; International Normalized Ratio; Male; Middle Aged; Pandemics; Pneumonia, Viral; Predictive Value of Tests; Quarantine; Risk Factors; SARS-CoV-2; Vitamin K

Vitamin K-Antagonists (VKAs) are the treatment of choice in patients with indications other than atrial fibrillation and venous thromboembolism. Moreover, some patients still assume VKAs refusing to change their therapy when direct oral anticoagulants (DOACs) are properly indicated. The COVID-19 pandemic has completely changed our lives, nullifying inter-personal relationships to avoid contagion, making difficult the VKAs monitoring. We describe the re-organization of our thrombosis centre (TC) as an example on how to face the emergency due to the COVID-19 pandemic. In the first phase, to avoid overcrowding at the TC, we planned to increase the interval time between INRs checks and to encourage blood sampling at home, especially for elderly patients. Moreover, precise scheduled blood sampling was also organized while telephone and email counselling were guaranteed by two doctors of the TC. In the second phase, to reduce the number of patients who daily attended our TC a switch from VKAs to DOACs was carried out, if no contraindications were identified. In the third phase, to protect patients, healthcare staff and hospital from COVID-19 widespread, telemedicine was strengthened. We tried to extend self-testing at home by means of portable coagulometers to as more patients as possible. To avoid patients staying or coming back to the TC an ad hoc web platform for sending the therapeutic dose adjustment and the next scheduled appointment was developed. The TC re-organization allowed us to monitor anticoagulated patients respecting personal isolation and security measures to avoid possible COVID-19 contagion.

Topics: Blood Coagulation; Coronavirus Infections; COVID-19; Humans; Italy; Pandemics; Pneumonia, Viral; Thrombosis; Vitamin K

BACKGROUND COVID-19 was declared a pandemic in March 2020 in the United States. It has been associated with high mortality and morbidity all over the world. COVID-19 can cause a significant inflammatory response leading to coagulopathy and this hypercoagulable state has been associated with worse clinical outcomes in these patients. The published data regarding the presence of lupus anticoagulant in critically ill COVID-19-positive patients is limited and indicates varying conclusions so far. CASE REPORT Here, we present a case of a 31-year-old man who was admitted to the hospital with COVID-19 pneumonia, complicated with superadded bacterial empyema and required video-assisted thoracoscopic surgery with decortication. This patient also had prolonged prothrombin time on preoperative labs, which was not corrected with mixing study. Further workup detected positive lupus anticoagulant and anti-cardiolipin IgM along with alteration in other coagulation factor levels. The patient was treated with fresh frozen plasma and vitamin K before surgical intervention. He had an uneventful surgical course. He received prophylactic-dose low molecular weight heparin for venous thromboembolism prophylaxis and did not experience any thrombotic events while hospitalized. CONCLUSIONS COVID-19 infection creates a prothrombotic state in affected patients. The formation of micro-thrombotic emboli results in significantly increased mortality and morbidity. Routine anticoagulation with low molecular weight heparin can prevent thrombotic events and thus can improve patient outcomes. In patients with elevated prothrombin time, lupus anticoagulant/anti-cardiolipin antibody-positivity should be suspected, and anticoagulation prophylaxis should be continued perioperatively for better outcomes.

Topics: Adult; Antifibrinolytic Agents; Betacoronavirus; Cardiolipins; Chest Tubes; Coronavirus Infections; COVID-19; Empyema, Pleural; Humans; Immunoglobulin M; International Normalized Ratio; Lupus Coagulation Inhibitor; Male; Pandemics; Partial Thromboplastin Time; Plasma; Pneumonia, Viral; Prothrombin Time; SARS-CoV-2; Tomography, X-Ray Computed; Venous Thromboembolism; Vitamin K