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2. A Single-Centre Experience of Post-COVID-19 Vaccine-Related Immune-Mediated Complications.

Author

Palmer D, Davis L, Sivaloganathan H, and Chevassut T

Abstract

The significant impact of the COVID-19 pandemic has resulted in a worldwide effort to develop effective vaccines. In the United Kingdom, the COVID-19 vaccine development and roll-out has been overwhelmingly successful in reducing infections and deaths. However, case reports have emerged of a rare syndrome of vaccine-induced immune thrombocytopenia and thrombosis (VITT), as well as cases of immune thrombocytopenia (ITP). This has necessitated a better understanding of these conditions. However, as both VITT and "vaccine-associated ITP" are emerging conditions, evidence on the clinical features, epidemiology, and management is still evolving. Subsequently, with the initiation of the COVID-19 vaccine booster program, it has become increasingly important to continue to collect accurate data on post-COVID-19 vaccine complications to aid with their prompt recognition and management. In this case series, we report on the presentations and management of seven cases of post-COVID-19 vaccine-related immune-mediated complications which occurred at our center between the months of March and July 2021., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 David Palmer et al.)

Published
2022
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3. Von Willebrand factor (vWF): marker of endothelial damage and thrombotic risk in COVID-19?

Author

Ladikou EE, Sivaloganathan H, Milne KM, Arter WE, Ramasamy R, Saad R, Stoneham SM, Philips B, Eziefula AC, and Chevassut T

Subjects
Biomarkers blood, COVID-19, Cohort Studies, Coronavirus Infections diagnosis, Coronavirus Infections mortality, Female, Fibrin Fibrinogen Degradation Products metabolism, Fibrinogen metabolism, Hospitals, University, Humans, Intensive Care Units, Male, Pandemics, Pneumonia, Viral diagnosis, Pneumonia, Viral mortality, Risk Assessment, Sampling Studies, Severe Acute Respiratory Syndrome diagnosis, Survival Rate, United Kingdom, Venous Thromboembolism blood, Venous Thromboembolism mortality, Coronavirus Infections complications, Endothelium, Vascular pathology, Hospital Mortality trends, Pneumonia, Viral complications, Severe Acute Respiratory Syndrome blood, Venous Thromboembolism etiology, von Willebrand Factor metabolism
Abstract

Background: COVID-19 infection is characterised, among other features, by a prothrombotic state with high rate of venous thromboembolism (VTE), D-dimer, and fibrinogen levels. Clinical observations have also highlighted that these patients have elevated von Willebrand factor (vWF) and factor VIIIc., Methods: 24 consecutive COVID-19 positive patients were selected from the intensive care unit (ICU) or the high acuity ward of Brighton and Sussex University Hospitals NHS Trust., Results: The rate of VTE was 25% and mortality rate was 16.7%. Fibrinogen and D-Dimers were elevated, 7.9 (1.6) g/L and 2.4 (2.02) ug/ml respectively. Factor VIIIc and von vWF antigen levels were both extremely elevated at 279 (148) u/dL and 350 (131) % respectively, which are comparable to levels seen in ICU patients with severe sepsis. vWF levels were significantly higher in patients that died (p=0.017) and showed a positive correlation with age. There was a statistically significant association between COVID-19 disease and non-O blood group (p=0.02); 80% (4/5) of COVID-19 patients with VTE were blood group A., Conclusion: Very high levels of vWF and factor VIIIc are common in COVID-19 patients, comparable to levels in severely septic non-COVID ICU patients. This could contribute to the hypercoagulable state and increased VTE rate in COVID-19. Further studies are needed to evaluate the use of vWF for stratifying thrombotic risk in COVID-19 and to determine if elevated vWF is contributing to disease pathogenesis., (© Royal College of Physicians 2020. All rights reserved.)

Published
2020
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4. COVID-19 mortality in patients on anticoagulants and antiplatelet agents.

Author

Sivaloganathan H, Ladikou EE, and Chevassut T

Subjects
Aged, Aged, 80 and over, COVID-19 blood, Disease-Free Survival, Female, Humans, Male, Survival Rate, Anticoagulants administration & dosage, COVID-19 mortality, Hospital Mortality, Platelet Aggregation Inhibitors administration & dosage, SARS-CoV-2, COVID-19 Drug Treatment
Published
2020
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5. Thrombotic risk in COVID-19: a case series and case-control study.

Author

Stoneham SM, Milne KM, Nuttall E, Frew GH, Sturrock BR, Sivaloganathan H, Ladikou EE, Drage S, Phillips B, Chevassut TJ, and Eziefula AC

Subjects
Aged, Aged, 80 and over, Anticoagulants therapeutic use, Biomarkers blood, COVID-19, Case-Control Studies, Coronavirus Infections blood, Female, Heparin, Low-Molecular-Weight therapeutic use, Humans, Incidence, Male, Middle Aged, Pandemics, Pneumonia, Viral blood, Retrospective Studies, Risk Factors, SARS-CoV-2, Venous Thromboembolism drug therapy, Venous Thromboembolism virology, Betacoronavirus, Coronavirus Infections complications, Fibrin Fibrinogen Degradation Products metabolism, Pneumonia, Viral complications, Venous Thromboembolism blood, Venous Thromboembolism epidemiology
Abstract

Background: A possible association between COVID-19 infection and thrombosis, either as a direct consequence of the virus or as a complication of inflammation, is emerging in the literature. Data on the incidence of venous thromboembolism (VTE) are extremely limited., Methods: We describe three cases of thromboembolism refractory to heparin treatment, the incidence of VTE in an inpatient cohort, and a case-control study to identify risk factors associated with VTE., Results: We identified 274 confirmed (208) or probable (66) COVID-19 patients. 21 (7.7%) were diagnosed with VTE. D-dimer was elevated in both cases (confirmed VTE) and controls (no confirmed VTE) but higher levels were seen in confirmed VTE cases (4.1 vs 1.2 μg/mL, p<0.001)., Conclusion: Incidence of VTE is high in patients hospitalised with COVID-19. Urgent clinical trials are needed to evaluate the role of anticoagulation in COVID-19. Monitoring of D-dimer and anti-factor Xa levels may be beneficial in guiding management., (© Royal College of Physicians 2020. All rights reserved.)

Published
2020
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