Cardiology

Singhania, N., Bansal, S., Nimmatoori, D.P., Ejaz, A.A., McCullough, P.A. and Singhania, G. (2020). “Current Overview on Hypercoagulability in COVID-19.” Am J Cardiovasc Drugs 20(5): 393-403.

Full text of this article.

The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has brought many unique pathologies, such as coagulopathy, prompting a desperate need for effective management. COVID-19-associated coagulopathy (CAC) can cause various thromboembolic complications, especially in critically ill patients. The pathogenesis is likely due to endothelial injury, immobilization, and an increase in circulating prothrombotic factors. Data on treatment are limited, although prophylactic anticoagulation is advised in all hospitalized patients. Herein, we have comprehensively reviewed the current literature available on CAC and highlight the pathogenesis, clinical features, and management of CAC.

Ruocco, G., McCullough, P.A., Tecson, K.M., Mancone, M., De Ferrari, G.M., D’Ascenzo, F., De Rosa, F.G., Paggi, A., Forleo, G., Secco, G.G., Pistis, G., Monticone, S., Vicenzi, M., Rota, I., Blasi, F., Pugliese, F., Fedele, F. and Palazzuoli, A. (2020). “Mortality Risk Assessment Using CHA(2)DS(2)-VASc Scores in Patients Hospitalized With Coronavirus Disease 2019 Infection.” Am J Cardiol Sep 28;S0002-9149(20)31004-3. [Epub ahead of print.].

Full text of this article.

Early risk stratification for complications and death related to Coronavirus disease 2019 (COVID-19) infection is needed. Because many patients with COVID-19 who developed acute respiratory distress syndrome have diffuse alveolar inflammatory damage associated with microvessel thrombosis, we aimed to investigate a common clinical tool, the CHA(2)DS(2)-VASc, to aid in the prognostication of outcomes for COVID-19 patients. We analyzed consecutive patients from the multicenter observational CORACLE registry, which contains data of patients hospitalized for COVID-19 infection in 4 regions of Italy, according to data-driven tertiles of CHA(2)DS(2)-VASc score. The primary outcomes were inpatient death and a composite of inpatient death or invasive ventilation. Of 1045 patients in the registry, 864 (82.7%) had data available to calculate CHA(2)DS(2)-VASc score and were included in the analysis. Of these, 167 (19.3%) died, 123 (14.2%) received invasive ventilation, and 249 (28.8%) had the composite outcome. Stratification by CHA(2)DS(2)-VASc tertiles (T1: ≤1; T2: 2 to 3; T3: ≥4) revealed increases in both death (8.1%, 24.3%, 33.3%, respectively; p <0.001) and the composite end point (18.6%, 31.9%, 43.5%, respectively; p <0.001). The odds ratios for mortality and the composite end point for T2 patients versus T1 CHA(2)DS(2)-VASc score were 3.62 (95% CI:2.29 to 5.73,p <0.001) and 2.04 (95% CI:1.42 to 2.93, p <0.001), respectively. Similarly, the odds ratios for mortality and the composite end point for T3 patients versus T1 were 5.65 (95% CI:3.54 to 9.01, p <0.001) and 3.36 (95% CI:2.30 to 4.90,p <0.001), respectively. In conclusion, among Italian patients hospitalized for COVID-19 infection, the CHA(2)DS(2)-VASc risk score for thromboembolic events enhanced the ability to achieve risk stratification for complications and death.

McCullough, P.A. (2020). “Favipiravir and the Need for Early Ambulatory Treatment of SARS-CoV2 Infection (COVID-19).” Antimicrob Agents Chemother Sep 23;AAC.02017-20. [Epub ahead of print.].

Full text of this article.

It is becoming increasingly clear that SARS-CoV-2 like most human viral infections will require multiple drugs in combination to treat COVID-19 illness. In this issue of the Journal, Doi and colleagues successfully treated patients with early COVID-19 with favipiravir, an oral polymerase inhibitor to rapidly and substantially clear SARS-CoV-2 from nasal secretions irrespective if it was started relatively early or later within the first week of infection. These data support the concept that favipiravir could be paired with at least one more off-target antiviral agent (doxycycline, azithromycin, ivermectin) followed by corticosteroids and antithrombotics to prevent COVID-19 hospitalization and death in those over age 50 an or those with one or more comorbidities. Clinical trials and advanced practice should immediately pivot to combination/sequential drug therapy for ambulatory COVID-19 illness.

Raju, B., Roberts, C.S., Sathyamoorthy, M., Schiffman, R., Swift, C. and McCullough, P.A. (2020). “Ventricular Septal Myectomy for the Treatment of Left Ventricular Outflow Tract Obstruction Due to Fabry Disease.” Am J Cardiol 132: 160-164.

Full text of this article.

Fabry cardiomyopathy can cause symptomatic left ventricular outflow tract obstruction. We review a case of Fabry cardiomyopathy mimicking hypertrophic cardiomyopathy on echocardiography with severe left ventricular outflow tract obstruction treated with ventricular septal myectomy.

Briedis, K., Aldujeli, A., Aldujeili, M., Briede, K., Zaliunas, R., Hamadeh, A., Stoler, R.C. and McCullough, P.A. (2020). “Considerations for Management of Acute Coronary Syndromes During the SARS-CoV-2 (COVID-19) Pandemic.” Am J Cardiol 131: 115-119.

Full text of this article.

Accumulating evidence suggests that influenza and influenza-like illnesses can act as a trigger for acute myocardial infarction. Despite these unprecedented times providers should not overlook acute coronary syndrome (ACS) guidelines, but may choose to modify the recommended approach in situations with confirmed or suspected COVID-19 disease. In this document, we suggest recommendations as to how to triage patients diagnosed with ACSs and provide with algorithms of how to manage the patients and decide the appropriate treatment options in the era of COVID-19 pandemic. We also address the inpatient logistics and discharge to follow-up considerations for the function of already established ACS network during the pandemic.